Contingency and paradoxes in management practices-development plan as a case.

PURPOSE: As part of a national plan to govern professional and organizational development in Norwegian specialist healthcare, the country's hospital clinics are tasked with constructing development plans. Using the development plan as a case, the paper analyzes how managers navigate and legitimize the planning process among central actors and deals with the contingency of decisions in such strategy work. DESIGN/METHODOLOGY/APPROACH: This study applies a qualitative research design using a case study method. The material consists of public documents, observations and single interviews, covering the process of constructing a development plan at the clinical level. FINDINGS: The findings suggest that the development plan was shaped through a multilevel translation process consisting of different contending rationalities. At the clinical level, the management had difficulties in legitimizing the process. The underlying tension between top-down and bottom-up steering challenged involvement and made it difficult to manage the contingency of decisions. PRACTICAL IMPLICATIONS: The findings are relevant to public sector managers working on strategy documents and policymakers identifying challenges that might hinder the fulfillment of political intentions. ORIGINALITY/VALUE: This paper draws on a case from Norway; however, the findings are of general interest. The study contributes to the academic discussion on how to consider both the health authorities' perspective and the organizational perspective to understand the manager's role in handling the contingency of decisions and managing paradoxes in the decision-making process.

The impact of green-listed companies on rural ecological environments in China: A spatial heterogeneity and empirical analysis.

Based on the panel data of 22 inland provinces in China from 2010 to 2020, this study constructs and measures the level of rural ecological environment in China. The impact of the financial performance of green-listed companies on the rural ecological environment and its moderating and threshold effects are analyzed. The following conclusions are drawn: (1) During 2010-2020, China's rural ecological environment shows a trend of "fluctuating-decreasing-rising" with significant regional non-equilibrium characteristics. (2) The financial performance of green-listed companies has a significantly negative impact on rural ecology. This negative impact has a crucial heterogeneous feature, with a more significant negative impact in areas with a higher rural ecological environment index and less substantial performance in regions with a lower rural ecological environment index. (3) There is a significant positive moderating effect of education level and digitalization on the relationship between the financial performance of green-listed companies on the level of rural ecological development. As moderating variables, the digitalization and education level weakens the negative impact of green-listed companies' performance on the ecological environment. The positive impact of the financial performance of green-listed companies on the development level of the rural ecological environment is more vital in areas with higher per capita education levels and digitalization in rural areas. (4) There is a significant threshold effect on the financial performance of green-listed companies on the level of rural ecological development. When the financial performance of green-listed companies exceeds a particular threshold value, the impact of the financial performance of green-listed companies on the development level of the rural ecological environment is significantly positive. Based on the above findings, this paper puts forward corresponding countermeasure suggestions.

A Framework for Evaluating Local Adaptive Capacity to Health Impacts of Climate Change: Use of Kenya's County-Level Integrated Development Plans.

Background: Health National Adaptation Plans were developed to increase the capacity of low- and middle-income countries (LMICs) to adapt to the impacts of climate change on the health sector. Climate and its health impacts vary locally, yet frameworks for evaluating the adaptive capacity of health systems on the subnational scale are lacking. In Kenya, counties prepare county integrated development plans (CIDPs), which contain information that might support evaluations of the extent to which counties are planning climate change adaptation for health. Objectives: To develop and apply a framework for evaluating CIDPs to assess the extent to which Kenya's counties are addressing the health sector's adaptive capacity to climate change. Methods: CIDPs were analyzed based on the extent to which they addressed climate change in their description of county health status, whether health is noted in their descriptions of climate change, and whether they mention plans for developing climate and health programs. Based on these and other data points, composite climate and health adaptation (CHA) scores were calculated. Associations between CHA scores and poverty rates were analyzed. Findings: CHA scores varied widely and were not associated with county-level poverty. Nearly all CIDPs noted climate change, approximately half mentioned health in the context of climate change and only 16 (34%) noted one or more specific climate-sensitive health conditions. Twelve (25%) had plans for a sub-program in both adaptive capacity and environmental health. Among the 24 counties with plans to develop climate-related programs in health programs, all specified capacity building, and 20% specified integrating health into disaster risk reduction. Conclusion: Analyses of county planning documents provide insights into the extent to which the impacts of climate change on health are being addressed at the subnational level in Kenya. This approach may support governments elsewhere in evaluating climate change adaptation for health by subnational governments.

