Implementation Of Local Plans Research Articles

Global expert views on the diagnosis, classification and pharmacotherapy of allergic rhinitis in clinical practice using a modified Delphi panel technique

BackgroundDiagnosis, classification, and treatment of allergic rhinitis (AR) varies considerably despite the availability of treatment guidelines. ObjectivesWe aimed to carry out a two-part modified Delphi panel study to elucidate global expert management of AR in real life. MethodsThe modified Delphi panel study was composed of two ten-minute online questionnaires sent to global AR experts, aiming to identify areas of consensus (defined as >75% respondent agreement) on aspects of their real-world daily practice related to AR diagnosis, classification, and pharmacotherapy. A workshop discussion with respondents held after the first-round questionnaire informed the development of the second-round questionnaire. ResultsEighteen experts (from 7 countries across 3 continents) completed both questionnaires in September–October 2021 and January 2022, respectively. The majority of respondents agreed that diagnosis of AR is best confirmed using a mixture of observation and testing (n = 15) and collaborating with colleagues across other specialties (n = 14). Experts agreed that severity (n = 18), upper/lower respiratory tract involvement (n = 15) and symptom frequency (n = 14) are important factors when classifying AR, however consensus was not reached on which classification tool should be used. Although there were mixed opinions on the preferred pharmacotherapy treatment in the presented case studies, respondents largely agreed on which treatments require less monitoring (intranasal corticosteroid therapies [INCS]) and when treatments should be stepped down (≤3 months). Although opinions varied across respondents, some respondents considered as-needed INCS treatment and surgery to be viable treatment options. ConclusionWe identified clear differences between real-world practice and treatment guidelines related to the management of AR. Furthermore, we recognized differences among physicians concerning their clinical practice in the pharmacological treatment of AR. These findings highlight the need for greater research into the management of AR and further indicate there is still a major gap between treatment guidelines and daily practice, even among specialists, suggesting a need for local guideline adaptation and implementation plans.

Improving mental healthcare access and experience for people from minority ethnic groups: an England-wide multisite experience-based codesign (EBCD) study

BackgroundLong-standing ethnic inequalities in access and mental healthcare were worsened by the COVID-19 pandemic.ObjectivesStakeholders coproduced local and national implementation plans to improve mental healthcare for people from minority ethnic groups.MethodsExperience-based...

Benefits realization management in the context of a national digital transformation initiative in English provider organizations.

BackgroundThe Global Digital Exemplar (GDE) Programme is a national initiative to promote digitally enabled transformation in English provider organizations. The Programme applied benefits realization management techniques to promote and demonstrate transformative outcomes. This work was part of an independent national evaluation of the GDE Programme.AimsWe explored how benefits realization management was approached and conceptualized in the GDE Programme.MethodsWe conducted a series of 36 longitudinal case studies of provider organizations participating in the GDE Programme, 12 of which were in depth. Data collection included a combination of 628 interviews (with implementation staff in provider organizations, national programme management staff, and suppliers), 499 documents (of national and local implementation plans and lessons learned), and 190 nonparticipant observations (of national and local programme management meetings to develop insights into the broader context of benefits realization activities, tensions arising, and how these were negotiated). Data were coded drawing on a sociotechnical framework developed in related work and thematically analyzed, initially within and then across cases, with the help of NVivo 11 software.ResultsMost stakeholders broadly agreed with the rationale of benefits realization in the GDE Programme to show due diligence that public money was appropriately spent, and to develop an evidence base supporting the value of digitally enabled transformation. Differing national and local reporting purposes, however, created tensions. Central requirements, for progress reporting and tracking high-level benefits, had limited perceived local value and were seen to impose an unnecessary burden on provider organizations. This was accentuated by the lack of harmonization of reporting requirements to different stakeholders (which differed in content and timing). There were tensions between the desire for early evidence of outcomes and the slow processes of infrastructural change (which created problems of attribution of benefits to causes as benefits emerged gradually and over long timeframes), and also between reporting immediately visible local changes and showing how these flowed through to high level organization wide benefits (eg, in terms of health outcomes or cost savings/return on investment). The attempt to fulfill these diverging agendas and informational needs within a single reporting tool had limited success. These difficulties were mitigated by efforts to simplify reporting requirements and to support targeted collection of key national outcome measures. Although progress was hampered by an initial lack of benefits realization expertise in provider organizations, some providers subsequently retained these skills for their own change management purposes.ConclusionsThere is a need to recognize the limitations and cost of benefits realization management practices in the context of healthcare digitalization where benefits may materialize over long timeframes and in unanticipated ways. Although diverse stakeholder information needs may create tensions, prior agreement about rationales for collecting information and a targeted approach to tracking local and high-level benefits may enhance local relevance, reduce perceived reporting burdens, and improve acceptance/effectiveness. A single integrated reporting mechanism is unlikely to fulfill both national and local requirements.

