Sample records for adoption implementation maintenance

  1. Statewide dissemination of a rural, non-chain restaurant intervention: adoption, implementation and maintenance

    PubMed Central

    Nothwehr, F.; Haines, H.; Chrisman, M.; Schultz, U.

    2014-01-01

    The obesity epidemic calls for greater dissemination of nutrition-related programs, yet there remain few studies of the dissemination process. This study, guided by elements of the RE-AIM model, describes the statewide dissemination of a simple, point-of-purchase restaurant intervention. Conducted in rural counties of the Midwest, United States, the study targeted randomly selected, non-chain, family-style restaurants. Owners were recruited through mail, then telephone follow-up. Data were collected through telephone at baseline, and 3, 6, 12 and 18 months post-adoption. Using mixed methods, measures captured the program adoption rate, characteristics of adopters and non-adopters, program implementation and maintenance issues, and owner and customer satisfaction. Analyses involved descriptive statistics and summaries of qualitative data. The program adoption rate was 28%. Adopters were similar to responding non-adopters demographically, but varied in attitudes. The majority of restaurants maintained the program for at least 12 months. Adopters and their customers expressed satisfaction with the program. With some adjustments, the RE-AIM model was helpful in guiding evaluation of this process. Results provide implications for future dissemination of this and other programs with regard to research procedures and potential barriers that may be encountered. Research on alternative strategies for widespread dissemination of such programs is needed in this and other settings. PMID:24650944

  2. Evaluation of physical activity interventions in youth via the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework: A systematic review of randomised and non-randomised trials.

    PubMed

    McGoey, Tara; Root, Zach; Bruner, Mark W; Law, Barbi

    2015-07-01

    An identified limitation of existing reviews of physical activity interventions in school-aged youth is the lack of reporting on issues related to the translatability of the research into health promotion practice. This review used the Reach, Efficacy/Effectiveness, Adoption, Implementation and Maintenance framework to determine the extent to which intervention studies promoting physical activity in youth report on factors that inform generalizability across settings and populations. A systematic search for controlled interventions conducted within the last ten years identified 50 studies that met the selection criteria. Based on Reach, Efficacy/Effectiveness, Adoption, Implementation and Maintenance criteria, most of these studies focused on statistically significant findings and internal validity rather than on issues of external validity. Due to this lack of information, it is difficult to determine whether or not reportedly successful interventions are feasible and sustainable in an uncontrolled, real-world setting. Areas requiring further research include costs associated with recruitment and implementation, adoption rate, and representativeness of participants and settings. This review adds data to support recommendations that interventions promoting physical activity in youth should include assessment of adoption and implementation issues. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. 45 CFR 233.110 - Foster care maintenance and adoption assistance.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 2 2012-10-01 2012-10-01 false Foster care maintenance and adoption assistance. 233.110 Section 233.110 Public Welfare Regulations Relating to Public Welfare OFFICE OF FAMILY... maintenance and adoption assistance. (a) State plan requirements. A State plan under title IV-A of the Social...

  4. 45 CFR 233.110 - Foster care maintenance and adoption assistance.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 2 2014-10-01 2012-10-01 true Foster care maintenance and adoption assistance. 233.110 Section 233.110 Public Welfare Regulations Relating to Public Welfare OFFICE OF FAMILY... maintenance and adoption assistance. (a) State plan requirements. A State plan under title IV-A of the Social...

  5. 45 CFR 233.110 - Foster care maintenance and adoption assistance.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 2 2010-10-01 2010-10-01 false Foster care maintenance and adoption assistance. 233.110 Section 233.110 Public Welfare Regulations Relating to Public Welfare OFFICE OF FAMILY... maintenance and adoption assistance. (a) State plan requirements. A State plan under title IV-A of the Social...

  6. 45 CFR 233.110 - Foster care maintenance and adoption assistance.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 2 2011-10-01 2011-10-01 false Foster care maintenance and adoption assistance. 233.110 Section 233.110 Public Welfare Regulations Relating to Public Welfare OFFICE OF FAMILY... maintenance and adoption assistance. (a) State plan requirements. A State plan under title IV-A of the Social...

  7. 45 CFR 233.110 - Foster care maintenance and adoption assistance.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 2 2013-10-01 2012-10-01 true Foster care maintenance and adoption assistance. 233.110 Section 233.110 Public Welfare Regulations Relating to Public Welfare OFFICE OF FAMILY... maintenance and adoption assistance. (a) State plan requirements. A State plan under title IV-A of the Social...

  8. Anticipated affective consequences of physical activity adoption and maintenance.

    PubMed

    Dunton, Genevieve Fridlund; Vaughan, Elaine

    2008-11-01

    The expected emotional consequences of future actions are thought to play an important role in health behavior change. This research examined whether anticipated affective consequences of success and failure vary across stages of physical activity change and differentially predict physical activity adoption as compared to maintenance. Using a prospective design over a 3-month period, a community sample of 329 healthy, middle-aged adults were assessed at 2 time points. Anticipated positive and negative emotions, stage of behavior change (precontemplation [PC], contemplation [C], preparation [P], action [A], maintenance [M]), and level of physical activity. At baseline, anticipated positive emotions were greater in C versus PC, whereas anticipated negative emotions were greater in M versus A and in M versus P. Higher anticipated positive but not negative emotions predicted physical activity adoption and maintenance after 3 months. Although the expected affective consequences of future success and failure differentiated among individuals in the early and later stages of physical activity change, respectively; only the anticipated affective consequences of success predicted future behavior.

  9. Using Intervention Mapping for Program Design and Production of iCHAMPSS: An Online Decision Support System to Increase Adoption, Implementation, and Maintenance of Evidence-Based Sexual Health Programs

    PubMed Central

    Peskin, Melissa F.; Hernandez, Belinda F.; Gabay, Efrat K.; Cuccaro, Paula; Li, Dennis H.; Ratliff, Eric; Reed-Hirsch, Kelly; Rivera, Yanneth; Johnson-Baker, Kimberly; Emery, Susan Tortolero; Shegog, Ross

    2017-01-01

    In Texas and across the United States, unintended pregnancy, HIV, and sexually transmitted infections (STIs) among adolescents remain serious public health issues. Sexual risk-taking behaviors, including early sexual initiation, contribute to these public health problems. Over 35 sexual health evidence-based programs (EBPs) have been shown to reduce sexual risk behaviors and/or prevent teen pregnancies or STIs. Because more than half of these EBPs are designed for schools, they could reach and impact a considerable number of adolescents if implemented in these settings. Most schools across the U.S. and in Texas, however, do not implement these programs. U.S. school districts face many barriers to the successful dissemination (i.e., adoption, implementation, and maintenance) of sexual health EBPs, including lack of knowledge about EBPs and where to find them, perceived lack of support from school administrators and parents, lack of guidance regarding the adoption process, competing priorities, and lack of specialized training on sexual health. Therefore, this paper describes how we used intervention mapping (Steps 3 and 4, in particular), a systematic design framework that uses theory, empirical evidence, and input from the community to develop CHoosing And Maintaining Effective Programs for Sex Education in Schools (iCHAMPSS), an online decision support system to help school districts adopt, implement, and maintain sexual health EBPs. Guided by this systematic intervention design approach, iCHAMPSS has the potential to increase dissemination of sexual health EBPs in school settings. PMID:28848729

  10. Using Intervention Mapping for Program Design and Production of iCHAMPSS: An Online Decision Support System to Increase Adoption, Implementation, and Maintenance of Evidence-Based Sexual Health Programs.

    PubMed

    Peskin, Melissa F; Hernandez, Belinda F; Gabay, Efrat K; Cuccaro, Paula; Li, Dennis H; Ratliff, Eric; Reed-Hirsch, Kelly; Rivera, Yanneth; Johnson-Baker, Kimberly; Emery, Susan Tortolero; Shegog, Ross

    2017-01-01

    In Texas and across the United States, unintended pregnancy, HIV, and sexually transmitted infections (STIs) among adolescents remain serious public health issues. Sexual risk-taking behaviors, including early sexual initiation, contribute to these public health problems. Over 35 sexual health evidence-based programs (EBPs) have been shown to reduce sexual risk behaviors and/or prevent teen pregnancies or STIs. Because more than half of these EBPs are designed for schools, they could reach and impact a considerable number of adolescents if implemented in these settings. Most schools across the U.S. and in Texas, however, do not implement these programs. U.S. school districts face many barriers to the successful dissemination (i.e., adoption, implementation, and maintenance) of sexual health EBPs, including lack of knowledge about EBPs and where to find them, perceived lack of support from school administrators and parents, lack of guidance regarding the adoption process, competing priorities, and lack of specialized training on sexual health. Therefore, this paper describes how we used intervention mapping (Steps 3 and 4, in particular), a systematic design framework that uses theory, empirical evidence, and input from the community to develop CH oosing A nd M aintaining Effective P rograms for S ex Education in S chools ( iCHAMPSS ), an online decision support system to help school districts adopt, implement, and maintain sexual health EBPs. Guided by this systematic intervention design approach, iCHAMPSS has the potential to increase dissemination of sexual health EBPs in school settings.

  11. Adoption, reach, and implementation of a cancer education intervention in African American churches.

    PubMed

    Santos, Sherie Lou Zara; Tagai, Erin K; Scheirer, Mary Ann; Bowie, Janice; Haider, Muhiuddin; Slade, Jimmie; Wang, Min Qi; Holt, Cheryl L

    2017-03-14

    Use of technology is increasing in health promotion and has continued growth potential in intervention research. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this paper reports on the adoption, reach, and implementation of Project HEAL (Health through Early Awareness and Learning)-a community-based implementation trial of a cancer educational intervention in 14 African American churches. We compare adoption, reach, and implementation at the organizational and participant level for churches in which lay peer community health advisors (CHAs) were trained using traditional classroom didactic methods compared with a new online system. Fifteen churches were randomized to one of two study groups in which two CHAs per church were trained through either classroom ("Traditional"; n = 16 CHAs in 8 churches) or web-based ("Technology"; n = 14 CHAs in 7 churches) training methods. Once trained and certified, all CHAs conducted a series of three group educational workshops in their churches on cancer early detection (breast, prostate, and colorectal). Adoption, reach, and implementation were assessed using multiple data sources including church-level data, participant engagement in the workshops, and study staff observations of CHA performance. The project had a 41% overall adoption rate at the church level. In terms of reach, a total of 375 participants enrolled in Project HEAL-226 participants in the Traditional group (43% reach) and 149 in the Technology group (21% reach; p < .10). Implementation was evaluated in terms of adherence, dosage, and quality. All churches fully completed the three workshops; however, the Traditional churches took somewhat longer (M = 84 days) to complete the workshop series than churches in the Technology group (M = 64 days). Other implementation outcomes were comparable between both the Traditional and Technology groups (p > .05). Overall, the Project HEAL

  12. Views of policy makers and health promotion professionals on factors facilitating implementation and maintenance of interventions and policies promoting physical activity and healthy eating: results of the DEDIPAC project.

    PubMed

    Muellmann, Saskia; Steenbock, Berit; De Cocker, Katrien; De Craemer, Marieke; Hayes, Catherine; O'Shea, Miriam P; Horodyska, Karolina; Bell, Justyna; Luszczynska, Aleksandra; Roos, Gun; Langøien, Lars Jørun; Rugseth, Gro; Terragni, Laura; De Bourdeaudhuij, Ilse; Brug, Johannes; Pischke, Claudia R

    2017-12-06

    The uptake, implementation, and maintenance of effective interventions promoting physical activity (PA) and a healthy diet and the implementation of policies targeting these behaviors are processes not well understood. We aimed to gain a better understanding of what health promotion professionals and policy makers think are important factors facilitating adoption, implementation, and maintenance of multi-level interventions and policies promoting healthy eating and PA in Belgium, Germany, Ireland, Norway, and Poland. Six interventions and six policies were identified based on pre-defined criteria. Forty semi-structured interviews were conducted with stakeholders from various sectors to elicit information on factors impacting adoption, implementation, and maintenance of these interventions and policies. All interview transcripts were coded in NVivo, using a common categorization matrix. Coding in the respective countries was done by one researcher and validated by a second researcher. Active involvement of relevant stakeholders and good communication between coordinating organizations were described as important factors contributing to successful adoption and implementation of both interventions and policies. Additional facilitating factors included sufficient training of staff and tailoring of materials to match needs of various target groups. The respondents indicated that maintenance of implemented interventions/policies depended on whether they were embedded in existing or newly created organizational structures in different settings and whether continued funding was secured. Despite considerable heterogeneity of interventions and health policies in the five countries, stakeholders across these countries identify similar factors facilitating adoption, implementation, and maintenance of these interventions and policies.

  13. Designing Interventions that Last: A Classification of Environmental Behaviors in Relation to the Activities, Costs, and Effort Involved for Adoption and Maintenance

    PubMed Central

    Moore, Harriet E.; Boldero, Jennifer

    2017-01-01

    Policy makers draw on behavioral research to design interventions that promote the voluntary adoption of environmental behavior in societies. Many environmental behaviors will only be effective if they are maintained over the long-term. In the context of climate change and concerns about future water security, behaviors that involve reducing energy consumption and improving water quality must be continued indefinitely to mitigate global warming and preserve scarce resources. Previous reviews of environmental behavior have focused exclusively on factors related to adoption. This review investigates the factors that influence both adoption and maintenance, and presents a classification of environmental behaviors in terms of the activities, costs, and effort required for both adoption and maintenance. Three categories of behavior are suggested. One-off behaviors involve performing an activity once, such as purchasing an energy efficient washing machine, or signing a petition. Continuous behaviors involve the performance of the same set of behaviors for adoption and for maintenance, such as curbside recycling. Dynamic behaviors involve the performance of different behaviors for adoption and maintenance, such as revegetation. Behaviors can also be classified into four categories related to cost and effort: those that involve little cost and effort for adoption and maintenance, those that involve moderate cost and effort for adoption and maintenance, those that involve a high cost or effort for adoption and less for maintenance, and those that involve less cost or effort for adoption and a higher amount for maintenance. In order to design interventions that last, policy makers should consider the factors that influence the maintenance as well as the adoption of environmental behaviors. PMID:29163265

  14. Hospital IT adoption strategies associated with implementation success: implications for achieving meaningful use.

    PubMed

    Ford, Eric W; Menachemi, Nir; Huerta, Timothy R; Yu, Feliciano

    2010-01-01

    Health systems are facing significant pressure to either implement health information technology (HIT) systems that have "certified" electronic health record applications and that fulfill the federal government's definition of "meaningful use" or risk substantial financial penalties in the near future. To this end, hospitals have adopted one of three strategies, described as "best of breed," "best of suite," and "single vendor," to meet organizational and regulatory demands. The single-vendor strategy is used by the simple majority of U.S. hospitals, but is it the most effective mode for achieving full implementation? Moreover, what are the implications of adopting this strategy for achieving meaningful use? The simple answer to the first question is that the hospitals using the hybrid best of suite strategy had fully implemented HIT systems in significantly greater proportions than did hospitals employing either of the other strategies. Nonprofit and system-affiliated hospitals were more likely to have fully implemented their HIT systems. In addition, increased health maintenance organization market penetration rates were positively correlated with complete implementation rates. These results have ongoing implications for achieving meaningful use in the near term. The federal government's rewards and incentives program related to the meaningful use of HIT in hospitals has created an organizational imperative to implement such systems. For hospitals that have not begun systemwide implementation, pursuing a best of suite strategy may provide the greatest chance for achieving all or some of the meaningful use targets in the near term or at least avoiding future penalties scheduled to begin in 2015.

  15. Adoption, reach, implementation, and maintenance of a behavioral and mental health assessment in primary care.

    PubMed

    Krist, Alex H; Phillips, Siobhan M; Sabo, Roy T; Balasubramanian, Bijal A; Heurtin-Roberts, Suzanne; Ory, Marcia G; Johnson, Sallie Beth; Sheinfeld-Gorin, Sherri N; Estabrooks, Paul A; Ritzwoller, Debra P; Glasgow, Russell E

    2014-01-01

    Guidelines recommend screening patients for unhealthy behaviors and mental health concerns. Health risk assessments can systematically identify patient needs and trigger care. This study seeks to evaluate whether primary care practices can routinely implement such assessments into routine care. As part of a cluster-randomized pragmatic trial, 9 diverse primary care practices implemented My Own Health Report (MOHR)-an electronic or paper-based health behavior and mental health assessment and feedback system paired with counseling and goal setting. We observed how practices integrated MOHR into their workflows, what additional practice staff time it required, and what percentage of patients completed a MOHR assessment (Reach). Most practices approached (60%) agreed to adopt MOHR. How they implemented MOHR depended on practice resources, informatics capacity, and patient characteristics. Three practices mailed patients invitations to complete MOHR on the Web, 1 called patients and completed MOHR over the telephone, 1 had patients complete MOHR on paper in the office, and 4 had staff help patients complete MOHR on the Web in the office. Overall, 3,591 patients were approached and 1,782 completed MOHR (Reach = 49.6%). Reach varied by implementation strategy with higher reach when MOHR was completed by staff than by patients (71.2% vs 30.2%, P <.001). No practices were able to sustain the complete MOHR assessment without adaptations after study completion. Fielding MOHR increased staff and clinician time an average of 28 minutes per visit. Primary care practices can implement health behavior and mental health assessments, but counseling patients effectively requires effort. Practices will need more support to implement and sustain assessments. © 2014 Annals of Family Medicine, Inc.

