Mainstream Practice Research Articles

Global adaptation governance: how intergovernmental organizations mainstream climate change adaptation

ABSTRACT Climate change adaptation is increasingly being mainstreamed into all types of organizations across the world. A large number of intergovernmental organizations (IGOs), such as the European Union, the World Bank, or Food and Agriculture Organization, have already started to mainstream adaptation. Yet, despite a surge in scholarly interest in climate policy integration over the past decade, adaptation is still predominantly studied as a local issue and mainstreaming in IGOs remains poorly understood. In this article, we develop and test an innovative framework for examining adaptation mainstreaming practices in IGOs. Using quantitative and qualitative data derived from extensive fieldwork conducted between 2017 and 2020, we examine mainstreaming practices in a large number of IGOs and arrive at two key findings. First, adaptation has been mainstreamed within the procedures and outputs of IGOs across ten (nonclimate) issue areas, while there is also evidence of important issue-specific variation. Second, there is variation across mainstreaming practices in the sense that discursive mainstreaming is most common, whereas more concrete collaboration, policy change affecting projects and programs, and budget allocations are less common. We conclude with a discussion of how our framework can inform the theory and practice of global adaptation governance. Key Policy Insights IGOs have mainstreamed adaptation into a large array of issue areas, yet scholarly and practical debates remain siloed. Mainstreaming adaptation has advanced most in IGOs in the areas of food and development and least in the domain of migration and security. Discursive mainstreaming is more common than other types of adaptation mainstreaming in IGOs, regardless of the issue area. Global governance is a distinct setting in which powerful states, institutional complexity, and funding constraints strongly affect IGO practices to successfully mainstream adaptation.

A Narrative Review of Factors Historically Influencing Telehealth Use across Six Medical Specialties in the United States

Prior to the COVID-19 pandemic, studies in the US have identified wide variations in telehealth use across medical specialties. This is an intriguing problem, because the US has historically lacked a standardized set of telehealth coverage and reimbursement policies, which has posed a barrier to telehealth use across all specialties. Although all medical specialties in the US have been affected by these macro (policy-level) barriers, some specialties have been able to integrate telehealth use into mainstream practice, while others are just gaining momentum with telehealth during COVID-19. Although the temporary removal of policy (coverage) restrictions during the pandemic has accelerated telehealth use, uncertainties remain regarding future telehealth sustainability. Since macro (policy-level) factors by themselves do not serve to explain the variation in telehealth use across specialties, it would be important to examine meso (organizational-level) and micro (individual-level) factors historically influencing telehealth use across specialties, to understand underlying reasons for variation and identify implications for widespread sustainability. This paper draws upon the existing literature to develop a conceptual framework on macro-meso-micro factors influencing telehealth use within a medical specialty. The framework is then used to guide a narrative review of the telehealth literature across six medical specialties, including three specialties with lower telehealth use (allergy-immunology, family medicine, gastroenterology) and three with higher telehealth use (psychiatry, cardiology, radiology) in the US, in order to synthesize themes and gain insights into barriers and facilitators to telehealth use. In doing so, this review addresses a gap in the literature and provides a foundation for future research. Importantly, it helps to identify implications for ensuring widespread sustainability of telehealth use in the post-pandemic future.