Economic Consequences of Adopting Local Spatial Development Plans for the Spatial Management System: The Case of Poland

The spatial management system in Poland struggles with serious costs as a consequence of local planning. The problem is the lack of appropriate value capturing mechanisms and cost compensation for municipalities, along with significant burdens. Private property is subject to special protection, but the public good is less valued. The article attempts to assess the situation in Poland, recalling also the experiences of spatial management systems from other European countries. It combines legal, economic, and geographical perspectives. The specific objectives were demonstration of geographical (interregional and functional) regularities related to the economic (financial) consequences of adopting local plans and identification of financial effects resulting from the implementation of local plans in communes, i.e., in particular, their size, structure of revenues (income), and expenditures, in relations with the budgets of municipalities and the population living in communes. First, the determinants of spatial policy were defined in the context of institutional economics and the real estate market. Then, a unique database of forecasted and realized budgetary revenues and expenditures of 2477 communes in Poland related to spatial development (infrastructure construction, land transformation, purchase, etc.) was analyzed statistically. Additionally, for five selected communes of different functional types, this issue was examined in detail. It has been shown that municipalities do not derive adequate income from spatial development, and improper policy of local self-governments results in heavy burdens, threatening to disturb their financial balance. The formulated conclusions regarding the legal, economic, and spatial mechanisms may contribute to building tools (instruments) for more effective spatial management in various countries.

ECOLOGICAL BALANCE OF TERRITORIAL COMMUNITY DEVELOPMENT IN UKRAINE

The key guidelines and ecological balance of community development in Ukraine are studied. It has been shown that social progress depends on establishing a balance between the goals of economic and social development and ensuring environmental security. The quality system of public administration at the local level is recognized as the main precondition for achieving the goals of development of territorial communities. It is established that local governments pay more attention to social and economic issues, without promoting environmental awareness among the population. The development and implementation of local plans, projects, and environmental protection programs are recognized as tools for strengthening the environmental component of territorial development. The existing positive practices for promoting sustainable development in general and environmental in particular at the level of territorial communities are characterized. It has been confirmed that local communities are better able to manage natural resources than the state or the private sector. Guidelines on ecological balance of development of territorial communities are given. The effectiveness of the tool of strategic environmental assessment is investigated. Emphasis is placed on the need to form a proper environmental awareness of the population of territorial communities. Data on human impact on the environment are presented. The main problems of ecological consciousness of the population are outlined. The need to ensure the real participation of the local population in the adoption and implementation of decisions concerning important environmental issues (to transform latent consumers into an active civil society) has been proved. It is emphasized that an effective communication process is able to support the social mobilization of the population of territorial communities in the direction of eco-awareness and ecological balance of the community itself. The premise for integration of ecological interests of all participants of interaction at the level of territorial communities is presented. The main conditions for the formation, accumulation and use of communication potential of interaction on the ecological balance of community development are outlined.

