System-Level Barriers to Uptake of Existing and Novel Radioimmunotherapy for People with Lymphoma

Introduction: Radioimmunotherapy is a targeted approach to cancer care. It has been shown to improve progression-free survival and quality of life in people with specific types of non-Hodgkin's lymphoma, including CD20- and CD37-positive B-cell lymphoma (Barr et al., 2018 NCT00770224; Green & Press, 2017; Kolstad et al., 2018 NCT01796171; Witzig et al., 2002). It has also been shown to increase the proportion of people who achieve complete response to therapy (Green & Press, 2017). Although CD20-targeted therapy has been approved in the US and Europe for nearly two decades, its use remains limited. At its peak in the UK in 2007, only 57 people with lymphoma were treated with the therapy (Rojas et al., 2019). However, research is ongoing; a PubMed search for 'radioimmunotherapy' and 'lymphoma' produces 1,097 articles in the past 20 years, including over 300 articles in the past ten years. With novel applications (CD37- and CD22-targeted) currently under investigation, it is increasingly important to understand potential system and policy barriers to uptake, such that existing roadblocks are overcome. Tackling these challenges is essential to ensuring that radioimmunotherapy is appropriately integrated into relevant clinical guidelines and care pathways. Aim: To better understand the policy and system barriers to integration of existing and novel radioimmunotherapy into lymphoma care in the US and the UK. Methodology: We conducted a structured literature review, taking a systems approach, to explore each of the five domains of the health system as outlined in the Radioligand Therapy Readiness Assessment Framework (Figure 1. Five core domains of the health system, with subdomains; The Health Policy Partnership, 2021). This approach allowed us to gain a holistic understanding of what integration of radioimmunotherapy involves and identify potential barriers, from clinical development through to patient care. We also conducted semi-structured interviews with lymphoma experts in the US (N=5) and UK (N=6), including clinicians and nurses ('clinical experts', N=8) and patient advocates ('advocates', N=3). Our work was guided by national expert advisory groups in each country. Results: While the US and UK health systems are organized and funded very differently, the literature and expert interviews revealed many common strategic challenges to the integration of radioimmunotherapy. These were: 1) low awareness and understanding of radioimmunotherapy among newly licensed healthcare professionals (an issue raised by n=8 clinical experts); 2) limited awareness by patient advocates, patients and policymakers (n=3 advocates); 3) caution around uptake of new radioimmunotherapy agents based on limited access to and use of older treatments (n=7 clinical experts); 4) nonexistent referral pathways and unclear models of working which discourage shared care and hinder multidisciplinary coordination (n=4 clinical experts); 5) lack of recent clinical data and research to support evidence-based use (n=5 clinical experts); 6) reimbursement concerns (n=5 clinical experts). Policy implications: Taking a systems approach to explore potential barriers to integration of radioimmunotherapy has allowed us to explore potential adaptations needed to achieve multisectoral and multidisciplinary working. Our findings reveal that professional societies, policymakers and patient advocacy groups will need to work together to overcome these barriers by: 1) reaching consensus on timing and eligibility criteria for use of radioimmunotherapy; 2) creating accurate and consistent patient-friendly information; 3) efficiently updating clinical training and treatment guidelines to include approved radioimmunotherapy; 4) developing evidence-based and personalized referral and treatment pathways which ensure consistency of care; and 5) investing in data collection and analysis to continually inform practice. Figure 1 Figure 1. Disclosures Morgan: Nordic Nanovector: Consultancy; Advanced Accelerator Applications: Consultancy. Merkel: Advanced Accelerator Applications: Consultancy; Amgen: Consultancy; AstraZeneca: Consultancy; Bayer: Consultancy; Bristol-Myers Squibb: Consultancy; Curium: Consultancy; Johnson & Johnson: Consultancy; MSD: Consultancy; Nordic Nanovector: Consultancy; Novartis: Consultancy. Gordon: Zylem Biosciences: Patents & Royalties: Patents, No royalties; Bristol Myers Squibb: Honoraria, Research Funding. Buscombe: Advanced Accelerator Applications Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Wait: Bayer: Consultancy; Curium: Consultancy; Johnson & Johnson: Consultancy; MSD: Consultancy; Advanced Accelerator Applications: Consultancy; Nordic Nanovector: Consultancy; Shionogi: Consultancy; Bristol-Myers Squibb: Consultancy; Amgen: Consultancy; AstraZeneca: Consultancy. Dreyling: Genmab: Consultancy; Celgene: Consultancy, Research Funding, Speakers Bureau; Amgen: Speakers Bureau; Astra Zeneca: Consultancy, Speakers Bureau; Bayer HealthCare Pharmaceuticals: Consultancy, Research Funding, Speakers Bureau; BeiGene: Consultancy; Gilead/Kite: Consultancy, Research Funding, Speakers Bureau; Incyte: Consultancy, Speakers Bureau; Janssen: Consultancy, Research Funding, Speakers Bureau; Novartis: Consultancy, Speakers Bureau; Roche: Consultancy, Research Funding, Speakers Bureau; Abbvie: Research Funding. Mittra: Advanced Accelerator Applications Novartis: Consultancy, Honoraria, Research Funding; Curium: Consultancy, Honoraria; Nordic Nanovector: Research Funding. Gopal: Janssen: Consultancy, Honoraria, Research Funding; Cellectar: Consultancy, Honoraria; Bristol Meyers Squibb: Research Funding; SeaGen: Consultancy, Honoraria, Research Funding; I-Mab bio: Consultancy, Honoraria, Research Funding; Incyte: Honoraria; MorphoSys: Honoraria; Servier: Consultancy, Honoraria; Genetech: Consultancy, Honoraria, Research Funding; IGM Biosciences: Research Funding; Astra-Zeneca: Research Funding; Karyopharm: Consultancy, Honoraria; Takeda: Research Funding; Teva: Research Funding; Agios: Research Funding; Kite: Consultancy, Honoraria; ADC Therapeutics: Consultancy, Honoraria; Acrotech: Consultancy, Honoraria; Merck: Consultancy, Honoraria, Research Funding; Epizyme: Consultancy, Honoraria; Nurix Inc: Consultancy, Honoraria; Beigene: Consultancy, Honoraria; Gilead: Consultancy, Honoraria, Research Funding.

