text:
The effectiveness of knowledge translation strategies used in public health: a systematic review
Rebecca LaRocca1,
Jennifer Yost2,
Maureen Dobbins2,
Donna Ciliska2 &
Michelle Butt2
BMC Public Health volume 12, Article number: 751 (2012) Cite this article
Literature related to the effectiveness of knowledge translation (KT) strategies used in public health is lacking. The capacity to seek, analyze, and synthesize evidence-based information in public health is linked to greater success in making policy choices that have the best potential to yield positive outcomes for populations. The purpose of this systematic review is to identify the effectiveness of KT strategies used to promote evidence-informed decision making (EIDM) among public health decision makers.
A search strategy was developed to identify primary studies published between 2000–2010. Studies were obtained from multiple electronic databases (CINAHL, Medline, EMBASE, and the Cochrane Database of Systematic Reviews). Searches were supplemented by hand searching and checking the reference lists of included articles. Two independent review authors screened studies for relevance, assessed methodological quality of relevant studies, and extracted data from studies using standardized tools.
After removal of duplicates, the search identified 64, 391 titles related to KT strategies. Following title and abstract review, 346 publications were deemed potentially relevant, of which 5 met all relevance criteria on full text screen. The included publications were of moderate quality and consisted of five primary studies (four randomized controlled trials and one interrupted time series analysis). Results were synthesized narratively. Simple or single KT strategies were shown in some circumstances to be as effective as complex, multifaceted ones when changing practice including tailored and targeted messaging. Multifaceted KT strategies led to changes in knowledge but not practice. Knowledge translation strategies shown to be less effective were passive and included access to registries of pre-processed research evidence or print materials. While knowledge brokering did not have a significant effect generally, results suggested that it did have a positive effect on those organizations that at baseline perceived their organization to place little value on evidence-informed decision making.
No singular KT strategy was shown to be effective in all contexts. Conclusions about interventions cannot be taken on their own without considering the characteristics of the knowledge that was being transferred, providers, participants and organizations.
Globally, and at all levels of health care, health systems fail to use research evidence optimally [1]. This gap results in negative effects, such as a reduction in both quantity and quality of life [2] and inefficient use of limited health care resources [1, 3]. As political and societal pressures to use research evidence in decision making continue to rise, there is increased interest in the concept of knowledge translation [4]. Knowledge translation (KT) is defined by the Canadian Institutes of Health Research as "a dynamic and iterative process that includes the synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of populations, provide more effective health services and products and strengthen the health care system"[4]. KT strategies are used in public health to promote evidence-informed decision making (EIDM). EIDM refers to incorporating the best available research evidence into public health policy and program decision making [5]. The rationale for engaging in EIDM is the belief that optimal patient and population health outcomes will result [6].
Translating best available research evidence into programmatic change is a complex process [7]. Multiple barriers to EIDM exist at different levels. Examples of these include but are not limited to: the health care system itself (lack of financial incentives); health care organizations (limited access to research evidence, lack of equipment); health care teams (existing standards may not be in line with recommended practice); individual health care professionals (lack of knowledge, attitudes and skills in critically appraising and using evidence from the literature, lack of time and resistance to change); and patients (poor compliance to recommendations) [1, 5].
Despite KT strategies to overcome such barriers in public health, literature related to how to effectively promote and facilitate these strategies are lacking [8]. To our knowledge, only one related systematic review in public health was completed by Stone and colleagues [9]. Inclusive of primary studies published prior to 2000, Stone and colleagues evaluated KT intervention components classified as provider reminders, provider feedback, provider education, provider financial incentive, and organizational change to increase screening related to immunisation and cancer. The KT strategy found to be most effective for improved use of adult preventative services by providers was organizational change. The KT strategy found to be least effective was provider feedback [9].
While important evidence can come from a variety of sources, evidence from best available research findings should be one of the essential components of the policy development and decision making processes that occur within public health agencies. There is however a paucity of literature regarding how to facilitate this process specifically in the public health setting [5, 7, 8, 10]. The objective of this review is to address which KT strategies are most effective among practitioners, managers and policy makers to promote the use of research evidence in public health settings.
Data sources and search strategy for identification of studies
Multiple and competing terms exist to describe the study of implementing research findings into practice [11]; it is referred to as "KT" in this review. Terms for related concepts are often used interchangeably, and definitions are unclear [3, 12] which makes information retrieval related to the field of KT very difficult [11]. As such, the search strategy for this systematic review was developed by Dr. Ann McKibbon, of the Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics at McMaster University. In addition to using the two key concept categories of 'public health', and knowledge translation'; related KT terms identified in the cross-sectional study by Dr. Ann McKibbon and colleagues [11] with high and medium discriminatory power were used to identify potentially relevant studies.
The search strategy, which aimed to find both published and unpublished studies, was limited to the English language and restricted to the dates 2000 to 2010 inclusive (see Additional File 1). These dates were chosen for three different reasons. The first and primary reason was that due to the challenges associated with retrieving articles related to the field of KT described above, the assumption was made that our purposely broad and inclusive literature search of ten years would produce an extremely large yield. Reviewing an extremely large yield of references in a systematic and unbiased manner is challenging and can be extensive in terms of resources including time. The assumption of a large yield resulting from our search was also based on the review authors' prior experiences locating related KT literature.
The second reason was based on the likelihood of very few public health relevant studies existing prior to the year 2000. While evidence exists to support the need for KT, very little evidence exists that measures the impact of KT interventions [13]. Only one related public health study, a systematic review by Stone and colleagues [9] was found in the search for the current review. This systematic review included primary studies published prior to 2000 and their primary limitation reported was the quantity of existing original studies. In addition, unlike the interest and resources long committed to evidence-based medicine, EIDM only became part of the public health sector's lexicon in the 1990's [14]. It is therefore reasonable to assume that the literature prior to 2000 would primarily have a focus on medical or acute care professionals , which are not the targeted group in this review. Similarly, while the term KT has been used in adult education research in the 1950s, only recently has KT become used in the context of implementing best research evidence and was more recognized and studied as such in the late 1990s and early 2000s [11].
The third and final reason the search strategy was limited to studies since 2000 was to obtain related literature that would reflect the public health system today since context weighs heavily on the effectiveness of different KT interventions [14]. The context-specific nature of KT adds an additional degree of complexity in evaluating the impact of KT strategies [15]. The review authors therefore felt it was important to locate research evidence that may be more generalizable to the environments public health practitioners are working in today.
The Effective Practice and Organisation of Care Group (EPOC) is a group within the Cochrane Collaboration (available at: http://epoc.cochrane.org/). After searching their database and finding very few studies related to KT and public health, the following databases were searched on April 12, 2010: CINAHL, Medline, EMBASE, and the Cochrane Database of Systematic Reviews from 2000 to 2010. Methodological study filters from EPOC were utilized in order to search for relevant study designs (see inclusion criteria). The electronic searches were supplemented by checking the reference lists of included articles and hand searching online databases of research relevant to KT or public health including Knowledge Translation + (available at: http://plus.mcmaster.ca/kt/) and Public Health + (available at: http://www.nccmt.ca/public_health_plus/all/1/list-eng.html). Searches were also supplemented by checking conference proceedings and grey literature including: Canadian Public Health Association, Research Transfer Network of Alberta, Knowledge Exchange in Public Health, National Institutes of Health, and the 2010 Public Health Policy Conference. Contact was also made with study authors to identify additional studies.
Type of participants
Studies directed towards health practitioners in a public health or community setting were included in this review. The recipients of the strategy or intervention was all practitioners, including allied health professionals, involved in public health and health promotion services. Public health services exist to help persons achieve better health and well-being by promoting good health, preventing chronic disease and injury, and protecting persons from infectious disease and other threats to their health [16]. Its focus is therefore on prevention, opposed to treating existing illness. Examples of public health services include vaccinations and immunizations, health promotion of preventable illness such as childhood obesity and diabetes, pandemic preparedness, and injury prevention. Inclusion criteria included studies directed towards health professionals involved in the delivery of these or additional preventative services. This included but was not limited to nurses, physicians, social workers, occupational therapists, dietitians, administrators, policy and decision makers whose focus was on preventative care.
If the practitioners in the studies were decided by the review authors to be involved in activities focused on clinical care, for example the treatment of an existing illness such as cancer, opposed to activities focused on prevention and health promotion described above; they were not considered public health practitioners and excluded from this review. Studies where participants were students learning in a school setting and practitioners in the primary care, tertiary or community health settings focused on clinical care were excluded.
Type of intervention
Any KT strategy directed towards the providers and aimed at building capacity for EIDM by promoting or facilitating the utilization of research evidence were included in this review. Evidence informed capacity can be defined as the ability of practitioners to draw on, filter and amplify appropriate research evidence [17]. Examples of eligible KT interventions included, but were not limited to, the use of education, reminders, audit and feedback, knowledge brokers, tailored messaging or champions.
Type of outcomes
This review focused on a variety of possible outcomes that can be categorized to include change in knowledge, skill or practice. A change in knowledge included any concrete change in knowledge or understanding. For example, a positive change in knowledge or understanding could be observed through an improved test score evaluating respondents' knowledge of EIDM concepts taught in the KT intervention. A change in attitude was not included because the review authors felt that a change in attitude was not a concrete measure of change in knowledge.
A change in skill may include skills in commissioning and interpreting evidence. For example, an increased ability to locate best available evidence within appropriate databases. A change in practice was defined as the concrete application of knowledge. This could be an actual change in behaviour or practice including a change in decision making used to influence program planning or influence policy. Changes in practice could be observed through research evidence being referenced or utilized in public health policy, practice, program or guideline development, or changes in public health policy and practice [5].
Type of studies
Given many KT interventions are tested in real-life, practice based settings it is not always feasible to evaluate them using randomized controlled trials (RCT)s [18]. Therefore study designs accepted for EPOC systematic reviews were included in this review: practitioner randomized controlled trials, cluster randomized controlled trials, non-randomized cluster controlled trials, controlled before and after studies, and interrupted time series designs. Relevant systematic reviews were also included. Qualitative and mixed method study designs were excluded.
Screening, quality assessment and data extraction
The web based application DistillerSR (available at: http://systematic-review.net/) was used to manage all references and assist in the review process. After duplicate articles were removed, the titles and abstracts from all search strategies were imported into DistillerSR and screened independently by the primary researcher (RL) and one of four other reviewers. Studies deemed to be potentially relevant by either reviewer were retrieved for full-text review. The full-text was assessed for relevance independently by two review authors: the primary author (RL) and the corresponding author (JY). Agreement needed to be reached by both authors for inclusion.
Studies deemed to be relevant were then assessed for methodological quality by two independent review authors (RL, JY) using standardized tools. All studies that met the inclusion criteria were included in the review, regardless of methodological quality (See Additional file 2). For RCTs, the review authors (RL, JY) conducted a domain-based evaluation of the risk of bias within each included study using a tool recommended by the Cochrane Collaboration [19]. The following criteria were addressed independently by two blinded review authors: sequence generation, allocation concealment, blinding, incomplete outcome data, selective outcome reporting and 'other issues.' Sequence generation, allocation concealment and selective outcome reporting were addressed by a single entry for each study while blinding and incomplete outcome data assessments were made separately for different outcomes [19]. For designs that utilized an interrupted time series design, risk of bias was assessed using EPOC's Risk of Bias tool (available at: http://www.epoc.cochrane.org).
Data were extracted using a tool developed by the Effective Public Health Practice Project [20]. The data extraction tool has been pilot tested and refined over use in more than 20 reviews. The primary review author conducted the data extraction and it was reviewed by a second review author (JY). Specific details including characteristics of included studies, details about the intervention, population, follow-up period, attrition rates, study methods and outcomes significant to the review were also extracted. Outcome data prior to the intervention and at the last follow up date were extracted. Authors were contacted for missing data or when clarification was required. Disagreements that occurred during the screening, quality assessment, or data extraction were discussed until consensus was achieved. A third review author was consulted if consensus could not be reached
The search strategy identified 92,548 titles related to KT interventions; 64,391 after duplicate articles were removed (Figure 1).
Flow Diagram. Flow diagram of systematic review to identify eligible studies.
Of the 64, 391 articles, 346 articles were deemed potentially relevant following title and abstract review. Titles were most often considered not relevant because the KT strategy was not implemented in a public health or community setting or because the KT strategy was not directed towards public health practitioners. Of the 346 articles retrieved for full text review, 5 primary studies met all relevance criteria and were included in this review. The most common reasons full-text studies were judged as not relevant were that the intervention was not a knowledge translation strategy or information on relevant outcomes were not reported. Of the 5 studies, four were RCTs [5, 21–23], and one was a time series analysis [24]. Additional File 3 provides the characteristics of included studies. The systematic review by Stone and colleagues [9] was not included because the individual studies included in their review were all published between 1979 to 1999 which did not meet our inclusion criteria.
Participants and settings
Of the five included primary studies one was conducted in the United States [22], two were conducted in Canada [5, 21], and the remaining two conducted in European countries, Norway [23], and England [24]. The unit of allocation was done by individual [23] and by organization or site [5, 21, 22, 24]. The smallest sample size was 34 public health practitioners [21] and the largest sample size included 188 practitioners [22]. All of the studies evaluated the outcome, change in practice, three studies evaluated changes in knowledge [21–23] and none evaluated changes in skill level. Four of the five studies evaluated outcomes immediately following the intervention, with one of the studies evaluating outcomes six months post intervention [22].