Examining non-medical prescribing trends in New Zealand: 2016\u20132020

BackgroundPopulation growth and general practitioner workforce constraints are creating increasing demand for health services in New Zealand (NZ) and internationally. Non-medical prescribing (NMP) is one strategy that has been introduced to help manage this. Little is known about the NMP practice trends in NZ. The aim of this study was to provide a current overview of the scale, scope, and trends of NMP practice in NZ.MethodsAll claims for community dispensed medicines prescribed by a non-medical prescriber were extracted from the NZ Pharmaceutical Collection for the period 2016–2020. Patient demographics were retrieved from the Primary Health Organisation enrolment collection. These national databases contain prescription information for all subsidised community pharmacy medicines dispensed and healthcare enrolment data for 96% of New Zealanders.ResultsThe proportion of prescriptions written by all NMP providers and patients receiving NMP prescriptions increased each year from 1.8% (2016) to 3.6% (2019) and 8.4% (2016) to 14.4% (2019) respectively. From 2016 to 2019, the proportion of NMP patients who had at least one NMP prescription increased from 26% to 39% for nurse prescribers, from 1% to 9% for pharmacist prescribers, from 2% to 3% for dietitian prescribers, and decreased from 47% to 22% for dentists, and from 20% to 12% for midwives. The most commonly prescribed medicines were antibiotics (amoxicillin, amoxicillin with clavulanic acid, and metronidazole), and analgesics (paracetamol, and codeine phosphate). While some NMP providers were prescribing for patients with greater health needs, all NMP providers could be better utilised to reach more of these patients.ConclusionsThis study highlights that although the NMP service has been implemented in NZ, it has yet to become mainstream healthcare practice. This work provides a baseline to evaluate the NMP service moving forward and enable policy development. Improved implementation and integration of primary care NMP services can ensure continued access to prescribing services and medicines for our communities.

Inherited Platelet Disorders: An Updated Overview.

Platelets play a major role in hemostasis as ppwell as in many other physiological and pathological processes. Accordingly, production of about 1011 platelet per day as well as appropriate survival and functions are life essential events. Inherited platelet disorders (IPDs), affecting either platelet count or platelet functions, comprise a heterogenous group of about sixty rare diseases caused by molecular anomalies in many culprit genes. Their clinical relevance is highly variable according to the specific disease and even within the same type, ranging from almost negligible to life-threatening. Mucocutaneous bleeding diathesis (epistaxis, gum bleeding, purpura, menorrhagia), but also multisystemic disorders and/or malignancy comprise the clinical spectrum of IPDs. The early and accurate diagnosis of IPDs and a close patient medical follow-up is of great importance. A genotype–phenotype relationship in many IPDs makes a molecular diagnosis especially relevant to proper clinical management. Genetic diagnosis of IPDs has been greatly facilitated by the introduction of high throughput sequencing (HTS) techniques into mainstream investigation practice in these diseases. However, there are still unsolved ethical concerns on general genetic investigations. Patients should be informed and comprehend the potential implications of their genetic analysis. Unlike the progress in diagnosis, there have been no major advances in the clinical management of IPDs. Educational and preventive measures, few hemostatic drugs, platelet transfusions, thrombopoietin receptor agonists, and in life-threatening IPDs, allogeneic hematopoietic stem cell transplantation are therapeutic possibilities. Gene therapy may be a future option. Regular follow-up by a specialized hematology service with multidisciplinary support especially for syndromic IPDs is mandatory.

Towards Accessible Remote Work

Working from home has become a mainstream work practice in many organizations during the COVID-19 pandemic. While remote work has received much scholarly and public attention over the years, we still know little about how people with disabilities engage in remote work from their homes and what access means in this context. To understand and rethink accessibility in remote work, the present paper studies work-from-home practices of neurodivergent professionals who have Autism Spectrum Disorder, Attention Deficit Hyperactivity Disorder, learning disabilities (e.g., dyslexia) and psychosocial disabilities (e.g., anxiety, depression). We report on interviews with 36 US-based neurodivergent professionals who have been working from home during the pandemic. Our findings reveal that while working from home, neurodivergent professionals create accessible physical and digital workspaces, negotiate accessible communication practices, and reconcile tensions between productivity and wellbeing. Our analysis reconsiders what access means in remote work for neurodivergent professionals and offers practical insights for inclusive work practices and accessibility improvements in remote collaboration tools.

Multivariate analysis of Brillouin imaging data by supervised and unsupervised learning.

Brillouin imaging relies on the reliable extraction of subtle spectral information from hyperspectral datasets. To date, the mainstream practice has been to use line fitting of spectral features to retrieve the average peak shift and linewidth parameters. Good results, however, depend heavily on sufficient signal-to-noise ratio and may not be applicable in complex samples that consist of spectral mixtures. In this work, we thus propose the use of various multivariate algorithms that can be used to perform supervised or unsupervised analysis of the hyperspectral data, with which we explore advanced image analysis applications, namely unmixing, classification and segmentation in a phantom and live cells. The resulting images are shown to provide more contrast and detail, and obtained on a timescale ∼102 faster than fitting. The estimated spectral parameters are consistent with those calculated from pure fitting.

