Integration Project Research Articles

Economic evaluation of acupuncture in treating patients with pain and mental health concerns: the results of the Alberta Complementary Health Integration Project.

The COVID-19 pandemic and its economic impact have heightened the risk of mental health and pain-related issues. The integration of acupuncture with conventional medicine shows promise in improving treatment outcomes for these conditions. The Alberta Complementary Health Integration Project (ABCHIP) aimed to provide acupuncture to youth (aged 24 and under) and seniors (aged 55 and above) experiencing chronic pain, pain management issues, mental health issues, and/or related conditions. The program aimed to promote integrative care, assess the effectiveness and cost-effectiveness of these therapies, and deliver patient-centered care. ABCHIP provided acupuncture to address pain, mental health, and addiction issues at no cost to two vulnerable populations in Alberta: youth and the older adult. A total of 606 patients aged 14-65 received 5,424 acupuncture treatments. Outcome measures included pain interference, pain severity, sleep quality, depression, anxiety, fatigue, anger, and quality of life. Short-term outcomes were assessed through questionnaires completed at the beginning and completion of the treatments, while long-term benefits were estimated using these outcome indicators and existing literature on the economic cost of illnesses. The cost-effectiveness analysis revealed the following ratios per Quality-Adjusted Life Year (QALY): CND12,171 for the overall sample, CND10,766 for patients with pain, CND9,331 for individuals with depression, and CND9,030 for those with anxiety. The cost-benefit analysis demonstrated annual cost savings ranging from CND1,487 to CND5,255, with an average of CND3,371. The study findings indicate that ABCHIP's treatment for pain, depression, anxiety, and sleep issues is cost-effective, leading to substantial cost savings and improved quality of life for patients. The program's cost per Quality-Adjusted Life Year (QALY) is significantly lower than benchmarks used in other countries, demonstrating high cost-effectiveness and value. Patients receiving 12 treatments experienced significant improvements across all measures, with estimated economic benefits surpassing treatment costs. In summary, ABCHIP offers a cost-effective and economically efficient therapy choice for individuals dealing with pain and mental health issues.

Causal associations of air pollution with rheumatoid arthritis: A transethnic Mendelian randomization study.

Rheumatoid arthritis is a common rheumatic disease, and its onset is closely related to genetic and environmental factors, however, the relationship between air pollution and RA is still hotly debated. Further investigation of the relationship between air pollution and rheumatoid arthritis is conducive to a comprehensive understanding of the risk factors of the disease, providing certain value for the clinical prevention and treatment of RA. We used a Two-Sample Mendelian Randomization approach, integrating the large-scale public genomewide association study, to assess the genetically predicted causal effect of air pollution (including: PM2.5, PM2.5-10, PM10, nitrogen dioxide, nitrogen oxides) on RA in European and European East Asian populations, respectively. Indicators related to air pollution (2,505 individuals to 423,796 individuals), including European and East Asian populations were obtained from the Integrative Epidemiology Unit open GWAS project. Published East Asian RA data were also obtained from the IEU open GWAS project (212,453 individuals), while large-scale publicly available European RA data were obtained from finngen R10 (13,621 cases and 262,844 controls). Inverse variance weighting was used as the primary analytical method, complemented by MR-egger, Weighed median, and Weighted mode results. Cochran Q tested for heterogeneity, and MR-Egger regression analyses were performed to test for multiplicity. leave-one-out analysis allowed for the robustness and reliability were assessed. No statistically significant effects of PM2.5, PM2.5-10, PM10, nitrogen dioxide, nitrogen oxides and RA were observed in either European or East Asian populations. Results from European data: PM2.5 (IVW OR: 0.71; 95% CI: 0.27-1.91; p = 0.498; number of SNPs: 5), PM2.5-10 (IVW OR: 1.20; 95% CI: 0.61-2.40; p = 0.596; number of SNPs: 15), PM10 (IVW OR: 1.69; 95% CI: 0.84-3.39; p = 0.142; number of SNPs: 9), nitrogen dioxide (IVW OR: 3.88; 95% CI: 0.19-77.77; p = 0.375; number of SNPs: 2), nitrogen oxides (IVW OR: 0.51; 95% CI: 0.16-1.67; p = 0.268; number of SNPs: 4). East Asian data results: PM2.5 (IVW OR: 1.16; 95% CI: 0.98-1.38; p = 0.086; number of SNPs: 4), PM2.5-10 (IVW OR: 1.14; 95% CI: 0.95-1.38; p = 0.166; number of SNPs: 2), PM10 (IVW OR: 0.95; 95% CI: 0.81-1.11; p = 0.503; number of SNPs: 3), nitrogen dioxide (IVW OR: 0.87; 95% CI: 0.76-1.00; p = 0.051; number of SNPs: 6), nitrogen oxides (IVW OR: 0.96; 95% CI: 0.82-1.14; p = 0.671; number of SNPs: 3). No signs of pleiotropy or heterogeneity were observed in the MR-Egger intercept, MR-PRESSO and Cochrane's Q (p>0.05). In addition, no outliers were found in the MR-PRESSO analysis. The results were further validated by leave-one-out tests, confirming the robustness of the findings. We performed transethnic MR analysis suggesting that there may not be a genetically predicted causal relationship between air pollution and RA.

