A Framework to Support the Progressive Implementation of Integrated Team-based Care for the Management of Copd: a Collective Case Study

Background: In Canada, there is widespread agreement about the need for integrated models of team-based care. However, there is less agreement on how to support the scale-up and spread of successful models; there is limited empirical evidence to support this process in chronic disease management. We studied the supporting, and mitigating factors required to successfully implement and scale-up an integrated model of team-based care in primary care.Methods: We conducted a collective case study using multiple methods of data collection including interviews, document analysis, living documents, and a focus group. Our study explored a team-based model of care for chronic obstructive pulmonary disease (COPD) known as Best Care COPD (BCC) that has been implemented in primary care settings across Southwestern Ontario. BCC is a quality improvement initiative that was developed to enhance the quality of care for patients with COPD. Participants included healthcare providers involved in the delivery of the BCC program. Results: We identified several mechanisms influencing the scale-up and spread of BCC and categorized them as Foundational (e.g., evidence-based program, readiness to implement, peer-led implementation team), Transformative (adaptive process, empowerment and collaboration, embedded evaluation), and Enabling Mechanisms (provider training, administrative support, role clarity, patient outcomes). Based on these results, we developed a framework to inform the progressive implementation of integrated, team-based care for chronic disease management. Our framework builds off our empirical work and is framed by local contextual factors. Conclusions: This study explores the implementation and spread of integrated team-based care in a primary care setting. Despite the study’s focus on COPD, we believe the findings can be applied in other chronic disease contexts. We provide a framework to support the progressive implementation of integrated team-based care for chronic disease management.

Barriers to the Implementation of Alcohol Policies in Jayapura City

Background: Basic Health Research (RISKESDAS) in 2018 found as many as 15 provinces out of 35 provinces had a prevalence of alcohol consumption above the national prevalence, and Papua was reportedly in the top 15 of the prevalence of high alcohol consumption (alcohol) as much as 4.6%. Objective: To describe the obstacles to the implementation of local government policies in curbing the circulation of alcohol in Jayapura City. Method: This is a descriptive study using a qualitative single instrumental case study design in Jayapura City from May to September 2020. Purposive sampling technique was employed to determine participants who consisted of an integrated team of alcohol control and supervision (n =6). Data collection was using in-depth interviews and non-participant observation. Result: Communication between the integrated team was not optimal. National Food and Drug Agency (BPOM) had not routinely conducted sample tests as the majority of traditional alcoholic beverages sold in shops such as local liquors were illegal. The division of duties and responsibilities by the integrated team was good, but the execution in the field was not as agreed upon. There were alcohol traders who have not applied for licenses to sell alcohol because the process to get license permits was too complicated. The content of Perda No.8 of 2014 weakened the police because they could not give punishment like Satpol PP, however, Satpol PP did not have an investigating team. Conclusion: The lack of commitment from the control and supervision team of alcohol circulation in carrying out their duties. The resources involved were lacking. Coordination among the integrated teams was not going well thus the division of tasks and authorities with implementation actions in the field did not work according to the policy enforce in Jayapura City. Evaluation of work programs by policy implementers could be carried out to increase the success of implementation.

The Impact of the COVID-19 Outbreak on Intensive Care in Northern Saitama Japan

Background We examined and compared the actual impact of COVID-19 on local medical care in northern Saitama Japan, especially in intensive care units (ICUs), before (2019) and during (2020) the pandemic. Methods The impact of COVID-19 on emergency care responses was compared with acceptances and refusals in 2019 and 2020. We also examined the number of surgeries performed by ICU surgical departments. The impact on intensive care was examined regarding the numbers of incident reports and the severity percentage calculated from the integrated team medical care and safety system. We also compared the overtime work of physicians working. Results In 2019, there were 2,136 emergency patient requests, and 1,811 patients were received. In contrast, in 2020, there were 2,371 emergency patient requests, and 1,822 patients were accepted, representing a decrease of 76% (p = 0‧931). There were significantly more refusals in 2020, 303 (14‧1%) in 2019 and 506 (21‧3%) in 2020 (p = 0‧0004). In 2020, the number of surgeries increased in neurosurgery, cardiac surgeries, and vascular surgeries and over time increased in all surgical units. There were 396 incidents reported in ICUs in 2019; this increased significantly to 510 in 2020 (p = 0‧001). Conclusion Even though intensive care management was restricted, the number of patients and doctors’ overtime work increased compared to before the spread of COVID-19, and the surrounding environment led to an increase in the number of incidents. The environments in ICUs must be actively improved to prepare for an even more severe situation in the future.

Project 80KOPD: A Geologist's Perspective to a Successful Production Ramp-Up Effort.

