Multi-level Collaboration Research Articles

Collaborative place-based health governance systems: stakeholders' perceptions in the Portuguese Baixo Vouga sub-region.

This study aimed to assess the Baixo Vouga sub-region (Portugal) governance system through 15 interviews with leaders of institutions with decision-making power and provide healthcare. The interviews were subjected to a content analysis, organized in matrices by cases, categories, subcategories, and indicators. Recording units were extracted from the interviews to produce data for each indicator. A Collaborative Place-based Governance Framework systematizing operational definitions of collaborative governance was implemented to serve as a benchmark for assessing the collaborative and place-based dimensions. The Baixo Vouga sub-Region governance system is collaborative because it is based on a shared structure of principles that translates into the services provided. It has a multilevel and multisector collaboration, and can undertake shared decisions. These dimensions could be reinforced through increased participation, autonomy, subsidiarity if more place-based information and practical knowledge were sought. The system would also benefit from an extensive adoption of bottom-up methods to formulate and implement policies.

Sustaining collaborative software development through strategic consortium

In recent years, consortium-based open source software (COSS) development has emerged as a strategic alternative to resource-intensive in-house development and misaligned commercial software acquisition. Yet consortia undertaking such collaborative efforts struggle to balance the oft-competing demands of innovation and sustainability. Drawing upon a longitudinal case study of the Kuali initiative, this analysis examines the mechanisms of exploration and exploitation involved in developing and sustaining a COSS approach. Based on our findings in the Kuali case, we develop a conceptual framework to discern whether and how COSS development initiatives can achieve contextual ambidexterity, balancing the strategic goals of innovation and sustainability over time. While exploration- and exploitation-oriented efforts compete for resources, our analysis reveals that they may also complement one another across distinct layers of institutional activity. The contextual ambidexterity is achieved through multi-level collaboration enabled by a modular technical and organizational design.

Operationalising One Health in Nigeria: Reflections From a High-Level Expert Panel Discussion Commemorating the 2020 World Antibiotics Awareness Week.

Antimicrobial resistance (AMR) poses an important One Health challenge for all countries of the world. As human, animal and environmental health are closely linked, it is essential that interventions targeted at reducing the spread of AMR and those promoting antimicrobial stewardship are conducted with all sectors in mind. Tackling this global slow-moving pandemic (AMR) also requires action and strong commitment from all countries of the world. Nigeria, like many other countries, have made considerable progress in implementing the National Action Plan on Antimicrobial Resistance. The accomplishments and ongoing work led by the National Technical Working Group on AMR is commendable. However, gaps still exist in terms of operationalising One Health interventions for AMR, especially regarding rational antimicrobial use and antimicrobial stewardship. The 2020 World Antimicrobial Awareness Week presented an opportunity to convene a multi-sectoral expert panel from national government agencies, research, academia and the World Health Organisation across the Nigerian One Health space. The panel discussion analysed the progress made so far and identified the barriers and the opportunities for operationalising One Health interventions on AMR. The discussion highlighted poor awareness and the fear phenomenon, driven by technical and socio-economic factors, as a common cross-sectoral denominator at the heart of inappropriate antibiotic use within the country. At the system level, suboptimal use of antimicrobials fuelled by the ease of purchase, poor regulations and insufficient enforcement of prescription-only access to antimicrobials, and limited infection prevention and biosecurity measures resonated as drivers of AMR across One Health sectors in Nigeria. Looking forward, the panel discussion identified substantial investment in the governance of the existing One Health component structures, inclusive bottom-up institutional antimicrobial stewardship that fosters community participation and multi-level cross-sectoral collaborations as the next level strategic imperatives. In this respect is the need for a strengthened One Health infrastructure, including an operational workforce, educational strategies to elevate AMR and rational antimicrobial use into public consciousness, and the use of improved data systems as countermeasures to the challenge of AMR.

