A Dyadic View on the Post-separation Network of Single Mothers

Many empirical studies have focused on the quantitative changes in the social networks of divorced and separated people. In this qualitative study, we use interviews with dyads to construct a two-sided view of the support network after separation. The aim of the study is to gain insight into the needs for support after a relational breakup. Including a network member in the analysis enables a more detailed view on the interaction at hand in the bond between these women and their supportive network members. The results show that personal coping resources are left untouched. Giving advice on ones daily activities is counter-productive. This is better understood by non family members compared to the women’s parents (especially the mother). With respect to the reciprocity in these relationships, network members do not expect a return in the period after the separation.

Using Network and Complexity Theories to Understand the Functionality of Referral Systems for Surgical Patients in Resource-Limited Settings, the Case of Malawi

Background: A functionally effective referral system that links district level hospitals (DLHs) with referral hospitals (RHs) facilitates surgical patients getting timely access to specialist surgical expertise not available locally. Most published studies from low- and middle-income countries have examined only selected aspects of such referral systems, which are often fragmented. Inadequate understanding of their functionality leads to missed opportunities for improvements. This research aimed to investigate the functionality of the referral system for surgical patients in Malawi, a low-income country. Methods: This study, conducted in 2017-2019, integrated principles from two theories. We used network theory to explore interprofessional relationships between DLHs and RHs at referral network, member (hospital) and community levels; and used principles from complex adaptive systems theory to unpack the mechanisms of network dynamics. The study employed mixed-methods, specifically surveys (n=22 DLHs), interviews with clinicians (n=20), and a database of incoming referrals at two sentinel RHs over a six-month period. Results: Obstacles to referral system functionality in Malawi included weaknesses in formal coordination structures, notably: unclear scope of practice of district surgical teams; lack of referral protocols; lack of referral communication standards; and misaligned organisational practices. Deficiencies in informal relationships included mistrust and uncollaborative operating environments, undermining coordination between DLHs and RHs. Poor system functionality adversely impacted the quality, efficiency and safety of patient referral-related care. Respondents identified aspects of the district-referral hospital relationships, which could be leveraged to build more collaborative and productive inter-professional relationships in the future. Conclusion: Multi-level interventions are needed to address failures at both ends of the referral pathway. This study captured new insights into longstanding problems in referral systems in resource-limited settings, contributing to a better understanding of how to build more functional systems to optimise the continuum and quality of surgical care for rural populations in similar settings.

Social Network Characteristics and Smoking Index Among Smoking Cessation Outpatients in Kunming’s Grade-A Tertiary Hospitals in China: A Cross-Sectional Observational Study

IntroductionThe success rate of smoking cessation outpatients remains modest. Previous studies have highlighted the importance of social networks for quitting smoking, yet there is a substantial lack of studies examining participants in outpatient smoking cessation programs, especially regarding their smoking index.AimWe aimed to identify the associations between the social network characteristics of smoking cessation outpatients and their smoking indexes. The association was analyzed with participants in Grade-A Tertiary Hospitals in Kunming, the capital of Yunnan province in China.MethodsA multicenter cross-sectional survey was conducted in Kunming in six randomly sampled Grade-A tertiary hospitals. Participants included 351 smoking cessation outpatients who provided data on cigarette smoking and social networks. Multivariate logistic regression was used to examine the association between social network characteristics and smoking index across outpatients. Strong associations were identified using adjusted odds ratios and a 95% confidence interval.ResultsLarge network size (AOR=1.79, 95%CI=0.99, 3.86), having children (AOR = 6.35, 95%CI = 2.26, 19.86), and at least one highly influential person in the network (AOR = 2.74, 95% CI =1.13, 7.01)were all associated with the risk of a high smoking index. However, having drinking friends (AOR = 0.28, 95% CI = 0.14, 0.56), non-smoking and non-drinking friends in the network (AOR = 0.44, 95% CI = 0.21, 0.88), and a network member who provided health advice (AOR = 0.41, 95% CI = 0.11, 1.35) were associated with a lower risk of a high smoking index.The results were sustained even after adjusting for demographic details.ConclusionsThe study findings suggest the importance of social network characteristics for smoking cessation physicians when formulating a personalized smoking cessation plan for outpatients.

