Multiple Agencies Research Articles

One size does not fit all: The value of information and coexistence of rating agencies

AbstractThis study investigates the production of information by multiple rating agencies and the selection of rating agencies when the value of information to buyers is heterogeneous. We argue that firms strategically choose a rating agency based on the value of information. Not only can a rating agency with a finer rating scheme than a dominant agency offer information to the market, but an agency with a coarser scheme can also provide information by serving low‐information‐value users and sellers who could not obtain a rating otherwise. This does not necessarily result in rating shopping. We tested these hypotheses using the U.S. property‐casualty insurance market, examining insurers' rating agency selections among AM Best, Demotech, and S&P. Our results indicate that the value of information to users influences both the design of rating schemes by rating agencies and the selection of rating agencies by firms. The coexistence of multiple rating agencies with different rating schemes suggests their ability to serve heterogeneous information clienteles.

A point-of-care testing strip based on a rationally designed antigen and antibody for fast and reliable Diquat poisoning detection: Ready for clinical application

AbstractDiquat (DQ) is a nonselective quick-acting herbicide, which can directly contaminate humans and the environment during improper use and production. The early diagnosis of DQ poisoning allows for patients to receive timely treatment. Here, a novel monoclonal antibody was screened based on the rational design and synthesis of a DQ hapten and complete antigen. With the custom-designed anti-DQ antibody, we developed a stable and specific immunochromatographic strip to recognize DQ within 10 ∼ 15 min in various biological samples. The test strips could recognize DQ at concentrations as low as 20 ng/mL and be read by the naked eye, reaching the detection level of liquid chromatography-mass spectrometry. Moreover, quantitative methods involving the use of immunochromatographic strips and ELISA were developed to continuously monitor DQ concentrations. DQ and paraquat (PQ) joint test strips were developed to simultaneously measure DQ and PQ. Notably, the clinical performance of the proposed test strips was evaluated in multiple hospitals and public health agencies. Taken together, our study provides the first clinical DQ-targeted colloidal gold immunochromatographic test strips with excellent performance, which are expected to be useful for clinical practice, environmental monitoring, food safety and scientific research.

Functioning in the hot seat: exploring the competencies of police incident commanders

PurposeIncident commanders (ICs) are senior police officials tasked with being the key operational decision-makers and leading a command team during major, critical and public order incidents (e.g. bomb threats, hostage situations and protests). Such events are often characterized by heavy time pressures and little information, requiring a highly skilled, integrated emergency response across multiple agencies and significant police planning, organizing and management. ICs must possess the necessary skills, traits and behaviors to deal with such incidents and their challenges. Therefore, the purpose of this study is to identify the competencies of ICs.Design/methodology/approachWe conducted a thematic analysis of thirty-eight (n = 38) in-depth interviews with police personnel who have professional experience as ICs.FindingsResults provided information on the competencies important for effective incident command, including a range of skills, traits and behaviors these police personnel should exhibit, such as command presence, decision-making, confidence, risk assessment, teamwork, task management, stress management, humility and others.Originality/valueWe provide a novel literature contribution by proposing a framework of police IC competencies and their interrelatedness based on first-hand interviews with experts in the field. Practitioners and policymakers need to know actionable strategies for developing standardized training and assessment curricula for ICs. The next steps are to delineate what skills, traits and behaviors are trainable and need to be selected for at the time of recruitment (e.g. occupational aptitude, personality). We provide the foundation upon which researchers and practitioners can make actionable decisions on moving forward to attain these important goals.

Prediction and policy: Do empirical gross calorific value prediction help reduce coal testing overload?

