Establishing mixed method research design guidelines in health impact assessment investigations

In the last decade local policymakers and community health officials have been using a Health Impact Assessment (HIA) strategy to assess the health impacts of their policy decisions. The HIA research design is founded on the mixed method research approach (integration of quantitative and qualitative data slices within a single investigation) to get as comprehensive assessment as possible of the expected impacts. The HIA literature has yet to provide any guidelines on how community health investigators should conduct a mixed-method HIA research. We conducted a content analysis of 100 HIAs executed around the world published between 1999 and 2011 and analysed their research methodologies. Observations generated from the analysed HIAs were used to establish an ‘HIA mixed method model’ by which a series of mixed-method design guidelines were used to help community health researchers improve the analytical capabilities in their future HIA investigations.     

Use and effectiveness of health impact assessment in the energy and natural resources sector in the United States, 2007 – 2016

Decisions made in the energy and natural resources sector can affect public health. This report reviews the characteristics and assesses the effectiveness of health impact assessments (HIAs) conducted in this sector. A total of 30 HIAs conducted in 14 states in the United States were identified using a targeted literature search. Five HIAs illustrative of the different source and sub-sector categories, and with identifiable impacts on decision-making processes were selected for review. An existing conceptual framework (Wismar) was used to assess the effectiveness of the five selected HIAs on decision-making related to non-renewable energy, renewable energy, mining, and energy conservation. The 30 HIAs were performed for a variety of projects and assessed health impacts ranging from metabolic disorders to community livability. Eight of the 30 reports were incorporated into environmental impact assessments. All five selected HIAs were generally effective and raised awareness of the health effects of the projects being assessed; four were directly effective and led to changes in final project decisions. Their variable effectiveness may be related to the extent of community engagement and consideration of equity issues, differences in the details and quality of monitoring and evaluation plans devised as part of the HIA process, and whether the outcomes of monitoring and evaluation are reported.     

Developing a model curriculum for a university course in health impact assessment in the USA

As health impact assessments (HIAs) become increasingly common in the USA, there is growing demand for instruction beyond short courses and online training. As of October 2013, there are graduate level courses that include instruction on HIA in at least 17 universities in the USA, including four courses that focus explicitly on HIA. Instructors of these four courses collaborated to develop a model curriculum for teaching HIA that draws on a framework for experiential learning and on a theoretical model of curriculum formulation. This article includes an in-depth analysis of these courses and presents a model curriculum for HIA instruction during an academic quarter or semester course in a university. This model curriculum may help faculty develop a graduate level HIA course at their institution, as well as inform public health and community design professionals interested in building capacity to conduct HIAs, and students considering taking an HIA course. International instructors could also learn from the US experience, and apply the model curriculum to their setting and educational structure.     

Public understanding of risk in health impact assessment: a psychosocial approach

Development projects inevitably pose risks to the health of humans and the planet. Health impact assessment (HIA) practitioners increasingly evaluate the mental health effects of development but have rarely considered those caused by public understanding of risk (‘risk perception’) itself a determinant of health. This paper proposes a new psychosocial model of public understanding of risk in response to the literature on perceived high risk developments. It exemplifies the psychosocial process that occurs when people respond to industrial threats to health. In doing this, it draws upon literature from psychology, social science and public health. The model is foregrounded in the context of psychosocial health in HIA. The paper also reviews the health and well-being effects that may result. Overall, it is argued that the philosophical and moral underpinnings of HIA compel practitioners and developers to understand the formation and ongoing development of public understandings of risk in light of the cultural, demographic, temporal and other contextual factors shaping them in unique development contexts where HIAs are undertaken, and how understandings of risk actually affect community health. We encourage them to propose mitigation measures and solutions that accord with the values of Planetary Health.     