KT strategies were aimed at a variety of public health professionals involved in public or community prevention orientated coalitions from a range of public health disciplines including mental health [21, 24], preventative adolescent substance abuse services [22], healthy body weight promotion [5] and immunization and cancer screening prevention [23]. Strategies were targeted at community providers employed by public health departments, community agencies and policy making bodies including school personnel, social workers, registered nurses, physicians, program managers, coordinators or directors.
Knowledge translation strategies
Although the universal objective of studies was to build capacity for practitioners involved in using evidence, KT strategies varied considerably with none of the primary studies evaluating the same KT strategy. KT strategies evaluated in the five studies included: educational sessions involving peer development [21, 24] and workshops [23]; dissemination channels including print, CD-ROM, and Internet [22]; technical assistance and staff training from consultants with varying levels of interaction and supervision [5, 23]; and web-based services such as databases, information services and discussion lists [23], and registries of pre-processed research evidence or online tailored and targeted messaging [5].
Effect of the intervention
Due to the variability in the type of KT strategies and implementation of these strategies, as well as differences in data collection between the included studies it is difficult to estimate the magnitude of the impact. With such variation, a meta-analysis was not warranted. Therefore the following provides a narrative synthesis of the results which should be interpreted cautiously.
Change in knowledge
Three of the five studies evaluated changes in knowledge all of which were RCTs [21–23]. Two of the three studies [22, 23] found statistically significant between group differences (Table 1). Di Noia et al. [22] disseminated adolescent substance abuse prevention program materials to school personnel, community providers and policy makers through pamphlet, CD-ROM, and Internet channels. At 6 month follow-up, respondents who received prevention materials disseminated via CD-ROM and Internet showed significantly greater knowledge of where to locate drug abuse prevention findings and materials compared to those who received printed pamphlets (p < 0.05) [22]. Bonferroni post hoc comparisons revealed differences in favour of respondents using the Internet (p < 0.05) [22]. Forsetlund et al. [23] tested a multi-faceted strategy designed to lead participants through steps outlined in Rogers' model of innovation diffusion. The strategy for the intervention group included an 11 course skill building workshop on evidence-based public health involving small group problem-based activities and discussion, goal setting, access to web-based information services (inclusive of a question and answer service, discussion list, and ongoing support services), and 3 newsletters. The control group received access to library services only. Statistically significant differences were found between the two groups for both concept (p = 0.001) and source knowledge scores (p < 0.01). Sensitivity analysis was conducted and a significant difference remained even after assigning the control group's mean value (1.1) to missing values in both groups. When assigning the control group's lowest value (0) to replace missing data in both groups, the results for concept knowledge became non-significant [23].
Table 1 Outcomes table for change in knowledge
Barwick et al. [21] was the third study that evaluated changes in knowledge by administering a 20-item true or false questionnaire measuring participants knowledge related to the use of an evidence based tool recently introduced into practice. Members in the community of practice group were defined as deliberate communities of people who share knowledge, learn together and create common practices supporting knowledge exchange among practitioners. Statistically significant between group differences were not reported between practitioners involved in an interactive communities of practice group versus usual practice.
Change in practice
Randomized Controlled Trials All of the included studies evaluated change in practice (Table 2). Significant between group differences for changes in practice were only found in one of the five included studies by Dobbins et al. [5]. This study evaluated the effectiveness of KT strategies on evidence based decision making and the number of public health policies and programs implemented which documented the inclusion of research evidence. While a significant effect of any of the interventions was not shown on global EIDM (p < 0.45), in regards to effects on the number of public health policies and programs, health departments that received tailored and targeted messages plus access to an online registry of pre-processed research evidence improved significantly from baseline to follow-up (p < 0.01) [5]. This was in comparison to the groups that had access to the online registry only, or the groups that had access to the online registry and also had a knowledge broker working one on one with them. Also observed was that the use of knowledge brokers along with access to the online registry of pre-processed research evidence showed a trend towards a positive effect when organizational research culture was perceived at baseline as low. However, health departments with a low organizational research culture only benefited slightly when they received the tailored and targeted messaging plus access to the online registry, yet showed great improvements when the research culture was high [5]. Simply having access to an online registry of research evidence appeared to have no impact on evidence-informed decision making.
Table 2 Change in practice
Table 3 Time series analysis (1)
There were no statistically significant differences on the outcome change in practice on participants allocated to communities of practice in Barwick et al. [21] versus usual practice. While the KT strategies evaluated in Forsetlund et al. [23] and in Di Noia et al. [22] (described above) showed significant between group differences on the outcome knowledge, the KT strategies did not translate into significant changes in practice. Participants in Forsetlund et al. [23] who received the multi-faceted strategy related to EIDM showed no change in the use of research in written reports after the intervention.
The time series analysis included in this review [24] evaluated the effectiveness of a theory of planned behaviour intervention implemented among community mental health professionals to improve adherence to a national suicide prevention guideline (Table 3). The KT strategy which consisted of an educational session comprised of didactic presentation, peer discussion, and group work on real life vignettes did not have a significant impact on adherence. During the course of the study two extraneous events occurred including: a national event where a guideline was introduced by the Health Care Commission which occurred in both intervention and control groups; and a local event causing a change in system for monitoring service-user-discharges which occurred in the intervention site only. Although the extraneous events made it difficult to isolate the effects of this from the intervention, using multiple time series analysis and including a control site, it was possible to model this into the analyses to estimate the impact of each of the events. Although the review authors did not focus on within group data, when comparing the intervention, local, and national event upon the change in the intervention group only, the national event had a statistically significant impact on adherence, p = 0.0001 [24].
Barriers and supports to research use can arise from various sources including: the practice environment, potential adopters and the evidence-based innovation [3, 25, 26]. Characteristics of these sources help provide insight into the impact of KT interventions tested.
Characteristics of the interventions and providers
Characteristics of the intervention, including exposure to the intervention, may have affected the extent to which the KT interventions resulted in knowledge or practice change among participants. For example, the educational session in Hanbury et al. [24] was only one day in length which may have been too short to have had an impact on participants' practice. Similarly, Dobbins et al. [5] report that there may have been discrepancies in the ability of the interventions to be implemented, with the rate of successful intervention differing across intervention groups. Given that 30% of participants allocated to the knowledge broker group had limited or no engagement it is possible that exposure to knowledge brokers may have been inadequate to affect practice.
Successful KT strategies may have increased exposure to the intervention, given that they were highly accessible or contained an element of tailoring responsive to the needs and preferences of providers. For example, the KT strategy in Di Noia et al. [22] did not require participants to physically travel anywhere or set aside a pre-specified time to review materials over the Internet, CD-ROM, or pamphlet thereby allowing participants to review materials at their own convenience. Materials were also sent out to participants by mail, fax, or email according to their preference and materials were tailored to include constituency specific content responsive to differing prevention needs. Post hoc analyses in the study by Di Noia et al. [22] favoured dissemination of materials via the Internet. This finding is supported in a recent meta-analysis of moderate quality examining Internet-based learning in the health professions. Internet-based learning was shown to be educationally beneficial and resulted in effects similar to those of traditional instructional methods [27]. A limitation of the meta-analysis however, was the pooling of disparate sources of evidence. Statistically significant differences were found favouring tutorials, longer-duration courses, and online peer discussion suggesting that an increased level of interaction may be beneficial. More studies are needed to investigate whether Internet based learning leads to actual and sustained change in practice.
Dobbins et al. [5] demonstrated in their study that KT interventions actively delivered and tailored to the needs of end users show promising results. The most effective KT strategy in their study was tailored, targeted messages which also employed content matching by ensuring the content of the message is relevant and applicable to the intended audience. This KT strategy was also actively delivered to decision makers rather than requiring them to access it independently. Providing a high level of accessibility plus tailoring the KT strategy to meet the personal needs of decision makers may lead to changes in knowledge and practice. The ability of tailored messaging to facilitate research use is supported by existing literature [28] as study participants show increased motivation to process information actively when they perceive the information to be personally relevant [29].
Forsetlund et al. [23] catered to the needs of participants to increase higher attendance at workshops. This was associated with greater effects in changing provider knowledge in a positive direction, however, the intervention did not translate to change in practice. One explanation may be that while workshops and educational sessions have been shown to modestly affect simple behaviours, they are less effective at changing complex behaviours [30].
Passive versus active interventions
Comparisons between passive versus interactive, and multi-component versus single interventions are often cited in the literature. Commonly reported findings, including a meta-analysis by Mansouri and colleagues [31, 32], suggest that multi-component interventions have greater effects than single interventions. Differing results were found in this review. Simple or single KT strategies that included an active component assessed in this review were shown in some circumstances to be as effective as complex, multi-component ones when changing practice, a finding supported in a high quality systematic review by Grimshaw and colleagues [9, 33]. This was evidenced in two of the five primary studies [5, 22]. The highly interactive, multi-component interventions tested in both Forsetlund et al. [23] and Dobbins et al. [5] did not influence change in practice. The complexity of interventions may dilute the key messages of the intervention and reduce the ability of providers to understand or to acquire the information presented [5].
Passive strategies that were implemented unaccompanied with additional interventions were tested in two of the five studies and were ineffective. This finding is also frequently supported by existing literature [31, 32, 34–37]. Dobbins et al. [5] demonstrated that simply having access to a resource that repackaged review contents into a short summary of key findings, assessment of the methodological quality and recommendations, was not enough to influence evidence-informed decision making among public health practitioners. Systematic reviews have become widely recognized as a support to evidence-informed decision making in health care. The availability of a systematic review alone does not ensure that decision makers know it is available to them or can interpret the findings or use the evidence in service delivery decisions [38]. Further evaluations of these resources are needed to ensure users' needs and preferences are being met, to demonstrate their impact, justify their funding [39, 40] and ensure the relevance and applicability of the results to the practice setting [41].
The second study evaluated the effectiveness of printed materials (pamphlet), another single and passive strategy. Pamphlets were less effective when compared with single but more active KT strategies including CD-ROM and Internet [22]. This finding is supported in a recent review by Farmer et al. [36] that reported when compared to no intervention, printed educational materials slightly improved professional behaviour but not patient outcomes. When dissemination of printed educational materials was compared to alternative interventions including educational initiatives; Farmer et al. concluded that they may slightly improve outcomes but there was not enough evidence to be certain. Grimshaw et al. [33] found slightly different results when they evaluated the effects of the dissemination of educational materials compared to audit and feedback and multi-component interventions involving educational outreach. Grimshaw et al. [33] concluded that because printed educational materials may lead to improvements in care, policy makers should not dismiss this strategy given its possible effect, low cost and feasibility in the health care system. The variation in study findings may be due to the characteristics of the KT strategy itself as important features of the information source including attractiveness, content, format, mode of delivery, timing, frequency, and complexity of targeted behaviour change are likely to have an effect on uptake [36].
Characteristics of participants
Characteristics of participants in the studies comprising this review also varied which may have led to differences in the effectiveness of interventions. A high quality systematic review by Squires and colleagues [42] found that nurses' use of research is positively influenced by education (having a graduate degree compared to a bachelors degree or diploma); current role (leadership, advanced practice, clinical specialty compared to staff nurse); and job satisfaction. The results in this review did not consistently confirm this earlier research. For example, the KT strategy evaluated among well educated physicians with advance practice roles in Forsetlund et al. [23] did not positively influence research use. The sample in Barwick et al. [21] consisted of a wide range of individuals involved in child and youth mental health including social work, child and youth care, early education and one registered nurse. The level of education among this group varied from diploma or certification to graduate level education. The large differences in this group may have led to more variability in change in knowledge and practice scores among participants, due to differences in interest, willingness and ability to acquire new knowledge. The differences in effect found among the different studies, despite factors present that have been shown to positively influence research use, may be due to individual factors including attitudes toward research. Attitudes toward research was confirmed to positively affect research use in the same high quality review by Squires and colleagues [42] of individual characteristics related to research utilization. Lavis [39] reported on existing reviews examining the factors that influence the use of research evidence in policymaking and found that when there is harmony between research evidence and the beliefs, values, interests or political goals of policymakers, the use of research evidence is likely to increase. Several characteristics of the individual practitioner have been identified as being influential in the translation of research to practice [43]. Further research is required to investigate which individual characteristics of public health practitioners are associated with research utilization.
Characteristics of the organizations
Finally, differences in the characteristics of the organizations may have also led to differences in the effectiveness of interventions. This is evidenced by the findings presented in Dobbins et al. [5] which revealed both positive and negative changes in the KT intervention's effectiveness when matched with organizational research culture.