The gross calorific value (GCV) of coal is pivotal in shaping policies across various sectors of the Indian economy. It plays a crucial role in classification and valuation of coal and is a major factor in determining electricity tariffs charged by thermal power plants. With coal production escalating year-on-year to meet India's increasing electricity demand, there is significant rise in coal testing activities along the pit-to-power supply chain at multiple points and by multiple testing agencies often driven by sector-specific policy requirements. While laboratory testing accurately determines GCV, it is costly and time-consuming due to the reliance on expensive equipment and skilled personnel. Global researchers have previously devised a plethora of empirical formulae predicting GCV based on its correlations with easy-to-measure properties like moisture and ash content. However, the applicability and utility of these formulae to the prevalent policy matrix of coal and power sector remain to be explored. The introduction of independent third-party assessment of coal quality by Coal India Limited in 2016 has generated a vast dataset of coal sample-test results, offering an opportunity to reassess existing empirical formulae, test their alignment with existing policies, and explore possibility of a unified, region-neutral formula for rapid GCV prediction with a special focus on alleviating the current overload in coal testing.

A Study of Administrative Regulations on Real Estate Project Finance and Recent PF Market Issues

Real estate project financing is the process by which real estate developers secure funding. This study categorizes the types of real estate finance and analyzes investment types based on the degree of financial companies’ participation. Financial companies invest in real estate development projects either through direct financing, using PF loans, or through indirect financing via mechanisms such as collective investment schemes. However, if a financial company is not merely a financial investor but also acts directly as a developing entity, appropriate regulation is required. From an investor protection perspective, the Financial Act aims to alleviate information asymmetry and enhance the financial soundness of financial companies. An important issue is the regulation of financial companies directly implementing real estate development projects. In particular, if a real estate development project fails, the implementer bears primary responsibility. Therefore, granting enforcement authority to a financial company that controls the funding mechanism may pose a risk to financial companies. Real estate financing suggests that administrative regulations should be organized in a way that facilitates collaboration among multiple administrative agencies. The regulatory frameworks of both the Construction Act and the Financial Act should govern financial companies’ participation in real estate development projects, necessitating close cooperation among different administrative agencies. In the complex and specialized administrative legislative process, overlapping responsibilities among multiple administrative agencies, such as those under the Real Estate Investment Company Act, may occur; conversely, gaps in responsibilities may also arise. With this in mind, it is necessary to acknowledge the role of financial companies beyond their fundraising function in real estate finance and to investigate the complex and diverse legal relationships that may arise as a result. In particular, given the current situation—marked by the downturn in the real estate PF market that began last year, the subsequent workout of Taeyoung Construction, and concerns about the deterioration of savings banks’ soundness—, it is crucial to explore an effective regulatory system for real estate development finance by integrating the Construction Act and the Financial Act.

Design of a Mixed-Reality Application to Reduce Pediatric Medication Errors in Prehospital Emergency Care

Children in prehospital emergency care are particularly vulnerable to medication errors, often with serious consequences. A prior study analyzing prehospital pediatric medication dosing errors, conducted after the implementation of a statewide pediatric drug-dosing reference for emergency medical services (EMS), identified an alarmingly high error rate. This significant finding led to the current study, which aims to develop technological interventions to reduce the frequency of medication errors for children during treatment by EMS. The current study focuses on the design and development of a safety strategy to automate medication administration using mixed-reality technology. Simulations were conducted to inform the design process, focusing on three scenarios: cardiac arrest, seizure, and burns. The design team included medical and engineering researchers, paramedics, and emergency medical technicians from multiple emergency medical service agencies. Root cause analysis (RCA) and failure mode and effects analysis (FMEA) were conducted after the simulations were completed. The RCA and FMEA were used to identify and prioritize failure points, which were then addressed in a mixed-reality solution using Microsoft HoloLens 2 to automate and enhance pediatric medication administration in prehospital emergency care. The resulting application will provide real-time assistance to guide paramedics through the complicated medication dosing and administration process using a detailed step-by-step guide, aiming to decrease medication errors and improve medication dosing accuracy.

Coordinating a growing data enterprise: strategies for facilitating multiple research-practice relationships for the public good.