Instructional change following formative instructional practices professional development

ABSTRACTSignificant funds have been allocated in the United States at the federal, state, and local levels to provide teacher professional development aimed at bringing about instructional change and resulting in improved student achievement. One important indicator for quality and effectiveness in professional development is change in teaching practice. This study was designed to observe instructional change among 45 classroom teachers across three data points: at the beginning, in the middle, and at the end of a two-year statewide professional development initiative focused on incorporating formative instructional practices into daily classroom work. Repeated measure analysis results indicated significant changes in providing effective feedback and encouraging student ownership of learning. Change patterns in the classrooms included in this study informed future professional development focus, design, and delivery. Researchers found that implementing a comprehensive teacher professional development initiative to improve instructional quality is promising yet challenging because of differing local implementation plans, organizational structures, priorities, and resources.

Strategic Action for Affordable Housing: How Advocacy Organizations Accomplish Policy Change

State retrenchment, public input requirements, and local budgetary constraints make advocacy organization’s (AO) work vital to the adoption and implementation of local plans. Yet, the strategies AOs use to influence policies have gone understudied in planning literature. The current study fills this gap through a case study of how AOs exert influence in planning for affordable housing in four cities in Los Angeles County. Data were collected through interviews (AO leaders and city officials), document review (AO materials), and content analysis of Housing Elements. The study found that the range of tactics depends on the political context and organizational resources.

Rethinking mental health provision in the secure estate for children and young people: a framework for integrated care (SECURE STAIRS)

PurposeThe purpose of this paper is to outline the challenges to achieving positive outcomes for young people within the secure estate in England, and introduces a psychologically informed framework, SECURE STAIRS (SS), aimed at improving outcomes.Design/methodology/approachThe paper argues that there is a need for a fundamental shift in the way care and intervention for young people within the secure estate is delivered. It gives an overview of current challenges and needs and summarises the theoretical concepts and evidence base which can guide practice and form the foundations of the SS framework.FindingsThe framework recommends that intervention shift from focussing primarily on individual assessment and treatment to a greater emphasis on supporting the work of the wider system of care. Recommendations include promoting trauma-informed care, a focus on the system dynamics within institutions and how these impact on the care young people receive, and on the collaborative development with residential staff and young people of formulation-led care plans that include a focus on issues of sustainability after leaving the secure estate.Practical implicationsThese include the establishment of discrete residential groupings with truly integrated and trauma-informed work across residential, mental health, education and criminal justice agencies. This involves addressing governance issues around shared record keeping, and challenges to sustainability and the accompanying need for local implementation plans for each establishment alongside central support at a strategic level.Originality/valueThis paper describes a new and innovative way of working within secure settings to ensure children and young people’s needs are better met.

Restoration Plan for Degraded Forest in The Democratic People’s Republic of Korea Considering Suitable Tree Species and Spatial Distribution

The ecosystem across the Democratic People’s Republic of Korea (DPRK) is threatened by deforestation. However, there is very little attention being given to government efforts for afforestation and rehabilitation plan. The most significant barriers to addressing this problem are technique limitations, availability of information, and lack of a stepwise forest management plan. This study identifies spatially suitable tree species, and establishes a stepwise restoration plan to support decision making for restoring degraded forest in the DPRK throughout a suitable restoration map. First off, target species were chosen from reference data, and spatial distribution maps for each tree species were prepared based on social needs as well as natural conditions in the DPRK. The suitable restoration map was calculated by two priorities in a weighting method; suitable priority, and distributional clustering level. Finally, the 23 afforestation species were selected for the suitable restoration map, including 11 coniferous and 12 deciduous tree species. We introduced a stepwise afforestation/restoration plan of degraded forest in the DPRK; general (long-term), detailed (medium-term), implementation (short-term) plans. Maps with different spatial resolutions were prepared for each of the plans. A restoration map with 12.5 km spatial resolution can be used for the general plan at the national level, and maps with 5 km and 1 km spatial resolutions can be used for detailed plan at the local level and implementation plan at the site level, respectively.