CHALLENGES AND BARRIERS TO INTEGRATION OF ICT IN INDIAN SCHOOLS AND ROLE OF TEACHER

The present conceptual paper focused with the information of challenges and barriers to integration of ICT in Indian schools. ICT resource sharing and role of teacher is also explained in the paper. This current paper deals with the concept of ICT and discus the need and importance of ICT in present education scenario. The need to being information to various users has encouraged the creation of much innovative work with new technology. Also focused how information technology has made in inevitable for school education to keep pace by constant innovative atmosphere in the educational organization. The present paper focused with prime objectives are (i) To understand the concept and importance of ICT. (ii) To analyze the challenges and barriers to integration of ICT in Indian schools. (iii) To discuss the role of teacher in the Information and communication Technology.

Intro to this special issue: refugees/displaced people in the workplace

This special issue focuses on refugees’ experiences and displaced people across a diverse set of ethnicities and circumstances. The growing number of refugees and displaced people and the work and life difficulties they face are central social issues in the world today. This special issue will explore how refugees and displaced people in Brazil can be fully integrated, socialized, engaged, embraced, and affirmed into the workplace and society. Research is presented on the experiences of refugees and displaced people, a growing but under-researched segment of the world’s population. Little is known about refugees’ career experiences and displaced people and how organizations, leaders, and policymakers can assist them in finding work, maintaining employment, and creating positive life outcomes. There are 12 articles included in this special issue. They focus on three areas of refugees in the workplace. The first area explores biases in the perceptions of refugees based on factors such as skin complexion, countries of origin, and race. The second area presents research that elaborates on the theme of displacement of refugees and barriers to integration, inclusion, social recognition, and belonging. The third area examines ways in which refugees have been integrated and acculturated into Brazilian society, often through the assistance of NGOs or through the efforts of managers in the workplace. It is our hope that the research presented in this special issue will increase interest in this important topic and lead to additional future research related to reducing barriers to integration and acculturation that refugees and displaced people face.

Challenges to Inclusion

The expansion of inclusion practices has led to an increase in the integration of special education learners into general education classrooms. In order to meet the needs of all learners within inclusion classrooms, general and special education teachers must combine their respective teaching expertise. However, there are significant challenges to inclusion opportunities arising from a variety of sources. These major barriers to integration are described as environmental, knowledge-based, and relationship-based challenges. Examples of these challenges are discussed with respect to issues related to inclusion faced by both general and special education teachers.

Integrating physical and mental healthcare: Facilitators and barriers to success

Introduction: Effective and appropriate provision of mental healthcare has long been a struggle globally, resulting in significant disparity between prevalence of mental illness and access to care. One attempt to address such disparity was the Patient Protection and Affordable Care Act (PPACA), 2010, mandate in the United States to integrate physical and mental healthcare in Federally Qualified Health Centers (FQHCs). The notion of integration is attractive, as it has demonstrated the potential to improve both access to mental healthcare and healthcare outcomes. However, while the PPACA mandate set this requirement for FQHCs, no clear process as to how these centers should achieve successful integration was identified. Methods: This research employed case study methods to examine the implementation of this policy in two FQHCs in New England. Data were obtained from in-depth interviews with leadership, management, and frontline staff at two case study sites. Results: Study findings include multiple definitions of and approaches for integrating physical and mental healthcare, mental healthcare being subsumed into, rather than integrated with, the medical model and multiple facilitators of and barriers to integration. Conclusion: This study asked questions about what integration means, how it occurs, and what factors facilitate or pose barriers to integration. Integration is facilitated by co-location of providers within the same department, a warm hand-off, collaborative collegial relationships, strong leadership support, and a shared electronic health record. However, interdisciplinary conflict, power differentials, job insecurity, communication challenges, and the subsumption of mental health into the medical model pose barriers to successful integration.

Development of a structural model based on ISM for analysis of barriers to integration of leanwith industry 4.0

PurposeTo develop a structural model based on Interpretive Structural Modelling (ISM) approach to analyse the barriers to integration of Lean with Industry 4.0.Design/methodology/approachIntegrated lean and I4.0 is essential for optimising customer value, rapid product design and redesign to comply with customer demand on time. Also, manufacturing processes to be made more flexible, intelligent and agile. In this context, integrated lean and Industry 4.0 barriers were identified and an ISM approach is employed to identify hierarchical structure of barriers and analysed.FindingsThe result obtained reflects that barriers “increasing competitive pressure”, “lack of long-term vision”, “lack of management support”, “lack of capital fund” are found to be the important barriers that affect the integration of lean and I4.0.Research limitations/implicationsIn the present study, 16 barriers are analysed. In future, additional barriers could be included.Practical implicationsThe driving and dependence power of barriers were analysed from ISM model and it provided guidance for practitioners to concentrate on barriers for integrating lean and I4.0.Originality/valueThe idea of developing structural model for analysis of barriers to integration of lean with I4.0 is the original contribution.