Salud, género y reciclaje: un encuentro impostergable / Health, gender and recycling: a meeting that cannot be put off

Introducción. En Asunción existe una zona geográfica llamada Bañados, en esta zona se conforman los llamados «cinturones de pobreza», donde el trabajo informal se impone como principal medio de sustento. El oficio del reciclaje corresponde a uno de los trabajos informales más practicados. Objetivos. Describir aspectos de la zona donde desarrollan su vida trabajadora de la recolección. Incorporar elementos de resignificación positiva acerca del trabajo de reciclaje a mujeres recicladoras organizadas o no del Bañado Sur de la ciudad de Asunción, Paraguay. Material y métodos. Se realizaron 28 encuentros con 153 mujeres agrupadas en 7 grupos, durante el período del 2019 al 2022. La muestra fue seleccionada fue por conveniencia. Se eligió la modalidad de «taller» debido a las prácticas ya conocidas y aceptadas por la comunidad. Resultados. Se realizó conjuntamente la clasificación de la basura o residuos urbanos en sus categorías orgánica/inorgánica/tóxica, pero también en una clasificación más cercana a su realidad concreta. Se identificó cómo son las relaciones familiares y comunitarias, las preocupaciones por los hijos e hijas, el cambio climático, las inundaciones, las viviendas precarias, el acceso al agua, la inseguridad en el barrio y la problemática de drogas en la comunidad. Conclusión. Las jornadas se desarrollaron con mujeres recicladoras organizadas, miembros de una organización civil, que residen en el Bañado Sur – Tacumbú, Asunción (Paraguay). Durante el proceso se logró acercar a los grupos de mujeres que han podido participar de la experiencia, una resignificación positiva del trabajo y su rol en la sociedad, mediante el diálogo. (AU)

Introduction. In Asunción there is a geographic area called Bañados. They make up the so-called “poverty belts”, where informal work is laid down as the main means of support. The job of recycling is one of the most performed informal jobs. Aims. To report aspects of the area where collection workers go about their lives. Incorporate elements of positive new meaning about the recycling work to organized or disorganized women recyclers from Bañado Sur in the city of Asunción, Paraguay. Methods. In total 28 meetings were held with 153 women grouped into seven groups, during the period from 2019 to 2022. The sample was selected by convenience. The “workshop” modality was chosen due to the practices already known and accepted by the community. Results. Garbage or urban waste could be classified together in its organic/inorganic/toxic categories but also in a classification more akin to its specific reality. Family and community relationships, concerns for children, climate change, floods, precarious housing, access to water, insecurity in the neighbourhood and drug problems in the community were all identified. Conclusion. The sessions were held with organized women recyclers, members of a civil organization residing in Bañado Sur – Tacumbú, Asunción, Paraguay. During the process, it was possible to bring together the groups of women who were able to take part in the experience, a positive new meaning for work and their role in society, by means of dialogue. (AU)

Community development in the production of concentrated flourhigh in amino acids made from a combination of eel and tempe / Desarrollo comunitario en la producción de harina concentrada rica en aminoácidos a partir de una combinación de anguila y tempe

Introduction and Objectives: To date, there are no known supplement products made from a combination of eel and tempe. The development of concentrate from eels in combination with tempe (ETF) aims to create supplements containing the essential amino acid L-arginine, which has many proven health benefits. Methods: The community empowerment was held from June to July 2023 at Cangkringan, Sleman, Yogyakarta. The main agendas consisted of ETF training production and the cooking creation of ETF-based food. Aside from that, there were several secondary agendas such as food halal socialization, accessories design training, patchwork utilization training, computer and Microsoft Office training, English language education, public speaking class, Al-Qur’an and miscellaneous education for children, community service, mutual cinema, and competitions for the community. Results: The community development program in the production of high-amino acid concentrated ETF flour has succeeded in achieving the three main objectives of the program, namely functional product innovation, empowerment of micro, small, and medium enterprises and local communities, as well as increasing demand for local commodities, showing the importance of collaboration between the government, community, and private sector in supporting the development of local products that are economically and health-beneficial and can be used as examples to share similar initiatives in other areas.(AU)

Aligning the planning, development, and implementation of complex interventions to local contexts with an equity focus: application of the PRISM/RE-AIM Framework.

