Stakeholder Discussions Research Articles

Use of Basket Trials to Solve Sleep Problems in Patients with Rare Diseases

The need for sleep is universal, and the ability to meet this need impacts the quality of life for patients, families, and caregivers. Although substantial progress has been made in treating rare diseases, many patients have unmet medical sleep needs, and current regulatory policy makes it prohibitively difficult to address those needs medically. This opinion reviews the rare disease experience with sleep disorders and explores potential solutions. First, we provide case profiles for the rare diseases Wilson’s Disease, Angelman Syndrome, and Prader–Willi Syndrome. These profiles highlight challenges in rare disease diagnosis and barriers to pinpointing disease pathophysiology, including biomarkers that intersect with sleep disorders. Second, we transition to a bird’s eye view of sleep disorders and rare diseases by reporting input from a stakeholder discussion with the U.S. Food and Drug Administration regarding abnormal sleep patterns in various rare diseases. Last, in response to the profound unmet medical needs of patients with rare diseases and sleep disorders, we propose adapting and using the clinical trial design known as a “basket trial”. In this case, a basket trial would include patients with different rare diseases but the same debilitating symptoms. This research approach has the potential to benefit many rare disease patients who are otherwise left with profound unmet medical needs.

Developing regional Diabetes Registries in Italy: pilot projects implementation within JACARDI

Abstract Issue/Problem In Italy a National Diabetes registry is planned but not yet set up at the Ministry; JACARDI is contributing to speed up the process so that critical gaps in health data availability can be filled. While some regional registries exist, the lack of cohesion and standardization hinders the tracking of prevalence, incidence, and sequelae, crucial for evidence-based policymaking amidst rising diabetes rates. Description of the Problem The JACARDI project, supported by EU funding and running for four years, engages 76 partners from 21 countries and includes 142 national-level projects. Among its focus areas is enhancing data availability, aiming to establish harmonized regional Diabetes registries in Italy to tackle this issue. These efforts aim to create a scalable model enabling data linkage, diabetes type differentiation, and socio-demographic integration. Collaboration with health authorities and societies, drawing insights from existing registries, informs the development process. Results A total of 11 regional Diabetes registries are currently in the design phase of implementation. They adhere to a clearly defined methodology, with established essential parameters and data linkage. Consensus on these parameters and linkage was reached through stakeholder discussions, drawing on past registry experiences. The primary goal of the registries is to monitor diabetes prevalence, stratify incidence by demographics, and track sequelae to inform targeted interventions and resource allocation. While scalability beyond Italy may encounter administrative challenges, standardized protocols facilitate transferability. Data Protection stands out as a significant implementation obstacle. Lessons Standardized data collection, stakeholder collaboration, and sustainability are vital in registry development. Leveraging data availability for surveillance demonstrates adaptability and scalability, offering valuable insights for enhancing diabetes management. Key messages • Standardized data collection and stakeholder collaboration are pivotal in establishing effective diabetes registries, fostering equity and improving health outcomes. • Leveraging data availability for surveillance offers a scalable and sustainable approach to diabetes management, facilitating informed policymaking and interventions.

Life cycle sustainability assessments of critical civil infrastructure systems: additional guidance for future research and practical application

ABSTRACT Sustainable development of critical civil infrastructure systems should include economic, environmental, and social considerations, as well as considerations that are of high value to stakeholders and decision-makers. Life cycle economic and environmental impacts of critical civil infrastructure systems are commonly quantified by well-established methodologies such as life cycle assessment and life cycle costing. However, social and other related impacts of critical civil infrastructure systems can be difficult to quantify and are therefore less commonly and thoroughly addressed. A mini-literature review was conducted to explore how sustainability is currently evaluated for critical civil infrastructure systems. The review found that, while there are life cycle assessment frameworks available, there is vague guidance available for addressing factors that are not directly related to environmental, economic, or social (i.e., difficult to quantify) impacts. In response, the authors build upon currently available methodologies by discussing a supplemental approach for collecting additional data for critical civil infrastructure systems, which includes the use of stakeholder discussions and semistructured interviews. Including a range of factors early on in life cycle sustainability assessments of critical civil infrastructure can improve study robustness and allow for further integration of decision-making factors in life cycle sustainability assessments.

