Key Program Elements Research Articles

Growing the pool of rural general practitioners.

The critical importance of primary health care in maintaining a healthy population is well established internationally. Nevertheless, general practitioner care is not always easily accessible for some patients in Australia, particularly in rural regions. This is partly due to an insufficient number of medical graduates entering and being retained in the rural general practitioner workforce. Key elements of international and national programs designed to address this shortfall are discussed and include the use of entry requirements that preferentially select for applicants from a rural residence background, and immersion of medical students for a large share, or entire duration, of their training in rural communities. In addition, other factors that can influence decisions to enter and stay in rural practice are discussed.

Using a College Curriculum to Integrate Informal Science Learning Opportunities for University and Middle School Students

We used community partnerships to develop an integrated science-learning program focused on two groups of learners – university and middle school (MS) students – to increase students’ interest and confidence in science as well as motivation to pursue science. Key program elements include a university course for undergraduate and graduate students, university student-led weekly afterschool clubs held at local middle schools (mostly Title I), and a capstone museum science festival led by university and MS students. Across nine course offerings, 78 university students conducted 25 clubs at seven middle schools and engaged at least 240 MS students. The capstone science festival engaged ~1,200 public participants across six events. We evaluated the program in two phases. Quantitative and qualitative assessments show that university students enjoyed the course and increased their ability to describe complex scientific phenomenon to youth. Middle school students reported significant increases in science interest, science understanding, and understanding scientists (1st evaluation phase); and increased interest in a career in science and in their perception of others seeing them as a scientist (2nd phase). Consistent with prior research, overall we found an increase in interest and understanding of science, science identity, and interest in future science careers for MS students.

Lessons from the ongoing crisis for labour market institutions in Russia

The paper discusses the role of unemployment insurance system in economic development in general and in the context of the ongoing crisis due to the forced lockdown related to COVID-19. The key elements of employment subsidy programs with reduced working hours or partial unemployment benefits, based on the experience of OECD countries get special attention.

Startup Supplier Programs: A New Model for Managing Corporate-Startup Partnerships

Collaborations between established firms and startups are increasingly considered an ingredient of corporate strategy. This article describes a startup collaboration model that has emerged in practice, a model that complements today’s predominantly used engagement vehicles of corporate accelerators and corporate venture capital. Startup supplier programs are outside-in programs that enable firms to get access to innovations that increase competitiveness of products or productivity of processes by engaging with startups based upon supplier relationships. This article presents empirical data from companies that have run successful startup supplier programs, and it explores the firms’ reasons for implementing these programs, identifies key elements of startup supplier programs, and determines how firms can run them effectively.

Three Configurations of Corporate Innovation Programs and Their Interplay

Purpose: The success of corporate innovation is based less upon the success of a single innovation program than on a holistic and overarching corporate innovation system integrating various activities. Taking this perspective, this study extends existing research on the design of innovation programs. Design/methodology/approach: Utilizing an inductive theory-building case study approach, this study provides a detailed analysis of how one of the largest and most successful German technology companies structures its many innovation activities. Findings: The analysis identifies key elements of innovation programs and suggests three configurations that illustrate how these generic elements can be structured so as to offer the best fit with the underlying logic of the respective innovation program. Furthermore, this study highlights how the identified configurations come together to deliver overarching strategic innovation goals. Originality/value: Existing research too often focuses solely on single innovation programs. The current research is among the first to take a holistic and overarching perspective, considering different innovation programs within a single company and analyzing their configuration and their interplay.

A Pragmatic Internet Intervention to Promote Positive Parenting and School Readiness in Early Childhood: Initial Evidence of Program Use and Satisfaction.

BackgroundInternet-based parenting programs have the potential to connect families to research-informed materials to promote positive child development. However, such programs can only succeed to the extent that the intended population engages with them.ObjectiveThis study aimed to evaluate engagement in the 5-a-Day Parenting program, a technology-based program designed with low-income families in mind, to promote daily use of 5 specific parenting activities conducive to children’s school readiness. Following earlier pilot data, the program was enhanced with an initial motivational e-intervention and tailored text messages designed to promote engagement.MethodsParents were recruited from local childcare centers and through a participant registry. We examined rates of receipt of program text messages and use of video-based content on the program website, 3 factors that may affect website use, and satisfaction with key program elements.ResultsA total of 360 parents of young children learned about the study and had the opportunity to use the 5-a-Day Parenting website. Of these, 94 parents participated in the study, and 33% (31/94) accessed the video-based content on the website at least once. No association was found between website use and program recruitment approach, program-affiliation message, sociocontextual risk, and baseline use of the five parenting activities. Satisfaction with text messages and video-based content was high.ConclusionsFor some parents, technology-based programs appear useful; however, engagement could still be enhanced. Additional research should seek innovative strategies for promoting engagement in Web-based parenting programs.

