Team Partners Research Articles

Creating an Age-Friendly Community in Affordable Housing Using a Resident Health Risk Assessment Focused on the 4Ms

The NJGWEP team in partnership with Fair Share Housing/Northgate II (NGII), an affordable housing complex in Camden, NJ, employed an iterative quality improvement process to collaboratively develop a Resident Health Risk Assessment (RHRA) to meet the needs of the housing facility and incorporate the essential elements of the 4Ms framework (Mentation, Medication, Mobility, and What Matters). Using the RHRA, NG II social services staff and Rutgers School of Nursing (RSoN) students were trained to collect health information and administer several evidence-based screening tools (i.e., MiniCog, TUG, PHQ-2). A final element of the RHRA still in development is the documentation process of referral and follow-up based on personalized care plans. Since July 2019, 43 RHRAs have been completed (60% female, mean age 66, age range=43 to 88). Almost all residents (94%) have at least 1 chronic condition (HTN, DM, COPD, CHF), although only 26% have an advance care plan. Most (81%) were screened for future fall risk; function (ADLs/IADLs) was assessed for all (100%). Every resident who was able or did not refuse (88%) was screened for cognitive impairment. Just 7% were taking a high-risk medication (i.e., an opioid or benzodiazepine). The NJGWEP team has initiated an age-friendly community at NGII by providing education on geriatric-focused topics and implementing the 4Ms-focused RHRA to detect issues impacting the resident’s well-being. Establishing a follow-up process to track referrals to available resources will enable NGII to allow residents to age in place with appropriate supports.

Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries

Falls represent a leading cause of preventable injury in hospitals and a frequently reported serious adverse event. Hospitalization is associated with an increased risk for falls and serious injuries including hip fractures, subdural hematomas, or even death. Multifactorial strategies have been shown to reduce falls in acute care hospitals, but evidence for fall-related injury prevention in hospitals is lacking. To assess whether a fall-prevention tool kit that engages patients and families in the fall-prevention process throughout hospitalization is associated with reduced falls and injurious falls. This nonrandomized controlled trial using stepped wedge design was conducted between November 1, 2015, and October 31, 2018, in 14 medical units within 3 academic medical centers in Boston and New York City. All adult inpatients hospitalized in participating units were included in the analysis. A nurse-led fall-prevention tool kit linking evidence-based preventive interventions to patient-specific fall risk factors and designed to integrate continuous patient and family engagement in the fall-prevention process. The primary outcome was the rate of patient falls per 1000 patient-days in targeted units during the study period. The secondary outcome was the rate of falls with injury per 1000 patient-days. During the interrupted time series, 37 231 patients were evaluated, including 17 948 before the intervention (mean [SD] age, 60.56 [18.30] years; 9723 [54.17%] women) and 19 283 after the intervention (mean [SD] age, 60.92 [18.10] years; 10 325 [53.54%] women). There was an overall adjusted 15% reduction in falls after implementation of the fall-prevention tool kit compared with before implementation (2.92 vs 2.49 falls per 1000 patient-days [95% CI, 2.06-3.00 falls per 1000 patient-days]; adjusted rate ratio 0.85; 95% CI, 0.75-0.96; P = .01) and an adjusted 34% reduction in injurious falls (0.73 vs 0.48 injurious falls per 1000 patient-days [95% CI, 0.34-0.70 injurious falls per 1000 patient-days]; adjusted rate ratio, 0.66; 95% CI, 0.53-0.88; P = .003). In this nonrandomized controlled trial, implementation of a fall-prevention tool kit was associated with a significant reduction in falls and related injuries. A patient-care team partnership appears to be beneficial for prevention of falls and fall-related injuries. ClinicalTrials.gov Identifier: NCT02969343.

