Inclusion Decisions Research Articles

Effect of NaFeEDTA-Fortified Soy Sauce on Anemia Prevalence in China: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

To assess the effect of sodium iron ethylenediaminetetraacetate (NaFeEDTA)-fortified soy sauce on anemia prevalence in the Chinese population. A systematic review was performed to identify potential studies by searching the electronic databases of PubMed, Cochrane Library, WHO Library, HighWire, CNKI, and other sources. The selection criteria included randomized controlled trials that compared the efficacy of NaFeEDTA-fortified soy sauce with that of non-fortified soy sauce. Anemia rates and hemoglobin levels were the outcomes of interest. Inclusion decisions, quality assessment, and data extraction were performed by two reviewers independently. A total of 16 studies met the inclusion criteria for anemia rate analysis, of which 12 studies met the inclusion criteria for hemoglobin analysis. All included studies assessed the effect of NaFeEDTA-fortified soy sauce on anemia rates and hemoglobin concentrations. After the intervention, the hemoglobin concentration increased and anemia rates decreased significantly as compared with the non-fortified soy sauce groups. For anemia rates, data from 16 studies could be pooled, and the pooled estimate odds ratio was 0.25 (95% CI 0.19-0.35). For hemoglobin concentrations, data from 12 studies could be pooled, and the pooled weighted mean difference was 8.81 g/L (95% CI 5.96-11.67). NaFeEDTA-fortified soy sauce has a positive effect on anemia control and prevention in the at-risk population.

Study protocol: developing a decision system for inclusive housing: applying a systematic, mixed-method quasi-experimental design.

BackgroundIdentifying the housing preferences of people with complex disabilities is a much needed, but under-developed area of practice and scholarship. Despite the recognition that housing is a social determinant of health and quality of life, there is an absence of empirical methodologies that can practically and systematically involve consumers in this complex service delivery and housing design market. A rigorous process for making effective and consistent development decisions is needed to ensure resources are used effectively and the needs of consumers with complex disability are properly met.Methods/DesignThis 3-year project aims to identify how the public and private housing market in Australia can better respond to the needs of people with complex disabilities whilst simultaneously achieving key corporate objectives. First, using the Customer Relationship Management framework, qualitative (Nominal Group Technique) and quantitative (Discrete Choice Experiment) methods will be used to quantify the housing preferences of consumers and their carers. A systematic mixed-method, quasi-experimental design will then be used to quantify the development priorities of other key stakeholders (e.g., architects, developers, Government housing services etc.) in relation to inclusive housing for people with complex disabilities. Stakeholders randomly assigned to Group 1 (experimental group) will participate in a series of focus groups employing Analytical Hierarchical Process (AHP) methodology. Stakeholders randomly assigned to Group 2 (control group) will participate in focus groups employing existing decision making processes to inclusive housing development (e.g., Risk, Opportunity, Cost, Benefit considerations). Using comparative stakeholder analysis, this research design will enable the AHP methodology (a proposed tool to guide inclusive housing development decisions) to be tested.DiscussionIt is anticipated that the findings of this study will enable stakeholders to incorporate consumer housing preferences into commercial decisions. Housing designers and developers will benefit from the creation of a parsimonious set of consumer-led housing preferences by which to make informed investments in future housing and contribute to future housing policy. The research design has not been applied in the Australian research context or elsewhere, and will provide a much needed blueprint for market investment to develop viable, consumer directed inclusive housing options for people with complex disability.

Abstract 27: Is Butter Back? A Systematic Review and Meta-analysis of Butter Consumption and Risk of Cardiovascular Disease, Diabetes, and Total Mortality