  16. Dynamics of Implementation and Maintenance of Organizational Health Interventions.

    PubMed

    Jalali, Mohammad S; Rahmandad, Hazhir; Bullock, Sally Lawrence; Ammerman, Alice

    2017-08-15

    In this study, we present case studies to explore the dynamics of implementation and maintenance of health interventions. We analyze how specific interventions are built and eroded, how the building and erosion mechanisms are interconnected, and why we can see significantly different erosion rates across otherwise similar organizations. We use multiple comparative obesity prevention case studies to provide empirical information on the mechanisms of interest, and use qualitative systems modeling to integrate our evolving understanding into an internally consistent and transparent theory of the phenomenon. Our preliminary results identify reinforcing feedback mechanisms, including design of organizational processes, motivation of stakeholders, and communication among stakeholders, which influence implementation and maintenance of intervention components. Over time, these feedback mechanisms may drive a wedge between otherwise similar organizations, leading to distinct configurations of implementation and maintenance processes.

  17. Dynamics of Implementation and Maintenance of Organizational Health Interventions

    PubMed Central

    Rahmandad, Hazhir; Bullock, Sally Lawrence; Ammerman, Alice

    2017-01-01

    In this study, we present case studies to explore the dynamics of implementation and maintenance of health interventions. We analyze how specific interventions are built and eroded, how the building and erosion mechanisms are interconnected, and why we can see significantly different erosion rates across otherwise similar organizations. We use multiple comparative obesity prevention case studies to provide empirical information on the mechanisms of interest, and use qualitative systems modeling to integrate our evolving understanding into an internally consistent and transparent theory of the phenomenon. Our preliminary results identify reinforcing feedback mechanisms, including design of organizational processes, motivation of stakeholders, and communication among stakeholders, which influence implementation and maintenance of intervention components. Over time, these feedback mechanisms may drive a wedge between otherwise similar organizations, leading to distinct configurations of implementation and maintenance processes. PMID:28809807

  18. 45 CFR 1356.40 - Adoption assistance program: Administrative requirements to implement section 473 of the Act.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...(s) in determining eligibility for adoption assistance payments. (d) In the event an adoptive family... SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES REQUIREMENTS APPLICABLE TO TITLE IV-E § 1356.40 Adoption assistance...

  19. Implementation, adoption, and utility of family health history risk assessment in diverse care settings: evaluating implementation processes and impact with an implementation framework.

    PubMed

    Wu, R Ryanne; Myers, Rachel A; Sperber, Nina; Voils, Corrine I; Neuner, Joan; McCarty, Catherine A; Haller, Irina V; Harry, Melissa; Fulda, Kimberly G; Cross, Deanna; Dimmock, David; Rakhra-Burris, Teji; Buchanan, Adam H; Ginsburg, Geoffrey S; Orlando, Lori A

    2018-06-06

    This paper describes the implementation outcomes associated with integrating a family health history-based risk assessment and clinical decision support platform within primary care clinics at four diverse healthcare systems. A type III hybrid implementation-effectiveness trial. Uptake and implementation processes were evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. One hundred (58%) primary care providers and 2514 (7.8%) adult patients enrolled. Enrolled patients were 69% female, 22% minority, and 32% Medicare/Medicaid. Compared with their respective clinic's population, patient-participants were more likely to be female (69 vs. 59%), older (mean age 57 vs. 49), and Caucasian (88 vs. 69%) (all p values <0.001). Female (81.3% of females vs. 78.5% of males, p value = 0.018) and Caucasian (Caucasians 90.4% vs. minority 84.1%, p value = 0.02) patient-participants were more likely to complete the study once enrolled. Patient-participant survey responses indicated MeTree was easy to use (95%), and patient-participants would recommend it to family/friends (91%). Minorities and those with less education reported greatest benefit. Enrolled providers reflected demographics of underlying provider population. Family health history-based risk assessment can be effectively implemented in diverse primary care settings and can effectively engage patients and providers. Future research should focus on finding better ways to engage young adults, males, and minorities in preventive healthcare.

  20. Aviation Maintenance Technology. General. Curriculum Implementation Guide.

    ERIC Educational Resources Information Center

    Moore, John, Jr.; And Others

    This curriculum implementation guide is a scope and sequence for the general section of a course in aviation maintenance technology. The course materials were prepared through a cooperative effort of airframe and powerplant mechanics, general aviation industry representatives, Federal Aviation Administration representatives, and vocational…

  1. 40 CFR 52.786 - Inspection and maintenance program.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ..., commitment to timely adopt and implement enhanced inspection and maintenance (I/M) rules for Lake and Porter... parts of the program to certify compliance. (e) After July 1, 1976, the State of Indiana, County of... pertaining to the development and adoption of necessary authority for the I/M program. This disapproval...

  2. 40 CFR 52.786 - Inspection and maintenance program.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ..., commitment to timely adopt and implement enhanced inspection and maintenance (I/M) rules for Lake and Porter... parts of the program to certify compliance. (e) After July 1, 1976, the State of Indiana, County of... pertaining to the development and adoption of necessary authority for the I/M program. This disapproval...

  3. Qualitative study on maintenance management in Moroccan industries

    NASA Astrophysics Data System (ADS)

    Naji, Amal; El Oumami, Mohamed; Bouksour, Otmane; Beidouri, Zitouni

    2018-05-01

    Maintenance management is, and has been studied in depth, especially for strategies to be implemented in industry, even though, authors note that there is a gap between literature and management adopted by industries. In this paper, we present a qualitative study in five Moroccan industries to investigate “how maintenance is managed” rather than “how it should be”. The questionnaire utilized for the study consists on semi-structured and open-ended questions. We consider factors and variables related to maintenance management and we explore the relationships between those factors. The original contribution of this paper is to provide a «real view »about maintenance management in Moroccan industries, which could help to improve understanding of barriers to implementing maintenance strategy.

  4. Evaluation System and Implementation Countermeasure of Automobile Green Maintenance

    NASA Astrophysics Data System (ADS)

    Zhang, Fei; Xie, Xinxin; Yan, Chaoyong

    2018-01-01

    Green maintenance research is in the beginning of our country, the work is being explored. Based on the existing research results at home and abroad, this paper learns and draws lessons from the experiences and lessons of foreign advanced countries and domestic advanced enterprises. In the face of the challenges brought by economic development and energy saving and emission reduction, this paper discusses the green maintenance theory and security system, And the research status of green maintenance content and system at home and abroad, through the deletion and selection of green maintenance index, through the AHP method to determine the green evaluation criteria, and the introduction of C equivalent evaluation system, the use of fuzzy synthesis Evaluation method to build a green maintenance evaluation model, and the actual validation, put forward the implementation of green maintenance feasibility programs and related security recommendations, vehicle maintenance enterprises to carry out green maintenance, improve business efficiency and reduce environmental management costs to provide theoretical basis. And to achieve effective reduction of environmental pollution, reduce maintenance costs of the target, a reasonable promotion of maintenance and environmental protection and sustainable development. Promote green maintenance from research to practice, from the laboratory to the maintenance of enterprises, from the pilot to the overall development and transformation.

  5. Tales of Refusal, Adoption, and Maintenance: Evidence-Based Substance Abuse Prevention via School-Extension Collaborations

    ERIC Educational Resources Information Center

    St. Pierre, Tena L.; Kaltreider, D. Lynne

    2004-01-01

    Despite availability of empirically supported school-based substance abuse prevention programs, adoption and implementation fidelity of such programs appear to be low. A replicated case study was conducted to investigate school adoption and implementation processes of the EXSELS model (Project ALERT delivered by program leaders through Cooperative…

  6. Arts Curriculum Implementation: "Adopt and Adapt" as Policy Translation

    ERIC Educational Resources Information Center

    Chapman, Sian; Wright, Peter; Pascoe, Robin

    2018-01-01

    This article examines macro, meso, and micro understandings of policy enactment within Western Australian primary school arts education where a new national arts curriculum is being revised and implemented through a process colloquially known as "adopt and adapt." This article focuses on how a government-led implementation policy has…

  7. 45 CFR 1356.21 - Foster care maintenance payments program implementation requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... be filed within 60 days of the judicial determination that the child is an abandoned infant; or, (iii... (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND...

  8. 45 CFR 1356.21 - Foster care maintenance payments program implementation requirements.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... be filed within 60 days of the judicial determination that the child is an abandoned infant; or, (iii... (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND...

  9. Implementation of a Computerized Maintenance Management System

    NASA Technical Reports Server (NTRS)

    Shen, Yong-Hong; Askari, Bruce

    1994-01-01

    A primer Computerized Maintenance Management System (CMMS) has been established for NASA Ames pressure component certification program. The CMMS takes full advantage of the latest computer technology and SQL relational database to perform periodic services for vital pressure components. The Ames certification program is briefly described and the aspects of the CMMS implementation are discussed as they are related to the certification objectives.

  10. 45 CFR 1356.21 - Foster care maintenance payments program implementation requirements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND... maintain the family unit and prevent the unnecessary removal of a child from his/her home, as long as the...

  11. 45 CFR 1356.21 - Foster care maintenance payments program implementation requirements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND... maintain the family unit and prevent the unnecessary removal of a child from his/her home, as long as the...

  12. 45 CFR 1356.21 - Foster care maintenance payments program implementation requirements.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND... maintain the family unit and prevent the unnecessary removal of a child from his/her home, as long as the...

  13. 40 CFR 52.786 - Inspection and maintenance program.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38, Jan. 2, 1981; 51 FR 40677, Nov. 7, 1986; 55 FR 31052, July 31, 1990; 58 FR 62535, Nov. 29, 1993] ..., commitment to timely adopt and implement enhanced inspection and maintenance (I/M) rules for Lake and Porter...

  14. Adoption and implementation of mandated diabetes registries by community health centers.

    PubMed

    Helfrich, Christian D; Savitz, Lucy A; Swiger, Kathleen D; Weiner, Bryan J

    2007-07-01

    Innovations adopted by healthcare organizations are often externally mandated. However, few studies examine how mandated innovations progress from adoption to sustained effective use. This study uses Rogers's model of organizational innovation to explore community health centers' (CHCs') mandated adoption and implementation of disease registries in the federal Health Disparities Collaborative (HDC). Case studies were conducted on six CHCs in North Carolina participating in the HDC on type 2 diabetes mellitus. Data were collected from semistructured interviews with key staff, and from site-level and individual-level surveys. Although disease registry adoption and implementation were mandated, CHCs exercised prerogative in the timing of registry adoption and the functions emphasized. Executive and medical director involvement, often directly on the HDC teams, was the single most salient influence on adoption and implementation. Staff members' personal experience with diabetes also provided context and gave registries added significance. Participants lauded HDC's technique of small-scale, rapid-cycle change, but valued even more shared problem solving and peer learning among HDC teams. However, lack of cross-training, inadequate resources, and staff turnover posed serious threats to sustainability of the registries. The present study illustrates the usefulness of Rogers's model for studying mandated innovation and highlights several key factors, including direct, personal involvement of organizational leadership, and shared problem solving and peer learning facilitated by the HDC. However, these six CHCs elected to participate early in the HDC, and may not be typical of North Carolina's remaining CHCs. Furthermore, most face important long-term challenges that threaten routinization.

  15. Pricing Health Behavior Interventions to Promote Adoption

    PubMed Central

    Ribisl, Kurt M.; Leeman, Jennifer; Glasser, Allison M.

    2015-01-01

    The relatively high cost of delivering many public health interventions limits their potential for broad public impact by reducing their likelihood of adoption and maintenance over time. Practitioners identify cost as the primary factor for which interventions they select to implement, but researchers rarely disseminate cost information or consider its importance when developing new interventions. A new approach is proposed, whereby intervention developers assess what individuals and agencies adopting their interventions are willing to pay and then design interventions that are responsive to this price range. The ultimate goal is to develop effective and affordable interventions, called lean interventions, which are widely adopted and have greater public health impact. PMID:24842743

  16. Guide for Implementing State Adopted Texts, 1969-1970.

    ERIC Educational Resources Information Center

    Sanchis, Robert A.; And Others

    The materials and procedures used by the Fountain Valley School District, California, to implement their reading program are described. Included are a description of the reading principles on which the program is based and information on methodology and organizational procedures. Also described are lists of state-adopted texts, summaries of basic…

  17. Barriers to adopting and implementing local-level tobacco control policies.

    PubMed

    Satterlund, Travis D; Cassady, Diana; Treiber, Jeanette; Lemp, Cathy

    2011-08-01

    Although California communities have been relatively successful in adopting and implementing a wide range of local tobacco control policies, the process has not been without its setbacks and barriers. Little is known about local policy adoption, and this paper examines these processes related to adopting and implementing outdoor smoke-free policies, focusing on the major barriers faced by local-level tobacco control organizations in this process. Ninety-six projects funded by the California Tobacco Control Program submitted final evaluation reports pertaining to an outdoor smoking objective, and the reports from these projects were analyzed. The barriers were grouped in three primary areas: politically polarizing barriers, organizational barriers, and local political orientation. The barriers identified in this study underscore the need for an organized action plan in adopting local tobacco policy. The authors also suggest potential strategies to offset the barriers, including: (1) having a "champion" who helps to carry an objective forward; (2) tapping into a pool of youth volunteers; (3) collecting and using local data as a persuasive tool; (4) educating the community in smoke-free policy efforts; (5) working strategically within the local political climate; and (6) demonstrating to policymakers the constituent support for proposed policy.

  18. Evaluation of physical activity interventions in children via the reach, efficacy/effectiveness, adoption, implementation, and maintenance (RE-AIM) framework: A systematic review of randomized and non-randomized trials.

    PubMed

    McGoey, Tara; Root, Zach; Bruner, Mark W; Law, Barbi

    2016-01-01

    Existing reviews of physical activity (PA) interventions designed to increase PA behavior exclusively in children (ages 5 to 11years) focus primarily on the efficacy (e.g., internal validity) of the interventions without addressing the applicability of the results in terms of generalizability and translatability (e.g., external validity). This review used the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance) framework to measure the degree to which randomized and non-randomized PA interventions in children report on internal and external validity factors. A systematic search for controlled interventions conducted within the past 12years identified 78 studies that met the inclusion criteria. Based on the RE-AIM criteria, most of the studies focused on elements of internal validity (e.g., sample size, intervention location and efficacy/effectiveness) with minimal reporting of external validity indicators (e.g., representativeness of participants, start-up costs, protocol fidelity and sustainability). Results of this RE-AIM review emphasize the need for future PA interventions in children to report on real-world challenges and limitations, and to highlight considerations for translating evidence-based results into health promotion practice. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Knowledge barriers to PACS adoption and implementation in hospitals.

    PubMed

    Paré, Guy; Trudel, Marie-Claude

    2007-01-01

    Drawing on the classical theory of diffusion of innovations advanced by Rogers [E.M. Rogers, Diffusion of Innovations, 4th ed., Free Press, New York, NY, 1995] and on the theory of barriers to innovation [P. Attewell, Technology diffusion and organizational learning: the case of business computing. Organ. Sci. 3 (1992) 1-19; H. Tanriverdi, C.S. Iacono, Knowledge barriers to diffusion of telemedicine. Proceedings of the 20th International Conference on Information Systems, Charlotte, NC, 1999, pp. 39-50; S. Nambisan, Y.-M. Wang, Roadblocks to web technology adoption? Commun. ACM, 42 (1) (1999) 98-101], this study seeks a better understanding of challenges faced in PACS implementations in hospitals and of the strategies required to ensure their success. To attain this objective, we describe and analyze the process used to adopt and implement PACS at two Canadian hospitals. Our findings clearly demonstrate the importance of treating any PACS deployment not simply as a rollout of new technology but as a project that will transform the organization. Proponents of these projects must not lose sight of the fact that, even if technological complexity represents a significant issue, it must not garner all the project team's attention. This situation is even more dangerous, inasmuch as the greatest risk to the implementation often lies elsewhere. It would also appear to be crucial to anticipate and address organizational and behavioral challenges from the very first phase of the innovation process, in order to ensure that all participants will be committed to the project. In order to maximize the likelihood of PACS success, it appears crucial to adopt a proactive implementation strategy, one that takes into consideration all the technical, economic, organizational, and human factors, and does so from the first phase of the innovation process.