For the fields of implementation science and health equity, understanding and being responsive to local contexts is of utmost importance to better inform the development, implementation, and evaluation of healthcare and public health interventions to increase their uptake and sustainment. Contexts are multi-level and include political, historical, economic, and social factors that influence health, as well as organizational characteristics, reflecting the richness of members' views, resources, values, and needs. Poor alignment between solutions and those contextual characteristics could have an impact on inequities. The PRISM (Practical Robust Implementation and Sustainability Model) is a context-based implementation science framework that incorporates RE-AIM outcomes (Reach, Effectiveness, Adoption, Implementation, Maintenance) and offers guidance to researchers, practitioners, and their patient and community partners on how to conceptualize, assess, and address contextual domains with a focus on health equity. Drawing from systems thinking, participatory engagement, and health equity principles, this commentary expands on previous work to 1) offer a novel perspective on how to align an intervention's core functions and forms with the PRISM's contextual domains, and 2) foster an ongoing and iterative engagement process with diverse partners throughout the research and practice process using a co-creation approach. We recommend intervention-to-context alignment through iterative cycles. To that end, we present the RE-AIM Framework's 'outcomes cascade' to illustrate touch points of opportunity and gaps within and across each of the five RE-AIM outcomes to illustrate 'where things go wrong'. We present a case study to illustrate and offer recommendations for research and practice efforts to increase contextual responsiveness, and enhance alignment with context before, during, and after implementation efforts and to ensure equity is being addressed. We strive to make a conceptual contribution to advance the field of pragmatic research and implementation of evidence-based practices through the application of the contextually-based PRISM framework with a focus on health equity.

Statewide Age-Friendly Virtual Fair as a Tactic for Social Change Across the Aging Ecosystem.

Prior research has demonstrated ways in which community events help to establish age-friendly community initiatives and strengthen their impact. We extend these insights by discussing how the design and implementation of a statewide event - the New Jersey Age-Friendly Virtual Fair - exemplifies this practice theory and extends its applicability beyond local community development toward broader state-level age-friendly ecosystems. We describe how events that are deliberately multi-organizational, multi-sectoral, and multi-level can help to further propel the Age-Friendly Movement toward systems change for aging in community.

Rural areas development and pro-environmental behavior in China: implications for rural development and planning.

This research adds to the body of knowledge by examining the asymmetric link between rural development and pro-environmental behavior in rural China. Rural development is assessed via rural income and digital financial inclusion. We use linear and nonlinear autoregressive distributed lag (ARDL) models to assess short- and long-term effects. The linear analysis suggests that a rise in rural income and digital financial inclusion encourages long-term access to clean fuels and technologies (CFT) in rural areas, while they do not have any significant impact in the short run. On the other side, the nonlinear framework illustrates that a positive shock in rural income and digital financial inclusion encourages long-term access to CFT in rural areas. A negative shock in rural income reduces long-term access to CFT in rural areas, and a negative shock in digital financial inclusion does not significantly impact access to CFT. However, in the short run, only the estimates of rural income are significant, while the estimates attached to digital financial inclusion are insignificant, implying that a rise in rural income increases access to CFT and a fall in rural income reduces access to CFT. Thus, government should encourage collaboration between private sector and civil society organizations to promote sustainable rural development and pro-environmental behavior.

Assessing the extent and impacts of linear infrastructure on Sri Lanka's natural and protected areas: Implications for future development planning.