It takes time, energy, and goodwill to start a data partnership. The corollary to this truism is that maintaining and expanding such partnerships will demand as much, if not more, of these resources. Learn about the strategies we are using to expand our ability to produce rigorous, policy-relevant evidence to combat poverty and inequality while staying committed to addressing the needs of our long-term partners. Developed by the University of Wisconsin-Madison’s Institute for Research on Poverty (IRP), the Wisconsin Administrative Data Core (WADC) evolved from a series of large-scale evaluation projects conducted for the state starting in the 1980s. This data enterprise, built by linking administrative data from multiple agencies, allows for cross-program analyses that are otherwise impossible. Increased turnover since the pandemic coupled with more formalized data governance structures has highlighted the importance of maintaining good relationships and providing value back to partners who devote scarce bandwidth to sharing data. At the same time, we are adding new agency partners and working to increase usage of the WADC. These changes multiply the complexity involved in coordinating the data enterprise. We are adapting to this new world by focusing on relationships: creating formal structures that deepen the network of direct relationships among agency staff and researchers, taking advantage of increased turnover by hiring staff who have worked in state agencies, and seeking agency partners who want to be active partners versus data providers. More solid relationships will yield more policy-relevant research that agencies can use to better serve the state.

Development of a Enhanced System Review for Public Agency Multi-Sectoral Integrated Data Systems

While traditional security assessments (such as mandated external security reviews which include a penetration test tied to a security framework) are a critical component to securing your data infrastructure, the complexities and governance structures around integrated data systems that involve multiple public sector agencies require a more comprehensive framework to address comprehensive risk, regulatory, and governance considerations that are critical to the confidentiality of the data within these systems. In January of 2024, the Data Integration Support Center (DISC) created and piloted an enhanced system review that includes components that are often overlooked or oversimplified when working with today's technologies such as cloud-based secure enclaves. By following up on a mandated security review, an enhanced system review can help a maturing Integrated Data System (IDS) address both security and privacy risks as it moves forward. An enhanced system review looks primarily, though not necessarily exclusively, at the following aspects of an IDS, principally in the interest of ensuring privacy: IDS alignment with its legal framework and other structuring documents (e.g., policies, procedures, interagency agreements) Training to support privacy and security Use of technology to prevent or mitigate human error The results of the review are provided directly to the IDS leadership and generally include a list of recommendations in the areas of improved legal agreements, leveraging privacy enhancing technologies to mitigate or reduce errors, procedural/policy gap identification and/or architectural recommendations to improve the security.

ESG uncertainty, investor attention and stock price crash risk in China: evidence from PVAR model analysis

ESG uncertainty refers to the discrepancies in ratings by multiple third-party ESG rating agencies, challenging investors in assessing a company’s true ESG status. This study integrates ESG rating data from six major Chinese agencies to construct an ESG Uncertainty Index. Using a PVAR model, it explores the bidirectional relationships among ESG uncertainty, investor attention, and stock price crash risk in the Chinese capital market. The findings reveal no direct causal relationship between ESG uncertainty and stock price crash risk. However, there is a bidirectional Granger causality between ESG uncertainty and investor attention, as well as between stock price crash risk and investor attention. This suggests that increased ESG uncertainty and stock price crash risk attract more investor attention, which in turn amplifies these issues. The study implies that investor attention mediates the relationship between ESG uncertainty and stock price crash risk, indirectly affecting the latter. These findings highlight the importance of enhancing information disclosure regarding ESG factors to improve market transparency and stability.

Anti-Ceramide ScFv Prophylaxis for First Responders to a Limited Nuclear Attack.

After 9/11, multiple government agencies instituted programs aimed at developing medical radiation countermeasures (MRCs) for two syndromes lethal within weeks of a limited nuclear attack; the hematopoietic-acute radiation syndrome (H-ARS) and the higher-dose gastrointestinal-acute radiation syndrome (GI-ARS). While re-purposing drugs that enhance marrow repopulation treats H-ARS, no mitigator protects GI tract. We recently reported anti-ceramide 6B5 single-chain variable fragment (scFv) pre-treatment abrogates ongoing small intestinal endothelial apoptosis to rescue Lgr5+ stem cells, preventing GI-ARS lethality in C57B/L6J mice. Here, with US Department of Defense support, we provide evidence that humanized anti-ceramide scFv (CX-01) is a promising prophylactic MRC for first responders, who risk exposure upon entering a radiation-contaminated site. CX-01, when delivered up to 90 min before irradiation, is highly-effective in preventing small intestinal endothelial apoptosis in mice and lethality in both sexes. Unexpectedly, females require an ~2-fold higher CX-01 dose than males for full protection. CX-01 is effective subcutaneously and intramuscularly, a property critical for battlefield use. Increasing the maximally-effective dose 5-fold does not extend duration of bioeffectiveness. While CX-01 prevents GI-ARS lethality, structural modification to extend half-life may be necessary to optimize first responder prophylaxis.