Bringing health impact assessment to the Mongolian resource sector: a story of successful diffusion

Following the 2009 signing of the stability agreement between the Mongolian Government and Canadian mining company Turquoise Hill Resources (formerly known as Ivanhoe Mines), researchers from Simon Fraser University secured funding from the Canadian Institutes for Health Research to conduct applied knowledge translation (KT) research that introduces health impact assessment (HIA) to Mongolia's rapidly emerging resource sector. HIA is a highly regarded informed decision-making tool that helps to identify, assess and mitigate (or promote) potential positive and negative human health impacts of policies, projects and programs. We engaged in a series of knowledge synthesis, KT and dissemination activities with key public and private sector stakeholders as well as community representatives. Our goals were to develop consensus on a socially and culturally appropriate approach to equity-focused HIA, draw on this consensus to develop a contextualized HIA toolkit, build local HIA capacity based on this toolkit, strengthen the HIA regulatory environment and provide evidence-based support for efforts to institutionalize HIA in the resource sector. These efforts have resulted in the inclusion of HIA in the environmental impact assessment law of Mongolia, and the focus has now shifted from KT to further supporting HIA institutionalization and practice.     

HIA practices in Nigeria

Health impact assessment (HIA) provides useful information on existing health services, their capabilities and the health status of the local communities, which is otherwise often unavailable. In Nigeria, HIA is usually applied to projects and, by exposing existing health inequities in project communities, provides the necessary tool for development proponents to act to provide or improve health services and to implement health promotion activities. Based on HIA experience in Nigeria, this paper highlights the deficiencies in national legislation with regards to HIA/EIA (environmental impact assessment) integration and a number of learning points are discussed. First, a complete health baseline is critical to the understanding of project impacts; analysis must be broad-based, considering existing health determinants. Second, community stakeholders and proponents may modify the implementation of health mitigation measures and should be seen as collaborators in the assessment process. Third, strong HIA recommendations can influence project design. A greater participation of the health sector in EIA is required to enhance HIA utilization.     

Implementation of QA and QC standards in radiology in Slovakia

The Slovak government organizes the radiation protection policy through its regulatory authorities within the Ministry of Health, on a central level. The health protection regulations are compatible with international standards and recommendations of the ICRP and the EC. The general requirements on quality assurance (QA) and quality control (QC) (acceptance, constancy and routine tests), the guidance levels for various types of radiological examinations and the instructions for optimisation procedures are supported by Slovak technical standards, compatible with European standards. But the QA/QC process, as well as the training of the staff, needs improvement. The Slovak Medical University participates in the QA implementation through organising and managing national audits for control of the QA programme. In this paper, we present results of patient dose measurement studies carried out in the Slovak Republic, in the framework of activities of the Slovak Commission of QA established by the Slovak Ministry of Health.     

Mental health impact assessment: population mental health in Englewood,Chicago, Illinois,USA

In this paper, we describe a pilot mental health impact assessment (MHIA) undertaken by the Institute on Social Exclusion (ISE) at the Adler School of Professional Psychology. This pilot involved a multi-method approach that included literature reviews and direct engagement of community stakeholders. It resulted in a policy document that summarized the anticipated effects of a proposed amendment to Chicago's Vacant Buildings Ordinance on the collective mental health of people living in Englewood, a neighbourhood located on the city's southwest side. The Chicago City Council passed the proposed amendment in the summer of 2011.Working to advance health impact assessment (HIA) practice, the project aimed to assist Englewood residents by empowering them to participate in the systematic review of a proposed policy change that would impact their own community's mental health. Additionally, the pilot sought to ensure that any policy decision reflected an evidence-based understanding of its probable effects on the mental health of Englewood residents. Thus, these efforts were designed to narrow several health inequities as suggested by key indicators of community mental health.     

Assessing impacts on people's relationships to place and community in health impact assessment: an anthropological approach

This paper explores a way in which health impact assessment (HIA) practitioners can improve their evaluation of the effects of infrastructure developments on people's intangible connections and emotional attachments to places and communities, and their health impacts. This assessment poses conceptual and methodological challenges. It is argued that social anthropology and the social sciences offer HIA a conceptual vocabulary and a methodology for exploring these relationships. These relationships are defined then positioned in HIA as an outcome of the health determinant, social capital. The paper offers a critique of their treatment in an HIA case study from the United Kingdom. Its shortcomings are used to propose a predominantly qualitative, anthropological methodology. The overall approach offers benefits. Practitioners gain clarification, new tools, a more holistic HIA, and links between these relationships, well-being, and sustainability and resilience. Developers are shown how to sensitise their approach, potentially enhancing community support.     

