Research Question, Study Design and Continuous Research Education and Training Exercises (CREATE) Program.

The clinical research project starts with identifying the optimal research question, one that is ethical, impactful, feasible, scientifically sound, novel, relevant, and interesting. The project continues with the design of the study to answer the research question. Such design should be consistent with ethical and methodological principles, and make optimal use of resources in order to have the best chances of identifying a meaningful answer to the research question. Physicians and other healthcare providers are optimally positioned to identify meaningful research questions the answer to which could make significant impact on healthcare delivery. The typical medical education curriculum, however, lacks solid training in clinical research. We propose CREATE (Continuous Research Education And Training Exercises) as a peer- and group-based, interactive, analytical, customized, and accrediting program with didactic, training, mentoring, administrative, and professional support to enhance clinical research knowledge and skills among healthcare professionals, promote the generation of original research projects, increase the chances of their successful completion and potential for meaningful impact. The key features of the program are successive intra- and inter-group discussions and confrontational thematic challenges among participating peers aimed at capitalizing on the groups' collective knowledge, experience and skills, and combined intellectual processing capabilities to optimize choice of research project elements and stakeholder decision-making.

Factors influencing malaria control policy-making in Kenya, Uganda and Tanzania.

BACKGROUND: Policy decisions for malaria control are often difficult to make as decision-makers have to carefully consider an array of options and respond to the needs of a large number of stakeholders. This study assessed the factors and specific objectives that influence malaria control policy decisions, as a crucial first step towards developing an inclusive malaria decision analysis support tool (MDAST). METHODS: Country-specific stakeholder engagement activities using structured questionnaires were carried out in Kenya, Uganda and Tanzania. The survey respondents were drawn from a non-random purposeful sample of stakeholders, targeting individuals in ministries and non-governmental organizations whose policy decisions and actions are likely to have an impact on the status of malaria. Summary statistics across the three countries are presented in aggregate. RESULTS: Important findings aggregated across countries included a belief that donor preferences and agendas were exerting too much influence on malaria policies in the countries. Respondents on average also thought that some relevant objectives such as engaging members of parliament by the agency responsible for malaria control in a particular country were not being given enough consideration in malaria decision-making. Factors found to influence decisions regarding specific malaria control strategies included donor agendas, costs, effectiveness of interventions, health and environmental impacts, compliance and/acceptance, financial sustainability, and vector resistance to insecticides. CONCLUSION: Malaria control decision-makers in Kenya, Uganda and Tanzania take into account health and environmental impacts as well as cost implications of different intervention strategies. Further engagement of government legislators and other policy makers is needed in order to increase funding from domestic sources, reduce donor dependence, sustain interventions and consolidate current gains in malaria.

Poverty and Place in the Context of the American South

In the United States, poverty has been historically higher and disproportionately concentrated in the American South. Despite this fact, much of the conventional poverty literature in the United States has focused on urban poverty in cities, particularly in the Northeast and Midwest. Relatively less American poverty research has focused on the enduring economic distress in the South, which Wimberley (2008:899) calls “a neglected regional crisis of historic and contemporary urgency.” Accordingly, this dissertation contributes to the inequality literature by focusing much needed attention on poverty in the South.

Each empirical chapter focuses on a different aspect of poverty in the South. Chapter 2 examines why poverty is higher in the South relative to the Non-South. Chapter 3 focuses on poverty predictors within the South and whether there are differences in the sub-regions of the Deep South and Peripheral South. These two chapters compare the roles of family demography, economic structure, racial/ethnic composition and heterogeneity, and power resources in shaping poverty. Chapter 4 examines whether poverty in the South has been shaped by historical racial regimes.

The Luxembourg Income Study (LIS) United States datasets (2000, 2004, 2007, 2010, and 2013) (derived from the U.S. Census Current Population Survey (CPS) Annual Social and Economic Supplement) provide all the individual-level data for this study. The LIS sample of 745,135 individuals is nested in rich economic, political, and racial state-level data compiled from multiple sources (e.g. U.S. Census Bureau, U.S. Department of Agriculture, University of Kentucky Center for Poverty Research, etc.). Analyses involve a combination of techniques including linear probability regression models to predict poverty and binary decomposition of poverty differences.