DiScO: novel rapid systems mapping to inform digital transformation of health systems

BackgroundGlobal health systems are confronting challenges that intersect climate change with evolving communicable and non-communicable public health risks. Addressing these challenges requires systems integration via citizen big data that exist outside health systems. However, systems integration across jurisdictions is a complex challenge that requires stakeholder input. This study’s purpose was to conduct rapid systems mapping with international health system stakeholders to inform the development and implementation of a global digital citizen science observatory (DiScO), which aims to catalyze digital transformation of health systems across jurisdictions.MethodsA rapid qualitative systems mapping study was conducted during the International Society for Behavioral Nutrition and Physical Activity Annual Global Summit in Uppsala, Sweden, in June 2023. The choice of the venue and approach was informed by three key criteria: (1) Established evidence linking physical activity and nutrition with non-communicable diseases; (2) Concrete existing methods of obtaining citizen big data by physical activity and nutrition researchers; (3) Precedence of physical activity and nutrition researchers conducting citizen science as well behavioral/clinical big data collection. The design of this study was an innovative pre-post systems map development, which consisted of (1) real-time rapid systems mapping (pre/initial map) by engaging with international stakeholders and (2) adjustment of the real-time systems map (post/final map) after analyzing stakeholder discussion data.ResultsRapid systems mapping resulted in a complex network that included key themes to successfully develop and implement DiScO: priorities, opportunities, risks, challenges, partnerships, and resources. Additionally, a new theme emerged organically through stakeholder group discussions – mitigation strategies. The adapted rapid systems map (i.e., after data analyses) depicts 23 key nodes of intervention across the seven key themes.ConclusionRapid systems mapping at international symposia is a novel methodological approach to capture stakeholder input, particularly to understand complexity across international jurisdictions – an approach that can be replicated across disciplines and sectors to inform digital transformation of health systems. The development and implementation of DiScO, a platform for decentralization and democratization of technology, will take into consideration all the key nodes of intervention identified in the rapid systems map to promote digital health for equity across global jurisdictions.

A Survey to Determine the Zone of Equipoise for the Proximal FEmur Resection or Internal Fixation fOR Metastases (PERFORM) Randomized Controlled Trial.

The objective of this study was to establish a zone of clinical equipoise for the P roximal F E mur R esection or Internal F ixation f OR M etastases (PERFORM) randomized controlled trial, which will compare resection and endoprosthetic reconstruction to internal fixation for skeletal metastases of the proximal femur. A survey was developed, piloted, and distributed to self-declared interested stakeholders in the PERFORM trial. The survey targeted orthopaedic oncologists and was designed to assess patient and bone lesion characteristics that drive surgical decision making in the treatment of skeletal metastases in the proximal femur. An Ethics Waiver was obtained at the lead academic institution and data was collected in the REDCap survey database. Responses were complete from 76 surgeons across North America, South America, Europe, Asia and Africa. Responses indicate that a study population for which either resection and endoprosthetic reconstruction or internal fixation are acceptable options include: (1) life expectancy at least 6 months, (2) bone loss of no more than 75% and no less than 25%, and (3) minimal to moderate risk for peri-operative complications. Ninety-three percent of respondents indicated that they would be interested in participating in the PERFORM trial. A preliminary zone of equipoise for the PERFORM trial includes patients with 25-75% bone loss, low to moderate risk of operative complications, and life expectancy of at least 6 months. Further stakeholder discussions will finalize the PERFORM trial protocol prior to study initiation.

Design process of ruins of the Great East Japan Earthquake: Nakahama Elementary School

PurposeThis study clarifies the design process for preserving and opening Nakahama Elementary School, damaged in the 2011 Great East Japan Earthquake, to the public in 2020 as a museum facility that allows visitors to view the interior and learn about what was experienced here on March 11, 2011.Design/methodology/approachThere are several unique aspects of the processes for preserving Nakahama Elementary School and the design for reopening it as a disaster ruins and museum facility. This paper explains the significances of the processes and results and provides detailed insights from involvement in the design process and includes a detailed chronology of the process. It also deals with important questions raised regarding the preservation of disaster remains and what lessons should be conveyed to visitors based on the reality of the disaster experience on this site.FindingsOver 10 years, storytelling, committee recommendations, a master plan, regulations and renovation design were developed through a layered, step-by-step process to determine the meaning of the ruins. Rather than emphasizing earthquake threats or reconstruction achievements, it was important to understand the latent meaning of the site through stakeholder discussions, capture details of the disaster experience for visitors to relive and express the region’s unique disaster culture.Originality/valueThis original case study comprehensively describes administrative procedures and community relationships in preserving and utilizing disaster remains. As the author served on the initial study committee and continued to be responsible for the basic planning, architectural renovation design, exhibition planning and actual production of the guidebooks, the paper presents rare insights from the real experience of practical involvement in the planning and design process of the preservation of this heritage site.