  20. Why sub-Saharan Africa lags in electronic health record adoption and possible strategies to increase its adoption in this region

    PubMed Central

    Odekunle, Florence Femi; Odekunle, Raphael Oluseun; Shankar, Srinivasan

    2017-01-01

    Poor health information system has been identified as a major challenge in the health-care system in many developing countries including sub-Saharan African countries. Electronic health record (EHR) has been shown as an important tool to improve access to patient information with attendance improved quality of care. However, EHR has not been widely implemented/adopted in sub-Saharan Africa. This study sought to identify factors that affect the adoption of an EHR in sub-Saharan Africa and strategies to improve its adoption in this region. A comprehensive literature search was conducted on three electronic databases: PubMed, Medline, and Google Scholar. Articles of interest were those published in English that contained information on factors that limit the adoption of an EHR as well as strategies that improve its adoption in sub-Saharan African countries. The available evidence indicated that there were many factors that hindered the widespread adoption of an EHR in sub-Saharan Africa. These were high costs of procurement and maintenance of the EHR system, lack of financial incentives and priorities, poor electricity supply and internet connectivity, and primary user’s limited computer skills. However, strategies such as implementation planning, financial supports, appropriate EHR system selection, training of primary users, and the adoption of the phased implementation process have been identified to facilitate the use of an EHR. Wide adoption of an EHR in sub-Saharan Africa region requires a lot more effort than what is assumed because of the current poor level of technological development, lack of required computer skills, and limited resources. PMID:29085270

  1. Implementation Science: Understanding and Finding Solutions to Variation in Program Implementation

    ERIC Educational Resources Information Center

    Nordstrum, Lee E.; LeMahieu, Paul G.; Berrena, Elaine

    2017-01-01

    Purpose: This paper is one of seven in this volume elaborating upon different approaches to quality improvement in education. This paper aims to delineate a methodology called Implementation Science, focusing on methods to enhance the reach, adoption, use and maintenance of innovations and discoveries in diverse education contexts.…

  2. HIV Pre-exposure Prophylaxis Program Implementation Using Intervention Mapping.

    PubMed

    Flash, Charlene A; Frost, Elizabeth L T; Giordano, Thomas P; Amico, K Rivet; Cully, Jeffrey A; Markham, Christine M

    2018-04-01

    HIV pre-exposure prophylaxis has been proven to be an effective tool in HIV prevention. However, numerous barriers still exist in pre-exposure prophylaxis implementation. The framework of Intervention Mapping was used from August 2016 to October 2017 to describe the process of adoption, implementation, and maintenance of an HIV prevention program from 2012 through 2017 in Houston, Texas, that is nested within a county health system HIV clinic. Using the tasks outlined in the Intervention Mapping framework, potential program implementers were identified, outcomes and performance objectives established, matrices of change objectives created, and methods and practical applications formed. Results include the formation of three matrices that document program outcomes, change agents involved in the process, and the determinants needed to facilitate program adoption, implementation, and maintenance. Key features that facilitated successful program adoption and implementation were obtaining leadership buy-in, leveraging existing resources, systematic evaluation of operations, ongoing education for both clinical and nonclinical staff, and attention to emergent issues during launch. The utilization of Intervention Mapping to delineate the program planning steps can provide a model for pre-exposure prophylaxis implementation in other settings. Copyright © 2018. Published by Elsevier Inc.

  3. Adopting and implementing nutrition guidelines in recreational facilities: tensions between public health and corporate profitability.

    PubMed

    Olstad, Dana Lee; Raine, Kim D; McCargar, Linda J

    2013-05-01

    Little is known about how public entities can partner with industry to achieve public health goals. We investigated industry's perspective of factors that influenced their adoption and implementation of voluntary, government-issued nutrition guidelines (Alberta Nutrition Guidelines for Children and Youth, ANGCY) in recreational facilities. In-depth semi-structured interviews were conducted. Data were analysed using directed content analysis. Food services in recreational facilities. Seven managers from industry participated; five from companies that had adopted and implemented the ANGCY (adopters) in recreational facilities and two from companies that had not (non-adopters). Industry views nutrition guidelines through the lens of profitability. Non-adopters were unwilling to implement the ANGCY for fear of sacrificing short-term profitability, whereas adopters adhered to them in an attempt to position themselves for long-term profitability. Adopters faced barriers including few resources, no training, complex guidelines, low availability of and demand for ANGCY-compliant products, competitive pressures and substantial declines in revenue. Managers believed widespread voluntary adoption of the ANGCY was unlikely without government incentives and/or a mandate, as the environmental context for voluntary action was poor. All managers supported government-mandated implementation of the ANGCY to level the playing field upon which companies compete. Public-private partnerships in recreational facilities can embrace public health goals in the short term, provided industry perceives potential for long-term financial gain. Widespread uptake of voluntary nutrition guidelines in this setting is unlikely, however, as market mechanisms do not encourage industry to sell and promote healthier options. Government legislation may therefore be warranted.

  4. Translational research: bridging the gap between long-term weight loss maintenance research and practice.

    PubMed

    Akers, Jeremy D; Estabrooks, Paul A; Davy, Brenda M

    2010-10-01

    The number of US adults classified as overweight or obese has dramatically increased in the past 25 years, resulting in a significant body of research addressing weight loss and weight loss maintenance. However, little is known about the potential of weight loss maintenance interventions to be translated into actual practice settings. Thus, the purpose of this article is to determine the translation potential of published weight loss maintenance intervention studies by determining the extent to which they report information across the reach, efficacy/effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. A secondary purpose is to provide recommendations for research based on these findings. To identify relevant research articles, a literature search was conducted using four databases; 19 weight loss maintenance intervention studies were identified for inclusion. Each article was evaluated using the RE-AIM Coding Sheet for Publications to determine the extent to which dimensions related to internal and external validity were reported. Approximately half of the articles provided information addressing three RE-AIM dimensions, yet only a quarter provided information addressing adoption and maintenance. Significant gaps were identified in understanding external validity, and metrics that could facilitate the translation of these interventions from research to practice are presented. Based upon this review, it is unknown how effective weight loss maintenance interventions could be in real-world situations, such as clinical or community practice settings. Future studies should be planned to address how weight loss maintenance intervention programs will be adopted and maintained, with special attention to costs for participants and for program implementation. Copyright © 2010 American Dietetic Association. Published by Elsevier Inc. All rights reserved.

  5. Factors influencing organizational adoption and implementation of clinical genetic services.

    PubMed

    Hamilton, Alison B; Oishi, Sabine; Yano, Elizabeth M; Gammage, Cynthia E; Marshall, Nell J; Scheuner, Maren T

    2014-03-01

    We sought to identify characteristics of genetic services that facilitate or hinder adoption. We conducted semi-structured key informant interviews in five clinical specialties (primary care, medical oncology, neurology, cardiology, pathology/laboratory medicine) within 13 Veterans Administration facilities. Genetic services (defined as genetic testing and consultation) were not typically characterized by informants (n = 64) as advantageous for their facilities or their patients; compatible with organizational norms of low cost and high clinical impact; or applicable to patient populations or norms of clinical care. Furthermore, genetic services had not been systematically adopted in most facilities because of their complexity: knowledge of and expertise on genetic testing was limited, and organizational barriers to utilization of genetic services were formidable. The few facilities that had some success with implementation of genetic services had knowledgeable clinicians interested in developing services and organizational-level facilitators such as accessible genetic test-ordering processes. Adoption and implementation of genetic services will require a multilevel effort that includes education of providers and administrators, opportunities for observing the benefits of genetic medicine, strategies for reducing the complexity of genomic medicine, expanded strategies for accessing genetics expertise and streamlining utilization, and resources dedicated to assessing the value of genetic information for the outcomes that matter to health-care organizations.

  6. More than just a question of technology: factors related to hospitals' adoption and implementation of health information exchange.

    PubMed

    Vest, Joshua R

    2010-12-01

    The provisions of the American Recovery & Reinvestment Act increased the likelihood of more widespread health information exchange (HIE), the electronic transfer of patient-level information between organizations, by essentially mandating the use of electronic health record systems. While important, the sparse body of research on HIE efforts and anecdotal reports indicate the barriers to HIE adoption and implementation include factors beyond simply the presence or absence of a specific technology. This paper examines those technological, organizational, and environmental factors that are associated with both HIE adoption and implementation in a sample of 4830 U.S. hospitals. Factors associated with adoption and implementation were modeled using random-intercept logistic regression. Consistent with a perspective that adoption and implementation are different phenomena, many factors associated with an increased odds of adoption, were unassociated with implementation and vice versa. Non-profit status, public hospitals, more live and operation applications, more emergency room visits, network membership, and the presence of physician portals all increased hospitals' odds of HIE adoption. However, only network membership increased the odds of HIE implementation, whereas competition decreased those odds significantly. This study agreed with earlier case-studies and anecdotal reports that factors beyond technology were important to both adoption and implementation. While current U.S. policy on healthcare information technology adoption focuses on technological barriers, many other non-technological factors may ultimately hinder effective HIE. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  7. 76 FR 36471 - Approval and Promulgation of Air Quality Implementation Plans; Virginia; Adoption of the Revised...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-22

    ... Promulgation of Air Quality Implementation Plans; Virginia; Adoption of the Revised Nitrogen Dioxide Standard... of adding the new 1-hour nitrogen dioxide (NO 2 ) standard at a level of 100 parts per billion (ppb... Promulgation of Air Quality Implementation Plans; Virginia; Adoption of the Revised Nitrogen Dioxide Standards...

  8. Factors Influencing Adoption and Implementation of Cooking with Kids, an Experiential School-Based Nutrition Education Curriculum

    ERIC Educational Resources Information Center

    Diker, Ann; Walters, Lynn M.; Cunningham-Sabo, Leslie; Baker, Susan S.

    2011-01-01

    Little research has been conducted to examine factors leading to adoption and implementation of nutrition education curricula. Data from two Web-based surveys (n = 313) and 27 interviews were used to explore how Diffusion of Innovations' perceived attributes contributed to adoption and implementation of Cooking with Kids (CWK) food and nutrition…

  9. EVALUATION OF THE IMPLEMENTATION OF OPERATIONS AND MAINTENANCE PROGRAMS IN NEW JERSEY SCHOOLS

    EPA Science Inventory

    The Asbestos Hazard Emergency Response Act (AHERA) required all schools to develop and implement an asbestos management plan (AMP). The key component of the AMP is the operations and maintenance (O&M) program. A study was conducted to evaluate the implementation of O&M programs a...

  10. Improving children's nutrition environments: A survey of adoption and implementation of nutrition guidelines in recreational facilities

    PubMed Central

    2011-01-01

    Background Although the mandate of recreational facilities is to enhance well-being, many offer foods inconsistent with recommendations for healthy eating. Little is known regarding recreational facility food environments and how they might be improved, as few studies exist. The Alberta Nutrition Guidelines for Children and Youth (ANGCY) are intended to ensure access to healthy food choices in schools, childcare and recreational facilities. This study investigated awareness, adoption and implementation of the ANGCY among recreational facilities in Alberta, Canada, one year following their release. Methods A cross-sectional telephone survey was conducted from June - December, 2009 (n = 151) with managers of publicly funded recreational facilities that served food. The questionnaire included 10 closed and 7 open ended questions to assess the organizational priority for healthy eating, awareness, adoption and implementation of the ANGCY. Chi-squared tests examined quantitative variables, while qualitative data were analysed using directed content analysis. Greenhalgh's model of diffusion of complex innovations within health service organizations constituted the theoretical framework for the study. Results One half of respondents had heard of the ANGCY, however their knowledge of them was limited. Although 51% of facilities had made changes to improve the nutritional quality of foods offered in the past year, only a small fraction (11%) of these changes were motivated by the ANGCY. At the time of the survey, 14% of facilities had adopted the ANGCY and 6% had implemented them. Barriers to adoption and implementation were primarily related to perceived negative attributes of the ANGCY, the inner (organizational) context, and negative feedback received during the implementation process. Managers strongly perceived that implementing nutrition guidelines would limit their profit-making ability. Conclusions If fully adopted and implemented, the ANGCY have the potential to

  11. Buildings Lean Maintenance Implementation Model

    NASA Astrophysics Data System (ADS)

    Abreu, Antonio; Calado, João; Requeijo, José

    2016-11-01

    Nowadays, companies in global markets have to achieve high levels of performance and competitiveness to stay "alive".Within this assumption, the building maintenance cannot be done in a casual and improvised way due to the costs related. Starting with some discussion about lean management and building maintenance, this paper introduces a model to support the Lean Building Maintenance (LBM) approach. Finally based on a real case study from a Portuguese company, the benefits, challenges and difficulties are presented and discussed.

  12. Implementation factors and their effect on e-Health service adoption in rural communities: a systematic literature review

    PubMed Central

    2013-01-01

    Background An ageing population is seen as a threat to the quality of life and health in rural communities, and it is often assumed that e-Health services can address this issue. As successful e-Health implementation in organizations has proven difficult, this systematic literature review considers whether this is so for rural communities. This review identifies the critical implementation factors and, following the change model of Pettigrew and Whipp, classifies them in terms of “context”, “process”, and “content”. Through this lens, we analyze the empirical findings found in the literature to address the question: How do context, process, and content factors of e-Health implementation influence its adoption in rural communities? Methods We conducted a systematic literature review. This review included papers that met six inclusion and exclusion criteria and had sufficient methodological quality. Findings were categorized in a classification matrix to identify promoting and restraining implementation factors and to explore whether any interactions between context, process, and content affect adoption. Results Of the 5,896 abstracts initially identified, only 51 papers met all our criteria and were included in the review. We distinguished five different perspectives on rural e-Health implementation in these papers. Further, we list the context, process, and content implementation factors found to either promote or restrain rural e-Health adoption. Many implementation factors appear repeatedly, but there are also some contradictory results. Based on a further analysis of the papers’ findings, we argue that interaction effects between context, process, and content elements of change may explain these contradictory results. More specifically, three themes that appear crucial in e-Health implementation in rural communities surfaced: the dual effects of geographical isolation, the targeting of underprivileged groups, and the changes in ownership required

  13. Rates, levels, and determinants of electronic health record system adoption: a study of hospitals in Riyadh, Saudi Arabia.

    PubMed

    Aldosari, Bakheet

    2014-05-01

    Outside a small number of OECD countries, little information exists regarding the rates, levels, and determinants of hospital electronic health record (EHR) system adoption. This study examines EHR system adoption in Riyadh, Saudi Arabia. Respondents from 22 hospitals were surveyed regarding the implementation, maintenance, and improvement phases of EHR system adoption. Thirty-seven items were graded on a three-point scale of preparedness/completion. Measured determinants included hospital size, level of care, ownership, and EHR system development team composition. Eleven of the hospitals had implemented fully functioning EHR systems, eight had systems in progress, and three had not adopted a system. Sixteen different systems were being used across the 19 adopting hospitals. Differential adoption levels were positively related to hospital size and negatively to the level of care (secondary versus tertiary). Hospital ownership (nonprofit versus private) and development team composition showed mixed effects depending on the particular adoption phase being considered. Adoption rates compare favourably with those reported from other countries and other districts in Saudi Arabia, but wide variations exist among hospitals in the levels of adoption of individual items. General weaknesses in the implementation phase concern the legacy of paper data systems, including document scanning and data conversion; in the maintenance phase concern updating/maintaining software; and in the improvement phase concern the communication and exchange of health information. This study is the first to investigate the level and determinants of EHR system adoption for public, other nonprofit, and private hospitals in Saudi Arabia. Wide interhospital variations in adoption bear implications for policy-making and funding intervention. Identified areas of weakness require action to increase the degree of adoption and usefulness of EHR systems. Copyright © 2014 Elsevier Ireland Ltd. All rights

  14. Implementing a Daily Maintenance Care Bundle to Prevent Central Line-Associated Bloodstream Infections in Pediatric Oncology Patients.

    PubMed

    Duffy, Elizabeth A; Rodgers, Cheryl C; Shever, Leah L; Hockenberry, Marilyn J

    2015-01-01

    Eliminating central line-associated bloodstream infection (CLABSI) is a national priority. Central venous catheter (CVC) care bundles are composed of a series of interventions that, when used together, are effective in preventing CLABSI. A CVC daily maintenance care bundle includes procedural guidelines for hygiene, dressing changes, and access as well as specific timeframes. Failure to complete one of the components of the care bundle predisposes the patient to a bloodstream infection. A nurse-led multidisciplinary team implemented and, for six months, sustained a daily maintenance care bundle for pediatric oncology patients. This quality improvement project focused on nursing staffs' implementation of the daily maintenance care bundle and the sustainment of the intervention. The project used a pre-post program design to evaluate outcomes of CVC daily maintenance care bundle compliancy and CLABSI. A statistically significant increase between the pre- and post-assessments of the compliance was noted with the CVC daily maintenance care bundle. CLABSI infection rates decreased during the intervention. Strategies to implement practice change and promote sustainability are discussed. © 2015 by Association of Pediatric Hematology/Oncology Nurses.

  15. 49 CFR 1548.5 - Adoption and implementation of the security program.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... carrier having a security program must: (1) Maintain an original of the security program at its corporate... 49 Transportation 9 2014-10-01 2014-10-01 false Adoption and implementation of the security...) TRANSPORTATION SECURITY ADMINISTRATION, DEPARTMENT OF HOMELAND SECURITY CIVIL AVIATION SECURITY INDIRECT AIR...

  16. 49 CFR 1548.5 - Adoption and implementation of the security program.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... carrier having a security program must: (1) Maintain an original of the security program at its corporate... 49 Transportation 9 2010-10-01 2010-10-01 false Adoption and implementation of the security...) TRANSPORTATION SECURITY ADMINISTRATION, DEPARTMENT OF HOMELAND SECURITY CIVIL AVIATION SECURITY INDIRECT AIR...

  17. 49 CFR 1549.5 - Adoption and implementation of the security program.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... facility must: (1) Maintain an original of the security program at its corporate office. (2) Have... 49 Transportation 9 2013-10-01 2013-10-01 false Adoption and implementation of the security...) TRANSPORTATION SECURITY ADMINISTRATION, DEPARTMENT OF HOMELAND SECURITY CIVIL AVIATION SECURITY CERTIFIED CARGO...

  18. 49 CFR 1549.5 - Adoption and implementation of the security program.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... facility must: (1) Maintain an original of the security program at its corporate office. (2) Have... 49 Transportation 9 2011-10-01 2011-10-01 false Adoption and implementation of the security...) TRANSPORTATION SECURITY ADMINISTRATION, DEPARTMENT OF HOMELAND SECURITY CIVIL AVIATION SECURITY CERTIFIED CARGO...

