Cross-sector surveys assessing perceptions of key stakeholders towards barriers, concerns and facilitators to the appropriate use of adaptive designs in confirmatory trials

Background Appropriately conducted adaptive designs (ADs) offer many potential advantages over conventional trials. They make better use of accruing data, potentially saving time, trial participants, and limited resources compared to conventional, fixed sample size designs. However, one can argue that ADs are not implemented as often as they should be, particularly in publicly funded confirmatory trials. This study explored barriers, concerns, and potential facilitators to the appropriate use of ADs in confirmatory trials among key stakeholders. Methods We conducted three cross-sectional, online parallel surveys between November 2014 and January 2015. The surveys were based upon findings drawn from in-depth interviews of key research stakeholders, predominantly in the UK, and targeted Clinical Trials Units (CTUs), public funders, and private sector organisations. Response rates were as follows: 30(55 %) UK CTUs, 17(68 %) private sector, and 86(41 %) public funders. A Rating Scale Model was used to rank barriers and concerns in order of perceived importance for prioritisation. Results Top-ranked barriers included the lack of bridge funding accessible to UK CTUs to support the design of ADs, limited practical implementation knowledge, preference for traditional mainstream designs, difficulties in marketing ADs to key stakeholders, time constraints to support ADs relative to competing priorities, lack of applied training, and insufficient access to case studies of undertaken ADs to facilitate practical learning and successful implementation. Associated practical complexities and inadequate data management infrastructure to support ADs were reported as more pronounced in the private sector. For funders of public research, the inadequate description of the rationale, scope, and decision-making criteria to guide the planned AD in grant proposals by researchers were all viewed as major obstacles. Conclusions There are still persistent and important perceptions of individual and organisational obstacles hampering the use of ADs in confirmatory trials research. Stakeholder perceptions about barriers are largely consistent across sectors, with a few exceptions that reflect differences in organisations’ funding structures, experiences and characterisation of study interventions. Most barriers appear connected to a lack of practical implementation knowledge and applied training, and limited access to case studies to facilitate practical learning. Keywords: Adaptive designs; flexible designs; barriers; surveys; confirmatory trials; Phase 3; clinical trials; early stopping; interim analyses

Stakeholder perceptions of event attribution in the loss and damage debate

In 2013 the Warsaw International Mechanism (WIM) for loss and damage (L&D) associated with climate change impacts was established under the United Nations Framework Convention on Climate Change (UNFCCC). For scientists, L&D raises ques- tions around the extent that such impacts can be attributed to anthropogenic climate change, which may generate complex results and be controversial in the policy arena. This is particularly true in the case of probabilistic event attribution (PEA) science, a new and rapidly evolving field that assesses whether changes in the probabilities of extreme events are attributable to GHG emissions. If the potential applications of PEA are to be considered responsibly, dialogue between scientists and policy makers is fundamental. Two key questions are considered here through a literature review and key stakeholder interviews with representatives from the science and policy sectors underpinning L&D. These provided the opportunity for in-depth insights into stakeholders’ views on firstly, how much is known and understood about PEA by those associated with the L&D debate? Secondly, how might PEA inform L&D and wider climate policy? Results show debate within the climate science community, and limited understanding among other stakeholders, around the sense in which extreme events can be attributed to climate change. However, stake- holders do identify and discuss potential uses for PEA in the WIM and wider policy, but it remains difficult to explore precise applications given the ambiguity surrounding L&D. This implies a need for stakeholders to develop greater understandings of alternative conceptions of L&D and the role of science, and also identify how PEA can best be used to support policy, and address associated challenges.