A Study of Advanced Practice Provider Staffing Models and Professional Development Opportunities at National Comprehensive Cancer Network Member Institutions

Introduction: The National Comprehensive Cancer Network (NCCN) Best Practices Committee created an Advanced Practice Provider (APP) Workgroup to develop recommendations to support APP roles at NCCN Member Institutions. Methods: The Workgroup conducted three surveys to understand APP program structure, staffing models, and professional development opportunities at NCCN Member Institutions. Results: The total number of new and follow-up visits a 1.0 APP full-time equivalent conducts per week in shared and independent visits ranged from 11 to 97, with an average of 40 visits per week (n = 39). The type of visits APPs conduct include follow-up shared (47.2%), follow-up independent (46%), new shared (6.5%), and new independent visits (0.5%). Seventy-two percent of respondents utilize a mixed model visit type, with 15% utilizing only independent visits and 13% utilizing only shared visits (n = 39). Of the 95% of centers with APP leads, 100% indicated that leads carry administrative and clinical responsibilities (n = 20); however, results varied with respect to how this time is allocated. Professional development opportunities offered included posters, papers, and presentations (84%), leadership development (57%), research opportunities (52%), writing book chapters (19%), and other professional development activities (12%; n = 422). Twenty percent of APPs indicated that protected time to engage in development opportunities should be offered. Conclusion: As evidenced by the variability of the survey results, the field would benefit from developing standards for APPs. There is a lack of information regarding leadership structures to help support APPs, and additional research is needed. Additionally, centers should continuously assess the career-long opportunities needed to maximize the value of oncology APPs.

Preferences in Oncology History Documentation Styles Among Clinical Practitioners

PURPOSE: Clinical notes function as the de facto handoff between providers and assume great importance during unplanned medical encounters. An organized and thorough oncology history is essential in care coordination. We sought to understand reader preferences for oncology history organization by comparing between chronologic and narrative formats. METHODS: A convenience sample of 562 clinicians from 19 National Comprehensive Cancer Network Member Institutions responded to a survey comparing two formats of oncology histories, narrative and chronologic, for the same patient. Both histories were consensus-derived real-world examples. Each history was evaluated using semantic differential attributes ( thorough, useful, organized, comprehensible, and succinct). Respondents choose a preference between the two styles for history gathering and as the basis of a new note. Open-ended responses were also solicited. RESULTS: Respondents preferred the chronologic over the narrative history to prepare for a visit with an unknown patient (66% preference) and as a basis for their own note preparation (77% preference) ( P < .01). The chronologic summary was preferred in four of the five measured attributes ( useful, organized, comprehensible, and succinct); the narrative summary was favored for thoroughness ( P < .01). Open-ended responses reflected the attribute scoring and noted the utility of content describing social determinants of health in the narrative history. CONCLUSION: Respondents of this convenience sample preferred a chronologic oncology history to a concise narrative history. Further studies are needed to determine the optimal structure and content of chronologic documentation for oncology patients and the provider effort to use this format.

Industry Cluster Innovation Upgrading and Knowledge Evolution: A Simulation Analysis Based on Small-World Networks

This article focuses on the innovation and knowledge evolution of industry clusters. We examine the effects of the hub firm and the interaction of network member firms on the upgrading of the cluster. Our study is based on two patterns of knowledge learning and innovation, namely, STI (science, technology, and innovation) and DUI (doing, using, and interacting). This article adopts a knowledge diffusion simulation model to study the exchange of knowledge between cluster network actors in the context of small-world networks. The results indicate that we must pay close attention to the influence of hub enterprises on cluster evolution. Although hub companies may have certain innovation capabilities, if knowledge absorption problems among members are not properly resolved in the cluster network, the innovation performance of the local clusters is likely to be weakened, despite the success of the hub firm.