  19. 49 CFR 1549.5 - Adoption and implementation of the security program.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... facility must: (1) Maintain an original of the security program at its corporate office. (2) Have... 49 Transportation 9 2014-10-01 2014-10-01 false Adoption and implementation of the security...) TRANSPORTATION SECURITY ADMINISTRATION, DEPARTMENT OF HOMELAND SECURITY CIVIL AVIATION SECURITY CERTIFIED CARGO...

  20. 49 CFR 1548.5 - Adoption and implementation of the security program.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... carrier having a security program must: (1) Maintain an original of the security program at its corporate... 49 Transportation 9 2013-10-01 2013-10-01 false Adoption and implementation of the security...) TRANSPORTATION SECURITY ADMINISTRATION, DEPARTMENT OF HOMELAND SECURITY CIVIL AVIATION SECURITY INDIRECT AIR...

  1. 49 CFR 1549.5 - Adoption and implementation of the security program.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... facility must: (1) Maintain an original of the security program at its corporate office. (2) Have... 49 Transportation 9 2010-10-01 2010-10-01 false Adoption and implementation of the security...) TRANSPORTATION SECURITY ADMINISTRATION, DEPARTMENT OF HOMELAND SECURITY CIVIL AVIATION SECURITY CERTIFIED CARGO...

  2. 49 CFR 1548.5 - Adoption and implementation of the security program.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... carrier having a security program must: (1) Maintain an original of the security program at its corporate... 49 Transportation 9 2011-10-01 2011-10-01 false Adoption and implementation of the security...) TRANSPORTATION SECURITY ADMINISTRATION, DEPARTMENT OF HOMELAND SECURITY CIVIL AVIATION SECURITY INDIRECT AIR...

  3. 49 CFR 1549.5 - Adoption and implementation of the security program.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... facility must: (1) Maintain an original of the security program at its corporate office. (2) Have... 49 Transportation 9 2012-10-01 2012-10-01 false Adoption and implementation of the security...) TRANSPORTATION SECURITY ADMINISTRATION, DEPARTMENT OF HOMELAND SECURITY CIVIL AVIATION SECURITY CERTIFIED CARGO...

  4. 77 FR 35873 - Approval, Disapproval and Promulgation of Air Quality Implementation Plan; Utah; Maintenance Plan...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-15

    ... change the maintenance plan's trigger for contingency measures. Instead of a defined trigger, the revised plan would allow the State to consider several factors in deciding whether contingency measures should... the maintenance plan, the State must commit to implement one or more contingency measures within a set...

  5. 75 FR 59086 - Approval and Promulgation of Air Quality Implementation Plans; Maryland; Adoption of Control...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-27

    ... package printing entitled ``Control Techniques Guidelines for Flexible Package Printing'' (Publication No... adoption of the EPA CTG for flexible packaging printing. EPA develops CTGs as guidance on control... Promulgation of Air Quality Implementation Plans; Maryland; Adoption of Control Techniques Guidelines for...

  6. Exploring end user adoption and maintenance of a telephone-based physical activity counseling service for individuals with physical disabilities using the Theoretical Domains Framework.

    PubMed

    Tomasone, Jennifer R; Arbour-Nicitopoulos, Kelly P; Pila, Eva; Lamontagne, Marie-Eve; Cummings, Isabelle; Latimer-Cheung, Amy E; Routhier, François

    2017-06-01

    In Canada, two counseling services are offered to facilitate physical activity participation among persons with physical disabilities, yet both have encountered concerns related to the recruitment and retainment of clients. The purpose of this paper is to explore factors related to service adoption among nonusers, and the barriers and facilitators to maintaining service participation among adopters. Individuals who had never enrolled in the services (nonusers, n = 13) as well as current/previous service clients (adopters, n = 26) participated in interviews based on the Theoretical Domains Framework. Transcripts were subjected to deductive thematic analysis according to participant group. Fifteen themes relating to service adoption within 10 of the 12 theoretical domains were identified for nonusers, while 23 themes relating to maintenence of service participation were identified across all 12 theoretical domains for adopters. The findings provide strategies to improve recruitment, adoption, and retention of clients in counseling services and to enhance the experiences of targeted service users. Implications for Rehabiliation Peer support and education for equipment use should be built into physical activity programs to encourage participation among persons with physical disabilities. Programs that encourage physical activity among individuals with disabilities should be designed by practitioners to be responsive to a variety of needs, which are addressed in the program's advertisements and offerings. The Theoretical Domains Framework is a useful framework for providing valuable insight about clients' experiences of adoption and maintenance of a behavior change service, suggesting merit in other rehabilitation settings.

  7. Adopting and implementing nutrition guidelines in recreational facilities: Public and private sector roles. A multiple case study

    PubMed Central

    2012-01-01

    Background Recreational facilities are an important community resource for health promotion because they provide access to affordable physical activities. However, despite their health mandate, many have unhealthy food environments that may paradoxically increase the risk of childhood obesity. The Alberta Nutrition Guidelines for Children and Youth (ANGCY) are government-initiated, voluntary guidelines intended to facilitate children’s access to healthy food and beverage choices in schools, childcare and recreational facilities, however few recreational facilities are using them. Methods We used mixed methods within an exploratory multiple case study to examine factors that influenced adoption and implementation of the ANGCY and the nature of the food environment within three cases: an adopter, a semi-adopter and a non-adopter of the ANGCY. Diffusion of Innovations theory provided the theoretical platform for the study. Qualitative data were generated through interviews, observations, and document reviews, and were analysed using directed content analysis. Set theoretic logic was used to identify factors that differentiated adopters from the non-adopter. Quantitative sales data were also collected, and the quality of the food environment was scored using four complementary tools. Results The keys to adoption and implementation of nutrition guidelines in recreational facilities related to the managers’ nutrition-related knowledge, beliefs and perceptions, as these shaped his decisions and actions. The manager, however, could not accomplish adoption and implementation alone. Intersectoral linkages with schools and formal, health promoting partnerships with industry were also important for adoption and implementation to occur. The food environment in facilities that had adopted the ANGCY did not appear to be superior to the food environment in facilities that had not adopted the ANGCY. Conclusions ANGCY uptake may continue to falter under the current voluntary

  8. Technology adoption and implementation in organisations: comparative case studies of 12 English NHS Trusts

    PubMed Central

    Ahmad, Raheelah; Holmes, Alison

    2012-01-01

    Objectives To understand organisational technology adoption (initiation, adoption decision, implementation) by looking at the different types of innovation knowledge used during this process. Design Qualitative, multisite, comparative case study design. Setting One primary care and 11 acute care organisations (trusts) across all health regions in England in the context of infection prevention and control. Participants and data analysis 121 semistructured individual and group interviews with 109 informants, involving clinical and non-clinical staff from all organisational levels and various professional groups. Documentary evidence and field notes were also used. 38 technology adoption processes were analysed using an integrated approach combining inductive and deductive reasoning. Main findings Those involved in the process variably accessed three types of innovation knowledge: ‘awareness’ (information that an innovation exists), ‘principles’ (information about an innovation's functioning principles) and ‘how-to’ (information required to use an innovation properly at individual and organisational levels). Centralised (national, government-led) and local sources were used to obtain this knowledge. Localised professional networks were preferred sources for all three types of knowledge. Professional backgrounds influenced an asymmetric attention to different types of innovation knowledge. When less attention was given to ‘how-to’ compared with ‘principles’ knowledge at the early stages of the process, this contributed to 12 cases of incomplete implementation or discontinuance after initial adoption. Conclusions Potential adopters and change agents often overlooked or undervalued ‘how-to’ knowledge. Balancing ‘principles’ and ‘how-to’ knowledge early in the innovation process enhanced successful technology adoption and implementation by considering efficacy as well as strategic, structural and cultural fit with the organisation's context

  9. Implementation of newly adopted technology in acute care settings: a qualitative analysis of clinical staff

    PubMed Central

    Langhan, Melissa L.; Riera, Antonio; Kurtz, Jordan C.; Schaeffer, Paula; Asnes, Andrea G.

    2015-01-01

    Objective Technologies are not always successfully implemented into practise. We elicited experiences of acute care providers with the introduction of technology and identified barriers and facilitators in the implementation process. Methods A qualitative study using one-on-one interviews among a purposeful sample of 19 physicians and nurses within ten emergency departments and intensive care units was performed. Grounded theory, iterative data analysis and the constant comparative method were used to inductively generate ideas and build theories. Results Five major categories emerged: decision-making factors, the impact on practise, technology's perceived value, facilitators and barriers to implementation. Barriers included negative experiences, age, infrequent use, and access difficulties. A positive outlook, sufficient training, support staff, and user friendliness were facilitators. Conclusions This study describes strategies implicated in the successful implementation of newly adopted technology in acute care settings. Improved implementation methods and evaluation of implementation processes are necessary for successful adoption of new technology. PMID:25367721

  10. 76 FR 51922 - Approval and Promulgation of Air Quality Implementation Plans; Maryland; Adoption of Plastic...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-19

    ... Promulgation of Air Quality Implementation Plans; Maryland; Adoption of Plastic Parts and Business Machines..., Plastic Parts and Business Machines Coating. Maryland's SIP revision meets the requirement to adopt... (CTG) for Miscellaneous Metal and Plastic Parts Coatings and will help Maryland attain and maintain the...

  11. Pre-adoptive Factors Predicting Lesbian, Gay, and Heterosexual Couples’ Relationship Quality Across the Transition to Adoptive Parenthood

    PubMed Central

    Goldberg, Abbie E.; Smith, JuliAnna Z.; Kashy, Deborah A.

    2010-01-01

    The current study examined pre-adoptive factors as predictors of relationship quality (love, ambivalence, and conflict) among 125 couples (44 lesbian couples, 30 gay couples, and 51 heterosexual couples) across the first year of adoptive parenthood. On average, all new parents experienced declines in their relationship quality across the first year of parenthood, regardless of sexual orientation, with women experiencing steeper declines in love. Parents who, pre-adoption, reported higher levels of depression, greater use of avoidant coping, lower levels of relationship maintenance behaviors, and less satisfaction with their adoption agencies reported lower relationship quality at the time of the adoption. The effect of avoidant coping on relationship quality varied by gender. Parents who, pre-adoption, reported higher levels of depression, greater use of confrontative coping, and higher levels of relationship maintenance behaviors reported greater declines in relationship quality. These findings have implications for professionals who work with adoptive parents both pre- and post-adoption. PMID:20545395

  12. Factors affecting adoption and implementation of AHRQ health literacy tools in pharmacies.

    PubMed

    Shoemaker, Sarah J; Staub-DeLong, Leah; Wasserman, Melanie; Spranca, Mark

    2013-01-01

    Pharmacies are key sources of medication information for patients, yet few effectively serve patients with low health literacy. The Agency for Healthcare Research and Quality (AHRQ) supported the development of four health literacy tools for pharmacists to address this problem, and to help assess and improve pharmacies' health literacy practices. This study aimed to understand the facilitators and barriers to the adoption and implementation of AHRQ's health literacy tools, particularly a tool to assess a pharmacy's health literacy practices. We conducted a comparative, multiple-case study of eight pharmacies, guided by an adaptation of Rogers's Diffusion of Innovations model. Data were collected and triangulated through interviews, site visit observations, and the review of documents, and analyzed on the factors affecting pharmacies' adoption decisions and implementation of the tools. Factors important to pharmacies' decision to adopt the health literacy tools included awareness of health literacy; a culture of innovation; a change champion; the relative advantage and compatibility of the tools; and an invitation to utilize and receive support to use the tools. The barriers included a lack of leadership support, limited staff time, and a perception of the tools as complex with limited value. For implementation, the primary facilitators were buy-in from leadership, qualified staff, college-affiliated change champions, the adaptability and organization of the tool, and support. Barriers to implementation were limited leadership buy-in, prioritization of other activities, lack of qualified staff, and tool complexity. If pharmacists are provided tools that could ultimately improve their health literacy practices and patient-centered services; and the tools have a clear relative advantage, are simple as well adaptable, and the pharmacists are supported in their efforts - either by colleagues or by collaborating with colleges of pharmacy-then there could be important

  13. The present status and future growth of maintenance in US manufacturing: results from a pilot survey.

    PubMed

    Jin, Xiaoning; Siegel, David; Weiss, Brian A; Gamel, Ellen; Wang, Wei; Lee, Jay; Ni, Jun

    A research study was conducted (1) to examine the practices employed by US manufacturers to achieve productivity goals and (2) to understand what level of intelligent maintenance technologies and strategies are being incorporated into these practices. This study found that the effectiveness and choice of maintenance strategy were strongly correlated to the size of the manufacturing enterprise; there were large differences in adoption of advanced maintenance practices and diagnostics and prognostics technologies between small and medium-sized enterprises (SMEs). Despite their greater adoption of maintenance practices and technologies, large manufacturing organizations have had only modest success with respect to diagnostics and prognostics and preventive maintenance projects. The varying degrees of success with respect to preventative maintenance programs highlight the opportunity for larger manufacturers to improve their maintenance practices and use of advanced prognostics and health management (PHM) technology. The future outlook for manufacturing PHM technology among the manufacturing organizations considered in this study was overwhelmingly positive; many manufacturing organizations have current and planned projects in this area. Given the current modest state of implementation and positive outlook for this technology, gaps, future trends, and roadmaps for manufacturing PHM and maintenance strategy are presented.

  14. The present status and future growth of maintenance in US manufacturing: results from a pilot survey

    PubMed Central

    Jin, Xiaoning; Siegel, David; Weiss, Brian A.; Gamel, Ellen; Wang, Wei; Lee, Jay; Ni, Jun

    2016-01-01

    A research study was conducted (1) to examine the practices employed by US manufacturers to achieve productivity goals and (2) to understand what level of intelligent maintenance technologies and strategies are being incorporated into these practices. This study found that the effectiveness and choice of maintenance strategy were strongly correlated to the size of the manufacturing enterprise; there were large differences in adoption of advanced maintenance practices and diagnostics and prognostics technologies between small and medium-sized enterprises (SMEs). Despite their greater adoption of maintenance practices and technologies, large manufacturing organizations have had only modest success with respect to diagnostics and prognostics and preventive maintenance projects. The varying degrees of success with respect to preventative maintenance programs highlight the opportunity for larger manufacturers to improve their maintenance practices and use of advanced prognostics and health management (PHM) technology. The future outlook for manufacturing PHM technology among the manufacturing organizations considered in this study was overwhelmingly positive; many manufacturing organizations have current and planned projects in this area. Given the current modest state of implementation and positive outlook for this technology, gaps, future trends, and roadmaps for manufacturing PHM and maintenance strategy are presented. PMID:27525253

  15. Routines for change: how managers can use absorptive capacity to adopt and implement evidence-based practice.

    PubMed

    Innis, Jennifer; Berta, Whitney

    2016-09-01

    This paper uses the construct of absorptive capacity to understand how nurse managers can facilitate the adoption and use of evidence-based practice within health-care organisations. How health-care organisations adopt and implement innovations such as new evidence-based practices will depend on their absorptive, or learning, capacity. Absorptive capacity manifests as routines, which are the practices, procedures and customs that organisational members use to carry out work and to make work-related decisions. Using the construct of absorptive capacity as well as a recent literature review of how health-care organisations take on best practices, we illustrate how the uptake and use of new knowledge, such as evidence-based practices, can be facilitated through the use of routines. This paper highlights routines that nurse managers can use to foster environments where evidence-based practices can be readily identified, and strategies for facilitating their adoption and implementation. The construct of absorptive capacity and the use of routines can be used to examine the ways in which nurse managers can adopt, implement and evaluate the use of evidence-based practices. © 2016 John Wiley & Sons Ltd.

  16. The Autonomous Maintenance Implementation Directory as a Step Toward the Intelligent Quality Management System

    NASA Astrophysics Data System (ADS)

    Molenda, Michał

    2016-12-01

    The article describes the effects of the improvement of the production process which one of the industrial enterprises obtained by implementing the method of Autonomous Maintenance (AM), which is one of the pillars of the concept of Total Productive Maintenance (TPM). AM method was presented as an aid to the formation of intelligent, self-improving procesess of the quality management system (QMS). The main part of this article is to present results of studies that have been conducted in one of the large industrial enterprises in Poland, manufacturing for the automotive industry. The aim of the study was to evaluate the effectiveness of the implementation of the AM method as a tool for selfimprovement of industrial processes in the following company. The study was conducted in 2015. The gathering and comparison of data from the period of two years, ie. the year before and the year after the implementation of AM, helped to determine the effectiveness of AM in building intelligent quality management system.

  17. Media Competition Implementation for the Massachusetts Childhood Obesity Research Demonstration Study (MA-CORD): Adoption and Reach

    PubMed Central

    Criss, Shaniece; Cheung, Lilian; Giles, Catherine; Gortmaker, Steven; Viswanath, Kasisomayajula; Kwass, Jo-Ann; Davison, Kirsten

    2016-01-01

    The Massachusetts Childhood Obesity Research Demonstration Study (MA-CORD) was a multi-level, multi-sector community intervention with a media competition component to provide an overarching synergy and promote awareness of target behaviors to reduce childhood obesity. Students participating in the media competition were tasked with developing videos, song/rap lyrics, and artwork that reflected the goals. The aim of this study is to document the process used to develop and implement the media competition along with its reach and adoption. An adapted version of Neta and colleagues’ 2015 framework on dissemination and implementation was used to summarize the process by which the media competition was developed and implemented. Adoption was defined by whether eligible schools or afterschool programs decided to implement the media competition. Reach was defined by student participation rates within schools/programs and the number of votes cast for the finalists on the coalition website and students’ paper ballots. A total of 595 students participated in the media competition from 18 school and afterschool programs in two communities. Adoption of the media competitions ranged from 22% to 100% in programs and reach ranged from 3% to 33% of the student population. The documentation of the implementation should contribute to the replication of the media competition. PMID:27058549

  18. Arizona Air Quality State Implementation Plans; Final Approval; Douglas, Arizona; Second 10-Year Sulfur Dioxide Maintenance Plan

    EPA Pesticide Factsheets

    EPA is taking final rulemaking action to approve, as part of the State Implementation Plan (SIP) for the State of Arizona, the second 10-year maintenance plan for the Douglas maintenance area for the 1971 National Ambient Air Quality Standards for SO2.