Advancing patient-centered clinical decision support in today's health care ecosystem: key themes from the Clinical Decision Support Innovation Collaborative's 2023 Annual Meeting.

This perspective summarizes key themes that arose from stakeholder discussions at the inaugural Clinical Decision Support Innovation Collaborative (CDSiC) 2023 Annual Meeting. The CDSiC is an Agency for Healthcare Research and Quality (AHRQ)-funded innovation hub for patient-centered clinical decision support (PC CDS). The meeting took place on May 16-17, 2023, and engaged 73 participants that represented a range of stakeholder groups including researchers, informaticians, federal representatives, clinicians, patients, and electronic health record developers. Each meeting session was recorded and had 2 notetakers. CDSiC leadership analyzed the compiled meeting notes to synthesize key themes. Participants discussed 7 key opportunities to advance PC CDS: (1) establish feedback loops between patients and clinicians; (2) develop new workflows; (3) expand the evidence base; (4) adapt the CDS Five Rights for the patient perspective; (5) advance health equity; (6) explore perceptions on the use of artificial intelligence; and (7) encourage widespread use and scalability of PC CDS. Innovative approaches are needed to ensure patients' and caregivers' voices are meaningfully included to advance PC CDS.

Access to healthcare services and factors associated with unmet needs among migrants in Phuket Province, Thailand, 2023: a cross-sectional mixed-method study

BackgroundPhuket Province is a major tourist destination with a migrant workforce accounting for 10% of its population. Despite governmental efforts to adjust health insurance policies, migrants face healthcare access challenges. This study examines the current healthcare access situation and factors associated with unmet needs among migrants in Phuket Province.MethodsWe used a cross-sectional mixed-methods approach, recruiting participants through snowball sampling from the Migrant Health Volunteer Network. Quantitative data were gathered using self-administered questionnaires, with unmet need defined as desired outpatient or recommended inpatient services not received at government hospitals. Multivariable logistic regression identified unmet need predictors, and we assessed the mediating effect of health insurance status. Qualitative data from three focus groups on healthcare access provided context and enriched the quantitative findings.ResultsThis study includes 296 migrants mainly from Myanmar. The overall unmet need prevalence was 14.86%, mainly attributed to having undocumented status (34.09%), affordability issues (20.45%), and language barriers (18.18%). Working in the fishery industry significantly increased unmet needs risk (aOR 2.68, 95% CI 1.08–6.62). Undocumented status contributed a marginal total effect of 4.86 (95% CI 1.62–14.54), with a natural indirect effect through uninsured status of only 1.16 (95% CI 0.88–1.52). Focus group participants used various medical resources, with insured individuals preferring hospital care, but faced obstacles due to undocumented status and language barriers.ConclusionValid legal documents, including work permits and visas, are crucial for healthcare access. Attention to fishery industry practices is needed. We recommend stakeholder discussions to streamline the process of obtaining and maintaining these documents for migrant workers. These improvements could enhance health insurance acquisition and ultimately improve healthcare affordability for this population. These insights could be applied to migrant workers in other urban and suburban area of Thailand regarding access to government healthcare facilities.