Eupsychian Management: Spirit of the Good in Humanity and Society

Eupsychian management was Abraham Maslow’s term for workplaces of creativity, synergy, and continuous learning. His ideas were crystalized while visiting Non-Linear Systems, founded by Andrew Kay. Eupsychian management, a phrase congruent yet distinct from utopian concepts, specifically referred to environments designed for improving the self-fulfillment and psychological health of all its members. Maslow astutely observed that the characteristics of such environments were its general atmosphere for creative pursuit rather than a specific policy or practice. With retrospective hindsight, Maslow’s managerial ideas, once visionary in nature, have been largely integrated into mainstream management theory and practice. However, his desire for less competitive, controlling, and hierarchical workplaces has been frustrated by ever-increasing global competition, fragmentation, and pressure for cost-efficiencies. The lasting impact of Eupsychian ideals may lie in its humanistic clarity. Human beings long for meaning, purpose, and contribution to a more just and regenerative world. The workplace cannot succeed as an island of psychological health separate from broader efforts to bring forth social justice and environmental renewal.

Exploring cultural values in conflict management: a qualitative study of university heads of departments

PurposeIn seeking to understand the impact of culture on conflict management (CM), extant organisational management research has, for the most part, confined itself to using the one-dimensional collectivism/individualism model of Hofstede's cultural theory. The purpose of this present study is to extend this knowledge area by adopting the more comprehensive analysis of Hofstede's fourfold dimensional typology – power distance, individualism/collectivism, uncertainty avoidance and masculinity/femininity – as a conceptual lens to investigate how national culture impacts the interpersonal CM of those in leadership positions in higher education institutions. Specifically, this article explores the extent to which cultural values influence the CM practices of university heads of departments (HODs).Design/methodology/approachAdopting a qualitative approach, 36 interviews were conducted with heads of different departments across a variety of disciplines in selected Nigerian universities.FindingsThe study's results conceptualise how underlying cultural norms – promoting paternalism, servility and social relations – influence the conflict-handling strategies adopted by university HODs. It consequently emerged from the thematic analysis that in Nigeria, conflict-handling decisions are shaped by status-based dictates, a normative emphasis on communality, masculine hegemony and religious motivation – as opposed to Western cultures, where these benevolent and integrative values play a far smaller role.Research limitations/implicationsThe study focussed on a small group of research subjects. Although the sample is not a sample that enables generalisation, the findings provide theoretical insights into how cultural ascendancy could frame conflict resolutions. This research is especially relevant as it runs in a culture significantly different from the ones that originally were investigated and in which managerial books and mainstream practices emerged and, thus, can contribute to challenge and enhance theory.Originality/valueThe study seeks to advance knowledge of the interface between culture and CM in a sub-Saharan African context where literature is scarce.

Being a feral occupational therapist

ABSTRACT This case study explores the background and practice of a feral occupational therapist working in community mental health. The concept of feral occupational therapist is explained and the socio-economic and political climate of feral practice is described and considered. The practice began when unmet occupational and mental health needs in the community were identified and the opportunity for slow rehabilitation was found possible. The feral occupational therapist role, which is outside the restrictions of targets and time limits set by others, allows creativity in thinking drawn from the deep philosophy of occupational therapy, perhaps in some ways now lost in contemporary, mainstream practice.

Should intramuscular clozapine be adopted into mainstream clinical practice?

Clozapine is under-used in the UK, and Casetta et al's recent paper in the BJPsych adds to a growing number of small studies that support the use of intramuscular clozapine to initiate and maintain treatment with oral clozapine. However, intramuscular clozapine remains unlicensed and, because of the risks associated with its administration, it should be used only cautiously before it can be adopted more widely into mainstream clinical practice.