Development of a Multidisciplinary Medical Home Program for NICU Graduates.

Typical primary care practices are often not equipped to meet the medical, developmental or social needs of infants discharged from a neonatal intensive care unit (NICU). These needs are exacerbated for infants and caregivers residing in poverty. This article discusses a multidisciplinary, family-centered medical home designed to address the needs of this special population. This is a descriptive analysis of a cohort of patients in the Next Steps Program (NSP), a multidisciplinary primary care medical home. Key program elements include: continuity of care from the NICU to primary care, routine developmental surveillance, care coordination, and proactive screening to address medical and social needs. The NSP has become a primary referral source for local NICUs, with a total of 549 medically fragile infants enrolled from its inception in 2011 through 2016. Caregivers and patients experience psychosocial stressors at averages statistically significantly higher than the rest of the Commonwealth of Pennsylvania and the US. Although patients in the program use medical resources beyond that of typically developing infants, hospital utilization among this patient cohort is trending down. Caring for medically fragile NICU graduates can be daunting for families given the array of necessary services, supports, and resources to maximize their potential. A multidisciplinary primary care medical home, such as the NSP, is a successful model of patient care demonstrating favorable associations with health care utilization, care coordination, and addressing/improving family functioning and their experience.

Zero Endemic Cases of Wildlife Rabies (Classical Rabies Virus, RABV) in the European Union by 2020: An Achievable Goal.

The elimination of rabies transmitted by Classical Rabies Virus (RABV) in the European Union (EU) is now in sight. Scientific advances have made it possible to develop oral vaccination for wildlife by incorporating rabies vaccines in baits for foxes. At the start of the 1980s, aerial distribution of vaccine baits was tested and found to be a promising tool. The EU identified rabies elimination as a priority, and provided considerable financial and technical resources to the infected EU Member States, allowing regular and large-scale rabies eradication programs based on aerial vaccination. The EU also provides support to non-EU countries in its eastern and south eastern borders. The key elements of the rabies eradication programs are oral rabies vaccination (ORV), quality control of vaccines and control of their distribution, rabies surveillance and monitoring of the vaccination effectiveness. EU Member States and non-EU countries with EU funded eradication programs counted on the technical support of the rabies subgroup of the Task Force for monitoring disease eradication and of the EU Reference Laboratory (EURL) for rabies. In 2018, eight rabies cases induced by classical rabies virus RABV (six in wild animals and two in domestic animals) were detected in three EU Member States, representing a sharp decrease compared to the situation in 2010, where there were more than 1500 cases in nine EU Member States. The goal is to reach zero cases in wildlife and domestic animals in the EU by 2020, a target that now seems achievable.

Well on the way: An exploratory study on occupational health in hospitality

This study conducted a comprehensive review of work conditions and health risks/problems for various hospitality workers and summarized the various health and wellness promotion programs available in the workplace with the aim of identifying the key elements of successful employee wellness programs. In this review, physical health problems, such as musculoskeletal disorders, lung diseases, and dermatologic diseases, as well as mental health problems that are common among hospitality employees were discussed. In addition, different types of wellness programs that may help employees to overcome these health problems were included. In the next stage, interviews with hotel staff holding multiple positions were conducted to identify the most significant health challenges and assess their preference for various types of wellness initiatives. Using MAXQDA Pro, health-related categories and themes were extracted from the interviews. Participants believed that the lack of time, physical challenges and stress are the top three wellness challenges in the hospitality industry. In order to tackle the challenges, they stated that hospitality businesses should provide various wellness initiatives including healthy eating and weight management, smoking cessation, stress management, exercise programs, and fitbits or other wellness tracker devices.

Reducing the Second Victim Phenomenon: Healing Our Healers With Caritas Coaching.

The second victim phenomenon is one in which nurses and other health care providers use dysfunctional mechanisms, such as anger, projection of blame, or drugs and/or alcohol, to cope with serious mistakes in the absence of a healthier means for healing. The main purpose of this article is to provide evidence and practices that support the need for caring organizational support systems following serious adverse clinical events. Recommendations are provided on key elements of programs to prevent the prevalence, symptoms, and impact of the second victim phenomenon on our health care professionals, our patients, and our health care system.