A case study of the Tatweer school system in Saudi Arabia: the perceptions of leaders and teachers

School reform is a major concern in many countries that seek to improve their educational systems and enhance their performances. In consequence, many global schemes, theories, studies, attempts, and programmes have been introduced to promote education in recent years. Saudi Arabia is one of these countries that implemented educational change by introducing many initiatives. The Tatweer Programme is one of these initiatives and is considered as a major recent reform. The main purpose of this study is to investigate this reform in depth by examining the perceptions and experiences of the Tatweer leaders and teachers to find out which extent they have been enabled to be innovative, and to examine the types of leadership and decision-making that have been undertaken by such schools. This study adopted a qualitative case study that employed interviews, focus groups and documentary analysis. The design of the study has been divided into two phases; the first phase was the feasibility study and the second phase was the main study. The research sample of the feasibility study was head teachers, educational experts and Tatweer Unit’s members. The sample of the main study was three Tatweer schools, Tatweer Unit members and one official of Tatweer Project in Riyadh. The findings of this study identified the level of autonomy in managing the school; the Tatweer schools’ system is semi-autonomous when it comes to the internal management, but it lacks autonomy when it comes to staff appointment, student assessment, and curriculum development. In addition, the managerial work has been distributed through teams and members; the Excellence Team plays a critical role in school effectiveness leading an efficient change. Moreover, Professional Learning Communities have been used to enhance the work within Tatweer schools. Finally the findings show that there have been major shifts in the Tatweer schools’ system; the shifting from centralisation to semi-decentralisation; from the culture of the individual to the culture of community; from the traditional school to one focused on self-evaluation and planning; from management to leadership; and from an isolated school being open to society. These shifts have impacted positively on the attitudes of students, parents and staff.

Effects of infant cleft lip on adult gaze and perceptions of ‘cuteness'

Objective: Early mother-infant interactions are impaired in the context of infant cleft lip, and are associated with adverse child psychological outcomes, but the nature of these interaction difficulties is not yet fully understood. The aim of this study was to explore adult gaze behaviour and cuteness perception, which are particularly important during early social exchanges, in response to infants with cleft lip, in order to investigate potential foundations for the interaction difficulties seen in this population. Methods: Using an eye-tracker, eye movements were recorded as adult participants viewed images of infant faces with and without cleft lip. Participants also rated each infant on a scale of cuteness. Results: Participants fixated significantly longer on the mouths of infants with cleft lip, which occurred at the expense of fixation on eyes. Severity of cleft lip was associated with the strength of fixation bias, with participants looking even longer at the mouths of infants with the most severe clefts. Infants with cleft lip were rated as significantly less cute than unaffected infants. Men rated infants as less cute than women overall, but gave particularly low ratings to infants with cleft lip Conclusions: Results demonstrate that the limited disturbance in infant facial configuration of cleft lip can significantly alter adult gaze patterns and cuteness perception. Our findings could have important implications for early interactions, and may help in the development of interventions to foster healthy development in infants with cleft lip.

Community perceptions of four protected areas in the Northern portion of the Cerrado hotspot, Brazil

Establishing effective networks of protected areas (PAS) is one of the major goals of conservation strategies worldwide. However, the success of PAS in promoting biodiversity conservation depends on their integration to local and regional contexts, reducing and mitigating human impacts originating from buffer zones. Community perceptions affect interactions between residents and PAS, and thereby conservation effectiveness. Research at Tocantins state (northern Brazilian Cerrado), aimed to analyse local community perceptions of four PAs, discussing how different factors may influence these. Perceptions were assessed through standardized interviews applied to PA employees and 275 local inhabitants. There was modest community participation in PA establishment and management. Residents were aware of the PAS` existence, but were unfamiliar with their goals. Length of residency and occupation of inhabitants influenced their PA perceptions, shaping different people-park relations in each of the four studied PAs. Involvement of local residents in PA planning and management represents a central strategy to strengthen local support for PAS over the long term. In those areas that still have settlements inside their boundaries, community relocation should follow a careful participatory process to avoid significant changes in local perceptions and attitudes towards these PAS, crucial for conserving Brazilian biodiversity.