The quality and implementation of local plans: An integrated evaluation

Local plans are key components of municipal planning and scholars have developed methodologies to evaluate them. However, the purpose and use of local plans may vary, making their evaluation challenging, especially in comparative studies. In this context, existing evaluation methodologies that target local plans do not always account for the purpose of plans when evaluating their quality. Moreover, it is still unclear whether high-quality plans are better implemented than plans of lower quality. In this paper, we propose an integrated evaluation approach that links plan quality to implementation. To assess plan quality, we developed a flexible framework that accounts for the fact that local plans may present different characteristics according to their purpose. The framework rests on the analysis of the communication- and action-oriented dimensions of plans, and a system of coordinates that enables the classification of plans into four types (i.e. visions, blueprints, communicative policy acts, and basic plans) according to the score on each dimension. Plan implementation, assessed as conformance and performance, is determined based on the perception of local planners. Our approach and framework are applied to a set of 37 Swiss local plans. The approach is presented in a transparent way and requires basic numeracy skills, making it accessible to scholars and planning practitioners. Findings may be used to guide municipalities towards enhancing the quality of plans and identify best practices.

Getting Started - Getting Better

An introduction: (comprising context and problem statement) Midland Area Parenting Partnership (MAPP) Triple P initiative is the first population-based intervention in Ireland to demonstrate that a parenting programme significantly impacted on prevalence of children’s socio-emotional and behavioural problems. Short description of practice change implemented: Effectiveness relates to integration of Triple P Positive Parenting Programme evidence, local implementation plan and the enabling environment. These 3 elements benefited from planned and systematic practice change. Aim and theory of change: The aims of this initiative were to determine whether a reduction could be achieved in the prevalence rate of children showing socio-emotional and behavioural problems and to develop an implementation guide. The theory of change, hypothesised that the combination of inputs (access to communication approaches, evidence based programme, high quality training accreditation and mentoring for practitioners, internal and external partnerships and resources) and effective implementation would achieve wide ranging gains for children and parents within the population. Targeted population and stakeholders: The target population was parents of children aged 3-7. The MAPP partnership comprised statutory, voluntary and community sector organisations Timeline: The evaluation was completed over a 2.5 year. The Implementation Guide was developed upon this experience and the expansion into 2 new counties. Highlights: (innovation, Impact and outcomes) Innovation in the present study included the use of a locally developed implementation framework and a core team consisting of multidisciplinary staff from partner organisations who reoriented their work. The evaluation showed a significant reduction in the prevalence rates of socio-emotional and behavioural problems over time. A guide was developed to facilitate the intentional, explicit and systematic implementation of the MAPP approach in other areas. Comments on sustainability: The elements of this model which promote sustainability are: The use of a core delivery team. Routine focus on the enabling environment & Routine gathering and use of implementation and outcome data. Comments on transferability: The local evidence of effectiveness combined with the implementation guide support transferability, in addition the outcomes need to be sufficiently valued by local parents and partner organisations. MAPP has expanded into 4 counties and delivers to parents with children 15 years of age and younger. Conclusions: (comprising key findings) This work demonstrated that a partnership approach to universal parenting when implemented well can result in significant reduction in prevalence rates for socio-emotional and behavioural problems. Discussions: The relationship between the evidence-based programme, implementation plan and enabling environment are the active ingredients needed to achieve better outcomes. The implementation structure was a key determinant in achieving the positive results for partners, practitioners and families, and the partnership was key to establishing and maintaining the enabling environment Lessons learned: The partnership fostered the enabling environment and the core team becomes the key driver for the implementation. A key element for the successful integrated planning was the devolving of authority to the core team for developing and progressing the implementation. A strong focus on implementation contributed to the population effect.