Severe fire regimes decrease resilience of ectothermic populations.

Understanding populations' responses to environmental change is crucial for mitigating human-induced disturbances. Here, we test hypotheses regarding how three essential components of demographic resilience (resistance, compensation and recovery) co-vary along the distinct life histories of three lizard species exposed to variable, prescribed fire regimes. Using a Bayesian hierarchical framework, we estimate vital rates (survival, growth and reproduction) with 14 years of monthly individual-level data and mark-recapture models to parameterize stochastic integral projection models from five sites in Brazilian savannas, each historically subjected to different fire regimes. With these models, we investigate how weather, microclimate and ecophysiological traits of each species influence their vital rates, emergent life history traits and demographic resilience components in varying fire regimes. Overall, weather and microclimate are better predictors of the species' vital rates, rather than their ecophysiological traits. Our findings reveal that severe fire regimes increase populations' resistance but decrease compensation or recovery abilities. Instead, populations have higher compensatory and recovery abilities at intermediate degrees of fire severity. Additionally, we identify generation time and reproductive output as predictors of resilience trends across fire regimes and climate. Our analyses demonstrate that the probability and quantity of monthly reproduction are the proximal drivers of demographic resilience across the three species. Our findings suggest that populations surpass a tipping point in severe fire regimes and achieve an alternative stable state to persist. Thus, higher heterogeneity in fire regimes can increase the reproductive aspects and resilience of different populations and avoid high-severity regimes that homogenize the environment. Despite being more resistant, species with long generation times and low reproductive output take longer to recover and cannot compensate as much as species with faster paces of life. We emphasize how reproductive constraints, such as viviparity and fixed clutch sizes, impact the ability of ectothermic populations to benefit and recover from disturbances, underscoring their relevance in conservation assessments.

Improving 4C Skills Through the Application of Gamification-Based Interactive Evaluation Media Using Flipped Classroom Integrated Project Based Learning Model

This study sought to ascertain how well students' 4C skills were improved by utilizing gamification-based interactive evaluation materials in conjunction with a flipped classroom and project-based learning approach. Pre-experimental research with a quantitative approach and one sample class was the methodology employed in this study. Students enrolled in the Jambi University Chemistry Education Study Program's course on chemistry learning curriculum creation served as the study's samples. A questionnaire was used to collect data on the 4C competencies of the pupils. The normalcy of the variation in the students' 4C skills outcomes was examined. The data from the sample class is normally distributed and parametric tests can be performed if the significance value is higher than 0.05. In this study, one sample t-test was employed for hypothesis testing. To find out how well gamification-based interactive evaluation materials combined with a flipped classroom and project-based learning approach improve 4C abilities, hypothesis testing was done. The study's conclusion is that students' 4C skills can be effectively improved by implementing gamification-based interactive evaluation materials in conjunction with a flipped classroom and project-based learning approach.