“Hybrid” medical leadership emergency medicine training for international medical graduates

PurposeThe purpose of this paper is to outline the “Hybrid” “International” Emergency Medicine (HIEM) programme, which is an ethical pathway for the recruitment, employment and training of Emergency Medicine doctors; with a rotation through the NHS on a two-year medical training initiative with a Tier 5 visa, “earn, learn and return” programme. The HIEM programme offers an advantage to the Tier 2 visa by combining training, education and employment resulting in new learning to help improve the health system in Nepal and provide continued cultural support, clinical and leadership development experience in the UK NHS. Finally, this programme also provides a Return on Investment to the NHS.Design/methodology/approachA shortage of doctors in the UK, combined with a need to develop Emergency Medicine doctors in Nepal, led to a UK Emergency Medicine Physician (PS) to facilitate collaboration between UK/Nepal partners. A mapping exercise of the Royal College of Emergency Medicine curriculum with the competencies for the health system and quality improvement leaders and partners with patients produced a “HIEM programme”. The HIEM programme aims to develop first-class doctors to study in Emergency Departments in the UK NHS while also building trainee capability to improve the health system in Nepal with a research thesis.FindingsThe HIEM programme has 12 doctors on its programme across years one and two, with the first six doctors working in the UK NHS and progressing well. There are reports of high levels of satisfaction with the trainees in their transition from Nepal to the UK and the hospital is due to save £720,000 (after costs) over two years. Each trainee will earn £79,200 over two years which is enough to pay back the £16,000 cost for the course fees. Nepal as a country will benefit from the HIEM programme as each trainee will submit a health system improvement Thesis.Research limitations/implicationsThe HIEM programme is in its infancy as it is two years through a four-year programme. Further evaluation data are required to assess the full impact of this programme. In addition, the HIEM programme has only focussed on the development of one medical speciality which is Emergency Medicine. Further research is required to evaluate the impact of this model across other medical and surgical specialties.Practical implicationsThe HIEM programme has exciting potential to support International Medical Graduates undertake a planned programme of development while they study in the UK with a Tier 5 visa. IMGs require continuous support while in the UK and are required to demonstrate continued learning through continuous professional development (CPD). The HIEM programme offers an opportunity for this CPD learning to be structured, meaningful and progressive to enable new learning. There is also specific support to develop academic and research skills to undertake a thesis in an area that requires health system improvement in Nepal.Originality/valueThis is the first time an integrated clinical, leadership, quality improvement and patient partnership model curriculum has been developed. The integrated nature of the curriculum saves precious time, money and resources. The integrated nature of this “hybrid” curriculum supports the development of an evidence-based approach to generating attitudes of collaboration, partnership and facilitation and team building in medical leadership with patient engagement. This “hybrid” model gives hope for the increased added value of the programme at a time of global austerity and challenges in healthcare.

Optimizing the Meaningful Engagement of Older Adults With Multimorbidity and Their Caregivers as Research Partners: A Qualitative Study.

It is widely recognized that the engagement of older adults with multimorbidity and their caregivers as partners in health care research is important and invaluable. The objective of this study was to examine how researchers can best engage and support older adults with multimorbidity and informal friend or family caregivers of older adults with multimorbidity as research partners in health care research teams. The persona-scenario method was used for participants to create fictional stories. These stories were analyzed to shed light on specific strategies that can support older adults and caregivers as partners on health care research teams, such as a patient-centered approach, identifying and addressing barriers to engagement, and clarifying roles and responsibilities on the research team. The results from this study can be used to inform research, policy, and education on supporting older adults with multimorbidity and caregivers of older adults with multimorbidity as research partners.

214TF Advancing Communication Excellence at Stanford in Emergency Medicine Residency: A Curriculum for Interns