Impact of planning mandates on local plans: a multi-method assessment

ABSTRACTAn increasing number of subnational government bodies mandate municipalities to establish a vision for their future development with a local plan. Outside the U.S., few studies have assessed whether these mandates succeed at increasing formal quality, policy focus and implementation of local plans. In addition, the reasons that prompt governments to impose mandates remain unclear. To tackle these issues, we used a multi-method approach combining interviews, plan content analysis and questionnaires to compare mandated and voluntary planning in Switzerland. Our analysis reveals that mandates only have limited impact on local plans. In particular, they do not produce higher quality plans than voluntary planning and do not improve implementation of policies. Our results may imply that (a) planning mandates from subnational governments are ineffective in general or (b) Swiss mandates in particular entail too few requirements and enforcement mechanisms to show a clear effect. Further studies could explore this issue empirically by comparing the characteristics of different planning mandates and assessing their effect on the quality and implementation of local plans. Alternatively, future research efforts could also examine how to find a compromise between mandated and voluntary planning in order to increase local commitment towards plan making.

Integrating Prevention into Clinical Practice - Developing the Irish National Policy for Health Behaviour Change - Make Every Contact Count (MECC)

Introduction: Current health reforms and policy developments in Ireland focus on improving the nation’s health and on integrating health care through the development of Integrated Care Programmes1. The policy “Healthy Ireland” sets out a framework for improved health and wellbeing for the Country from 2013 to 2025 2.In 2015 the HSE published the National Implementation Plan for Healthy Ireland in the Health Services (2015 – 2017)3. A number of these actions relate to incorporating prevention and behaviour change interventions into clinical models of care. Hence the Integrated Care Programme for Chronic Disease will include the full pathway of care to be integrated ranging from primary prevention, early detection, secondary prevention, through Primary, Secondary and Tertiary Care, all supported by self management supports.An essential focus of the policy and programme is to enable all health care professionals to engage in preventive interventions as part of their routine clinical consultations. All professionals should enquire about patients modifiable life style risk factors and give the appropriate level of intervention (brief advice, brief intervention, extended brief intervention etc.).Actions under the Healthy Ireland Implementation Plan include developing a Framework and Implementation Plan for Health Behaviour Change Interventions i.e. a plan to “Make Every Contact Count for Prevention” in the health service.Policy for Health Behaviour Change: The framework for health behaviour change is aimed at all health care workers to ensure it is every ones responsibility to engage in prevention activity in their routine work. The Model for Health Behaviour Change is presented as a pyramid with less intensive interventions at the lower end of the pyramid, applying to all patients and staff. As one moves up the pyramid the interventions become more intensive, with the most specialised interventions at the top of the pyramid. The numbers of health care workers delivering these interventions will also decrease as one moves up the pyramid, hence the greatest concentration of resources will be at the lower levels.The framework outlines what patients, in what care settings and by which staff the various levels of intervention are required. The training plan outlines how the various staff groupings would be trained in the skills required.Methods Used for Policy Development: The development of this policy commenced in late 2014. The team found that the key development stages were;• Evidence review• Establishment of rationale• Discussion with key informants• Draft of outline policy• Informal consultation with selected key stakeholders• Formal consultation across the health service and external key stakeholders, this included 1 to 1 meetings, focus groups, workshops and survey• Assessment of operational readiness• Finalisation of framework• Development of implementation plan• Development of training plan• Procurement of a training programme• Appointment of dedicated staff to drive implementation of the framework and implementation plan• Identification of key implementation resources• Identification of key clinical ICT systems that require amendment to capture this preventive activity• Negotiation with system owners to amend systems, system amendment and data capture• Development of a common minimum data set for capture of prevention activity in the setting, and agreement to standardise this across clinical systems.Highlights:• A concise summary of evidence was essential in gaining support from professionals.• Time spent in consultation paid dividends in designing the implementation plan.• Dedicated implementation staff and resources nationally and in local units essential.• Lessons from other Countries very useful.• Recording of activity difficult but necessary.Conclusion: The Integrated Care Programme for Chronic Disease in Ireland will take a population health approach and will include prevention in the services to be integrated at clinical, professional, organisational and system levels.A nationally directed approach has been useful in creating leadership, policy and resource buy in. Implementation has been aided by inclusion of this initiative in local Hospital Group and Community Health Organisation implementation plans. Support from Royal Colleges, professional organisations and patient advocacy groups has been very helpful.The presentation at the International Foundation Conference will outline the details of the Framework for Behaviour Change, the development process and the Implementation Plan developed.

