New Technologies, New Challenges for Human Rights? The Work of the Council of Europe

Convergence of emerging technologies (e.g. biotechnologies, information and cognitive technologies) has opened new perspectives for progress with regard to human health. However, these technologies also open new possibilities for interventions on human beings, which may be more invasive, and possibly affect and modify individuals. Established practices in the field of biomedicine are also evolving in a way that exerts pressure on existing protective mechanisms. Thus, consideration is required as to whether existing human rights provisions are still fit for purpose or whether there is a need to re-examine, clarify or re-enforce them or even a need to identify new human rights and protective measures. This article gives an overview of the main issues considered by the Committee on Bioethics of the Council of Europe to develop a Strategic Action Plan aimed at ensuring appropriate protection of human rights in the developments in biomedicine, promoting thereby progress for human health.

Evaluation of technological competence and operations efficiency in the defense industry: The strategic planning of South Korea

This research aims to contribute to efficiency improvement by providing the implications for decision-making on continuous defense R&D investment strategies and acquisition methods via analyzing the current position and measuring the efficiency of overall weapon systems on technological competence and operations. This research is distinctive in comparison to previous studies because it is structured in a two-stage DEA analysis for efficiency by distinguishing between the technology and operations of the current eight fields of weapon systems and by adding the external index for government competence and market competence. In 2016, in comparison to the year 2013, the eight major weapon systems' efficiency fields of the overall system of Korea, efficiency of technological competence, and efficiency of operations all increased. This research introduced the input and output variable that fits in with the defense industry by connecting the weapon systems efficiency with the national innovation system and the sectoral innovation system that are both projected in this industry. It also formed the concepts of technological competence efficiency and operations efficiency using the two-stage Network DEA method.

American Association for Geriatric Psychiatry-Strategic Thinking

Never has there been a more pressing time for the American Association for Geriatric Psychiatry (AAGP) to articulate a unified strategy to meet the challenges of our aging world. To this end, this report summarizes an AAGP leadership meeting that reviewed the results from a recent membership survey and launched a strategic planning process on behalf of AAGP members and stakeholders. This meeting was the first step in drafting a blueprint for the future that may serve as our guide in the context of finite resources to meet the infinitely complex and growing need for education, research, public advocacy, and clinical practice support. The following report serves to invite our valued colleagues to provide feedback and actively participate in defining our mission. Among the outcomes of the planning session, the following aspirations were identified by the participants 1) assert the AAGP as the "go to" organization for all things related to geriatric mental health, 2) prioritize activities that enhance the inclusivity/diversity of membership, and 3) collaborate across disciplines focused on geriatric mental health. From this initial framework, the group developed four general themes to guide AAGP's strategic future: 1) collaboration, 2) advocacy, 3) inclusivity, 4) high purpose. Inclusivity was further defined as encompassing growth, return on investment, and workforce development. Higher purpose was further defined as encompassing engagement, purpose, branding, communication, and expertise. The AAGP affirmed its commitment to serving the needs of its members and widening its scope of impact in view of staggering demands for better access to geriatric mental healthcare.

Quality Criteria to Evaluate Performance and Scope of 2030 Agenda in Metropolitan Areas: Case Study on Strategic Planning of Environmental Municipality Management

The United Nations’ (UN) 2030 Agenda brings new governance challenges to municipal environmental planning, both in large urban centres and in metropolitan peripheries. The opportunities of the new framework of action proposed by the United Nations (UN) and its integrative, global, and transversal nature constitute advances from the previous models of municipal management based on the Local Agenda 21. This text provides evidence to apply quality criteria and validated instruments of participatory evaluation. These instruments have been built on the foundation of evaluative research, a scientific discipline that provides rigour and validity to those decisions adopted at a municipal level. A case study focused on a metropolitan area serves as a field of experimentation for this model of the modernization of environmental management structures at a local level. Details of the instruments, agents, priority decision areas, methodologies, participation processes, and quality criteria are provided, as well as an empirically validated model for participatory municipal management based on action research processes and strategic planning that favours a shared responsibility across all social groups in the decision-making process and in the development of continuous improvement activities that are committed to sustainability. Finally, a critical comparison of weaknesses and strengths is included in light of the evidence collected.