The process of change for people with cognitive impairment in a residential rehabilitation program for substance problems: a phenomenographical analysis

Cognitive impairment is prevalent among people with substance problems and a factor affecting retention in treatment. Empirical phenomenography was used to systematically explore how people with cognitive impairment viewed a novel residential rehabilitation program – Project RE PIN – designed with cognitive compensatory behaviour change activities and from a strengths-based approach. Twelve participants took part in semi-structured interviews and cross-case analysis identified the overarching theme of change. Key program elements were the safe environment, structured routines, modified psycho-educational material and staff support. Critical changes that participants attributed to the program were in dealing with their own and others’ emotions, experiencing daily life without drugs or alcohol and reframing their self-view. Fear and anxiety about relapse were common and few participants had strategies or support to cope in the future. This study demonstrates that program activities changed participants’ thoughts, feelings and behaviours about themselves and their substance use. The results indicate that RE-PIN’s modified content and processes can benefit people with cognitive impairments in treatment. The study highlights that some treatment users may be vulnerable to resumption of drug use despite gains made during a residential program and their desire to remain substance-free.

An Observational Study Framework to Assess Breast Cancer Control Policy Needs in Low- and Middle-Income Countries

Purpose Women with breast cancer in low- and middle-income countries (LMICs) have worse health outcomes than their counterparts in high-income countries (HICs). Improved outcomes in HICs are attributable to more rigorous breast cancer control policies, implementation of evidence-based guidelines, and greater national investment in health care. In resource-limited settings, identifying the most effective resource-appropriate policies can be a challenge. The proposed study will provide a framework to identify unmet breast cancer policy and infrastructure needs in LMICs and will aid in the prioritization of key elements of successful breast cancer control programs. Building on previous work, we will develop a framework for policy analysis and conduct a breast cancer policy needs assessment through a comparative analysis of attitudes and preferences for breast cancer control elements in 30 countries. Methods The proposed observational survey-based study will measure and compare attitudes and preferences for breast cancer control across 24 LMICs and six reference HICs from across the six WHO regions, stratifying countries by health care spending and mortality-to-incidence ratios. This study will be a cross-sectional survey of medical, policy, and advocacy experts in breast cancer from each of the selected countries. Research will be conducted in three phases. First, we will conduct key informant interviews of international breast cancer experts. Then we will develop and pilot a survey tool. Finally, we will conduct the full survey in countries. The study will use analysis of variance, conjoint analysis, and best-worst scaling to analyze survey results. Results This study will assess current breast cancer control needs, prioritize elements of a comprehensive breast cancer control plan, and determine attitudes about the potential of emerging technologies to improve breast cancer control. Conclusion This study will facilitate the improvement of health outcomes for women with breast cancer by assessing the specific unmet breast cancer policy and infrastructure needs in LMICs and prioritizing elements to improve breast cancer control programs. The study thus provides a resource-appropriate framework to improve breast cancer control policy, reform, and implementation. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Barri M. Blauvelt Stock or Other Ownership: AstraZeneca, Biogen, Celgene, Ecolab, Elite Pharmaceuticals Consulting or Advisory Role: Boehringer Ingelheim, Novartis

Education programs for medical psychiatry collaborative care: A scoping review.

To understand the current state of collaborative care education programs reported in the literature. Following Arksey and O'Malley methodology for scoping reviews, data was abstracted in following domains: article details, program details, program outcomes, and implementation factors. Numerical summaries were calculated where necessary. Implementation factors underwent a qualitative thematic analysis. This review identified 40 unique collaborative care education programs. Most programs (n = 25; 62.5%) were delivered to a multi-disciplinary group of learners through didactic (n = 34; 85.0%) and/or in vivo (n = 32; 80.0%) training methods. The majority of programs focused on clinical knowledge/skill acquisition (n = 38; 95.0%) as opposed to attitudes towards mental health and collaboration (n = 27; 67.5%). Implementation factors fell within four themes: program development, supportive environment, necessary resources, and clinical change agents/leaders. Despite the growing evidence for collaborative care, few collaborative care education programs are reported in the literature. Key elements of collaborative care education programs include: routine multi-disciplinary interaction, curriculum focus on attitudes; clinical change agents and leaders to accelerate implementation; and a user-centred design development process. Future implementations can learn from these experiences to avoid potential barriers and focus on enabling successful programs to enhance care.