Integration Projects and Institutional Matrices

In this paper, an attempt is made to understand the reasons for the formation of a particular order in a region based on the institutional approach. The connection between regional order and regional regulation with the type of institutional matrices of integrating countries is shown. It is established that when integrating social systems in order to mitigate possible institutional imbalances, institutions complementary to those dominant in the institutional matrix are used: when integrating X-matrix countries – market institutions and vice versa. The factors blocking regionalism in integration projects involving countries with institutional matrices of the same type include: the presence of one clearly expressed hegemon and its support of supranational regulatory bodies, the presence of federal rather than unitary states in the region. It has been established that for countries with different types of institutional matrix, convergence is possible (for example, cooperation in the security sphere, participation in the Free Trade Zone), but integration in this case will be limited to only certain areas that are of exceptional importance for social systems, with the prevalence of regionalization processes (integration “from below” without the creation of any significant and effective supranational bodies). Factors that hinder the development of both regionalism and regionalization are increasing political differences between countries, polarization along religious lines, manifestations of nationalism and racism.

Evaluating Real World Health System Resource Utilization and Costs for a Risk-Based Breast Cancer Screening Approach in the Canadian PERSPECTIVE Integration and Implementation Project.

A prospective cohort study was undertaken within the PERSPECTIVE I&I project to evaluate healthcare resource utilization and costs associated with breast cancer risk assessment and screening and overall costs stratified by risk level, in Ontario, Canada. From July 2019 to December 2022, 1997 females aged 50 to 70 years consented to risk assessment and received their breast cancer risk level and personalized screening action plan in Ontario. The mean costs for risk-stratified screening-related activities included risk assessment, screening and diagnostic costs. The GETCOST macro from the Institute of Clinical Evaluative Sciences (ICES) assessed the mean overall healthcare system costs. For the 1997 participants, 83.3%, 14.4% and 2.3% were estimated to be average, higher than average, and high risk, respectively (median age (IQR): 60 [56-64] years). Stratification into the three risk levels was determined using the validated multifactorial CanRisk prediction tool that includes family history information, a polygenic risk score (PRS), breast density and established lifestyle/hormonal risk factors. The mean number of genetic counseling visits, mammograms and MRIs per individual increased with risk level. High-risk participants incurred the highest overall mean risk-stratified screening-related costs in 2022 CAD (±SD) at CAD 905 (±269) followed by CAD 580 (±192) and CAD 521 (±163) for higher-than-average and average-risk participants, respectively. Among the breast screening-related costs, the greatest cost burden across all risk groups was the risk assessment cost, followed by total diagnostic and screening costs. The mean overall healthcare cost per participant (±SD) was the highest for the average risk participants with CAD 6311 (±19,641), followed by higher than average risk with CAD 5391 (±8325) and high risk with CAD 5169 (±7676). Although high-risk participants incurred the highest risk-stratified screening-related costs, their costs for overall healthcare utilization costs were similar to other risk levels. Our study underscored the importance of integrating risk stratification as part of the screening pathway to support breast cancer detection at an earlier and more treatable stage, thereby reducing costs and the overall burden on the healthcare system.

Assessing the Impact of Project Management Practices on the Success of Construction Projects in Zambia: A Case Study of the Construction Projects in Lusaka between 2022 and 2023

This study investigated the influence of project management practices on the success of construction projects within Zambia, focusing on selected construction projects from 2022 to 2023. The research objectives aimed at assessing current project management practices and strategies, and identifying challenges for improvement. The study used theoretical frameworks such as Project Success Theory and Project Management Theory to analyse findings comprehensively. A qualitative approach was used for this study. Interviews were utilised to collect data from construction companies and thematic analysis was used to analyse the data. The research results identified key project management practices as being crucial for success, including comprehensive planning, effective risk management, clear communication, and robust performance monitoring. Challenges such as limited awareness, stakeholder engagement issues, and deficiencies in practical implementation were uncovered. The study recommends enhancing training, stakeholder engagement, risk management, and performance monitoring. Furthermore, gaps for research include exploring gender diversity, regional variations, sustainability integration, and longitudinal project performance studies. This study contributed valuable insights to the construction industry, aiming to optimise project management practices and foster sustainable development in Zambia.

