Victoria Walsh

The World Health Organization (WHO) in collaboration with partners is developing a toolkit of resources to guide lymphatic filariasis (LF) morbidity management and disability prevention (MMDP) implementation and evaluation. Direct health facility inspection is the preferred method for documenting the readiness of a country programme to provide quality lymphoedema management services, one of the three MMDP criteria used to demonstrate the elimination of LF as a public health problem. As component of tool development, a Delphi consultation was implemented to gain consensus on six proposed domains and fourteen proposed tracer indicators to measure national programme readiness to provide quality health facility-based lymphoedema management services. A seven-point Likert-type scale was used to rank the importance of proposed domains and tracer indicators. Consensus for inclusion of the indicator was defined a priori as 70% or more of respondents ranking the proposed indicator in the top three tiers (5–7). Purposive sampling was used to select 43 representative experts including country representatives, programme implementers, and technical experts. A 55.8% response rate (n = 24) was achieved for the survey. Analysis of the responses demonstrated that consensus for inclusion had been reached for all proposed domains including trained staff (mean = 6.9, standard deviation (SD) = 0.34), case management and education materials (mean = 6.1, SD = 0.65), water infrastructure (mean = 6.3, SD = 0.81), medicines and commodities (mean = 6.3, SD = 0.69), patient tracking system (mean = 6.3, SD = 0.85), and staff knowledge (mean = 6.5, SD = 0.66). The Delphi consultation provided an efficient and structured method for gaining consensus among lymphatic filariasis experts around key lymphoedema management quality indicators. The results from this analysis were used to refine the indicators included within the direct inspection protocol tool to ensure its ability to assess health facility readiness to provide quality lymphoedema management services. Prior to this assessment, there was a need for clearly defined, measurable indicators for global lymphoedema management programmes to use to evaluate their lymphoedema morbidity management and disability prevention services. The results presented in this report outline a framework for indicators to assess healthcare facility-based readiness to provide quality lymphoedema management services. We describe our use of the Delphi methodology to obtain consensus on programme evaluation metrics as a model for elimination or control metrics and targets. The quality indicators developed from this Delphi consultation will be used to improve the direct inspection protocol tool that can be used to assess health facility readiness to provide quality lymphoedema management services LF endemic countries.

Tate, and by implication the modern art museum in general, is struggling with a double paradox. How, on the one hand, can modernity’s notion of linear progressive time be maintained in a world where, through the proliferation of technology and networked mobile devices, our time horizon has shrunk to that of the present; and, on the other, can aesthetic modernism’s atemporal space of exhibition and display be maintained in the face of the multiplicity of times experienced within presentness?

Looking back to the rise of institutional critique in the 1980s and New Institutionalism in the 1990s, the Foucauldian project to critically analyze the structural organization of power and knowledge in institutions seems historic when one considers the current relation between the art museum and the academy. Today, the ability to move across these two institutions—and particularly the art school and the art museum—has never been so open and fluid, nor the practices at one level so close, at least in the United Kingdom. For the development of formal research practices in the art museums now effectively parallels those of the university: initiating and leading research projects funded by the public and private sectors, running doctoral programs, supporting fellowships, developing research centers, hosting seminars, and organizing conferences for specialist audiences.