Local plan implementation: assessing conformance and influence of local plans in the United States

Attention to if and how plans are implemented is increasing. Among the conceptions of plan implementation used by scholars, plan conformance and plan performance are most prominent, though rarely have both been assessed in a single study. We assess plan conformance and a modified version of performance, which we call influence, for a sample of more than 100 local hazard mitigation plans developed in response to a national planning requirement in the United States. Our findings indicate that progress on implementation of the policies included in the plans (plan conformance) is moderate, but that the rate of progress varies widely by the type of policy and the state in which the local jurisdiction is located. The findings also indicate that coordination of hazard mitigation plans (plan influence) is strongest with other emergency management agency-led planning initiatives and weaker with planning initiatives led by other agencies. National officials interested in advancing local implementation of national goals need to consider the degree to which state and local governments are given autonomy to select and prioritize local policies included in plans, as well as constraints on coordination across planning initiatives.

Monitoring and managing metabolic effects of antipsychotics: a cluster randomized trial of an intervention combining evidence-based quality improvement and external facilitation.

BackgroundTreatment of psychotic disorders consists primarily of second generation antipsychotics, which are associated with metabolic side effects such as overweight/obesity, diabetes, and dyslipidemia. Evidence-based clinical practice guidelines recommend timely assessment and management of these conditions; however, research studies show deficits and delays in metabolic monitoring and management for these patients. This protocol article describes the project ‘Monitoring and Management for Metabolic Side Effects of Antipsychotics,’ which is testing an approach to implement recommendations for these practices.Methods/DesignThis project employs a cluster randomized clinical trial design to test effectiveness of an evidence-based quality improvement plus facilitation intervention. Eligible study sites were VA Medical Centers with ≥300 patients started on a new antipsychotic prescription in a six-month period. A total of 12 sites, matched in pairs based on scores on an organizational practice survey, were then randomized within pairs to intervention or control conditions.Study participants include VA employees involved in metabolic monitoring and management of patients treated with antipsychotics at participating sites. The intervention involves researchers partnering with clinical stakeholders to facilitate tailoring of local implementation strategies to address barriers to metabolic side-effect monitoring and management. The intervention includes a Design Phase (initial site visit and subsequent development of a local implementation plan); Implementation Phase (guided by an experienced external facilitator); and a Sustainability Phase. Evaluation includes developmental, implementation-focused, progress-focused and interpretative formative evaluation components, as well as summative evaluation. Evaluation methods include surveys, qualitative data collection from provider participants, and quantitative data analysis of data for all patients prescribed a new antipsychotic medication at a study site who are due for monitoring or management of metabolic side effects during the study phases. Changes in rates of recommended monitoring and management actions at intervention and control sites will be compared using time series analyses.DiscussionImproving monitoring for metabolic side effects of antipsychotics, as well as promoting timely evidence-based management when these effects emerge, will lead to improved patient safety and long-term outcomes. This article discusses key strengths and challenges of the study.Trial registrationNCT01875861

Methodology of socially-oriented observations and the possibilities of their implementation in the Arctic resilience assessment.