Chapter 2 results suggest that power resources, followed by economic structure, are most important in explaining the higher poverty in the South. This underscores the salience of political and economic contexts in shaping poverty across place. Chapter 3 results indicate that individual-level economic factors are the largest predictors of poverty within the South, and even more so in the Deep South. Moreover, divergent results between the South, Deep South, and Peripheral South illustrate how the impact of poverty predictors can vary in different contexts. Chapter 4 results show significant bivariate associations between historical race regimes and poverty among Southern states, although regression models fail to yield significant effects. Conversely, historical race regimes do have a small, but significant effect in explaining the Black-White poverty gap. Results also suggest that employment and education are key to understanding poverty among Blacks and the Black-White poverty gap. Collectively, these chapters underscore why place is so important for understanding poverty and inequality. They also illustrate the salience of micro and macro characteristics of place for helping create, maintain, and reproduce systems of inequality across place.

Decision models - an analytical framework for the Watertime Project

This paper suggests a possible framework for the encapsulation of the decision making process for the Waterime project. The final outcome maybe a computerised model, but the process advocated is not prescriptive, and involves the production of a "paper model" as mediating representation between the knowledge acquired and any computerised system. This paper model may suffice in terms of the project's goals.

Industrial water pollution in Dhaka, Bangladesh: strategies and incentives for pollution control in small and medium enterprises

The extent and gravity of the environmental degradation of the water resources in Dhaka due to untreated industrial waste is not fully recognised in international discourse. Pollution levels affect vast numbers, but the poor and the vulnerable are the worst affected. For example, rice productivity, the mainstay of poor farmers, in the Dhaka watershed has declined by 40% over a period of ten years. The study found significant correlations between water pollution and diseases such as jaundice, diarrhoea and skin problems. It was reported that the cost of treatment of one episode of skin disease could be as high as 29% of the weekly earnings of some of the poorest households. The dominant approach to deal with pollution in the SMEs is technocratic. Given the magnitude of the problem this paper argues that to control industrial pollution by SMEs and to enhance their compliance it is necessary to move from the technocratic approach to one which can also address the wider institutional and attitudinal issues. Underlying this shift is the need to adopt the appropriate methodology. The multi-stakeholder analysis enables an understanding of the actors, their influence, their capacity to participate in, or oppose change, and the existing and embedded incentive structures which allow them to pursue interests which are generally detrimental to environmental good. This enabled core and supporting strategies to be developed around three types of actors in industrial pollution, i.e., (i) principal actors, who directly contribute to industrial pollution; (ii) stakeholders who exacerbate the situation; and (iii) potential actors in mitigation. Within a carrot-and-stick framework, the strategies aim to improve environmental governance and transparency, set up a packet to incentive for industry and increase public awareness.

We could make a meal out of nothing: contested explanations of inequalities in health

This paper reports on the qualitative findings from a comparative study of public health and lifestyles in South East England and Northern France, regions with similar geographic and economic characteristics. Data from health surveys showed that both countries had an increasing BMI with age, particularly in Northern France. This was despite the finding that the percentage eating fresh fruit and vegetable at least five days a week in Northern France increased with age (from well over 50% to over 90%) compared to around 50% to around 75% in South East England. Qualitative data on health inequalities and how they could be addressed were gathered by focus groups sampling from five tiers using the Townsend Index for comparability (14 in England with 106 participants overall; 13 in France with 143 participants). Both had about two thirds women participants, with a preponderance of middle aged and older people. There was a striking difference in the salience of diet between the two countries; in the French data it was raised only 14 times, whereas in England there were 165 occurrences, and these were often distinguished by their use of narrative. Older respondents contrasted the pressures on families today and the expense of fresh fruit and vegetables with their own childhood or childrearing, when cheap meals could be created using skills which have now been lost. These data therefore provide further evidence that providing food is a moral activity.

Sustainability and local tourism branding in England's South Downs

This paper reports on a stakeholder consultation exercise that examined the tourism industry's perception of developing a local tourism branding scheme within the South Downs' protected areas in south-east England. The research shows that such schemes could offer potential benefits that are recognisable by the tourism industry, while helping to meet the statutory aims of the protected area. The paper records the perceptions of small tourism businesses, their fears, awareness of tourism impacts, perceptions of sustainable tourism and of local branding, and key criteria connected to the future organisation of a local tourism branding scheme. The conclusion lists the recommendations for the implementation of a local branding scheme, including grassroots stakeholder consultation that encourages ownership and participation, institutional frameworks that support capacity-building and the importance of developing core values within a local brand.