Perceptions of climate change at ski resorts in midsouth of Sweden

Climate change as a phenomenon will imply new risks for the ski industry. Intergovernmental Panal on Climate Change presents three future scenarios, during the periods between 1990-2100, in forms of increased temperatures, a rise in the sea level and seasonal variations, variables out of which two have direct impacts on the ski industry. The aim for this study was to explore and compare attitudes towards climate change between five ski resorts located in mid-south of Sweden. This was done through in depth interviews in both face to face and by telephone. The result of the study was that all the chosen ski resorts were aware of climate change as a phenomenon but have not yet recognized its consequences. All ski resorts use methods to maintain skiing i.e. artificial snow production though not because of climate change.

Solar Collectors for Historic Homes : Linking consumption to perceptions of space

Reduction of household energy consumption is one of the top issues in contemporary discussions on sustainable consumption. This chapter concerns one way through which consumption of purchased energy for house heating can be reduced; by having a solar thermal system added to one's house. However, the fact that one of the components - the solar collector - usually is situated on the roof or the facade of a building, is a recurrent impediment to such installations. In certain contexts, these attributes may melt into the building, while in others, they may be perceived as problematic. The latter may particularly be the case when the appearance of the building is of major imiportance, as with houses deemed worthy of preservation for coming generations. This chapter draws upon a study carried out in Visby Town, a walled Hanseatic town and a World Heritage site on the island of Gotland, Sweden.

Health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia : a systematic literature review of qualitative and quantitative data.

BACKGROUND: Unsafe abortions are a serious public health problem and a major human rights issue. In low-income countries, where restrictive abortion laws are common, safe abortion care is not always available to women in need. Health care providers have an important role in the provision of abortion services. However, the shortage of health care providers in low-income countries is critical and exacerbated by the unwillingness of some health care providers to provide abortion services. The aim of this study was to identify, summarise and synthesise available research addressing health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia. METHODS: A systematic literature search of three databases was conducted in November 2014, as well as a manual search of reference lists. The selection criteria included quantitative and qualitative research studies written in English, regardless of the year of publication, exploring health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia. The quality of all articles that met the inclusion criteria was assessed. The studies were critically appraised, and thematic analysis was used to synthesise the data. RESULTS: Thirty-six studies, published during 1977 and 2014, including data from 15 different countries, met the inclusion criteria. Nine key themes were identified as influencing the health care providers' attitudes towards induced abortions: 1) human rights, 2) gender, 3) religion, 4) access, 5) unpreparedness, 6) quality of life, 7) ambivalence 8) quality of care and 9) stigma and victimisation. CONCLUSIONS: Health care providers in sub-Saharan Africa and Southeast Asia have moral-, social- and gender-based reservations about induced abortion. These reservations influence attitudes towards induced abortions and subsequently affect the relationship between the health care provider and the pregnant woman who wishes to have an abortion. A values clarification exercise among abortion care providers is needed.

Guides of the Falu Mine : Perceptions of Differences and Similarities onDomestic and International Visitors

Industrial heritage tourism has been in focus for many academic studies and tourism is an alternative developmental tool for mines and contributes to their economic success. This thesis is about the Falu Mine in Dalarna, Sweden, which has World Heritage status since 2001 and is one of the biggest attractions in the region. Its history and cultural importance are reasons for the importance of preserving the heritage. The Falu Mine is under the management of the Great Copper Mountain Trust and one of their ambitions is to ensure the continuous popularity among domestic and international visitors. In order to gain a better understanding of the visitors and to find strategies to improve performance, a visitor survey has been conducted in the summer of 2011. It is the authors believe that the guides of the Falu Mine have the best available insight and that their perceptions help to add to the understanding about the visitors. Therefore, this thesis aims to explore the perceptions of the guides about their visitors, to investigate how the perceptions correspond to the statistical results and to study if there are any differences between domestic and international visitors. The mixed methods approach will increase the depth and accuracy of the results, by linking qualitative with quantitative data. The results show that differences between domestic and international visitors exist, both proven by interviews with the guides and the visitor survey. These differences occur in the factors, such as level of education of the visitors, group size and number of children in the group, knowledge of the visitors prior to and after the visit, sources of information and the fulfillment of the visitor expectations. The perceptions emphasize how these differences impact the guided tours. The guides of the Falu Mine have to be aware of those differences in order to adjust the tour accordingly, as well as the management of the Falu Mine can use this knowledge in order to identify strategies for improving performance.