Effective communication is essential for patient safety and enhancing the patient experience in the Emergency Department. Effective communication also promotes efficiency in practice and a culture of wellness needed to attain professional fulfillment. Patient-centered care may conflict with physicians creating boundaries and their attempt to advocate for self-care and self-valuation in their roles as healers. With a strategic focus of developing a relationship-centered culture, the EM residency leadership, EM interns and the Physician Partnership Team in Patient Experience designed an innovative pilot using formative and summative evaluation to identify how best to deliver knowledge, and practice 3 relationship-centered communication (RCC) skills. A series of 4 workshops and individualized coaching observations were part of the design. We proposed a curriculum for EM interns focusing on relationship-centered care using the Advancing Communication Excellence at Stanford (ACES) initially designed for Stanford faculty. By teaching evidenced-based strategies on managing challenging interactions in the health care arena, we hope to provide our EM interns a curriculum to develop skills that will enhance the physician-patient relationship, while also addressing physician wellbeing. The primary objective was to learn how best to engage EM interns to learn and adopt the 3 foundational RCC ACES skills. The second objective was to design a reproducible EM RCC curriculum within the residency program based on time constraints and entry-level cognitive demands. Curricular Design: We developed a curriculum for EM interns, supplemented by individualized coaching and asynchronous learning using the flipped-classroom model. We used intern-driven scenarios and role-playing techniques to demonstrate and emphasize key communication skills. We used online surveys and text-messages check-ins to assess the effectiveness and further iterate this learner-centered curriculum. The first 3 sessions included a reflection, a check-in, demonstration of a skillset and small group practice with an ACES coach. Bedside clinical EM coaching was scheduled with each intern between sessions 3 and 4. Session 4 integrated all 3 skills with a standardized patient. This session was video-recorded and coded in addition to the immediate feedback and debrief after each encounter. This will be used in the final individual coaching session. The ACES in EM Residency Curriculum is an effective way to teach communication skills that promote relationship-centered care. We have successfully integrated the RCC into the EM intern curriculum over 3 in-person, 60-90-minute workshop sessions and individualized clinical coaching. The impact will be assessed through a learner self-assessment and coaching assessment. We plan to scale this to the entire EM residency.

Using Communication to Modulate Neural Synchronization in Teams.

Throughout training and team performance, teams may be assessed based on their communication patterns to identify which behaviors contributed to the team’s performance; however, this process of establishing meaning in communication is burdensome and time consuming despite the low monetary cost. A current topic in team research is developing covert measures, which are easier to analyze in real-time, to identify team processes as they occur during team performance; however, little is known about how overt and covert measures of team process relate to one another. In this study, we investigated the relationship between overt (communication) and covert (neural) measures of team process by manipulating the interaction partner (participant or experimenter) team members worked with and the type of task (decision-making or action-based) teams performed to assess their effects on team neural synchronization (measured as neurodynamic entropy) and communication (measured as both flow and content). The results indicated that the type of task affected how the teams structured their communication but had unpredictable effects on the neural synchronization of the team when averaged across the task session. The interaction partner did not affect team neural synchronization when averaged. However, there were significant relationships when communication and neural processes were examined over time between the neurodynamic entropy and the communication flow time series due to both the type of task and the interaction partner. Specifically, significant relationships across time were observed when participants were interacting with the other participant, during the second task trial, and across different regions of the cortex depending on the type of task being performed. The findings from the time series analyses suggest that factors that are previously known to affect communication (interaction partner and task type) also structure the relationship between team communication and neural synchronization—cross-level effects—but only when examined across time. Future research should consider these factors when developing new conceptualizations of team process measurement for measuring team performance over time.

Mental Health Support to Health Care Workers During COVID-19 Pandemic: Is the Front Line Necessarily the Priority Line?

Mental Health Support to Health Care Workers During COVID-19 Pandemic: Is the Front Line Necessarily the Priority Line?

Student teachers’ perceptions of trust during the team practicum

ABSTRACT Team teaching as a form of collaborative teaching practice is increasingly employed in teacher education. Positive and trusting relationships with the team partner and the mentor teacher are at the core of such internships and form the basis for optimal learning experiences and successful cooperation in the practicum. However, trust has been little explored in pre-service teacher education. The present study addressed students’ perceptions of trust in their team partner and their mentor teacher. A total of 109 Swiss students studying pre-primary and primary teacher education filled in questionnaires (open-ended questions), and another 27 student teachers were interviewed. The results reveal that many different facets contributed to student teachers’ perceptions of trust. These could be divided into the two main dimensions: interpersonal and professional trust. Open communication based on mutual appreciation and respect was the core element of a ‘trusting’ relationship from the students’ perspective.

A model for global surgical training and capacity development: the Children's of Alabama-Viet Nam pediatric neurosurgery partnership.