Ethnicity in Nigeria:Reflections on Achieving Unity in Diversity

Ethnicity is an important factor of interactions in a multi-ethnic societies like Nigeria. This explains its centrality in the nature and character of Nigerian state within the context of inter-group relations. The complexity of ethnicity has adversely affected inter-group relations in Nigeria. Thus, the influence of ethnic consciousness on the politics of Nigeria cannot be ignored. Rather than becoming more unified and cohesive, Nigeria remains deeply divided as ever before. This paper argues that no matter the centrality of conflict in inter-group relations, social interactions are usually dynamic and the pervasiveness of conflict also depends on the strategies in which group relations are managed. The paper seeks to demonstrate on one hand the historical exploration of ethnicity and ethnic politics in contemporary Nigeria and on the other hand, the need to use ethnicity as a national integration project. Thus, it is pertinent to evolve a state-wide national identity from the many ethno-cultural groupings with which they are presently constituted in Nigeria. This is important because unity in diversity can be a tool for socio-economic development in Nigeria.

Improving Engagement in Residential Treatment for Substance Use Disorders: An Integrated Care Quality Improvement Project for Individuals With Mental Health and Substance Use Disorders

Substance use disorder continues to pose significant challenges in the United States, with increasing opioid-related fatalities. Residential recovery treatment programs are effective; however, high attrition rates impact successful long-term outcomes. This quality improvement project aimed to enhance patient engagement in treatment for mental health and substance use disorder to improve retention rates. It also implemented an integrated care approach incorporating psychotherapy, psychopharmacologic interventions, and recovery support services. The project was conducted using a 2-group predesign and postdesign, analyzing 134 admissions. The approach resulted in a statistically significant increase in patient engagement in treatment from 24% to 92%. Substance use relapse rates significantly reduced from 25% to 12%, and a clinically meaningful increase in the 3-month retention rate was noted. Integrated care is a promising strategy to improve outcomes for individuals receiving care for co-occurring disorders via residential treatment settings. Future studies should explore integrative models of care, patient motivation, and retention in residential treatment centers.

Cover Image

COVER PHOTO: Mulla et al. (this issue; Article e4368; doi:10.1002/ecy.4368) performed annual monitoring to assess the recovery of coral populations which led to the emergence of a Pocillopora‐dominated reef at Orchid Island (also called Lanyu), Taiwan, pictured on the cover. Their demographic data collection from 2012 to 2020 tracks individual corals after Typhoon Morakot severely impacted the region in 2009. Coral cover increased from 1.1% to 20.2% as Pocillopora juveniles quickly transitioned to sexually mature adults and dominated the reefs within six years of the disturbance. The increase of Pocillopora cover was accompanied with a decrease in the number of individuals. The authors used integral projection models (IPMs) to construct eight successive models examining annual changes to illustrate how the application of IPMs based on long‐term data can be useful for robust predictions and an improved comprehension of ecological dynamics. Photo credit: Aziz J. Mulla. image

Women in Defense of Territory in Morelos, Mexico

Women in Mexico who take part in the defense of their territory face the concrete manifestations of capitalist accumulation and patriarchal logic, as well as the colonialist dynamics of extractive projects. These conditions transform their family relationships and their participation in community life. This article reflects upon the experiences of women who have fought against the Morelos Integral Project in central Mexico. It draws from the interviews conducted by the author between 2018 and 2022, as well the author’s participant observation in organizational meetings at the national, regional, and local levels.

Trends and Prospects for Foreign Economic Policy and Trade of EAEU Member States: The Fate of Integration Projects in Armenia

Trends and Prospects for Foreign Economic Policy and Trade of EAEU Member States: The Fate of Integration Projects in Armenia

Alberta Complementary Health Integration Project (ABCHIP): Meeting the Pain and Mental Health Care Needs under COVID-19 for Vulnerable Populations

Alberta Complementary Health Integration Project (ABCHIP): Meeting the Pain and Mental Health Care Needs under COVID-19 for Vulnerable Populations

Genetic Insights Into Perinatal Outcomes of Maternal Antihypertensive Therapy During Pregnancy