The methodology of socially-oriented observations (SOO) started to be developed within the International Polar Year (IPY) 2007–2008 PPS Arctic project. The main objective of SOO is to increase knowledge and observation of changes in quality of life conditions and to reveal trends in human capital and capacities. SOO are needed also to assess and monitor trends in resilience and sustainability of coupled socio-ecological systems and to predict changes. Moreover they should help to identify and monitor the implementation of local plans and adaptation strategies that will stimulate human capital improvement and act not only as the agent of economic modernisation, but as important directions for building resilient socio-ecological systems. The first experiments to implement SOO methodology were carried out in the municipal regions of the Russian north in different biomes (from coastal tundra to southern taiga zone) of Murmansk, Arkhangelsk Oblast and the Republic of Komi. SOO approaches, based both on local people's perceptions and statistics, help to identify the main issues and targets for life quality, human capital and environment improvement and thus to distinguish the most important changes and trends for further monitoring. Key issues were identified in the state of human capital and quality of life conditions: depopulation, increasing unemployment, aging, declining physical and mental health, quality of education, loss of traditional knowledge, marginalisation etc. Human induced disturbances such as uncontrolled forests cuttings and poaching are increasing while observed changes in climate and biota have become additional factors influencing land use and overall sustainability. The main aim of this paper is to show how the methodology of SOO may help to delineate main thresholds arising within socio-ecological systems for their resilience assessment.

Development, Design and Flight Test Evaluation of Continuous Descent Approach Procedure in FIR Zagreb

As part of Local Conversion and Implementation Plan which is based on the EUROCONTROL Revised Convention the Republic of Croatia has undertaken to make a plan of implementing the Basic Continuous Descent Approach procedures. This paper addresses the issue of navigational path optimization for the A-319/320 commercial aircraft within the fleet of Croatia Airlines, during the approach part of flight, which has a positive effect on fuel consumption, greenhouse gas emission and area of surface affected by noise. The experiments were carried out in real conditions, using internal sensors onboard (Flight Data Recorder) and independent GPS system. Two types of approach were tested: Continuous Descent Approach (CDA) and Step Down Approach. The implementation of CDA procedures, just for the fleet of Airbus 320/319 aircraft of the Croatia Airlines results in approximate calculation in fuel saving which amounts to 1.5 x 106 kg annually (only on Zagreb airport). In this way, the productiveness of an air carrier, which is an integral part of the traffic process along with the airports and air traffic control, is directly increased, thus fulfilling the purpose of air traffic technology research. KEY WORDS: navigational procedures, continuous descent approach, air traffic, ecology

The West Central Alberta Woodland Caribou Landscape Plan: Using a Modeling Approach to Develop Alternative Scenarios

Woodland caribou (Rangifer tarandus) are classified as threatened in Alberta. In support of Canada's Species at Risk Act, a Recovery Plan for Woodland Caribou in Alberta was completed in 2004 which required local implementation plans to be completed within 5 areas of the province. The West Central Alberta Caribou Landscape Plan (WCCLP) is the first of these to be initiated and it addresses the recovery strategies for 4 herds. Two aspatial computer models built on the STELLA© modelling platform (ISee Systems, 2007) were used to assist the planning team in evaluating cumulative effects and alternative scenarios for caribou conservation. The ALCES© (Forem Technologies 2008) modelling tool was used to forecast potential changes in the west central Alberta landscape over time. Yearly landscape condition outputs from ALCES© were then exported into a caribou-specific population model, REMUS© (Weclaw, 2004), that was used to project potential population responses by woodland caribou, other primary prey species [moose (Alces alces), elk (Cervus elaphus) and deer (Odocoileus sp.)] and wolves (Canis lupus) (Weclaw & Hudson, 2004). Simulated habitat management strategies that resulted in the highest likelihood of caribou recovery included the maintenance of a high proportion of old forest, the aggregation of industrial footprints and the reclamation of historic seismic lines (although the latter took decades to provide real dividends). Sharing of industrial roads, protection of fragments of old-growth, and expanding an already aggressive fire control strategy in Alberta had little additional effect on caribou recovery. Simulated population management strategies that were successful all involved decades of intensive wolf control, either directly or indirectly through intensive primary prey control (with the exception of woodland caribou) until old-growth forests recovered to densities that provided caribou habitat and decreased alternate prey of wolves. Although this modelling approach makes broad assumptions, it provides simple fundamental relationships that were useful in a multi-stakeholder team setting when evaluating the efficacy of different management strategies for the conservation of woodland caribou.