It is obvious that contextual factors weigh heavily on the effectiveness of different interventions. Influences on professional behaviour are complex and are influenced by organizational and contextual variables that should be considered [44]. This suggests that several barriers may need to be assessed and overcome prior to implementing certain KT interventions. A shortage of knowledge exists regarding how organizational characteristics are related to the decision to implement evidence-based practices [45]. Wang et al. [45] surveyed county system leaders and found that their decision to implement an evidence-based program was influenced by their objective need for the program and by their perception of the county's organization climate and motivation to change. The importance of culture, a factor found to be influential on research use in this review, is also supported by existing research. Orton and colleagues [46] examined the use of research evidence by public health policy-makers in a systematic review and report one of the many barriers to use of research evidence included the culture in which policy-makers work. Additionally, in a systematic review by Meijers et al. [47] statistically significant relationships were found between research use and the role of the nurse, multi-faceted access to resources, organizational climate, multi-faceted support, time for research activities, and provision of education. These findings highlight the need for future research that examines organizational characteristics and how factors of systems or agencies including capacity, climate, culture and readiness to change affect research uptake.
There were several strengths and limitations of this review. Strengths include a comprehensive search strategy that was developed in accordance with expert opinion. We consider the included studies to be a relatively complete set of studies for the period 2000 to 2010. For this review, we used KT terms that were shown to have high and medium discriminatory power in the search strategy due to the difficulty in information retrieval related to the field of KT. Studies were obtained from multiple electronic databases, supplemented by hand searching and reference list checking of included articles and background papers for potentially relevant studies. This systematic review followed rigorous methodology including the use of two independent review authors to screen all studies for relevance and assessment of methodological quality of relevant studies. We also undertook detailed data extraction about the quality of the studies, characteristics of the studies, and interventions [19].
A limitation common in the KT literature was the quantity and quality of existing research related to this field of research. The review authors found a paucity of literature directed towards changing the knowledge, skills, or practice of public health practitioners despite increased societal pressure to increase capacity of EIDM among this group of health care providers. The quality of evidence included in this review was moderate (See Additional file 2).
The paucity of literature in this field of research combined with the high variation in described settings, interventions and outcome measures across studies made it difficult to synthesize and draw conclusions from this evidence base. In addition, a major limitation of this systematic review is the difficultly to disentangle whether the KT strategy itself was effective or whether it was in fact the context in which it was delivered. Recommendations related to interventions can therefore only be given or considered within the boundaries of the context they were delivered in.
A final limitation common in the KT literature and studies in public health is the use of self-report measures which are subject to recall bias, and often had unknown validity or reliability. In addition, there was inconsistency in the measures being used for the outcome of interest making it difficult if not impossible to build a consistent body of knowledge on which KT interventions influence changes in knowledge or practice. The development and testing of more objective data collection tools for measuring evidence-based practice is needed as limitations of current methods constrain the ability to validly measure research utilization [43].
There is an imperfect evidence base to support decisions about which KT strategies are likely to be effective for increasing research use under different circumstances [33]. Due to differing characteristics of the users, the providers, the intervention and the organizations where the interventions may have been implemented, it is difficult to predict the effectiveness of KT interventions or suggest if their effectiveness will remain constant in differing contexts. Conclusions about interventions therefore cannot be taken on their own without considering the characteristics of the knowledge that was being transferred, the providers, participants and organizations.
Knowledge translation is a multidimensional concept that requires an understanding of its mechanisms, methods, and measurements, as well as its influencing factors at the individual and contextual levels, and the interaction between those levels [48]. While randomized controlled designs are the most rigorous designs for evaluating effectiveness, this design does not illuminate why certain KT interventions are successful or not. Other study designs including mixed methods and qualitative studies are valuable as they may increase understanding of the processes involved between program delivery and outcome [48]. In addition, a realist synthesis method, aimed at not only explaining how and why certain interventions work, but understanding the contexts in which they work best, may provide insight regarding "complex social interventions which act on complex social systems" [49]. We would also recommend that programmatic research in the area of research utilization in public health be undertaken to break this large research topic into smaller more manageable pieces allowing for more detailed analysis of different classes of determinants. This may help build a more coherent picture from smaller study findings.
The theory of planned behaviour based intervention tested by Hanbury and colleagues [24] was not effective at changing practice. Behaviour change interventions are commonly designed without evidence of a formal analysis of the target behaviour or the theoretically predicted mechanisms of action [50]. Behaviour interventions are often guided by implicit common sense models of behaviour that do not cover the full range of possible influences often excluding potentially important variables. Further research is needed to develop more comprehensive models and evaluate the effectiveness of existing ones that guide the development of behaviour change interventions.
It is essential that KT strategies in public health continue to be evaluated and their usefulness documented in the literature so that they can be adjusted or modified accordingly. The documented effectiveness of KT strategies in public health and the contexts in which they were delivered in can be utilized by practitioners whom wish to promote evidence-informed decision making among public health decision makers.
Straus SE, Tetro J, Graham I: Defining knowledge translation. Can Med Assoc J. 2009, 181: 165-173. 10.1503/cmaj.081229.
Davis D, Evans M, Jadad A: The case for knowledge translation: shortening the journey from evidence to effect. Br Med J. 2003, 327: 33-35. 10.1136/bmj.327.7405.33.
Graham I, Logan J, Harrison M, Straus S, Tetro J, Caswell W, et al: Lost in knowledge translation: Time for a map?. J Contin Educ Health Prof. 2006, 26: 13-24. 10.1002/chp.47.
Canadian Institute for Health Research: About knowledge translation. http:www.cihrirsc.gc.ca/e/29418.html,
Dobbins M, Hanna SE, Ciliska D, Manske S, Cameron R, Mercer SL, et al: A randomized controlled trial evaluating the impact of knowledge translation and exchange strategies. Implement Sci. 2009, 4: 61-10.1186/1748-5908-4-61.
Lavis JN, Robertson D, Woodside JM, McLeod CB, Abelson J: How Can Research Organizations More Effectively Transfer Research Knowledge to DecisionMakers?. Milbank Q. 2003, 81: 221-248. 10.1111/1468-0009.t01-1-00052.
Mitton C, Adair CE, McKenzie E, Patten SB, Perry BW: Knowledge transfer and exchange: Review and synthesis of the literature. Milbank Q. 2007, 85: 729-768. 10.1111/j.1468-0009.2007.00506.x.
Armstrong R, Waters E, Crockett B, Keleher H: The nature of evidence resources and knowledge translation for health promotion practitioners. Health Promot Internation. 2007, 22: 254-260. 10.1093/heapro/dam017.
Stone E, Morton S, Hulscher M, Maglione M, Roth E, Grimshaw J, et al: Organisational changes are more effective than education and reminders for raising adult immunisation and cancer screening rates. Evidence-Based Healthcare. 2002, 6: 186-187. 10.1054/ebhc.2002.0555.
Dobbins M, DeCorby K, Twiddy T: A knowledge transfer strategy for public health decision makers. Worldviews Evid Based Nurs. 2004, 1: 120-128. 10.1111/j.1741-6787.2004.t01-1-04009.x.
McKibbon KA, Lokker C, Wilczynski NL, Ciliska D, Dobbins M, Davis DA, et al: A cross-sectional study of the number and frequency of terms used to refer to knowledge translation in a body of health literature in 2006: a Tower of Babel?. Implement Sci. 2010, 5: 16-27. 10.1186/1748-5908-5-16.
Estabrooks CA, Thompson D, Lovely J, Hofmeyer A: A guide to knowledge translation theory. J Contin Educ Health Prof. 2006, 26: 25-36. 10.1002/chp.48.
Tetroe J, Graham I, Foy R, Robinson N, Eccles M, Wensing M, et al: Health Research Funding Agencies' Support and Promotion of Knowledge Translation: An International Study. Milbank Q. 2008, 86: 125-155. 10.1111/j.1468-0009.2007.00515.x.
Lomas J: Using 'linkage and exchange' to move research into policy at a Canadian foundation. Health Aff. 2000, 19: 236-240. 10.1377/hlthaff.19.3.236.
Van Eerd D, Cole D, Keown K, Irvin E, Kramer D, Brennenman-Gibson J, et al: A systematic review of the quality and types of instruments used to assess KTE implementation and impact. 2011, Institute for Work & Health, Toronto, ON
Public Health Agency of Canada: What is Public Health. 2011, http://www.phac-aspc.gc.ca/index-eng.php,
Andrew G, Sarah B: Sound Choices:Enhancing Capacity for Evidence-Informed Policy. 2007, World Health Organization, Geneva, Switzerland
A Review Group of the Cochrane Collaboration: Study designs for EPOC reviews. http://epoc.cochrane.org/epoc-register-studies,
The Cochrane Collaboration: Cochrane Handbook for Systematic Reviews of Interventions. 2009, JPT&GS, Higgins, Version 502
Fitzpatrick-Lewis D: Personal communication. 2010, ,
Barwick MA, Peters J, Boydell K: Getting to uptake: Do communities of practice support the implementation of evidence-based practice?. Journal of the Canadian Academy of Child and Adolescent Psychiatry. 2009, 18: 16-29.
Di Noia J, Schwinn TM, Dastur ZA, Schinke SP: The relative efficacy of pamphlets, CD-ROM, and the Internet for disseminating adolescent drug abuse prevention programs: an exploratory study. Prev Med. 2003, 37: 646-653. 10.1016/j.ypmed.2003.09.009.
Forsetlund L, Bradley P, Forsen L, Nordheim L, Jamtvedt G, Bjorndal A: Randomised controlled trial of a theoretically grounded tailored intervention to diffuse evidence-based public health practice [ISRCTN23257060]. BMC Med Educ. 2003, 3: 2-10.1186/1472-6920-3-2.
Hanbury A, Wallace L, Clark M: Use of a time series design to test effectiveness of a theory-based intervention targeting adherence of health professionals to a clinical guideline. Br J Health Psychol. 2009, 14: 505-518. 10.1348/135910708X369558.
Logan J, Graham I: Toward a comprehensive interdisciplinary model of health care research use. Sci Commun. 1998, 20: 227-246. 10.1177/1075547098020002004.
Estabrooks CA, Floyd JA, Scott-Findlay S, O'Leary KA, Gushta M: Individual determinants of research utilization: A systematic review. J Adv Nurs. 2003, 43: 506-520. 10.1046/j.1365-2648.2003.02748.x.
Cook DA, Levinson AJ, Garside S: Internet based learning in the health professions: A meta-analysis. JAMA. 2008, 300: 1181-1196. 10.1001/jama.300.10.1181.
Hawkins RP, Kreuter M, Resnicow K, Fishbein M, Dijkstra A: Understanding tailoring in communicating about health. Health Educ Res. 2008, 23: 454-466. 10.1093/her/cyn004.
Kreuter MW, Wray RJ: Tailored and targeted health communication: strategies for enhancing information relevance. American Journal of Health Behaviour. 2003, 27 (Suppl 3): S227-S232.
Forsetlund L, Bjorndal A, Rashidian A, Jamtvedt G, O'Brien MA, Wolf F, et al: Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009, 2:
Mansouri M, Lockyer J: A meta-analysis of continuing medical education effectiveness. J Contin Educ Health Prof. 2007, 27: 6-15. 10.1002/chp.88.
Marinopoulos SS, Dorman T, Ratanawongsa N, Wilson LM, Ashar BH, Magaziner JL, et al: Effectiveness of continuing medical education. Evid Rep Technol Assess. 2007, 149: 1-29.
Grimshaw J, Eccles M, Thomas R, MacLennan G, Ramsay C, Fraser C, et al: et al.: Toward evidence-based quality improvement: Evidence (and its limitations) of the effectiveness of guideline dissemination and implementation strategies 1966–1998. J Gen Intern Med. 2006, 21 (Suppl2): 14-20.
Althabe F, Bergel E, Caffarata ML, Gibbons L, Ciapponi A, Aleman A, et al: Strategies for improving the quality of health care in maternal and child health in low-and middle-income countries: an overview of systematic reviews. Paediatr Perinat Epidemiol. 2008, 22 (Suppl 1): 42-60.
Bero L, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA: Closing the gap between research and practice: An overview of systematic reviews of interventions to promote the implementation of research findings. Br Med J. 1998, 317: 465-468. 10.1136/bmj.317.7156.465.
Farmer AP, Legare F, Turcot L, Grimshaw J, Harvey E, McGowan JL, et al: Printed educational materials: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2008, 3: -10.1002/14651858.CD004398.
Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, et al: Changing provider behaviour: An overview of systematic reviews of interventions. Medical Care. 2001, 39: 2-45.
Centre for Reviews and Dissemination: Systematic Reviews: CRD's Guidance for Undertaking Reviews in Health Care. 2009, University of York, York
Lavis JN, Permanand B, Oxman AD, Lewin S, Fretheim A: Tools for Evidence-Informed Health Policymaking (STP) 13: Preparing and Using Policy Briefs to Support Evidence-Informed Policymaking. Health Research Policy and Systems. 2009, 7: S13-10.1186/1478-4505-7-S1-S13.
Chambers C, Wilson PM, Thompson CA, Hanbury AH, Farley K, Light K: Maximizing the impact of systematic reviews in health care decision making: a systematic scoping review of knowledge-translation resources. Milbank Q. 2011, 89: 131-156. 10.1111/j.1468-0009.2011.00622.x.
Dobbins M, Rosenbaum P, Plews N, Law M, Fysh A: Information transfer: what do decision makers want and need from researchers?. Implement Sci. 2007, 2: 1-12. 10.1186/1748-5908-2-1.
Squires JE, Estabrooks CA, Gustavsson P, Wallin L: Individual determinants of research utilization by nurses: a systematic review update. Implement Sci. 2011, 6: -10.1186/1748-5908-6-1.
Squires JE, Hutchinson AM, Bostrom A, O'Rourke HM, Cobban SJ, Estabrooks CA: To what extent do nurses use research in clinical practice? A systematic review. Implement Sci. 2011, 6: -10.1186/1748-5908-6-21.
Brownson RC, Fielding JE, Maylahn CM: Evidence-based public health: a fundamental concept for public health practice. Annu Rev Public Health. 2009, 30: 201-
Wang W, Saldana L, Brown CH, Chamberlain P: Factors that influenced county system leaders to implement an evidence-based program: a baseline surveywithin a randomized controlled trial. Implement Sci. 2010, 72: -10.1186/1748-5908-5-72.
Orton L, Lloyd-Williams F, Taylor-Robinson D, O'Flaherty M, Capewell S: Systematic review: the use of research evidence by public health policy-makers. J Epidemiol Community Health. 2010, 64: -10.1136/jech.2010.120956.52.
Meijers JMM, Janssen MAP, Cummings GG, Wallin L, Estabrooks CA, Halfens R: Assessing the relationships between contextual factors and research utilization in nursing: Systematic literature review. Journal of Advanced Practice Nursing. 2006, 55: 622-635.
Sudsawad P: A conceptual framework to increase usability of outcome research for evidence-based practice. American Journal of Occupation Therapy. 2007, 59: 351-355.
Pawson R, Greenhalgh T, Harvey G, Walshe K: Realist review–a new method of systematic review designed for complex policy interventions. Journal of Health Services and Research. 2005, 10: 21-34. 10.1258/1355819054308530.
Michie S, van Stralen MM, West R: The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci. 2011, 6: 42-10.1186/1748-5908-6-42.
Pre-publication history
The pre-publication history for this paper can be accessed here:http://0-www.biomedcentral.com.brum.beds.ac.uk/1471-2458/12/751/prepub
We are grateful to Ann McKibbon for her direction and expertise in developing a search strategy and Angela Sletcher Eady who provided technical support for the literature searches. For Reference Manager support, thank you to Sharon Peck-Reid, a research assistant at Effective Public Health Practice Project. As well, we would like to acknowledge and thank McMaster University fourth year students, Amanda Walters, Brittany Stukas, and Arjune Jokhu, who participated in abstract and title screening.
This work was supported by the National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, ON.
McMaster University Medical Centre, 1200 Main St. West, Hamilton, Ontario, Canada
Rebecca LaRocca
School of Nursing, McMaster University, 1280 Main St. West, Hamilton, Ontario, Canada
Jennifer Yost
, Maureen Dobbins
, Donna Ciliska
& Michelle Butt
Search for Rebecca LaRocca in:
Search for Jennifer Yost in:
Search for Maureen Dobbins in:
Search for Donna Ciliska in:
Search for Michelle Butt in:
Correspondence to Jennifer Yost.
DC and RL created the study concept, design and constructed and refined the search strategy. All titles and abstracts were screened independently. RL, JY and three undergraduate nursing students from McMaster University also contributed to the review of titles and abstracts. RL and JY independently conducted full text review of potentially relevant articles and quality assessment. Data extraction was done first by RL and reviewed by JY. Drafting of the manuscript and critical revision for important intellectual content was done by RL, JY, MD, DC and MB. RL wrote the final report and is the guarantor for the paper. All authors read and approved the final manuscript.
Additional file 1: Search Strategies. Table of data listing literature search strategies. (PDF 113 KB)
Additional file 2: Risk of Bias Assessment of Included Studies. Results from the critical appraisal of included studies. (PDF 155 KB)
Additional file 3: Characteristics of Included Studies. Table of data describing characteristics of included studies. (PDF 201 KB)
LaRocca, R., Yost, J., Dobbins, M. et al. The effectiveness of knowledge translation strategies used in public health: a systematic review. BMC Public Health 12, 751 (2012). https://0-doi-org.brum.beds.ac.uk/10.1186/1471-2458-12-751
DOI: https://0-doi-org.brum.beds.ac.uk/10.1186/1471-2458-12-751
Research utilisation
Health policies, systems and management in high-income countries