Training capable and competent neurosurgeons to work in underserved regions of the world is an essential component of building global neurosurgical capacity. One strategy for achieving this goal is establishing longitudinal partnerships between institutions in low- and middle-income countries (LMICs) and their counterparts in high-income countries (HICs) utilizing a multi-component model. We describe the initial experience of the Children's of Alabama (COA) Global Surgery Program partnership with multiple Vietnamese neurosurgical centers. The training model developed by the COA Global Surgery Program utilizes three complementary and interdependent methods to expand neurosurgical capacity: in-country training, out-of-country training, and ongoing support and mentorship. Multiple Vietnamese hospital systems have participated in the partnership, including three hospitals in Hanoi and one hospital in Ho Chi Minh City. During the 7years of the partnership, the COA and Viet Nam teams have collaborated on expanding pediatric neurosurgical care in numerous areas of clinical need including five subspecialized areas of pediatric neurosurgery: cerebrovascular, epilepsy, neuroendoscopy for hydrocephalus management, craniofacial, and neuro-oncology. Long-term partnerships between academic departments in LMICs and HICs focused on education and training are playing an increasingly important role in scaling up global surgical capacity. We believe that our multi-faceted approach consisting of in-country targeted hands-on training, out-of-country fellowship training at the mentor institution, and ongoing mentorship using telecollaboration and Internet-based tools is a viable and generalizable model for enhancing surgical capacity globally.

A protocol for the establishment and evaluation of an older adult stakeholder panel for health services research

Background: There has been a policy shift towards public and patient involvement (PPI) in population health and health services research in Ireland and internationally. Despite growing evidence that PPI can have positive impacts on the quality and appropriateness of health research, little is known about the involvement and impact of older adults as research partners. The aim of this study is to 1) describe the process of establishing a PPI panel of older adults, family carers and ageing research academics and 2) to evaluate the impact of this research partnership on all research partners. Methods: A partnership-focused framework will guide the recruitment and establishment of a PPI panel of older adults, family carers and academic researchers. Eight to ten older adults and four to six family carers with experience of using health services will be recruited through gatekeepers in a range of non-governmental, voluntary, and community organisations in the Mid-West region of Ireland. Academic researchers will be recruited through the Ageing Research Centre at the University of Limerick. To evaluating the impact of the research partnership on all members of the PPI panel we propose to record an activity log, maintain a record of all meeting, panel discussions and conduct individual interviews with all members of the research team at key time points. The final plan for evaluation will be negotiated and agreed with all members of the PPI panel. Data will be transcribed, managed in NVivo and analysed using an inductive approach to thematic analysis. Dissemination of research findings will be facilitated by the research partnership team of academics and older adults. Discussion: This study will identify learning about the process of establishing a PPI panel guided by a partnership-focused framework and will evaluate the impact of participation in a PPI panel for all members of the research team.

A protocol for the establishment and evaluation of an older adult stakeholder panel for health services research

Background: There has been a policy shift towards public and patient involvement (PPI) in population health and health services research in Ireland and internationally. Despite growing evidence that PPI can have positive impacts on the quality and appropriateness of health research, little is known about the involvement and impact of older adults as research partners. The aim of this study is to 1) describe the process of establishing a PPI panel of older adults, family carers and ageing research academics and 2) to evaluate the impact of this research partnership on all research partners. Methods: A partnership-focused framework will guide the recruitment and establishment of a PPI panel of older adults, family carers and academic researchers. Eight to ten older adults and four to six family carers with experience of using health services will be recruited through gatekeepers in a range of non-governmental, voluntary, and community organisations in the Mid-West region of Ireland. Academic researchers will be recruited through the Ageing Research Centre at the University of Limerick. To evaluating the impact of the research partnership on all members of the PPI panel we propose to record an activity log, maintain a record of all meeting, panel discussions and conduct individual interviews with all members of the research team at key time points. The final plan for evaluation will be negotiated and agreed with all members of the PPI panel. Data will be transcribed, managed in NVivo and analysed using an inductive approach to thematic analysis. Dissemination of research findings will be facilitated by the research partnership team of academics and older adults. Discussion: This study will identify learning about the process of establishing a PPI panel guided by a partnership-focused framework and will evaluate the impact of participation in a PPI panel for all members of the research team.

