New England Regional Health Equity Profile & Call to Action

Good health is a foundation that allows people to participate in the most important aspects of life. The purpose of the New England Regional Health Equity Profile and Call to Action is to identify where differences in good health exist among racial, ethnic, and disability populations in New England as well as foster policy, programmatic, and individual action to combat health disparities and achieve health equity for racial, ethnic, disability and underserved populations in New England. The report was written by the members of the New England Regional Health Equity Council (RHEC), one of ten regional health equity councils formed by the Office of Minority Health at the federal Department of Health and Human Services. The mission of the New England RHEC is to achieve health equity for all through collective action in the New England region. The New England RHEC’s vision is to achieve health equity through cross-sector interaction and collaboration of activities and resources to optimize health for all where they live, learn, work, and play. The New England Regional Health Equity Profile and Call to Action uses a “social determinants of health” approach. A social determinants of health approach focuses on understanding how the intersection of the social and physical environments; individual behaviors; and access to education, income, healthy foods and health care, impacts a wide range of health and quality-of-life outcomes. The report examines the following topics: Socio-Economic Status, Healthy Eating and Physical Activity, Risky Behaviors, Cultural Competency in Health Care, Health Care Access, Health Outcomes, and the Intersection of Race/Ethnicity & Disability. It also includes a description of State Health Equity Activities and a Regional Call to Action

Don't know, can't know: Embracing deeper uncertainties when analysing risks

This article is available open access through the publisher’s website at the link below. Copyright @ 2011 The Royal Society.Numerous types of uncertainty arise when using formal models in the analysis of risks. Uncertainty is best seen as a relation, allowing a clear separation of the object, source and ‘owner’ of the uncertainty, and we argue that all expressions of uncertainty are constructed from judgements based on possibly inadequate assumptions, and are therefore contingent. We consider a five-level structure for assessing and communicating uncertainties, distinguishing three within-model levels—event, parameter and model uncertainty—and two extra-model levels concerning acknowledged and unknown inadequacies in the modelling process, including possible disagreements about the framing of the problem. We consider the forms of expression of uncertainty within the five levels, providing numerous examples of the way in which inadequacies in understanding are handled, and examining criticisms of the attempts taken by the Intergovernmental Panel on Climate Change to separate the likelihood of events from the confidence in the science. Expressing our confidence in the adequacy of the modelling process requires an assessment of the quality of the underlying evidence, and we draw on a scale that is widely used within evidence-based medicine. We conclude that the contingent nature of risk-modelling needs to be explicitly acknowledged in advice given to policy-makers, and that unconditional expressions of uncertainty remain an aspiration

Structural Material Property Tailoring Using Deep Neural Networks

Advances in robotics, artificial intelligence, and machine learning are ushering in a new age of automation, as machines match or outperform human performance. Machine intelligence can enable businesses to improve performance by reducing errors, improving sensitivity, quality and speed, and in some cases achieving outcomes that go beyond current resource capabilities. Relevant applications include new product architecture design, rapid material characterization, and life-cycle management tied with a digital strategy that will enable efficient development of products from cradle to grave. In addition, there are also challenges to overcome that must be addressed through a major, sustained research effort that is based solidly on both inferential and computational principles applied to design tailoring of functionally optimized structures. Current applications of structural materials in the aerospace industry demand the highest quality control of material microstructure, especially for advanced rotational turbomachinery in aircraft engines in order to have the best tailored material property. In this paper, deep convolutional neural networks were developed to accurately predict processing-structure-property relations from materials microstructures images, surpassing current best practices and modeling efforts. The models automatically learn critical features, without the need for manual specification and/or subjective and expensive image analysis. Further, in combination with generative deep learning models, a framework is proposed to enable rapid material design space exploration and property identification and optimization. The implementation must take account of real-time decision cycles and the trade-offs between speed and accuracy

Improving statistical skills through students’ participation in the development of resources

This paper summarizes the evaluation of a project that involved undergraduate mathematics students in the development of teaching and learning resources for statistics modules taught in various departments of a university. This evaluation regards students’ participation in the project and its impact on their learning of statistics, as characterized in terms of statistical reasoning, statistical thinking, and skills for statistical consultancy. The participation of students is evaluated from the viewpoint of communities of practice. The evaluation resulted in a characterization of the benefits of such a project and suggestions for implementations of future projects, and in addition brought to light new theoretical elements both as regards the learning of statistics and as regards communities of practice. In particular, the analysis highlighted contributions of the students involved to resource development practice in the community of university statistics teachers, as well as contributions to students’ learning as a result of participation in this community

