A snapshot on a journey from frustration to readiness-A qualitative pre-implementation exploration of readiness for technology adoption in Public Health Protection in Ireland.

In an era of emergent infectious disease, the timely and efficient management of disease outbreaks is critical to public health protection. Integrated technologies for case and incident management (CIM) collect real-time health intelligence for decision making in Public Health. In Ireland, a Public Health reform program is preparing for implementation of a health information system for health protection. Project implementers seek to document and understand the readiness and willingness of future users to adopt the new system, prior to system procurement and implementation. Qualitative key informant interviews were conducted (n = 8) with Public Health personnel from a single regional department of Public Health representing medical, nursing, disease surveillance and administrative roles, at managerial and staff levels. A qualitative thematic analysis was performed. Participants were frustrated by weaknesses in the current practice of CIM and were ready and willing to adopt a digital CIM system if it met their needs. However, they were frustrated by lack of clear timelines. We identified 7 enablers and 3 barriers to readiness and willingness to adopt a CIM system. 'Newness of the workforce' was the main enabler of readiness and willingness, while 'lack of knowledge and familiarity with system' was the main barrier to readiness and willingness. Experiences during the COVID-19 pandemic gave a clear understanding of the problems and need for a digital CIM system and the reform program facilitated a culture of change, readying the workforce for the new health information system. New members of the Public Health departments are a likely ready and eager cohort for adoption of a modern, 'fit for purpose' CIM system and the execution of implementation will likely determine how ready and willing the wider network of departments will be to adopt a national CIMS.

A review of the inclusion of equity stratifiers for the measurement of health inequalities within health and social care data collections in Ireland.

BACKGROUND: Health equity differs from the concept of health inequality by taking into consideration the fairness of an inequality. Inequities may be culturally specific, based on social relations within a society. Measuring these inequities often requires grouping individuals. These groupings can be termed equity stratifiers. The most common groupings affected by health inequalities are summarised by the acronym PROGRESS (Place of residence, Race, Occupation, Gender, Religion, Education, Socioeconomic status, Social capital). The aim of this review was to examine the use of equity stratifiers in routinely collected health and social care data collections in Ireland. METHODS: One hundred and twenty data collections were identified from the Health Information and Quality Authority (HIQA) document, "Catalogue of national health and social care data collections: Version 3.0". Managers of all the data collections included were contacted and a data dictionary was requested where one was not available via the HIQA website. Each of the data dictionaries available was reviewed to identify the equity stratifiers recorded. RESULTS: Eighty-three of the 120 data collections were considered eligible to be included for review. Twenty-nine data dictionaries were made available. There was neither a data dictionary available nor a response to our query from data collection managers for twenty-three (27.7%) of the data collections eligible for inclusion. Data dictionaries were from national data collections, regional data collections and national surveys. All data dictionaries contained at least one of the PROGRESS equity stratifiers. National surveys included more equity stratifiers compared with national and regional data collections. Definitions used for recording social groups for the stratifiers examined lacked consistency. CONCLUSIONS: While there has been much discussion on tackling health inequalities in Ireland in recent years, health and social care data collections do not always record the social groupings that are most commonly affected. In order to address this, it is necessary to consider which equity stratifiers should be used for the Irish population and, subsequently, for agreed stratifiers to be incorporated into routine health data collection. These are lessons that can be shared internationally as other countries begin to address deficits in their use of equity stratifiers.

Attitudes Towards Gambling and Gambling Reform in Australia.

The Attitudes Towards Gambling Scale (ATGS) is a 14-item survey instrument examining general attitudes towards gambling (Orford et al. in Int Gambl Stud 9(1):39-54, 2009). The current study examined the validity of this scale in an Australian community sample of 1794 adults (52.8 % female). As well as considering measures of internal consistency and factor loadings, we examined the functional utility of the scale as a mediator of gambling activity, problem gambling status, and consequent opinions on national gambling-reform legislation. We found internal consistency and factor loadings of the ATGS within the Australian sample to be comparable with those observed in the original UK study. Additionally, ATGS scores were found to be a relatively robust predictor of attitudes towards gambling reform and harm minimisation. Further, the ATGS mediated the relationships between experiences with gambling and attitudes towards harm reduction. The findings suggest that the ATGS is a useful tool for examining general attitudes towards gambling within an Australian context.

Hydrodynamics selects the pathway for displacive transformations in DNA-linked colloidal crystallites.