Criteria for evaluation of modern architecture in Bosnia and Herzegovina to support its preservation

PurposeAs detailed criteria for evaluation of modern architecture do not yet exist in Bosnia and Herzegovina (B&H), the aim of this paper is to assist in their development by providing an analysis of the scope of those criteria in the related international documents. The research objective is to identify what values of modern architecture were historically and are currently considered significant to merit its preservation.Design/methodology/approachThe research methods include a review of relevant literature, collecting data from the B&H and international organisations criteria for evaluation of architectural heritage; a comparative analysis of the collected data to propose criteria for evaluation of modern architecture in B&H that are aligned with the evaluation criteria of UNESCO’s World Heritage List and with Docomomo’s criteria.FindingsThe above comparative analysis showed that such criteria could be developed by selecting relevant criteria from a long list of criteria for evaluation of built heritage in B&H, which currently do not consider architecture built after 1960.Practical implicationsThe proposed evaluation criteria will be tested on different typologies of modern architecture in B&H to enable wider discussion of stakeholders and relevant agencies on their applicability.Social implicationsThe proposed evaluation criteria will contribute to the promotion of architectural heritage of the 20th century in B&H.Originality/valueThere has been no previous research on how to develop criteria for evaluation of architectural heritage of the 20th century in B&H.

From needs to policy action: Italian agri-food districts as a case of territorial cooperation

In the context of ecological and social challenges in global food systems, this study investigates the potential of agri-food districts to foster balanced territorial development. A multi-step approach to developing sustainable agri-food districts is outlined. How these districts, as integrated systems and meso-level organizational forms, can enhance sustainability through governance is then assessed. This research uses a context-driven analysis pathway involving stakeholder participation and needs identification. The theoretical background, the Italian regulatory framework, and a case study from Lombardy are presented. Needs are identified through participatory approaches and actions are prioritized using desk research and a narrative SWOT analysis combined with key stakeholder discussions (focus group). A total of eighteen needs are identified and categorized into 3 dimensions of sustainability: economic, environmental, and socio-institutional. Findings indicate that agri-food district organization has great potential to help achieve local and regional policy goals in line with the shift to sustainable approaches in the Common Agricultural Policy (CAP). The paper proposes actions to strengthen district capacity-building, focusing on internal governance and sustainable production chains. Additionally, initiatives to attract young people to rural areas and agreements for ecosystem services in agri-food districts are suggested. These actions aim to promote sustainability and competitiveness while addressing challenges related to governance, innovation, branding, demographics, and environment. In conclusion, the study prompts critical inquiry into governance models and system dynamics. The innovative aspects of this study lie in its methodological approach, integration of theory and practice, holistic perspective, policy relevance, and critical inquiry, which collectively contribute to advancing knowledge and understanding in the field of sustainable agriculture and territorial development.

Exploring Important Attributes, the Potential Use Cases and Feasibility of Introduction of Measles and Rubella Microarray Patches (MR-MAPs): Insights from Nine Countries.

Background: Microarray patches (MAPs) are innovative, needle-free vaccine delivery systems, suitable for administration by minimally trained health care workers or trained community health workers. Their introduction may transform immunization programmes, particularly for vaccines where high coverage is required for population immunity, such as measles, and where vaccine delivery is challenging, such as in low- and middle-income countries. Recognizing the need to understand how best to tailor these products to reflect country priorities, workshops on measles and rubella MAPs (MR-MAPs) were conducted in multiple regions to collect insights on needs and preferences from relevant stakeholders at country level. Methods: The CAPACITI Innovation Framework was used to structure stakeholder discussions in nine countries in the period from August 2022 to July 2023. The discussions, building on the findings from a situation analysis on the barriers related to measles and rubella vaccine delivery, followed the four-step process outlined in the framework. Results: Key barriers hindering delivery of measles and rubella vaccines across the countries were in the categories of human resource management, service delivery, and demand generation. MR-MAP attributes that stakeholders believed would reduce or eliminate these barriers included ease of preparation and administration, improved thermostability, fewer (ancillary) components, and single-dose presentation. Some attributes such as the site of administration, wear time, and storage volume could exacerbate certain barriers. Based on an understanding of key barriers, product attributes, and underserved populations, stakeholders identified several potential use cases for MR-MAPs: (i) delivery at a fixed health post, (ii) delivery through outreach sessions conducted by health workers, and (iii) administration by community health workers. To enable robust national decision making about the introduction of MR-MAPs and successful implementation, global and national evidence on feasibility and acceptability of MR-MAPs should be generated. To prepare for the potential introduction of MR-MAPs, immunization programmes should evaluate their immunization policies based on their preferred use cases and modify them if needed, for example, to enable community health workers to administer vaccines, along with making programmatic adjustments to waste management and training. Conclusions: MR-MAPs have the potential to reduce key barriers to MR delivery. Yet, their future impact depends on the ability of global stakeholders to steer the development of MR-MAPs to be responsive to country needs and preferences. The generation of evidence to enable robust decision making, timely modification of vaccine policies, and addressing programmatic considerations will be key to successful uptake.