A simulation-based optimization model for watershed multi-scale irrigation water use with considering impacts of climate changes

It is attractive and advantageous to realize process-based optimization of irrigation water use on large scales. In this study, a simulation-based regional irrigation water optimization model (SRIOP) was developed for watershed-scale optimal spatial allocation based on dynamic responses of agro-hydrological process and its spatial differences. The SRIOP model tightly linked a field-scale agro-hydrological model (SWAP-EPIC) with an optimization algorithm (NSGA-II) in a regional multi-level optimization framework. It performed at three levels that sequentially dealt with optimal irrigation water allocation on field, irrigation district and irrigated watershed scales, with two objectives of maximizing yield/benefit and minimizing irrigation water. The model was tested with a case study in the major irrigation system (MIS) of middle reaches of the Heihe River basin, northwest China. The optimal spatial distribution of irrigation water showed a decreased variation coefficient (0.17) and increased irrigation benefit (9.8% higher) as compared with that of the present year, and better reflected the effects of multi-level collaboration and crop-soil field distribution. The impacts of climate condition changes on optimized results and resulting uncertainty were also quantified and evaluated through optimizations in different climate years. The case study indicated that the model is a computationally efficient and feasible approach for process-based optimization on large scales with considering impacts of climate condition changes.

Transitioning to co-management in Caribbean reef fisheries: Tela Bay case study

Caribbean fisheries are characterized by their heterogeneous socio-ecological conditions. Paradoxically, they are generally managed through a top-down, government centered, one-size fits all approach. Here, we assessed the governance and socioeconomic context of a Caribbean reef fishery (Tela Bay, Honduras), to disentangle the main challenges and opportunities faced during the transition to fisheries co-management. Similar to the rest of the region, Tela Bay communities depend on reef fisheries for their livelihoods and food security but they turned to co-management as a means to achieve a sustainable fishery. We identified four main challenges for the successful implementation of co-management, these were: (1) weak institutions, (2) financial constraints, (3) reduced group cohesion due to the high heterogeneity among stakeholders and (4) lack of formal legal agreements to legitimize co-management arrangements. Despite these challenges, the Tela Bay communities were able to successfully implement co-management, due to 2 key aspects: (1) bridging organizations that fostered multilevel collaboration, promoted participation, strengthened organizations, generated financial support and improved accountability and (2) social capital, reflected through community participation, cooperation, trust and conflict resolution mechanisms. The Tela Bay case study has contributed to sustainability science by demonstrating that the conceptualization of co-management differs according to the socioeconomic context of the fishery. In its early implementation in Caribbean fisheries, co-management should be viewed as institution building and governance. Thus, successful case studies must continue to be monitored to scale-up these efforts in the region.

Digitalisation Labs: A New Arena for Policy Design in German Multilevel Governance

The federal system has long been seen as one of the biggest obstacles to the digital transformation of the German state. With the enactment of the Online Access Act (OZG), a law that obliges all federal levels to offer their administrative services digitally in a joint portal network by the end of 2022, a new arena for multilevel collaboration has developed in Germany; the so-called digitalisation labs. The labs are intended to bring together representatives of all federal levels, external actors and citizens to promote problem-oriented policy design and the development of innovative policy solutions. Following a neo-institutionalist perspective and using the analytical concepts of multilevel governance and problem-solving, this paper investigates how the institutional settings, internal dynamics and actors’ composition influence policy design processes in the labs. The empirical analysis is built on a qualitative case study of two digitalisation labs in the policy field ‘Immigration and Emigration', and based on ten expert interviews as well as an extensive document analysis. The paper concludes that, by promoting problem-solving, the institutional settings as well as the organisational design and actors’ constellations have influenced the policy design process in several ways.