Introduction: Dietary guidelines recommend avoiding foods high in saturated fat. Yet, emerging evidence suggests potential cardiometabolic benefits of dairy products and dairy fat. Evidence on the role of butter, with high saturated dairy fat content, for total mortality, CVD, and diabetes remains unclear. Objective: To systematically investigate the prospective association of butter consumption with all-cause mortality, CVD, and type 2 diabetes. Methods: We searched 9 databases from inception to May 2015 without restriction on publication year, setting, or language, using keywords related to butter intake and outcomes of interest. We included prospective cohorts or randomized clinical trials providing estimates of effects of butter intake on mortality, CVD (including CHD or stroke), or diabetes in general adult populations. Inclusion decisions and data extractions were performed independently and in duplicate, including on study and participant characteristics, exposure and outcome definitions and assessments, analysis methods, and adjusted risk estimates and uncertainty of prospective multivariate associations. Study quality was evaluated by a modified Newcastle-Ottawa score. Findings were pooled by random and fixed effects meta-analysis, with heterogeneity assessed by the I2 statistic and publication bias by Egger’s test and funnel plots. Results: We identified 9 publications including 15 country-specific cohorts, with 636,151 unique participants, 6.5 million person-years of follow-up, and 28,271 total deaths, 9,783 cases of incident CVD, and 23,954 cases of incident diabetes. Quality ratings were high for all studies. Butter consumption was weakly associated with all-cause mortality (N=9 country-specific cohorts; per 14 g (1 tablespoon)/day: RR=1.01, 95%CI=1.00, 1.03, P=0.045); was not significantly associated with any CVD (N=4; RR=1.00, 95%CI=0.98, 1.02; P=0.79), CHD (N=3; RR=0.99, 95%CI=0.96, 1.03; P=0.605), or stroke (N=3; RR=1.00, 95%CI=0.98, 1.03; P=0.79), and was inversely associated with incidence of diabetes (N=11; RR=0.96, 95%CI=0.93, 0.99; P=0.02). We did not identify evidence for heterogeneity nor publication bias. Conclusions: This systematic review and meta-analysis identified a weak association of butter intake with total mortality, no association with CVD, and a modest protective association with diabetes. The studies identified indicate that many global cohorts have not reported on these associations; if publication bias exists, it would likely be for unpublished reports with null findings, rather than significant associations. In sum, these results suggest relatively neutral effects of butter consumption on major health outcomes, with a possible modest benefit for diabetes.

The attribute reductions of three-way concept lattices

Three-way concept analysis is a newly proposed area of formal concept analysis from which one can obtain both the inclusion decision and the exclusion decision. In general, given a context, some attributes may not be essential in three-way concept analysis, such as forming three-way concept lattice. So in this paper, we study the attribute reductions of three-way concept lattices in order to make the data easily be understood. Firstly, based on different criteria generated from object-induced three-way concept (OE-concept), four kinds of attribute reductions are proposed. The four reductions together embody different characteristics of a formal context and can be used in different occasions. Secondly, we discuss their relationships, including their advantages and disadvantages and the relationships among consistent sets and among the cores. Thirdly, based on attribute-induced three-way concept (AE-concept), we also give four attribute-induced three-way attribute reductions and discuss their relationships. Finally, the approaches to computing these attribute reductions are presented and the obtained results are demonstrated and verified by an empirical case. In this paper, we systematically investigate the attribute reductions of three-way concept lattices which enriches the study of formal concept analysis.

Continuity and change within the social-ecological and political landscape of the Maasai Mara, Kenya

Traditional livestock management has historically been blamed for the mismanagement of rangelands, but there is a growing recognition of the importance of extensive herding strategies and the local knowledge embedded in these practices. Here, we apply the lens of continuity and change to understand how local herders interpret environmental change. By exploring traditional rangeland indicators as used by Maasai herders, we highlight some of the forces of change that appear to constrain the application of local knowledge of rangeland health. Fieldwork was conducted from January to August 2013 in the Mara Division, Narok County, Kenya, employing semi-structured interviews, transect walks, focus groups, participatory mapping and participant observation. Findings suggest that continuity exists in many of the traditional methods of observing land and livestock. However, various obstructions are surfacing in a political landscape in which local knowledge holders are not always able to put their knowledge and observations into practice. These obstructions of knowledge, practices and skills occurred through three broad forces involving acculturation, prohibition and applicability. As possible consequences of a system in transition, these forces illustrate the unbalanced nature of overlap between heterogeneous users, conflicting interests and power differentials. In order to facilitate continued importance and growth of local knowledge, we conclude that resource and protected area managers must recognize local knowledge holders and ensure such knowledge is considered as more than anecdotal or strategic. By encouraging hybrid knowledge co-production in management decisions, the decision-making frame can be broadened to include herders for more inclusive decision-making.