An effective hybrid immune algorithm for solving the distributed permutation flow-shop scheduling problem

In this article, an effective hybrid immune algorithm (HIA) is presented to solve the distributed permutation flow-shop scheduling problem (DPFSP). First, a decoding method is proposed to transfer a job permutation sequence to a feasible schedule considering both factory dispatching and job sequencing. Secondly, a local search with four search operators is presented based on the characteristics of the problem. Thirdly, a special crossover operator is designed for the DPFSP, and mutation and vaccination operators are also applied within the framework of the HIA to perform an immune search. The influence of parameter setting on the HIA is investigated based on the Taguchi method of design of experiment. Extensive numerical testing results based on 420 small-sized instances and 720 large-sized instances are provided. The effectiveness of the HIA is demonstrated by comparison with some existing heuristic algorithms and the variable neighbourhood descent methods. New best known solutions are obtained by the HIA for 17 out of 420 small-sized instances and 585 out of 720 large-sized instances.     

The importance of a successful Quality Assurance (QA) program from a research manager's perspective.

One responsibility of an EPA research manager is to ensure that data from research projects are acquired, processed, and reported in accordance with Quality Assurance (QA) requirements established by the Agency. To meet this responsibility, the research manager should understand Agency QA requirements, require an appropriate, effective Quality Assurance program to ensure that data are of known and acceptable quality for the intended use of the data, and provide support, guidance, and oversight to principal investigators in meeting QA requirements. In addition, the effectiveness of the QA effort can be enhanced if the research manager 1) ensures that principal investigators and other managers are aware that QA is viewed as an essential, integrated component of the research programs; 2) provides adequate resources (people and money) to support an effective Quality Assurance program; 3) encourages cooperative, productive interactions between researchers and Quality Assurance professionals; and 4) maintains oversight so that issues that have the potential for adversely affecting research and Quality Assurance objectives can be negotiated and corrected quickly. This presentation will discuss the Air Pollution Prevention and Control Division's Quality Assurance program and the approaches used to meet Quality Assurance requirements in the Division. The presentation will be a technical manager's perspective of the Division's requirements for and approach to Quality Assurance in its research programs. The presentation will include the design of the QA Team, the roles of members of the QA Team, training and technical aids provided by the QA Team to promote understanding of and adherence to Agency QA requirements, the interactions of the QA Team members with principal investigators, and examples of effective conflict resolution.     

Sustainable development of process facilities: state-of-the-art review of pollution prevention frameworks

Pollution prevention (P2) strategy is receiving significant attention in industries all over the world, over end-of-pipe pollution control and management strategy. This paper is a review of the existing pollution prevention frameworks. The reviewed frameworks contributed significantly to bring the P2 approach into practice and gradually improved it towards a sustainable solution; nevertheless, some objectives are yet to be achieved. In this context, the paper has proposed a P2 framework 'IP2M' addressing the limitations for systematic implementation of the P2 program in industries at design as well as retrofit stages. The main features of the proposed framework are that, firstly, it has integrated cradle-to-gate life cycle assessment (LCA) tool with other adequate P2 opportunity analysis tools in P2 opportunity analysis phase and secondly, it has re-used the risk-based cradle-to-gate LCA during the environmental evaluation of different P2 options. Furthermore, in multi-objective optimization phase, it simultaneously considers the P2 options with available end-of-pipe control options in order to select the sustainable environmental management option.     

Large Scale Infrastructure Projects: The Art of Project or Change Management?