Starting and Operating a Public Cardiac Catheterization Laboratory in a Low Resource Setting: The Eight-Year Story of the Uganda Heart Institute Catheter Laboratory

Background:Low- and-middle-income-countries (LMICs) currently bear 80% of the world’s cardiovascular disease (CVD) mortality burden. The same countries are underequipped to handle the disease burden due to critical shortage of resources. Functional cardiac catheterization laboratories (cath labs) are central in the diagnosis and management of CVDs. Yet, most LMICs, including Uganda, fall remarkably below the minimum recommended standards of cath lab:population ratio due to a host of factors including the start-up and recurring costs.Objectives:To review the performance, challenges and solutions employed, lessons learned, and projections for the future for a single cath lab that has been serving the Ugandan population of 40 million people in the past eight years.Methods:A retrospective review of the Uganda Heart Institute cath lab clinical database from 15 February 2012 to 31 December 2019 was performed.Results:In the initial two years, this cath lab was dependent on skills transfer camps by visiting expert teams, but currently, Ugandan resident specialists independently operate this lab. 3,542 adult and pediatric procedures were conducted in 8 years, including coronary angiograms and percutaneous coronary interventions, device implantations, valvuloplasties, and cardiac defect closures, among others. There was a consistent expansion of the spectrum of procedures conducted in this cath lab each year. The initial lack of technical expertise and sourcing for equipment, as well as the continual need for sundries present(ed) major roadblocks. Government support and leveraging existing multi-level collaborations has provided a platform for several solutions. Sustainability of cath lab services remains a significant challenge especially in relation to the high cost of sundries and other consumables amidst a limited budget.Conclusion:A practical example of how centers in LMIC can set up and sustain a public cardiac catheterization laboratory is presented. Government support, research, and training collaborations, if present, become invaluable leverage opportunities.

Rethinking Second-Line Therapy for Overactive Bladder to Improve Patient Access to Treatment Options.

Idiopathic overactive bladder (OAB) is a chronic condition that negatively affects quality of life, and oral medications are an important component of the OAB treatment algorithm. Recent literature has shown that anticholinergics, the most commonly prescribed oral medication for the treatment of OAB, are associated with cognitive side effects including dementia. β3-adrenoceptor agonists, the only alternative oral treatment for OAB, are similar in efficacy to anticholinergics with a more favorable side effect profile without the same cognitive effects. However, there are marked cost variations and barriers to access for OAB medications, resulting in expensive copays and medication trial requirements that ultimately limit access to β3-adrenoceptor agonists and more advanced procedural therapies. This contributes to and perpetuates health care inequality by burdening the patients with the least resources with a greater risk of dementia. When prescribing these medications, health care professionals are caught in a delicate balancing act between cost and patient safety. Through multilevel collaboration, we can help disrupt health care inequalities and provide better care for patients with OAB.

Imagining the Future of Learning in Healthcare: The GAME 2019 #FuturistForum

ABSTRACT The GAME 2019 #FuturistForum involved an exchange of ideas and perspectives on the future of learning in healthcare and necessary evolutions to sustain future health systems. This event allowed for reflection and discourse around a) what medical learning or learning in healthcare may look like 10–15 years from now, b) how technology would impact that evolution, and c) what collaborative roles distinct stakeholders would play. Seventy-five (75) key stakeholders, experts from various fields, participated in the two-day event. Four multifaceted themes were uncovered from the qualitative analysis, which are: learning will be lifelong and outcome-based, the health system will follow a preventive care model, technology will be an enabler of evolution in education and health systems, and that multi-level collaboration will support and sustain future progress. Future implications, exacerbated by the ongoing COVID-19 pandemic, and study limitations are described.