Limited information exists regarding the impact of pharmacotherapy in pregnancy due to ethical concerns of unintended fetal harm. Yet, maternal prescriptive drug use for chronic conditions such as hypertension is common. To investigate potential causal relationships between perturbing maternal genetic variants influencing antihypertensive drug targets and perinatal outcomes among offspring using mendelian randomization (MR). This 2-sample MR study used individual-level single-nucleotide variation (SNV) outcome data from mother-father-offspring trios with complete genetic and phenotypic information from the Norwegian Mother, Father and Child Cohort Study (MoBa) and summary-level SNV exposure data from UK Biobank participants sourced from the Integrative Epidemiology Unit OpenGWAS project. Pregnant individuals were recruited across Norway during their routine ultrasonography examination at 18 weeks' gestation between June 1999 and December 2008, and mothers, fathers, and offspring were followed up after birth. Novel genetic instruments for maternal antihypertensive drug targets that act via systolic blood pressure (SBP) were derived from individual-level data analyzed in January 2018. Two-sample multivariable MR analysis of these maternal drug targets and offspring outcomes were performed between January 2023 and April 2024. Maternal genetic variants associated with drug targets for treatments of hypertension, as specified in the National Health Service dictionary of medicines and devices. Offspring outcomes were Apgar score at 1 minute and 5 minutes, offspring developmental score at 6 months, birth length, birth weight z score, gestational age, head circumference, and congenital malformation. Maternal hypertensive disorders of pregnancy were a positive control. The MoBa sample contained 29 849 family trios, with a mean (SD) maternal age of 30.2 (18.6) years and a mean (SD) paternal age of 32.8 (13.1) years; 51.1% of offspring were male. Seven independent SNVs were identified as influencing maternal SBP via the antihypertensive drug target instruments. For higher levels of maternal SBP acting through the CACNB2 calcium channel blocker target, the estimated change in gestational age was 3.99 days (95% CI, 0.02-7.96 days) per 10-mm Hg decrease in SBP. There was no evidence of differential risk for measured perinatal outcomes from maternal SBP acting through drug targets for multiple hypertensive subclasses, such as between the ADRB1 β-adrenoceptor-blocking target and risk of congenital malformation (estimated odds ratio, 0.28 [95% CI, 0.02-4.71] per 10-mm Hg decrease in SBP). Maternal and paternal SBP acting through the EDNRA vasodilator antihypertensive target did not have a potential causal effect on birth weight z score, with respective β estimates of 0.71 (95% CI, -0.09 to 1.51) and 0.72 (95% CI, -0.08 to 1.53) per 10-mm Hg decrease in SBP. The findings provided little evidence to indicate that perturbation of maternal genetic variants for SBP that influence antihypertensive drug targets had potential causal relationships with measures of perinatal development and health within this study. These findings may be triangulated with existing literature to guide physicians and mothers in decisions about antihypertensive use during pregnancy.

Interlinkage between Integration Management, Risk Factors, and Project Management Performance in the Construction Industry of UAE

Introduction: The key purpose of the present study was to investigate the role of integration management, technical risk, social risk, and project management risk in determining the performance of United Arab Emirates’ (UAE) construction sector, grounded in the theoretical foundations of agency theory and resource-based view (RBV).Methods: Data was collected through a survey questionnaire from various respondents linked with the UAE construction industry. A final valid sample of 288 respondents was utilized for both descriptive and inferential statistics. Measurement model and structural model assessments were conducted using Smart PLS.Results: The study findings showed a significant positive impact of integration management on project management performance within the construction sector. Conversely, technical risk and project management risk were found to be adversely and significantly linked with project performance.Conclusions: For achieving peak performance in the construction industry, project managers and related individuals need to mitigate the adverse impacts of the identified risk factors. Additionally, promoting integration across different functional departments and project-related activities can enhance project management performance. The study also discusses meaningful policy implications, future research directions, and limitations.

Exploring Staff Perspectives and Experiences from a Nurse Practitioner-Led Behavioral Health Integration Project in North Carolina Multi-Site Federally Qualified Health Center: A Qualitative Descriptive Study

Purpose As primary care (PC) clinics seek to integrate behavioral health (BH) services into patient care, it is crucial to understand the experiences of the clinic team and the impact on workflow and well-being. This study was designed to identify perspectives and experiences of nurse practitioner-led PC teams as they implemented a behavioral health integration (BHI) model into their Federally Qualified Health Center PC practices. Methods We conducted in-depth qualitative interviews with staff members at three clinic sites that implemented BHI. Interviewees were asked questions about the benefits and challenges encountered in the new BHI workflow, the dynamics of the warm hand-off, the tools and resources they used and desired, and the changes they would like to see to promote efficient workflows. Results We interviewed 21 staff members during May and June of 2020. An analysis of the qualitative data showed the most frequently reported experiences and attitudes focused on (a) the availability of behavioral health consultants (BHC); (b) procedural uses of the warm hand-off; (c) the organization’s productivity goals; and (d) desired tools and resources that are generally unavailable to the clinicians but could make a difference to patient care. Conclusion Our results can assist FQHCs and similar organizations to achieve both BHI and the Quintuple aim. Integrating BH services into PC clinics is valuable and may mitigate clinician-staff burnout. However, PC organizations desiring to integrate new sustainable care models should consider involving staff in every phase of the transitional process phase to increase staff buy-in and staff rapport.