Linear infrastructure (LI) has varying effects on landscapes depending on different ecosystems' sensitivity and threat levels. Economically developing tropical countries are particularly at risk from LI. Therefore, understanding a country's current LI network and planning future developments to avoid further fragmentation and disturbance is crucial. This study aimed to assess the extent of Sri Lanka's LI network (i.e., roads, railroads, and powerlines), given that it is both a biodiversity hotspot and an economically developing country in the tropics. First, we calculated the average normalized difference vegetation index (NDVI) and normalized difference built-up index (NDBI) indices and examined their spatial autocorrelation per divisional secretariat division. Then a multivariate cluster analysis was used to determine clusters of natural and protected areas that may receive similar impacts from different LI and their combinations. Results indicated that roads are the most widespread LI type in Sri Lanka, followed by powerlines and railroads. Over 80% of Sri Lanka's total land area falls within 1 km of either a national or a provincial/local road. Areas with high NDVI were primarily manmade habitats, with less than 20% contribution from protected areas. Over 50% of the total protected area of Sri Lanka is being impacted by all three types of LI. Powerlines were the most common LI type in protected areas in proportion to their total network lengths. To minimize environmental impact while achieving development goals, future LI development activities should use a landscape approach to identify development needs and strategies informed by these findings.

Impact of the National Nursing Development Plan on nursing human resources in China: An interrupted time series analysis for 1978-2021.

BACKGROUND: Shortages of nurses and unequal distribution of nursing staff have been huge challenges for global health services. OBJECTIVES: The aim of our study was to evaluate the impact of the National Nursing Development Plan on nursing human resources in China. METHODS: An interrupted time series design was used in this study. The data for this study were extracted from the National Health Statistics Yearbook from 1978 to 2021. The Ministry of Health issued the National Nursing Development Plan (2005-2010) in July 2005. Subsequently, the strategic plan was issued every 5 years: the National Nursing Development Plan (2011-2015), the National Nursing Development Plan (2016-2020), and the National Nursing Development Plan (2021-2025). This study used five indicators including 1) the number of registered nurses (RNs) in China, 2) the number of RNs per 1000 population in China, 3) the proportion of RNs in health technical personnel in China, 4) the doctor-nurse ratio and 5) the number of nurses working in primary medical institutions to evaluate the changing trend of nursing human resources in China from 1978 to 2021. RESULTS: Interrupted time series analysis showed that after the implementation of the National Nursing Development Plan (2005-2010), the building of nurses in China was gradually strengthening, and the number of RNs in China increased by 0.198 million per year (95%CI 0.174-0.223; P < 0.001); the number of RNs per 1000 population (Coefficient = 0.139; 95%CI 0.123-0.154; P < 0.001); the proportion of RNs in the total number of health professionals in China has increased from 29.6 % to 44.6 % (Coefficient = 0.010; 95%CI 0.009-0.010; P < 0.001); in China, the doctor-nurse ratio increased by 0.024 (95%CI 0.019-0.029; P < 0.001). In 2021, the number of RNs working in primary medical institutions increased by approximately 0.86 million compared with that in 2005, and the proportion of RNs in the country increased by 1.4 %. The development of nurses is especially tilted to the primary level to meet the health and nursing needs of the primary level. CONCLUSIONS: The implementation of the National Nursing Development Plan has greatly expanded the scale of nursing human resources in China and significantly optimized the efficiency of allocation. The implementation of the National Nursing Development Plan (2011-2015) and the National Nursing Development Plan (2016-2020) well continued the strategic plan from 2005 to 2010, further expanded the nursing workforce and further optimized the allocation efficiency. TWEETABLE ABSTRACT: The implementation of the National Nursing Development Plan has greatly expanded the scale of nursing human resources in China and significantly optimized the efficiency of allocation.

Usos exploratorios de los paseos comunitarios en barrios urbanos / Exploratory Uses of Community Walks in Urban Neighborhoods

Los paseos comunitarios consisten en la realización de un itinerario urbano comentado por los participantes. En los últimos años se han extendido como un medio para descubrir las ciudades, promover la toma de conciencia sobre los problemas urbanos y contribuir indirectamente al desarrollo local. En este comentario mostramos que los paseos comunitarios pueden utilizarse también como herramienta de investigación, tanto en la evaluación etnográfica rápida como en la identificación de líderes locales y escenarios de conducta (AU)

Community walks consist of carrying out an urban itinerary commented by the participants. In recent years they have spread as a means to discover cities, promote awareness of urban problems and contribute to local development. In this commentary we show that community walks can also be used as a research tool, both in rapid ethnographic assessment and in the identification of local leaders and behavior setting (AU)

What Are Public Health Agencies Planning for Workforce Development? A Content Analysis of Workforce Development Plans of Accredited Public Health Departments.

