Making change last? Exploring the value of sustainability approaches in healthcare: a scoping review.

BACKGROUND: Numerous models, tools and frameworks have been produced to improve the sustainability of evidence-based interventions. Due to the vast number available, choosing the most appropriate one is increasingly difficult for researchers and practitioners. To understand the value of such approaches, evidence warranting their use is needed. However, there is limited understanding of how sustainability approaches have been used and how they have impacted research or practice. This review aims to consolidate evidence on the application and impact of sustainability approaches in healthcare settings. METHODS: A systematic scoping review was designed to search for peer-reviewed publications detailing the use of sustainability approaches in practice. A 5-stage framework for scoping reviews directed the search strategy, and quality assessment was performed using the Mixed Method Appraisal Tool. Searches were performed through electronic citation tracking and snowballing of references. Articles were obtained through Web of Science, PubMed and Google Scholar. Six outcome variables for sustainability were explored to ascertain impact of approaches. RESULTS: This review includes 68 articles demonstrating the application of sustainability approaches in practice. Results show an increase in the use of sustainability approaches in peer-reviewed studies. Approaches have been applied across a range of healthcare settings, including primary, secondary, tertiary and community healthcare. Approaches are used for five main purposes, namely analysis, evaluation, guidance, assessment and planning. Results outline benefits (e.g. improved conceptualisation of sustainability constructs and improved ability to interpret sustainability data) and challenges (e.g. issues with approach constructs and difficulty in application) associated with using a sustainability approach in practice. Few articles (14/68) reported the sustainability outcome variables explored; therefore, the impact of approaches on sustainability remains unclear. Additional sustainability outcome variables reported in retrieved articles are discussed. CONCLUSIONS: This review provides practitioners and researchers with a consolidated evidence base on sustainability approaches. Findings highlight the remaining gaps in the literature and emphasise the need for improved rigour and reporting of sustainability approaches in research studies. To guide future assessment and study of sustainability in healthcare settings an updated list of sustainability outcome variables is proposed. TRIAL REGISTRATION: This review was registered on the PROSPERO database CRD 42016040081 in June 2016.

Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare.

BACKGROUND: Improvement initiatives offer a valuable mechanism for delivering and testing innovations in healthcare settings. Many of these initiatives deliver meaningful and necessary changes to patient care and outcomes. However, many improvement initiatives fail to sustain to a point where their full benefits can be realised. This has led many researchers and healthcare practitioners to develop frameworks, models and tools to support and monitor sustainability. This work aimed to identify what approaches are available to assess and influence sustainability in healthcare and to describe the different perspectives, applications and constructs within these approaches to guide their future use. METHODS: A systematic review was carried out following PRISMA guidelines to identify publications that reported approaches to support or influence sustainability in healthcare. Eligibility criteria were defined through an iterative process in which two reviewers independently assessed 20% of articles to test the objectivity of the selection criteria. Data were extracted from the identified articles, and a template analysis was undertaken to identify and assess the sustainability constructs within each reported approach. RESULTS: The search strategy identified 1748 publications with 227 articles retrieved in full text for full documentary analysis. In total, 62 publications identifying a sustainability approach were included in this review (32 frameworks, 16 models, 8 tools, 4 strategies, 1 checklist and 1 process). Constructs across approaches were compared and 40 individual constructs for sustainability were found. Comparison across approaches demonstrated consistent constructs were seen regardless of proposed interventions, setting or level of application with 6 constructs included in 75% of the approaches. Although similarities were found, no approaches contained the same combination of the constructs nor did any single approach capture all identified constructs. From these results, a consolidated framework for sustainability constructs in healthcare was developed. CONCLUSIONS: Choosing a sustainability method can pose a challenge because of the diverse approaches reported in the literature. This review provides a valuable resource to researchers, healthcare professionals and improvement practitioners by providing a summary of available sustainability approaches and their characteristics. TRIAL REGISTRATION: This review was registered on the PROSPERO database: CRD42016040081 in June 2016.

z ~ 1 Lyα EMITTERS. I. THE LUMINOSITY FUNCTION.

We construct a flux-limited sample of 135 candidate z ~ 1 Lyα emitters (LAEs) from Galaxy Evolution Explorer (GALEX) grism data using a new data cube search method. These LAEs have luminosities comparable to those at high redshifts and lie within a 7 Gyr gap present in existing LAE samples. We use archival and newly obtained optical spectra to verify the UV redshifts of these LAEs. We use the combination of the GALEX UV spectra, optical spectra, and X-ray imaging data to estimate the active galactic nucleus (AGN) fraction and its dependence on Lyα luminosity. We remove the AGNs and compute the luminosity function (LF) from 60 z ~ 1 LAE galaxies. We find that the best-fit LF implies a luminosity density increase by a factor of ~1.5 from z ~ 0.3 to z ~ 1 and ~20 from z ~ 1 to z ~ 2. We find a z ~ 1 volumetric Lyα escape fraction of 0.7% ± 0.4%.

High-redshift galaxy populations.