Towards a definition of anti-oppressive dietetic practice in Canada

Increasingly, dietitians have found ourselves working with racialized clients, communities, and colleagues across the health and food systems in Canada. We are often asked to treat the adverse health outcomes of Black, Indigenous, and racialized communities resulting from these oppressions at the individual level. However, it is the role of dietitians to engage in efforts to "reduce health inequities and protect human rights; promote fairness and equitable treatment" (College of Dietitians of Ontario, 2019). An anti-oppression approach is required for dietitians to understand how their power and privilege shape the dietitian-client relationship. The purpose of this commentary is to propose a shift from cultural competence or diversity and inclusion in dietetics to an explicit intention of anti-oppressive dietetic practice. We begin our exploration from the Canadian context. We draw from our background working in health equity in public health, and our experiences facilitating equity training using anti-oppression approaches with dietetic learners and other public health practitioners. In creating a working definition of anti-oppressive dietetic practice, we conducted a scan of anti-oppression statements by health and social services organizations in Ontario, Canada, and literature from critical dietetics. A literature search revealed anti-oppressive practice frameworks in nursing and social work. However, this language is lacking in mainstream dietetic practice, with anti-oppression only discussed within the literature on critical dietetics and social justice. We propose that "dietitians can engage in anti-oppressive practice by providing food and nutrition care/planning/service to clients while simultaneously seeking to transform health and social systems towards social justice."

Brain MRI Intelligent Diagnostic Using an Improved Deep Convolutional Neural Network

The diagnosis of brain diseases based on magnetic resonance imaging (MRI) is a mainstream practice. In the course of practical treatment, medical personnel observe and analyze the changes in the size, position, and shape of various brain tissues in the brain MRI image, thereby judging whether the brain tissue has been diseased, and formulating the corresponding medical plan. The conclusion drawn after observing the image will be influenced by the subjective experience of the experts and is not objective. Therefore, it has become necessary to try to avoid subjective factors interfering with the diagnosis. This paper proposes an intelligent diagnosis model based on improved deep convolutional neural network (IDCNN). This model introduces integrated support vector machine (SVM) into IDCNN. During image segmentation, if IDCNN has problems such as irrational layer settings, too many parameters, etc., it will make its segmentation accuracy low. This study made a slight adjustment to the structure of IDCNN. First, adjust the number of convolution layers and down-sampling layers in the DCNN network structure, adjust the network’s activation function, and optimize the parameters to improve IDCNN’s non-linear expression ability. Then, use the integrated SVM classifier to replace the original Softmax classifier in IDCNN to improve its classification ability. The simulation experiment results tell that compared with the model before improvement and other classic classifiers, IDCNN improves segmentation results and promote the intelligent diagnosis of brain tissue.

Examination of Korean immigrant mothers' parenting practices: By using the framework of bilinear acculturation.

By using the conceptual framework of bilinear acculturation, this study examined Korean immigrant mothers' parenting practices among 389 mother-youth (adolescent children in middle or high school) dyads. We examined (a) how mothers' acculturation and enculturation were related to mainstream (i.e., authoritarian vs. authoritative styles, communication, warmth/bonding, autonomy support) versus culture specific parenting practices (i.e., interdependence, commitment to education, academic control) and (b) how parenting practices were, in turn, linked to youth outcomes of depression, antisocial behaviors, and academic performance as measured 1.5 years later. Mothers and youth had significant perceptual gaps in parenting practices, especially in autonomy support and parental commitment to education. Therefore, path analyses were conducted separately for mother-reported versus youth-reported parenting. As hypothesized, mothers' acculturation was more closely related to mainstream parenting, while enculturation was to culture specific parenting. Mother-reported autonomy support predicted higher academic performance, while youth-reported authoritarian parenting predicted lower academic performance. Youth-reported communication predicted lower depression and antisocial behaviors. The current findings have implications for parenting and family interventions to optimize Korean immigrant youth's wellbeing in the bicultural context. Additionally, bilinear acculturation was found to be a useful conceptual framework in studying immigrant parenting.

