Standard Email Research Articles

Is online job training for all? Experimental evidence on the effects of a Coursera program in Costa Rica

Massive open online courses (MOOCs) are frequently viewed as a tool for democratizing education and job training. However, their effectiveness is largely untested. We report on the first randomized evaluation of a job training program offering cost-free access to curated, short Coursera MOOCs and certificates. We find low course completion rates (10%), with males and wealthier individuals more likely to complete a course. Personalized reminders did not increase treatment take-up over a simple, standardized email reminder. Treatment has no significant effect on labour market outcomes roughly two years after the program. However, we find marginally significant evidence that treatment increases post-secondary education enrolment by 11%. Evidence on mechanisms suggests that this may be operating partially through the program motivating individuals who lacked sufficient skills to pursue further specialization.

Development of the method for fuzz testing mail services based on an intelligent input parameter mutation

This article proposes a method of fuzz testing mail services based on an intelligent input parameter mutation, which is applicable not only to standard email protocols but also to their extended versions. The research examines the main extensions of POP, IMAP, and SMTP protocols. The described method was applied in laboratory conditions to evaluate its effectiveness compared to traditional fuzz testing methods. The results confirmed the possibility of using the method for fuzz testing not only email clients but also servers. Further research is planned to create intelligent methods for evaluating testing coverage in the absence of prior instrumentation of email client and server source code.

Impact of Incentives on Physician Participation in Research Surveys: Randomized Experiment.

Web-based surveys can be effective data collection instruments; however, participation is notoriously low, particularly among professionals such as physicians. Few studies have explored the impact of varying amounts of monetary incentives on survey completion. This study aims to conduct a randomized study to assess how different incentive amounts influenced survey participation among neurologists in the United States. We distributed a web-based survey using standardized email text to 21,753 individuals randomly divided into 5 equal groups (≈4351 per group). In phase 1, each group was assigned to receive either nothing or a gift card for US $10, $20, $50, or $75, which was noted in the email subject and text. After 4 reminders, phase 2 began and each remaining individual was offered a US $75 gift card to complete the survey. We calculated and compared the proportions who completed the survey by phase 1 arm, both before and after the incentive change, using a chi-square test. As a secondary outcome, we also looked at survey participation as opposed to completion. For the 20,820 emails delivered, 879 (4.2%) recipients completed the survey; of the 879 recipients, 622 (70.8%) were neurologists. Among the neurologists, most were male (412/622, 66.2%), White (430/622, 69.1%), non-Hispanic (592/622, 95.2%), graduates of American medical schools (465/622, 74.8%), and board certified (598/622, 96.1%). A total of 39.7% (247/622) completed their neurology residency more than 20 years ago, and 62.4% (388/622) practiced in an urban setting. For phase 1, the proportions of respondents completing the survey increased as the incentive amount increased (46/4185, 1.1%; 76/4165, 1.8%; 86/4160, 2.1%; 104/4162, 2.5%; and 119/4148, 2.9%, for US $0, $10, $20, $50, and $75, respectively; P<.001). In phase 2, the survey completion rate for the former US $0 arm increased to 3% (116/3928). Those originally offered US $10, $20, $50, and $75 who had not yet participated were less likely to participate compared with the former US $0 arm (116/3928, 3%; 90/3936, 2.3%; 80/3902, 2.1%; 88/3845, 2.3%; and 74/3878, 1.9%, for US $0, $10, $20, $50, and $75, respectively; P=.03). For our secondary outcome of survey participation, a trend similar to that of survey completion was observed in phase 1 (55/4185, 1.3%; 85/4165, 2%; 96/4160, 2.3%; 118/4162, 2.8%; and 135/4148, 3.3%, for US $0, $10, $20, $50, and $75, respectively; P<.001) and phase 2 (116/3928, 3%; 90/3936, 2.3%; 80/3902, 2.1%; 88/3845, 2.3%; and 86/3845, 2.2%, for US $0, $10, $20, $50, and $75, respectively; P=.10). As expected, monetary incentives can boost physician survey participation and completion, with a positive correlation between the amount offered and participation.

Experimental evidence on a "light-touch" personalized email intervention in an online, undergraduate physiology course.

