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Global Health Action Jan 2021: The term 'last mile' has been used across disciplines to refer to populations who are farthest away, most difficult to reach, or last to benefit from a program or...
: The term 'last mile' has been used across disciplines to refer to populations who are farthest away, most difficult to reach, or last to benefit from a program or service. However, last mile research lacks a shared understanding around its conceptualization.: This project used a concept mapping process to answer the questions: what is last mile research in global health and, how can it be used to make positive change for health equity in the last mile?: Between July and December 2019, a five-stage concept mapping exercise was undertaken using online concept mapping software and an in-person consensus meeting. The stages were: establishment of an expert group and focus prompt; idea generation; sorting and rating; initial analysis and final consensus meeting.: A group of 15 health researchers with experience working with populations in last mile contexts and who were based at the Matariki Network institutions of Queen's University, CAN and Dartmouth College, USA took part. The resulting concept map had 64 unique idea statements and the process resulted in a map with five clusters. These included: (1) Last mile populations; (2) Research methods and approaches; (3) Structural and systemic factors; (4) Health system factors, and (5) Broader environmental factors. Central to the map were the ideas of equity, human rights, health systems, and contextual sensitivity.: This is the first time 'last mile research' has been the focus of a formal concept mapping exercise. The resulting map showed consensus about last mile populations are, research should be undertaken in the last mile and last mile health disparities exist. The map can be used to inform research training programs, however, repeating this process with researchers and members from different last mile populations would also add further insight.
Topics: Consensus; Exercise; Health Equity; Humans; Research Design; Research Personnel
PubMed: 33736574
DOI: 10.1080/16549716.2021.1893026 -
Academic Medicine : Journal of the... May 2023
PubMed: 36226958
DOI: 10.1097/ACM.0000000000005039 -
Sexual and Reproductive Health Matters Dec 2022Globally, significant progress has been made in the realm of adolescent sexual and reproductive health. We conceptualised "last mile" adolescents as having two or more... (Review)
Review
Globally, significant progress has been made in the realm of adolescent sexual and reproductive health. We conceptualised "last mile" adolescents as having two or more of the following factors of identity: refugee, Indigenous, 2SLGBTQIA+, out of school, rurally or remotely located, slum dwelling, incarcerated or previously incarcerated, HIV/AIDS infected, and living with a disability. We conducted a scoping review with an aim to synthesise evidence and identify research gaps in the literature pertaining to the sexual and reproductive health and rights (SRHR) of last mile adolescents. We conducted searches in three databases (Embase, Global Health, and Medline). Fifty-four publications met our inclusion criteria. Our results revealed that the state of evidence on the SRHR of last mile adolescents is poor. Very few studies used qualitative and mixed-method inquiry. The number of studies carried out in North America, Europe, and Oceania were limited. We found insufficient disaggregated data with respect to SRHR-related knowledge, behaviour, and access to services. Adopting an intersectional lens is critical to uncover the multiplicative effects of last mile adolescents' factors of identity on their SRHR. National data systems should be strengthened to enable the collection of quality disaggregated data which can play a vital role in identifying SRHR inequities affecting last mile adolescents. Research priorities should be realigned to generate data globally on the SRHR of last mile adolescents whose lives are marked by intersecting vulnerabilities.
Topics: Adolescent; Humans; Reproductive Health; Reproductive Health Services; Reproductive Rights; Sexual Behavior; Sexual Health
PubMed: 35666196
DOI: 10.1080/26410397.2022.2077283 -
Bridging the "last mile" gap between AI implementation and operation: "data awareness" that matters.Annals of Translational Medicine Apr 2020Interest in the application of machine learning (ML) techniques to medicine is growing fast and wide because of their ability to endow decision support systems with... (Review)
Review
Interest in the application of machine learning (ML) techniques to medicine is growing fast and wide because of their ability to endow decision support systems with so-called artificial intelligence, particularly in those medical disciplines that extensively rely on digital imaging. Nonetheless, achieving a pragmatic and ecological validation of medical AI systems in real-world settings is difficult, even when these systems exhibit very high accuracy in laboratory settings. This difficulty has been called the "last mile of implementation." In this review of the concept, we claim that this metaphorical mile presents two chasms: the hiatus of human trust and the hiatus of machine experience. The former hiatus encompasses all that can hinder the concrete use of AI at the point of care, including availability and usability issues, but also the contradictory phenomena of cognitive ergonomics, such as automation bias (overreliance on technology) and prejudice against the machine (clearly the opposite). The latter hiatus, on the other hand, relates to the production and availability of a sufficient amount of reliable and accurate clinical data that is suitable to be the "experience" with which a machine can be trained. In briefly reviewing the existing literature, we focus on this latter hiatus of the last mile, as it has been largely neglected by both ML developers and doctors. In doing so, we argue that efforts to cross this chasm require data governance practices and a focus on data work, including the practices of data awareness and data hygiene. To address the challenge of bridging the chasms in the last mile of medical AI implementation, we discuss the six main socio-technical challenges that must be overcome in order to build robust bridges and deploy potentially effective AI in real-world clinical settings.