“I teach it because it is the biggest threat to health”: Integrating sustainable healthcare into health professions education

Background Steering planetary and human health towards a more sustainable future demands educated and prepared health professionals. Aim This research aimed: to explore health professions educators’ sustainable healthcare education (SHE) knowledge, attitudes, self-efficacy and teaching practices across 13 health professions courses in one Australian university. Methods Utilising a sequential mixed-methods design: Phase one (understanding) involved an online survey to ascertain educators’ SHE knowledge, attitudes, self-efficacy and teaching practices to inform phase two (solution generation), ‘Teach Green’ Hackathon. Survey data was descriptively analysed and a gap analysis performed to promote generation of solutions during phase two. Results from the hackathon were thematically analysed to produce five recommendations. Results Regarding SHE, survey data across 13 health professions disciplines (n = 163) identified strong content knowledge (90.8%); however, only (36.9%) reported confidence to ‘explain’ and (44.2%) to ‘inspire’ students. Two thirds of participants (67.5%) reported not knowing how best to teach SHE. Hackathon data revealed three main influencing factors: regulatory, policy and socio-cultural drivers. Conclusions The five actionable recommendations to strengthen interdisciplinary capacity to integrate SHE include: inspire multi-level leadership and collaboration; privilege student voice; develop a SHE curriculum and resources repository; and integrate SHE into course accreditation standards.

Similarities and differences in managing the Covid-19 crisis and climate change risk

Purpose This paper investigates both similarities and differences between two global threats represented by climate change (CC) and Covid-19 (CV). This will help understand the reasons behind the recognition of the CV as a pandemic that requires global efforts, whereas efforts to tackle climate change still lack such urgency. This paper aims to answer to the following questions: What are the elements that make CV restrictions acceptable by both the public and policymakers? and What are the elements that make CC restrictions not acceptable? Design/methodology/approach This paper analyses the situation reports released by the World Health Organisation between the 11th of March (declaration of pandemic) and the 22nd of April, and their associated documents such as the Strategic Preparedness and Response Plan (WHO), the Risk Communication and Community Engagement Action Plan (WHO) and its updated version (WHO) and the Handbook for public health capacity-building (WHO). The analysis ends one week after President Trump’s announcement to suspend US funding to WHO (Fedor and Manson, 2020) and his support to public demonstrations against restrictions. Findings The application of the second stage of the “Crisis and Emergency Risk Communication” model identifies five lessons that can be learned from this comparison. These relate to the necessity to simultaneously warn (about the severity of a threat) and reassure (by suggesting specific courses of action) the public; the need for multilevel collaboration that integrates collective and individual actions; the capacity to present cohesive messages to the public; the risk of politicisation and commodification of the issue that might undermine global efforts to tackle the threat; and the capacity to trigger individual responses through the promotion of self-efficacy. Originality/value This paper identifies both similarities and differences between CC and CV managements to understand why the two threats are perceived and tackled in different ways. The analysis of official documents released by both the World Health Organisation and the Intergovernmental Panel on Climate CV outbreak as a crisis, whereas climate change is still anchored to the status of a future-oriented risk.

Video shot boundary detection based on multi-level features collaboration

Video shot boundary detection (SBD) is a basic work of content-based video retrieval and analysis. Various SBD methods have been proposed; however, there exist limitations in the complexity of boundary detection process. In this paper, a simple yet efficient SBD method is proposed, and the aim here is to speed up the boundary detection and simplify the detection process without loss of detection recall and accuracy. In our proposed model, we mainly use a top-down zoom rule, the image color feature, and local descriptors and combine a kind of motion area extraction algorithm to achieve shot boundary detection. Firstly, we select candidate transition segments via color histogram and the speeded-up robust features. Then, we perform cut transition detection through uneven slice matching, pixel difference, and color histogram. Finally, we perform gradual transition detection by the motion area extraction, scale-invariant feature transform, and even slice matching. The experiment is evaluated on the TRECVid2001 and the TRECVid2007 video datasets, and the experimental results show that our proposed method improves the recall, accuracy, and the detection speed, compared with some other related SBD methods.

