Programs In Different Countries Research Articles

Establishment of an internationally agreed minimum data set for acute telestroke

Introduction Globally, the use of telestroke programmes for acute care is expanding. Currently, a standardised set of variables for enabling reliable international comparisons of telestroke programmes does not exist. The aim of the study was to establish a consensus-based, minimum dataset for acute telestroke to enable the reliable comparison of programmes, clinical management and patient outcomes. Methods An initial scoping review of variables was conducted, supplemented by reaching out to colleagues leading some of these programmes in different countries. An international expert panel of clinicians, researchers and managers (n = 20) from the Australasia Pacific region, USA, UK and Europe was convened. A modified-Delphi technique was used to achieve consensus via online questionnaires, teleconferences and email. Results Overall, 533 variables were initially identified and harmonised into 159 variables for the expert panel to review. The final dataset included 110 variables covering three themes (service configuration, consultations, patient information) and 12 categories: (1) details about telestroke network/programme (n = 12), (2) details about initiating hospital (n = 10), (3) telestroke consultation (n = 17), (4) patient characteristics (n = 7), (5) presentation to hospital (n = 5), (6) general clinical care within first 24 hours (n = 10), (7) thrombolysis treatment (n = 10), (8) endovascular treatment (n = 13), (9) neurosurgery treatment (n = 8), (10) processes of care beyond 24 hours (n = 7), (11) discharge information (n = 5), (12) post-discharge and follow-up data (n = 6). Discussion The acute telestroke minimum dataset provides a recommended set of variables to systematically evaluate acute telestroke programmes in different countries. Adoption is recommended for new and existing services.

Immunisation program reviews in East and Southern Africa: 2012-2018; key lessons.

IntroductionWorld Health Organisation (WHO) recommends that countries conduct comprehensive national immunisation programme reviews regularly to help them identify systems wide-barriers or gaps and monitor performance against the set targets.Methodswe reviewed reports from the latest national immunisation program reviews conducted in the 20 countries in the subregion in the course of 2012-2018. We generated descriptive analysis of the findings across the subregion.Resultsthe 20 program reviews included field observations to the subnational levels as well as interviews with program staff and stakeholders. At the time of the reviews, only 11 countries had functional National Immunisation Technical Advisory Groups. Operational funding was inadequate in half of the countries. The reviews documented the cancellation of outreach services, supportive supervision visits and maintenance of cold chain equipment due to the lack of fuel or operational funding. Immunisation programs in 10 countries had major human resource gaps. Vaccine stock management tools were not effectively used in 10 countries, and stockout of vaccines and supplies was documented in 9 countries during the review. The full components of the Reaching Every District (RED) Strategy were implemented in only 3 of the 20 countries. Twelve countries reported challenges with the availability and accuracy of target populations. Four countries had documented the presence of vaccine hesitant groups at the time of the reviews.Conclusionthe reviews demonstrated challenges in various aspects of the programs in different countries. The implementation of the review recommendations should be built into the annual program plans, as well as into costed multi-year plans, in order to address the gaps and helps the program to attain the set targets. With the rapid evolution of the scope and complexity of the immunisation programs in recent years, countries should invest their efforts in building the capacity of their human resources as well as updating their logistics and data systems.

Regional settlement systems in Ukraine: features of development in terms of decentralization reform

Administrative and territorial reform in Ukraine is an extremely important stage in the development of our country. Decentralization creates new challenges for the regions, gives local authorities new powers, duties and responsibilities. For a comprehensive analysis of the possibilities and prospects of decentralization reform, it is important to analyze the existing world experience in implementing of the similar regional development programs in different countries. The implementation of such reforms in highly developed and developed countries is usually more successful than in developing countries, mainly due to the unpreparedness of local governments to the transformation of socio-political relations. Domestic and foreign scholars who have researched the course of decentralization reform in Ukraine note that it is extremely important to make appropriate changes to the Constitution of Ukraine and consolidate them at the highest state level. Decentralization reform, of course, cannot be considered as a universal tool for solving all existing problems of Ukraine, but it is an extremely important step towards comprehensive development of our country, taking into account the needs of the state and regions, the specifics of each, and the possibility for more effective implementation of regional policy measures by expanding the powers of local authorities. Thus, according to the new division, the largest districts in terms of population, the centers of which are the largest cities in Ukraine: Kharkiv, Odesa and Dnipro, which account for 4.8%, 3.8% and 3.2% of the population of the country's districts, respectively. Zaporizhia district of Zaporizhia region, Lviv district of Lviv region account for 2.4-2.1% of the population. Based on the cluster analysis of 119 newly formed districts of Ukraine by the Ward method, according to 24 indicators as of 2020, 8 clusters were identified. Cluster analysis of the regions of Ukraine by a similar method according to the level of urbanization allowed to identify 6 clusters. The established features should be taken into account in forming plans and programs of regional development, which should be scientifically substantiated, take into account the peculiarities of decentralization of power and contribute to improving the level and quality of life of the population.