Multi-objective design of single room ventilation units with heat and water recovery

The present paper describes the design improvement of a single-room ventilation unit. This ventilation system presents many advantages, however, several drawbacks exist. The first one is the acoustic disturbance. As the facilities are directly installed within the rooms, the fans’ noise may create discomfort. Furthermore, in the cold or temperate climates, condensation or frost may appear. A dedicated management should then be implemented. Finally, as the system is not centralized, communication between the different units is required to ensure the global system efficiency. A team of several industrial partners and research institutes tackles the above-mentioned issues in the frame of the “Silenthalpic” project. The project is split in three major tasks. To correctly reduce the sound emission level (i), a spectral analysis of the noise emitted by an existing unit was undertaken, revealing that frequencies under 1 kHz are mainly responsible for the noise disturbance. From this analysis, active and passive solutions for noise reduction are envisaged, showing encouraging trends. The next research aspect is the exchanger of the ventilation unit (ii). The constituting material is a new porous membrane allowing the humidity transfer (vapor or liquid). This specific exchanger is numerically modelled to predict its performances. The last considered problematic is the optimization of the ventilation and control strategies for the specific case of decentralized units (iii), taking advantage of sensors and recent communication technologies like IOT (Internet Of Things) to establish communication between decentralized units and ensure their consistent control. The association of the three aspects presented here should then lead to versatile and efficient ventilation systems.

Lessons learned in preparing for and responding to the early stages of the COVID-19 pandemic: one simulation\u2019s program experience adapting to the new normal

Use of simulation to ensure an organization is ready for significant events, like COVID-19 pandemic, has shifted from a “backburner” training tool to a “first choice” strategy for ensuring individual, team, and system readiness. In this report, we summarize our simulation program’s response during the COVID-19 pandemic, including the associated challenges and lessons learned. We also reflect on anticipated changes within our program as we adapt to a “new normal” following this pandemic. We intend for this report to function as a guide for other simulation programs to consult as this COVID-19 crisis continues to unfold, and during future challenges within global healthcare systems. We argue that this pandemic has cemented simulation programs as fundamental for any healthcare organization interested in ensuring its workforce can adapt in times of crisis. With the right team and set of partners, we believe that sustained investments in a simulation program will amplify into immeasurable impacts across a healthcare system.

Abstract B047: Community-academic partners working in a small grants program

Abstract Community-based participatory research can help reduce health disparities among underserved populations. The New Mexico State University - Fred Hutchinson Cancer Research Center Partnership for the Advancement of Cancer Research (NMSU – Fred Hutch PACR) aims to reduce cancer health disparities in part through the establishment of community-academic partnerships. The Outreach Core of the PACR has supported a small grants program since 2015 to award funds to competitive community-academic partnership teams addressing regional cancer or health disparities issues through health education. Each year, the Outreach Core staff presents a grant-writing workshop to assist community groups in the development of competitive proposals and to identify academic partners at NMSU. Participants at the grant-writing workshop submit proposals, which are then reviewed by two NMSU faculty researchers. All participants, including the awardees, receive the reviewers’ feedback on their proposal. Over the past four cycles, the grant-writing workshop has trained 60 community members. The top two proposals are funded each year. To date, eight different proposals have been funded, six at $7500 each and two at $5,000 each. All of the funded projects undergo an IRB review at NMSU before the start of the research project. The NMSU academic partners are involved with the community groups through the design, submission of Human Subjects protocol to the IRB, and through data analysis and reporting. Examples of small grant proposals will be presented, including a discussion of how their partnerships worked. This interaction between the community groups and research academics increases the relevance of academic research by assisting the community groups in evaluating their novel educational interventions through robust research projects. Furthermore, these small grant partnerships may serve to provide pilot data for more extensive efforts funded by other agencies. Citation Format: Karoline Sondgeroth, Rebecca Palacios, Graciela A Unguez, Mary O'Connell, Helena B Loest, Kaitlin Englund. Community-academic partners working in a small grants program [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B047.