In large physiology classes, there is a demand for low-effort, or "light touch," strategies that faculty can use to connect with students and promote increased academic performance and student engagement. The purpose of this study was to compare personalized versus standardized emails following unit quizzes on student perceptions of faculty engagement, participation in academic resources, and academic performance in a junior-level, online physiology course. Students completed the online unit quiz and received a subsequent feedback email from the course director. Students were randomized into the Control (n = 101) or the Experimental (n = 104) group for general or personalized performance feedback emails, respectively. Students completed start and end of semester surveys capturing demographics, course expectations, self-reported use of resources, and impressions of the faculty. Final exam and course grades were collected. Perceptions of faculty were similar between groups, and receiving professor feedback after quizzes did not make the Experimental group more likely to use any of the available academic support services. There was no difference in final exam grades (Control: 73.9 ± 14.1%; Experimental: 73.4 ± 15.3%) or final course grades between groups (Control: 79.2 ± 13.1%; Experimental: 78.7 ± 13.3; P > 0.05). Personalized performance feedback from light-touch emails did not improve student perceptions of faculty engagement, self-reported participation in academic resources, or academic performance compared with a standardized email in a junior-level, online physiology course. Overall, this study does not support the use of personalized emails regarding quiz performance in an online physiology course.NEW & NOTEWORTHY Personalized performance feedback from light-touch emails did not improve student perceptions of faculty engagement, self-reported participation in academic resources, or academic performance compared with a standardized email in a junior-level, online physiology course.

Clinician Perspectives Regarding the Impact of Information Technology on Multidisciplinary Tumor Boards: A National Comprehensive Cancer Network Survey.

Multidisciplinary tumor boards (MTBs) support high-quality cancer care. Little is known about the impact of information technology (IT) tools on the operational and technical aspects of MTBs. The National Comprehensive Cancer Network EHR Oncology Advisory Group formed a workgroup to investigate the impact of IT tools such as EHRs and virtual conferencing on MTBs. The workgroup created a cross-sectional survey for oncology clinicians (eg, pathology, medical, surgical, radiation, etc) participating in MTBs at 31 National Comprehensive Cancer Network member institutions. A standard invitation e-mail was shared with each EHR Advisory Group Member with a hyperlink to the survey, and each member distributed the survey to MTB participants at their institution or identified the appropriate person at their institution to do so. The survey was open from February 26, 2022, to April 26, 2022. Descriptive statistics were applied in the analysis of responses, and a qualitative thematic analysis of open-ended responses was completed. Individuals from 27 institutions participated. Almost all respondents (99%, n = 764 of 767) indicated that their MTBs had participants attending virtually. Most indicated increased attendance (69%, n = 514 of 741) after virtualization with the same or improved quality of discussion (75%, n = 557 of 741) compared with in-person MTBs. Several gaps between the current and ideal state emerged regarding EHR integration: 57% (n = 433 of 758) of respondents noted the importance of adding patients for MTB presentation via the EHR, but only 40% (n = 302 of 747) reported being able to do so most of the time. Similarly, 87% (n = 661 of 760) indicated the importance of documenting recommendations in the EHR, but only 53% (n = 394 of 746) reported this occurring routinely. Major gaps include the lack of EHR integration for MTBs. Clinical workflows and EHR functionalities could be improved to further optimize EHRs for MTB management and documentation.

The impact of an e-newsletter or animated video to disseminate outdoor free-play information in relation to COVID-19 guidelines in New South Wales early childhood education and care services: a randomised controlled trial

BackgroundState-based Guidelines were issued for Early Childhood Education and Care (ECEC) services (caring for children 0–6 years) recommending greater time outdoors and inclusion of indoor-outdoor programs to facilitate social distancing to reduce spread of COVID-19. The aim of this 3-arm randomised controlled trial (RCT) was to examine the impact of different dissemination strategies on increasing ECEC service intentions to adopt recommendations from the Guidelines.MethodsThis was a post-intervention only RCT. A sample of eligible ECEC services in New South Wales (n = 1026) were randomly allocated to one of three groups; (i) e-newsletter resource; (ii) animated video resource; or (iii) control (standard email). The intervention was designed to address key determinants of guideline adoption including awareness and knowledge. Following delivery of the intervention in September 2021, services were invited to participate in an online or telephone survey from October-December 2021. The primary trial outcome was the proportion of services intending to adopt the Guidelines, defined as intention to; (i) offer an indoor-outdoor program for the full day; or (ii) offer more outdoor play time. Secondary outcomes included awareness, reach, knowledge and implementation of the Guidelines. Barriers to Guideline implementation, cost of the dissemination strategies and analytic data to measure fidelity of intervention delivery were also captured.ResultsOf the 154 services that provided post-intervention data, 58 received the e-newsletter (37.7%), 50 received the animated video (32.5%), and 46 received the control (29.9%). Services who received the animated video had nearly five times the odds (OR: 4.91 [1.03, 23.34] p = 0.046) than those in the control group, to report having intentions to adopt the Guidelines. There were no statistically significant differences in awareness or knowledge of the Guidelines between either intervention or control services. Development costs were greatest for the animated video. The extent to which the dissemination strategy was viewed in full, were similar for both the e-newsletter and animated video.ConclusionThis study found potential for the inclusion of interactive strategies to disseminate policy and guideline information within the ECEC setting, in the context of the need for rapid communication. Further research should explore the added benefits of embedding such strategies within a multi-strategy intervention.Trial registrationRetrospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) on the 23/02/2023 (ACTRN 12,623,000,198,628).