The degree to which DNA-linked particle crystals, particularly those composed of micrometer-scale colloids, are able to dynamically evolve or whether they are kinetically arrested after formation remains poorly understood. Here, we study a recently observed displacive transformation in colloidal binary superlattice crystals, whereby a body-centered cubic to face-centered cubic transformation is found to proceed spontaneously under some annealing conditions. Using a comprehensive suite of computer simulation tools, we develop a framework for analyzing the many displacive transformation pathways corresponding to distinct, but energetically degenerate, random hexagonal close-packed end states. Due to the short-ranged, spherically symmetric nature of the particle interactions the pathways are all barrierless, suggesting that all end states should be equally likely. Instead, we find that hydrodynamic correlations between particles result in anisotropic mobility along the various possible displacive pathways, strongly selecting for pathways that lead to the fcc-CuAu-I configuration, explaining recent experimental observations. This finding may provide clues for discovering new approaches for controlling structure in this emerging class of materials.

Prevalence and associations of limited health literacy in chronic kidney disease: a systematic review.

BACKGROUND: Health literacy (HL) is important in chronic disease. This review aimed to evaluate the literature evidence on prevalence and associations of limited HL in chronic kidney disease (CKD). METHODS: Seven databases were searched using terms for CKD and HL. Studies were included that ascertained the prevalence of limited HL using a validated tool in adults with CKD of any stage. The primary outcome was an objectively measured prevalence of limited HL in a population with CKD. The secondary outcome was associations of limited HL. Two reviewers assessed study inclusion and quality. Prevalence values were combined using a random-effect model to give overall prevalence. RESULTS: Eighty-two studies were identified from searching, of which six met the inclusion criteria. The total number of people in all studies was 1405. Five studies were in dialysis or transplant populations, and all were from the USA. There was a significant heterogeneity in the prevalence of limited HL [9-32% (median 25%, inter-quartile range 16%)]. The pooled prevalence of limited HL in all studies was 22.7% (95% confidence interval 20.6-24.8%), but study heterogeneity limited the generalizability of this combined prevalence. The review identified associations between limited HL and socio-economic factors (lower education attainment, lower income), and certain process and outcome measures (lower likelihood of referral for transplant, higher mortality). CONCLUSIONS: Limited HL is common among people with CKD and independently associated with socio-economic factors and health outcomes. It may represent an important determinant of inequality in CKD.

Driving diffusionless transformations in colloidal crystals using DNA handshaking.

Many crystals, such as those of metals, can transform from one symmetry into another having lower free energy via a diffusionless transformation. Here we create binary colloidal crystals consisting of polymer microspheres, pulled together by DNA bridges, that induce specific, reversible attractions between two species of microspheres. Depending on the relative strength of the different interactions, the suspensions spontaneously form either compositionally ordered crystals with CsCl and CuAu-I symmetries, or disordered, solid solution crystals when slowly cooled. Our observations indicate that the CuAu-I crystals form from CsCl parent crystals by a diffusionless transformation, analogous to the Martensitic transformation of iron. Detailed simulations confirm that CuAu-I is not kinetically accessible by direct nucleation from the fluid, but does have a lower free energy than CsCl. The ease with which such structural transformations occur suggests new ways of creating unique metamaterials having structures that may be otherwise kinetically inaccessible.

Impact of critical social empowerment on psychological empowerment and job satisfaction in nursing and midwifery settings.

AIM: To test an expanded model of empowerment which specifies the relationships between structural, psychological, critical social empowerment and job satisfaction. BACKGROUND: There is evidence that structural empowerment predicts psychological empowerment and these two dimensions of empowerment are independent predictors of job satisfaction. This study explored a third dimension of empowerment-- critical social empowerment--and its impact on psychological empowerment and job satisfaction. METHOD: A predictive, non-experimental design in a sample of 306 nurses and midwives in Ireland using the Conditions of Work Effectiveness Questionnaire, the Psychological Empowerment Questionnaire, a researcher developed tool to measure critical social empowerment and a job satisfaction questionnaire. RESULTS: While both structural and critical social empowerment were significant independent predictors of psychological empowerment and job satisfaction, critical social empowerment was the stronger predictor. CONCLUSIONS: The findings support the inclusion of the critical social dimension of empowerment in the understanding of empowerment. IMPLICATIONS FOR NURSING MANAGEMENT: Managers at all levels must attend to critical social empowerment as well as structural empowerment in order to increase job satisfaction, retention and engagement of highly qualified committed nurses and midwives.

An assessment tool for acutely ill medical patients.

This article reports the implementation and impact of a standardized systematic evidence-based predictive score for the initial assessment of acutely ill medical patients. The Simple Clinical Score (SCS) was introduced in the A&E department and the medical floor of the authors' hospital between June 2007 and July 2008. The SCS was well received by the staff - 67% felt it greatly improved patient assessment and was very valuable for ensuring appropriate placement of the patient after admission and improved the quality of care. This article describes the change process, the pilot evaluation and the training programme undertaken during the implementation of the SCS. It is hoped that this experience will be of value to other project teams who are undertaking similar initiatives.