Strategic alliances in a town centre : Stakeholder’s perceptions of property owner’s role

In order for town centres to manage increased competition in retailing, co-operation between stakeholders in a strategic alliance has become more important. A typical set of stakeholders in a strategic alliance for strengthening retailingare retailers, local authorities and property owners. The roles of retailer’sand local authorities’ are well researched. However, the role of property owners is not. The aim of this paper seeks to unfold the role of property owners in a strategic alliance. This is a case study of a medium-sized town in which semi-structured interviews with different stakeholders were conducted. In the chosen town there is a TCM alliance co-operation at work. The above mentioned stakeholders are possible members in an alliance. The case studied shows a fragmented property owner market with no dominant property owner, as it is in many medium-sized towns. Our study shows that many stakeholders look at the role of property owners as crucial for town centre development. However, property owners do not see that they can significantly contribute to or benefit from the development.The main reasons for this opinion are that they consider themselves as not having enough resources or the capability to influence the town development.

Nurses’ perceptions of climate and environmental issues : a qualitative study

Aim: The aim of this study was to explore nurses' perceptions of climate and environmental issues and examine how nurses perceive their role in contributing to the process of sustainable development.  Background: Climate change and its implications for human health represent an increasingly important issue for the healthcare sector. According to the International Council of Nurses Code of Ethics, nurses have a responsibility to be involved and support climate change mitigation and adaptation to protect human health.  Design: This is a descriptive, explorative qualitative study.  Methods: Nurses (n=18) were recruited from hospitals, primary care and emergency medical services; eight participated in semi-structured, in-depth individual interviews and 10 participated in two focus groups. Data were collected from April-October 2013 in Sweden; interviews were transcribed verbatim and analysed using content analysis.  Results: Two main themes were identified from the interviews: (i) an incongruence between climate and environmental issues and nurses' daily work; and (ii) public health work is regarded as a health co-benefit of climate change mitigation. While being green is not the primary task in a lifesaving, hectic and economically challenging context, nurses' perceived their profession as entailing responsibility, opportunities and a sense of individual commitment to influence the environment in a positive direction.  Conclusions: This study argues there is a need for increased awareness of issues and methods that are crucial for the healthcare sector to respond to climate change. Efforts to develop interventions should explore how nurses should be able to contribute to the healthcare sector's preparedness for and contributions to sustainable development.

Psychometric properties of the Swedish version of the Fear of Complications Questionnaire

Objectives: To translate and evaluate the psychometric properties of the Swedish version of the Fear of Complications Questionnaire. Design: Cross-sectional study design and scale development. Settings: Totally, 469 adults (response rate 63.5%) with Type 1 diabetes completed the questionnaires. Participants were recruited from two university hospitals in Sweden. Participants: Eligible patients were those who met the following inclusion criteria: diagnosed with Type 1 diabetes, diabetes duration of at least 1 year and aged at least 18 years. Methods: The Fear of Complications Questionnaire was translated using the forward-backward translation method. Factor analyses of the questionnaire were performed in two steps using both exploratory and confirmatory factor analysis. Convergent validity was examined using the Hospital Anxiety and Depression Scale and the Fear of Hypoglycaemia Fear Survey. Internal consistency was estimated using Cronbach’s alpha.Results: Exploratory factor analysis supported a two-factor solution. One factor contained three items having to do with fear of kidney-related complications and one factor included the rest of items concerning fear of other diabetes-related complications, as well as fear of complications in general. Internal consistency was high Cronbach’s alpha 0.96. The findings also gave support for convergent validity, with significant positive correlations between measures (r = 0.51 to 0.54). Conclusion: The clinical relevance of the identified two-factor model with a structure of one dominant subdomain may be considered. We suggest, however a one-factor model covering all the items as a relevant basis to assess fear of complications among people with Type 1 diabetes.