Exploring Potential Challenges in Implementing a Standardized Curriculum for the Physician Associate Program in India: Insights From Stakeholder Discussions

Introduction This article explores the potential challenges in implementing a national-level standardized curriculum for physician associate (PA) programs in India, an initiative under the directions of the National Commission for Allied and Healthcare Professionals Act of 2021. Methods Initiated in August 2023, a multistage process began with emailing a draft curriculum for review to key stakeholders, followed by a virtual meeting on September 3. Key stakeholders, including faculty from various universities, participated in focus group discussions (FGDs) at the International Association of Physician Associate Educators and the Indian Association of Physician Assistants annual conference on September 21, 2023, in Gandhinagar. Results Four major themes emerged: (1) faculty development, (2) faculty recruitment, (3) alignment with the National Educational Policy, and (4) the necessity of master's degree programs for PAs. Challenges identified included shortage of qualified faculty, uncompetitive salaries for academic roles, and low enrollment in master's programs. Recommendations included increasing financial compensation for teaching PAs, developing more PA educators through additional master's programs, encouraging hospitals to mandate clinical and teaching roles for recruits, and introducing pedagogical training for PAs interested in teaching. Discussion Implementing a standardized curriculum for PAs faces significant challenges, especially in faculty recruitment and retention. Engaging a broader range of stakeholders is essential for the successful rollout of the curriculum and for meeting India's evolving health care needs.

Stakeholder Perspectives on Research, Policy and Practice Priorities to Increase Human Milk Feeding Rates in the United Kingdom.

Human milk feeding rates in the United Kingdom are a public health concern. Changes to United Kingdom policy and practice are needed to improve lactation support. These should be informed by those with lived experience of human milk feeding and those who provide support. The aim of this study was to identify research, policy, and practice priorities for increasing human milk feeding rates using insights from a wide range of stakeholders. A secondary aim was to evaluate the influence of a World Café on individual attendees and their interactions within the organizations and communities of which they are a part. The research employed a participatory qualitative design, incorporating a cross-sectional survey and World Café discussions. World Café is a novel approach to engaging stakeholders in discussion, resulting in consensus-building and participatory-driven recommendations. A pre-event survey was completed by a self-selected sample of 67 participants; 37 of these (55%) took part in World Café discussions or an online focus group. World Café discussions and the online focus groups were recorded and transcribed verbatim. Following the World Café, 12 participants (32%) completed a post-event survey, and eight (22%) completed an additional follow-up survey at 2 months. Priority policy and practice changes were identified, including enhancing education, the need for dedicated funding for human milk feeding support, the need to include family within support provision, and the need to change policy regarding media representations of infant feeding. In addition, World Café methodology proved valuable for facilitating networking and instigating changes in relation to support. World Café generated stakeholder agreed-on priorities for research and policy. Many of the recommendations from historical policy and guidance continue to be areas for further development.

Including a wider range of values in healthcare policy: how can public value evaluation help?

To meet future healthcare challenges a broader range of values need to be included in analysis, debate and policy. Different modes of governance foreground and facilitate different values. Collaboration, the governing principle of the newly formed integrated care systems, values the contribution of diverse stakeholders in discussions and decisions, to foster creativity and produce durable solutions to complex problems. Approaches to evaluation reinforce particular values, as captured in the adage 'what's measured is what matters'. New approaches are needed to support the collaborative aims of integrated care systems. Public value evaluation proceeds through values inquiry, establishing what is important to different stakeholders (including policy makers, healthcare staff, patients and communities) as a backdrop to understanding the effects of policies and programmes.