Discontinuation and nonpublication analysis of chronic pain randomized controlled trials.

The primary objective of this cross-sectional analysis is to evaluate rates of discontinuation and nonpublication of Randomized controlled trials (RCTs) of therapeutic interventions to treat chronic pain. Using ClinicalTrials.gov, a sample was obtained which included clinical trials pertaining to chronic pain. Trials were analyzed for publication status and completion status of each trial. If information was unavailable on the trial registry database, or could not be allocated through a systematic search, the corresponding trialist was contacted and data points were gathered. In our final analysis of the 408 RCTs, we found that 281 (68.9%) were published in a peer-reviewed journal and 127 (31.1%) were unpublished trials. Of 112 discontinued trials, 59 (52.7%) reached publication. In addition, 221 of 296 completed trials (74.7%) were published, and 75 (25.3%) remained unpublished after trial completion. The most common listed reason for trial discontinuation was administrative recommendations (41 of 71 trials [57.7%]), while not receiving an email reply to our standardized email from the corresponding trialist was the most common result for trial nonpublication (49 of 88 trials [55.7%]). Clinical trials funded by nonindustry sponsors were more likely to reach publication than industry-funded clinical trials (unadjusted odds ratio 1.86 [95% CI, 1.18-2.95]; adjusted odds ratio 3.01 [95% CI, 1.76-5.14]). The rate of discontinuation of RCTs involving patients with chronic pain is concerning. Chronic pain affects many patients; thus, the importance of having quality data from clinical trials cannot be overstated. Our study indicates that chronic pain RCTs are frequently discontinued and their findings often go unpublished - all of which could provide crucial information to providers and patients regarding the treatment of chronic pain. We offer suggestions to enhance chronic pain RCT completion, thereby reducing the waste of resources in chronic pain research.

Survey on Carbon Dioxide Emissions Through Email Conversion

In today’s scenario emissions of carbon dioxide and methane areca increasing day by day, leading to climate change. The aim of this paper is to explain carbon dioxide emissions through e-mail conversion. As an average spam email, a standard email, and an email with ‘long attachments’ emits 0.3g CO2e (carbon dioxide equivalent), 4g CO2e and 50g CO2e, respectively. The number of emails received by a common office worker is 121 and half of them are spam. The carbon footprint of emails received in a day is similar to 1,652 g CO2e. And those one year- received emails emit 0.6 tons of carbon dioxide. The carbon footprint of an Indian’s entire year is around 1.5 tons CO2e. So, three average workplace staff members yearly receive emails to exceed their carbon footprint for all the activities of another human for a year. An email with attachments releases 50g CO2e, that is an equivalent quantity as if one had used 5 plastic bags. So, overall, this paper shows how much carbon dioxide is emitted by an e-mail and how it works.In today’s scenario emissions of carbon dioxide and methane areca increasing day by day, leading to climate change. The aim of this paper is to explain carbon dioxide emissions through e-mail conversion. As an average spam email, a standard email, and an email with ‘long attachments’ emits 0.3g CO2e (carbon dioxide equivalent), 4g CO2e and 50g CO2e, respectively. The number of emails received by a common office worker is 121 and half of them are spam. The carbon footprint of emails received in a day is similar to 1,652 g CO2e. And those one year- received emails emit 0.6 tons of carbon dioxide. The carbon footprint of an Indian’s entire year is around 1.5 tons CO2e. So, three average workplace staff members yearly receive emails to exceed their carbon footprint for all the activities of another human for a year. An email with attachments releases 50g CO2e, that is an equivalent quantity as if one had used 5 plastic bags. So, overall, this paper shows how much carbon dioxide is emitted by an e-mail and how it works.