Strategic Planning in Health Professions Education: Scholarship or Management?

Strategic planning, in its various forms, is an evaluation practice that is ubiquitous in academic medicine. However, published reports of strategic planning at academic health centers usually ignore theory. In a 2017 strategic planning exercise at the Wilson Centre, a scholarly model evolved using a theoretical framework and a research approach rather than a conventional management model, which typically identifies outcomes and how to achieve them. After completing this exercise, the authors considered the larger questions of the assumptions underpinning different models of strategic planning and strategic planning's value to academic medicine. To elaborate on these questions, the authors examine relevant literature and set out the Wilson Centre's emergent scholarly model. They describe the main features of the scholarly model, including ways it differs from a management approach and from the typical approach to strategic planning in the authors' experience and in the field of health professions education research. The authors also share lessons learned as a means to encourage consideration by other academic organizations.

Does Strategic Planning Matter?

In this Invited Commentary, the author examines the history, use, and effectiveness of strategic planning in higher education, academic medicine, and nonprofit settings. Strategic planning is a process by which an organization differentiates itself from its direct or emergent competition to achieve its mission. This form of planning is distinct from operational planning, in which an organization identifies the ways in which it will continuously improve. Many organizations employ a combination of strategic planning and operational planning but use the former term to describe their planning process without a clear definition or conceptual framework.The empirical literature across disciplines has not demonstrated that strategic planning leads to positive organizational outcomes. Over the modern history of academic medicine in the United States, strategic planning may have had limited impact on organizational outcomes because of favorable environmental circumstances that catalyzed growth and innovation regardless of planning efforts. In the current environment, organizational and departmental leaders need to define trade-offs between the various opportunities that they confront; allow for both planned and emergent strategy formulation; avoid platitudes and fluff; and focus on operational excellence.Theories from anthropology suggest that strategic plans may be more important for what they express than what they produce. Repetition of the themes and language of strategy in formal and informal discourse can have a decisive effect on the culture of the organization. Strategic planning, therefore, matters for its effect on organizational values, rituals, and ability to move the organization in new directions.

Modelling targeted rabies vaccination strategies for a domestic dog population with heterogeneous roaming patterns

Australia is currently canine rabies free. However, communities located on the northern coastline-such as the Northern Peninsula Area (NPA), Queensland-are at risk of an incursion due to their large populations of susceptible free-roaming dogs and proximity to rabies-infected Indonesian islands. A rabies-spread model was used to simulate potential outbreaks and evaluate various disease control strategies. A heterogeneous contact structure previously described in the population of interest-explorer dogs, roamer dogs and stay-at-home dogs-was incorporated into the model using six spatial kernels describing contacts between dog roaming categories. Twenty-seven vaccination strategies were investigated based on a complete block design of 50%, 70% and 90% coverage for each of the three roaming categories to simulate various targeted vaccination strategies. The 27 strategies were implemented in four population structures in which the proportion of dogs in each category varied-explorer dominant, roamer dominant, stay-at-home dominant and a field population (based on field estimates of population structure). The overall vaccination coverage varied depending on the subpopulation targeted for vaccination and the population structure modelled. A total of 108 scenarios were simulated 2000 times and the model outputs (outbreak size and duration) were compared to Strategy 14 (a standard recommended overall 70% vaccination coverage). In general, targeting explorer dogs-and to a lesser extent roamer dogs-produced similar outbreaks to Strategy 14 but with a lower overall vaccination coverage. Similarly, strategies that targeted stay-at-home dogs required a higher vaccination coverage to produce significantly smaller and shorter outbreaks. This study provides some theoretical evidence that targeting subpopulations of dogs for vaccination based on their roaming behaviours (and therefore risk of rabies transmission) could be more efficient than blanket 70% vaccination campaigns. Such information can be used in preparedness planning to help improve control of a potential rabies incursion in Australia.