PubMed: 32395545
DOI: 10.21037/atm.2020.03.63 -
Vaccine: X Aug 2022Recommendations for storage of most vaccines imply a continuous exposure to a temperature range between 0 °C and 10 °C, from the production to the administration to... (Review)
Review
Recommendations for storage of most vaccines imply a continuous exposure to a temperature range between 0 °C and 10 °C, from the production to the administration to beneficiaries. According to the World Health Organization, more than 50% of vaccines are wasted around the world. Discontinuities of the cold chain in low-income settings where electricity is scarce contributes to this wastage. Recently, several advances have been made in cooling technologies to store and transport vaccines. This paper presents an overview of refrigeration technologies based on scientific publications, industry white papers and other grey literature. With a focus on vaccine transport, we briefly describe each refrigeration method, its best performing available devices as well as the outstanding research challenges in order to further improve its performance.
PubMed: 35800134
DOI: 10.1016/j.jvacx.2022.100184 -
The Lancet. HIV Mar 2023
PubMed: 36706780
DOI: 10.1016/S2352-3018(23)00010-3 -
Nature Nov 2023
Topics: Humans; Food
PubMed: 37989774
DOI: 10.1038/d41586-023-03617-y -
Transportation Research. Part E,... Apr 2023The COVID-19 pandemic led to a significant breakdown of the traditional retail sector resulting in an unprecedented surge in e-commerce demand for the delivery of...
The COVID-19 pandemic led to a significant breakdown of the traditional retail sector resulting in an unprecedented surge in e-commerce demand for the delivery of essential goods. Consequently, the pandemic raised concerns pertaining to e-retailers' ability to maintain and efficiently restore level of service in the event of such low-probability high-severity market disruptions. Thus, considering e-retailers' role in the supply of essential goods, this study assesses the resilience of last-mile distribution operations under disruptions by integrating a Continuous Approximation (CA) based last-mile distribution model, the resilience triangle concept, and the Robustness, Redundancy, Resourcefulness, and Rapidity (R4) resilience framework. The proposed R4 Last Mile Distribution Resilience Triangle Framework is a novel performance-based qualitative-cum-quantitative domain-agnostic framework. Through a set of empirical analyses, this study highlights the opportunities and challenges of different distribution/outsourcing strategies to cope with disruption. In particular, the authors analyzed the use of an independent crowdsourced fleet (flexible service contingent on driver availability); the use of collection-point pickup (unconstrained downstream capacity contingent on customer willingness to self-collect); and integration with a logistics service provider (reliable service with high distribution costs). Overall, this work recommends the e-retailers to create a suitable platform to ensure reliable crowdsourced deliveries, position sufficient collection-points to ensure customer willingness to self-collect, and negotiate contracts with several logistics service providers to ensure adequate backup distribution.
PubMed: 36844256
DOI: 10.1016/j.tre.2023.103066 -
The Journal of Thoracic and... Jul 2018
Topics: Cardiopulmonary Bypass; Water
PubMed: 29572026
DOI: 10.1016/j.jtcvs.2018.02.050 -
Applied Optics Nov 2023Free-space optics (FSO) and visible light communication (VLC) are interesting solutions for last mile access due to their benefits over conventional wired and wireless...
Free-space optics (FSO) and visible light communication (VLC) are interesting solutions for last mile access due to their benefits over conventional wired and wireless communication systems, including easy installation, low latency, high bandwidth, and low cost. This study aims to present last mile access using hybrid FSO/VLC, addressing the shortcomings of each technology. A hybrid system might, for instance, use VLC to give last meter connectivity to specific buildings and FSO to provide high-bandwidth outdoor connectivity across vast distances. In this paper, three proposed scenarios are designed using Optisystem and Matlab software, employing pulse amplitude modulation with four levels (PAM-4). The first scenario involves designing the last mile of the FSO-VLC system. In contrast, the second uses wavelength division multiplexing (WDM) technology to increase the data transmission capacity by enabling multiple optical signals at various wavelengths. The last scenario entails using VLC systems and the non-orthogonal multiple access (NOMA) approach to accommodate several users simultaneously. The simulation results show that the proposed system can fulfill outdoor link distances of more than 10 km and indoor coverage of about 2 m with a bit-error rate (BER) of 1.5×10 for a 10 Gbps data rate. However, the proposed systems can achieve the same data rate with a reduced FSO distance under different turbulence and weather conditions.
PubMed: 38037945
DOI: 10.1364/AO.503272