Combining internal and external motivations in multi-actor governance arrangements for biodiversity and ecosystem services

This paper analyses the possibility of building a mutually supportive dynamics between internally and externally motivated behaviour for biodiversity conservation and ecosystem services provision. To this purpose a face to face survey amongst 169 key actors of 34 highly successful and prominent biodiversity arrangements in seven EU countries was conducted. The main finding of the paper is the feasibility of combining inherently intrinsically motivated behaviours (providing enjoyment, pleasure from experimentation and learning, aesthetic satisfaction) and internalized extrinsic motivations (related to the identification with the collective goals of conservation policy) through a common set of governance features. Successful initiatives that combine internal and external motivations share the following features: inclusive decision making processes, a broad monitoring by “peers” beyond the core staff of the initiatives, and a context that is supportive for the building of autonomous actor competences. These findings are in line with the psycho-sociological theory of motivation, which shows the importance of a psycho-social context leading to a subjective perception of autonomy and a sense of competence of the actors.

Financial Knowledge Direct Financial Inclusion and Better Decisions

Financial knowledge is essential for every individual, due to the complexity of the financial structure it becomes essential for everyone to manage their cash effectively. Because less financial knowledge consumers are confused while deciding that which product and services are most profitable. Therefore, this study aims at examining the relationship of financial knowledge with financial inclusion and financial decisions. We researched 8 districts of Punjab province in Pakistan. Data is collected through a survey questionnaire from a sample of 332 respondents. The results show that there is a positive relationship of financial knowledge with financial inclusion and financial decisions. The findings suggest that financially literate individuals can plan good financial decisions for their future life and they can also avail the services of financial institutions. The results are informative for the researchers and policymakers to deem how they can operationalize a balance of financial aid information and personal financial management guidance.

Social Exclusion Based on Group Membership is a Form of Prejudice.

Children around the world are affected by bias, prejudice, and discrimination. In this chapter, we argue that intergroup social exclusion-exclusion of peers on the basis of group membership-is a form of prejudice. As such, research efforts should be directed at uncovering the negative intergroup attitudes that sustain these behaviors, and encouraging the development of children's capacity to resist biases in favor of inclusion and just treatment of others. In order to interpret what is known about intergroup social exclusion in childhood, as well as identify compelling issues for current investigation, we introduce our integrative social reasoning developmental model, which emphasizes how children weigh moral and social concerns in everyday peer contexts. This chapter emphasizes three areas of research that have contributed to understanding social inclusion and exclusion decisions in childhood which include the roles of: (1) intergroup contact and friendship, (2) peer group norms, and (3) messages from parents and teachers. While providing a background on the state of research to date, this chapter also pinpoints recent work, shedding new light on the complex interplay of moral reasoning and intergroup attitudes in children's inclusion and exclusion decisions.

Visualisation techniques to support public interpretation of future climate change and land-use choices: a case study from N-E Scotland

ABSTRACTMitigating and adapting to climate change includes a requirement to evaluate the role of future land uses in delivering robust integrated responses that are sensitive to local landscape contexts. In practice, this emphasises the need for community engagement, planning and inclusive decision-making. Community engagement may be potentially facilitated by the use of spatially explicit quantitative scenarios of land-use change in combination with interactive visualisation. This requires a coherent framework to integrate spatial data modelling, analytical capabilities and visualisation tools in a format that will also engage diverse public audiences. These challenges were explored with a case study of virtual landscapes from N-E Scotland that was used to test preferences for scenarios of future land use. Visualisations employed texture-based rendering rather than full photo-realistic rendering to facilitate interactivity and this provided additional scope for audiences to explore multiple future scenarios compared to the present landscape. Interactive voting in a virtual landscape theatre suggested preferences for visual diversity, good stewardship and perceived naturalness that should be considered in developing planned responses to change. Further investigation of preferences was conducted using interactive 3D features located within the landscape. Study findings are reviewed against objectives for inclusive engagement in the Digital Earth agenda and used to make further recommendations on the use of scenarios and visualisation tools. In particular, technical advances in user engagement need to be developed in conjunction with emerging good practice that addresses ethical, behavioural and inclusion issues so that the content is presented in as transparent and unbiased format as possible.