Research interrupted: applying the CONSERVE 2021 Statement to a randomized trial of rehabilitation during critical illness affected by the COVID-19 pandemic

RationaleThe COVID-19 pandemic disrupted non-COVID critical care trials globally as intensive care units (ICUs) prioritized patient care and COVID-specific research. The international randomized controlled trial CYCLE (Critical Care Cycling to Improve Lower Extremity Strength) was forced to halt recruitment at all sites in March 2020, creating immediate challenges. We applied the CONSERVE (CONSORT and SPIRIT Extension for RCTs Revised in Extenuating Circumstance) statement as a framework to report the impact of the pandemic on CYCLE and describe our mitigation approaches.MethodsOn March 23, 2020, the CYCLE Methods Centre distributed a standardized email to determine the number of patients still in-hospital and those requiring imminent 90-day endpoint assessments. We assessed protocol fidelity by documenting attempts to provide the in-hospital randomized intervention (cycling or routine physiotherapy) and collect the primary outcome (physical function 3-days post-ICU discharge) and 90-day outcomes. We advised sites to prioritize data for the study’s primary outcome. We sought feedback on pandemic barriers related to trial procedures.ResultsOur main Methods Centre mitigation strategies included identifying patients at risk for protocol deviations, communicating early and frequently with sites, developing standardized internal tools focused on high-risk points in the protocol for monitoring patient progress, data entry, and validation, and providing guidance to conduct some research activities remotely. For study sites, our strategies included determining how institutional pandemic research policies applied to CYCLE, communicating with the Methods Centre about capacity to continue any part of the research, and developing contingency plans to ensure the protocol was delivered as intended. From 15 active sites (12 Canada, 2 US, 1 Australia), 5 patients were still receiving the study intervention in ICUs, 6 required primary outcomes, and 17 required 90-day assessments. With these mitigation strategies, we attempted 100% of ICU interventions, 83% of primary outcomes, and 100% of 90-day assessments per our protocol.ConclusionsWe retained all enrolled patients with minimal missing data using several time-sensitive strategies. Although CONSERVE recommends reporting only major modifications incurred by extenuating circumstances, we suggest that it also provides a helpful framework for reporting mitigation strategies with the goal of improving research transparency and trial management.Trial registrationNCT03471247. Registered on March 20, 2018.

P387 Rapid Implementation of an Evidence-Based, Virtual COVID-19 Vaccine Education Clinic at the Nova Scotia Collaborative Inflammatory Bowel Disease Clinic (NSCIBD) Program

BackgroundThe COVID-19 global pandemic has been associated with significant morbidity and mortality. Rapid adaptation of approaches to clinical management as well as policy decisions in relation to implementation of vaccination programs for persons living with IBD has been required throughout the pandemic. To meet the sudden demand of large scale public health-mandated COVID-19 vaccine education for patients living with IBD in Nova Scotia a novel, evidence-based, virtual COVID-19 vaccine educational intervention was developed, implemented, and evaluated.MethodsThis was a prospective, observational, cross sectional, implementation-effectiveness study conducted at the NSCIBD program between April-July, 2021. The educational intervention consisted of a standardized email outlining evidence relating to risks and benefits of COVID-19 vaccinations. The intervention was offered to all patients contacting the NSCIBD program with questions or concerns about the vaccine. During one-on-one virtual visits, standardized and evidence-based information was provided by a gastroenterologist or IBD nurse practitioner. Following the session, an anonymous questionnaire (NoviSurvey) evaluated key implementation metrics including satisfaction, appropriateness, usefulness, perceived impact on knowledge and vaccine hesitancy, willingness to participate in future sessions, and recommendations for improvement. Descriptive analyses were conducted, with group means expressed as proportions for categorical variables and means for numerical variables.ResultsA total of, 265 patients were invited to participate in the online survey, with a response rate of, 49% (131/265). Before the session, 48.9% (64/131) expressed COVID-19 vaccine hesitancy and, 26% (35/131) expressed concerns relating to risks versus benefits of COVID-19 vaccines. Ninety-one percent (119/131) of respondents found the education program to be helpful and, 92% (121/131) indicated there was no information perceived to be lacking from the session. Following the intervention, the proportion of those willing to get vaccinated rose from, 61% to, 86.3%. Only, 1.5% (2/131) indicated that they would likely not get vaccinated. Most participants (77%, 101/131) found the written and virtually administered educational content to be satisfactory and, 88% (115/131) were willing to participate in similar virtual education offerings in the future.ConclusionImplementation of an evidence-based, multidisciplinary COVID-19 vaccination education intervention delivered using a virtual platform was perceived to be feasible, acceptable, and effective by IBD patients. Further research on innovative, evidence-based, multidisciplinary educational interventions and the impact of these interventions on IBD clinical outcomes are needed.