We now see many galaxies as they were only 800 million years after the Big Bang, and that limit may soon be exceeded when wide-field infrared detectors are widely available. Multi-wavelength studies show that there was relatively little star formation at very early times and that star formation was at its maximum at about half the age of the Universe. A small number of high-redshift objects have been found by targeting X-ray and radio sources and most recently, gamma-ray bursts. The gamma-ray burst sources may provide a way to reach even higher-redshift galaxies in the future, and to probe the first generation of stars.

Praxis and gesture comprehension in 4-, 5-, and 6-year-olds.

This investigation examined (a) whether the ability to comprehend pantomimed gestures improves with age in young children and whether the ability to point to the actual object precedes the ability to point to a functional associate and (b) whether there is a difference in the ability to comprehend pantomimed gestures between learning-disabled and normal subjects. The Gesture Comprehension Test, the Imitation of Postures test, and the Test for Auditory Comprehension of Language were administered to 68 normal children and 24 learning-disabled children 4 to 6 years of age. Results indicated that gesture comprehension improved with age and that the ability to point to the actual object preceded the ability to point to its functional associate. Boys performed significantly better than girls. There was no significant difference between normal and learning-disabled subjects' ability to comprehend gestures. A moderate correlation was found between the Gesture Comprehension Test and the Test for Auditory Comprehension of Language; a low correlation was found between the Gesture Comprehension Test and the Imitation of Postures test. These results suggest the possibility that in preschool children and young school-age children, gesture comprehension may be more closely related to language than to nonsymbolic aspects of praxis.

Strategic market positions for mental health services.

Faced with a rapidly changing market, increased legislation and intense competition, mental health service providers must be sophisticated planners and position themselves advantageously in the marketplace. They can effectively position themselves to be profitable and sustaining through market segmentation and sensitivity. The following article will address one concept of marketing that has received less attention but is of critical importance: positioning. As the market environment becomes increasingly competitive, positioning will be the key to success for mental health programs and institutions.

Marketing your nursing product line: reaping the benefits.

Survival in today's cost-conscious, competitive health care scene depends on strategic business skills, marketing, and product line management. As a major contributor to the delivery of health care, nursing practice must now include an orientation toward business with definable products. The authors discuss their success in developing a product line that results in professional growth, improved nurse recruitment and retention, and a greater competitive edge in the health care arena.

A small-group approach to teaching family medicine.

The authors describe a method for teaching preclinical medical students some important family medicine concepts utilizing a seminar format which allows for improved student-teacher interaction and individualization of material. These seminars, on family health behavior, compliance, behavioral interventions for life-style change, and managing stress, were designed to encourage freshman medical students to understand and apply concepts concerning health behavior and attitudes, both personally and professionally. The format of these sessions included the use of self-assessment instruments, discussion, role play, and case studies. Results of student evaluations indicate they perceived the seminars positively. Specific areas of positive value included the content and small-group related processes. The seminars also provided data useful for developing programs for students.

Fungicide Enhancement of Nitrogen Fixation and Colonization of Phaseolus vulgaris by Rhizobium phaseoli.

The number and weight of pods and the weight and nitrogen content of the tops of beans (Phaseolus vulgaris) derived from seeds inoculated with a thiram-resistant strain of Rhizobium phaseoli were increased if the seeds were treated with thiram before sowing in soil. A greater percentage of the nodules on 21-day-old plants were derived from the resistant strain, more nodules were formed, and these nodules were more effective in the presence of the fungicide than in its absence. These differences in nodule numbers were no longer present in 56-day-old plants, and only a small percentage of the nodules contained the resistant strain. The abundance of the fungicide-tolerant R. phaseoli increased rapidly soon after planting the seed and subsequently fell markedly, but the rate of decline was less if the seeds had been treated with the chemical. Protozoa also proliferated if thiram had not been applied to the seed, but their numbers were deleteriously influenced by thiram. Bdellovibrio, bacteriophages, and lytic micro-organisms acting on R. phaseoli were rare under these conditions. Ciliates and flagellated protozoa were initially suppressed by planting thiram-coated bean seeds in nonsterile soil, but the former were inhibited longer than the latter and the ciliate numbers never fully recovered if the seeds were treated with the fungicide. The resistant strain grew well in sterile soil also inoculated with a protozoa-free mixture of soil microorganisms whether thiram was added or not, but after an initial rise in numbers, its abundance fell if the mixture contained protozoa; the rate of this fall was delayed by the fungicide. The numbers of R. phaseoli were consistently less in sterile soil inoculated with the rhizobium plus a mixture of soil microorganisms containing ciliates and other protozoa than if the inoculum contained other protozoa but no ciliates. These results suggest that a suppression of protozoa, and possibly especially the ciliates, accounts for the enhanced growth of beans and the greater initial frequency of nodules formed by the thiram-resistant R. phaseoli in the presence of this fungicide. Thiram applied to uninoculated seed enhanced bean growth if thiram-resistant R. phaseoli were present in soil.