1.Publisher/ Magazine Contact information is collected in order to provide these details to potential clients/advertisers.
2.Contact information, such as your name, address, telephone number, or email address, submitted by users will be used for registration to the MemberZone or passed on to the Magazine to fulfill your subscription request.
3.When you sign up for a Magazine's email newsletter including the latest promotions and specials, your address is sent directly to the Magazine for inclusion into their newsletter database. Magazines.co.za™ will not be held responsible for the content and delivery therof as all future correspondence will take place directly between the Magazines.co.za™ user and the Magazine.
Showcase MediaTM (Pty) Ltd / Magazines.co.za™ will endeavour to protect both personal and non-personal information from loss, misuse and unauthorized access, disclosure, alteration or destruction.


text:
Fresh Meat: Kill 'Em with Cayenne by Gail Oust
By Rachel Kramer Bussel
Kill 'Em with Cayenne by Gail Oust is the second cozy in the Spice Shop Mystery Series featuring Piper Prescott in the aftermath of the murder of a barbecue competition contestant (available December 16, 2014).
Kill 'Em with Cayenne, the second in Gail Oust's flavorful Spice Shop Mystery Series, finds the small town of Brandywine Creek, Georgia, gearing up for an upcoming barbecue festival. Piper Prescott is busy running Spice It Up! and looking forward to advising barbecue fans on how to best make their meal sizzle, while also juggling two potential love interests and a teenage daughter starting to explore her independence. Her delight comes to a halt when she finds one of the festival contestants, Becca Dapkins, dead in the street during a jog.
When Becca's rival in love and barbecue (and friend of Piper), Maybelle Humphries, is fingered as the main suspect, Piper is sure the police have the wrong target…or is she? When Maybelle gives even her friends reason to question her, Piper can't be completely certain.
Buzz resettled his cap, a worried look on his cubby face. "Ever since we broke up, I've taken to driving past Maybelle's place at night—just to make sure she's all right. Never get up enough nerve to stop. Don't think she'd want to see me anyways, but I feel better knowing she's safe. Funny thing is, she's never home Tuesday nights."
Generally I subscribe to the philosophy that if you don't want an answer, don't ask the questions. But I just couldn't help myself. "What about the night Becca was killed?"
"Nope." He shook his head. "No lights on in her house. "No car in the carport."
Women's intuition and small town life are major themes here, with Piper's hunches pitted against traditional police work, such as when she and her friend Reba Mae, upon snooping in Becca's house, find what they consider a tell-tale clue:
Reba Mae poked her finger into the pot, then came away with a small, shiny object. "Look what I found. What do you s'pose it is? A shell of some sort?"
I took it from her hand and placed it in my palm. "Neither," I murmured, nudging it gently. "It's a broken fingernail. A tip torn from a manicure-polished Pucker Up Pink."
"Becca would never venture out in public unless her nails were perfect."
"No," I echoed. "Becca was much too vain. Unless…"
Closing my eyes, I tried to imagine Becca as I'd last seen her, sprawled on her side, one arm outstretched as if to break her fall. I willed myself to visualize that arm.
And that hand.
McBride always preached that memory was a funny thing. "Funny" isn't exactly the term I'd use. In this instance, it was downright weird. Becca Dapkins's perfect manicure had been less than perfect. The nail on her middle finger had been broken down to the quick.
This clue nags at Piper, even when one of the men who makes her heart flutter, the aforementioned police chief Wyatt McBride, utterly discounts her suspicions. Piper has a quiet yet steely determination to make sure no one else is in danger, especially after Maybelle's wallet is stolen and her shop is vandalized. There's a charming and proudly amateur flavor to her sleuthing; she doesn't want to become an expert at solving murders, but can't help but add up the inconsistencies and coincidences that keep appearing.
Piper is a reluctant detective, who'd rather focus on her budding business than get tangled in another crime, but she can't help poking her head farther and farther into the web of lies and possibilities. Oust offers a perfect blend of crime solving and personal drama, as Piper balances the comfort of her relationship with veterinarian Doug Winters, who's also a barbecue festival contestant, with those aforementioned flutters as she tries to impress and outsmart McBride.
That Brandywine Creek is a town where seemingly everyone knows one another to some degree gives this cozy an authentic feel and allows long-simmering tensions between characters to add to the plot. It's also nice to see a divorced single mom getting her dating mojo back, but not letting her emotions get in the way of her pursuit of the truth.
See more new releases at our Fresh Meat feature page.
To learn more or order a copy, visit:
Rachel Kramer Bussel is a freelance and erotica writer, and editor of over 50 anthologies, including The Big Book of Orgasms: 69 Sexy Stories; Only You: Erotic Romance for Women; Serving Him: Sexy Stories of Submission and others. She tweets @raquelita and blogs at Lusty Lady.
Read all of Rachel Kramer Bussel's posts for Criminal Element.
Number 5 of the Scams of Christmas: Grumpy Greeting Cards
Thief: New Audio Excerpt
The 16th installment of the Mystery with Recipes series finds the intrepid Simmons sisters wondering why a regular customer has forgotten to pick up her long-standing monthly order. Margo Hemsley is the kind of person who isn't just punctual, she's habitually early. Every month for the past five years, she's ordered the same few items…
Cooking the Books: Fishing for Trouble by Elizabeth Logan
It's just another busy Alaskan tourist season day at Charlie Cooke's Bear Claw Diner until one of her guests abruptly starts choking at his table before falling over unconscious. Paramedics whisk young Ethan Johnson away to the nearest medical center, and a concerned Charlie drives there with his lunch date, Zoe, since only family members…
Cooking the Books: Murder at Veronica's Diner by J.D. Griffo
The four intergenerational members of the Ferrara Family Detective Agency—as their unofficial sleuthing club is known—are enjoying a nice breakfast at local institution Veronica's Diner when their waitress, Teri Jo, approaches their table. Nothing out of the ordinary, despite Teri Jo having asked them earlier to deliver a package she didn't have time to send…
Cooking the Books: Have Yourself a Fudgy Little Christmas by Nancy Coco
At the end of the previous book in the series, Fudge Bites, our heroine, fudge-maker Allie McMurphy, decided to turn down her ex-boyfriend Trent Jessop's offer to winter in Chicago with full use of his commercial kitchen in favor of finally becoming an official year-round resident of Michigan's Mackinac Island. She's also planning on reopening…