Traps of multi-level governance. Lessons from the implementation of the Water Framework Directive in Italy

During recent decades, different patterns of multi-level governance (MLG) have spread across Europe as a consequence of Europeanisation of public policies, which have increasingly adopted decentralized and participatory procedures conceived as a tool of more effective and accountable policy-making. It appears, however, that the implementation of operational designs based on MLG may be rather problematic and it does not necessarily bring to the expected performance improvements. Referring to the case of the EU Water Framework Directive (2000/60/EC), which conceives the creation of new multi-level institutional settings as a key tool for enacting a new holistic approach to water management and protection, this article explores the difficulties that the implementation of such settings has brought in Italy, despite some favorable pre-conditions existing in the country. Evidence is provided that along with institutional and agency variables, the implementation effectiveness of MLG arrangements promoted by the EU can be challenged by their inherent characteristics

The ConStratO model of handover: a tool to support technology design and evaluation

Handovers are a specific kind of multidisciplinary team meeting. Shift handovers and transfers are both regular features of hospital work but there is currently great variation in how such handovers are conducted, presenting a challenging for those seeking to develop technology to support handover. This paper presents the ConStratO model of handover, which captures aspects of the context that influence how the handover is conducted, a range of different handover strategies relating to different aspects of the handover, and possible outcomes of handover. The model is based on detailed data collection in a range of clinical settings. We present the model as a tool for developing and evaluating technology support for handover

Primary care physicians' perceptions of barriers and facilitators to management of chronic kidney disease: A mixed methods study.

BackgroundGiven the high prevalence of chronic kidney disease (CKD), primary care physicians (PCPs) frequently manage early stage CKD. Nonetheless, there are challenges in providing optimal CKD care in the primary care setting. This study sought to understand PCPs' perceptions of barriers and facilitators to the optimal management of CKD.Study designMixed methods study.Settings and participantsCommunity-based PCPs in four US cities: Baltimore, MD; St. Louis, MO; Raleigh, NC and San Francisco, CA.MethodologyWe used a self-administered questionnaire and conducted 4 focus groups of PCPs (n = 8 PCPs/focus group) in each city to identify key barriers and facilitators to management of patients with CKD in primary care.Analytic approachWe conducted descriptive analyses of the survey data. Major themes were identified from audio-recorded interviews that were transcribed and coded by the research team.ResultsOf 32 participating PCPs, 31 (97%) had been in practice for >10 years, and 29 (91%) practiced in a non-academic setting. PCPs identified multiple barriers to managing CKD in primary care including at the level of the patient (e.g., low awareness of CKD, poor adherence to treatment recommendations), the provider (e.g., staying current with CKD guidelines), and the health care system (e.g., inflexible electronic medical record, limited time and resources). PCPs desired electronic prompts and lab decision support, concise guidelines, and healthcare financing reform to improve CKD care.ConclusionsPCPs face substantial but modifiable barriers in providing care to patients with CKD. Interventions that address these barriers and promote facilitative tools may improve PCPs' effectiveness and capacity to care for patients with CKD

"Am iz kwiin" (I'm his queen): Combining interpretative phenomenological analysis with a feminist approach to work with gems in a resource-constrained setting

This article focuses on working with gems using a feminist approach to interpretative phenomenological analysis (IPA) in a resource-constrained setting. The research explores the experiences of maternal disclosure of HIV to children of HIV positive mothers in Kingston, Jamaica. A feminist approach helps recognise power imbalances within research relationships and the women’s lived experiences. We present three “gems” which illuminate women’s lived experiences and explore how popularised representations of women’s sexuality and mothering influence disclosure discourses. We use emotion work as a conceptual resource to structure the women’s narratives and challenge existing policy discourses, which arguably represent disclosure within a binary, rationalist, decision-making framework. This article adds to global literature on maternal HIV disclosure and problematises policy discourses by bringing into relief the emotion work women engage in when deciding if and how to communicate their HIV status to their children. It adds to the body of research using IPA, particularly in resource-constrained settings where IPA has thus far had little application