Forward Path Research Articles

Patient Experience (PX) Giants: Pioneers and the Path Forward

Patient Experience (PX) Giants: Pioneers and the Path Forward

Abstract 4125940: Hypertensive Disorders During Pregnancy: Patient Perspectives on Care, Barriers, and a Path Forward

Background: The future risk of cardiovascular disease (CVD) after a diagnosis of hypertensive disorders of pregnancy (HDP) is well established. Blood pressure (BP) assessment and management after delivery is one essential part of downstream risk mitigation of future CVD. This requires intentional follow-up by clinicians and understanding by patients. We sought the perspectives of patients regarding solutions to barriers for health care interventions and self-care support after a HDP diagnosis. Methods: Phone interviews were conducted three to six months following a delivery from a random sample of women diagnosed with HDP, determined by ICD-10 codes. Interview questions were designed by a multidisciplinary team that included those who specialize in women’s CVD health and pregnancy. Interviews were conducted by a senior qualitative researcher. Questions aimed to discover health care and self-care steps taken following HDP diagnosis, reasons why these were not started or used consistently, education recalled, and areas for improvement. Results: A total of 20 women were interviewed from ages 21-42 (20-29, n=10; 30-39, n=8; and 40-42, n= 2) among 9 different hospitals (1 quaternary, 3 tertiary care hospitals, and 5 small-medium-rural community hospitals). Of the respondents, 50% were diagnosed during their third trimester, 25% in their second trimester, 20% in their first trimester, and 5% within a week after delivery. A total of 8 (40%) of the women were induced early given HDP concerns. Table 1 describes health care and self-care steps taken for HDP during and after pregnancy. If health care and/or self-care for HDP did not start or did not continue beyond the fourth trimester (>12-weeks post-delivery), reasons included BP stabilized or returned to normal, the clinician ‘wasn’t concerned’, and/or they didn’t have a history of a hypertension diagnosis. Table 2 lists suggested areas from those interviewed for improving support to women with HDP. Conclusion: This study suggests a high prevalence of unclear education with low patient recall and incomplete follow-up after delivery among women with HDP, with health care support and self-care diminishing after the fourth trimester. Understanding the perspectives of women with HDP and its associated risk factors can help in developing effective clinician and patient education and clinical pathways to reduce barriers for long-term care and CVD risk mitigation.

Glissant and the Politics of Coordination

This is an ironic moment for Edouard Glissant’s growing community of readers. So many are discovering Glissant’s work for the first time, myself included, in part because a fervent commitment to a politics of recognition now dominates in many corners of the humanities. This is ironic largely because while the choice to engage with Glissant might be motivated by an all too generalized logic of recognition, to read Glissant is to learn about how the basic premises underpinning this logic are deeply misguided. The politics of recognition, as a term of art, after all, is built on the conceptual planks made available by the standardizing impulses of the nation-state form and capitalism combined. Glissant, on the other hand, is nothing if not a theorist calling fervently for a path forward that does not depend on the complicities found in the conceptual imperialism inherent to the bureaucratic standardizing practices that bolster both the nation-state and contemporary capitalism. Glissant calls instead for an approach that offers the philosophical building blocks for a politics of coordination, which is described in Patchell Markell’s book, Bound by Recognition (2003) as a politics of acknowledgement. This politics entails forgingan alternative approach to the self and other, to identity and place, and to social orders in general than what the politics of recognition espouses.

Communication and engagement for basic science: insights and practical considerations

Basic research underpins the innovations that power the global economy and shape society. It is the focus of scientific investment for both The Kavli Foundation and the U.S. Department of Energy Office of Science. Yet it has been rare to see basic research command much attention, practice, or scholarship in science communication. In December 2020, we launched the Science Public Engagement Partnership, or SciPEP, a limited term public-private partnership, to dive into basic science communication headlong. Our work through SciPEP has led to new insights about audiences’ relationship to basic science, as well as the needs and interests of those who communicate basic research. We see a path forward that involves forging more partnerships between scholars who study science communication and practitioners of basic science communication.

Exploring Gender Diversity in Aviation Education: A Comprehensive Review of Challenges, Initiatives, and the Path Forward

Gender diversity in aviation education has long been a significant issue for the aviation industry. This review investigates gender diversity by analyzing historical participation, key barriers, and initiatives to promote inclusivity. Using a systematic approach, academic databases such as Google Scholar, JSTOR, ResearchGate, Scholarly Commons, Academia.edu, and specialized aviation industry sources were searched. Peer-reviewed articles published within the last 10 years were selected based on inclusion criteria, including relevance to aviation education and gender diversity. A thematic analysis was performed to identify significant gaps, key challenges, initiatives and outcomes to assess the current state of gender diversity in the field. This review highlights the need for comprehensive efforts to create a more inclusive educational environment to close the gender gap in aviation education and improve the industry’s overall sustainability.

"So You Made a Mistake" - The Path Forward Through Surgical Pathology Errors by Extreme Ownership and a Focus on the Patient.