Although it is generally understood that change is a fundamental component of managing projects in the construction industry in general and an inevitable challenge for large scale infrastructure project in particular, there has been little to no attention in the literature to understand change in this context from a more holistic perspective. For this purpose, this work looks at change through the eyes of a framework of six batteries of change that seem essential to charge an organization’s capabilities for change. The framework brings together the expertise of four specialists that all have developed their insights over many years of study and practice, and has been validated through an extensive review of the management literature on organization development and change. Reflections on the application of this model in the construction industry and in large scale infrastructure projects demonstrate that energizing organizations to successfully deal with change goes beyond the traditional techniques of managing change from a program or project management perspective. Assessing the six batteries of change in this context can help organizations to develop capabilities for change that build change energy by balancing formal/rational methods with informal/emotional interventions at both a local (department/subproject) and global (business) level.     

One fish, two fish, we QC fish: controlling data quality among more than 50 organizations over a four-year period.

EPA is conducting a National Study of Chemical Residues in Lake Fish Tissue. The study involves five analytical laboratories, multiple sampling teams from each of the 47 participating states, several tribes, all 10 EPA Regions and several EPA program offices, with input from other federal agencies. To fulfill study objectives, state and tribal sampling teams are voluntarily collecting predator and bottom-dwelling fish from approximately 500 randomly selected lakes over a 4-year period. The fish will be analyzed for more than 300 pollutants. The long-term nature of the study, combined with the large number of participants, created several QA challenges: (1) controlling variability among sampling activities performed by different sampling teams from more than 50 organizations over a 4-year period; (2) controlling variability in lab processes over a 4-year period; (3) generating results that will meet the primary study objectives for use by OW statisticians; (4) generating results that will meet the undefined needs of more than 50 participating organizations; and (5) devising a system for evaluating and defining data quality and for reporting data quality assessments concurrently with the data to ensure that assessment efforts are streamlined and that assessments are consistent among organizations. This paper describes the QA program employed for the study and presents an interim assessment of the program's effectiveness.     

Development of training syllabi for radiation protection and quality assurance of dual-energy X-ray absorptiometry (DXA) systems

The use of dual-energy X-ray absorptiometry (DXA) scanners for measuring bone mineral density (BMD) is on the increase. A single DXA scan is a relatively low-dose diagnostic X-ray examination; however, radiation protection (RP) issues should not be trivialised. One objective of the EU 6th Framework SENTINEL co-ordination action was to develop training syllabi in RP and quality assurance (QA) for BMD, and this study presents the results. An EU-wide survey was carried out which confirmed that there was a need for an accredited DXA RP training course in many EU states. There is also limited published guidance on acceptance testing/QA for DXA. Two training syllabi were developed: one on RP and one on QA of DXA systems. A training course was delivered in Ireland in 2006 by the Medical Physics & Bioengineering Department of St James's Hospital, Dublin. Following the training course, a PC-based training CD was developed and will be made available. A harmonised approach to training will promote consistent approaches to radiation safety across the EU.     

European survey of dental X-ray equipment

The implementation of an X-ray Quality Assurance (QA) program is a legal requirement in Europe as stipulated in the EU Council Directive 97/43/EURATOM (MED). A review of the literature has identified that European countries are performing some level of QA testing of their dental X-ray equipment, although the type and level to which testing is performed can differ. The European SENTINEL co-ordination action proposed to collate a survey of equipment data for both conventional and digital dental X-ray installations among the SENTINEL partners. The European QA results confirm that systems can be operated below tolerance, and in some cases significantly so, while still in clinical use. This can occur despite servicing of equipment. The results have emphasised the fact that there is a requirement for the medical physics/engineering professions to become more closely involved in the management of dental radiology equipment. This also includes their involvement in the development and delivery of appropriate training courses for dentists and suppliers of dental radiology equipment.     