The development of a global chiropractic rehabilitation competency framework by the World Federation of Chiropractic

The World Health Organization (WHO), in its "Rehabilitation 2030 A Call for Action", identified the need to strengthen rehabilitation in health systems to meet the growing demands of current and future populations. Greater access to rehabilitation services is required to secure the achievement of the United Nation's third Sustainable Development Goal, "Ensure healthy lives and promote well-being for all at all ages". To support this mandate, WHO issued a call for non-governmental organizations, associations and institutions to share their rehabilitation-related competency frameworks which will be used to construct a global rehabilitation competency framework. In response to this call, the World Federation of Chiropractic (WFC) developed a chiropractic rehabilitation competency framework. In this article, we present the chiropractic rehabilitation competency framework that will contribute to the development of the global framework in support of WHO's strategic planning for rehabilitation. The goal of WHO's strategic planning is to improve the integration and support of multi-disciplinary rehabilitation and establishing opportunities for global networks and partnerships in rehabilitation.

Mapping vaccination coverage to explore the effects of delivery mechanisms and inform vaccination strategies

The success of vaccination programs depends largely on the mechanisms used in vaccine delivery. National immunization programs offer childhood vaccines through fixed and outreach services within the health system and often, additional supplementary immunization activities (SIAs) are undertaken to fill gaps and boost coverage. Here, we map predicted coverage at 1 × 1 km spatial resolution in five low- and middle-income countries to identify areas that are under-vaccinated via each delivery method using Demographic and Health Surveys data. We compare estimates of the coverage of the third dose of diphtheria-tetanus-pertussis-containing vaccine (DTP3), which is typically delivered through routine immunization (RI), with those of measles-containing vaccine (MCV) for which SIAs are also undertaken. We find that SIAs have boosted MCV coverage in some places, but not in others, particularly where RI had been deficient, as depicted by DTP coverage. The modelling approaches outlined here can help to guide geographical prioritization and strategy design.

Future Needs for Science-Driven Geospatial and Temporal Extravehicular Activity Planning and Execution

Future human missions to Mars are expected to emphasize scientific exploration. While recent Mars rover missions have addressed a wide range of science objectives, human extravehicular activities (EVAs), including the Apollo missions, have had limited experience with science operations. Current EVAs are carefully choreographed and guided continuously from Earth with negligible delay in communications between crew and flight controllers. Future crews on Mars will be expected to achieve their science objectives while operating and coordinating with a science team back on Earth under communication latency and bandwidth restrictions. The BASALT (Biologic Analog Science Associated with Lava Terrains) research program conducted Mars analog science on Earth to understand the concept of operations and capabilities needed to support these new kinds of EVAs. A suite of software tools (Minerva) was used for planning and executing all BASALT EVAs, supporting text communication across communication latency, and managing the collection of operational and scientific EVA data. This paper describes the support capabilities provided by Minerva to cope with various geospatial and temporal constraints to support the planning and execution phases of the EVAs performed during the BASALT research program. The results of this work provide insights on software needs for future science-driven planetary EVAs.

A mixed-methods approach to strategic planning for multi-benefit regional water infrastructure

Finding regional solutions for water infrastructure and other environmental management challenges requires coordination, communication, and a shared understanding among different stakeholders. To develop a more versatile and collaborative decision-making process for nutrient management in the San Francisco Bay Area, we used a mixed-methods approach consisting of stakeholder analysis with cluster analysis, multi-criteria decision analysis (MCDA), and scenario planning. These methods allowed us to identify agreements and disagreements in stakeholder objectives and preferences, clarify ways in which different options could meet the goals of diverse stakeholders, and elucidate how scientific uncertainty about technical performance and future conditions could affect management strategies. Results of the analysis indicate that several non-conventional nutrient management options like constructed wetlands and increased water recycling for irrigation met the goals of many stakeholders under a variety of future scenarios. A comparison of MCDA results with a more traditional 'cost-efficiency' measure (i.e., optimizing for the lowest cost per mass of nutrients removed) revealed little correlation between the two methods for stakeholders who expressed a preference for co-benefits of management options such as increased water supply and nutrient recovery for fertilizer use. The method also allowed us to identify key areas of disagreement (e.g., the relative importance of constructing infrastructure that would not be affected by sea level rise) that should find regulatory or professional consensus before advancing with decision-making. This mixed-methods approach is time-consuming and requires specific expertise that is not always available to stakeholders. The development of more efficient preference elicitation and interaction procedures would increase the likelihood that decision-makers would make the extra effort required to use this potentially powerful method. Nonetheless, the mixed-methods approach had several important advantages over more traditional strategic planning methods including its ability to stimulate discussions amongst stakeholders who do not regularly interact, support collaborative planning, and encourage multi-benefit solutions.

