Are Outcomes in Congenital Cardiac Surgery Better Than Ever?

Background and Aim of the Study: Congenital heart disease is the most common congenital defect among infants born in the United States. Within the first year of life, 1 in 4 of these infants will need surgery. Only one generation removed from an overall mortality of 14%, many changes have been introduced into the field. Have these changes measurably improved outcomes? Methods: The literature search was conducted through PubMed MEDLINE and Google Scholar from inception to October 31, 2021. Ultimately, 78 publications were chosen for inclusion. Results: The outcome of overall mortality has experienced continuous improvements in the modern era of the specialty despite the performance of more technically demanding surgeries on patients with complex comorbidities. This modality does not account for case-mix, however. In turn, clinical outcomes have not been consistent from center to center. Furthermore, variation in practice between institutions has also been documented. A recurring theme in the literature is a movement towards standardization and universalization. Examples include mortality risk-stratification that has allowed direct comparison of outcomes between programs and improved definitions of morbidities which provide an enhanced framework for diagnosis and management. Conclusions: Overall mortality is now below 3%, which suggests that more patients are surviving their interventions than in any previous era in congenital cardiac surgery. Focus has transitioned from survival to improving the quality of life in the survivors by decreasing the incidence of morbidity and associated long-term effects. With the transformation towards standardization and interinstitutional collaboration, future advancements are expected.

Strengthening the Mentorship and Leadership Capacity of HIV/AIDS and Tuberculosis Researchers in South Africa

Programs to increase emerging and established HIV and tuberculosis (TB) researchers’ capacity to be more effective leaders and mentors are urgently needed in low- and middle-income countries (LMICs). Although conceptual frameworks of mentoring and mentoring toolkits have been developed by and for researchers in LMIC settings, few mentor training programs have been implemented and evaluated in these settings. We created, implemented, and evaluated a 9-month, certificate-level mentorship training program to strengthen the pipeline of HIV and TB researchers in South Africa. Differentiating features of the program included careful contextualization of mentorship tools and approaches, inclusion of a leadership curriculum to improve participant ability to work effectively in teams and organizations, and attention to processes that promote interinstitutional collaboration in mentorship. Twelve mid-career researchers graduated from the first cohort of the program. Among participants, we observed significant longitudinal improvement in mentorship competencies, increased numbers of network connections in multiple domains of collaboration, and high levels of satisfaction. We anticipate that the program description and results will be useful to researchers, research institutions, and funders seeking to build research mentorship and leadership capacity in LMIC settings.

Relevance of social and community mediation for health, in processes of reinsertion of people with addictive behaviors and dependencies (ABD)

Background The knowledge of the importance of intervention in the reintegration of people with addictive behaviors and dependencies (ABD), combined with the complexity of the process and the multiplicity of associated factors (SICAD, 2014), has motivated a study developed on social and community mediation, through a interinstitutional collaboration of seven public entities, linking the academy to entities that intervene in the field of health (SICAD, in press). This paper aims to explore and disseminate some of the research results, reflecting on the importance of social intervention in the global health of the citizen. Methods This research was carried out according to a mixed case study plan (multi-case and multi-perspective), which involved reinsertion professionals, people with ABD, families and other stakeholders, in a total of 18 cases, 51 interviews and 21 questionnaires. It has a national scope and combines the descriptive component with the analytical and reflective component. Results Crossing the mapping of the diagnosed problems with the results and impacts of the developed intervention, which translate into changes perceived by the interviewees in several areas, it is possible to explore axes of the effectiveness of the intervention implemented in the reinsertion process. Conclusions The results show a high level of effectiveness (individual, family and community level), which goes beyond the changes in the scope of dependencies and affects the various areas of life of the citizen. The developed intervention generated impacts felt in the health level by the interviewees as positive and allowed to modify the fragile conditions that were identified in the diagnosis.