Student experiences of democratic education and the implications for social justice

Using data from a case-study school as a springboard, this article explores how enactments of democratic education might both problematise and illuminate new possibilities for the way we conceptualise social justice in education. Nancy Fraser’s tripartite framework of social justice is used to analyse in-depth interviews with students aged 14–16 from a democratic school in the United Kingdom. The article makes two key arguments: first, it highlights the interdependence of ‘recognition’ and ‘representation’ and, consequently, calls on mainstream policy and practice to make a substantive commitment to participatory democracy as part of the ‘inclusive education’ agenda. Second, it points to the tensions between ‘redistributive’ justice and other social justice aims which may be particularly stark in democratic education (and other progressive education) spaces. The article suggests that a strengthened relationship between democratic schools and research communities would offer a crucial contribution to collective critical reflection on social justice in education.

Comparing perceptions of a dimmable LED lighting system between a real space and a virtual reality display

Over the last several decades, designers have used digital screens to view images of real and simulated spaces and make critical design decisions. Screen technology has improved during this time, as technologies like OLED have replaced legacy displays (CRT, plasma, and LCD). These new screens provide a higher pixel resolution, luminous output and contrast ratio. Immersive head-mounted displays now allow designers to view immersive images, and recent developments in real-time rendering have encouraged the uptake of virtual reality (VR) head-mounted displays in mainstream practice and design education. This paper presents an experiment on lighting perception using a series of LED lighting conditions in a real space and a virtual representation of those conditions captured using a 360° high-dynamic-range camera and presented on an HTC Vive Pro HMD. Fifty-three participants were asked to rate each lighting condition by viewing it in a real space (n = 30) or via immersive HDR photographs displayed in a VR HMD (n = 23). The results show that ratings of visual comfort, pleasantness, evenness, contrast and glare are similar between the HTC Vive Pro HMD and our real space when evaluating well-lit scenes, but significant differences emerge in dim and highly contrasted scenes for a number of rating scales.

Machine Learning in Arrhythmia and Electrophysiology.

Machine learning (ML), a branch of artificial intelligence, where machines learn from big data, is at the crest of a technological wave of change sweeping society. Cardiovascular medicine is at the forefront of many ML applications, and there is a significant effort to bring them into mainstream clinical practice. In the field of cardiac electrophysiology, ML applications have also seen a rapid growth and popularity, particularly the use of ML in the automatic interpretation of ECGs, which has been extensively covered in the literature. Much lesser known are the other aspects of ML application in cardiac electrophysiology and arrhythmias, such as those in basic science research on arrhythmia mechanisms, both experimental and computational; in the development of better techniques for mapping of cardiac electrical function; and in translational research related to arrhythmia management. In the current review, we examine comprehensively such ML applications as they match the scope of this journal. The current review is organized in 3 parts. The first provides an overview of general ML principles and methodologies that will afford readers of the necessary information on the subject, serving as the foundation for inviting further ML applications in arrhythmia research. The basic information we provide can serve as a guide on how one might design and conduct an ML study. The second part is a review of arrhythmia and electrophysiology studies in which ML has been utilized, highlighting the broad potential of ML approaches. For each subject, we outline comprehensively the general topics, while reviewing some of the research advances utilizing ML under the subject. Finally, we discuss the main challenges and the perspectives for ML-driven cardiac electrophysiology and arrhythmia research.