Mobilising support when the stakes are high: Mass emails affect constituent‐to‐legislator lobbying

AbstractMass emails are frequently used by advocacy groups to mobilise supporters to lobby legislators. But how effective are they at inducing constituent‐to‐legislator lobbying when the stakes are high? We test the efficacy of a large‐scale email campaign conducted by the UK's main anti‐Brexit organisation. In 2019, the group prominently displayed a ‘Write to your MP’ tool on their website and assigned 119,362 supporters represented by legislators with incongruent views to one of four email messages encouraging them to write to their MP or a control condition (no email). Messages varied across two factors: whether the MP's incongruent position was highlighted, and if urgency was emphasised. We find that 3.4 per cent of treatment subjects contacted their representative, compared to 0.1 per cent of those in the control, representing an additional 3,344 emails sent to MPs. We show that there was no substitution away from the most frequently used online legislator contact platform in the United Kingdom. While, on average, position and urgency cues had no marginal effects above the standard email, the most engaged supporters were more mobilised when informed that their MP held incongruent views. This study shows that advocacy groups can use low‐cost communication techniques to mobilise supporters to lobby representatives when the stakes are high.

Evaluating the efficacy of a multistrain probiotic supplementation for prevention of neonatal sepsis in 0\u20132-month-old low birth weight infants in India\u2014the \u201cProSPoNS\u201d Study protocol for a phase III, multicentric, randomized, double-blind, placebo-controlled trial

BackgroundProgress has been made in the reduction of under-five mortality in India; however, neonatal mortality is reducing at a slower rate. Efforts are required to bring down neonatal mortality in order to attain the Sustainable Development Goal-3. Prevention of sepsis among the high-risk, vulnerable low birth weight neonates by a newer intervention with probiotic supplementation is promising.MethodsA phase III, multicenter, randomized, double-blind, placebo-controlled study is being conducted at six sites in India. A total of 6144 healthy low birth weight (LBW) infants fulfilling the eligibility criteria would be enrolled within the first week of life, after obtaining written informed consent from the parents of the infant. Randomization in 1:1 ratio, stratified by site, sex, and birth weight, would be done through an interactive web response system (IWRS) using a standard web browser and email service. Vivomixx®, a probiotic containing a mix of 8 strains of bacteria, in a suspension form standardized to deliver 10 billion CFU/ml, or an organoleptically similar placebo would be fed to enrolled infants in a 1-ml/day dose for 30 days. The follow-up of enrolled infants for 60 days would take place as per a pre-specified schedule for recording morbidities and outcome assessments at the six participating sites. Screening for morbidities would be conducted by trained field workers in the community, and sick infants would be referred to designated clinics/hospitals. A physician would examine the referred infants presenting with complaints and clinical signs, and blood samples would be collected from sick infants for diagnosis of neonatal sepsis by performing sepsis screen and blood culture. Appropriate treatment would be provided as per hospital protocol. The study would be implemented as per the MRC guideline for the management of Global Health Trials in accordance with ICH-GCP and Indian Regulatory guidelines. A contract research organization would be engaged for comprehensive monitoring and quality assurance. The final analysis would be conducted in a blinded manner as per the statistical analysis plan (SAP) to estimate the primary outcomes of sepsis, possible serious bacterial infection (PSBI), and secondary outcomes. The codes will be broken after DMC permission. The protocol has been reviewed by the Research Ethics Committee of the Liverpool School of Tropical Medicine (REC-LSTM), from Research Ethics Committees of the six subject recruitment participating sites.DiscussionThis adequately powered and well-designed trial would conclusively answer the question whether probiotics can prevent neonatal sepsis in the high-risk group of low birth weight infants as indicated by a pilot study in 1340 LBW infants, evidence from systematic reviews of hospital-based studies, and a primary study on healthy newborns in Orissa. Results of the study would be generalizable to India and other low–middle-income countries.Trial registrationClinical Trial Registry of India (CTRI) CTRI/2019/05/019197. Registered on 16 May 2019

Impact of Pre-visit Contextual Data Collection on Patient-Physician Communication and Patient Activation: a Randomized Trial.