  19. A Case Study: Implementing an Interactive Video Instruction System in Teaching Electronics and Industrial Maintenance.

    ERIC Educational Resources Information Center

    Shipe, Ron; And Others

    A study examined the development and implementation of an interactive video instruction system for teaching electronics and industrial maintenance at the University of Tennessee. The specific purposes of the study were to document unusual problems that may be encountered when this new technology is implemented, suggest corrective actions, and…

  20. Paranal maintenance and CMMS experience

    NASA Astrophysics Data System (ADS)

    Montano, Nelson

    2004-10-01

    During the last four years of operations, low technical downtime has been one of the relevant records of the Paranal Observatory. From the beginning of the Very Large Telescope (VLT) project, European Southern Observatory (ESO) has considered the implementation of a proper maintenance strategy a fundamental point in order to ensure low technical down time and preserve the Observatory's assets. The implementation of the maintenance strategy was based on the following aspects: - Strong maintenance sense during the design stage. Line Replacement Unit (LRU) concept, standardization and modularity of the Observatory equipment - Creation of a dedicated team for Maintenance - The implementation of a Computerized Maintenance Management System After four operational years, the result of these aspects has exceeded the expectations; the Observatory has been operating with high availability under a sustainable strategy. The strengths of the maintenance strategy have been based on modern maintenance concepts applied by regular production companies, where any minute of down time involves high cost. The operation of the actual Paranal Maintenance System is based mainly on proactive activities, such as regular inspections, preventive maintenance (PM) and predictive maintenance (PdM) plans. Nevertheless, it has been necessary to implement a strong plan for corrective maintenance (CM). The Spare Parts Strategy has also been an important point linked to the Maintenance Strategy and CMMS implementation. At present, almost 4,000 items related to the Observatory spare parts are loaded into the CMMS database. Currently, we are studying the implementation of a Reliability Centered Maintenance (RCM) project in one of our critical systems The following document presents the actual status of the Paranal Maintenance Strategy and which have been the motivations to implement the established strategy.

  1. Adopting and Implementing Globalised Policies of Intercultural Education: The Example of Cyprus

    ERIC Educational Resources Information Center

    Hajisoteriou, Christina; Angelides, Panayiotis

    2017-01-01

    Globalisation has heavily influenced the terrain of intercultural education policy development and implementation in multiple countries around the world. To this end, in this article, we seek to introduce a broader focus of analysis encompassing not only the development of globalised policies of intercultural education, but also the adoption,…

  2. Implementation of personalized music listening for assisted living residents with dementia.

    PubMed

    Murphy, Kelly; Liu, Winston W; Goltz, Daniel; Fixsen, Emma; Kirchner, Stephen; Hu, Janice; White, Heidi

    2018-05-03

    Personalized music listening (PML) has been touted as a safe and inexpensive means of improving the quality of life, mood, and behavior of persons with dementia. A PML program was implemented in an assisted living facility and evaluated across the five dimensions of the RE-AIM framework: reach, effectiveness, adoption, implementation, and maintenance. The first 17 residents invited to participate were enrolled and followed over eight months. Effectiveness was evident in staff-reported mood improvement in 62% of encounters. Adoption was evident in qualitative feedback collected from medication technicians. Implementation was facilitated by low costs, engagement of external volunteers, highlighting outcomes that are relevant to staff, and attention to playlists over time. Maintenance required continued engagement of volunteers, ongoing fundraising, attention to facility staff engagement, and iterative adjustments to the program framework as staffing changes occurred. PML was found to be a meaningful intervention that is possible at a reasonable cost. Copyright © 2018 Elsevier Inc. All rights reserved.

  3. Barriers to Electronic Health Record Adoption: a Systematic Literature Review.

    PubMed

    Kruse, Clemens Scott; Kristof, Caitlin; Jones, Beau; Mitchell, Erica; Martinez, Angelica

    2016-12-01

    Federal efforts and local initiatives to increase adoption and use of electronic health records (EHRs) continue, particularly since the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act. Roughly one in four hospitals not adopted even a basic EHR system. A review of the barriers may help in understanding the factors deterring certain healthcare organizations from implementation. We wanted to assemble an updated and comprehensive list of adoption barriers of EHR systems in the United States. Authors searched CINAHL, MEDLINE, and Google Scholar, and accepted only articles relevant to our primary objective. Reviewers independently assessed the works highlighted by our search and selected several for review. Through multiple consensus meetings, authors tapered articles to a final selection most germane to the topic (n = 27). Each article was thoroughly examined by multiple authors in order to achieve greater validity. Authors identified 39 barriers to EHR adoption within the literature selected for the review. These barriers appeared 125 times in the literature; the most frequently mentioned barriers were regarding cost, technical concerns, technical support, and resistance to change. Despite federal and local incentives, the initial cost of adopting an EHR is a common existing barrier. The other most commonly mentioned barriers include technical support, technical concerns, and maintenance/ongoing costs. Policy makers should consider incentives that continue to reduce implementation cost, possibly aimed more directly at organizations that are known to have lower adoption rates, such as small hospitals in rural areas.

  4. Meausures of organizational characteristics associated with adoption and/or implementation of innovations: A systematic review.

    PubMed

    Allen, Jennifer D; Towne, Samuel D; Maxwell, Annette E; DiMartino, Lisa; Leyva, Bryan; Bowen, Deborah J; Linnan, Laura; Weiner, Bryan J

    2017-08-23

    This paper identifies and describes measures of constructs relevant to the adoption or implementation of innovations (i.e., new policies, programs or practices) at the organizational-level. This work is intended to advance the field of dissemination and implementation research by aiding scientists in the identification of existing measures and highlighting methodological issues that require additional attention. We searched for published studies (1973-2013) in 11 bibliographic databases for quantitative, empirical studies that presented outcome data related to adoption and/or implementation of an innovation. Included studies had to assess latent constructs related to the "inner setting" of the organization, as defined by the Consolidated Framework for Implementation Research. Of the 76 studies included, most (86%) were cross sectional and nearly half (49%) were conducted in health care settings. Nearly half (46%) involved implementation of evidence-based or "best practice" strategies; roughly a quarter (26%) examined use of new technologies. Primary outcomes most often assessed were innovation implementation (57%) and adoption (34%); while 4% of included studies assessed both outcomes. There was wide variability in conceptual and operational definitions of organizational constructs. The two most frequently assessed constructs included "organizational climate" and "readiness for implementation." More than half (55%) of the studies did not articulate an organizational theory or conceptual framework guiding the inquiry; about a third (34%) referenced Diffusion of Innovations theory. Overall, only 46% of articles reported psychometric properties of measures assessing latent organizational characteristics. Of these, 94% (33/35) described reliability and 71% (25/35) reported on validity. The lack of clarity associated with construct definitions, inconsistent use of theory, absence of standardized reporting criteria for implementation research, and the fact that few

  5. Adoption and Implementation of Physical Activity and Dietary Counseling by Community Health Center Providers and Nurses

    PubMed Central

    Wilcox, Sara; Parra-Medina, Deborah; Felton, Gwen M.; Poston, Mary Elizabeth; McClain, Amanda

    2011-01-01

    Background Primary care providers are expected to provide lifestyle counseling, yet many barriers exist. Few studies report on adoption and implementation in routine practice. This study reports training, adoption, and implementation of an intervention to promote physical activity (PA) and dietary counseling in community health centers. Methods Providers (n = 30) and nurses (n = 28) from 9 clinics were invited to participate. Adopters completed CD-ROM training in stage-matched, patient-centered counseling and goal setting. Encounters were audio recorded. A subsample was coded for fidelity. Results Fifty-seven percent of providers and nurses adopted the program. Provider counseling was seen in 66% and nurse goal setting in 58% of participant (N = 266) encounters, although audio recordings were lower. Duration of provider counseling and nurse goal setting was 4.9 ± 4.5 and 7.3 ± 3.8 minutes, respectively. Most PA (80%) and diet (94%) goals were stage-appropriate. Although most providers discussed at least 1 behavioral topic, some topics (eg, self-efficacy, social support) were rarely covered. Conclusions A sizeable percentage of providers and nurses completed training, rated it favorably, and delivered lifestyle counseling, although with variable fidelity. With low implementation cost and limited office time required, this model has the potential to be disseminated to improve counseling rates in primary care. PMID:20864755

  6. Discovery of Implementation Factors That Lead to Technology Adoption in Long-Term Care.

    PubMed

    Schoville, Rhonda R

    2017-10-01

    The current exploratory, qualitative study discovered and clarified implementation factors that led to technology adoption in long-term care (LTC). The Integrated Technology Implementation model guided the study of an electronic health record used in three LTC settings. Thirty key stakeholders (i.e., directors of nursing, nurses, and certified nurse aides) participated in focus groups or interviews. Findings indicated experiences were more similar than different among groups and facilities. Five major implementation themes supported by a variety of minor themes were identified. Implications for nursing include that leaders must be knowledgeable and committed to the change and engage staff throughout the implementation process. In addition, various communication and education strategies are required. [Journal of Gerontological Nursing, 43(10), 21-26.]. Copyright 2017, SLACK Incorporated.

  7. Does user satisfaction relate to adoption behavior?: an exploratory analysis using CPRS implementation.

    PubMed Central

    Weir, C. R.; Crockett, R.; Gohlinghorst, S.; McCarthy, C.

    2000-01-01

    User satisfaction is commonly assessed in evaluations of information systems as a proxy for user adoption. However few studies actually report directly assessing the relationship between the two constructs. In this study the relationship between four user satisfaction measures and five adoption behaviors were explored in the context of the implementation of the Veteran's Health Administration Computerized Patient Record System 1.0. Findings suggest that the relationship is modest and depends on the measurement system used. Specifically, direct reports of affect and judgements of specific task efficacy related to behavior more often than usability and a general user satisfaction instrument. PMID:11080017

  8. A Framework for Institutional Adoption and Implementation of Blended Learning in Higher Education

    ERIC Educational Resources Information Center

    Graham, Charles R.; Woodfield, Wendy; Harrison, J. Buckley

    2013-01-01

    There has been rapid growth in blended learning implementation and research focused on course-level issues such as improved learning outcomes, but very limited research focused on institutional policy and adoption issues. More institutional-level blended learning research is needed to guide institutions of higher education in strategically…

  9. Evaluation of the Implementation of Operations and Maintenance Programs in New Jersey Schools.

    ERIC Educational Resources Information Center

    Kominsky, John R.; Freyberg, Ronald W.; Gerber, Donald R.; Centifonti, Gary J.

    All schools are required to develop and implement an asbestos management plan (AMP). The key component of this plan is each school's operations and maintenance (O&M) program. This report outlines the importance of such programs. It describes an O&M program as an administrative framework that prescribes specific activities and work…

  10. Shuttle Flight Operations Contract Generator Maintenance Facility Land Use Control Implementation Plan (LUCIP)

    NASA Technical Reports Server (NTRS)

    Applegate, Joseph L.

    2014-01-01

    This Land Use Control Implementation Plan (LUCIP) has been prepared to inform current and potential future users of the Kennedy Space Center (KSC) Shuttle Flight Operations Contract Generator Maintenance Facility (SFOC; SWMU 081; "the Site") of institutional controls that have been implemented at the Site1. Although there are no current unacceptable risks to human health or the environment associated with the SFOC, an institutional land use control (LUC) is necessary to prevent human health exposure to antimony-affected groundwater at the Site. Controls will include periodic inspection, condition certification, and agency notification.

  11. Hospital adoption of automated surveillance technology and the implementation of infection prevention and control programs.

    PubMed

    Halpin, Helen; Shortell, Stephen M; Milstein, Arnold; Vanneman, Megan

    2011-05-01

    This research analyzes the relationship between hospital use of automated surveillance technology (AST) for identification and control of hospital-acquired infections (HAI) and implementation of evidence-based infection control practices. Our hypothesis is that hospitals that use AST have made more progress implementing infection control practices than hospitals that rely on manual surveillance. A survey of all acute general care hospitals in California was conducted from October 2008 through January 2009. A structured computer-assisted telephone interview was conducted with the quality director of each hospital. The final sample includes 241 general acute care hospitals (response rate, 83%). Approximately one third (32.4%) of California's hospitals use AST for monitoring HAI. Adoption of AST is statistically significant and positively associated with the depth of implementation of evidence-based practices for methicillin-resistant Staphylococcus aureus and ventilator-associated pneumonia and adoption of contact precautions and surgical care infection practices. Use of AST is also statistically significantly associated with the breadth of hospital implementation of evidence-based practices across all 5 targeted HAI. Our findings suggest that hospitals using AST can achieve greater depth and breadth in implementing evidenced-based infection control practices. Copyright © 2011 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  12. Pricing health behavior interventions to promote adoption: lessons from the marketing and business literature.

    PubMed

    Ribisl, Kurt M; Leeman, Jennifer; Glasser, Allison M

    2014-06-01

    The relatively high cost of delivering many public health interventions limits their potential for broad public impact by reducing their likelihood of adoption and maintenance over time. Practitioners identify cost as the primary factor for which interventions they select to implement, but researchers rarely disseminate cost information or consider its importance when developing new interventions. A new approach is proposed whereby intervention developers assess what individuals and agencies adopting their interventions are willing to pay and then design interventions that are responsive to this price range. The ultimate goal is to develop effective and affordable interventions, called lean interventions, which are widely adopted and have greater public health impact. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  13. A case study of one school system's adoption and implementation of an elementary science program

    NASA Astrophysics Data System (ADS)

    Kelly, Michael Patrick

    2000-10-01

    The researcher's purpose in this study was to examine the process used by the Minot Public Schools to adopt and implement a new elementary science program from Silver Burdett Ginn called Discovery Works. Using case study methods within a naturalistic design, the researcher investigated teachers' concerns as they adopted and implemented Discovery Works in their classrooms. Data were gathered using the Concerns Based Adoption Model (CBAM) instrument, interviews with adoption committee members, classroom teachers, grade level meetings, and document analysis of field notes related to each phase of the study. Content analysis methods were used to analyze the data. Emergent themes were presented and substantiated in the data, in terms of six research questions that guided this research. The data were analyzed both quantitatively and qualitatively to provide a rich, thick description that and enabled the researcher to confirm and triangulate the concerns of teachers in this study. The quantitative data revealed a general nonuser profile by teachers as they implemented Discovery Works. Three major themes of concerns emerged from a qualitative analysis of the data. The first theme was implementation, including issues related to teacher attitudes and inservice needs. The second theme, management issues, had five concerns subsumed within it. These included concerns related to time, materials, storage, reorder, and cooperative groups. The third theme, effects on students, included issues concerning hands-on methods of teaching science, vocabulary, especially at the upper elementary, and assessment issues. Possible solutions to resolve each of the concerns were presented. Major conclusions are that teacher concerns about Discovery Works were normal for any group experiencing a new innovation. Teachers and students enjoyed using the hands-on materials, and that Minot Public Schools has taken a small, but important step forward on the road to science education reform. Although

  14. The timing and sources of information for the adoption and implementation of production innovations

    NASA Technical Reports Server (NTRS)

    Ettlie, J. E.

    1976-01-01

    Two dimensions (personal-impersonal and internal-external) are used to characterize information sources as they become important during the interorganizational transfer of production innovations. The results of three studies are reviewed for the purpose of deriving a model of the timing and importance of different information sources and the utilization of new technology. Based on the findings of two retrospective studies, it was concluded that the pattern of information seeking behavior in user organizations during the awareness stage of adoption is not a reliable predictor of the eventual utilization rate. Using the additional findings of a real-time study, an empirical model of the relative importance of information sources for successful user organizations is presented. These results are extended and integrated into a theoretical model consisting of a time-profile of successful implementations and the relative importance of four types of information sources during seven stages of the adoption-implementation process.

  15. Implementation and adoption of mechanical patient lift equipment in the hospital setting: The importance of organizational and cultural factors.

    PubMed

    Schoenfisch, Ashley L; Myers, Douglas J; Pompeii, Lisa A; Lipscomb, Hester J

    2011-12-01

    Work focused on understanding implementation and adoption of interventions designed to prevent patient-handling injuries in the hospital setting is lacking in the injury literature and may be more insightful than more traditional evaluation measures. Data from focus groups with health care workers were used to describe barriers and promoters of the adoption of patient lift equipment and a shift to a "minimal-manual lift environment" at two affiliated hospitals. Several factors influencing the adoption of the lift equipment and patient-handling policy were noted: time, knowledge/ability, staffing, patient characteristics, and organizational and cultural aspects of work. The adoption process was complex, and considerable variability by hospital and across units was observed. The use of qualitative data can enhance the understanding of factors that influence implementation and adoption of interventions designed to prevent patient-handling injuries among health care workers. Copyright © 2011 Wiley Periodicals, Inc.