The maze of real-world evidence frameworks: from a desert to a jungle! An environmental scan and comparison across regulatory and health technology assessment agencies.

Aim: Regulatory and health technology assessment (HTA) agencies have increasingly published frameworks,guidelines, and recommendations for the use of real-world evidence (RWE) in healthcare decision-making. Variations in the scope and content of these documents, with updates running in parallel, may create challenges for their implementation especially during the market authorization and reimbursementphases of a medicine'slifecycle. This environmental scan aimed to comprehensively identify andsummarize the guidancedocumentsfor RWEdeveloped by most well-establishedregulatory and reimbursement agencies, as well asother organizations focused on healthcare decision-making, and present their similarities and differences.Methods: RWE guidance documents, including white papers from regulatory and HTA agencies, werereviewed in March 2024. Data on scope and recommendations from each body were extracted by two reviewers and similarities and differences were summarized across four topics: study planning, choosing fit-for-purpose data, study conduct, and reporting. Post-authorization or non-pharmacological guidance was excluded. Results: Forty-six documents were identified across multiple agencies; US FDA produced the most RWE-related guidance. All agencies addressed specific andoften similar methodological issues related to study design, data fitness-for-purpose,reliability, and reproducibility,although inconsistency in terminologies on these topics was noted. Two HTA bodies (National Institute for Health and Care Excellence [NICE] and Canada's Drug Agency) each centralized all related RWE guidance under a unified framework. RWE quality tools and checklists were not consistently named and some differences in preferences were noted. European Medicines Agency, NICE, Haute Autorité de Santé, and the Institute for Quality and Efficiency in HealthCare included specific recommendations on the use of analytical approaches to address RWE complexities and increase trust in its findings. Conclusion: Similarities in agencies' expectations on RWE studiesdesign, quality elements, and reporting will facilitate evidence generation strategy andactivitiesfor manufacturers facing multiple, includingglobal,regulatory and reimbursementsubmissions and re-submissions. Astrong preference by decision-making bodiesfor local real-world datageneration may hinder opportunities for data sharing and outputs from international federated data networks. Closer collaboration between decision-makingagencies towards a harmonized RWE roadmap, which can be centrally preserved in a living mode,will provide manufacturers and researchersclarity on minimum acceptance requirements and expectations, especially as novel methodologies for RWE generationare rapidly emerging.

Understanding barriers to spinal cord injury rehabilitation services in Nepal: A qualitative study of rehabilitation professionals' perspectives.

This study aims to explore the perspectives of rehabilitation professionals regarding the barriers to spinal cord injury (SCI) rehabilitation services in Nepal. A qualitative study involved 15 rehabilitation professionals working in the Spinal Injury Rehabilitation Center in Nepal. After obtaining informed consent, in-depth semistructured interviews were conducted using Zoom and phone calls between June and July 2023. Braun and Clarke's thematic analysis approach was utilized to analyze the interviews and generate themes from the participants' responses. The participants represented nine different rehabilitation professions. Over half of them were female (53.33%), and 86.67% had one to 10 years of experience in SCI rehabilitation. From in-depth interviews, four themes depicting barriers to rehabilitation were identified: (a) resource constraints within the rehabilitation centers, (b) concerns related to finance, awareness, and support mechanisms, (c) systemic problems coupled with geographical and physical barriers, and (d) beliefs and practices influencing access and adherence to rehabilitation. Delivering effective rehabilitation services for people with SCI presents a range of barriers. Considering the critical importance of rehabilitation for this population, the findings underscore the necessity of engaging stakeholders at multiple levels, individuals, communities, and government agencies to address the identified barriers and improve rehabilitation services in Nepal. The implications of the findings are further discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Changed Seasonality and Forcings of Peak Annual Flows in Ephemeral Channels at Flagstaff, Northern Arizona, USA