Patient contextual data (PCD) are often missing from electronic health records, limiting the opportunity to incorporate preferences and life circumstances into care. Engaging patients through tools that collect and summarize such data may improve communication and patient activation. However, differential tool adoption by race might widen health care disparities. Determine if a digital tool designed to collect and present PCD improves communication and patient activation; secondarily, evaluate if use impacts outcomes by race. A pragmatic, two-armed, non-blinded, randomized controlled trial conducted during 2019 in a primary care setting. The PCD tool (PatientWisdom) invited patients to identify preferences, values, goals, and barriers to care. Patients were randomized to a standard pre-visit email or facilitated enrollment with dedicated outreach to encourage use of the tool. Outcomes of interest were post-visit patient communication and patient activation measured by the Communication Assessment Tool (CAT) and Patient Activation Measure (PAM), respectively. Outcomes were evaluated using treatment-on-the-treated (TOT) and intention-to-treat (ITT) principles. A total of 301 patients were enrolled. Facilitated enrollment resulted in a five-fold increase in uptake of the PCD tool. TOT analysis indicated that the PCD tool was associated with notable increases in specific CAT items rated as excellent: "treated me with respect" (+ 13 percentage points; p = 0.04), "showed interest in my ideas" (+ 14 percentage points; p = 0.03), "showed care and concern" (+ 16 percentage points; p = 0.02), and "spent about the right amount of time with me" (+ 11 percentage points; p = 0.05). There were no significant pre/post-visit differences in PAM scores between arms (- 4.41 percentage points; p = 0.58). ITT results were similar. We saw no evidence of the treatment effect varying by race in ITT or TOT analyses. The inclusion of PCD enhanced essential aspects of patient-provider communication but did not affect patient activation. Outcomes did not differ by race. Clincaltrials.gov identifier: NCT03766841.

Farmer views on climate change\u2014a longitudinal study of threats, opportunities and action

Any new policy measure aiming to mitigate climate change and support adaptation in agriculture is implemented at the farm scale. This makes a farmer the key actor. This study aimed to understand farmers’ climate change views and reveal how farmers see their role, responsibilities and possibilities to mitigate and adapt to climate change. Furthermore, this study aimed to assess how various background variables and values associate with farmers’ views in order to have novel and comprehensive on farmers’ perspectives on climate change. Short-term changes in views were studied with a longitudinal framework. In total, 4401 farmers in Finland answered a standardized e-mail survey in spring 2018. A total of 2000 of them responded again in spring 2020. The respondents differed in gender, age, education, farming system, farm type, farm organization, farm size, revenue and region. The farmers were not a uniform group of citizens, and their views on climate change varied widely. For a Nordic, boreal zone country like Finland, climate change will bring not only challenges but also opportunities that may even strengthen the agricultural production. Such a “two-sided coin” causes confusion for farmers as indicated by this study. Climate change–induced risks often dominate the public dialogue with farmers. This study emphasizes the need for better balance between risks and opportunities not only in the dialogue with farmers but also with policy makers and all public discussion. Acknowledging farmers’ views in planning the future climate policies for agricultural sector is elemental to ensure success in farm-scale implementation.

Perceptions of Environmental Health and Willingness to Compost Fresh Cut Floral Waste by Retail Flower Shop Owners

In the United States there has been a push to convert industries to a more environmentally sustainable business attitude in recent years. Environmentally sustainable practices are not only good for the environment, but there is increasing evidence these practices lead to an increase in customer loyalty. The trend of self-regulation, willingly imposing more stringent environmental policies than required by the government, is progressing toward a time where environmentally friendly practices will be a competitive necessity for businesses to survive. The main purpose of this research was to investigate the perceptions of environmental health of retail flower shop owners and their willingness to recycle fresh cut floral waste produced at retail flower shops for use as compost and to determine if there is a statistical correlation between environmental awareness and willingness to compost fresh cut flower waste. A mailing list of retail florists from across the United States was compiled. A total of 1974 florists from all 50 states were sent a standardized e-mail explaining the purpose of the study. Embedded in the e-mail was a hyperlink that redirected willing respondents to the survey. Each person on the mailing list was emailed one time. Of the 300 retail florists who took part in the survey, a majority, 190 (63.33%), were ranked as having “high concern” for environmental health. A majority of florists 247 (82.33%) “agreed” or “strongly agreed” to collaborate with Master Gardener programs and other organizations if it meant they could recycle their floral waste through composting. Through the creation of industry- and state-sponsored certifications, florists could brand and promote their business as more environmentally conscious by composting their floral waste. This could possibly, in turn, stimulate sales and increase profit margins while having the added benefit of reducing the amount of waste entering landfills.