Bringing agency back in: neighbourhood countries' perceptions of their hegemonic power relation with the EU and Russia

ABSTRACT Russia's current war against Ukraine takes place in the wider context of geopolitical competition in the region. The EU and Russia promoted integration projects that have, in fact, become conflicting for the “in-between” countries. Existing scholarship put forward power-based explanations for these countries' behaviour that ignored their agency. This paper brings agency back in by developing a conceptual framework that highlights the relational nature of hegemony and that includes the perceptions of the small state in the analysis of power. To illustrate the applicability of this framework, two neighbourhood countries' (Moldova and Armenia) power relations with the EU and Russia are analysed. The focus is on how the structural aspects were acted out and shaped by the two aspiring regional hegemons to understand how small state actors perceived EU and Russian hegemonic power. The findings show the different expressions the phenomenon of hegemonic power can take in practice and how these were perceived in Moldova and Armenia.

Migration vis-à-vis Philoxenia in South African context

Many scholars in the field of migration and xenophobia have consistently examined various levels and expressions of xenophobic behavior within the South African context. They have contributed significantly to conceptualizing migration as inherently conflict-prone, often citing incidents categorized as xenophobia, Afrophobia, and color-blind xenophobia in both scholarly and public discussions. While ample scholarly evidence exists regarding factors that promote social cohesion between South Africans and African immigrants, as well as their implications for African continental integration, there is a notable dearth of scholarly attention on how Philoxenia, the concept of extending friendship or hospitality to strangers, can contribute to the project of African continental integration. Utilizing qualitative research methods and document analysis as a data collection technique, this paper reveals those certain aspects of the South African migration legislative framework exhibit Philoxenic characteristics. Moreover, the paper provides evidence of multiple economic sectors and communities in the country that demonstrate Philoxenia. The paper concludes that Philoxenia can serve as a catalyst towards achieving a united state of Africa, while "xenophobia", "Afrophobia", "Threats” to social cohesion”, "colour-blind xenophobia” and “sibling fights or sibling bullying” are impediments to this long-term objective of the African Union. The paper recommends that, South Africa as one of Africa’s dominant African immigrants’ host state must come up with legislation that criminalizes the latter actions.

Missions, conditions and the policy transfer of Smart Specialisation in the European Union

ABSTRACT Smart Specialisation is fundamentally a bottom-up policymaking process premised on entrepreneurial discovery and peer learning. Nonetheless, the European Union has relied on coercive policy transfer through the ex-ante funding conditionality instrument to secure its implementation across regions. This paper examines how the use of conditionality has shaped the implementation of Smart Specialisation in the European Union and its regions. Furthermore, it discusses whether the use of conditionality to ensure the implementation of a particular type of innovation policy reflects a changed perception of the role of the state in the broader European integration project.

Investigating the role of knowledge management on the relationship between integration management, risk factors, and performance management of construction projects: a case of UAE

Introduction: This research aimed to assess the impact of integration management, social risk, and technical risk on project management performance within the construction sector in the UAE.Methods: A survey questionnaire was developed by extracting items from existing literature. A random sampling technique was used for data collection, resulting in a final valid response of 288 questionnaires. The data was empirically tested through measurement and structural models using Smart PLS.Results: The study demonstrated reliability, convergent validity, and discriminant validity of the latent constructs. The structural model results confirmed that integration management, technical risk, and knowledge management had a significant effect on construction project performance. Additionally, knowledge management significantly moderated the relationship between integration management and project performance, as well as between social risk and project performance in the UAE.Conclusions: The findings suggest that effective knowledge management can enhance project performance by moderating the impact of integration management and risk factors. Several policy implications were provided based on these results.