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The whole energy system requires renewables that scale and produce reliable, valuable energy at an acceptable cost. The key to increasing the deployment of ocean energy is bringing down development and operating costs. This paper proposes a structured approach to innovation in ocean energy systems that would spur innovation and expand the market for ocean energy. This approach can be used by a wide range of stakeholders—including technology and project developers and investors—when considering creating or improving designs. The Structured Innovation design tool within the DTOceanPlus suite is one of a kind beyond the current state-of-the-art. It enables the adaptation and integration of systematic problem-solving tools based on quality function deployment (QFD), the theory of inventive thinking (TRIZ), and the failure modes and effects analysis (FMEA) methodologies for the ocean energy sector. In obtaining and assessing innovative concepts, the integration of TRIZ into QFD enables the designers to define the innovation problem, identifies trade-offs in the system, and, with TRIZ as a systematic inventive problem-solving methodology, generates potential design concepts for the contradicting requirements. Additionally, the FMEA is used to assess the technical risks associated with the proposed design concepts. The methodology is demonstrated using high-level functional requirements for a small array of ten tidal turbines to improve the devices layout and power cabling architecture. The Structured Innovation design tool output comprises critical functional requirements with the highest overall impact and the least organisational effort to implement, along with appropriate alternative solutions to conflicting requirements.

In engineering, there are many obstacles that women face ranging from underlying stereotypes to physical restrictions in certain environments. The deficit of women in University programs has created a hurdle for young women entering the field of engineering. The objective of this study was to identify the challenges experienced by female undergraduate and graduate students that contribute to the systemic issue of inequity. A total of 372 male and female students actively participated in a 21-question survey featuring both multiple-choice answers as well as open-ended questions. Three themes emerged relating to culture (built environment and attitudes), gender (stereotypes and lack of role models), and personal (sense of belonging and the imposter syndrome). It was found that the built environment created physical barriers, while the attitudes of male peers, teaching assistants, and professors led to negative experiences, limiting female student success. Comments made about gender disparities focused on stereotypes and the lack of role models, which were later determined to influence students’ sense of belonging and feelings of imposter syndrome. Over half of the female students who participated in the survey felt discouragement due to the lack of gender diversity that has further impacted their experiences and education. This research may not be reflective of the experience for all females in engineering but does reflect the challenges of those who came forward. Both equity and equality within engineering must be sought to make the predominately male environment more inclusive.

Background Medical abortion is usually offered in a clinic or hospital, but could potentially be offered in other settings such as pharmacies. In many countries, pharmacies are a common first point of access for women seeking reproductive health information and services. Offering medical abortion through pharmacies is a potential strategy to improve access to abortion. Objectives To compare the effectiveness and safety of medical abortion offered in pharmacy settings with clinic-based medical abortion. Search methods We searched CENTRAL, MEDLINE, Embase, four other databases, two trials registries and grey literature websites in November 2020. We also handsearched key references and contacted authors to locate unpublished studies or studies not identified in the database searches. Selection criteria We identified studies that compared women receiving the same regimen of medical abortion or post-abortion care in either a clinic or pharmacy setting. Studies published in any language employing the following designs were included: randomized trials and non-randomized studies including a comparative group. Data collection and analysis Two review authors independently reviewed both retrieved abstracts and full-text publications. A third author was consulted in case of disagreement. We intended to use the Cochrane risk of bias tool, RoB 2, for randomized studies and used the ROBINS-I tool (Risk Of Bias In Non-randomized Studies of Interventions) to assess risk of bias in non-randomized studies. GRADE methodology was used to assess the certainty of the evidence. The primary outcomes were completion of abortion without additional intervention, need for blood transfusion, and presence of uterine or systemic infection within 30 days of medical abortion. Main results Our search yielded 2030 records. We assessed a total of 89 full-text articles for eligibility. One prospective cohort study met our inclusion criteria. The included study collected data on outcomes from 605 women who obtained a medical abortion in Nepal from either a clinic or pharmacy setting. Both sites of care were staffed by the same auxiliary nurse midwives. Over all domains, the risk of bias was judged to be low for our primary outcome. During the pre-intervention period, the study's investigators identified a priori appropriate confounders, which were clearly measured and adjusted for in the final analysis. For women who received medical abortion in a pharmacy setting, compared to a clinic setting, there may be little or no difference in complete abortion rates (adjusted risk difference (RD)) 1.5, 95% confidence interval (CI) -0.8 to 3.8; 1 study, 600 participants; low certainty evidence). The study reported no cases of blood transfusion, and a composite outcome, comprised mainly of infection complications, showed there may be little or no difference between settings (adjusted RD 0.8, 95% CI -1.0 to 2.8; 1 study, 600 participants; very low certainty evidence). The study reported no events for hospital admission for an abortion-related event or need for surgical intervention, and there may be no difference in women reporting being highly satisfied with the facility where they were seen (38% pharmacy versus 34% clinic, P = 0.87; 1 study, 600 participants; low certainty evidence). Authors' conclusions Conclusions about the effectiveness and safety of pharmacy provision of medical abortion are limited by the lack of comparative studies. One study, judged to provide low certainty evidence, suggests that the effectiveness of medical abortion may not be different between the pharmacy and clinic settings. However, evidence for safety is insufficient to draw any conclusions, and more research on factors contributing to potential differences in quality of care is needed. It is important to note that this study included a care model where a clinician provided services in a pharmacy, not direct provision of care by pharmacists or pharmacy staff. Three ongoing studies are potentially eligible for inclusion in review updates. More research is needed because pharmacy provision could expand timely access to medical abortion, especially in settings where clinic services may be more difficult to obtain. Evidence is particularly limited on the patient experience and how the care process and quality of services may differ across different types of settings.

Introduction:The US Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) program sponsors the development of systematic reviews to inform clinical policy and practice. The EPC program sought to better understand how health systems identify and use this evidence.Methods:Representatives from eleven EPCs, the EPC Scientific Resource Center, and AHRQ developed a semi-structured interview script to query a diverse group of nine Key Informants (KIs) involved in health system quality, safety and process improvement about how they identify and use evidence. Interviews were transcribed and qualitatively summarized into key themes.Results:All KIs reported that their organizations have either centralized quality, safety, and process improvement functions within their system, or they have partnerships with other organizations to conduct this work. There was variation in how evidence was identified, with larger health systems having medical librarians and central bureaus to gather and disseminate information and smaller systems having local chief medical officers or individual clinicians do this work. KIs generally prefer guidelines, especially those with treatment algorithms, because they are actionable. They like systematic reviews because they efficiently condense study results and reconcile conflicting data. They prefer information from systematic reviews to be presented as short digestible summaries with the full report available on demand. KIs preferred systematic reviews from reputable entities and those without commercial bias. Some of the challenges KIs reported include how to resolve conflicting evidence, the generalizability of evidence to local needs, determining whether the evidence is up-to-date, and the length of time required to generate reviews. The topics of greatest interest included predictive analytics, high-value care, advance care planning, and care coordination. To increase awareness of AHRQ EPC reviews, KIs suggest alerting people at multiple levels in a health-system when new evidence reports are available and making reports easier to find in common search engines.Conclusions:Systematic reviews are valued by health system leaders. To be most useful they should be easy to locate and available in different formats targeted to the needs of different audiences.