Flood variability associated with urbanization, ecological change, and climatic change is of increasing economic and social concern in and around Flagstaff, Arizona, where flood hydrology is influenced by a biannual precipitation regime and the relatively unique geologic setting at the edge of the San Francisco Volcanic Field on the southern edge of the Colorado Plateau. There has been limited long-term gauging of the ephemeral channels draining the developed lands and dry coniferous forests of the region, resulting in a spaciotemporal gap in observation-based assessments of large-scale flooding patterns. We present new data from over 10 years of flood monitoring using a crest stage gauge network, combined with other channel monitoring records from multiple agency sources, to assess inter-decadal patterns of flood change in the area, with a specific emphasis on examining how various controls and disturbances have altered the character and seasonality of peak annual flows. Methods of analysis included the following: using Fisher’s Exact Test to compare the seasonality of flooding between historic data spanning the 1970s and contemporary data obtained since 2010; summarizing GIS-based spatial data and meteorological timeseries to characterize study catchment conditions and changes between flood study periods; and relating spatiotemporal patterns of flood seasonality and occurrences of notably large floods with catchment characteristics and environmental changes. Our results show systematic patterns and changes in Flagstaff-area flood regimes that relate to geologic and topographic controls of the varied catchment systems, and in response to records of climate variations and local catchment disturbances, including urbanization and, especially, high-severity wildfire. For most catchments there has been a shift from predominantly late winter to spring snowmelt floods, or mixed seasonal flood regimes, towards monsoon-dominated flooding, patterns which may relate to observed local warming and precipitation changes. Post-wildfire flooding has produced extreme flood discharges which have likely exceeded historical estimates of flood magnitude over decade-long monitoring periods by one to two orders of magnitude. We advocate for continued monitoring and the expansion of local stream gauge networks to enable seasonal, magnitude-frequency trend analyses, improved climate and environmental change attribution, and to better inform the many planned and ongoing flood mitigation projects being undertaken in the increasingly developed Flagstaff region.

Medication for Opioid Use Disorder After Serious Injection-Related Infections in Massachusetts

Serious injection-related infections (SIRIs) cause significant morbidity and mortality. Medication for opioid use disorder (MOUD) improves outcomes but is underused. Understanding MOUD treatment after SIRIs could inform interventions to close this gap. To examine rehospitalization, death rates, and MOUD receipt for individuals with SIRIs and to assess characteristics associated with MOUD receipt. This retrospective cohort study used the Massachusetts Public Health Data Warehouse, which included all individuals with a claim in the All-Payer Claims Database and is linked to individual-level data from multiple government agencies, to assess individuals aged 18 to 64 years with opioid use disorder and hospitalization for endocarditis, osteomyelitis, epidural abscess, septic arthritis, or bloodstream infection (ie, SIRI) between July 1, 2014, and December 31, 2019. Data analysis was performed from November 2021 to May 2023. Demographic and clinical factors potentially associated with posthospitalization MOUD receipt. The main outcome was MOUD receipt measured weekly in the 12 months after hospitalization. We used zero-inflated negative binomial regression to examine characteristics associated with any MOUD receipt and rates of treatment in the 12 months after hospitalization. Secondary outcomes were receipt of any buprenorphine formulation, methadone, and extended-release naltrexone examined individually. Among 8769 individuals (mean [SD] age, 43.2 [12.0] years; 5066 [57.8%] male) who survived a SIRI hospitalization, 4305 (49.1%) received MOUD, 5919 (67.5%) were rehospitalized, and 973 (11.1%) died within 12 months. Of those treated with MOUD in the 12 months after hospitalization, the mean (SD) number of MOUD initiations during follow-up was 3.0 (1.7), with 956 of 4305 individuals (22.2%) receiving treatment at least 80% of the time. MOUD treatment after SIRI hospitalization was significantly associated with MOUD in the prior 6 months (buprenorphine: adjusted odds ratio [AOR], 16.51; 95% CI, 13.81-19.74; methadone: AOR, 28.46; 95% CI, 22.41-36.14; or naltrexone: AOR, 2.05; 95% CI, 1.56-2.69). Prior buprenorphine (incident rate ratio [IRR], 1.17; 95% CI, 1.11-1.24) or methadone (IRR, 1.89; 95% CI, 1.79-2.01) use was associated with higher treatment rates after hospitalization, and prior naltrexone use (IRR, 0.86; 95% CI, 0.77-0.95) was associated with lower rates. This study found that in the year after a SIRI hospitalization in Massachusetts, mortality and rehospitalization were common, and only half of patients received MOUD. Treatment with MOUD before a SIRI was associated with posthospitalization MOUD initiation and time receiving MOUD. Efforts are needed to initiate MOUD treatment during SIRI hospitalizations and subsequently retain patients in treatment.