Urban youth preserving the environmental commons: student learning in place-based stewardship education as citizen scientists

BackgroundThe urban ecology and especially youth of color living in urban spaces have received relatively little attention in environmental education. The purpose of this work was to assess what urban youth learn about the Environmental Commons by participating in place-based stewardship education (PBSE) projects. By the Environmental Commons we refer to: 1) the natural resources and systems on which all life depends, and 2) the public spaces and processes in which people work together to determine how they will care for those resources and for the communities they inhabit. Core principles in all projects include: experiential education about the natural environment in the local urban ecology; students’ scientific and civic agency; and collective learning/action in teams of students, teachers, and adult community partners committed to sustaining the local ecosystem. After engaging in the projects, students were asked to reflect in their own words on what they had learned.ResultsThe reflective essays of 205 children (14% in 4th–5th grade) and adolescents (86% in 6th–12th grade) from predominantly (79%) racial/ethnic minority backgrounds and residing in urban communities were analyzed. Coding was informed by Environmental Commons theory and by Elinor Ostrom’s work on the practices of groups that are effective in stewarding common pool resources, with the highest number of coding categories assigned to any individual response being 8. Analyses revealed that students: became aware of human impact on nature and were resolved to redress negative impact; identified as stakeholders of the environmental commons and their local community; felt a sense of pride and collective efficacy in their team efforts that benefitted both the human and more than human communities with whom they identified. Verbatim excerpts from students’ reflective essays are included to illustrate the range of ways that youth interpret in their own words the interdependence of human life with other living systems and the responsibility of humans to work together to sustain those living systems.ConclusionsSince younger generations will bear the burdens of the climate crisis, it is imperative that they reimagine what gives their lives meaning. The PBSE model documented here offers hope for nurturing an identification and commitment to the Environmental Commons in urban youth.

Psychological aspects of effective strategic partnership management

Strategic partnerships that were formed since the end of the last century, as effective business elements of integration of the economic world, are now the most promising form of business development. They allow us to overcome the negative aspects of forced growth and consolidation, leave partners room to choose the best solutions, focus on the future, and increase the stability of partner companies in providing resources and distributing products and services. Today, such partnerships have become an important tool of competition, opening up opportunities to enter new markets. According to the structure, a strategic partnership can combine numerous organizational forms, including joint ventures, license agreements, long-term contracts for the supply and purchase of products, j oint research and development programs, and mutual provision of implementation networks. Strategic partnership management is a very complex, specific activity and area of corporate management in which it is extremely important to maintain a balance between the interests of the alliance as a whole, the interests of the company and the interests of the partner company, taking into account the interests of shareholders, strategic investors and other interested parties. Specific examples of strategic alliances, the dynamics of their development, and the reasons for their success or failure have been considered in the article. It has been demonstrated that a serious obstacle to effective corporate cooperation has mainly psychological than economic reasons. The concept of the psychological syndrome of strategic partnership has been proposed, its content and structure, including individual, organizational and cultural components, have been revealed. The ways to overcome this syndrome, including the creation and training of a strategic partnership team, have been briefly outlined. For a detailed description and evaluation of the effectiveness of the proposed psychotechnology of organizational development, a separate article will be required, which we plan to present in one of the next issues.

Collaborative Development and Implementation of a Video-Based Curriculum Expansion to Improve Refugee Women's Birth Experiences in the United States.

Many refugee and immigrant women in the United States experience cultural and language barriers when seeking pregnancy-related medical care. Such barriers may delay needed care and adversely impact birth outcomes. Embrace Refugee Birth Support (Embrace) in Clarkston, Georgia, supports pregnant refugee women by offering birth education classes in the women's primary languages. Our academic-practice partnership designed and implemented a series of birth education videos for Embrace participants. Based on input from former participants, the partnership team created video scenarios that could be embedded into Embrace's existing didactic curriculum. The videos addressed common challenges and learning needs identified by previous participants. All videos were filmed in the participant's primary languages (Swahili and Kinyarwanda) and featured actual Embrace graduates who spoke the languages. Then, Embrace trainers used the video scenarios to augment teaching on birth preparedness and foster participant discussion during class sessions. After implementation, a focus group with participants in the video-expanded class reported the videos were well received, understood, and practically related to their pregnancy needs. Overall, participants reported that video scenarios were an important part of their learning and skill development, as well as a positive experience. Embrace has plans to continue creating native language educational videos for additional languages and birth-related topics. The academic partner's attempts to measure video impact with standardized quantitative instruments at baseline were terminated. The substantive revisions in data collection strategies highlight the need for cross-cultural flexibility and the potential for unforeseen barriers when using quantitative research tools among non-English-speaking participants.