OBJECTIVE: Recruiting and retaining public health employees and ensuring they have the skills necessary to respond are vital for meeting public health needs. As the first study examining health department (HD) workforce development plans (WDPs), this study presents gaps and strategies identified in WDPs across 201 accredited HDs (168 initial/33 reaccreditation plans). DESIGN: This cross-sectional study employed qualitative review and content analysis of WDPs submitted to the Public Health Accreditation Board (PHAB) between March 2016 and November 2021. MAIN OUTCOME MEASURES: Eight overarching workforce themes were examined: planning/coordination, leadership, organizational culture, workplace supports/retention, recruitment, planning for departmental training, delivery of departmental training, and partnership/engagement. Within each theme, related subthemes were identified. Coders indicated whether the WDP (1) identified the subtheme as a gap; (2) stated an intent to address the subtheme; and/or (3) identified a strategy for addressing the subtheme. RESULTS: The most common gaps identified included prepare workforce for community engagement/partnership (34.3%, n = 69), followed by resource/fund training (24.9%, n = 50). The subtheme that had the most instances of an identified strategy to address it was assess training needs (84.1%, n = 169), followed by foster quality improvement (QI) culture/provide QI training (63.2%, n = 127). While both of these strategies were common among the majority of HDs, those subthemes were rarely identified as a gap. Secondary findings indicate that increase recruitment diversity/recruit from a more diverse applicant pool was rarely identified as a gap (6.0%, n = 12) and rarely had an identified strategy for addressing the subtheme (9.0%, n = 18). CONCLUSION: While HDs recognized many workforce gaps, HDs did not always propose a strategy for addressing them within the WDP. Conversely, some WDPs proposed strategies for subthemes that did not reflect recognized gaps. Such discrepancies between identified gaps and strategies in WDPs may suggest areas where HDs could use additional support and guidance.

Using a Hybrid Multiattribute Decision-Making Model for Evaluating the Sustainable Development Potential of Characteristic Towns and Exploring Development Planning Strategies.

In recent years, with the development of 'China's new urbanization, the "characteristic town movement" with the development of industrial economy first has brought problems to a large number of rural settlements, such as no cultural planning, no consumption of industry, and no soul. Then, in reality, there are still a large number of rural settlements under the planning of the upper-level local government, with the goal of developing into a characteristic town in the future. Therefore, this study believes that there is an urgent need to build a framework for evaluating the construction potential of rural settlements with sustainable characteristic towns. Not only that but also a decision analysis model should be provided for real-world empirical cases. This model needs to cover the assessment of the sustainable development potential of characteristic towns as the goal and the formulation of improvement strategies. This study combines the data collection of current characteristic town development rating reports, applies data exploration technology to extract core impact elements and obtain hierarchical decision rules, integrates expert domain knowledge with DEMATEL technology, and establishes an impact network relationship diagram between core impact elements. At the same time, the representative characteristic town cases are assessed for their sustainable development potential, and the modified VIKOR technique is applied to clarify the actual problems of the empirical cases, in an attempt to determine whether the development potential and development plan of the characteristic town meet the sustainable development needs from the pre-evaluation mechanism.

Evaluation and development strategy of urban-rural integration under ecological protection in the Yellow River Basin, China.

The problem of imbalanced urban-rural development in China is becoming increasingly serious. Urban-rural integration (URI) is an inevitable way to narrow the urban-rural gap and promote rural development. The Yellow River Basin (YRB) is an important barrier to China's ecological security and plays a crucial role in promoting ecological protection and in high-quality development strategies. Therefore, this article constructs an evaluation index system for URI from five dimensions: economic integration, social integration, ecological integration, element integration, and spatial integration. The simulated annealing-projection pursuit model and time degree are used to analyze the dynamic urban-rural integration level (URIL) of 373 counties from 2000 to 2019. Building upon this foundation, this study classifies four types of URI zones and proposes development strategies tailored to each zone. The results indicate (1) that the URIL in the YRB continues to increase, and that there has been a significant increase in high-level integration areas since 2010. (2) The URIL exhibits a distinct spatial clustering pattern, characterized by lower levels in the upper reaches, and higher levels in the middle and lower reaches. (3) There exists a spatial disparity between economic development and the ecological environment, and it is particularly noticeable in the lower reaches regions. These results contribute to a better understanding of URI in the YRB and provide a reference for the sustainable development of URI in various regions.