Unconditional Basic Income: Public Opinion Attitude and Financial and Economic Aspects of Implementation

The Main Provisions of the Article. The article deals with studing the impact of introducing unconditional basic income (hereinafter in the text of the article DB) on the level of employment, the degree of social protection, and the quality of life of the population. The theoretical part of the article analyzes the results of several opinion polls abroad and in Russiya; the possible cost and economic risks of introducing database programs in different countries are given, assessed based on the results of simulation modeling by foreign authors, database capabilities in the field of combating poverty and inequality, its effect on employment is separately considered; positive and negative aspects, contradictions and limitations of this tool are highlighted and classified; The results of the largest experimental projects at the moment are systematized and analyzed. The conclusion is drawn about the complexity of the practical application of the database concept in Russiya. A number of practical recommendations have been made to predict the emergence of a number of problems associated with the introduction of unconditional basic income in our country: problems are identified that require further studyThe Object of the Study are countries and individual socio-demographic groupsThe Subject of the Study is the financial and socio-economic aspects and consequences of introducing unconditional basic income in the world: the attitude to the UBI of various socio-demographic groups, the impact of the UBI on employment, social protection of the population and quality of life.The purpose of the Studyis analyzing and study the results of opinion polls abroad and in Russiya, analyzing the cost and risks of implementing UBI programs, studing the results of existing simulation experiments, systematizing the available disparate information, analyzing and summarizing the results of the largest experimental projects and, based on them, giving practical recommendations for implementing UBI in Russia

Реабілітація пацієнтів із серцево-судинними захворюваннями: історичні віхи, сучасні підходи, місце в клінічній практиці та виклики

In the treatment of patients with myocardial infarction, a special place belongs to cardiac rehabilitation (CR), which today is positioned as a multifaceted multidisciplinary science, combined with preventive cardiology. CR includes physical training, psychological rehabilitation, sessions with a social worker (motivation to return to work); consultations and training programs which embrace discussion of issues of secondary prevention, including modification of risk factors, stimulating adherence to physical activity and drug treatment. Its purpose is to maximize the recovery of the physical, psycho-emotional and social condition of patients with their return to work, to preserve the quality of life and provide long-term detention of the progression of atherosclerosis. The review presents the main historical aspects of the development of CR, provides statistical indicators of inclusion in the program of CR after a cardiac event – myocardial infarction, percutaneous coronary intervention or coronary artery bypass grafting, presents indications and contraindications for CR. The data are presented of registries and clinical examinations on the effectiveness of CR with physical training for reducing the rates of overall mortality, cardiovascular mortality, hospitalizations, improvement of quality of life, impact on lipid metabolism and processes of myocardial remodeling. Issues related to the time of the beginning of CR with exercise training after index event, duration and intensity of aerobic exercise, assignment of dynamic and static exercises were discussed. One of the main problems in assessing the effectiveness of CR is the existence of many programs in different countries and even in different centers, which limits the possibility of correct comparison of research results. We provide the results of our own study (n=91) in which 47 patients underwent training on a cycle ergometer 11–45 days after the infarction. No differences were found in load tolerance, depending on the start of training. The efficiency of CR with its physical component has been proved regarding the threshold power level and the hemodynamic value of the work performed. The results are presented of cycling ergometry after training in dynamics during 1 year of observation after myocardial infarction depending on the time of coronary circulation recovery in the infarct-determining coronary artery, the number of affected coronary arteries and the completeness of revascularization. Based on the data of leading associations of rehabilitation and preventive cardiology in Europe and America, the main perspective directions for further development of CR are outlined.

