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Cardiac implantable electronic device (CIED) implantations are common and expensive. Tracking post-surgical infections of these devices is a key component of monitoring health system performance and ensuring high quality care. Given human resource constraints with traditional infection prevention and control (IPC) programs, CIED infections cannot be systemically monitored in many jurisdictions. This project endeavored to implement a policy change in Alberta, Canada, using administrative data for tracking CIED infection trends over time.
Methods:
Prior work validated the use of administrative data to track CIED infections. The current work focused on exploring policy options to optimize this use of administrative data and elicit feedback from knowledge users/operational leaders via a workshop and electronic communications. Options for presentation and communication modalities of data including quarterly reports or Tableau dashboards were explored.
Results:
Based on consensus from the workshop and subsequent electronic communications, three policy options were provided along with a recommended choice as well as preferred reporting options. The final options were all included in a policy brief provided to operational leadership. Ultimately, the recommended approaches of using administrative data for surveillance were accepted resulting in a policy change for CIED infection surveillance in Alberta that is currently being implemented and evaluated.
Conclusions:
CIED infections are a devastating complication following implantation. Administrative data may offer an alternative to traditional IPC surveillance given constrained resources. Engagement and presentation of evidence-based policy options resulted in the adoption of a novel data driven policy in Alberta for CIED infection surveillance.
The Third Crusade left a significant imprint on the manuscript cultures of Western Europe connected to the crusading movement. Contemporaries copied, engaged with, and modified narratives about the Third Crusade and its context on a scale not seen since the First Crusade. Texts range from documentary sources, such as the desperate Hilferuf of Patriarch Eraclius as Saladin's army closed in on the city of Jerusalem and the papal response in the form of Audita tremendi, to longer-form narratives, such as the compilations known as the Itinerarium peregrinorum et gesta regis Ricardi, which exists in several versions, and the Historia de expeditione Friderici imperatoris. Scribal activity took place from the time of the launch of the crusade in 1187–1188, during the campaign itself, and extended into the thirteenth and fourteenth centuries, encompassing the desire to record and understand events in the East as part of an overarching theological framework, to promote and engage with the crusading movement as a form of ‘scribal crusading’, and to commemorate and memorialise the crusade after its conclusion. In seeking to further these aims, authors and scribes not only transmitted texts but also took advantage of their plasticity in manuscript to interpolate new material, abridge them, and tailor them to local audiences.
To reduce the burden of depression, it is important to ensure that adolescents have access to effective, early interventions. Limited research has explored psychological practitioners’ views during the development of such interventions, despite the potential for this to improve implementation. A brief, imagery-based intervention (IMAGINE) has been co-developed to address issues in treatment provision for symptoms of depression in adolescents. Here, we investigate psychological practitioners’ and supervisors’ views about factors that may act as barriers and enablers to implementing IMAGINE. We used a qualitative interview study with (1) qualified low-intensity practitioners with experience of working in schools, and (2) clinical supervisors to these practitioners, working in England. Reflexive thematic analysis was initially inductive followed by a deductive mapping to normalisation process theory, a theory of how interventions become implemented and embedded in practice. Twenty-four participants (14 low-intensity practitioners and 10 supervisors) were interviewed. Six themes were identified: (1) ‘We could be doing more for young people with low mood’, (2) ‘IMAGINE stands out while feeling familiar’, (3) ‘Which young people is IMAGINE for?’, (4) ‘Pushing the depth of low-intensity practice’, (5) ‘Getting everyone on board’, and (6) ‘A good fit for services, more or less’. The findings show enthusiasm for new interventions to address adolescent depression, with low-intensity practitioners eager to enhance their clinical skills. This was balanced with concerns about the demand for low mood interventions and whether some components of IMAGINE fit within low-intensity practice. These insights suggest barriers and enablers for developing psychological interventions.
Key learning aims
(1) To identify implementation and contextual factors that may act as barriers and enablers to implementing imagery-based depression interventions in schools.
(2) To explore how an imagery-based psychological intervention for depression in adolescence is perceived from the perspective of psychological practitioners working in schools and their supervisors.
(3) To inform future research in the development of imagery- and school-based interventions for adolescent depression.
Objectives/Goals: In CTSA funding calls issued since 2021, the NCATS has differentiated the terms “translational research” and “translational science” which has resulted in confusion between the terms. We explore why this distinction has become challenging for CTSA hubs to implement as a requirement of pilot and UM1 awards and reflect on ways to reduce confusion. Methods/Study Population: We conducted a historically informed critical analysis of data collected from three sources. First, we looked at the scholarly literature on definitions of translational science and translational research since 2006. Second, we analyzed NCATS funding calls from 2006-2024 to identify if and how translational science and translational research were defined and utilized. Lastly, we used our professional experience over the last five years working at a CTSA hub and developing trainings to differentiate translational research and translational science for pilot awards. Results/Anticipated Results: Results suggest three reasons why challenges are commonplace. First, we demonstrate that NCATS has not consistently communicated this distinction, resulting in different interpretations of the concept of translational science. Second, we argue that the systems-level conceptualization of translational science is uncommon in biomedical science training, potentially contributing to gaps in understanding. Third, we show that the academic performance measures, funding, and infrastructures for biomedical research in the United States are not designed to support translational science projects, systems, and careers. Most notably, there are no NIH R01 mechanisms dedicated to translational science that provide standard NIH career pathways. Discussion/Significance of Impact: We propose education and peer-to-peer brainstorming sessions to improve the ability of CTSA investigators to understand the scope of translational science and translational research. However, to truly support long-term work in translational science, NCATS would need to develop a clear career path that includes R01s in translational science.