EFSA's activities on emerging risks in 2022

Abstract The main objectives of EFSA's activities on emerging risks encompass: (i) conducting activities to identify emerging risks; (ii) developing and improving emerging risk identification (ERI) methodologies and approaches; and (iii) communicating identified issues and risks. The outcome of these activities equips EFSA to anticipate forthcoming challenges in the continuously evolving landscape of risk assessment. EFSA networks of knowledge contributing to the emerging risks identification activity include the Emerging Risks Exchange Network (EREN), the Stakeholder Discussion Group on Emerging Risks (StaDG‐ER), EFSA's scientific units, the scientific panels, the Scientific Committee and their working groups. The current technical report summarises the activities of all groups involved in the emerging risk identification procedure, the issues identified in the course of 2022, the emerging risk identification methodologies being developed, and the collaborative activities. In total, 13 potential emerging issues were discussed in 2022 and two were concluded to be emerging risks. The potential issues were classified according to the hazard. The year 2022 marks a turn in EFSA's activities on emerging risk identification. To achieve strategic objective no. 2 ‘Ensure preparedness for future risks analysis needs’ of the EFSA Strategy 2027, a new process ‘Environmental scanning and strategic options definition’ has been developed. The process adds to the already existing emerging risks analysis workflow a second workflow that is more forward‐looking, to deal with horizon scanning in the areas of food and feed safety, plant health and animal health. Similarly to the emerging risks analysis workflow, the new workflow for horizon scanning strongly relies on partnership to be prepared for future challenges, build resilience, and proactively shape the future in a one‐health approach.

A Hybrid Decision Support System for Partition Walls

Partition walls play a crucial role in buildings, influencing their aesthetics, functionality, and integration with other architectural elements. However, the selection process for partition wall types is often challenging due to the multitude of options available, varying decision criteria, and inadequate decision-making practices in the Architecture, Engineering, and Construction (AEC) industry. To address these challenges and improve decision-making, a hybrid Decision Support System (DSS) named PartitionWall Pro is proposed. This tool combines both document-driven and model-driven approaches to assist in the selection and design of partition walls. The document-driven aspect utilizes a choosing-by-advantages (CBA) model to compare the advantages of different partition wall options, while the model-driven component employs computational design models to analyze the structural integrity of unreinforced masonry partition walls. Validation procedures ensure the reliability and accuracy of the DSS in practical applications. Through case studies involving a warehouse and a school, the study demonstrates how the DSS simplifies decision-making processes and encourages the adoption of cost-effective partition wall solutions. The results underline the potential of the DSS to enhance efficiency, foster stakeholder discussions, and improve communication in building design projects, thereby offering valuable insights for researchers and industry professionals alike, ultimately transforming partition wall design practice.

2354 Clinical assessment and documentation of delirium in older patients undergoing vascular surgery: a quality improvement project

Abstract Introduction The Centre for Perioperative Care recommends the assessment and documentation of delirium using a validated tool such as the 4-AT in older people undergoing surgery. Aim This quality improvement project (QIP) aimed to improve the assessment and documentation of delirium in patients aged 65 and above following vascular surgery in a tertiary centre. Methods Patients aged ≥65 years who had undergone vascular surgery were identified and data was collected with access to the electronic patient record system. Analysis was carried out using Microsoft Excel and SPSS. Following baseline measurements taken in August 2023, 1 plan-do-study-act (PDSA) cycle was completed between September 2023–January 2024. Baseline measures Baseline data collected between August 1-31st 2023 identified 51 patients, of which delirium was screened using the 4-AT tool in 39.2% (n = 20), on average 90 hours post-operatively. The 4-AT was never documented in a consultant-led surgical post-operative review (100%, n = 51). There were clinical concerns of post-operative delirium documented in 7 patients, with the 4-AT documented in 5 of those cases. Intervention Interventions included stakeholder discussions to identify key barriers in the assessment and documentation of delirium, multidisciplinary team education and poster reminders across the ward. These were introduced between November–December 2023. Results Post-intervention results reviewed between 10th-31st January 2024 showed that the 4-AT was used to screen for delirium in 61.9% of patients (n = 13), on average 45 hours post-operatively. The 4-AT was never documented in a consultant-led surgical post-operative review. In addition, 2 patients developed delirium post-operatively with the 4-AT reported in both cases. Conclusions This QIP has demonstrated a marked improvement in compliance with national guidelines on the assessment of delirium, highlighting the impact of multidisciplinary education in improving the perioperative clinical pathway for older people undergoing surgery. Future PDSA cycles will focus on improving the documentation of 4AT in the post-operative surgical review.