  16. Increasing Psychotherapists’ Adoption and Implementation of the Evidence-based Practice of Progress Monitoring

    PubMed Central

    Persons, Jacqueline B.; Koerner, Kelly; Eidelman, Polina; Thomas, Cannon; Liu, Howard

    2015-01-01

    Evidence-based practices (EBPs) reach consumers slowly because practitioners are slow to adopt and implement them. We hypothesized that giving psychotherapists a tool + training intervention that was designed to help the therapist integrate the EBP of progress monitoring into his or her usual way of working would be associated with adoption and sustained implementation of the particular progress monitoring tool we trained them to use (the Depression Anxiety Stress Scales on our Online Progress Tracking tool) and would generalize to all types of progress monitoring measures. To test these hypotheses, we developed an online progress monitoring tool and a course that trained psychotherapists to use it, and we assessed progress monitoring behavior in 26 psychotherapists before, during, immediately after, and 12 months after they received the tool and training. Immediately after receiving the tool + training intervention, participants showed statistically significant increases in use of the online tool and of all types of progress monitoring measures. Twelve months later, participants showed sustained use of any type of progress monitoring measure but not the online tool. PMID:26618237

  17. Private primary care physicians' perspectives on factors affecting the adoption of electronic medical records: a qualitative pre-implementation study.

    PubMed

    Or, Calvin; Wong, Katie; Tong, Ellen; Sek, Antonio

    2014-01-01

    Use of electronic medical records (EMR) has the potential to offer quality and safety benefits, but without the adoption of the technology, the benefits will not be realized. This study aimed to identify the factors perceived as relevant by private physicians when considering EMR adoption. A qualitative pre-implementation study was conducted using semi-structured, face to face interviews to explore the perspectives of physicians (n=16) operating in private clinics on the factors affecting their adoption of EMR. A multilevel, work system approach and the immersion/crystallization data analysis technique guided the researchers in examining the data, identifying patterns and key themes, and extracting representative quotes to illustrate these themes. The major factors associated with EMR adoption, which relate to the five categories of a work system, were system usefulness; user interface design; technical support; cost; system reliability; the privacy, confidentiality, and security of patient information; physical space in the clinic; data migration process; adverse work-related factors; and the computer and systems skills of physicians. Pre-implementation identification of factors important to adoption can allow system developers to focus proactively on these factors when developing the system and its implementation strategies, to maximize the likelihood of successful introduction.

  18. A multiple case history and systematic review of adoption, diffusion, implementation and impact of provincial daily physical activity policies in Canadian schools.

    PubMed

    Olstad, Dana Lee; Campbell, Elizabeth J; Raine, Kim D; Nykiforuk, Candace I J

    2015-04-15

    Few children meet physical activity (PA) recommendations, and are therefore at increased risk for overweight/obesity and adverse health outcomes. To increase children's opportunities for PA, several Canadian provinces have adopted school-based daily PA (DPA) policies. It is not clear why some jurisdictions have adopted DPA policies, and others have not, nor whether these policies have been implemented and have achieved their intended outcomes. The purpose of this study was to understand the processes underlying adoption and diffusion of Canadian DPA policies, and to review evidence regarding their implementation and impact. We adopted a multiple case history methodology in which we traced the chronological trajectory of DPA policies among Canadian provinces by compiling timelines detailing key historical events that preceded policy adoption. Publicly available documents posted on the internet were reviewed to characterize adopter innovativeness, describe the content of their DPA policies, and explore the context surrounding policy adoption. Diffusion of Innovations theory provided a conceptual framework for the analyses. A systematic literature search identified studies that had investigated adoption, diffusion, implementation or impact of Canadian DPA policies. Five of Canada's 13 provinces and territories (38.5%) have DPA policies. Although the underlying objectives of the policies are similar, there are clear differences among them and in their various policy trajectories. Adoption and diffusion of DPA policies were structured by the characteristics and capacities of adopters, the nature of their policies, and contextual factors. Limited data suggests implementation of DPA policies was moderate but inconsistent and that Canadian DPA policies have had little to no impact on school-aged children's PA levels or BMI. This study detailed the history and current status of Canadian DPA policies, highlighting the conditional nature of policy adoption and diffusion, and

  19. The art of successful implementation of psychosocial interventions in residential dementia care: a systematic review of the literature based on the RE-AIM framework.

    PubMed

    Boersma, Petra; van Weert, Julia C M; Lakerveld, Jeroen; Dröes, Rose-Marie

    2015-01-01

    In the past decades many psychosocial interventions for elderly people with dementia have been developed and implemented. Relatively little research has been done on the extent to which these interventions were implemented in the daily care. The aim of this study was to obtain insight into strategies for successful implementation of psychosocial interventions in the daily residential dementia care. Using a modified RE-AIM framework, the indicators that are considered important for effective and sustainable implementation were defined. A systematic literature search was undertaken in PubMed, PsycINFO, and Cinahl, followed by a hand search for key papers. The included publications were mapped based on the dimensions of the RE-AIM framework: Reach, Effectiveness, Adoption, Implementation, and Maintenance. Fifty-four papers met the inclusion criteria and described various psychosocial interventions. A distinction was made between studies that used one and studies that used multiple implementation strategies. This review shows that to improve their knowledge, caregivers needed at least multiple implementation strategies, only education is not enough. For increasing a more person-centered attitude, different types of knowledge transfer can be effective. Little consideration is given to the adoption of the method by caregivers and to the long-term sustainability (maintenance). This review shows that in order to successfully implement a psychosocial method the use of multiple implementation strategies is recommended. To ensure sustainability of a psychosocial care method in daily nursing home care, innovators as well as researchers should specifically pay attention to the dimensions Adoption, Implementation, and Maintenance of the RE-AIM implementation framework.

  20. A Tailored Ontology Supporting Sensor Implementation for the Maintenance of Industrial Machines.

    PubMed

    Maleki, Elaheh; Belkadi, Farouk; Ritou, Mathieu; Bernard, Alain

    2017-09-08

    The longtime productivity of an industrial machine is improved by condition-based maintenance strategies. To do this, the integration of sensors and other cyber-physical devices is necessary in order to capture and analyze a machine's condition through its lifespan. Thus, choosing the best sensor is a critical step to ensure the efficiency of the maintenance process. Indeed, considering the variety of sensors, and their features and performance, a formal classification of a sensor's domain knowledge is crucial. This classification facilitates the search for and reuse of solutions during the design of a new maintenance service. Following a Knowledge Management methodology, the paper proposes and develops a new sensor ontology that structures the domain knowledge, covering both theoretical and experimental sensor attributes. An industrial case study is conducted to validate the proposed ontology and to demonstrate its utility as a guideline to ease the search of suitable sensors. Based on the ontology, the final solution will be implemented in a shared repository connected to legacy CAD (computer-aided design) systems. The selection of the best sensor is, firstly, obtained by the matching of application requirements and sensor specifications (that are proposed by this sensor repository). Then, it is refined from the experimentation results. The achieved solution is recorded in the sensor repository for future reuse. As a result, the time and cost of the design process of new condition-based maintenance services is reduced.

  1. A Tailored Ontology Supporting Sensor Implementation for the Maintenance of Industrial Machines

    PubMed Central

    Belkadi, Farouk; Bernard, Alain

    2017-01-01

    The longtime productivity of an industrial machine is improved by condition-based maintenance strategies. To do this, the integration of sensors and other cyber-physical devices is necessary in order to capture and analyze a machine’s condition through its lifespan. Thus, choosing the best sensor is a critical step to ensure the efficiency of the maintenance process. Indeed, considering the variety of sensors, and their features and performance, a formal classification of a sensor’s domain knowledge is crucial. This classification facilitates the search for and reuse of solutions during the design of a new maintenance service. Following a Knowledge Management methodology, the paper proposes and develops a new sensor ontology that structures the domain knowledge, covering both theoretical and experimental sensor attributes. An industrial case study is conducted to validate the proposed ontology and to demonstrate its utility as a guideline to ease the search of suitable sensors. Based on the ontology, the final solution will be implemented in a shared repository connected to legacy CAD (computer-aided design) systems. The selection of the best sensor is, firstly, obtained by the matching of application requirements and sensor specifications (that are proposed by this sensor repository). Then, it is refined from the experimentation results. The achieved solution is recorded in the sensor repository for future reuse. As a result, the time and cost of the design process of new condition-based maintenance services is reduced. PMID:28885592

  2. 75 FR 59179 - Approval and Promulgation of Air Quality Implementation Plans; Maryland; Adoption of Control...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-27

    ... (RACT) for sources covered by EPA's Control Techniques Guidelines (CTG) for flexible packaging printing... Promulgation of Air Quality Implementation Plans; Maryland; Adoption of Control Techniques Guidelines for Flexible Packaging Printing AGENCY: Environmental Protection Agency (EPA). ACTION: Proposed rule. SUMMARY...

  3. The Current Status and Tendency of China Millimeter Coordinate Frame Implementation and Maintenance

    NASA Astrophysics Data System (ADS)

    Cheng, P.; Cheng, Y.; Bei, J.

    2017-12-01

    China Geodetic Coordinate System 2000 (CGCS2000) was first officially declared as the national standard coordinate system on July 1, 2008. This reference frame was defined in the ITRF97 frame at epoch 2000.0 and included 2600 GPS geodetic control points. The paper discusses differences between China Geodetic Coordinate System 2000 (CGCS2000) and later updated ITRF versions, such as ITRF2014,in terms of technical implementation and maintenance. With the development of the Beidou navigation satellite system, especially third generation of BDS with signal global coverage in the future, and with progress of space geodetic technology, it is possible for us to establish a global millimeter-level reference frame based on space geodetic technology including BDS. The millimeter reference frame implementation concerns two factors: 1) The variation of geocenter motion estimation, and 2) the site nonlinear motion modeling. In this paper, the geocentric inversion methods are discussed and compared among results derived from various technical methods. Our nonlinear site movement modeling focuses on singular spectrum analysis method, which is of apparent advantages over earth physical effect modeling. All presented in the paper expected to provide reference to our future CGCS2000 maintenance.

  4. Technical implementation of an Internet address database with online maintenance module.

    PubMed

    Mischke, K L; Bollmann, F; Ehmer, U

    2002-01-01

    The article describes the technical implementation and management of the Internet address database of the center for ZMK (University of Münster, Dental School) Münster, which is integrated in the "ZMK-Web" website. The editorially maintained system guarantees its topicality primarily due to the electronically organized division of work with the aid of an online maintenance module programmed in JavaScript/PHP, as well as a database-related feedback function for the visitor to the website through configuration-independent direct mail windows programmed in JavaScript/PHP.

  5. Developing a "toolkit" to measure implementation of concurrent palliative care in rural community cancer centers.

    PubMed

    Zubkoff, Lisa; Dionne-Odom, J Nicholas; Pisu, Maria; Babu, Dilip; Akyar, Imatullah; Smith, Tasha; Mancarella, Gisella A; Gansauer, Lucy; Sullivan, Margaret Murray; Swetz, Keith M; Azuero, Andres; Bakitas, Marie A

    2018-02-01

    Despite national guidelines recommending early concurrent palliative care for individuals newly diagnosed with metastatic cancer, few community cancer centers, especially those in underserved rural areas do so. We are implementing an early concurrent palliative care model, ENABLE (Educate, Nurture, Advise, Before Life Ends) in four, rural-serving community cancer centers. Our objective was to develop a "toolkit" to assist community cancer centers that wish to integrate early palliative care for patients with newly diagnosed advanced cancer and their family caregivers. Guided by the RE-AIM (Reach, Effectiveness-Adoption, Implementation, Maintenance) framework, we undertook an instrument-development process based on the literature, expert and site stakeholder review and feedback, and pilot testing during site visits. We developed four instruments to measure ENABLE implementation: (1) the ENABLE RE-AIM Self-Assessment Tool to assess reach, adoption, implementation, and maintenance; (2) the ENABLE General Organizational Index to assess institutional implementation; (3) an Implementation Costs Tool; and (4) an Oncology Clinicians' Perceptions of Early Concurrent Oncology Palliative Care survey. We developed four measures to determine early palliative care implementation. These measures have been pilot-tested, and will be integrated into a comprehensive "toolkit" to assist community cancer centers to measure implementation outcomes. We describe the lessons learned and recommend strategies for promoting long-term program sustainability.

  6. 76 FR 74803 - Laboratory Animal Welfare: Adoption and Implementation of the Eighth Edition of the Guide for the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-01

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Laboratory Animal Welfare: Adoption and Implementation of the Eighth Edition of the Guide for the Care and Use of Laboratory Animals... the Guide for the Care and Use of Laboratory Animals (Guide) and has determined to adopt the 8th...

  7. Increasing psychotherapists' adoption and implementation of the evidence-based practice of progress monitoring.

    PubMed

    Persons, Jacqueline B; Koerner, Kelly; Eidelman, Polina; Thomas, Cannon; Liu, Howard

    2016-01-01

    Evidence-based practices (EBPs) reach consumers slowly because practitioners are slow to adopt and implement them. We hypothesized that giving psychotherapists a tool + training intervention that was designed to help the therapist integrate the EBP of progress monitoring into his or her usual way of working would be associated with adoption and sustained implementation of the particular progress monitoring tool we trained them to use (the Depression Anxiety Stress Scales on our Online Progress Tracking tool) and would generalize to all types of progress monitoring measures. To test these hypotheses, we developed an online progress monitoring tool and a course that trained psychotherapists to use it, and we assessed progress monitoring behavior in 26 psychotherapists before, during, immediately after, and 12 months after they received the tool and training. Immediately after receiving the tool + training intervention, participants showed statistically significant increases in use of the online tool and of all types of progress monitoring measures. Twelve months later, participants showed sustained use of any type of progress monitoring measure but not the online tool. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Hypergol Maintenance Facility Hazardous Waste South Staging Areas, SWMU 070 Corrective Measures Implementation

    NASA Technical Reports Server (NTRS)

    Miller, Ralinda R.

    2016-01-01

    This document presents the Corrective Measures Implementation (CMI) Year 10 Annual Report for implementation of corrective measures at the Hypergol Maintenance Facility (HMF) Hazardous Waste South Staging Areas at Kennedy Space Center, Florida. The work is being performed by Tetra Tech, Inc., for the National Aeronautics and Space Administration (NASA) under Indefinite Delivery Indefinite Quantity (IDIQ) NNK12CA15B, Task Order (TO) 07. Mr. Harry Plaza, P.E., of NASA's Environmental Assurance Branch is the Remediation Project Manager for John F. Kennedy Space Center. The Tetra Tech Program Manager is Mr. Mark Speranza, P.E., and the Tetra Tech Project Manager is Robert Simcik, P.E.

  9. Development and Implementation of a Telecommuting Evaluation Framework, and Modeling the Executive Telecommuting Adoption Process

    NASA Astrophysics Data System (ADS)

    Vora, V. P.; Mahmassani, H. S.

    2002-02-01

    This work proposes and implements a comprehensive evaluation framework to document the telecommuter, organizational, and societal impacts of telecommuting through telecommuting programs. Evaluation processes and materials within the outlined framework are also proposed and implemented. As the first component of the evaluation process, the executive survey is administered within a public sector agency. The survey data is examined through exploratory analysis and is compared to a previous survey of private sector executives. The ordinal probit, dynamic probit, and dynamic generalized ordinal probit (DGOP) models of telecommuting adoption are calibrated to identify factors which significantly influence executive adoption preferences and to test the robustness of such factors. The public sector DGOP model of executive willingness to support telecommuting under different program scenarios is compared with an equivalent private sector DGOP model. Through the telecommuting program, a case study of telecommuting travel impacts is performed to further substantiate research.

  10. The MeSH translation maintenance system: structure, interface design, and implementation.

    PubMed

    Nelson, Stuart J; Schopen, Michael; Savage, Allan G; Schulman, Jacque-Lynne; Arluk, Natalie

    2004-01-01

    The National Library of Medicine (NLM) produces annual editions of the Medical Subject Headings (MeSH). Translations of MeSH are often done to make the vocabulary useful for non-English users. However, MeSH translators have encountered difficulties with entry vocabulary as they maintain and update their translation. Tracking MeSH changes and updating their translations in a reasonable time frame is cumbersome. NLM has developed and implemented a concept-centered vocabulary maintenance system for MeSH. This system has been extended to create an interlingual database of translations, the MeSH Translation Maintenance System (MTMS). This database allows continual updating of the translations, as well as facilitating tracking of the changes within MeSH from one year to another. The MTMS interface uses a Web-based design with multiple colors and fonts to indicate concepts needing translation or review. Concepts for which there is no exact English equivalent can be added. The system software encourages compliance with the Unicode standard in order to ensure that character sets with native alphabets and full orthography are used consistently.

  11. Identification of attributes that promote the adoption and implementation of 2005 Dietary Guidelines for Americans

    USDA-ARS?s Scientific Manuscript database

    As part of a larger study, this research was to identify attributes of the Dietary Guidelines for Americans (DGAs) that would promote their adoption and implementation by participants in a nutrition intervention. Project procedures were guided by the Diffusion of Innovations (DOI) theory. To identif...