What Works in Community-Led Suicide Prevention: Perspectives of Wesley LifeForce Network Coordinators

Community coalitions have been recognised as an important vehicle to advance health promotion and address relevant local health issues in communities, yet little is known about their effectiveness in the field of suicide prevention. The Wesley Lifeforce Suicide Prevention Networks program consists of a national cohort of local community-led suicide prevention networks. This study drew on a nationally representative survey and the perspectives of coordinators of these networks to identify the key factors underpinning positive perceived network member and community outcomes. Survey data were analysed through descriptive statistics and linear regression analyses. Networks typically reported better outcomes for network members and communities if they had been in existence for longer, had a focus on the general community, and had conducted more network meetings and internal processes, as well as specific community-focused activities. Study findings strengthen the evidence base for effective network operations and lend further support to the merit of community coalitions in the field of suicide prevention, with implications for similar initiatives, policymakers, and wider sector stakeholders seeking to address suicide prevention issues at a local community level.

How liminality enhances conviviality through multilingual co-creations: Young refugees in the Netherlands

This article explores the multilingual creativity of young refugees in the Netherlands and the social contexts and situations in which it develops. Because these young refugees form an under-researched group, the authors build on different discipline-based studies on (young migrants’) multilingualism, super-diversity, conviviality, liminality and networks. The authors start with the collection of personal network data including languages used with each network member. These data show that participants use and combine the Dutch language with the majority of non-native people in their networks. To explain this, the network data are connected with participants’ ‘network stories’. In these stories, participants refer to the asylum seeker centres, where they began their lives in the Netherlands, as the breeding ground for their multilingual creations with the Dutch language. The authors show how, in the liminal and super-diverse context of these centres, young refugees’ multilingual practices and innovations enhanced conviviality and connectedness. The authors also delineate how ‘oldcomer’ and ‘newcomer’ participants’ distinct multilingual innovations relate to their different present networks. In both groups, however, these innovations are a source of belonging among the non-natives in their networks.

Peer-leaders’ experiences and challenges in distributing HIV self-test kits in a rural fishing community, Rakai, Uganda

Background Distribution of HIV self-test kits by trained lay people in the community has resulted in increased uptake of HIV testing services among the targeted populations. However, little data exists on the experiences and challenges faced by trained lay people while distributing the kits. Methods This qualitative study was conducted in Kasensero fishing community, Rakai, Uganda, in September 2019. We purposely selected 18 out of 34 peer-leaders that participated in a peer-led HIV self-testing intervention to participate in a post-intervention qualitative evaluation. The main intervention included identification and training of lay people in the community (‘peer-leaders’) to distribute HIV self-test kits to pre-selected members of their social network. Data for this study were collected at the end of the intervention. Data were collected on peer-leaders’ experiences in distributing the kits, challenges experienced during distribution and suggestions on how to improve peer-led HIV self-testing in typical fishing communities in the future. Data were analyzed manually following a thematic framework approach. Results Of the 18 peer-leaders, eleven (61.1%) were aged 20–24 years while thirteen (72.2%) had secondary education. Most (n = 15) of the peer-leaders reported that they found it easier to distribute the kits to their social network members, with most of them distributing the kits at the social network members’ homes or at their own homes. HIV self-test kits were distributed at varying times (e.g. in the afternoon) depending on the agreement reached between the peer-leader and their social network member. A few peer-leaders reported that some of their social network members initially hesitated to accept the kits while other peer-leaders reported that they spent a ‘lot of time’ explaining the HIV self-testing procedures to some of their illiterate members. Peer-leaders argued for supervised HIV self-testing for illiterate people and the need to continuously follow-up social network members to check if they tested for HIV. Conclusion A majority of the peer-leaders successfully distributed the kits to their social network members save for a few who experienced challenges. These findings suggest that lay people can be trained as effective HIV self-test kits distributors to improve the distribution of kits in the community.

Prototyping a collaborative data curation service for coastal science

The growing push for open data resulted in an abundance of data for coastal researchers, which can lead to problems for individual researchers related to data discoverability. One solution is to explicitly develop services for coastal researchers to help curate data for discovery, hosting discussions around reuse, community building, and finding collaborators. To develop the idea of a coastal data curation service, we investigate aspects of the UNESCO International Coastal Atlas Network member sites that could be used to build a curation service. We develop a minimal example of a coastal data curation service, deploy this as a website, and describe the next steps to move beyond the prototype phase. We envision a coastal data curation service as a way to cultivate a community focused on coastal data discovery and reuse.