Optimal design of a parallel beam system with elastic supports to minimize flexural response to harmonic loading using a combined optimization algorithm

Mechanical systems subject to vibration are prevalent across many industries. Although potentially different in application, they sometimes share the need to minimize aspects of flexural deformation given harmonic loading and the need to consider a variety of both input and response-based constraints in the process. Practical design efforts also sometimes include the need for consideration of the optimal response of a platform-style product, including responses of multiple design variants supported by a common base structure. Harmonic problems can be especially challenging to optimize due to the likelihood that the response will be multi-modal; influenced by system natural frequencies throughout the design space. Further, analysis of these systems often involves large and complex computer models which require significant resources to execute. A harmonically loaded, platform-style parallel beam system with multiple family variants is used as an example in this work to demonstrate a proposed method for identifying an optimum in a constrained, multi-modal response environment with consideration for Expensive Black Box Functions (EBBF). The presented method proposes a combined approach where the high modality, EBBF’s domain is first surveyed for potential areas of optimal response using a method of Steepest Feasible Descent (SFD), followed by a local search in the optimal region using a more efficient direct search method. The method of SFD is a modification of the classical method of Steepest Descent, made useful for constrained models by a penalty system including both deterministic and programmatic methods. A sensitivity-based search vector method also helps to manage situations where significant difference in magnitude exists among the design variables. Evidentiary support for these key program elements is provided using standardized test functions. The effectiveness of the method is demonstrated by seeking a minimum flexural response for a parallel beam system subject to elastic support and response constraints.

The relationship between GEAR UP program involvement and Latina/o students’ performance on high-stakes tests

ABSTRACTTo assess the impact of a college preparation program, district-wide changes in high-stakes test pass rates are examined, followed by an examination of specific program elements that are associated with students’ score changes. Changes in pass rates for districts with and without services are compared for the Latina/o and overall student populations. This study also examines the relationship between hours of participation in various elements of the college preparation program and changes in test scores of low-income Latina/o students. Results indicate that key program elements related to improvements in test scores include participation in mentoring and summer programs.

Spreading Hindutva through education: Still a priority for the BJP?

ABSTRACTThis article explores how the Bharatiya Janata Party (BJP) has pursued its ideology of Hindu nationalism through educational reforms. It pays most attention to the reforms undertaken by the first BJP-led National Democratic Alliance (NDA) government, from 1998–2004. A key argument is that these reforms mirrored BJP’s ideology. The reforms were legitimized with reference to certain challenges facing contemporary Indian society, particularly the threats represented by value degradation and a weakening of indigenous traditions. I view such arguments in terms of sublimating all challenges to the cultural realm. Moreover, these reforms aimed to establish an education system based on a coherent, integrative framework, concurring with the ideological outlook of the BJP. In the final part of the article, I examine the current NDA regime and seek to explain why similar reforms do not appear to be high on Prime Minister Modi’s agenda. By doing so, the article sheds light on the question of Modi’s commitment to Hindu nationalist ideology. A major argument is that to Modi, Hindutva-inspired reforms of the education system collide with the promises made during his electoral campaign and with key elements of the political programs he has initiated so far.

Termination factor Rho: From the control of pervasive transcription to cell fate determination in Bacillus subtilis

In eukaryotes, RNA species originating from pervasive transcription are regulators of various cellular processes, from the expression of individual genes to the control of cellular development and oncogenesis. In prokaryotes, the function of pervasive transcription and its output on cell physiology is still unknown. Most bacteria possess termination factor Rho, which represses pervasive, mostly antisense, transcription. Here, we investigate the biological significance of Rho-controlled transcription in the Gram-positive model bacterium Bacillus subtilis. Rho inactivation strongly affected gene expression in B. subtilis, as assessed by transcriptome and proteome analysis of a rho–null mutant during exponential growth in rich medium. Subsequent physiological analyses demonstrated that a considerable part of Rho-controlled transcription is connected to balanced regulation of three mutually exclusive differentiation programs: cell motility, biofilm formation, and sporulation. In the absence of Rho, several up-regulated sense and antisense transcripts affect key structural and regulatory elements of these differentiation programs, thereby suppressing motility and biofilm formation and stimulating sporulation. We dissected how Rho is involved in the activity of the cell fate decision-making network, centered on the master regulator Spo0A. We also revealed a novel regulatory mechanism of Spo0A activation through Rho-dependent intragenic transcription termination of the protein kinase kinB gene. Altogether, our findings indicate that distinct Rho-controlled transcripts are functional and constitute a previously unknown built-in module for the control of cell differentiation in B. subtilis. In a broader context, our results highlight the recruitment of the termination factor Rho, for which the conserved biological role is probably to repress pervasive transcription, in highly integrated, bacterium-specific, regulatory networks.