Human Genetic Research in Pakistan: Challenges and Way forward

The 90s ushered in the era of molecular genetics in Pakistan. Our centuries’ old tradition of consanguineous marriages, resulting in the availability of large, inbred families with inherited disorders, proved to be a goldmine for geneticists, working to discover new genes and their functions. A multitude of novel genes with previously unknown functions were discovered through genetic linkage analysis, a technique that compares the segregations of DNA markers in normal and affected family members to pinpoint the region that contains the suspect gene. The first few landmark publications on linkage analysis in genetic diseases, from Pakistan, identified only the regions harboring the suspected disease genes.1,2 As the field advanced, disease causing mutations segregating in affected family members were identified through Sanger DNA sequencing of candidate genes in the linked region. In the last decade, the advent of high throughput techniques such as whole exome analysis and animal disease modeling, functional genomics studies became an integral of part of such genetic studies. In addition, bioinformatics tools were developed for predictive modeling of the effect of mutations on protein structure.
 The analysis of a single large multigenerational family with a genetic disorder could provide the same information that would be obtained from many small nuclear families, as usually found in developed countries. This allowed Pakistani researchers to attract collaborators from Universities around the world. DNA samples of numerous Pakistani families were sent to labs across the world for analysis, many times accompanied by a PhD student who would typically spend around six months working on those families. Universities developed efficient pipelines, whereby students would find families with genetic diseases, extract DNA and carry out linkage analysis and, in some cases, identify the gene mutations using Sanger sequencing. This led to a significant increase in the number of publications on genetics, from Pakistan. However, despite all the good work carried in the country, no credible effort had been made to build national capacity to carry the work beyond initial mutation screening.
 We lack the ability to conduct good quality high through put –omics analysis and animal model studies within the country. There are several reasons for this. Firstly, the cost of such research is prohibitive. While some institutes have invested in next generation sequencing platforms, these machines are largely underutilized due to high cost of consumables. Lack of adequate funding for reagents, required for genomic, transcriptomic and proteomic studies, is a major roadblock. Secondly, the ease in attracting foreign collaborators to carry out the functional studies in their labs, has made many Pakistani researchers complacent, often, they are happy to be co-authors in research papers without having to go through the pains to set up the required laboratory facilities. Lastly, the bureaucratic processes and red tape, especially in public sector Universities, make procurement of chemicals and consumables, tedious and time consuming, resulting in demotivation of researchers and faculty. There is a need to address these issues, if we wish to move towards self-sufficiency in conducting high level functional genomics and stem the flow of biological samples from Pakistan. 
 While genetic studies in Pakistan have resulted in the discovery of many novel genes, the benefit of these studies is yet to trickle down to the patients. The willingness of the affected families to participate in these studies is crucial. Many affected families belong to far flung rural areas and have no understanding of their disease, how it is inherited or the implications of participating in such research. It is unlikely that families participating in these studies have any immediate benefits and they should be informed at the time of recruitment using common language which they are able to understand. The role of Institutional Ethics and Review Boards, for the protection of study participants and their rights, needs to be strengthened. It is important not to abandon these families after sample collection but to relay the results of the study and counsel them regarding their future options.
 Despite the rapid advances in genetic medical knowledge, our population has yet to reap its benefits. A small step in right direction is the Compulsory Blood Test of the Relatives of Thalassemia Patient Bill-2017, which makes it compulsory for couples to get tested before marrying. However, the scarcity of gene testing facilities and healthcare professionals trained in clinical genetics is an impediment to the implementation of this bill in the true spirit. It is becoming imperative to educate our healthcare professionals regarding the application of genetics to medical practice. Clinical genetics and its related competencies need to be recognized as medical specialties in the country, before they can be introduced into mainstream clinical practice to improve health outcomes of our affected families.

Clinical challenges in interpreting multiple pathogenic mutations in single patients

BackgroundIn the past two decades, genetic testing for cancer risk assessment has entered mainstream clinical practice due to the availability of low-cost panels of multiple cancer-associated genes. However, the clinical value of multiple-gene panels for cancer susceptibility is not well established, especially in cases where panel testing identifies more than one pathogenic variant. The risk for specific malignancies as a result of a mutated gene is complex and likely influenced by superimposed modifier variants and/or environmental effects. Recent data suggests that the combination of multiple pathogenic variants may be fewer than reported by chance, suggesting that some mutation combinations may be detrimental. Management of patients with “incidentally” discovered mutations can be particularly challenging, especially when established guidelines call for radical procedures (e.g. total gastrectomy in CDH1) in patients and families without a classic clinical history concerning for that cancer predisposition syndrome.Case presentationWe present two cases, one of an individual and one of a family, with multiple pathogenic mutations detected by multi-gene panel testing to highlight challenges practitioners face in counseling patients about pathogenic variants and determining preventive and therapeutic interventions.ConclusionsOngoing investigation is needed to improve our understanding of inherited susceptibility to disease in general and cancer predisposition syndromes, as this information has the potential to lead to the development of more precise and patient-specific counseling and surveillance strategies. The real-world adoption of new or improved technologies into clinical practice frequently requires medical decision-making in the absence of established understanding of gene-gene interactions. In the meantime, practitioners must be prepared to apply a rationale based on currently available knowledge to clinical decision-making. Current practice is evolving to rely heavily on clinical concordance with personal and family history in making specific therapeutic decisions.