Molecular screening programs in different countries

Precision medicine arised as a new paradigm in oncology in which molecular profiling aims at guiding therapy in oncology. The implementation of precision medicine necessitates setting up molecular tumor boards (MTBs) that coordinate the workflow of tumor samples to efficiently seek for actionable molecular alterations. We review here the main precision medicine initiatives that involve MTBs and decipher challenges that still need to be overcome along with future perspectives for a broader implementation of precision medicine in routine patient care. MTBs have been implemented in multiple countries. They identify actionable molecular alteration in up to 50% of patients. However, around 10-20% receive matched therapy and less than 6% of patients experience an objective response. The challenges that need to be overcome for a successful implementation of precision medicine include an earlier molecular profiling of patients during their disease course, the use of liquid biopsies that allow sequential analyses, along with more exhaustive gene panels and extended access to drugs. Molecular screening programs allow to successfully guiding patients to individualized therapy in a minority of patients, and few patients actually benefit from these programs.

Short communication: Mycolicibacterium smegmatis, basonym Mycobacterium smegmatis, causing pyogranulomatous mastitis and its cross-reactivity in bovine (para)tuberculosis testing

Different mycobacterial species are encountered in bovine medicine. The fastidiously growing mycobacteria (Mycobacterium bovis as the cause of bovine tuberculosis, and Mycobacterium avium ssp. paratuberculosis, MAP, as the cause of paratuberculosis) are well known and targeted in eradication/control or monitoring programs in different countries, whereas the rapidly growing species is only rarely identified from bovine disease. The latter have occasionally been reported as the cause of bovine clinical mastitis, but recent reports are scarce. In this study, Mycolicibacterium smegmatis (basonym Mycobacterium smegmatis) was identified as cause of granulomatous, relapsing clinical mastitis in 2 cows from one Belgian dairy herd. Milk, blood, and fecal samples were collected, as well as tissue samples after the cows were culled. Serological analysis conducted on milk and serum samples resulted in positive reactions for MAP, but negative for Mycobacterium bovis. Production of IFN-γ showed sensitization with mycobacteria or similar organisms, other than M. bovis, in one cow. Detection of MAP by bacteriological culture and IS900-based quantitative PCR on milk and feces remained negative. In conclusion, this paper describes M. smegmatis as a cause of bovine clinical mastitis in Belgium and suggests cross-reactivity of the intramammary M. smegmatis infection with routinely used serological tests for MAP.

Improvement of Orthopedic Residency Programs and Diversity: Dilemmas and Challenges, an International Perspective.

To date, little has been published comparing the structure and requirements of orthopedic training programs across multiple countries. The goal of this study was to summarize and compare the characteristics of orthopedic training programs in the U.S.A., U.K., Canada, Australia, Germany, India, China, Saudi Arabia, Russia and Iran. We communicated with responders using a predetermined questionnaire regarding the national orthopedic training program requirements in each respondent's home country. Specific items of interest included the following: the structure of the residency program, the time required to become an orthopedic surgeon, whether there is a log book, whether there is a final examination prior to becoming an orthopedic surgeon, the type and extent of faculty supervision, and the nature of national in-training written exams and assessment methods. Questionnaire data were augmented by reviewing each country's publicly accessible residency training documents that are available on the web and visiting the official website of the main orthopedic association of each country. The syllabi consist of three elements: clinical knowledge, clinical skills, and professional skills. The skill of today's trainees predicts the quality of future orthopedic surgeons. The European Board of Orthopedics and Traumatology (EBOT) exam throughout the European Union countries should function as the European board examination in orthopedics. We must standardize many educational procedures worldwide in the same way we standardized patient safety. Considering the world's cultural and political diversity, the world is nearly unified in regards to orthopedics. The procedures (structure of the residency programs, duration of the residency programs, selection procedures, using a log book, continuous assessment and final examination) must be standardized worldwide, as implemented for patient safety. To achieve this goal, we must access and evaluate more information on the residency programs in different countries and their needs by questioning them regarding what they need and what we can do for them to make a difference.