How vision and leadership shaped the U.S. National Cancer Institute's 50-year journey to advance the evidence base of cancer control and cancer care delivery research

In 1971, Congress passed the National Cancer Act, landmark legislation that reorganized the National Institutes of Health's National Cancer Institute (NCI). The Act included a new focus on cancer control, including the requirement that the NCI award research grants and contracts, in collaboration with other public agencies and private industry, to conduct cancer control activities related to the diagnosis, prevention, and treatment of cancer. The requirement placed the NCI at the nexus of a rapidly changing science and a complex and dynamic healthcare delivery system and involved an evolutionary transformation to advance cancer control and cancer care delivery research along the cancer care continuum. Analysis is based on a qualitative ethnographic approach using historical records, oral histories, and targeted interviews. The multimethod approach provided the opportunity to describe the vision, leadership, and struggle to build an infrastructure, expand expertise, and forge collaboration with the NCI and a complex and changing healthcare system. As the 50th anniversary of the National Cancer Act approaches in 2021, the process and these achievements are at risk of being taken for granted or lost in the flow of history. Documenting the process, milestones, and key players provides insight and guidance for continuing to improve cancer care, advance research, and reduce cancer incidence and mortality. Cancer care is a microcosm of the larger healthcare system providing insight and lessons on the importance of developing and maintaining a research infrastructure and the role of multi-level collaboration and partnerships involving both the private and public sectors.

Adaptive Multilevel Collaborative Passenger Flow Control in Peak Hours for a Subway Line

Due to contradiction of large-scale passenger demand and limited transportation capacity, the passengers who cannot be transported away in time accumulate and congest in stations. To ensure travel safety, improve travel efficiency, and ameliorate waiting environments for passengers, this paper proposes an adaptive multilevel collaborative passenger flow control strategy integrating the control of station entrance and station hall. An integer linear programming model is constructed, which aims at minimizing the total passenger waiting time and taking the safe capacity of each key area of all stations as the necessary constraints. The model is applied in two scenarios with different scales of passenger demand in the morning peak of the Batong line. The results show that the proposed model can adaptively activate the appropriate control level, limit the amount of accumulated passengers in each key area of the station within its safe capacity, and shorten the total passenger waiting time.

Optimized Spatiotemporal Data Scheduling Based on Maximum Flow for Multilevel Visualization Tasks

Massive spatiotemporal data scheduling in a cloud environment play a significant role in real-time visualization. Existing methods focus on preloading, prefetching, multithread processing and multilevel cache collaboration, which waste hardware resources and cannot fully meet the different scheduling requirements of diversified tasks. This paper proposes an optimized spatiotemporal data scheduling method based on maximum flow for multilevel visualization tasks. First, the spatiotemporal data scheduling framework is designed based on the analysis of three levels of visualization tasks. Second, the maximum flow model is introduced to construct the spatiotemporal data scheduling topological network, and the calculation algorithm of the maximum data flow is presented in detail. Third, according to the change in the data access hotspot, the adaptive caching algorithm and maximum flow model parameter switching strategy are devised to achieve task-driven spatiotemporal data optimization scheduling. Compared with two typical methods of first come first serve (FCFS) and priority scheduling algorithm (PSA) by simulating visualization tasks at three levels, the proposed maximum flow scheduling (MFS) method has been proven to be more flexible and efficient in adjusting each spatiotemporal data flow type as needed, and the method realizes spatiotemporal data flow global optimization under limited hardware resources in the cloud environment.

Child psychiatry in China: Present situation and future prospects.

Child psychiatry in China: Present situation and future prospects.

Country ownership of adaptation: Stakeholder influence or government control?

