Constraining natural and anthropogenic disturbances in the delivery of coastal ecosystem services

Coastal ecosystems provide key services that benefit human wellbeing yet are undergoing rapid degradation due to natural and anthropogenic pressures. This thesis seeks to understand how disturbances impact salt marsh and estuarine ecosystem functioning in order to refine their role in coastal ecosystem service delivery and predict future resilience. Salt marsh survival relative to sealevel rise increasingly relies on the accumulation and preservation of soil organic carbon (SOC). Firstly, I characterized SOC development and turnover in a New England salt marsh and found that salt marsh soils typically store marsh grass-derived compounds that are reworked over centuries-to-millennia. Next, I assessed how two common marsh disturbances – natural ponding and anthropogenic mosquito ditching – affect salt marsh carbon cycling and storage. Salt marsh ponds deepen through soil erosion and decomposition of long-buried marsh peat. Further, the SOC lost during pond development is not fully recouped once drained ponds are revegetated and virtually indistinguishable from the surrounding marsh. Mosquito ditches, which were installed in ~ 90% of New England salt marshes during the Great Depression, did not significantly alter marsh carbon storage. In Buzzards Bay, Massachusetts, a US National Estuary, we tested relationships among measures of estuarine water quality, recreational activity, and local socioeconomic conditions to understand how the benefits of cultural ecosystem services are affected by shifts in water quality associated with global change and anthropogenic activity. Over a 24-year period, water quality degradation coinciding with increases in Chlorophyll a is associated with declines in fishery abundance and cultural ecosystem service values ($0.08 – 0.67 million USD). In combination, incorporation of both anthropogenic and natural disturbances to coastal ecosystem functioning and service delivery can produce improved estimates of ecosystem service valuation for effective resource decision-making under future climate scenarios.

Perceptions and Needs of Artificial Intelligence in Health Care to Increase Adoption: Scoping Review

Background Artificial intelligence (AI) has the potential to improve the efficiency and effectiveness of health care service delivery. However, the perceptions and needs of such systems remain elusive, hindering efforts to promote AI adoption in health care. Objective This study aims to provide an overview of the perceptions and needs of AI to increase its adoption in health care. Methods A systematic scoping review was conducted according to the 5-stage framework by Arksey and O’Malley. Articles that described the perceptions and needs of AI in health care were searched across nine databases: ACM Library, CINAHL, Cochrane Central, Embase, IEEE Xplore, PsycINFO, PubMed, Scopus, and Web of Science for studies that were published from inception until June 21, 2021. Articles that were not specific to AI, not research studies, and not written in English were omitted. Results Of the 3666 articles retrieved, 26 (0.71%) were eligible and included in this review. The mean age of the participants ranged from 30 to 72.6 years, the proportion of men ranged from 0% to 73.4%, and the sample sizes for primary studies ranged from 11 to 2780. The perceptions and needs of various populations in the use of AI were identified for general, primary, and community health care; chronic diseases self-management and self-diagnosis; mental health; and diagnostic procedures. The use of AI was perceived to be positive because of its availability, ease of use, and potential to improve efficiency and reduce the cost of health care service delivery. However, concerns were raised regarding the lack of trust in data privacy, patient safety, technological maturity, and the possibility of full automation. Suggestions for improving the adoption of AI in health care were highlighted: enhancing personalization and customizability; enhancing empathy and personification of AI-enabled chatbots and avatars; enhancing user experience, design, and interconnectedness with other devices; and educating the public on AI capabilities. Several corresponding mitigation strategies were also identified in this study. Conclusions The perceptions and needs of AI in its use in health care are crucial in improving its adoption by various stakeholders. Future studies and implementations should consider the points highlighted in this study to enhance the acceptability and adoption of AI in health care. This would facilitate an increase in the effectiveness and efficiency of health care service delivery to improve patient outcomes and satisfaction.