The Role of Community-Based Early Childhood Programmes in Children Learning: The Concept of Funds of Knowledge

In Turkey, the Government aims to implement a community-based early childhood programme for those who come from economically disadvantaged areas. This is highlighted in the 2023 Education Vision, which was released in 2018. Nurseries, local educational authorities and other local institutions such as municipalities in such areas are expected to prepare for the community-based programme. The goal of this study is to examine the implemented community-based early childhood programmes in different countries and to indicate how such programmes connect homes and communities to school. This study reviews literature on community-based early childhood programmes in different countries. It shows that such programmes can develop children cognitive and language skills, and readiness for future academic life. It also suggests that community-based early childhood programmes need to focus on how children transmit their learning from home and community to school, and from school to home

Perceptions of English Teachers in Turkey and Germany

We can assert that teachers have a key role for the success of program implementations. Also, the compatibility of beliefs and pedagogical practices of the teachers is significant. Analyzing the perceptions of teachers on programs in different countries may provide us with comparative lenses to comprehend how primary English programs are applied in each country and teachers' beliefs about English teaching. Therefore, the aim of this study is to compare the perceptions of English teachers on primary school English programs in Turkey and the states of Germany (North Rhine-Westphalia, Baden Wurttemberg and Berlin). This is a qualitative case study based on data from the perspectives of teachers. Semi-structured interview form was used with the study group including primary school English teachers in Turkey and Germany. On the basis of data, it can be concluded that teachers in Turkey are not trained to teach children and do not get sufficient support for professional development whereas the teachers in Germany are class teachers with English degrees, because the teacher trainings in these countries are different. In addition, while the teachers in Turkey experience difficulties with various reasons, English teachers in Germany have no difficulty in implementing the English programs overall.

Psychological management set against pharmacotherapy: A scholastic challenge in contemporary psychiatric training

Despite the fact that the swing of the pendulum toward biological psychiatry has led, in general, to a downgrading of psychotherapy within the realm of psychiatry, in current years a fresh debate regarding practice of psychotherapy by psychiatric residents and psychiatrists has gained a new place in the realm of academic training. Such kind of encouragement, for using psychotherapy on behalf of patients who are suffering from psychiatric complications, has instigated essential modification in the contemporary educational programs in different countries, including developing civilizations. In the present paper the exact condition and outlook of such an amendment has been discussed to understand that whether simple addition of a national curriculum can answer back, applicably, to increasing necessities of mental health in developing cultures, and how the honest exercise of psychological managements by psychiatrists can be improved.

DIGITALIZATION OF EDUCATION IN THE CONTEXT OF DIGITAL INEQUALITY

The problem of forming digital literacy of society is considered through the created so­cio-cultural prerequisites for the implementation of digitalization programs in different countries. It is shown that the existing methods for the analy­sis of digital involvement allow fixing the existing «digital gap», but do not answer the question of ways to preserve human capital in peripheral re­gions. In particular, it is shown that the implemen­tation of the «knowledge society»concept becomes a reality only for those countries whose manage­ment system has been coordinated at the state and regional levels, and has been able to implement the principles of openness and accessibility in the field of education and information technolo­gy. The implementation of these principles makes it possible to build a more flexible education sys­tem, which will create socio-cultural prerequisites for remote and less developed regions to solve the country»s new tasks of creating universal digital literacy and neutralizing social problems caused by increasing digital inequality. The interdisci­plinary research uses institutional, functional and socio-cultural approaches. The conclusions are il­lustrated by the results of quantitative assessment of the main parameters used to determine the level of digitalization of society.

Investing in early childhood development in the context of reforming educational funding in Ukraine

The world community agrees on the conceptualizing nature of early childhood development. This was formulated in the Incheon Declaration and in the 2030 Agenda for Sustainable Development. The most significant part of the early development concept is the pre-primary education, which covers early childhood educational development and pre-school programs. Society's investments in early childhood development are highly profitable as resources spent are much less than the return from them: according to some estimates, $1 spent on pre-primary education can gain from $4 to $17 of social return. At the same time, financial resources, that countries can spent on education, are limited, especially after the latest financial crisis. In Ukraine, the situation is worsened by the domestic socio-economic crisis of 2013–2014. The article aims at grounding the ways of pre-primary education financing in Ukraine in the context of the implementation of early childhood development concept. The author assesses financial support for childcare, early childhood education and pre-school education programs in different countries. The comparative analysis showed a low level of financing and a negative trend in Ukraine, in particular compared with the neighboring EU-countries such as Poland, Slovakia, Hungary and Romania. This indicates a low financial viability of providing quality pre-school education services in Ukraine. If the trend remains, Ukraine will lag behind the average indicators of social returns from pre-school education, especially in comparison with developed economies. The author substantiates the expediency of applying in Ukraine the measures aimed at supporting licensed private pre-school education institutions, in particular, simplifying the procedures for starting pre-school educational activities, state participation in financing licensed private pre-school institutions and applying innovative schemes for financing pre-school education based on public-private partnership.