Our goal for medicine is to make zero mistakes, yet the reality is that mistakes are an unfortunate part of medical practice. And when it comes to surgical pathology, it is a special case where the diagnostic "bottom line" is provided starkly and directly for all to see in the final diagnosis of the pathology report. When this diagnosis is wrong, particularly when it has serious adverse consequences for the patient, the resulting physical, mental, and emotional effects on patient, provider, pathologist, and health care system can be extremely serious. Head and neck surgical pathology, based on large second review-type studies, is a subspecialty area with average rates of major diagnostic error, but with potential for severely negative impacts on patients. Studies have shown between 1% and 7% major error rates for head and neck practice. How then, as the pathologist, can we react to and manage things when we have made a serious diagnostic mistake? Through personal experience over more than two decades, the hard-won answer is through extreme ownership and a focus on the needs of the patients, who, in the words of William J. Mayo, should have their "needs come first". The emotional impact on us as pathologists and on the clinicians we work with should also be acknowledged and managed. This article will serve as a thorough and open examination of these mistake scenarios and, focusing specifically on diagnostic errors, serve as a practical guide for what you can do, moving forward, to "make things right" to the best of your ability.

Multiple System Atrophy: Pathology, Pathogenesis, and Path Forward.

Multiple system atrophy (MSA) is a fatal neurodegenerative disease characterized by autonomic failure and motor impairment. The hallmark pathologic finding in MSA is widespread oligodendroglial cytoplasmic inclusions rich in aggregated α-synuclein (αSyn). MSA is widely held to be an oligodendroglial synucleinopathy, and we outline lines of evidence to support this assertion, including the presence of early myelin loss. We consider emerging data that support the possibility of neuronal or immune dysfunction as primary drivers of MSA. These hypotheses are placed in the context of a major recent discovery that αSyn is conformationally distinct in MSA versus other synucleinopathies such as Parkinson's disease. We outline emerging techniques in epidemiology, genetics, and molecular pathology that will shed more light on this mysterious disease. We anticipate a future in which cutting-edge developments in personalized disease modeling, including with pluripotent stem cells, bridge mechanistic developments at the bench and real benefits at the bedside.

A new forward‐flyback converter without right half plane zero

AbstractDue to its unique features, the flyback converter is widely used to convert DC to DC power. This converter has a non‐minimum phase (NMP) dynamic behavior, which is one of its most significant disadvantages. By changing the topology of the flyback converter to a forward‐flyback (FF) converter, the dynamic behavior of the converter can be minimum phase (MP) while the main advantages of the flyback converter such as isolation of the output from the input and simple topology are maintained. This article proposes an innovative FF converter topology by doubling the forward path and adding only one diode and one capacitor. In addition to better dynamic behavior, the proposed double FF (DFF) converter has the same advantages as the conventional FF converter. A new method is used to obtain the transfer function of the output voltage to the duty cycle of the proposed converter. The converter is designed in continuous conduction mode (CCM) with minimum phase dynamics. Finally, simulation and experimental results of both conventional FF and the proposed DFF converters are obtained and compared to validate the superiority of the proposed converter.

Collective Capabilities Complete a Neighbourhood

This article argues for the need for attention to agency as well as structure in planning for complete neighbourhoods and communities, drawing upon collective capabilities theory and driven by a community-engaged research approach. While complete communities planning proposes to provide more fulsome social and physical infrastructure to residents in a context of urban growth and change in Canadian cities, contemporary efforts tend to neglect or disdain the agency and empowerment of residents. This logic and rationale for complete communities planning has shifted compared to the origins of neighbourhood planning in Canada, as will be exemplified here drawing upon the case of Vancouver. The application of the theory of collective capabilities in complete communities planning offers a path forward that is not naïve to the challenges posed by participatory planning and that views organizations other than the government as having collective capabilities to plan. We demonstrate the potential of this through the case of our community-engaged research partnership based at the South Vancouver Neighbourhood House. The project mobilized spatial and statistical research to document the extent of inequities and needs experienced in South Vancouver neighbourhoods as well as the collective capabilities of residents working through the neighbourhood house hub to provide essential services and do effective neighbourhood planning.

MPox: An Evolving Threat and the Path Forward

MPox: An Evolving Threat and the Path Forward

The American College of Medical Toxicology Annual Scientific Meeting: A Look Back and the Path Forward.

More than 20 years that have elapsed since the inaugural American College of Medical Toxicology Spring Conference in 2002. During this time, the now ACMT Annual Scientific Meeting has grown in many ways, as demonstrated by the increase in attendance and abstract submissions, and diversification of educational offerings, and partners. Most importantly, the scientific rigor and presentation of new knowledge has continued to mature, and the conference is now firmly rooted in the annual educational schedule for medical toxicologists. In anticipation of the upcoming 2025 ASM, we reflect upon the evolution and growth of ACMT's research and educational agendas, and the Annual Scientific Meeting itself.