redpajama_set_name: RedPajamaCommonCrawl


text:
Hoboken is een plaats in België en een district van de stad Antwerpen. Tegen de Schelde kent Hoboken veel industrie, met als bekendste naam Umicore. In de media wordt Hoboken, evenals Wilrijk, het zuiderdistrict genoemd.

Naamgeving
De naam Hoboken is samengesteld uit twee bestandsdelen: Ho en boken. Ho is een afkorting van Hoog, boken komt van het Middelnederlandse boeken, wat tegenwoordig beuken heet. Hoboken betekent dus Hoge Beuken, bomen die de gemeente al eeuwenlang sieren. Naar de Hoge Beuken is het ziekenhuis van Hoboken genoemd.

Schertsend wordt Hoboken ook wel "het dorp waar de boeren stront koken" genoemd, oftewel het "strontdorp" van de "strontboeren" of "strontkokers". Dit komt tot uiting in het plaatselijke liedje: Wie pakt er den bak en wie rijdt er om kak? Strontboeren!.

In de volksmond vertelt men ook het verhaal van hoe de naam "Hoboken" vroeger was ontstaan. De toenmalige burgemeester had een naam nodig voor zijn gemeente, maar vond geen inspiratie. Totdat hij aan tafel zat en zijn dochter haar boterham liet vallen en zei: Ho, boke!. Dit werd dan: Hoboken.

Geschiedenis
De eerste vermelding van (de parochie) Hoboken dateert van 1135 als capellam de hobuechen qua libam. Hoboken was toen nog een onooglijk gehucht van Wilrijk in het hertogdom Brabant. Vanaf de 13e eeuw was Hoboken een heerlijkheid, bestuurd door de heren van het het land van Rumst. De heersende families waren, achtereenvolgens: van Perwijs, van Vianden en (in de 14e eeuw): van Coucy, van Béthune; in de 14e eeuw: van Bar, van Luxemburg en van Nassau. In 1559 werd de heerlijkheid, en het gehele Land van Rumst, door Willem van Oranje verkocht aan Melchior Schetz. Diens nazaten bleven heren van Hoboken tot het einde van het ancien régime. In 1600 werden ze verheven tot baron, vanaf 1617 namen ze de naam d'Ursel aan en in 1683 werden ze verheven tot graaf. In 1717 kregen ze de hertogstitel.

Hoboken werd meerdere malen verwoest, zoals tijdens het Beleg van Antwerpen (1584-1585). Van 1582-1584 werd de Hobokense Polder geïnundeerd en ook Hollandse troepen richtten ravage aan.