  12. Differences in Readiness between Rural Hospitals and Primary Care Providers for Telemedicine Adoption and Implementation: Findings from a Statewide Telemedicine Survey

    ERIC Educational Resources Information Center

    Martin, Amy Brock; Probst, Janice C.; Shah, Kyle; Chen, Zhimin; Garr, David

    2012-01-01

    Purpose: Published advantages of and challenges with telemedicine led us to examine the scope of telemedicine adoption, implementation readiness, and barriers in a southern state where adoption has been historically low. We hypothesized that rural hospitals and primary care providers (RPCPs) differ on adoption, readiness, and implementation…

  13. 45 CFR 1356.41 - Nonrecurring expenses of adoption.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES REQUIREMENTS... any adoptive placement. (2) States may set a reasonable lower maximum which must be based on...

  14. Factors influencing the implementation, adoption, use, sustainability and scalability of eLearning for family medicine specialty training: a systematic review protocol.

    PubMed

    Cotič, Živa; Rees, Rebecca; Wark, Petra A; Car, Josip

    2016-10-19

    In 2013, there was a shortage of approximately 7.2 million health workers worldwide, which is larger among family physicians than among specialists. eLearning could provide a potential solution to some of these global workforce challenges. However, there is little evidence on factors facilitating or hindering implementation, adoption, use, scalability and sustainability of eLearning. This review aims to synthesise results from qualitative and mixed methods studies to provide insight on factors influencing implementation of eLearning for family medicine specialty education and training. Additionally, this review aims to identify the actions needed to increase effectiveness of eLearning and identify the strategies required to improve eLearning implementation, adoption, use, sustainability and scalability for family medicine speciality education and training. A systematic search will be conducted across a range of databases for qualitative studies focusing on experiences, barriers, facilitators, and other factors related to the implementation, adoption, use, sustainability and scalability of eLearning for family medicine specialty education and training. Studies will be synthesised by using the framework analysis approach. This study will contribute to the evaluation of eLearning implementation, adoption, use, sustainability and scalability for family medicine specialty training and education and the development of eLearning guidelines for postgraduate medical education. PROSPERO http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016036449.

  15. The dynamics of de-adoption: a case study of policy change, de-adoption, and replacement of an evidence-based HIV intervention.

    PubMed

    McKay, Virginia R; Margaret Dolcini, M; Hoffer, Lee D

    2017-12-01

    Evidence-based intervention (EBI) de-adoption and its influence on public health organizations are largely unexplored within public health implementation research. However, a recent shift in support for HIV prevention EBIs by the Centers for Disease Control and Prevention provides an opportunity to explore EBI de-adoption. The current mixed-method study examines EBI de-adoption and the subsequent impact on a community-based organization (CBO) dedicated to HIV prevention. We conducted a case study with a CBO implementing RESPECT, an HIV prevention EBI, over 5 years (2010-2014), but then de-adopted the intervention. We collected archival data documenting RESPECT implementation and conducted two semi-structured interviews with RESPECT staff (N = 5). Using Fixsen and colleagues' implementation framework, we developed a narrative of RESPECT implementation, delivery, and de-adoption and a thematic analysis to understand additional consequences of RESPECT de-adoption. Discontinuation of RESPECT activities unfolded in a process over time, requiring effort by RESPECT staff. RESPECT de-adoption had wide-reaching influences on individual staff, interactions between the staff and the community, the agency overall, and for implementation of future EBIs. We propose a revision of the implementation framework, incorporating EBI de-adoption as a phase of the implementation cycle. Furthermore, EBI de-adoption may have important, unintended consequences and can inform future HIV prevention strategies and guide research focusing on EBI de-adoption.

  16. Foreign Language Maintenance Classes for Returnees.

    ERIC Educational Resources Information Center

    Yashiro, Kyoko

    Recent studies by the Management and Coordination Agency of the Japanese government and the Japan Overseas Educational Services (JOES) reveal that Japanese students returning from overseas want to retain their foreign language, and that a majority undertake various maintenance activities. Maintenance classes are widely adopted. Research indicates…

  17. Load-bearing masonry system adoption and performance: A case study of construction company in a developing country

    NASA Astrophysics Data System (ADS)

    Ramli, Nor Azlinda; Abdullah, Che Sobry; Nawi, Mohd Nasrun Mohd; Bahaudin, Ahmad Yusni

    2016-08-01

    This study addresses the factors that influence the adoption of load-bearing masonry (LBM) system. A case study of the load-bearing masonry (LBM) system adoption is conducted through an interview to explore the situation of the technology adoption in a construction company. The finding indicates the factors influence the adoption of LBM system for the construction company are: organizational resources, usefulness, less maintenance, reduce construction time and cost. From the findings, these factors consistent with previous literature. Furthermore, the performance of the company was measured by looking into the financial and non-financial aspects. The LBM system brings good performance as it increased the profits of the company, a good quality of product and attracts more demand from customers. Thus, these factors should be considered for the other companies that are interested in implementing the LBM system in their projects.

  18. Adoption: Overview and Major Recommendations.

    ERIC Educational Resources Information Center

    Schulman, Irving; Behrman, Richard E.

    1993-01-01

    Examines a number of facets of adoption in the United States and recommends that the federal government create an adoption data collection system; states implement a uniform adoption law; and the adoption process be more open, both for adoptees and prospective adoptive parents. Also discusses the adoption of children with special needs, and…

  19. Mediation of adoption and use: a key strategy for mitigating unintended consequences of health IT implementation.

    PubMed

    Novak, Laurie L; Anders, Shilo; Gadd, Cynthia S; Lorenzi, Nancy M

    2012-01-01

    Without careful attention to the work of users, implementation of health IT can produce new risks and inefficiencies in care. This paper uses the technology use mediation framework to examine the work of a group of nurses who serve as mediators of the adoption and use of a barcode medication administration (BCMA) system in an inpatient setting. The study uses ethnographic methods to explore the mediators' work. Data included field notes from observations, documents, and email communications. This variety of sources enabled triangulation of findings between activities observed, discussed in meetings, and reported in emails. Mediation work integrated the BCMA tool with nursing practice, anticipating and solving implementation problems. Three themes of mediation work include: resolving challenges related to coordination, integrating the physical aspects of BCMA into everyday practice, and advocacy work. Previous work suggests the following factors impact mediation effectiveness: proximity to the context of use, understanding of users' practices and norms, credibility with users, and knowledge of the technology and users' technical abilities. We describe three additional factors observed in this case: 'influence on system developers,' 'influence on institutional authorities,' and 'understanding the network of organizational relationships that shape the users' work.' Institutionally supported clinicians who facilitate adoption and use of health IT systems can improve the safety and effectiveness of implementation through the management of unintended consequences. Additional research on technology use mediation can advance the science of implementation by providing decision-makers with theoretically durable, empirically grounded evidence for designing implementations.

  20. Implementing solutions to improve and expand telehealth adoption: participatory action research in four community healthcare settings.

    PubMed

    Taylor, Johanna; Coates, Elizabeth; Wessels, Bridgette; Mountain, Gail; Hawley, Mark S

    2015-12-01

    Adoption of telehealth has been slower than anticipated, and little is known about the service improvements that help to embed telehealth into routine practice or the role of frontline staff in improving adoption. This paper reports on participatory action research carried out in four community health settings using telehealth for patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. To inform the action research, in-depth case studies of each telehealth service were conducted (May 2012-June 2013). Each service was then supported by researchers through two cycles of action research to implement changes to increase adoption of telehealth, completed over a seven month period (July 2013-April 2014). The action research was studied via observation of multi-stakeholder workshops, analysis of implementation plans, and focus groups. Action research participants included 57 staff and one patient, with between eight and 20 participants per site. The case study findings were identified as a key source of information for planning change, with sites addressing common challenges identified through this work. For example, refining referral criteria; standardizing how and when patients are monitored; improving data sharing; and establishing evaluation processes. Sites also focused on raising awareness of telehealth to increase adoption in other clinical teams and to help secure future financial investment for telehealth, which was required because of short-term funding arrangements. Specific solutions varied due to local infrastructures, resources, and opinion, as well as previous service developments. Local telehealth champions played an important role in engaging multiple stakeholders in the study. Action research enabled services to make planned changes to telehealth and share learning across multiple stakeholders about how and when to use telehealth. However, adoption was impeded by continual changes affecting telehealth and wider service provision

  1. The role of medical group practice administrators in the adoption and implementation of Medicare's physician quality reporting system.

    PubMed

    Coulam, Robert; Kralewski, John; Dowd, Bryan; Gans, David

    2016-01-01

    Although there are numerous studies of the factors influencing the adoption of quality assurance (QA) programs by medical group practices, few have focused on the role of group practice administrators. To gain insights into the role these administrators play in QA programs, we analyzed how medical practices adopted and implemented the Medicare Physician Quality Reporting System (PQRS), the largest physician quality reporting system in the United States. We conducted focus group interviews in 2011 with a national convenience sample of 76 medical group practice administrators. Responses were organized and analyzed using the innovation decision framework of Van de Ven and colleagues. Administrators conducted due diligence on PQRS, influenced how the issue was presented to physicians for adoption, and managed implementation thereafter. Administrators' recommendations were heavily influenced by practice characteristics, financial incentives, and practice commitments to early adoption of quality improvement innovations. Virtually, all who attempted it agreed that PQRS was straightforward to implement. However, the complexities of Medicare's PQRS reports impeded use of the data by administrators to support quality management. Group practice administrators are playing a prominent role in activities related to the quality of patient care--they are not limited to the business side of the practice. Especially, as PQRS becomes more nearly universal after 2014, Medicare should take account of the role that administrators play, by more actively engaging administrators in shaping these programs and making it easier for administrators to use the results. More research is needed on the rapidly evolving role of nonphysician administration in medical group practices. Practice administrators have a larger role than commonly understood in how quality reporting initiatives are adopted and used and are in an exceptional position to influence the more appropriate use of these resources if

  2. Nurse adoption of continuous patient monitoring on acute post-surgical units: managing technology implementation.

    PubMed

    Jeskey, Mary; Card, Elizabeth; Nelson, Donna; Mercaldo, Nathaniel D; Sanders, Neal; Higgins, Michael S; Shi, Yaping; Michaels, Damon; Miller, Anne

    2011-10-01

    To report an exploratory action-research process used during the implementation of continuous patient monitoring in acute post-surgical nursing units. Substantial US Federal funding has been committed to implementing new health care technology, but failure to manage implementation processes may limit successful adoption and the realisation of proposed benefits. Effective approaches for managing barriers to new technology implementation are needed. Continuous patient monitoring was implemented in three of 13 medical/surgical units. An exploratory action-feedback approach, using time-series nurse surveys, was used to identify barriers and develop and evaluate responses. Post-hoc interviews and document analysis were used to describe the change implementation process. Significant differences were identified in night- and dayshift nurses' perceptions of technology benefits. Research nurses' facilitated the change process by evolving 'clinical nurse implementation specialist' expertise. Health information technology (HIT)-related patient outcomes are mediated through nurses' acting on new information but HIT designed for critical care may not transfer to acute care settings. Exploratory action-feedback approaches can assist nurse managers in assessing and mitigating the real-world effects of HIT implementations. It is strongly recommended that nurse managers identify stakeholders and develop comprehensive plans for monitoring the effects of HIT in their units. © 2011 Blackwell Publishing Ltd.

  3. A case study of machinery maintenance protocols and procedures within the UK utilities sector.

    PubMed

    Edwards, David J; Love, Peter E D

    2016-08-01

    Failure to conduct periodic fixed-time-to (or scheduled) maintenance on off-highway plant and equipment represents a significant health and safety hazard and major litigation risk for utility contractors completing service excavation and reinstatement works on public highways. Mini-excavators are a ubiquitous mobile plant item used for such tasks and have recently been responsible for several major injuries and fatalities involving workers and members of the public in the United Kingdom (UK). The research utilises the method of triangulation to examine the maintenance practices of utility contractors in the UK. Findings from the research reveal that a combination of prevailing market forces and internal 'company' pressures have inadvertently removed knowledgeable and trained operators, site foremen and managerial supervisors from hands-on maintenance inspections. Rather, 'virtual' maintenance protocols and procedures are adopted by head office but rarely fully implemented on-site. The research concludes with pragmatic recommendations and direction for future research. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. An Evaluation of the Early Implementation of School-Based Bullying Prevention Programs in Massachusetts

    ERIC Educational Resources Information Center

    Sautter Errichetti, Karen

    2014-01-01

    Background: A quarter of U.S. children are bullied annually. State legislatures have responded to high profile media exposure of bullying and increased public concern by passing legislation aimed at preventing bullying among school children. Methods: The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was used to…

  5. Alternative Student Growth Measures for Teacher Evaluation: Implementation Experiences of Early-Adopting Districts. REL 2015-093

    ERIC Educational Resources Information Center

    McCullough, Moira; English, Brittany; Angus, Megan Hague; Gill, Brian

    2015-01-01

    Alternative student growth measures for teacher evaluation: Implementation experiences of early-adopting districts: State requirements to include student achievement growth in teacher evaluations are prompting the development of alternative ways to measure growth in grades and subjects not covered by state assessments. These alternative growth…

  6. 76 FR 14805 - Approval and Promulgation of Air Quality Implementation Plans; Virginia; Adoption of the Revised...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-18

    ... Promulgation of Air Quality Implementation Plans; Virginia; Adoption of the Revised Lead Standards and Related... SIP revisions add the primary and secondary lead standards of 0.15 micrograms per cubic meter ([mu]g... CFR Part 52 Environmental protection, Air pollution control, Incorporation by reference, Ozone...

  7. Implementation of an agile maintenance mechanic assignment methodology

    NASA Astrophysics Data System (ADS)

    Jimenez, Jesus A.; Quintana, Rolando

    2000-10-01

    The objective of this research was to develop a decision support system (DSS) to study the impact of introducing new equipment into a medical apparel plant from a maintenance organizational structure perspective. This system will enable the company to determine if their capacity is sufficient to meet current maintenance challenges. The DSS contains two database sets that describe equipment and maintenance resource profiles. The equipment profile specifies data such as mean time to failures, mean time to repairs, and minimum mechanic skill level required to fix each machine group. Similarly, maintenance-resource profile reports information about the mechanic staff, such as number and type of certifications received, education level, and experience. The DSS will then use this information to minimize machine downtime by assigning the highest skilled mechanics to machines with higher complexity and product value. A modified version of the simplex method, the transportation problem, was used to perform the optimization. The DSS was built using the Visual Basic for Applications (VBA) language contained in the Microsoft Excel environment. A case study was developed from current existing data. The analysis consisted of forty-two machine groups and six mechanic categories with ten skill levels. Results showed that only 56% of the mechanic workforce was utilized. Thus, the company had available resources for meeting future maintenance requirements.

  8. Implementing methadone maintenance treatment in prisons in Malaysia.

    PubMed

    Wickersham, Jeffrey A; Marcus, Ruthanne; Kamarulzaman, Adeeba; Zahari, Muhammad Muhsin; Altice, Frederick L

    2013-02-01

    In Malaysia, human immunodeficiency virus (HIV) infection is highly concentrated among people who inject opioids. For this reason, the country undertook a three-phase roll-out of a methadone maintenance treatment (MMT) programme. In Phase 3, described in this paper, MMT was implemented within prisons and retention in care was assessed. After developing standard operating procedures and agreement between its Prisons Department and Ministry of Health, Malaysia established pilot MMT programmes in two prisons in the states of Kelantan (2008) and Selangor (2009) - those with the highest proportions of HIV-infected prisoners. Community-based MMT programmes were also established in Malaysia to integrate treatment activities after prisoners' release. Having failed to reduce the incidence of HIV infection, in 2005 Malaysia embarked on a harm reduction strategy. STANDARD OPERATING PROCEDURES WERE MODIFIED TO: (i) escalate the dose of methadone more slowly; (ii) provide ongoing education and training for medical and correctional staff and inmates; (iii) increase the duration of methadone treatment before releasing prisoners; (iv) reinforce linkages with community MMT programmes after prisoners' release; (v) screen for and treat tuberculosis; (vi) escalate the dose of methadone during treatment for HIV infection and tuberculosis; and (vii) optimize the daily oral dose of methadone (> 80 mg) before releasing prisoners. Prison-based MMT programmes can be effectively implemented but require adequate dosing and measures are needed to improve communication between prison and police authorities, prevent police harassment of MMT clients after their release, and improve systems for tracking release dates.

  9. Shriners Hospitals for Children, Honolulu's experience with telemedicine: program implementation, maintenance, growth, and lessons learned.

    PubMed

    Ono, Craig M; Lindsey, Jana L

    2004-10-01

    Shriners Hospitals for Children, Honolulu Telemedicine Program conducts real-time video consultations with remotes sites in Hawaii, Guam, Saipan, American Samoa, the Federated States of Micronesia, and the Republic of the Marshall Islands. The program began in 1999 and has provided over 240 consultations. This report is a summary of the Shriners Hospitals experience and lessons learned regarding program implementation and maintenance.