This book examines how material systems such as transportation, energy and housing form the basis of human freedom. It begins by explaining this linkage by defining reliance systems, the basic way in which we become free to act not only as a result of our bodily capabilities or the absence of barriers but because of collectively produced systems. As virtually all of us rely on such systems – water, food, energy, healthcare, etc. – for freedom, the book argues that they must form the centre of a twenty-first-century politics. Rather than envisioning a healthier politics of reliance systems exclusively through rights or justice or deliberative democracy, we argue that they must become the centre of a new social contract. More specifically, we discuss the politics of reliance systems as a set of spatial contracts. Spatial contracts are the full set of politics governing any given system, and as such they are historically, geographically and system specific. In order to fully understand spatial contracts, we develop an analytical framework focused on three areas. Seeing like a system shows how systems thinking can enable us to avoid ideological approaches to understanding given spatial contracts, repurposing key ideas from mainstream and heterodox economics. Seeing like a settlement shows how systems come together in space to form human settlements, and exposes key political divides between urban and rural, and formal and informal. Adapting Iris Marion Young’s five faces of oppression enables an understanding of the specific ways in which reliance systems can be exploitative.
This chapter explains the concept of reliance and reliance systems – the way in which human agency stems from collectively produced systems. It then links this understanding of reliance and agency to capabilities theory, and explains the contribution that reliance systems make to rendering capabilities theory more aware of the materiality of capabilities. The chapter then delves into the nature of reliance systems, focusing on separating the material and functional components of reliance systems. We explain the need to modify social contract theory in order to pursue a better politics of reliance systems, as opposed to other possible political avenues such as rights and deliberative democracy. The chapter ends by suggesting six principles for examining the morality of any given spatial contract.
The introduction lays out the basic intellectual framework of the book. It argues that human agency is derived from collectively produced reliance systems such as energy, transportation and water. These systems are governed by complex formal and informal agreements called spatial contracts, which differ depending on the system, geography and moment in history. These spatial contracts need to become the focal point of twenty-first-century politics.
This chapter focuses on building an analytical framework for understanding reliance systems and spatial contracts. It is based on the argument that we must begin with the system, and understand the politics from the system up, rather than from the politics down. The framework draws on systems thinking to establish how we can differentiate between different systems. It then uses this systems perspective to repurpose ideas from economics which are useful if focused on systems instead of commodities.
This chapter furthers the development of the analytical framework by focusing on the relationship between reliance systems and exploitation. It reworks Iris Marion Young’s five faces of oppression for use with reliance systems and the spatial contract. These five faces are exploitation, marginalization, powerlessness, cultural imperialism and violence.
This chapter continues the work of building the analytical framework. Rather than pulling apart systems to appreciate their differences, as in Chapter 2, this chapter explains how systems must be seen together as human settlements. This settlements perspective illuminates two important sets of divisions that may hinder the development of healthier spatial contracts – the divide between urban and rural, and that between formal and informal.
This chapter summarizes the key contributions of the book. It highlights the way the text operates as three interlocking frameworks: an intellectual framework focused on an understanding of the relationship between collectively produced systems and human agency; a political framework which insists on the need for these systems to become the centre of politics; and an analytical framework which understands systems in context, with a focus on exploitation. It further demonstrates the utility of these frameworks by briefly analysing two current cases: the push for universal basic income globally, and the focus on the Green New Deal in the United States. The chapter also lists ten areas where future work is needed.
Acute rhinosinusitis is one of the most common conditions seen in primary care. One in seven adults are diagnosed with ARS annually, resulting in one in five of all antibiotic prescriptions. Yet there has been limited research comparing the effectiveness of widely used treatments such as antibiotics and nasal steroids. Conducting such a trial in the context of decades of established practice poses unique challenges.
Methods:
A feasibility phase was conducted with continuing feedback to provide refinement and guidance regarding the design of a large-scale, pragmatic randomized controlled trial. The pilot trial assessed the ability to enroll, retain, and evaluate adherence to the intervention and assessment protocols.
Results:
The feasibility phase allowed us to seek input from patients and experts. This resulted in changes pre and post pilot that will impact the full study. A priori enrollment targets for the pilot were achieved, and with high adherence rates. In total, 373 patients were pre-screened and 140 patients were enrolled participants. Adherence to data collection via the daily diary was 93% throughout the study, with 95% completing their diary on the day of the primary outcome, 3 post-randomization.
Conclusion:
Expert panels and a patient advisory committee recommended critical changes to our study design. Stakeholder engagement is a key component of this funding source and was widely used throughout the 18-months. An achieved primary goal of the feasibility phase was to evaluate recruitment and study methods prior to implementing a large clinical trial that requires significant resources.