Transcriptional response to a prime/boost vaccination of chickens with three vaccine variants based on HA DNA and Pichia-produced HA protein

Highly pathogenic avian influenza causes severe economic losses and is a potential threat to public health. Better knowledge of the mechanisms of chicken response to the novel types of vaccines against avian influenza might be helpful in their successful implementation into poultry vaccination programs in different countries. This work presents a comprehensive analysis of gene expression response elicited in chicken spleens by a combined DNA/recombinant protein prime/boost vaccination compared to DNA/DNA and protein/protein regimens. All groups of vaccinated chickens displayed changes in spleen transcriptomes in comparison to the control group with 423, 375 and 212 identified differentially expressed genes in protein/protein, DNA/DNA and DNA/protein group, respectively. Genes with most significantly changed expression belong to immune-related categories. Depending on a group, a fraction of 15–34% of up-regulated and a fraction of 15–42% of down-regulated immune-related genes are shared by all groups. Interestingly, the most upregulated genes encode β-defensins, short peptides with antimicrobial activity and immunomodulatory functions. Microarray results were validated with RT-qPCR method, which confirmed differential regulation of the selected immune-related genes. Immune-related differentially expressed genes and metabolic pathways identified in this work are compared to the available literature data on gene expression changes in vaccinated and non-vaccinated chickens after influenza infection.

Economic Citizenship: Is it Worthy Investment?

The selling of economic citizenship is expanding and gradually becoming an industry. Economic citizenship is a well-defined process whereby wealthy individuals can obtain a second citizenship quickly in exchange for an investment or donation. A Caribbean passport settles for 100,000 USD for singles and 150,000 USD for a family. The economic analysis of economic citizenship calls for a different approach than naturalized citizen’s decisions. This paper explains the economic citizenship concept and weighs the cost-benefit analysis of economic citizenship in three aspects, vis-a-vis: visa free, marginal contribution and investment threshold aspects. The return on economic citizenship investment for the visa free access is moderate, around 1% for a single and 2.5% for a family. However, the benefits of acquiring the economic citizenship from an EU country can compensate the low return on visa free access. Under the marginal analysis, we eliminated the redundancy among passports and we calculated the additional benefits of an extra passport. This shows that acquiring passport from developing countries is not meaningful for the citizens from developed countries, especially, Turkish and Jordanian citizenship, because investment programs remain very expensive. We are expecting that they will lower the investment threshold. Under the investment analysis, we demonstrated the minimum investment requirement and we suggested that the best deal is from Montenegro. Moreover, the paper predicts the upcoming fee changes and investment opportunities of economic citizenship programs in different countries.

CoCanCPG. Coordination of cancer clinical practice in Europe.

All European countries are facing common challenges for delivering appropriate, evidence-based care to patients with cancer. Despite tangible improvements in diagnosis and treatment, marked differences in cancer survival exist throughout Europe. The reliable translation of new research evidence into consistent patient-oriented strategies is a key endeavour to overcome inequalities in healthcare. Clinical-practice guidelines are important tools for improving quality of care by informing professionals and patients about the most appropriate clinical practice. Guideline programmes in different countries use similar strategies to achieve similar goals. This results in unnecessary duplication of effort and inefficient use of resources. While different initiatives at the international level have attempted to improve the quality of guidelines, less investment has been made to overcome existing fragmentation and duplication of effort in cancer guideline development and research. To provide added value to existing initiatives and foster equitable access to evidence-based cancer care in Europe, CoCanCPG will establish cooperation between cancer guideline programmes. CoCanCPG is an ERA-Net coordinated by the French National Cancer Institute with 17 partners from 11 countries. The CoCanCPG partners will achieve their goal through an ambitious, stepwise approach with a long-term perspective, involving: 1. implementing a common framework for sharing knowledge and skills; 2. developing shared activities for guideline development; 3. assembling a critical mass for pertinent research into guideline methods; 4. implementing an appropriate framework for cooperation. Successful development of joint activities involves learning how to adopt common quality standards and how to share responsibilities, while taking into account the cultural and organisational diversity of the participating organisations. Languages barriers and different organisational settings add a level of complexity to setting up transnational collaboration. Through its activities, CoCanCPG will make an important contribution towards better access to evidence-based cancer practices and thus contribute to reducing inequalities and improving care for patients with cancer across Europe.