Diversity in the Nonprofit and Voluntary Sector

In this introductory essay to the special issue of Nonprofit and Voluntary Sector Quarterly on diversity, we begin by reviewing management research on diversity in nonprofits. The preponderance of this research focuses on demographic representation. While more contemporary approaches emphasize inclusion in decision making, even this approach falls significantly short because group categorization and identity have become increasingly complex and fluid. We ultimately explore a values approach to diversity, where the fact that people are inherently diverse is recognized and valued in all organizational activities. The final section of this introduction reviews articles included in the special issue. We conclude that the diversity concept must move well beyond a managerial approach to include broader social theories, giving deep consideration to concepts of identity, power dynamics and hidden interest conflicts in diversity efforts, and the ways that societal diversity affects the dynamics of volunteering and the structuring of nonprofit organizations.

Effect of NaFeEDTA-Fortified Soy Sauce on Anemia Prevalence in China: A Systematic Review and Meta-analysis of Randomized Controlled Trials

ObjectiveTo assess the effect of sodium iron ethylenediaminetetraacetate (NaFeEDTA)-fortified soy sauce on anemia prevalence in the Chinese population. MethodsA systematic review was performed to identify potential studies by searching the electronic databases of PubMed, Cochrane Library, WHO Library, HighWire, CNKI, and other sources. The selection criteria included randomized controlled trials that compared the efficacy of NaFeEDTA-fortified soy sauce with that of non-fortified soy sauce. Anemia rates and hemoglobin levels were the outcomes of interest. Inclusion decisions, quality assessment, and data extraction were performed by two reviewers independently. A total of 16 studies met the inclusion criteria for anemia rate analysis, of which 12 studies met the inclusion criteria for hemoglobin analysis. All included studies assessed the effect of NaFeEDTA-fortified soy sauce on anemia rates and hemoglobin concentrations. ResultsAfter the intervention, the hemoglobin concentration increased and anemia rates decreased significantly as compared with the non-fortified soy sauce groups. For anemia rates, data from 16 studies could be pooled, and the pooled estimate odds ratio was 0.25 (95% CI 0.19-0.35). For hemoglobin concentrations, data from 12 studies could be pooled, and the pooled weighted mean difference was 8.81 g/L (95% CI 5.96-11.67). ConclusionNaFeEDTA-fortified soy sauce has a positive effect on anemia control and prevention in the at-risk population.

Disabling chronic conditions in childhood and socioeconomic disadvantage: a systematic review and meta-analyses of observational studies

ObjectiveTo determine the association of socioeconomic disadvantage with the prevalence of childhood disabling chronic conditions in high-income countries.Study designSystematic review and meta-analyses.Data sources6 electronic databases, relevant websites, reference lists and...

Objective and Subjective Party Leadership Selection: Regulations, Activists, and Voters in Poland

Over the last two decades, an increasing number of political parties have gradually formalized the influence of members in the process of leadership selection. This evolution has determined two partly contrasting behaviors in the new democracies of Eastern Europe: inclusive decision-making was formally mentioned but empirical evidence indicates implementation problems. Consequently, it remains an empirical question to what extent the East European political parties apply the formal provisions of inclusiveness when selecting their leaders. In order to provide an answer, this article compares the statutes and election regulations of four Polish parties with opinions of party members and voters. This study combines qualitative content analysis with aggregate statistics from individual-level data collected at the national level and covers the 2007–2011 electoral cycle.

Patient and family/friend satisfaction in a sample of Jordanian Critical Care Units

The aim of the study was to assess the validity of family members/friends as proxies by comparing perceptions of satisfaction with care and decision making between critically ill patients and their family/friends. A comparative, descriptive cross-sectional study. Seven Critical Care Units across four public and military hospitals in the centre and southern regions of Jordan. A modified version of the Family Satisfaction-ICU (FS-ICU) questionnaire was distributed to Critical Care Unit (CCU) patients before hospital discharge. In addition, up to two family members/close friends were also asked to complete the questionnaire. A total of 213 patients (response rate 72%) and 246 family members/friends (response rate 79%) completed and returned the questionnaire. Although the majority of family members/friends and patients were satisfied with overall care, patients were generally significantly less satisfied (mean (SD) care subscale 75.6 (17.8) and 70.9 (17.3), respectively, (p=0.005). When individual items were examined, significant differences in nursing care (family/friends 80.1 (20.7) versus patient 75.9 (22.2), p=0.038) and inclusion in decision making (family/friends 53.9 (33.2) versus patient 62.0 (34.2), p=0.010) were found. The study showed a degree of congruence between patients and their family members/friends in relation to their satisfaction with the CCU experience. Thus, views of family/friends may serve as a proxy in assessing care and decision making processes of critically ill patients. Appropriate training of the critical care team and provision of strategies to address the concerns of patients' families are needed to improve overall patient satisfaction.