Capacity needs assessment and challenges for multisectoral implementation of nutrition in Burkina Faso: A guide for the formulation of a capacity development plan.

INTRODUCTION: Achieving nutritional goals depends on individual, organisational and environmental capacities. The aim of this study was to analyse and identify capacity gaps among the coordination platforms and networks, and the key technical institutions related to nutrition in Burkina Faso for a capacity development plan formulation. METHODS: Using the new Nutrition Capacity Framework developed by the United Nations Network, information were collected using the Nutrition Stakeholder Mapping and Analysis tool, and the Checklist for Capacity Areas. Capacity needs were analysed in terms of Human resource and infrastructure, functional, organisational, coordination and partnership, and financial and resource mobilisation. RESULTS: Limited human resource capacity in nutrition was highlighted in most cases by the structures, and the nutrition coordination structure and more than 4/5 of the technical structures are faced with the unavailability of working materials, tools and basic Internet connection. Only 10 among the 30 structures have a unit or service for exchange on nutrition, and only three of them have integrated nutrition actions. Shortfalls were noted in terms of functional, facilitation, communication and advocacy skills, as well as a weak diversification of resource mobilisation strategies. CONCLUSION: The use of the analytical framework helped to identify the gaps and to propose paths for capacity development. Efforts need to be strengthened, intensified, coordinated, monitored, evaluated and funded.

Retornando al trabajo comunitario en la gestión de la pandemia en Navarra / Returning to community work in the management of the pandemic in Navarra

La progresiva implantación de las acciones previstas en el “Plan Global para el desarrollo de actuaciones sociosanitarias y comunitarias ante la COVID-19 en Navarra” permitió ir aumentando gradualmente la conciencia de que, para una adecuada y más eficaz gestión de la pandemia desde una perspectiva biopsicosocial, no era suficiente con reaccionar ante las necesidades que emergían diariamente, sino que era necesario tratar de anticiparse, o incluso ir un paso más allá con enfoques comunitarios para tratar de incidir en las causas de las causas. Volver al origen desde un modelo salutogénico, centrado más en las fortalezas de las comunidades para generar salud que en el modelo patogénico clásico centrado en controlar comportamientos individuales. Dentro del citado Plan desde el nivel de intervención comunitario, inicialmente se actuó de manera reactiva ante brotes localizados con alta concentración de indicadores de riesgo social en un total de nueve Zonas Básicas de Salud, generando conocimiento útil desde las primeras experiencias a las últimas, llegando a plantear recomendaciones organizativas para facilitar la intervención posterior en esas situaciones. La evolución lógica de estas enseñanzas llevó a avanzar en actuaciones de promoción de la salud mediante la potenciación y facilitación del trabajo con la comunidad a través de las Mesas de Trabajo Comunitario existentes anteriormente o impulsadas durante la pandemia, y a la articulación de redes de sensibilización en determinados puntos del territorio como Tudela.(AU)

How can public open spaces contribute to physical activity promotion? / Como os espaços públicos abertos podem contribuir para a promoção da atividade física?

Public open spaces (POSs) are means to ensure one's right to recreation and health. The objective of this essay is to present reflections and evidence on how these spaces contribute to promoting physi-cal activity (PA). Understanding how to access (proximity/distance), quantity and diversity, and the surrounding and internal conditions of places (quality, structure, aesthetics, safety) can affect the use of POSs is imperative for public management actions. Thinking of POS use beyond PA by recog-nizing its social, economic, and cultural benefits can be fundamental to reduce inequalities regarding access to these places. POS-related actions and demands are intersectoral, multiprofessional, and interdisciplinary, thus requiring political, academic, and community involvement and commitment for PA promotion