Collaboration among public organizations: a systematic literature review on determinants of interinstitutional performance

PurposeThe concept of collaboration has received increased attention from scholars in public management, as it has been seen as a viable solution to address “wicked” problems. Solving such problems may require a horizontal collaboration within the same governmental jurisdiction or, vertically, between different levels of government. Despite broad interest from the field of public management, the dynamics of public interinstitutional collaboration have received little attention within the literature. This paper aims to provide a systematic overview of the most significant academic contributions on the topic, highlighting the features of this collaborative context and identifying determinants those can foster its performance.Design/methodology/approachIn total, two main literature streams have occasionally dealt with public interinstitutional collaboration and related performance management: the “collaborative governance” stream and “public network performance”. Through a systematic literature review (SLR), this paper answers the following research question: what has been done and what is missing in order to assess performance in the context of public interinstitutional collaboration?FindingsThe findings of this study suggest that the most relevant papers are those dealing with public interagency collaboration, as this form of collaboration presents several similarities with public interinstitutional circumstances. Furthermore, the authors provide an analysis of the main determinants of public interinstitutional performance, which highlight the effects of trust, power sharing, leadership style, management strategies and formalization on the achievement of efficient and effective collaboration between public entities.Originality/valueBy drawing on two autonomous literature streams, this paper describes the main features of public interinstitutional collaboration. It contributes to the field by offering a systematic overview of how specific performance determinants, which are widely recognized as relevant for collaboration in general, work in the specificity of public–public contexts.

Violazioni amministrative in campo forestale. Confronto fra normative regionali

The present work is proposed as a contribution to discussion about new Italian forest legislation and as a possible starting point for future policies. Some regional regulations have been compared for what concerns the administrative sanctioning rules applied in the sector. To give concreteness to the present argument, a specific case study has been carried out in the province of Cuneo (Piedmont, Italy). The istance has been chosen for its representativeness and high frequency, being its dendrometric parameters common in other regional contexts. Specifically, a pure meso-eutrophic beechwood has been analyzed. This has revealed a certain lack of homogeneity in the attribution of the form of forest management (coppice vs. highforest management systems). In fact there are different legal definitions of their dendrometric parameters. As a result, there are different silvicultural treatments to apply and very different levels of growing stock (in terms of number of trees, canopy cover area or tree volume) to be released. But it is above all the estimations of the allowable cut considered illegal (i.e. in stock volume and in number of trees), and even more the amounts of the administrative penalties that display the greatest differences. These differences would be even more relevant in the case of implementation of the European Union Regulation no. 995/2010, the so-called “Due Diligence”, which contrasts the trade of illegally sourced timber, and enumerates cases of law infringements strictly dependent on the configuration of the administrative offenses defined by regional regulations. The study carried out therefore highlights the opportunity to evaluate, in the appropriate areas of interinstitutional collaboration, the control algorithms for the best possible harmonization of the applicable regulations in Italy; the final goal should be the reduction of possible competitive imbalances between various companies operating in different regional contexts.

Analysis of the technological change of the irrigation system of seven directories of the San Juan River.Ecuador

The present investigation carries out the analysis of the technological innovation of the application of pressurized irrigation in seven user directories of the San Juan - Patoa River of La Matriz Parish of the Pujilí Canton, for which the objectives were: To identify the degree of adoption of the technification of traditional irrigation; Observe the degree of commitment of the irrigators for the adoption of the irrigation system; Establish interinstitutional collaboration in the execution of the project. The methodology applied in the present analysis is based on the theory of innovation. From which it is concluded that: 14% of the seven directories of users of irrigation water, has implemented the system of pressurized irrigation with a reservoir of 80000 m3 for 490 ha; The members of the seven irrigation boards signed the agreements for the technification of the irrigation system; The municipal GAD of Pujilí canton paid for the studies, the Provincial GAD of Cotopaxi executed the work, with the supervision of the National Directorate of Water Resources Keywords: technological innovation, pressurized irrigation

Oficina de comunicación a distancia del Hospital de Pediatría “Prof. Dr. Juan P. Garrahan” – más de 20 años construyendo telemedicina = Outreach Communication Office of Hospital de Pediatría “Prof. Dr. Juan P. Garrahan” – more than 20 years building telemedicine