Fragility functions for reinforced concrete columns incorporating recycled aggregates

Using recycled aggregates in the production of structural members is a relatively new application that has the potential to become a mainstream practice with effective green policies. Therefore, performance-based seismic assessment of structures constructed using recycled aggregates gains importance. Fragility curves, cumulative distribution functions that represent the probability of being in or exceeding a threshold for a selected engineering demand parameter, can be used in risk evaluation of these structures.In this study, fragility functions are generated by compiling the data of reinforced concrete columns incorporating recycled concrete aggregate available in the literature. The data is first evaluated through physical damage states, and three different damage states, namely Damage State 1, Damage State 2 and Damage State 3, are defined. Each damage state is then mapped to a certain repair category (cosmetic repair, structural repair or structural enhancement) so that damage can be defined in terms of economic loss, which would provide a road map in the disaster management decision making process. Drift ratio is selected as the engineering demand parameter since generally displacement demand is taken into account in the evaluation of seismic performance of structures. Based on the results of the statistical analysis, the median drift ratio values of 0.30%, 1.21%, and 3.25%, and logarithmic standard deviations of 0.95, 0.42, and 0.45 are determined for Damage State 1, Damage State 2, and Damage State 3, respectively, for columns incorporating recycled concrete aggregates. Furthermore, the effect of parameters on the relationship between drift demand and damage is investigated. In addition, seismic performances of the columns are discussed in terms of their ductility capacity. It is also shown that the ductility limit defined according to Paulay and Priestley (1992), and UBC (1997) for the reinforced concrete columns made of natural aggregate concrete is valid also for the columns made of recycled aggregate concrete.Besides, fragility functions are also generated for columns made of natural aggregate concrete in order to compare damage progression in columns made of recycled aggregate concrete with the aim of identifying the variability in drift demand. From the comparison of the fragility curves of these columns, it is found that at the same drift ratio, damage exceedance probabilities of both column types are similar for Damage State 1 and Damage State 2. However, for Damage State 3, at the same drift ratio, the damage exceedance probability of columns incorporating recycled concrete aggregates is higher than that of the columns made of natural aggregate concrete owing to relatively lower lateral load capacity of these columns.

A System Innovation Perspective on the Potential for Scaling Up New Psychological Interventions for Refugees

In recent years, a range of brief protocolised psychological interventions like Problem Management Plus have been developed. Such “scalable psychological interventions” are meant to be delivered by nonspecialists which can greatly increase access to psychological therapies for people affected by adversity, including forced displacement. However, embedding new interventions into mainstream practices is challenging. Novel interventions can remain in the research phase for a long time or stop altogether, which minimises their intended impact and reach. In this conceptual paper we propose a “system innovation perspective” on scaling up new psychological interventions for refugees and argue that existing mental health systems often need to change to integrate new interventions in a sustainable way. We present a conceptual framework, which includes ideas on cycles of deepening (learning by doing), broadening (repeating and linking), and scaling up (embedding) and the multilevel and constellation perspective. This framework has been operationalised in our scalability research as part of the STRENGTHS study in which we increase our understanding of the opportunities for scaling up four new psychological interventions in eight countries hosting Syrian refugees, including in Europe (Germany, Netherlands, Sweden and Switzerland) and the Middle East (Egypt, Jordan, Turkey and Lebanon). Key implications for practice Researchers and practitioners involved in implementing and evaluating scalable psychological interventions such as Problem Management Plus should consider the inclusion of scalability assessments to increase understanding about the potential for integrating such innovations into mainstream services. A system innovation perspective views scaling up as the integration of an innovation into mainstream practices and suggests that mental health systems commonly need to change in order to effectively adopt new interventions, allowing them to reach their desired impact at scale and in a sustainable way. An improved understanding of the scalability of novel psychological interventions, including the potential (systemic) barriers and facilitators for scaling up, will provide essential knowledge for those involved in decision-making, implementation and evaluation of the further scale up of such interventions.