The importance of personal vote intentions for the responsiveness of legislators: A field experiment

AbstractIndividual legislators can be important agents of political representation. However, this is contingent upon their responsiveness to constituency requests. To study this topic, an increasing number of studies use field experiments in which the researcher sends a standardized email to legislators on behalf of a constituent. In this paper, we report the results of an original field experiment of this genre with the members of the German Bundestag. Supplementing previous research, we explore whether constituency requests in which voters mention a personal vote intention (rather than a partisan vote intention) increase legislators’ responsiveness, and how this treatment relates to electoral system's incentives. We find that legislators treated with a personal vote intention were more likely to respond (67 per cent) and respond faster than those treated with a partisan vote intention (59 per cent). However, we also show that the treatment effect is moderated by electoral system incentives: it is larger for nominally‐elected legislators than for those elected via a party list. Our results suggest that electoral system's incentives matter for legislators’ responsiveness only when constituents explicitly signals an intention to cast a personal vote.

Conditional Financing of Drugs in the Netherlands: Past, Present, and Future—Results From Stakeholder Interviews

BackgroundConditional financing (CF) of hospital drugs was implemented in the Netherlands as a form of managed entry agreements between 2006 and 2012. CF was a 4-year process comprising 3 stages: initial health technology assessment of the drug (T = 0), conduct of outcomes research studies, and reassessment of the drug (T = 4). ObjectivesTo analyze stakeholder experiences in implementing CF in practice. MethodsPublic and private stakeholders were approached for participation in stakeholder interviews through standardized email invitations. An interview guide was developed to guide discussions that covered the following topics: perceived aims of CF, functioning of CF, impact of CF, and conclusions and future perspectives. Extensive summaries were generated for each interview and subsequently used for directed content analysis. ResultsThirty stakeholders were interviewed. Differences emerged among the stakeholders on the perceived aims of CF. Conversely, there was some agreement among stakeholders on the shortcomings in the functioning of CF, the positive impact of CF on the Dutch healthcare setting, and improvement points for CF. ConclusionsDespite stakeholders' belief that CF either did not meet its aims or only partially did so, there was agreement on the need for new policy to address the same aims of CF in the future. Nevertheless, stakeholders diverged on whether CF should be improved on the basis of learnings identified and reintroduced into practice or replaced with new policy schemes.

Epidemiologic telephone conference in Albania - an interim evaluation, May–December 2017

Purpose: In Albania, regular epidemiological telephone conferences (EpiTel) between surveillance staff from national (Institute of Public Health, IPH) and subnational levels (12 prefectures and 24 districts) are a new tool for communicating, discussing, linking information related to infectious diseases events. Following the experience of Germany, Albania developed and established EpiTel in May 2017 in the scope of the German Global Health Protection Programme. After seven months of implementation, IPH conducted an evaluation in order to measure usefulness and identify strengths and weaknesses of EpiTel. Methods & Materials: In a first step, IPH analyzed the level of participation, reporting, and the most frequently discussed events from the weekly EpiTel minutes. In parallel, standardized email questionnaires targeting all EpiTel participants at national, prefecture and district level were used to assess the process further. They included open and closed questions rating logistics, content, minutes and usefulness of information exchanged. Results: In total, 28 weekly minutes were analyzed. Mean participation rate per prefecture was 86%. At IPH next to surveillance staff, the laboratory participated in 82% of conferences, the vaccination program and other sectors in 54%and 7.2%, respectively. On average, each prefecture presented an event in 59% of conferences. The most frequent international topics in EpiTel were Measles, Influenza, West Nile virus and Yellow Fever, while from the national and subnational level events reported via syndromic surveillance, influenza, a nationwide measles outbreak and challenges related to contact tracing and vaccinations were most frequently discussed. Overall, 10/15 staff members at national level, all prefectures and 50% of districts completed the questionnaires. The organization of the conference was found to be very well managed and Skype was agreed to be the best medium for communication. The information exchanged and shared was evaluated as accurate, informative, timely and facilitating the harmonization of control measures. All participants rated EpiTel as very useful for their daily work. Conclusion: EpiTel is an efficient way to communicate and discuss international and national infectious disease events routinely and in a condensed way between all levels of the public health system in Albania. The participatory process fosters horizontal exchange within an otherwise centralized surveillance system.