Study on the adverse effects affecting treatment outcome in smear positive tuberculosis patients under DOTS in Amritsar city

Background: The world adopts DOTS strategy for TB control thought the national TB control programs in different countries and is making good progress. Despite the positive therapeutic effects, studies have shown that utilization of multidrug regimens can cause undesirable adverse drug reactions (ADRs) of varying degrees of severity, such as hepatotoxicity, gastrointestinal disorders, allergic reactions, arthralgia, neurological disorders and non-adherence to treatment as well. Methods: The study was conducted on new smear positive patients registered under DOTS in two Treatment Units (TUs) present in Amritsar city. The prevalence of various adverse effects like gastro-intestinal, hepato-biliary, visual disturbances, musculoskeletal, skin and appendages, peripheral nervous system, etc was recorded and their effect on the outcome was observed. Data management and analysis was done by using Microsoft excel and SPSS version 17.00. Results: Out of 250 patients, 149 (59.6%) were males and 101(40.4%) were females. Out of the total 250 cases, adverse effects were present in 44.4% cases. Most common adverse effects observed were gastrointestinal in 63.9% followed by fever and chills in 28.8% of cases. Conclusions: On statistical analysis, it was observed that the absence of adverse effects was significantly associated with the favourable outcome (p<0.001).

Виміри глобального інноваційного розвитку та трансформація промислової політики країн.

The article is devoted to the analysis of changes in industrial development programs in different countries during the second polyvine of the XX and the beginning of the XXI centuries. Different views on the term strategy are considered, the evolution of the apparatus of planning by economies in the countries of the world is considered. The main factors influencing the change in the economy of the leading powers are presented. Also, the main drivers of innovation in the socio-political life of the countries of the world are identified. The article gives a taxonomy scheme for national innovation systems. The influence between the introduction of innovations and the development of the economy and the level of socio-political life of the states is proved.

Locations of L2/Ln Sign Language Pedagogy

There has been tremendous growth in the teaching of sign language as a foreign sign language in elementary/secondary schools, colleges/universities, private businesses, and agencies. While this surge has allowed students to obtain foreign language credit for personal or professional reasons, the acceptance of teaching sign languages has had its challenges. Traditionally, sign language courses have been provided face-to-face using a variety of curricula in diverse departments, academic programs, and degree programs in different countries. This paper acts as a reference guide that provides locations of where sign languages are formally taught around the world, as well as learning about Deaf culture. Historical and current pedagogical practices are also discussed. Looking ahead to the future, one growing trend is providing sign language courses online in a distance-learning format to meet the high demands of interested students and reach a wider population. Moreover, examining the importance of utilizing well-trained and certified instructors, and implementing current pedagogical practices and materials that include appropriate cultural opportunities are needed to effectively teach sign language classes.

The International Parenting Survey: Rationale, Development, and Potential Applications

ABSTRACTThe quality of parent-child interactions and family relationships has a powerful influence on children’s development and well-being. The International Parenting Survey (IPS) is a brief, web-based survey developed to provide a cross-national, community-level, population snapshot of the experiences of parents related to raising children. The IPS was developed as a planning tool to assist policy makers and community agencies plan, implement, and evaluate parenting programs and as a tracking tool to evaluate parenting support programs in different countries. We report the preliminary psychometric properties of the IPS on various domains of measurement in an international sample of over 9,000 parents. Moderate to high reliabilities were obtained for all domains of measurement. High internal consistency reliabilities (α = .88–.97) were obtained for the domains of children’s behavior and emotional maladjustment, for parental self-efficacy, parental distress and parental beliefs. Moderate levels of reliabilities (α = .52–.83) were obtained for domains of parental consistency, coercive parenting, positive encouragements, and parent-child relationships. Overall, the measure appears to have satisfactory reliability justifying further psychometric validation studies in population level studies of parenting. Examples of uses of the IPS are described and directions for future research and policy explored.