Urban policy responses to climate hazards in Addis Ababa, Ethiopia

Urban in-migration, high birth rates and unchecked development are driving the continued growth of African cities. Much of this urbanization occurs in informal settlements, where unplanned growth exacerbates the impacts of climate hazards. Our paper explores the challenges faced by urban planners seeking to address climate change threats in African cities. Focusing on Addis Ababa, we conduct a robust policy analysis of urban government response. Our main finding is that Addis Ababa’s environmental challenges are primarily a result of urban development and inadequate planning and policy enforcement. Environmental challenges are exacerbated by rapidly intensifying climate impacts, but not driven by them. Improved city-level policy responses can potentially mitigate many of Addis Ababa’s current environmental challenges and prepare the city to weather future ones. We highlight four areas of policy weakness: (1) ineffective or absent policies concerning green space; (2) the exclusion of informal settlements from ongoing resilience planning efforts; (3) limited public trust and transparency; and (4) a lack of coordination across the multiple agencies in Addis charged with planning. Holistic, multi-stakeholder planning is inhibited by a lack of collaboration, limited stakeholder participation, and a reluctance to engage in productive dialogue. Resolving all four issues will only occur with sustained increases in social trust, expertise, governance capacity and capital.

Why Effective Communication is Important in Management of Public Health Emergencies – A Viewpoint

Purpose: This article aims to present a reflective viewpoint of what entails effective communication and why it is important in a public health setting when dealing with emergencies. Methodology: The article uses the COVID 19 pandemic as a template to illustrate how effective communication is needed to address a public health emergency effectively. Findings: Centralized and non-conflicting communication is integral in ensuring effective management of a public health emergency. Effective management requires consistent, centralized, and simple to understand and implement communication. Unique Contribution to Theory Practice and Policy: Public Health Emergencies are national emergencies and require collaboration of multiple agencies and stakeholders to effectively address and control the situation. This process must ensure that the public who are the primary stakeholder receive the maximal benefits from any intervention to safeguard their health and safety while guaranteeing economic and social stability.

To move or not? Tourists’ perceptions and management considerations of a beached whale carcass in a South African national park and marine protected area

The handling of beached cetacean carcasses requires social, legal, financial, ecological and logistical considerations. However, limited research on the topic hinders informed decision-making. A large humpback whale carcass that washed ashore at a South African marine protected area (MPA) provided an opportunity to gain insight into tourists’ perspectives on carcass management within a national park and MPA setting. Eighty tourists were interviewed, and a thematic analysis approach was adopted to identify key themes and quantify the responses. Chi-square tests of independence were used to determine (i) whether the respondents’ views on cetacean carcass management were dependent on their knowledge of the site’s MPA designation, and (ii) whether the provision of contextual information would influence the respondents’ perceptions. Tourists had mixed responses to whale carcass management, with half the respondents indicating that the carcass should be left to decompose naturally. Viewpoints were significantly influenced when context and information on the decision-making process were provided, with more respondents stating that no management intervention should be necessary. We propose a simple flow-diagram as a decision-support tool, which, in combination with spatial zonation maps to identify applicable management options, will help guide decision-making for management authorities. Inclusivity, transparency and consultation with experienced role-players from multiple agencies will provide legitimacy to the final management decisions.