Strategies for water pollution control in Dhaka, Bangladesh: an institutional and economic analysis

This paper presents primary data based on research carried out as part of a large World Bank project. Results from our survey show that water pollution in Dhaka watershed has reached alarming levels and is posing significant threats to health and economic activity, particularly among the poor and vulnerable. Rice productivity in the watershed area, for example, has declined by 40% in recent years and vegetable cultivation in the riverbeds has been severely damaged. We also found significant correlation between water pollution and diseases such as jaundice, diarrhoea and skin problems. It was reported that the cost of treatment of skin diseases for one episode could be as high as 29% of the weekly earnings of poor households. Given the magnitude of the contamination problem, a multi-agent stakeholder approach was necessary to analyse the institutional and economic constraints that would need to be addressed in order to improve environmental management. This approach, in turn, enabled core strategies to be developed. The strategies were better understood around three types of actors in industrial pollution, i.e. (1) principal actors, who contribute directly to industrial pollution; (2) stakeholders, who exacerbate the situation by inaction; and (3) the potential actors in mitigation of water contamination. Within a carrot-and-stick framework, nine strategies leading to the strengthening of environmental management were explored. They aim at improving governance and transparency within public agencies and private industry through the setting up of incentive structures to advance compliance and enforcement of environmental standards. Civil society and the population at large are, on the other hand, encouraged to contribute actively to the mitigation of water pollution by improving the management of environmental information and by raising public awareness.

D9.2 - RAGE website

This deliverable comprises the general description of the RAGE project public website – referred also as the RAGE website, accessible at http://www.rageproject.eu. The RAGE website main objectives are to raise awareness about the project activities as well as to incentivise engagement from targeted stakeholder communities. It integrates social media networks such as Twitter, Google+ and LinkedIn and has been developed using Wordpress as Content Management System (CMS). The RAGE website is constantly monitored for content management and technical support purposes.

Priority research questions for the UK food system

The rise of food security up international political, societal and academic agendas has led to increasing interest in novel means of improving primary food production and reducing waste. There are however, also many 'post-farm gate' activities that are critical to food security, including processing, packaging, distributing, retailing, cooking and consuming. These activities all affect a range of important food security elements, notably availability, affordability and other aspects of access, nutrition and safety. Addressing the challenge of universal food security, in the context of a number of other policy goals (e.g. social, economic and environmental sustainability), is of keen interest to a range of UK stakeholders but requires an up-to-date evidence base and continuous innovation. An exercise was therefore conducted, under the auspices of the UK Global Food Security Programme, to identify priority research questions with a focus on the UK food system (though the outcomes may be broadly applicable to other developed nations). Emphasis was placed on incorporating a wide range of perspectives ('world views') from different stakeholder groups: policy, private sector, non-governmental organisations, advocacy groups and academia. A total of 456 individuals submitted 820 questions from which 100 were selected by a process of online voting and a three-stage workshop voting exercise. These 100 final questions were sorted into 10 themes and the 'top' question for each theme identified by a further voting exercise. This step also allowed four different stakeholder groups to select the top 7-8 questions from their perspectives. Results of these voting exercises are presented. It is clear from the wide range of questions prioritised in this exercise that the different stakeholder groups identified specific research needs on a range of post-farm gate activities and food security outcomes. Evidence needs related to food affordability, nutrition and food safety (all key elements of food security) featured highly in the exercise. While there were some questions relating to climate impacts on production, other important topics for food security (e.g. trade, transport, preference and cultural needs) were not viewed as strongly by the participants.

A thematic cost-benefit analysis of a marine protected area

The implementation of Marine Protected Areas (MPAs) is ultimately a social endeavour to sustain or improve human well-being via the conservation of marine ecosystems. The degree to which ecological gains are realised can depend upon how economic, ecological and social costs (negative impacts) and benefits (positive impacts) are included in the designation and management process. Without the support of key stakeholder groups whose user rights have been affected by the creation of an MPA, human impacts cannot be reduced. This study analyses a three year dataset to understand the themes associated with the economic, environmental and social costs and benefits of an MPA in Lyme Bay, United Kingdom (UK) following its establishment in 2008. Methodologically, the paper presents an ecosystem based management framework for analysing costs and benefits. Two hundred and forty one individuals were interviewed via questionnaire between 2008 and 2010 to determine perceptions and the level of support towards the MPA. Results reveal that despite the contentious manner in which this MPA was established, support for the MPA is strong amongst the majority of stakeholder groups. The level of support and the reasons given for support vary between stakeholder groups. Overall, the stakeholders perceive the social, economic and environmental benefits of the MPA to outweigh the perceived costs. There have been clear social costs of the MPA policy and these have been borne by mobile and static gear fishermen and charter boat operators. Local support for this MPA bodes well for the development of a network of MPAs around the UK coast under the United Kingdom Marine and Coastal Access Act 2009. However, this initial optimism is at risk if stakeholder expectation is not managed and the management vacuum is not filled.