Developing Future Deep-Space Telecommunication Architectures: A Historical Look at the Benefits of Analog Research on the Development of Solar System Internetworking for Future Human Spaceflight

Exploration analog field tests, missions, and deployments enable the integration and validation of new and experimental concepts and/or technologies through strategic experimental design. The results of these operations often create new capabilities for exploration and increase confidence in, and credibility of, emerging technologies, usually at very low cost and risk to the test subjects involved. While these experiments resemble missions 10-30 years into the future, insights obtained are often of immediate value. Knowledge gained in the field translates into strategic planning data to assist long-range exploration planners, and planners influence the experimental design of field deployments, creating a synergistic relationship. The Biologic Analog Science Associated with Lava Terrains (BASALT) communication architecture is a high-fidelity analog program that emulates conditions impacting future explorers on the martian surface. This article provides (1) a brief historical review of past analog operations that deliberately used elements of a flight-like telecommunication infrastructure to add fidelity to the test, (2) samples of the accomplishments made through analog operations, and (3) potentially significant deep-space telecommunication insights gained from the BASALT program in support of future extravehicular activity exploration of Mars. This article is paired with and complements Miller et al. in this issue which focuses on the telecommunication infrastructure utilized by the BASALT team during the field deployment.

Strategic Planning Insights for Future Science-Driven Extravehicular Activity on Mars

Short-term and long-term science plans were developed as part of the strategic planning process used by the Biologic Analog Science Associated with Lava Terrains (BASALT) science team to conduct two Mars-simulation missions investigating basalt habitability at terrestrial volcanic analog sites in 2016. A multidisciplinary team of scientists generated and codified a range of scientific hypotheses distilled into a Science Traceability Matrix (STM) that defined the set of objectives pursued in a series of extravehicular activity (EVA) campaigns performed across multiple field deployments. This STM was used to guide the pre-deployment selection of sampling stations within the selected Mars analog sites on the Earth based on precursor site information such as multispectral imagery. It also informed selection of hand-held instruments and observational data to collect during EVA to aid sample selection through latency-impacted interaction with an Earth-based Science Support Team. A significant portion of the pre-deployment strategic planning activities were devoted to station selection, ultimately the locations used for sample collection and EVA planning. During development of the EVAs, the BASALT science team identified lessons learned that could be used to inform future missions and analog activities, including the critical need for high-resolution precursor imagery that would enable the selection of stations that could meet the scientific objectives outlined in the STM.

Aligning Strategic Interests in an Academic Medical Center: A Framework for Evaluating GME Expansion Requests

BACKGROUND

In 2017, the Maine Medical Center Graduate Medical Education Committee received an unprecedented number of requests (n = 18) to start new graduate medical education (GME) programs or expand existing programs. There was no process by which multiple programs could be prioritized to compete for scarce GME resources.

OBJECTIVE

We developed a framework to strategically assess and prioritize GME program expansion requests to yield the greatest benefits for patients, learners, and the institution as well as to meet regional and societal priorities.

METHODS

A systems engineering methodology called tradespace exploration was applied to a 6-step process to identify relevant categories and metrics. Programs' final scores were peer evaluated, and prioritization recommendations were made. Correlation analysis was used to evaluate the relevance of each category to final scores. Stakeholder feedback was solicited for process refinement.

RESULTS

Five categories relevant to GME expansion were identified: institutional priorities, health care system priorities, regional and societal needs, program quality, and financial considerations. All categories, except program quality, correlated well with final scores (R ² range 0.413-0.662). Three of 18 requested programs were recommended for funding. A stakeholder survey revealed that almost half of respondents (48%, 14 of 29) agreed that the process was unbiased and inclusive. Focus group feedback noted that the process had been rigorous and deliberate, although communication could have been improved.