Examining the Agency-Foundation Relationship in Local Park and Recreation Services

Local park and recreation agencies supply a variety of community-based services, often at little or no direct cost to users. To supplement tax-based allocations, many agencies rely on partnerships with park foundations, nonprofit organizations that directly support park and recreation service delivery. Despite their prevalence and importance, there is a lack of empirical evidence about the agency-foundation (AF) relationship; this project begins to address this need, and seeks to inform the efforts of professionals navigating these partnerships. Results from a survey of National Recreation and Park Association (NRPA) member agencies (n = 235) illustrated that these partnerships are generally viewed as close, effective, and strong, and of particular value relevant to “big picture” agency activities such as fundraising and community engagement. A comparison of communities indicates that the AF relationship is more common in larger communities, and among larger and more complex agencies. Practical implications for practitioners and potential directions for future research are discussed.

Tele-Ethics in Communication Disorders: Asking the Right Questions, Finding the Right Answers

Purpose: A hypothetical case is used to illustrate legal and ethical issues involving the decision to replace the traditional in-person service delivery model with telepractice in schools beyond the context of the initial COVID-19 health emergency. In this clinical focus article, the reader follows Maria, the lead speech-language pathologist (SLP) in the district, as she determines the feasibility of continuing telepractice in her district now that students and clinicians are returning to schools. First, she considers the support needed to implement this service delivery model within the school setting given the anticipated changes to the rules and regulations governing lawful and ethical provision of telepractice after the health emergency ends. Next, she decides if telepractice is warranted in the district by considering the rationales behind the requests. Faced with balancing school, student, and clinician needs, Maria uses an ethical decision-making model to determine if requests for telepractice, tied to health safety concerns and potentially influenced by implicit bias, reflect legal, ethical, and/or moral issues driven by fear or unconscious discriminatory motives. Conclusions: The health emergency gave SLPs working in schools the unique opportunity to experience the benefits and utility of telepractice. Following the return to schools, continuation of telepractice services will require support and training of SLPs. Many factors must be considered including equivalency of services, technology, and protection of privacy as they relate to the changes to the laws and regulations governing telepractice after the health emergency allowances end. Of primary importance is the selection of telepractice to address student needs, not to avoid specific schools because of their characteristics or location. An ethical decision-making model can be used as a framework to guide service delivery model decisions that balance the needs of the student, the clinician, and the district.

Monitoring Progress in Citywide Sanitation

For over 10 years, citywide sanitation plans have been developed, and now, citywide inclusive sanitation is being piloted globally, yet no tools exist to monitor changes in sanitation at a citywide level. This paper explores the use of Shit Flow Diagram Graphics (SFDGs) and City Service Delivery Assessments (CSDAs) to monitor changes in sanitation at a citywide level. This was done by documenting the changes in sanitation from 2015 to 2019 in Tiruchirappalli, India, and developing SFDGs and CSDAs for those years. The changes in the SFDGs and CSDAs were then compared with the documented changes. The SFDGs captured all changes in service delivery that affected >1% of the population, and all of the interventions in the enabling environment change in terms of appropriateness, acknowledgment, or implementation were captured by the CSDAs. Therefore, units of both tools were assessed to be appropriate for monitoring purposes. Using these tools to monitor change was complex and tedious, and this was improved by the development of Trend Graphs and Citywide CSDAs. This paper highlights the potential of Trend Graphs and Citywide CSDAs to monitor sanitation at a citywide level. Additionally, this is the first paper to attempt to monitor changes in sanitation holistically at a citywide level.