Monitoring the Cost and Affordability of a Healthy Diet within Countries: Building Systems in Ethiopia, Ghana, Malawi, Nigeria, Pakistan, Tanzania, and Viet Nam

BackgroundGovernments around the world collect food price data on a frequent basis, often monthly, for the purpose of monitoring inflation. These routine economic data can be used with a nutrition-sensitive lens for understanding economic access to a healthy diet. The Food and Agriculture Organization of the United Nations has adopted the cost and affordability of a healthy diet (CoAHD) for annual tracking alongside other food security indicators. This indicator is relevant in many countries for informed decision-making and accountability toward Food Systems Summit pathways. National governments may wish to include this indicator in their own monitoring systems, using existing subnational price and income data. ObjectivesWe describe emerging systems in several countries for monitoring CoAHD and analytical tools that facilitate the calculation of CoAHD. We discuss reasons why the indicator may differ when calculated using subnational data compared with the global monitoring system and how to interpret differences. MethodsBetween June 2016 and February 2024, 19 workshops were held in 7 countries (Ethiopia, Ghana, Malawi, Nigeria, Pakistan, Tanzania, and Viet Nam), where stakeholder discussions covered sources of food price data, institutions involved, policy uses, and direct training in calculation of CoAHD. Food price data collected by national organizations were used to calculate CoAHD in partnership with government agencies. ResultsCalculating CoAHD using subnational data uses the same methods across settings, but the mechanisms for monitoring and dissemination are different in each country, illustrating heterogeneity in how the metric can most effectively be incorporated within existing structures. Results from national and global monitoring systems have expected differences based on data sources, healthy diet standards, and affordability standards. ConclusionsCoAHD can be calculated with existing data and resources, facilitated by new software tools and user tutorials. In the future, it can be further streamlined, leveraging technical assistance from global institutions and aligning national and global monitoring systems.

The Battle for Urban Space: Dynamics of Spatial Change In Siak, Riau, Indonesia

This study aims to examine the implications of changes in urban space as a result of the implementation of government policies in the development and expansion of the city of Siak on the existence of community space and how the community seizes and utilizes spaces of the industry and government to maintain their subsistence economic life. This study uses a rapid ethnography approach. Researchers conduct a desk study before fieldwork to obtain an initial research report. Researchers stayed in Siak District for 40 days to conduct observations, in-depth interviews, informal conversations, and stakeholder discussions. We conducted Focus Group Discussions (FGD) in the four research villages. The event was attended by 28 participants from four villages, comprising village heads, homemakers, peasants, small traders/street vendors, freelance workers, and NGOs at the district level. The study shows that the four research villages have changed from subsistence community spaces to industrial and government spaces. In this research, the community space is becoming increasingly limited, so people carry out two strategies in seizing industrial and government spaces, namely using government spaces to become places for work and business and controlling industrial spaces, Even though this can give rise to latent and manifest tenure conflicts, corporate and society's urban space becomes an arena for struggling for the means of production represented through control and ownership of space. Society must adapt to these conditions to obtain space for them. Government policies in developing and expanding the city of Siak have not taken the community's interests as the primary goal.

Understanding the Roles, Responsibilities, and Factors for Success of Health Equity Officers in Health Care Settings: A Qualitative Study.

Recent national guidelines aimed at addressing equity in health care settings have contributed to an increase in equity officer positions, yet little is known about their roles, responsibilities, or strategies for engaging in health equity work. To understand the roles and responsibilities of equity officers, as well as facilitators and barriers to their success. In-depth semi-structured interviews with selected respondents from the Equity Officer National Study. Hospitals and health care systems across the United States. Twenty-six equity officers who had responded to the Equity Officer National Study survey. The interview guide explored strategies, facilitators, and barriers for engaging in health equity work in hospitals/health systems and communities. The job roles described by participants fell into 4 categories: community benefits/relations, population/community health, workforce, and health equity. Equity officers described key areas to support success at the individual equity officer level: knowledge and expertise, professional skills, and interpersonal skills; at the hospital level: leadership, workforce, infrastructure and resources, and policies and processes; at the community level: leadership and partnerships; and at the system level: requirements and regulations, investment and resources, and sociocultural and political characteristics of the community. These key areas have been organized to create a Framework for Equity Officer Success. The Framework for Equity Officer Success should be incorporated into hospital board, community stakeholder, and policymaker discussions about how to support health equity work in hospitals and health care systems.