Production ramp-up can be a tricky exercise, with a repertoire of challenges and surprises, which can threaten the proposed percentage of success. These challenges largely stem from paucity of data, change in reservoir dynamics, impact of unauthorized third-party activities and the compliment of skill sets/experience in the team. In addition, reservoir models are in some cases, ineffective tools for reservoir management and prediction. This is especially true in assets that are heavily bunkered by crude oil thieves and in geologically complex reservoirs with very few wells. Therefore, models must be updated with recent data and new understanding, to remain useful and accurate. Of great importance to a successful production ramp-up effort is assembling an integrated team of experienced sub-surface professionals and field executors. Unfortunately, in some teams and companies, the position and opinions of Geologists are often overlooked, resulting in mixed outcomes. Geologists do not only think in "millions of years" but can add value and contribute significantly to the overall project objective. This paper explores and explains the role of a geologist, as part of an integrated asset management team, in the successful ramp-up of production from 45KOPD to about 80KOPD, without drilling a single well or executing any rig activity. It also showcases some work methodologies adopted in the evaluation of candidate wells and the power inherent in adopting an integrated subsurface approach.

“PERLINDUNGAN KONSUMEN TERHADAP PEREDARAN MAKANAN YANG MENGANDUNG PENGAWET BERBAHAYA (STUDI PASAR JUNJUNG BUIH KOTA SINTANG)”

Packaged food is a food product that is widely circulated and free in the community. Foods that will be circulated for consumption so as not to harm consumers must include adequate, correct, honest and responsible information. So that every business actor in the food sector that is circulated is burdened with responsibility, especially if the food he produces causes losses to consumers. Based on the Decree of the Regent of Sintang Number: 510/156 / KEP-INDAGKOP-C/ 2015 dated February 27, 2015, on the Integrated Supervision of Hazardous Materials Abused in Food, a joint team chaired by the Sintang DistrictHealth Office held a raid in the Junjung Buih market and the shops in the Sintang Inpres Market. Related to the raid conducted by this integrated team, where the purpose of the raid is in order to anticipate the entry of hazardous materials to the market, such as borax, formalin, dangerous dyes Keywords: Protection, Consumer, food preservatives

Integrated Strategy to Curtail Illegal Gold Mining: A Case Study in Central Kalimantan, Indonesia

Illegal gold mining has disturbed the operation of a mining company (Indo Muro Kencana) in Central Kalimantan since the early 1990s. Several disputes have happened, including two serious conflicts, causing financial losses, damage to facilities, and fatalities, forcing the company to stop operations in 2002 and 2013. Eventually, the original investors abandoned the site. Various countermeasures were taken, including harsh law enforcement involving police and military forces’ deployment, yet the illegal mining activities continued. Since 2015, the new management has implemented new approaches; within five years, the number of illegal miners has decreased considerably. This study aims to identify the reasons behind the disputes and how the new management reduces illegal mining within its concession without triggering further conflict. This research is a case study using in-depth interviews, complemented by a study of corporate and media documents. Five factors were identified behind the previous conflicts. The new management’s integrated strategy to manage social issues, including illegal mining, started with social mapping, then an integrated team to deal with social issues was established, and finally, an integrated plan was introduced with four agendas: engagement, presence, respect and inclusiveness, and cohesiveness. This study contributes to company-community model building in similar circumstances and, in practice, offers a solution to curtail illegal gold mining, particularly in Indonesia. Keywords: Conflict, illegal gold mining, illegal miners, integrated, Kalimantan.

“Track’s Coed, I Never Thought of It as Separate”: Challenging, Reproducing, and Negotiating Gender Stereotypes in Track and Field

In contrast to the sex-segregated model that dominates sport and contributes to its tradition of hegemonic masculinity, collegiate track and field typically follows a sex-integrated structure whereby men and women train, travel, and compete together. In this article, the authors examined how six collegiate male track-and-field athletes who are part of a sex-integrated team navigate gendered norms and hierarchies with a particular focus on their understandings of gender(ed) performance and abilities. Grounded in a feminist poststructuralist framework, the authors’ analysis found that although the participants were accepting of a sex-integrated training environment and challenged some gender stereotypes and instances of sexism, they simultaneously reified these same gender stereotypes by characterizing women athletes as “emotional” or “less competitive” and advocated individual solutions to institutional sexism.

Interdisciplinary Team Teaching (ITT) in the ACS Athens American Studies Combo

The “Combo,” as it is popularly known at ACS Athens, is a team-taught American Studies interdisciplinary English and Social Studies course in which students are heterogeneously grouped in a unique blended learning environment. With differentiated instruction, teachers use a wide range of strategies to engage students of all abilities and backgrounds. Over two decades in the making, the integrated team-taught course instructors apply a constructivist approach, inquiry-based learning, collaborative structures, the latest technology, and creative approaches to engage students in the development of 21st century skills. This chapter traces the philosophy behind interdisciplinary team-teaching (ITT) at ACS Athens and its theoretical and research-based underpinnings to provide unique insights into its benefits and challenges. Three units of study are presented to illustrate organic differentiation, innovated blended teaching strategies, and formative and summative assessments in blended and virtual learning environments.