The burden of asthma in the Chicago community fifteen years after the availability of national asthma guidelines: The design and initial results from the CHIRAH study

Since the early 1990s, asthma burden has been recognized as a national public health concern in the United States [1]. The asthma burden has disproportionately affected persons of certain racial/ethnic backgrounds, principally African Americans [2] and those persons living in urban environments [3,4]. Concern about the growing problem of asthma has led to a number of national, state, and local efforts towards improving asthma outcomes and control [5,6,7,8]. No national effort toward asthma control has been more celebrated than the implementation of the National Heart, Lung and Blood Institute's National Asthma Education and Prevention Program (NAEPP). Initiated in 1989, to a large extent in response to the public's concern about the increased asthma prevalence and burden, the NAEPP set its first programmatic effort to the establishment of guidelines to improve asthma care [9]. Since the initial release of these guidelines in 1991, hundreds of thousands of copies have been distributed [10] and there have been countless efforts directed toward moving these guidelines into practice including continuing medical education (CME) programs, disease management programs, clinical performance measures, and research efforts. The NAEPP continues efforts in the establishment of national guidelines through a series of updates to the original guidelines, including the recent release of a major update in November 2007 [11,12]. While there continues to be numerous reports of progress of local implementation and health plan efforts, these reports have focused on changes in asthma processes of care or on outcomes limited primarily to health care utilization among selected, mostly health plan or practice-based samples. To date, there is a rather modest literature on community-wide population-based status of asthma burden and quality of care. The Chicago Initiative to Raise Asthma Health Equity (CHIRAH) is one of the NHLBI Centers of Excellence in Reducing Asthma Disparities. The core activity of the CHIRAH has been to conduct a community-based cohort study designed to characterize those factors that are contributing to racial/ethnic disparities with the purpose of identifying mutable factors that may provide the basis for new intervention strategies to eliminate these disparities. The CHIRAH project therefore provides a unique opportunity to report on a population-based understanding of the burden of asthma in a large urban environment known to have one of the highest asthma mortality rates in the US [13]. The purpose of this report is to examine the overall burden of asthma morbidity and treatment as seen from the perspective of this community-based study.

Food projects in London: Lessons for policy and practice — A hidden sector and the need for `more unhealthy puddings … sometimes'

Background and Objective Successive governments have promoted local action to address food components of public health. This article presents findings from research commissioned by the (then) London NHS Office, scoping the range of food projects in the London area, and the potential challenges to public health practice. Methods Research followed four overlapping phases with a London focus: (1) a systemized review of the literature, (2) analysis of health authority Health Improvement Plans (HImPs) and Coronary Heart Disease (CHD) local implementation plans and Health Action Zone reports, (3) a scoping exercise of`food projects' and community-based participatory projects with a food focus using food databases and directories, and (4) 29 in-depth interviews with individuals responsible for commissioning and running projects. Results There were, in 2001/2, a variety of food projects in the London area, ranging from small-scale social enterprises to those whose turnover marked them out as small businesses. There was a significant human resource cost in maintaining and setting up such projects both from NHS staff and in terms of volunteer and paid labour. The lack of an overall or area-based approach to food policy development in London was apparent, and little thought seemed to have been given to creating a supportive policy environment. Food projects often existed as isolated entities in a borough or health authority area, with short-term funding and little systemic long-term support. The majority employed what might best be called health education approaches. This is now partially addressed by the draft London Food Strategy. Conclusions Food projects run by local professionals and/or volunteers operated within an isolated policy and suffered from a lack of support both from financial and human resources perspectives. The potential for long-term delivery of improved health was unrealized, as was their potential contribution to a London-wide food economy and to London food policy.