Adaptation to climate change needs to reflect local level priorities. Principles for country ownership of adaptation within the UNFCCC emphasise on intra-state multi-stakeholder engagement. Multilaterally-funded projects therefore embed multi-level stakeholder collaborations (MSCs) into their approaches. MSCs enable integration of diverse stakeholder voices into adaptation decision making. This supports equitable adaptation, as these stakeholders can highlight local level vulnerabilities and addresses adaptation needs. This paper uses a case study of a project in Tanzania administered by the Global Environment Facility (GEF) to understand whether multi-stakeholder engagement in MSCs enables intra-state stakeholder influence in adaptation decision making. Social exchange theory is used to understand power and influence in MSC decision-making. Influence is framed as a factor of resources exchanged, organisational and institutional structures, and rules determining stakeholder engagement. Results from interviews with adaptation stakeholders (n=47) show that most stakeholders perceived government's control of adaptation finance as a country ownership principle acting as enabling disproportionate government influence and exclusion of other stakeholders from adaptation decision making. The project's national level structures and the international level country ownership requirements limited the engagement of non-government and local actors in project design. These findings suggest that in seeking to implement projects that reflect country ownership principles, multilateral finance mechanisms may be reproducing injustices by creating structures that reinforce marginalization and exclusion of local level communities. The research recommends a re-evaluation of approaches for achieving country ownership, e.g. through identification of practical options for direct engagement with non-government and local level actors.

The city that the metro system built: Urban transformations and modalities of integrated planning in Stockholm

This paper investigates how housing and public transport planning in Stockholm has been integrated during the past 20 years through multi-level collaboration. Drawing upon how Stockholm has been portrayed in the literature on transit-oriented development (TOD), that is, as a successful case of integrated land use, housing and public transport planning, this paper suggests that multi-level collaboration in Stockholm’s urban transformations has had its own challenges related to de-integration and reintegration. By including an exploration of the development of the metro system since the 1960s and onwards, the more recent processes of de-integration and reintegration emerge as endemic but often marginalised aspects of achieving TOD-like urban development. The paper contributes to previous studies by proposing three modalities of integration: (1) de-integration by agreement, (2) integration by collaboration, and (3) reintegration by intervention. These modes are not evaluative but should rather be used as a point of departure for future studies empirically investigating how integrated planning is achieved in contexts where transit-oriented development is contingent on multi-level collaboration.

Making space for birds: Sourcing solutions from the mountain gorilla conservation model in Rwanda

Rwanda being one of the most densely populated countries in Africa, a large proportion of its native vegetation has been converted into agriculture and settlements, leading to the extensive loss and degradation of natural habitats, with significance for birds as well as other taxa. Despite this, tangible success has been attained in the conservation of mountain gorillas thanks to the high priority afforded to this species and the vigorous protection of its habitats. This article reviews the current conservation approaches in Rwanda, and their effectiveness in addressing threats to the country’s avifauna. Drawing lessons from the conservation of the mountain gorilla approach, and with reference to the principles of Systematic Conservation Planning, this paper argues that the creation of more reserves complementing existing protected areas, the development of bird-related tourism, and a multilevel collaboration of stakeholders at national and regional level, in which the public play a strong role, are crucial for the long-term conservation of birds. The aim of this analysis is both to provide policy options for Rwanda and to suggest an approach to conservation practice for wider application that is scalable and transferable within a developing country context.

Environmental citizenship for inclusive sustainable development: the case of Kelab Alami in Mukim Tanjung Kupang, Johor, Malaysia

ABSTRACTUsing environmental citizenship as the basis of its activities and initiatives, a community organisation, Kelab Alami, successfully combined environmental action with a socio-ecological systems approach to counter environmental and social injustice. The organisation fused traditional ecological knowledge with science for use in community-initiated ecotourism; engaged with surrounding developers, local authorities and the state government to mitigate environmental damage and maximize job opportunities for the community; nurtured and supported local entrepreneurship efforts and continues to spread environmental awareness and protection. This paper traces the development of Kelab Alami, the training and empowerment of youthful citizen scientists, and its attempt to garner multi-level support and collaboration for its environmental actions. This is a grounded illustration of resource mobilization in action, and a local view of a community’s efforts to cope with poverty, environmental degradation and urbanization; a model that could be adapted and adopted by other communities facing similar circumstances and threats.