Effects of total fat intake on body weight.

In order to prevent overweight and obesity in the general population we need to understand the relationship between the proportion of energy from fat and resulting weight and body fatness in the general population. To assess the effects of proportion of energy intake from fat on measures of weight and body fatness (including obesity, waist circumference and body mass index) in people not aiming to lose weight, using all appropriate randomised controlled trials (RCTs) and cohort studies in adults, children and young people We searched CENTRAL to March 2014 and MEDLINE, EMBASE and CINAHL to November 2014. We did not limit the search by language. We also checked the references of relevant reviews. Trials fulfilled the following criteria: 1) randomised intervention trial, 2) included children (aged ≥ 24 months), young people or adults, 3) randomised to a lower fat versus usual or moderate fat diet, without the intention to reduce weight in any participants, 4) not multifactorial and 5) assessed a measure of weight or body fatness after at least six months. We also included cohort studies in children, young people and adults that assessed the proportion of energy from fat at baseline and assessed the relationship with body weight or fatness after at least one year. We duplicated inclusion decisions and resolved disagreement by discussion or referral to a third party. We extracted data on the population, intervention, control and outcome measures in duplicate. We extracted measures of weight and body fatness independently in duplicate at all available time points. We performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity and funnel plot analyses. We included 32 RCTs (approximately 54,000 participants) and 30 sets of analyses of 25 cohorts. There is consistent evidence from RCTs in adults of a small weight-reducing effect of eating a smaller proportion of energy from fat; this was seen in almost all included studies and was highly resistant to sensitivity analyses. The effect of eating less fat (compared with usual diet) is a mean weight reduction of 1.5 kg (95% confidence interval (CI) -2.0 to -1.1 kg), but greater weight loss results from greater fat reductions. The size of the effect on weight does not alter over time and is mirrored by reductions in body mass index (BMI) (-0.5 kg/m(2), 95% CI -0.7 to -0.3) and waist circumference (-0.3 cm, 95% CI -0.6 to -0.02). Included cohort studies in children and adults most often do not suggest any relationship between total fat intake and later measures of weight, body fatness or change in body fatness. However, there was a suggestion that lower fat intake was associated with smaller increases in weight in middle-aged but not elderly adults, and in change in BMI in the highest validity child cohort. Trials where participants were randomised to a lower fat intake versus usual or moderate fat intake, but with no intention to reduce weight, showed a consistent, stable but small effect of low fat intake on body fatness: slightly lower weight, BMI and waist circumference compared with controls. Greater fat reduction and lower baseline fat intake were both associated with greater reductions in weight. This effect of reducing total fat was not consistently reflected in cohort studies assessing the relationship between total fat intake and later measures of body fatness or change in body fatness in studies of children, young people or adults.

Objective and Subjective Party Leadership Selection: Regulations, Activists and Voters in Poland

Over the last two decades an increasing number of political parties have gradually formalized the influence of members in the process of leadership selection. This evolution has determined two partly contrasting behaviors in the new democracies of Eastern Europe: the inclusive decision-making was formally mentioned but empirical evidence indicates implementation problems. Consequently, it remains an empirical question to what extent the East European political parties apply the formal provisions of inclusiveness when selecting their leaders. In order to provide an answer, this article compares the statutes and election regulations of four Polish parties with opinions of party members and voters. This study combines qualitative content analysis with aggregate statistics from individual level data collected at national level and covers the 2007-2011 electoral cycle.

Expectations About Ethnic Peer Group Inclusivity: The Role of Shared Interests, Group Norms, and Stereotypes.