Using rapid evaluation methods to assess service delivery changes: Lessons learned for evaluation practice during the COVID-19 pandemic

The COVID-19 pandemic required large-scale service delivery changes for government, and provided the opportunity for evaluators to step up and support decision makers to understand the impact of these changes. Rapid evaluation methods (REM) provide a pragmatic approach for generating timely information for evidence-based policy and decision-making. Grounded in developmental and utilisation-focused evaluation theory, REM incorporates a team-based, mixed methods design, executed over a 6–8-week period. Customised rubrics were used to rigorously assess effectiveness and scalability of practice changes to inform COVID-19 response planning. REM is an alternative approach to full-scale evaluation models frequently implemented to assess policies and programs. Adapted use of REM suggests that meaningful insights can be gained through use of smaller scale evaluations. This article shares lessons learned from a novel rapid evaluation method applied in the context of the COVID-19 pandemic. The rapid evaluation approach was implemented to provide real-time insights and evaluative conclusions for 15 program and practice adaptations across Victorian health and human service settings. The article shares insights about the practical applicability of balancing rigour and timeliness when implementing a rapid evaluation, and strengths and limitations of working within a fast-paced evaluation framework. Findings can inform evaluative practice in resource and time-limited settings.

Implications of updated protocol for classification of childhood malnutrition and service delivery in world’s largest refugee camp amid this COVID-19 pandemic

Objectives: During the COVID-19 pandemic, the authorities made a change in the classification of malnutrition and concomitant service delivery protocol among the Rohingya children, residing in world’s largest refugee camp, located in Bangladesh. In this paper, we discussed the potential implications of this updated protocol on the malnutrition status among children from the Rohingya camp. Design: This paper reviewed relevant literature and authors’ own experience to provide a perspective of the updated protocol for the classification of malnutrition among the children in the Rohingya camps and its implication from a broader perspective. Setting: Rohingya refugee camps, Bangladesh Participants: Children aged less than five years residing in the Rohingya camps. Results: Major adaptation during this COVID-19 was discontinuation of using weight-for-height z-score (WHZ) and use of only MUAC and presence of edema for admission, follow up and discharge of malnourished children in camps. However, evidence suggest that use of MUAC only can underestimate the prevalence of malnutrition among the children in Rohingya camps. These apparently non-malnourished children are devoid of the rations that they would otherwise receive if classified as malnourished, making them susceptible to more severe malnutrition. Conclusions: Our analysis suggests that policymakers should consider using the original protocol of using both MUAC and WHZ to classify malnutrition and retain the guided ration size. We also believe that it would not take an extra effort to adopt the original guideline as even with MUAC only guideline, certain health measures needed to adopt during this pandemic.

Assessment of the quality of sexual and reproductive health services delivered to adolescents at Ujala clinics: A qualitative study in Rajasthan, India

The Adolescent Friendly Health Clinic (AFHCs), a key component of the Government of India’s National Adolescent Health Programme a.k.a. Rashtriya Kishor Swasthya Karyakram (RKSK), aims to increase the accessibility and utilization of sexual-reproductive health services by adolescents and youth. However, low quality of care provided at AFHCs by counsellors calls for attention. We, thus, explore both the clients’ and providers’ perspectives using the World Health Organization’s (WHO) global standards for quality health-care services for adolescents to assess the quality of the sexual reproductive health service delivery at AFHCs in Rajasthan, India. We conducted a qualitative study, comprising observation of the service delivery using mystery clients (MCs) (n = 12) and in-depth interviews with the counsellors (n = 4) in four AFHCs. Interviews were transcribed in local language and were translated in English. The transcripts were coded thematically. Our study, using five of the eight WHO global standards for quality health-care services for adolescents highlighted several gaps in the quality-of-service delivery at AFHCs. We unearth various intricacies related to the quality of the services provided at the AFHCs by referring to the relevant input, process, and the output criteria of WHO global standards I, III, IV, V and VI. Our study calls for efforts to improve- (i) the counsellors’ competencies to increase adolescents’ health literacy on sensitive topics, (ii) the facilities at the clinic to ensure privacy, comfort and confidentiality of the adolescents seeking services, (iii) the referrals to improve appropriate package of services, and (iv) an overall environment to ensure an equity and non-discrimination for all the adolescents. Our findings unearth the barriers that both the service providers and the adolescents face at the AFHCs and underscore the need for regular monitoring and evaluation of the AFHCs to strengthen the facility-based intervention of the RKSK programme.