Where to begin to have impact on the treatment gap: Reply to Coifman and Gunstad (2024).

Coifman and Gunstad (2024) raise cogent points about childhood and adolescence as a place to begin to help close the mental health treatment gap, note the potential of applications (apps) as a modality of intervention given the pervasiveness of smartphones, and highlight a large-scale intervention study to convey that treatments can be scaled in outcome research. I expand the range of interventions we might consider, pose a best-buy approach to decide how and where to begin to address the treatment gap, and underscore that mental health problems in children, adolescents, and adults are on the rise. We still have no evidence that we can close the treatment gap and that to do so will require a marriage of multiple disciplines, interventions, and agencies to effect change. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supporting child and youth participation in service design and decision-making: The ReSPECT approach

The ReSPECT Project (Reconceptualising Services from the Perspectives of Children and Teens) was conducted in a disadvantaged urban community in Australia, with young people who experience marginalisation and who were involved with multiple service agencies across a range of service sectors. Its purpose was to work closely with young people to understand their experiences of service engagement, their perspectives on the service priorities for young people in their area, and to support them in the development, trial and implementation of a youth led service initiative. This paper describes the methodology employed with the young people, its theoretical underpinnings, and the challenges that needed to be overcome in the conduct of this research. Critical to the ReSPECT approach is relationship building and capacity development with local service providers. This aspect of our work is also briefly described in this paper. The ReSPECT approach makes a significant contribution to the participatory methodological literature. It is distinctive from existing approaches because (1) it gives equal attention to the sustained engagement and scaffolding of young people in the development of ideas, and to the capacity building of service providers addressing organisational culture and constraints; (2) it follows the process of service change from the conceptualisation of youth-led ideas, through to development, partnership, implementation and evaluation; and (3) it is designed for engagement with marginalised young people with diverse service experiences, whose voices are so often absent from participatory projects.

Rapid jail-based implementation of overdose education and naloxone distribution in response to the COVID-19 pandemic

BackgroundPeople incarcerated in jails are highly impacted by the opioid epidemic, and overdose education and naloxone distribution (OEND) is an effective strategy to reduce opioid overdose deaths. This study examines barriers and facilitators of fast-track OEND implementation within the jails in the Wave 1 Kentucky counties of the HEALing Communities Study during the COVID-19 pandemic.MethodsMeeting minutes with jail stakeholders were qualitatively coded using the Practical, Robust Implementation and Sustainability Model (PRISM) as the coding framework. The analysis highlighted the top barriers and facilitators to fast-track OEND implementation within the PRISM framework.ResultsSpace and staffing shortages related to the COVID-19 pandemic, disruptions in interorganizational programming from pandemic-related service suspensions, and a lack of technological solutions (e.g., reliable Internet access) for socially distanced delivery were the top barriers to fast-track OEND implementation. In addition, there were limitations on non-jail staff access to jails during COVID-19. Top facilitators included jail leadership support, the option to prioritize high-risk groups, and the incorporation of OEND processes into existing communications and management software. While the COVID-19 pandemic strained jail infrastructure, jail and partner agency collaboration led to creative implementation strategies for the successful integration of OEND into jail operations. Urban jails were more likely than rural jails to be early adopters of OEND during the public health emergency.ConclusionsUnderstanding the barriers to and facilitators of OEND within jails will improve implementation efforts seeking to curb opioid overdose deaths. Jail leadership support and interorganizational efforts were key facilitators to implementation; therefore, it is recommended to increase buy-in with multiple agencies to promote success. Challenges brought on by COVID-19 have resulted in a need for innovative solutions for implementation.Clinical trial informationClinicalTrials.gov, NCT04111939, Submitted 30 September 2019, https://clinicaltrials.gov/study/NCT04111939?titles=HEALing%20Communities%20Study&rank=1.