This study investigated three factors that contribute to social exclusion: group norms, individual characteristics, and stereotypes. Non-Arab American 12- and 16-year-olds (N = 199) judged their expectations about the inclusivity of Arab American and non-Arab American peer groups toward new peers characterized by: (a) different ethnic identity but similar interests (e.g., hobbies) and (b) same ethnic identity but different interests. Participants expected that when groups had exclusive norms, Arab American peers would base inclusion decisions on ethnic identity, but that their own non-Arab group would base decisions on shared interests. Participants who reported stereotypes expected their in-group to be ethnically less inclusive. With age, ethnic-based exclusion increased. The findings are discussed in light of current research on developmental intergroup relationships.

Three eGovernments Living Happily Ever After

There exists a vast amount of different texts (policy documents, guidelines, action plans etc.) with the aim of stipulating the road forward for digitalisation of public sector, and an often used rationale for digitalisation is that the use of digitalised services will stimulate efficiency, reduce costs and at the same time enhance service quality. This is also often coupled with the idea that guarantee of success can be found participatory practices. This paper aims to disclose some of the underpinnings to the above logic by a closer analysis of ‘the who, the why and how' of involving participators in digitalization of public sector. This paper uses a combination of discourse analysis and a Bourdieuan inspired use of the concept of epistemic cultures as an analytical framework to disentangle the notion of a participatory eGovernment development. The empirical case is a text analysis of a national action plan for digitalisation and the results of the analysis unfold two interesting notions; 1) three conflicting notions of for whom, why and how this is done, and 2) the consequences of conflicting epistemic cultures for practitioners to solve in the everyday practice when customer-oriented market logics are naively linked with democratically oriented inclusive participatory decision processes; two not so easily combined ideologies.

A Systematic Literature Review—Dynamic Design Challenges in Implementing Big Data

Big data becomes a new business as it creates value to the organization. There are few issues and challenges being highlighted and there is a need for the user and the system to understand each other’s designs and components that were integrated with big data. Aims: To uncover the challenges that arises without not to under seen the opportunities and the needs for future research. Method: Performing the systematic literature review (SLR) by searching the relevant keywords classified under journals articles and journals magazines. Results: In general, total of 320 relevant journals articles and magazines extracted after a relevance and quality check based on set criteria. Only 26 articles were found relevant to the studies after inclusion and exclusion decisions of the articles were conducted from a total of 7 electronic databases were searched. Conclusion: In conclusion, the big data issues have been significantly discussed in the existing literature. The listed issues in the literature have yet to be solved as the big data could be analyzed in order to create a new economic opportunity. However, there are rooms for improvement and still need to be opened for further discussion yet to obtain the utmost benefits out of it.

The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: a qualitative study of Kaiser Permanente

BackgroundPatient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain how effects come about is limited.MethodsThis paper uses qualitative methods to advance our understanding of the organizational dynamics that influence the impact of a patient portal on organizational performance and patient health. The study setting is Kaiser Permanente, the world’s largest not-for-profit integrated delivery system, which has been using a portal for over ten years. We interviewed eighteen physician leaders and executives particularly knowledgeable about the portal to learn about how they believe the patient portal works and what organizational factors affect its workings. Our analytical framework centered on two research questions. (1) How does the patient portal impact care delivery to produce the documented effects?; and (2) What are the important organizational factors that influence the patient portal’s development?ResultsWe identify five ways in which the patient portal may impact care delivery to produce reported effects. First, the portal’s ability to ease access to services improves some patients’ satisfaction as well as changes the way patients seek care. Second, the transparency and activation of information enable some patients to better manage their care. Third, care management may also be improved through augmented patient-physician interaction. This augmented interaction may also increase the ‘stickiness’ of some patients to their providers. Forth, a similar effect may be triggered by a closer connection between Kaiser Permanente and patients, which may reduce the likelihood that patients will switch health plans. Finally, the portal may induce efficiencies in physician workflow and administrative tasks, stimulating certain operational savings and deeper involvement of patients in medical decisions. Moreover, our analysis illuminated seven organizational factors of particular importance to the portal’s development - and thereby ability to impact care delivery: alignment with financial incentives, synergy with existing IT infrastructure and operations, physician-led governance, inclusive decision making and knowledge sharing, regional flexibility to implementation, continuous innovation, and emphasis on patient-centered design.ConclusionsThese findings show how organizational dynamics enable the patient portal to affect care delivery by summoning organization-wide support for and use of a portal that meets patient needs.