Optimising real time clinical librarian support to enhance the evidence base in radiotherapy clinical protocols

Clinical teams are professionally driven to adopt the latest evidence-based care ensuring optimal outcomes for patients. There can be delays in the latest evidence reaching practice. The radiotherapy multi-professional team in partnership with Clinical Librarians developed a lean process to undertake the real-time evidence-based live update of clinical radiotherapy protocols. Principles of Quality Function Deployment were deployed to create a lean process. The process was evaluated for the percentage difference to the radiotherapy protocol parameters over two years. Satisfaction of the live update was scored from 1: Very dissatisfied to 5: Very satisfied. Since 2014, 12 protocols have been through the process. The live update resulted in 80% of differences to the clinical protocol compared to the previous two years. Among 10 respondents, a mode of 5 was scored for satisfaction. This novel approach has been successful in providing a lean process ensuring that the latest evidence reaches radiotherapy practice.

Transdisciplinary interventions for environmental sustainability

This paper presents a case study of a transdisciplinary research based on an ex-post assessment of the environmental and socio-behavioral contexts of solid waste management in Lebanese peri-urban communities. Lessons learned are compiled into the Transdisciplinary Interventions for Environmental Sustainability conceptual framework. The approach starts with building a team of researchers and non-academic partners, continues with co-creating solution-oriented knowledge, and ends by integrating and applying the produced knowledge. The co-created knowledge includes the environmental and socio-behavioral ex-post assessment’s results. The former reveals low air pollution levels, evidence of waste-related water contamination, and higher self-reported frequencies of ill-health symptoms and diseases closer to the landfill. The latter indicates that the community’s perception about waste production differs from the real accounting of generated waste. Nine lessons are identified: (1) inherent common interest between the researchers and the community, (2) flexible interdisciplinary research team, (3) representative citizen committee, (4) contextually-informed outreach coordinator, (5) iterative research process accounting for the shifting socio-political context, (6) common expectations of the research process, (7) boundary objects leading to spin-off activities in the same setting, (8) effective communication strategy, and (9) ex-post assessment of subsequent societal and scientific impacts. The non-phased framework links all nine pointers in a logical order to ease scalability. The study answers a global need for a unified, clear, broadly adopted framework for transdisciplinarity and a deeper understanding of factors ensuring full-circle knowledge co-creation in waste-related contexts in the global South. The study offers managerial and research implications and suggests avenues for further research.

Delivering Drinking Water by Truck in Humanitarian Contexts: Results from Mixed-Methods Evaluations in the Democratic Republic of the Congo and Bangladesh.

Water trucking is a commonly implemented, but severely under-researched, drinking water supply intervention in humanitarian response. To fill this research gap, we conducted three mixed-methods water trucking program evaluations in the Democratic Republic of the Congo and Bangladesh, including interviews, water point observations, household surveys, focus groups, and water quality testing. Results indicated that the programs had complex implementation structures involving multiple agencies and limited infrastructure to properly collect, treat, and deliver water. All programs met queueing time and distance indicators, did not meet water quantity indicators, and inconsistently met water quality indicators. Free chlorine residual (FCR) declined through the water chain, and household water Escherichia coli concentrations were associated with household FCR, receiving behavior change messages, storage container type, and distance from the distribution point. Users appreciated water trucking, especially compared to previous water sources, and expressed desires for increased quantity, improved quality, and consistent delivery. If water trucking programs are implemented, it is recommended to have the financial resources to install sanitary collection and distribution infrastructure, establish a management team of all implementation partners, ensure sufficient water quantity is delivered, ensure recommended FCR levels at distribution points, monitor FCR throughout distribution, and complete behavior change communication activities about the program and safe water storage with users.