Hoboken bleef lang een landelijke gemeente. In de 18e eeuw werden de woeste gronden in het oosten ontgonnen en vanaf de 16e eeuw was er in het westen aan de Schelde sprake van baksteenindustrie. Verder bestond vanaf de 16e eeuw enige havenactiviteit, namelijk aan de Kille. Deze verzandde echter in de loop van de 19e eeuw en werd in 1925 afgesloten. Vanaf de 17e eeuw ontstonden hier buitenverblijven. Van het 25-tal van deze verblijven is er nog een viertal (Broydenborg, Gravenhof, Meerlenhof en Sorgvliedt) overgebleven.

Van 1657-1784 bestond hier ook het klooster van de Birgittijnen, met een kapel waarin het Kruis van de Zwarte God werd vereerd, dat in 1180 in de Kille aangespoeld zou zijn en als miraculeus werd aangezien.

Een keerpunt in de geschiedenis van Hoboken is de oprichting van Cockerill Yards in 1873. Deze ging failliet in 1982. In 1885 werd een wolkammerij gesticht die tot 1970 in bedrijf was. In 1887 volgde Metallurgie Hoboken, later bekend als Umicore. In 1877-1879 werden spoorlijnen aangelegd.

Dit alles ging gepaard met een aanzienlijke bevolkingstoename, die leidde tot tal van woonwijken, waaronder Moretusburg (vanaf 1921) en Polderstad (vanaf 1974).

De gemeente Hoboken werd op 1 januari 1983 opgeheven. Hoboken werd een Antwerps district.

Geografie

Ligging
De natuurlijke grenzen van Hoboken, vier waterlopen, vormen tot op de dag van vandaag de grens.

De grens in het noorden tussen Hoboken en Antwerpen wordt gevormd door de Halve Beek.
In het oosten wordt de grens met Wilrijk door de Hollebeek gevormd.
In het zuiden loopt de Winterbeek die de grens met Hemiksem vormt.
De Schelde in het westen is de grens met Kruibeke.

Dorpsindeling
Administratief wordt Hoboken ingedeeld in de volgende wijken:
Hoboken Centrum
Hoboken Noord
Hoboken West
Hoboken Zuid-Oost

De volgende wijkbenamingen zijn gebruikelijk:

Ten oosten van de spoorweg:

Hoboken-centrum: de Kioskplaats en omgeving.
Hertog van Brabant: wijk waar voorheen het Hof van Brabant lag, grofweg de Hertog van Brabantlei, de Leopoldslei en de Maria Henriëttalei.
Vogeltjeswijk: omgeving rond het Meerlenhof met onder andere de Nachtegaallaan en de Distelvinklaan.
Zwaantjes: grens met Wilrijk waar de Hollebeek via een vijver de Sint-Bernardsesteenweg kruiste. Hier was een gelijknamige brouwerij gevestigd dat de wijk zijn naam gaf.

Ten westen van de spoorweg:

Moretusburg: (bij oud station Hoboken-Kapelstraat) ten zuiden van de Kapelstraat.
Hertogvelden: (bij oud station Hoboken-Kapelstraat) ten noorden van de Kapelstraat.
Polderstad: in de jaren 70 aangelegde wijk (bij station Hoboken-Polder) ten noorden in het groen van de Hobokense Polder waarbij de Scheldelei in het verlengde van de Berkenrodelei ligt.

Demografie

Demografische ontwikkeling tot de fusie

Opmerking:resultaten volkstellingen op 31/12 tot en met 1970 + 01/01/1980 + 31/12/1982

Demografische ontwikkeling als district

Politiek

Structuur
Het district Hoboken maakt deel uit van de stad Antwerpen. Deze ligt in het kieskanton Antwerpen is identiek aan het provinciedistrict Antwerpen en ligt in het kiesarrondissement Antwerpen en de kieskring Antwerpen.

Districtscollege
Van 2019 tot 2024 bestaat de meerderheid uit N-VA, sp.a en CD&V.

Districtsraad

De Hobokense districtsraad telde 21 zetels tijdens de legislaturen 2001-2006 en 2007-2012. Sinds 2013 telt de districtsraad 23 zetels.

Geschiedenis

Voormalige burgemeesters en districtsvoorzitters
Zie: Lijst van burgemeesters van Hoboken

Legislatuur 2019 – 2024
De huidige districtsraad werd op 14 oktober 2018 gekozen. Het district wordt bestuurd door een coalitie van N-VA, sp.a en CD&V, samen goed voor 12 van de 23 zetels.

Resultaten districtraadsverkiezingen sinds 2000
Op 8 oktober 2000 werden de eerste districtsraadsverkiezingen voor het Antwerpse district Hoboken gehouden.

De vetjes gedrukte getallen vormen de hieruit onderhandelde bestuursmeerderheid. De grootste partij wordt in kleur weergegeven.

Bezienswaardigheden

Heilig Kruis Zeer bekend is het Wonderdadig Kruis van Hoboken, ook wel bekend als de Zwarte God, dat 800 jaar geleden tegen de stroom in aanspoelde in een inham van de Schelde. Het Kruis dankt zijn naam aan zijn zwarte kleur. Niemand slaagde erin het wit te verven. Toen bijna gans Hoboken én de Kruiskapel in 1584 afbrandde, bleef het Kruis, dat in het gewelf van de noorderbeuk was verborgen, onbeschadigd. Hoboken is met het Heilig Kruis een bedevaartsoord geworden.

Schoonselhof Het Schoonselhof is een grote Antwerpse begraafplaats. Het ligt gedeeltelijk op Hobokens, gedeeltelijk op Wilrijks grondgebied. Het Schoonselhof kreeg zijn naam naar het Hobokense gehucht Schoonsel(e).

Hobokense Polder De Hobokense Polder is een natuurreservaat van 170 ha: het stuk Hoboken tussen de spoorlijn en de Schelde met uitzondering van het industriegebied en de wijken Polderstad, Hertogvelden en Moretusburg.

Fort 8 Fort 8 neemt haast de volledige zuidelijke kant van Hoboken in beslag. Het is een onderdeel van de Brialmontgordel.

Nello en Patrasche De weesjongen Nello (een verkleinvorm van Corneel) en de trekhond Patrasche vormen samen de twee hoofdpersonages in A Dog of Flanders, een roman van Ouida (pseudoniem van Marie Louise de la Ramée) die herhaaldelijk werd verfilmd. Het verhaal is razend populair in Japan, terwijl het in Vlaanderen weinig bekend is. Er staat een beeldje van Nello en Patrasche in de Kapelstraat. Een plaatselijke brouwerij "De Arend" brouwt naar de twee vernoemde helden zowel een licht (Nello Blond) als een donker (Patrasche) bier die internationaal, vooral in Japan, een grote afzet van enkele tienduizend liter per jaar hebben.Tevens is naar de weesjongen het Café Nello, Kioskplaats 32, en naar de hond het restaurant Patrasche, Kioskplaats 54, genoemd.

Sorghvliedt Sorghvliedt is een kasteel dat thans dienst als districtshuis van Hoboken. Het bevindt zich in het park Sorghvliedt. Het werd in 1745 herbouwd door Jan Pieter van Baurscheit de Jonge, een architect die ook het Koninklijk Paleis van Antwerpen heeft ontworpen. In het park van Sorghvliedt vindt de jaarlijkse editie van Sjwilie Rock plaats.

Broydenborg Kasteel gelegen tussen de Broydenborglaan en het park Broydenborg. Het is in eigendom van de Stad Antwerpen.

Meerlenhof Het Meerlenhof is een lichtjes vervallen kasteel gelegen aan de Meerlenhoflaan. Recentelijk waren er vergevorderde plannen om het park te verkavelen. Na verzet van de bewoners gaat uiteindelijk Umicore het gebouw restaureren.

Cockerillhof Het Cockerillhof, de voormalige directeurswoning van de nu verdwenen scheepswerf Cockerill Yards, was ooit een charmante villa gelegen aan de Kapelstraat, vlak voor de spoorlijn. Na een lange tijd van verwaarlozing en verval, is er in 2012 een nieuwe bestemming aan toegewezen. De oude villa wordt gerenoveerd en zal twee woningen omvatten met een collectieve tuin. Het hier aangelegen bestaand buurtpark blijft behouden.

Gravenhof Kasteel Gravenhof, gebouwd in 1897, ligt in het gelijknamige park, op de hoek van de Lambrechtsstraat en de Louisalei. Voorheen deed het dienst als politiebureel, tot het in 1999 gedeeltelijk uitbrandde. Na lange leegstand, werd het tussen najaar 2013 en eind 2015 volledig gerenoveerd en omgevormd tot een cultuurcentrum. Het omliggend park werd eind 2017, begin 2018 heraangelegd

Blikfabriek De Blikfabriek is een actieve en sociale plaats in de vroegere Crown-fabriek. 30.000 leegstaande vierkante meter is getransformeerd tot een innovatief centrum voor jonge ondernemende mensen, een broedplaats vol creativiteit en een lokaal nest met ruimte voor eten, drinken, werken, buurtinitiatief, cultuur en sport.

Religie en levensbeschouwing
Hoboken telt vandaag vier katholieke parochies:
 De Onze-Lieve-Vrouw-Geboortekerk: de grootste en eveneens de oudste parochie, die het centrum van Hoboken, de Vinkeveldenwijk en Polderstad omvat. Ze bestaat reeds sinds 1135 en haar kerkgebouw is gelegen aan de Kioskplaats. Haar huidige uitzicht kreeg ze in de 19e eeuw (toen is tevens de pastorij gebouwd).
 De Heilig Hartkerk: gesticht in 1902; zij omvat het noordoosten van Hoboken. Het kerkgebouw, gelegen in het oosten van Hoboken in de Krugerstraat, werd gebouwd om te voldoen aan het toenemende aantal gelovigen in Hoboken en werd voltooid in 1912.
 De Sint-Jozefskerk: voor de wijk Moretusburg en Hertogvelden. De kerk werd ingewijd in 1913.
 De Heilige-Familiekerk: opgericht in 1944. Deze parochie beslaat het zuidoosten van Hoboken. Het kerkgebouw van de nieuwste parochie is gelegen aan de school Don Bosco en werd plechtig ingewijd in 1969.

De grens tussen Onze-Lieve-Vrouw Geboorte en Sint-Jozef wordt gevormd door de spoorweg Antwerpen-Puurs, met de uitzondering van Polderstad, dat tot de parochie Onze-Lieve-Vrouw Geboorte behoort, hoewel het ten westen van de spoorweg ligt.