Introducción: El Hospital de Pediatría “Prof. Dr. Juan P. Garrahan” ha sido pionero en la atención de la salud de la población infantil del país y de Latinoamérica. El 53% de los pacientes que concurren al hospital viven más allá del área metropolitana de Buenos Aires. En agosto de 1997, se creó la Oficina de Comunicación a Distancia como una herramienta para sostener la continuidad asistencial de los pacientes de áreas remotas; su apertura significó el embrión del primer programa de telemedicina del país. Objetivos: Promover la construcción de redes integradas de servicios de salud. Impulsar nuevos procesos que mejoren el acceso a la salud. Metodología: Basados en la lógica de redes integradas de servicios de salud con la incorporación de las tecnologías de la información y la comunicación. Resultados: Desde 1997 hasta el primer semestre de 218 se crearon 283 OCD. Se asistieron más de 70.000 consultas asincrónicas y se realizaron más de 5000 videoconferencias. Conclusiones: La modalidad de comunicación a distancia y telemedicina estimula el trabajo colaborativo interinstitucional favoreciendo la atención de los pacientes en origen.Palabras clave: Oficina de comunicación a distancia (OCD); telemedicina; redes; tecnologías de la información y la comunicación (TICS).Abstract Introduction: Hospital de Pediatría “Prof. Dr. Juan P. Garrahan” has been a Pioneer in health care for children in Argentina and Latin America. Overall, 53% of the patients that are covered by the hospital live outside the metropolitan area of Buenos Aires. In August 1997, the Outreach Communication Office (OCO) was created as a tool to sustain continuous care for patients living in remote areas; its inauguration was the seed for the first telemedicine program in the country. Objectives: To promote the development of networks of health-care services. To initiate processes to improve Access to health care. Methods: Development of comprehensive health-care networks with the incorporation of information and communication technologies. Results: Between 1997 and the first semester of 218, 283 OCO’s were created. Overall, 70,000 asynchronous consultations were conducted and more than 5000 videoconferences were held. Conclusions: The modality of outreach communication and telemedicine encourages interinstitutional collaboration favoring patient care at their site of origin.Keywords: Outreach Communication Office (OCO); Telemedicine; Networks; Information and Communication Technology (ICT).

Shortcomings of Higher Education Evaluation Systems

Higher Education Evaluation Systems supply information for diverse stakeholders. A “one size fits all” approach in university rankings is not enough. Looking to the future, evaluation may need to take into account criteria such as links with employers, lifelong education, implications of digitization, and interdisciplinary and interinstitutional collaboration across borders. The extensive possibilities of today’s research data based analyses are analysed, against the background of a whole industry devoted to this. Shortcomings, challenges and unintended consequences of the current approach are discussed. Impact analyses are seen as one of the ways forward, taking into account contributions to societies and their transformations. Diversity, “glocal” mindset and international collaboration are suggested as additional criteria for the competitive rankings of the future.

A Practical Guide to Whole Slide Imaging: A White Paper From the Digital Pathology Association

Context.— Whole slide imaging (WSI) represents a paradigm shift in pathology, serving as a necessary first step for a wide array of digital tools to enter the field. Its basic function is to digitize glass slides, but its impact on pathology workflows, reproducibility, dissemination of educational material, expansion of service to underprivileged areas, and intrainstitutional and interinstitutional collaboration exemplifies a significant innovative movement with far-reaching effects. Although the benefits of WSI to pathology practices, academic centers, and research institutions are many, the complexities of implementation remain an obstacle to widespread adoption. In the wake of the first regulatory clearance of WSI for primary diagnosis in the United States, some barriers to adoption have fallen. Nevertheless, implementation of WSI remains a difficult prospect for many institutions, especially those with stakeholders unfamiliar with the technologies necessary to implement a system or who cannot effectively communicate to executive leadership and sponsors the benefits of a technology that may lack clear and immediate reimbursement opportunity. Objectives.— To present an overview of WSI technology—present and future—and to demonstrate several immediate applications of WSI that support pathology practice, medical education, research, and collaboration. Data Sources.— Peer-reviewed literature was reviewed by pathologists, scientists, and technologists who have practical knowledge of and experience with WSI. Conclusions.— Implementation of WSI is a multifaceted and inherently multidisciplinary endeavor requiring contributions from pathologists, technologists, and executive leadership. Improved understanding of the current challenges to implementation, as well as the benefits and successes of the technology, can help prospective users identify the best path for success.