Marketing de Relacionamento: a utilização de estratégias digitais em Odontologia

Objetivo: analisar as estratégias digitais conhecidas e utilizadas pelos cirurgiões-dentistas em relação ao marketing de relacionamento. Material e Métodos: trata-se de uma pesquisa quantitativa, descritiva, documental, de campo e transversal. A pesquisa foi realizada por meio de um e-mail padrão enviado aos cirurgiões-dentistas do Estado de Santa Catarina, contendo um link para o questionário e o Termo de Consentimento Livre e Esclarecido. Resultados: após o período de coleta de dados, foram analisados ??31 questionários eletrônicos respondidos pelos cirurgiões-dentistas, delineando um perfil predominante dos participantes do estudo contendo mais frequentemente mulheres jovens, brancas e solteiras, com algum tipo de pós-graduação, variando de 1 a 4 anos de treinamento, sendo geralmente proprietários do lugar onde trabalham, com mais de uma relação de trabalho. As estratégias digitais mais conhecidas pelos participantes foram Facebook, WhatsApp, Instagram e Websites. Por sua vez, os mais utilizados foram o Facebook e o Instagram, e uma porcentagem significativa relatou não usar nenhuma estratégia digital. Conclusão: os cirurgiões-dentistas de Santa Catarina apresentaram pouco conhecimento sobre a definição de Marketing de Relacionamento e estratégias digitais. Embora as mídias digitais mais reportadas tenham sido o Facebook e o Instagram para fins de aprimoramento e comunicação, a mesma mídia tem sido pouco utilizada para ações de Marketing de Relacionamento.

A Picture is Not Worth a Thousand Words – Implementation of Offline Volumetric Image Review

The current institutional practice of communicating Head and Neck patient set-up problems and issues identified during image-guided radiation therapy (IGRT) is through email to the responsible radiation oncologist (RO). The email includes a screen capture of a single cone-beam computed tomography (CBCT) slice with a written description of the problem identified by front-line Radiation Therapists (RTTs). To gain a better understanding of the issue, the RO will often attend patient set-up the next day to review the CBCT with the RTTs on the treatment unit. To eliminate decision-making based on a single screen shot of a volumetric image and to reduce the number of times ROs are required at the treatment unit for online review, the use of Image Review Workspace in the Radiation Therapy Electronic Medical Records (RTEMR) system was piloted. The process for offline CBCT image review in Image Review Workspace within RT EMR was tested for feasibility through collaboration with the Head and Neck site leads (RO, Medical Physics [MP], RTT) and the clinical application specialist team. Workflow for offline review was assessed for feasibility and ease of use; technical issues identified were resolved prior to pilot roll-out. The workflow for offline review in Image Review Workspace initiates with an email alert by front line RTTs to the responsible RO, planner, and MP outlining the issue identified on the daily CBCT, requesting for image review. The RO would then view the volumetric CBCT in RTEMR and provide feedback regarding the set-up issue before the next clinical day. The image in RTEMR would not require approvals as the workspace is used solely as a platform to view the issue volumetrically. To assist with pilot implementation, training documents and teaching sessions were prepared for front-line RTTs and Head and Neck ROs describing the tools available within Image Review Workspace to view the patient CBCTs. Additionally, a standardized email template was created to ensure staff were comprehensive when describing IGRT issues, including a link with the instructions for using Image Review Workspace. The benefit of using the Image Review Workspace in RTEMR is that ROs can view the patient's entire CBCT image in a volume versus a single slice; decision-making is more informed based on three-dimensional data. This process also reduces the number of times ROs are required to attend set-up at the treatment unit to investigate image guidance issues. One identified challenge of Image Review Workspace is the amount of time required to initially load the patient's CBCT image, which can take up to two minutes. The ability to review CBCTs offline in a volumetric environment aids in clinical decision making and communication between the ROs and front-line team. Through the success of this pilot on the Head and Neck site, the process for offline CBCT image review in RTEMR is being implemented by other sites at our institution.