De grens tussen Onze-Lieve-Vrouw Geboorte enerzijds en Heilige Familie en Heilig Hart anderzijds verloopt dan weer grilliger, en wordt ongeveer gevormd door de Broydenborglaan, de Heidestraat, de Draaiboomstraat, de Mauroystraat en de Victor Dupontstraat.

De grens tussen de parochies Heilige Familie en Heilig Hart wordt gevormd door de Aartselaarstraat; deze behoort nog tot de Heilig Hartparochie (met uitzondering van het begin van deze straat, die tot de parochie Onze-Lieve-Vrouw Geboorte behoort). Wat ten noorden van deze straat ligt, behoort tot Heilig Hart, wat ten zuiden ligt, tot Heilige Familie.

Natuur en landschap
Hoboken ligt aan de Schelde met nabij deze rivier een poldergebied, waarbij de Hobokense Polder een natuurgebied is. Verder is langs de Schelde veel industrie te vinden. Hoboken is sterk verstedelijkt, behorend tot de Antwerpse agglomeratie. Het Park Sorghvliedt is een groenzone.

Mobiliteit

Openbaar vervoer
Hoboken heeft een degelijke verbinding met het stadscentrum van Antwerpen met tram 2, 4, en 10 en met bus 13, 14, 290, 291 en 295. Verder bus 33 tot in Ekeren via de randdistricten van Antwerpen.

Rond de vorige eeuwwisseling waren er in Hoboken drie spoorwegstations in gebruik. In 1915 werd het eerste station gesloten, Station Fort 8. De twee anderen (beide op spoorlijn 52) sloten in 1984: zowel het station Hoboken aan de Kapelstraat als het station Hoboken-Polder aan de Berkenrodelei. Het laatste station heropende in 1988 en is thans nog in gebruik.

Wegennet
Op de Sint-Bernardsesteenweg na kent Hoboken geen grote invalswegen.

Waterwegen
Het motorveer "Pieter Bruegel" is een fiets-/voetveer over de Zeeschelde die Kruibeke met Hoboken verbindt.

Vervuiling
In Hoboken bevindt zich een fabriek van Umicore, het vroegere Union Minière, dat zijn oorsprong kende in Metallurgie Hoboken. Deze was verantwoordelijk voor milieuverontreiniging door zware metalen, voornamelijk lood, in de omgeving. In de wijk Moretusburg, die aan het bedrijf grenst, werden hoge loodgehalten aangetroffen in de bodem en ook in het bloed van plaatselijke kinderen. Sinds begin jaren 80 worden de emissies van Umicore Hoboken nauwkeurig opgevolgd zoals voorzien in de wetgeving volgens VLAREM II en wordt er een continue daling van lood, cadmium, zwaveldioxide enz. gemeten. In 2006 werd aangevangen met de bodemsanering van de wijk Moretusburg, die heden bijna voltooid is.

Bekende Hobokenaren
 Caroline Bastiaens, politica (CD&V)
 Fred Bekky (1944), zanger, componist en muziekproducent (The Pebbles)
 Jan Bosmans, arts en auteur
 Mie Branders, arts en politica (PVDA)
 Victor Campenaerts, wielrenner
 Augustin De Bruyne, politicus en syndicalist
 Victor De Bruyne (1900-1999), burgemeester en politicus
 Ritchie De Laet, profvoetballer
 Anke De Mondt, basketbalspeelster
 Dirk Denoyelle, cabaretier, kunstenaar
 Guy De Pré, hoofdproducer VRT-radio en presentator
 Raymond Derine, politicus en voorzitter van het Davidsfonds
 Katrien De Ruysscher, actrice
 Leen van Dijck, directrice van het Letterenhuis te Antwerpen
 Kris Merckx, arts en politicus (PVDA)
 Gravity Noir, Patrick Knight (1965), zanger, componist, muziekproducent en regisseur
 Axl Peleman, musicus
 Sven Pichal, radiopresentator
 Gil Ricardo (1941), Belgisch goochelaar
 Marc Schaessens, voetballer
 Lowieke Staal, cabaretier
 Alice Toen, actrice
 Jorn Vancamp, voetballer
 Gil vander Heyden, auteur
 Kurt Van Eeghem, tv- en radiopresentator (Klara)
 Paul Vangenechten, voetballer
 Terry Van Ginderen, presentatrice
 Jef Van Linden, wielrenner
 Britt Van Marsenille, presentatrice
 Paul Vekemans, politicus
 Louis Vermoelen, politicus
 Kristof Waterschoot, politicus (CD&V)
 Jos Wijninckx, politicus (sp.a)
 Erik Vanobbergen, arts en politicus (PVDA)

Nabijgelegen kernen
Antwerpen, Kruibeke (veer), Hemiksem, Wilrijk

Externe links
 District Hoboken
 Inventaris Onroerend Erfgoed

Plaats in Antwerpen (provincie)

redpajama_set_name: RedPajamaWikipedia


When estrogen is not balanced with progesterone, the estradiol will stimulate the lining of the uterus to grow uncontrollably. The abnormal growth of part of the uterus tissue tends to develop fibroids. Furthermore, when menstrual blood flows backwards from the uterus into the fallopian tubes and spreads into pelvic tissues, part of the uterus lining can also travel with the blood and implant outside the uterus causing endometriosis (Khaleque Khan et al. 2005). Women with endometriosis tend to have higher than normal levels of hepatocyte growth factor and higher growth factor level may facilitate the endometrial tissue growing outside the uterus. The estrogen dominance condition can change the gene expression.


text:
Back To Expert Advice
Explore This Section Events Studies Feature Government Relations
Dogs are in the news every single day but you can count on our coverage to let you know about the latest – and most important – news for you and your dog.
The AKC Nibble newsletter!
Your sign-up for The AKC Nibble was successful!
Scent Work Gave This High-Energy and Incredibly Smart Dog a Job to Do
How Dogs Are Helping Returning Military Soldiers Combat PTSD
AKCLive! June 27: How to Keep Your Dog Cool This Summer, Take the Perfect Social Media Shot, and More
Meet a Junior Competitor in the 2018 AKC Rally National Championship
Breeder of Merit Patti Strand Reflects on the Decades She's Spent Raising Dalmatians
Wiki the Australian Shepherd Turns on Lights, Opens Doors, and Entertains in the Show Ring
AKCLive! June 20: Dr. Mary Burch, Director of AKC's Family Dog Program, Answers Your Questions
Nominate a Deserving Dog for an AKC Humane Fund Award for Canine Excellence
How One Woman's Borzois Saved Her From Isolation After Hearing Loss
AKCLive! June 13: Allergy Solutions, Father's Day Gift Suggestions, and More
Previous 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 Next


text:
COLOR OF CHANGE DEMANDS JUSTICE FOR KEENAN ANDERSON; LAPD OFFICERS MUST BE HELD ACCOUNTABLE
media@colorofchange.org
Rashad Robinson, president of Color Of Change, issued the following statement following the killing of Keenan Anderson:
"Keenan Anderson — a father and 10th grade English teacher — should be alive today. Instead, Keenan was killed in the streets of Los Angeles by the LAPD while begging for help. This tragedy is a result of failed policies and a policing system designed not to work –
one that relies on excessive force that all too often becomes deadly. The anguish and fear Keenan felt while saying that police were trying to 'George Floyd' him is haunting.
"Black communities deserve to feel safe and the system must be changed. Like countless other police officers who unjustly use aggressive, deadly force when interacting with Black people in communities, the officers involved in Anderson's case disregarded his cries for help and instead, murdered him. This isn't surprising. Last year, a record number of civilians were murdered at the hands of law enforcement. This is the third police killing by LAPD this year alone. When police officers use tasers they can be deadly, yet tasers continue to be funneled to police departments through donations to dubious police foundations. The investigations into these killings must be open and transparent, and the public kept informed.
"Black communities across the country are demanding an end to the police-only approach to public safety. It is too broken, too dangerous and has led to the holding back of our entire lives. As we work towards dismantling policing as it exists today, we call on LAPD to hold the officers involved accountable for their role in Anderson's death. Until we see widespread reform to better hold law enforcement officers accountable for their negligence and responsibility for murdering innocent Black lives, the onus is on LAPD to take appropriate action."
Color Of Change is the nation's largest online racial justice organization. We help people respond effectively to injustice in the world around us. As a national online force driven by over 7 million members, we move decision-makers in corporations and governments to create a more human and less hostile world for Black people in America. Visit www.colorofchange.org


Paris, September 24, 2018 – Businesses are pursuing digital transformation to achieve a step change in their speed, agility, and ability to innovate. Realizing the unique offerings of digital transformation rests on an organization's ability to access data at greater speed and in greater breadth. A new report released today from Capgemini entitled "Unlocking the hybrid integration dividend: How to transform your business with hybrid integration and APIs" reveals how modernized, hybrid integration and microservices-based Application Programming Interfaces (APIs) are the means to empower digital transformation and maximize capabilities to benefit from the API economy.
A hybrid integration approach involves the use of modern, cloud-based integration tools in combination with those on-premise, such as the enterprise service bus (ESB)4, to connect applications in different environments. The report found that 66% of surveyed firms use three or more cloud providers, with over three-quarters of their applications running in a private cloud or on-premise (or both). The traditional point-to-point integration approach used within monolithic systems will not be able to cope when hundreds of a company's applications reside in several different environments. Hybrid integration is a means of managing this complexity and ensuring that the firm's technology infrastructure can deliver on business objectives. However, there is a consensus among the respondents interviewed to be cautious of the "piecemeal" approach to integration, and they agreed that companies should not attempt to rip and replace their legacy integration architecture in one fell swoop. On the other hand, the report concludes that it is necessary to take the appropriate steps at the right time, and combat the inertia in order to seize the hybrid integration opportunity effectively.
"In companies with multiple units and sites that have done things in different ways using different technologies, standardizing the integrations across the organization is imperative, but it requires a big planning effort even before you start making any changes," said Charlie Li, Head of Cloud Services, North America, Capgemini. "APIs are controlled, they're standardized and they're secure. This allows companies to collaborate in a much bigger way than they have before." To download a copy of the report, click here.
1 APIs are a set of functions and procedures that allow the creation of applications which access the features or data of an operating system, application, or other service.
2 "Integrators" are defined as the most advanced group in the survey in terms of integration modernization, and account for 15% of the respondent firms. They meet the criteria of having developed a hybrid integration strategy; and cloud-based integration and/or microservices are "very prominent" in their integration approach.
3 "Deliberators" are respondent firms that do not meet the criteria of having developed a hybrid integration strategy, and account for 16% of the overall survey sample.
4 An "enterprise service bus (ESB)" implements a communication system between mutually interacting software applications in a service-oriented architecture (SOA).