Espaços públicos abertos (EPA) são equipamentos que promovem o direito à recreação e à saúde. O objetivo deste ensaio é apresentar reflexões e evidências sobre como esses espaços contribuem para a promoção da atividade física (AF). Compreender como o acesso (proximidade/distância), a quantidade e diversidade, as condições do entorno e internas dos locais (qualidade, estrutura, estética, segurança), podem afetar o uso dos EPA é fundamental para ações da gestão pública. Pensar o uso do EPA para além da prática de AF, reconhecendo seus benefícios sociais, econômicos e culturais pode ser fundamental para diminuir as iniquidades de acesso a esses locais. Ações e demandas relacionadas aos EPA são intersetoriais, multiprofissionais e interdisciplinares, necessitando com isso envolvimento e comprometimento político, acadêmico e comunitário, a fim de promover AF

ACU193, a Monoclonal Antibody that Selectively Binds Soluble Aß Oligomers: Development Rationale, Phase 1 Trial Design, and Clinical Development Plan.

BACKGROUND: Alzheimer's disease is a large and growing unmet medical need. Clinical trial designs need to assess disease-related outcomes earlier to accelerate the development of better treatments for Alzheimer's disease. ACU193 is a monoclonal antibody that selectively targets amyloid ß oligomers, thought to be the most toxic species of Aß that accumulates early in AD and contributes to downstream pathological effects. Nonclinical data indicate that ACU193 can reduce the toxic effects of amyloid ß oligomers. ACU193 is currently being investigated in a phase 1 clinical trial designed with the properties described in this report. This phase 1 trial is designed to provide data to enable a go/no-go decision regarding the initiation of a subsequent phase 2/3 study. OBJECTIVES: To design a phase 1 study that assesses target engagement and incorporates novel measures to support more rapid development of a potential disease-modifying treatment for Alzheimer's disease. DESIGN: The INTERCEPT-AD trial for ACU193 is an ongoing randomized, placebo-controlled phase 1a/b study that assesses safety, tolerability, pharmacokinetics, target engagement, clinical measures, and several Alzheimer's disease biomarkers, including novel digital and imaging biomarkers. SETTING: For INTERCEPT-AD, brief inpatient stays for patients in the single ascending dose portion of the study, with the remainder of the evaluations being performed as outpatients at multiple clinical trial sites in the U.S. PARTICIPANTS: Patients with early Alzheimer's disease (mild cognitive impairment or mild dementia with a positive florbetapir positron emission tomography scan). INTERVENTION: ACU193 administered intravenously at doses of 2- 60 mg/kg. MEASUREMENTS: Safety assessments including magnetic resonance imaging for the presence of amyloid-related imaging abnormalities, clinical assessments for Alzheimer's disease including the Alzheimer's Disease Rating Scale-cognition and Clinical Dementia Rating scale, pharmacokinetics, a measure of target engagement, and digital and imaging biomarkers, including a computerized cognitive test battery and a measure of cerebral blood flow using arterial spin labelling magnetic resonance imaging. RESULTS: A phase 1 study design was developed for ACU193 that allows collection of data that will enable a go/no-go decision for initiation of a subsequent adaptive phase 2/3 study. CONCLUSIONS: A phase 1a/b trial and an overall clinical development plan for an Alzheimer's disease treatment can be designed that maintains patient safety, allows informed decision-making, and achieves an accelerated timeline by using novel biomarkers and adaptive study designs.

Identifying Aging Adults' Housing Preferences: An Age-Friendly Initiative.

Community planning around housing needs of older adults is, at present, very understudied. This study stemmed from a practical need to determine the housing preferences of residents as part of an Age Friendly Community initiative. Data presented in this paper focus on the quantitative component of a sequential mixed methods study examining attitudes and preferences about housing. This first phase of this project involved data collected from 1,514 residents aged 30+ using a researcher-devised survey of 43 items. There was little difference in housing preferences between older and younger respondents or among those with varying financial means. Analysis revealed the most important housing considerations were safety in home, affordability, privacy, proximity to services frequently used, and accessibility. An unexpected finding was that almost half of older respondents expressed a willingness to share a home with a roommate. There were also differences in preferences on home environment based on current marital status. Data suggests that city planners and property developers should prioritize these preferences when planning for the housing-related needs of older residents. Future research should examine the interpretation of housing preferences, such as qualitative exploration of what it means for housing to be "safe" or 'affordable.'