Lessons learned implementing a province-wide smoking cessation initiative in Ontario’s cancer centres

Purpose A large body of evidence clearly shows that cancer patients experience significant health benefits with smoking cessation. Cancer Care Ontario, the provincial agency responsible for the quality of cancer services in Ontario, has undertaken a province-wide smoking cessation initiative. The strategies used, the results achieved, and the lessons learned are the subject of the present article.Methods Evidence related to the health benefits of smoking cessation in cancer patients was reviewed. A steering committee developed a vision statement for the initiative, created a framework for implementation, and made recommendations for the key elements of the initiative and for smoking cessation best practices.Results New ambulatory cancer patients are being screened for their smoking status in each of Ontario’s 14 regional cancer centres. Current or recent smokers are advised of the benefits of cessation and are directed to smoking cessation resources as appropriate. Performance metrics are captured and used to drive improvement through quarterly performance reviews and provincial rankings of the regional cancer centres.Conclusions Regional smoking cessation champions, commitment from Cancer Care Ontario senior leadership, a provincial secretariat, and guidance from smoking cessation experts have been important enablers of early success. Data capture has been difficult because of the variety of information systems in use and non-standardized administrative and clinical processes. Numerous challenges remain, including increasing physician engagement; obtaining funding for key program elements, including in-house resources to support smoking cessation; and overcoming financial barriers to access nicotine replacement therapy. Future efforts will focus on standardizing processes to the extent possible, while tailoring the approaches to the populations served and the resources available within the individual regional cancer programs.

Urgent need to strengthen and expand screening and other cancer control programs in the CARICOM Caribbean.

With high mortality in breast, cervical, prostate, and colorectal cancers in Caribbean Community (CARICOM) countries, we examined cancer control initiatives including screening as well as the implementation of relevant international and regional mandates. Secondary data were used to examine cancer control initiatives, which included the presence of national policies, programs, and screening services as well as the implementation of international and regional mandates. To identify the data, an on-line search was conducted using Google/Google Scholar. Data were available for 14 of the 15 full members of CARICOM. Although only six countries had distinct cancer control policies, strategies or action plans, all 14 had key elements of cancer control programs. Screening services were available in the 14 countries for cervical, in 12 countries for breast and in 11 for colorectal cancer. However, only four countries had screening policies. In addition, screening guidelines were available for cervical cancer in nine countries, in one country for breast and in none for colorectal cancer. Selected tobaccocontrol policies were present in the 14 countries and immunization policies for human papillomavirus (HPV) in 13. Treatment services included chemotherapy in 10 countries and radiotherapy in six. Nine countries had palliative care services for patients with advanced disease. The countries were at different stages of implementation/compliance with international and regional mandates and frameworks. There is an urgent need to develop and implement comprehensive and customized cancer control policies addressingscreening programs,treatment and palliative care.

Lessons learned implementing a province-wide smoking cessation initiative in Ontario's cancer centres.

A large body of evidence clearly shows that cancer patients experience significant health benefits with smoking cessation. Cancer Care Ontario, the provincial agency responsible for the quality of cancer services in Ontario, has undertaken a province-wide smoking cessation initiative. The strategies used, the results achieved, and the lessons learned are the subject of the present article. Evidence related to the health benefits of smoking cessation in cancer patients was reviewed. A steering committee developed a vision statement for the initiative, created a framework for implementation, and made recommendations for the key elements of the initiative and for smoking cessation best practices. New ambulatory cancer patients are being screened for their smoking status in each of Ontario's 14 regional cancer centres. Current or recent smokers are advised of the benefits of cessation and are directed to smoking cessation resources as appropriate. Performance metrics are captured and used to drive improvement through quarterly performance reviews and provincial rankings of the regional cancer centres. Regional smoking cessation champions, commitment from Cancer Care Ontario senior leadership, a provincial secretariat, and guidance from smoking cessation experts have been important enablers of early success. Data capture has been difficult because of the variety of information systems in use and non-standardized administrative and clinical processes. Numerous challenges remain, including increasing physician engagement; obtaining funding for key program elements, including in-house resources to support smoking cessation; and overcoming financial barriers to access nicotine replacement therapy. Future efforts will focus on standardizing processes to the extent possible, while tailoring the approaches to the populations served and the resources available within the individual regional cancer programs.