text:
Wuhan Tested Nearly 7 Million People in 12 Days to Prevent Second Coronavirus Wave, Health Officials Say
By Benjamin Fearnow On 5/26/20 at 11:28 AM EDT
U.S. Testing Coronavirus China
Chinese health officials in the city at the center of the initial coronavirus outbreak say they tested nearly 7 million people in 12 days to quash fears of a second wave.
Local health commission officials in Wuhan released data showing 6.68 million people underwent nucleic acid tests as part of a mass-testing effort to suppress concerns over a second wave of COVID-19 cases in the Hubei region of China. According to analysis conducted by Bloomberg News Tuesday, 206 people who were tested were listed as asymptomatic cases. Wuhan began testing its entire population of 11 million people "at all costs" on May 12, just days after new infections emerged following 76 days of lockdown.
Last week, China's National Health Commission reported the country had its first day of zero new confirmed cases, a first since the outbreak began in late 2019. Chinese health officials said there were only two suspected cases of coronavirus in all of mainland China, which contains nearly 1.45 billion people.
Speaking at annual legislative meetings in Beijing Monday, Chinese President Xi Jinping encouraged the aggressive testing effort to "not ruin the hard-won achievement" of containing the virus and reopening the country's economy.
The Wuhan Health Commission reported that on a single day, Saturday, May 23, the city conducted tests on over 1.1 million people. The pace of testing rapidly increased between May 12 and May 24 as health labs and companies across the city multiplied the number of people they tested 26 times over. By comparison, the United States tested fewer than 1 million people across the country during the entire month of March, according to the COVID Tracking Project.
The New York Times reported Tuesday that testing had reached 90 percent of the entire city and laboratories in Wuhan were processing as many as 1.47 million tests by Friday. By comparison, the state of New York - with a population of about 20 million - has only tested 1.7 million people since March 4.
Wuhan's massive testing effort preceded high-profile National People's Congress (NPC) lawmaker meetings in Beijing this week.
The Trump administration vowed in early April that 5 million tests would be available to Americans each day, but later backtracked on that number which was reduced to 2 million. But labs and data compiled by the COVID Tracking Project revealed the U.S. averaged at most 220,000 tests each day by the last week of April.
Prior to Wuhan's intense testing effort of nearly 7 million people beginning on May 12, many companies based in the sprawling city of 11 million residents were already requiring employees to be tested to gain access to their workplaces. Several companies in Wuhan required workers to have their throats swabbed or to have blood drawn before returning to work after several months in lockdown.
"We are not resuming work until we receive the negative results of all workers," said Ke Jianjun, an official at Kone Elevators Co., who helped workers line up in protective suits as they were tested in a tent outside their Wuhan office in early May, Reuters reported. "We cannot take the risk of restarting business if anyone is infected or suspected."
Chinese health officials in the city at the center of the initial coronavirus outbreak say they tested nearly 7 million people in 12 days in order to quash fears of a second wave. Stringer/Getty


text:
Q: Command `ip a show` in `zsh` not working I have an Ubuntu 18.04 distro in which I use zsh as default shell instead of bash.
Since I like the Kali Linux zsh setup, I copied the .zshrc config file to the Ubuntu machine and my shell seems to work right.
Still a problem arises: when I launch the ip a show command, I get as output:
Option "-color=auto" is unknown, try "ip -help".

I tried to google the error, but I cannot find anything useful.
Does anyone know where the problem lies? Thanks in advance.

A: You probably have an alias in your zsh configuration. Check with the alias command and/or with which ip.
Happy 20+ years zsh user here.  ;-)

redpajama_set_name: RedPajamaStackExchange


text:
Schizonycha singhalensis är en skalbaggsart som beskrevs av Brenske 1900. Schizonycha singhalensis ingår i släktet Schizonycha och familjen Melolonthidae. Inga underarter finns listade i Catalogue of Life.

Källor

Skalbaggar
singhalensis


text:
Gagma napiri (in Italia anche presentato con il titolo Di là dal fiume) è un film del 2009 diretto da George Ovashvili.

Trama
Tedo, il giovane protagonista, fuggito dall'Abcasia vive con la madre costretta a prostituirsi in un capanno vicino alla capitale georgiana Tbilisi.
Conscio del pericolo va ugualmente a cercare il padre a Tkvarcheli.

Collegamenti esterni

Film drammatici


Teresa Shulda, a partner in Foulston Siefkin's Employment & Labor Practice Group, has been litigating employment disputes and advising on workplace law matters for more than a decade. Based in the firm's Wichita office, much of Teresa's practice is focused on employer-side issues. She represents businesses that range from some of the city's largest corporations with thousands of workers around the globe to small, closely held businesses with fewer than 10 employees.
Known for her deep understanding of federal regulations as well as Kansas employment laws, Teresa is a powerful advocate for her clients – both in and out of the courtroom. She regularly defends employers against discrimination claims, including those involving age, race, religion, national origin, gender, or disability allegations. In addition, Teresa handles disputes related to wrongful termination, breach of contract, civil rights, and whistleblower retaliation claims. She is particularly well-versed in federal statues such as the Family and Medical Leave Act (FMLA), Americans with Disabilities Act (ADA), Title VII, the Age Discrimination in Employment Act (ADEA), and Pregnancy Discrimination Act, as well as the Kansas Wage Payment Act.
Teresa represents clients in federal and state courts, in regulatory agency proceedings, and in alternative dispute resolution forums. In a widely publicized age discrimination suit, she worked on the Foulston team that obtained a decisive victory for her client when the jury rendered a defense verdict in less than two hours, ending a 10-year litigation that originated as a collective action. Her enviable track record also includes numerous summary judgments on behalf of clients, several of which have been confirmed by higher courts. Teresa has also achieved many successful outcomes for her clients who are defending charges of discrimination filed with the Equal Employment Opportunity Commission (EEOC) or the Kansas Human Rights Commission. An accomplished negotiator, she has secured highly favorable settlements for her clients that averted prolonged litigation.
Much of Teresa's practice includes advising clients on compliance-related issues and litigation-avoidance tactics. Working hand-in-hand with human relations departments, company owners, and in-house legal counsel, she crafts strategies that meet the company's goals and fulfill federal and state requirements. Because much of her early career was focused on employee representation, she applies her understanding of the workforce perspective when counseling employers.
Teresa is often asked to share her insights with human resources professionals and legal colleagues at seminars and meetings across the region. She serves as the co-editor of BLR's Kansas Employment Law Letter and frequently publishes articles and client alerts on timely topics and legal rulings.


The Member States of World Health Organization (WHO) elected Tedros Adhanom Ghebreyesus, Ph.D., of Ethiopia as the new Director-General of WHO. Known as Dr. Tedros, he is the first African to head the agency.
The WHO Executive Board selected by vote three candidates for the post of Director-General of WHO. Member States chose among Dr. Tedros, Dr. David Nabarro, nominated by Great Britain and Northern Ireland, and Dr. Sania Nishtar, nominated by Pakistan, at the World Health Assembly on May 23.
Tedros was nominated by the Government of Ethiopia, where he previously served as Minister of Foreign Affairs, Ethiopia from 2012–2016 and as Minister of Health, Ethiopia from 2005–2012.
As Minister of Foreign Affairs, he led the effort to negotiate the Addis Ababa Action Agenda, in which 193 countries committed to the financing necessary to achieve the United Nation's Sustainable Development Goals, 17 goals that aim to end poverty, protect the planet and ensure that all people enjoy peace and prosperity.
As Minister of Health, Ethiopia, Tedros led a comprehensive reform effort of the country's health system, including the expansion of the country's health infrastructure, creating 3,500 health centers and 16,000 health posts; expanded the health workforce by 38,000 health extension workers; and initiated financing mechanisms to expand health insurance coverage.
According to his bio, he has also served as chair of the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria; as chair of the Roll Back Malaria (RBM) Partnership Board; and as co-chair of the Board of the Partnership for Maternal, Newborn and Child Health.
In addition, as Chair of the Global Fund and of RBM, Tedros secured record funding for the two organizations and created the Global Malaria Action Plan, which expanded RBM's reach beyond Africa to Asia and Latin America.
His top priorities under his leadership include transforming WHO into a more effective, transparent and accountable agency; advancing universal health coverage; improving health security to detect, prevent, and manage health emergencies; improving the well-being of women, children and adolescents; and better understanding and addressing the effects of climate and environmental change on health.
"I envision a world in which everyone can lead healthy and productive lives, regardless of who they are or where they live. I believe the global commitment to sustainable development – enshrined in the Sustainable Development Goals – offers a unique opportunity to address the social, economic and political determinants of health and improve the health and wellbeing of people everywhere," said Dr. Tedros in a campaign statement.
Tedros will begin his five-year term on July 1, 2017. He succeeds Margaret Chan, who has been WHO's Director-General since January 1, 2007.


Eli asked to be driven home.
Drew wanted to run for class president.
Jem had a hard time finding work.
Tran didn't manage to answer all the questions.
Tammy is a close friend.
Len mouthed the words "thank you."
Sam deserves to know what happened.
Janet was happy and carefree.
Samir hit her on the head.
Valeria has been trying to learn to speak French for a long time.
Skip was amazed to see Jinny's elaborate and upswept coiffure for her high school reunion. He wondered if, despite her very real accomplishments, she might still be at heart somewhat insecure, vain and egotistical.
I almost believed what Hurf said.
If that wasn't Soohong, who was it?
Lynne and I are both very happy.
Syun gave Kelly a friendly smile.
You're the only one who's seen Donna.
My advice is to tell Raanan how you feel.
Vivek is trying not to scare anybody.
Jianyun came back from Boston the week before last.
Helen and Joyce both left the room at the same time.
Amedeo has had a busy month.
Jeannie knew Holly wouldn't listen to anything he had to say.
Ronni has been missing for thirty days.
Merat doesn't hang out with Andreas anymore.
Is Hy planning to go back to Boston?
Liza used to swim every afternoon.
Jacob got in his car and followed the ambulance.
How do you think Toufic will cope with the situation?
I've known Kirsten a lot longer than you have.


Mascaro views preconstruction as the project foundation and the roadmap to successful project completion. We have a specialized in-house team to handle preconstruction services.
What sets us apart is that the individuals who will be building your project are involved in the process. Mascaro's concept of having the project team involved in the job from day one allows for a smooth transition from preconstruction to construction.
The services Mascaro provides during preconstruction are listed below.