Not Your Garden (Hose) Variety Emotion: An Integrative Review of the Flows of Anger and a Path Forward

Not Your Garden (Hose) Variety Emotion: An Integrative Review of the Flows of Anger and a Path Forward

Digital oncology, the dawn of a new era turning the clock back on tumor mass

Evolutionary path of cancer therapeutics which started around eighty-two years ago, following serendipitous discovery of nitrogen mustard [1] has been guided by an accelerated pace of new discoveries, an ever-increasing depth of understanding of intracellular biological processes [2] and application of advances made in other fields of science [3]. Success in any field, especially in cancer medicine, is based on embracing evolution in understanding other scientific fields [4] and its application to the forward move in cancer therapeutics. As such, we have gone through discovery of a diverse group of therapeutics, targeting different sub compartments of growth and proliferation pathways [5] and taking advantage of their synergistic efficacy, in different combinations [6]. Dissection of immune regulatory pathways [7] and their interaction with cancer cell has led to the generation of modern immune therapeutic agents. Single-cell sequencing technology [8] has paved the way for the development of spatial omics [9], which has opened the way on deeper understanding of tumor evolutionary path [10]. This would give us the opportunity to design a new generation of cancer therapeutics [11] intercepting with the forward evolutionary path of tumor mass. Along this path, we face insurmountable barriers in developing meaningful and game changing treatment strategies by directing single changes in a hyper complex biological system [12], manifested by complexities of genome [13], epigenome [14], microRNA network [15], gene regulatory mechanisms [16], and protein-protein interactions [17]. Consequently, we need to search for a solution that enables us to freeze or slow down the forward evolutionary path of tumor mass [18], by making a single change in a game changing variable of cancer cell.

Environmental health and justice screening tools: a critical examination and path forward

Environmental health and justice screening tools: a critical examination and path forward

Chronicling the pursuit for full practice authority in Tennessee: Recommendations for a path forward

BackgroundThe quest for full practice authority (FPA) for Tennessee Advanced Practice Registered Nurses (APRNs) began with promise in the late 1960s. However, progress has stalled in the ensuing time, and prospects for advancing FPA do not look promising. PurposeThe purpose of this article is to chronicle the pursuit of FPA in Tennessee, offer reflections on what has transpired to date, and suggest a path forward. MethodsVarious data from various sources were used to chronicle the history of FPA in Tennessee, make the case for its need, and identify better approaches for success. DiscussionAs one of a dwindling number of states without FPA, access to primary care health services and the economic vitality of Tennessee communities are of concern. ConclusionThe path forward for achieving FPA in Tennessee necessitates changes in approach and players. Specific recommendations are offered.

Celebrating Our Progress and Charting the Path Forward

Celebrating Our Progress and Charting the Path Forward

Global Neurosurgery: A Path Forward Through Health System Strengthening.

The future of global neurosurgery should focus on addressing the unmet neurosurgical need from a health system approach should we hope to achieve sustainable and ethical change. In this article, we review the global building blocks, as defined by the World Health Organization, and use this framework to propose strategies to strengthen neurosurgical care on the global frontier. The targets for Universal Healthcare Coverage by 2030, as outlined by the United Nations Sustainable Development Goals, are reviewed, and the role of neurosurgeons in addressing the global targets is discussed. Surgical indicators according to the Lancet Commission on Global Surgery are also reviewed, and neurosurgical indicators are proposed according to the 6 surgical indicators of the commission. The execution of these global targets and indicators within the context of health system strengthening will be a persistent challenge, given the complexity of health system and its components. The neurosurgical community must continue to support, promote, and diversify collaborations, especially among deserts of neurosurgical care across the world. Innovative technology and education are essential to this global dilemma.

Cholera Management in Iraq: Challenges, Strategies, and the Path Forward

Cholera Management in Iraq: Challenges, Strategies, and the Path Forward

A path forward: social democratic strategies and responses to far-right populist challenges

ABSTRACT Social Democratic parties have been in crisis across Europe in recent decades. The once dominant party family has struggled to adapt to the structural challenges of post-industrialization, changes in its core constituency, and increased political competition from alternative parties. This article analyzes the welfare chauvinist shift embraced by some Social Democratic parties to assess its viability as an electoral strategy in response to this changing political landscape and far-right party challenges. The article analyzes individual-level data from 26 European countries from successive European Voter Survey rounds for 2014 and 2019. This article tests the relationship between voter positions on government intervention, redistribution, and immigration and support for Social Democratic parties. Issue salience data is also examined to identify the importance granted by the public to different concerns over time. Despite claims that welfare chauvinist approaches represent a path forward for Social Democrats, this research finds that this strategy is not a broad winning formula. Rather there are incentives for Social Democrats to return to their egalitarian and progressive roots on key socioeconomic and sociocultural issues.

HOPE Framework

This article outlines the Healing Opportunities for Processing Eco-grief (or HOPE) framework. Modeled on hope theory research, the framework includes four textual markers for hope: 1) Motivation for Change, 2) Belief that Change is Possible, 3) Plans for a Path Forward, and 4) Agency to Take Action. This article introduces the HOPE framework as a pedagogical strategy to assist educators in climate literacy practices that spark dialogue and healing through centering hope as a lived practice.