Electrospinning: An emerging technology to construct polymer-based nanofibrous scaffolds for diabetic wound healing

A chronic wound in diabetic patients is a major public health concern withsocioeconomic and clinical manifestations.The underlying medical condition of diabeticpatients deteriorates the wound through physiological,metabolic,molecular,and cellularpathologies.Consequently,a wound enters a vicious pathological inflammatory cycle.Many therapeutic approaches are in practice to manage diabetic wounds hence ensuringthe regeneration process.Polymer-based biomaterials have come up with hightherapeutic promises.Many efforts have been devoted,over the years,to build aneffective wound healing material using polymers.The electrospinning technique,although not new,has turned out to be one of the most effective strategies in buildingwound healing biomaterials due to the special structural advantages of electrospunnanofibers over the other formulations.In this review,careful integration of allelectrospinning approaches has been presented which will not only give an insight intothe current updates but also be helpful in the development of new therapeutic materialconsidering pathophysiological conditions of a diabetic wound.     

Clinical performance improvement series. Classic CQI integrated with comprehensive disease management as a model for performance improvement.

BACKGROUND: In recent years, health and disease management has emerged as an effective means of delivering, integrating, and improving care through a population-based approach. Since 1997 the University of Pennsylvania Health System (UPHS) has utilized the key principles and components of continuous quality improvement (CQI) and disease management to form a model for health care improvement that focuses on designing best practices, using best practices to influence clinical decision making, changing processes and systems to deploy and deliver best practices, and measuring outcomes to improve the process. Experience with 28 programs and more than 14,000 patients indicates significant improvement in outcomes, including high physician satisfaction, increased patient satisfaction, reduced costs, and improved clinical process and outcome measures across multiple diseases. DIABETES DISEASE MANAGEMENT: In three months a UPHS multidisciplinary diabetes disease management team developed a best practice approach for the treatment of all patients with diabetes in the UPHS. After the program was pilot tested in three primary care physician sites, it was then introduced progressively to additional practice sites throughout the health system. The establishment of the role of the diabetes nurse care managers (certified diabetes educators) was central to successful program deployment. Office-based coordinators ensure incorporation of the best practice protocols into routine flow processes. A disease management intranet disseminates programs electronically. Outcomes of the UPHS health and disease management programs so far demonstrate success across multiple dimensions of performance-service, clinical quality, access, and value. DISCUSSION: The task of health care leadership today is to remove barriers and enable effective implementation of key strategies, such as health and disease management. Substantial effort and resources must be dedicated to gain physician buy-in and achieve compliance. The challenge is to provide leadership support, to reward and recognize best practice performers, and to emphasize the use of data for feedback and improvement. As these processes are implemented successfully, and evidence of improved outcomes is documented, it is likely that this approach will be more widely embraced and that organizationwide performance improvement will increase significantly. CONCLUSIONS: Health care has traditionally invested extraordinary resources in developing best practice approaches, including guidelines, education programs, or other tangible products and services. Comparatively little time, effort, and resources have been targeted to implementation and use, the stage at which most efforts fail. CQI's emphasis on data, rapid diffusion of innovative programs, and rapid cycle improvements enhance the implementation and effectiveness of disease management.     

Concept and model of a piezoelectric structural fiber for multifunctional composites

The use of piezoceramic materials for structural sensing and actuation is a fairly well developed practice that has found use in a wide variety of applications. However, just as advanced composites offer numerous benefits over traditional engineering materials for structural design, actuators that utilize the active properties of piezoelectric fibers can improve upon many of the limitations encountered when using monolithic piezoceramic devices. Several new piezoelectric fiber composites have been developed, however almost all studies have implemented these devices such that they are surface-bonded patches used for sensing or actuation. This paper will introduce a novel active piezoelectric structural fiber that can be laid up in a composite material to perform sensing and actuation, in addition to providing load bearing functionality. The sensing and actuation aspects of this multifunctional material will allow composites to be designed with numerous embedded functions including, structural health monitoring, power generation, vibration sensing and control, damping, and shape control through anisotropic actuation. A one-dimensional micromechanics model of the piezoelectric fiber will be developed to characterize the feasibility of constructing structural composite lamina with high piezoelectric coupling. The theoretical model will be validated through finite element (FE) modeling in ABAQUS. The results will show that the electromechanical coupling of a fiber-reinforced polymer composite incorporating the active structural fiber (ASF) could be more than 70% of the active constituent.