Toward the development of national telehealth services: the role of Veterans Health Administration and future directions for research.

The Veterans Health Administration (VHA) in the Department of Veteran Affairs (VA) has emerged as a national and international leader in the delivery and research of telehealth-based treatment. Several unique characteristics of care in VA settings intersect to create an ideal environment for telehealth modalities and research. However, the value of telehealth experience and initiatives in VA settings is limited if telehealth strategies cannot be widely exported to other public or private systems. Whereas a hierarchical organization, such as VA, can innovate and fund change relatively quickly based on provider and patient preferences and a growing knowledge base, other health provider organizations and third-party payers may likely require replicable scientific findings over time before incremental investments will be made to create infrastructure, reform regulatory barriers, and amend laws to accommodate expansion of telehealth modalities. Accordingly, large-scale scientifically rigorous telehealth research in VHA settings is essential not only to investigate the efficacy of existing and future telehealth practices in VHA, but also to hasten the development of telehealth infrastructure in private and other public health settings. We propose an expanded partnership between the VA, NIH, and other funding agencies to investigate creative and pragmatic uses of telehealth technology. To this end, we identify six specific areas of research we believe to be particularly relevant to the efficient development of telehealth modalities in civilian and military contexts outside VHA.

Human dimensions of bycatch reduction technology: Current assumptions and directions for future research

Bycatch reduction technology (BRT) modifies fishing gear to increase selectivity and avoid capture of non-target species, or to facilitate their non-lethal release. As a solution to fisheries-related mortality of non-target species, BRT is an attractive option; effectively implemented, BRT presents a technical 'fix' that can reduce pressure for politically contentious and economically detrimental interventions, such as fisheries closures. While a number of factors might contribute to effective implementation, our review of BRT literature finds that research has focused on technical design and experimental performance of individual technologies. In contrast, and with a few notable exceptions, research on the human and institutional context of BRT, and more specifically on how fishers respond to BRT, is limited. This is not to say that fisher attitudes are ignored or overlooked, but that incentives for fisher uptake of BRT are usually assumed rather than assessed or demonstrated. Three assumptions about fisher incentives dominate: (1) economic incentives will generate acceptance of BRT; (2) enforcement will generate compliance with BRT; and (3) 'participation' by fishers will increase acceptance and compliance, and overall support for BRT. In this paper, we explore evidence for and against these assumptions and situate our analysis in the wider social science literature on fisheries. Our goal is to highlight the need and suggest focal areas for further research. © Inter-Research 2008.