Social impacts of a temperate fisheries closure: understanding stakeholders' views

The social dimensions of marine protected areas (MPAs) play an important role in MPA success, yet these social dimensions are little understood. We explore the social impacts arising from the establishment of an MPA using Lyme Bay (south west England) as a case study. Through a series of small group semi-structured interviews the social impacts experienced by fishermen (mobile and static gear), recreational users (divers and sea anglers) and recreation service providers (charter boat and dive businesses) were explored. The social impacts expressed varied according to activity in which the stakeholder group engaged. Negative themes included lengthening fishing trips, tension and conflict, fishermen identity, equity and uncertainty in the long-term. Positive themes included improved experiences for both commercial fishermen and recreational users, and expectations for long-term benefits. These impacts need to be understood because they influence stakeholder behaviour. Failure to interpret stakeholder responses may lead to poor decision-making and worsening stakeholder relations. These findings have implications for the success of the MPA in Lyme Bay, but also for the future network of marine conservation zones around the UK. Any assessment of MPA impacts must therefore identify social as well as economic and environmental change.

Local perceptions of the QICS experimental offshore CO2 release: Results from social science research

This paper explores the social dimensions of an experimental release of carbon dioxide (CO2) carried out in Ardmucknish Bay, Argyll, United Kingdom. The experiment, which aimed to understand detectability and potential effects on the marine environment should there be any leakage from a CO2 storage site, provided a rare opportunity to study the social aspects of a carbon dioxide capture and storage-related event taking place in a lived-in environment. Qualitative research was carried out in the form of observation at public information events about the release, in-depth interviews with key project staff and local stakeholders/community members, and a review of online media coverage of the experiment. Focusing mainly on the observation and interview data, we discuss three key findings: the role of experience and analogues in learning about unfamiliar concepts like CO2 storage; the challenge of addressing questions of uncertainty in public engagement; and the issue of when to commence engagement and how to frame the discussion. We conclude that whilst there are clearly slippages between a small-scale experiment and full-scale CCS, the social research carried out for this project demonstrates that issues of public and stakeholder perception are as relevant for offshore CO2 storage as they are for onshore.

Peacebuilding and Consociational Electoral Engineering in Bosnia-Herzegovina'

What role do elections play in societies emerging from communal war and what type of institutions can serve as catalysts in deepening peace and compromise? While some analysts argue that ethnicity should be recognized through 'consociational' institutions, others maintain that 'integrative' devices - in particular, carefully crafted electoral rules - can limit or even break down the salience of ethnicity and increase the possibility for inter-ethnic accommodation. This article examines the post-war electoral experience of Bosnia and Herzegovina (BiH), arguing that elections had a problematic, unintended impact on peacebuilding. First, timid integrative electoral devices were adopted in a consociational system that reifies ethnic division and complicates compromise; second, peacebuilding agencies needlessly manufactured electoral rules that backfired; third, group-based features of the BiH political system run counter to individual human rights. The article ends with suggestions for improving the electoral framework.

Software Release Planning: An Evolutionary and Iterative Approach

Abstract To achieve higher flexibility and to better satisfy actual customer requirements, there is an increasing tendency to develop and deliver software in an incremental fashion. In adopting this process, requirements are delivered in releases and so a decision has to be made on which requirements should be delivered in which release. Three main considerations that need to be taken account of are the technical precedences inherent in the requirements, the typically conflicting priorities as determined by the representative stakeholders, as well as the balance between required and available effort. The technical precedence constraints relate to situations where one requirement cannot be implemented until another is completed or where one requirement is implemented in the same increment as another one. Stakeholder preferences may be based on the perceived value or urgency of delivered requirements to the different stakeholders involved. The technical priorities and individual stakeholder priorities may be in conflict and difficult to reconcile. This paper provides (i) a method for optimally allocating requirements to increments; (ii) a means of assessing and optimizing the degree to which the ordering conflicts with stakeholder priorities within technical precedence constraints; (iii) a means of balancing required and available resources for all increments; and (iv) an overall method called EVOLVE aimed at the continuous planning of incremental software development. The optimization method used is iterative and essentially based on a genetic algorithm. A set of the most promising candidate solutions is generated to support the final decision. The paper evaluates the proposed approach using a sample project.