CONCLUSIONS

Applying a systems engineering approach to develop institution-specific metrics for assessing GME expansion requests provided a reproducible framework, allowing consideration of institutional, health care system, and regional societal needs, as well as program quality and funding considerations.

Global Surgery: Could systems thinking be the key to success?

Surgery and anaesthesia care is progressively making its way into the Global Public Health arena, which was d omi na ted by ma ter nal an d c hild h e al th an d communicable diseases in low-and middle-income countries (LMICs). Global Surgery (GS) could potentially make an impact on survival and quality of life in all age groups for a variety of disease conditions. After success in highlighting knowledge, policy and advocacy gaps, Global Surgery is transitioning from problem identification to designing and implementing solutions. A shared vision will lay out priorities to achieve the common goal of providing safe and affordable surgical and anaesthesia care in under-developed and developing countries. A systematic thinking approach could amplify the impact of such efforts by highlighting the bigger picture, enabling Global Surgery leaders in such countries to build multidisciplinary coalitions and utilise crosslevel interactions between Global Surgery and other initiatives.

The Bell Has Rung: Answering the Door for Student-Athlete Concussion Issues in the National Collegiate Athletic Association

This Note examines the NCAA's unwillingness to enforce the requirement that all NCAA institutions must implement a concussion management plan; the NCAA's refusal to apply its appropriate enforcement mechanism when member institutions violate their concussion management plans, which are instituted in order to protect student-athletes from concussions; how both of these failures result in more concussions and a higher probability of debilitating long-term effects; and solutions to remedy this grave injustice. Part II describes what a concussion is, the long-term effects of concussions, the NCAA's management of concussions, and lawsuits challenging the NCAA in relation to concussions. Part III analyzes the inefficiencies of the NCAA in its management of concussions, the previous and current lawsuits' failure to stimulate change within the NCAA, and the proposed solutions that will help create a safe environment for student-athletes.

Strategic Litigation to Advance Public Health

The HIV movement has relied on strategic litigation as an important tool to develop and enforce legal protections critical to health. This experience contains lessons on the potential of strategic litigation to advance public health more generally. Beyond impacting laws and policies, strategic litigation can change practice, breathing life into existing legal rules never implemented. While cases may target a particular law, policy, or practice, indirect impacts beyond a particular court decision on future cases, other branches of government, and the public record may be just as important. Each case is only one step towards change, and a judgment can be helpful in laying groundwork and in other contexts. Strategic litigation can also shape public discourse on issues relevant to health through development of the court's record, integration of expert testimony, and the use of media advocacy. It provides a means to harness the law's potential to construct reality and historical truth, creating an opening for the narratives of marginalized and affected communities. Strategic litigation and social movements can also have a reciprocal relationship, strengthening each other. Connection to a movement gives a case a political dimension, and social movements can assist in identifying issues, supporting clients, mobilizing communities, engaging media, and following up on the implementation of judgments. Strategic litigation, in turn, can galvanize social movements, creating events around which mobilization and media engagement can occur and facilitating coalition-building and the development of leadership.

Challenges and potentialities of nursing work in street medical offices

OBJECTIVE

to analyze elements of the nursing work process in the Street Medical Offices, highlighting the challenges and potentialities of care for homeless people.

METHOD

this is an exploratory research of qualitative nature supported by the perspective of the health work process. The study was conducted through semi-structured interviews with nurses from the teams of the street medical offices at the city of Maceió and data were analyzed according to the content analysis technique, approaching issues related to the object, instruments and purposes of the nursing work process.

RESULTS

the identified themes were: Need for health care in the context of social and health vulnerability; Strategic planning and teamwork as tools for organizing the work process; Purposes and products of work: guaranteeing the right to access and care. . Before a work object designed by serious health needs resulting from the social vulnerability of this population, nurses use different instruments in their work process: strategic planning, acting in multiprofessional team and valorization of the light technologies of reception and bonding.

CONCLUSION

apart from the difficulties, the study presents a successful experience that explores the potentiality of sharing relationships of humanized care.