  10. Mediation of adoption and use: a key strategy for mitigating unintended consequences of health IT implementation

    PubMed Central

    Anders, Shilo; Gadd, Cynthia S; Lorenzi, Nancy M

    2012-01-01

    Objective Without careful attention to the work of users, implementation of health IT can produce new risks and inefficiencies in care. This paper uses the technology use mediation framework to examine the work of a group of nurses who serve as mediators of the adoption and use of a barcode medication administration (BCMA) system in an inpatient setting. Materials and methods The study uses ethnographic methods to explore the mediators' work. Data included field notes from observations, documents, and email communications. This variety of sources enabled triangulation of findings between activities observed, discussed in meetings, and reported in emails. Results Mediation work integrated the BCMA tool with nursing practice, anticipating and solving implementation problems. Three themes of mediation work include: resolving challenges related to coordination, integrating the physical aspects of BCMA into everyday practice, and advocacy work. Discussion Previous work suggests the following factors impact mediation effectiveness: proximity to the context of use, understanding of users' practices and norms, credibility with users, and knowledge of the technology and users' technical abilities. We describe three additional factors observed in this case: ‘influence on system developers,’ ‘influence on institutional authorities,’ and ‘understanding the network of organizational relationships that shape the users' work.’ Conclusion Institutionally supported clinicians who facilitate adoption and use of health IT systems can improve the safety and effectiveness of implementation through the management of unintended consequences. Additional research on technology use mediation can advance the science of implementation by providing decision-makers with theoretically durable, empirically grounded evidence for designing implementations. PMID:22634157

  11. Factors associated with contingency management adoption among opioid treatment providers receiving a comprehensive implementation strategy.

    PubMed

    Becker, Sara J; Kelly, Lourah M; Kang, Augustine W; Escobar, Katherine I; Squires, Daniel D

    2018-03-29

    Contingency management (CM) is an evidence-based behavioral intervention for opioid use disorders (OUDs); however, CM adoption in OUD treatment centers remains low due to barriers at patient, provider, and organizational levels. In a recent trial, OUD treatment providers who received the Science to Service Laboratory (SSL), a multilevel implementation strategy developed by a federally funded addiction training center, had significantly greater odds of CM adoption than providers who received training as usual. This study examined whether CM adoption frequency varied as a function of provider sociodemographic characteristics (i.e., age, race/ethnicity, licensure) and perceived barriers to adoption (i.e., patient-, provider-, organization-level) among providers receiving the SSL in an opioid treatment program. Thirty-nine providers (67% female, 77% non-Hispanic white, 72% with specialty licensure, M age = 42 [SD = 11.46]) received the SSL, which consisted of didactic training, performance feedback, specialized training of internal change champions, and external coaching. Providers completed a comprehensive baseline assessment and reported on their adoption of CM biweekly for 52 weeks. Providers reported using CM an average of nine 2-week intervals (SD = 6.35). Hierarchical multiple regression found that providers identifying as younger, non-Hispanic white, and without addiction-related licensure all had higher levels of CM adoption frequency. Higher perceived patient-level barriers predicted lower levels of CM adoption frequency, whereas provider- and organization-level barriers were not significant predictors. The significant effect of age on CM adoption frequency was consistent with prior research on predictors of evidence-based practice adoption, whereas the effect of licensure was counter to prior research. The finding that CM adoption frequency was lower among racially/ethnically diverse providers was not expected and suggests that the SSL may require adaptation

  12. Present Status and Future Growth of Advanced Maintenance Technology and Strategy in US Manufacturing.

    PubMed

    Jin, Xiaoning; Weiss, Brian A; Siegel, David; Lee, Jay

    2016-01-01

    The goals of this paper are to 1) examine the current practices of diagnostics, prognostics, and maintenance employed by United States (U.S.) manufacturers to achieve productivity and quality targets and 2) to understand the present level of maintenance technologies and strategies that are being incorporated into these practices. A study is performed to contrast the impact of various industry-specific factors on the effectiveness and profitability of the implementation of prognostics and health management technologies, and maintenance strategies using both surveys and case studies on a sample of U.S. manufacturing firms ranging from small to mid-sized enterprises (SMEs) to large-sized manufacturing enterprises in various industries. The results obtained provide important insights on the different impacts of specific factors on the successful adoption of these technologies between SMEs and large manufacturing enterprises. The varying degrees of success with respect to current maintenance programs highlight the opportunity for larger manufacturers to improve maintenance practices and consider the use of advanced prognostics and health management (PHM) technology. This paper also provides the existing gaps, barriers, future trends, and roadmaps for manufacturing PHM technology and maintenance strategy.

  13. Present Status and Future Growth of Advanced Maintenance Technology and Strategy in US Manufacturing

    PubMed Central

    Jin, Xiaoning; Weiss, Brian A.; Siegel, David; Lee, Jay

    2016-01-01

    The goals of this paper are to 1) examine the current practices of diagnostics, prognostics, and maintenance employed by United States (U.S.) manufacturers to achieve productivity and quality targets and 2) to understand the present level of maintenance technologies and strategies that are being incorporated into these practices. A study is performed to contrast the impact of various industry-specific factors on the effectiveness and profitability of the implementation of prognostics and health management technologies, and maintenance strategies using both surveys and case studies on a sample of U.S. manufacturing firms ranging from small to mid-sized enterprises (SMEs) to large-sized manufacturing enterprises in various industries. The results obtained provide important insights on the different impacts of specific factors on the successful adoption of these technologies between SMEs and large manufacturing enterprises. The varying degrees of success with respect to current maintenance programs highlight the opportunity for larger manufacturers to improve maintenance practices and consider the use of advanced prognostics and health management (PHM) technology. This paper also provides the existing gaps, barriers, future trends, and roadmaps for manufacturing PHM technology and maintenance strategy. PMID:28058173

  14. Optimisation of maintenance concept choice using risk-decision factor - a case study

    NASA Astrophysics Data System (ADS)

    Popovic, Vladimir M.; Vasic, Branko M.; Rakicevic, Branislav B.; Vorotovic, Goran S.

    2012-10-01

    The design of maintenance system and the corresponding logistic support is a very complex process, during which the aim is to find the compromise solutions regarding the relations among different maintenance procedures and the ways of their implementation. As a result of this, various solutions can be adopted, since this is conditioned by a series of important factors and criteria, which can be contradictory sometimes. There are different perspectives on ways of solving practical maintenance problems, that is dilemmas when it comes to the choice of maintenance concept. The principal dilemma is how and when to decide on carrying out maintenance procedures. Should the decision be based on theoretical grounds or experience, how does one reconcile those two extremes, who is to decide upon this? In this article we have offered one, basically new solution as a possibility for maintenance concept choice, based on a significant modification of the widely used failure modes and effects analysis (FMEA) method. This solution is risk-decision factor (RDF). This is a result of seven parameters (of different importance and weight) that have the key impact on the process of production and logistic support. The application of this factor is illustrated by the example of planning, organisation and functioning of the maintenance system applied in The Institute for Manufacturing Banknotes and Coins (ZIN) in Belgrade.

  15. Controlled ecological evaluation of an implemented exercise training programme to prevent lower limb injuries in sport: differences in implementation activity.

    PubMed

    Donaldson, Alex; Gabbe, Belinda J; Lloyd, David G; Cook, Jill; Finch, Caroline F

    2018-04-24

    The public health benefits of injury prevention programmes are maximised when programmes are widely adopted and adhered to. Therefore, these programmes require appropriate implementation support. This study evaluated implementation activity outcomes associated with the implementation of FootyFirst, an exercise training injury prevention programme for community Australian football, both with (FootyFirst+S) and without (FootyFirst+NS) implementation support. An evaluation plan based on the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) Sports Setting Matrix was applied in a controlled ecological evaluation of the implementation of FootyFirst. RE-AIM dimension-specific (range: 0-2) and total RE-AIM scores (range: 0-10) were derived by triangulating data from a number of sources (including surveys, interviews, direct observations and notes) describing FootyFirst implementation activities. The mean dimension-specific and total scores were compared for clubs in regions receiving FootyFirst+S and FootyFirst+NS, through analysis of variance. The mean total RE-AIM score forclubs in the FootyFirst+S regions was 2.4 times higher than for clubs in the FootyFirst+NS region (4.73 vs 1.94; 95% CI for the difference: 1.64 to 3.74). Similarly, all dimension-specific scores were significantly higher for clubs in the FootyFirst+S regions compared with clubs in the FootyFirst+NS region. In all regions, the dimension-specific scores were highest for reach and adoption, and lowest for implementation. Implementing exercise training injury prevention programmes in community sport is challenging. Delivering programme content supported by a context-specific and evidence-informed implementation plan leads to greater implementation activity, which is an important precursor to injury reductions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise

  16. 33 CFR 230.21 - Adoption.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 3 2011-07-01 2011-07-01 false Adoption. 230.21 Section 230.21... FOR IMPLEMENTING NEPA § 230.21 Adoption. See 40 CFR 1506.3. A district commander will normally adopt... processed in accordance with this regulation. A district commander may also adopt another agency's EA/FONSI. ...

  17. 33 CFR 230.21 - Adoption.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 3 2010-07-01 2010-07-01 false Adoption. 230.21 Section 230.21... FOR IMPLEMENTING NEPA § 230.21 Adoption. See 40 CFR 1506.3. A district commander will normally adopt... processed in accordance with this regulation. A district commander may also adopt another agency's EA/FONSI. ...

  18. 33 CFR 230.21 - Adoption.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 3 2013-07-01 2013-07-01 false Adoption. 230.21 Section 230.21... FOR IMPLEMENTING NEPA § 230.21 Adoption. See 40 CFR 1506.3. A district commander will normally adopt... processed in accordance with this regulation. A district commander may also adopt another agency's EA/FONSI. ...

  19. 33 CFR 230.21 - Adoption.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 3 2014-07-01 2014-07-01 false Adoption. 230.21 Section 230.21... FOR IMPLEMENTING NEPA § 230.21 Adoption. See 40 CFR 1506.3. A district commander will normally adopt... processed in accordance with this regulation. A district commander may also adopt another agency's EA/FONSI. ...

  20. 33 CFR 230.21 - Adoption.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 33 Navigation and Navigable Waters 3 2012-07-01 2012-07-01 false Adoption. 230.21 Section 230.21... FOR IMPLEMENTING NEPA § 230.21 Adoption. See 40 CFR 1506.3. A district commander will normally adopt... processed in accordance with this regulation. A district commander may also adopt another agency's EA/FONSI. ...

  1. Implementing methadone maintenance treatment in prisons in Malaysia

    PubMed Central

    Wickersham, Jeffrey A; Marcus, Ruthanne; Kamarulzaman, Adeeba; Zahari, Muhammad Muhsin

    2013-01-01

    Abstract Problem In Malaysia, human immunodeficiency virus (HIV) infection is highly concentrated among people who inject opioids. For this reason, the country undertook a three-phase roll-out of a methadone maintenance treatment (MMT) programme. In Phase 3, described in this paper, MMT was implemented within prisons and retention in care was assessed. Approach After developing standard operating procedures and agreement between its Prisons Department and Ministry of Health, Malaysia established pilot MMT programmes in two prisons in the states of Kelantan (2008) and Selangor (2009) – those with the highest proportions of HIV-infected prisoners. Community-based MMT programmes were also established in Malaysia to integrate treatment activities after prisoners’ release. Local setting Having failed to reduce the incidence of HIV infection, in 2005 Malaysia embarked on a harm reduction strategy. Relevant changes Standard operating procedures were modified to: (i) escalate the dose of methadone more slowly; (ii) provide ongoing education and training for medical and correctional staff and inmates; (iii) increase the duration of methadone treatment before releasing prisoners; (iv) reinforce linkages with community MMT programmes after prisoners’ release; (v) screen for and treat tuberculosis; (vi) escalate the dose of methadone during treatment for HIV infection and tuberculosis; and (vii) optimize the daily oral dose of methadone (> 80 mg) before releasing prisoners. Lessons learnt Prison-based MMT programmes can be effectively implemented but require adequate dosing and measures are needed to improve communication between prison and police authorities, prevent police harassment of MMT clients after their release, and improve systems for tracking release dates. PMID:23554524

  2. Increased Adoption of Quality Improvement Interventions to Implement Evidence-Based Practices for Pressure Ulcer Prevention in U.S. Academic Medical Centers.

    PubMed

    Padula, William V; Mishra, Manish K; Makic, Mary Beth F; Wald, Heidi L; Campbell, Jonathan D; Nair, Kavita V; Valuck, Robert J

    2015-12-01

    In 2008, the U.S. Centers for Medicare and Medicaid Services enacted a nonpayment policy for stage III and IV hospital-acquired pressure ulcers (HAPUs), which incentivized hospitals to improve prevention efforts. In response, hospitals looked for ways to support implementation of evidence-based practices for HAPU prevention, such as adoption of quality improvement (QI) interventions. The objective of this study was to quantify adoption patterns of QI interventions for supporting evidence-based practices for HAPU prevention. This study surveyed wound care specialists working at hospitals within the University HealthSystem Consortium. A questionnaire was used to retrospectively describe QI adoption patterns according to 25 HAPU-specific QI interventions into four domains: leadership, staff, information technology (IT), and performance and improvement. Respondents indicated QI interventions implemented between 2007 and 2012 to the nearest quarter and year. Descriptive statistics defined patterns of QI adoption. A t-test and statistical process control chart established statistically significant increase in adoption following nonpayment policy enactment in October 2008. Increase are described in terms of scope (number of QI domains employed) and scale (number of QI interventions within domains). Fifty-three of the 55 hospitals surveyed reported implementing QI interventions for HAPU prevention. Leadership interventions were most frequent, increasing in scope from 40% to 63% between 2008 and 2012; "annual programs to promote pressure ulcer prevention" showed the greatest increase in scale. Staff interventions increased in scope from 32% to 53%; "frequent consult driven huddles" showed the greatest increase in scale. IT interventions increased in scope from 31% to 55%. Performance and improvement interventions increased in scope from 18% to 40%, with "new skin care products . . ." increasing the most. Academic medical centers increased adoption of QI interventions

  3. Implementing a Reliability Centered Maintenance Program at NASA's Kennedy Space Center

    NASA Technical Reports Server (NTRS)

    Tuttle, Raymond E.; Pete, Robert R.

    1998-01-01

    Maintenance practices have long focused on time based "preventive maintenance" techniques. Components were changed out and parts replaced based on how long they had been in place instead of what condition they were in. A reliability centered maintenance (RCM) program seeks to offer equal or greater reliability at decreased cost by insuring only applicable, effective maintenance is performed and by in large part replacing time based maintenance with condition based maintenance. A significant portion of this program involved introducing non-intrusive technologies, such as vibration analysis, oil analysis and I/R cameras, to an existing labor force and management team.

  4. On the Consideration of Adoption and Implementation of The Next Generation Science Standards in a Local-Control Context: Supporting the Epistemology of Science through Education Policy

    NASA Astrophysics Data System (ADS)

    Lazzaro, Christopher C.

    On the Consideration of Adoption and Implementation of The Next Generation Science Standards in a Local-Control Context: Supporting the Epistemology of Science through Education Policy. Christopher C Lazzaro. The primary purpose of this research is to understand how and why members at each of the three levels of the education system within a local-control state made the decisions they did in supporting or hindering the adoption and implementation of the Next Generation Science Standards. This research concentrates on three levels of the education system in a local-control state; 1) the state level, 2) the district level, and 3) the school/teacher level, while investigating the following questions: 1. To what extent, and in what ways, do members in each of the three levels of the state education system advocate for adoption and implementation of the Next Generation Science Standards? 2. Are the members in each of the three levels motivated or compelled to consider adoption and implementation of the Next Generation Science Standards, why or why not? 3. To what extent, and in what ways, do the members in each of the three levels take into account science epistemology in their overall consideration of adoption/implementation of the NGSS? The data drew from a series of interviews from a prior study, "Challenges of Implementing the Next Generation Science Standards in Local-Control States in the U.S." (Sevian, Foster, & Scheff, 2012). After these data were coded and analyzed around the three research questions, this phenomenographic research study identified four key findings: Key Finding 1 - As the District Coordinators are uniquely situated within the state education system to be able to see both the on-the-ground practical implications and the high-level policy pressures of adopting and implementing the NGSS, they reflect the deepest level of awareness of how to best advocate for adoption and implementation of the NGSS. Key Finding 2 - Motivation to adopt and

  5. Training Opioid Addiction Treatment Providers to Adopt Contingency Management: A Prospective Pilot Trial of a Comprehensive Implementation Science Approach

    PubMed Central

    Becker, Sara J.; Squires, Daniel D.; Strong, David R.; Barnett, Nancy P.; Monti, Peter M.; Petry, Nancy M.

    2016-01-01

    Background Few prospective studies have evaluated theory-driven approaches to the implementation of evidence-based opioid treatment. This study compared the effectiveness of an implementation model (Science to Service Laboratory; SSL) to training as usual (TAU) in promoting the adoption of contingency management across a multi-site opiate addiction treatment program. We also examined whether the SSL affected putative mediators of contingency management adoption (perceived innovation characteristics and organizational readiness to change). Methods Sixty treatment providers (39 SSL, 21 TAU) from 15 geographically diverse satellite clinics (7 SSL, 8 TAU) participated in the 12-month study. Both conditions received didactic contingency management training and those in the pre-determined experimental region received 9 months of SSL-enhanced training. Contingency management adoption was monitored biweekly, while putative mediators were measured at baseline, 3-, and 12-months. Results Relative to providers in the TAU region, treatment providers in the SSL region had comparable likelihood of contingency management adoption in the first 20 weeks of the study, and then significantly higher likelihood of adoption (odds ratios = 2.4-13.5) for the remainder of the study. SSL providers also reported higher levels of one perceived innovation characteristic (Observability) and one aspect of organizational readiness to change (Adequacy of Training Resources), although there was no evidence that the SSL affected these putative mediators over time. Conclusions Results of this study indicate that a fully powered randomized trial of the SSL is warranted. Considerations for a future evaluation are discussed. PMID:26682582

  6. Training opioid addiction treatment providers to adopt contingency management: A prospective pilot trial of a comprehensive implementation science approach.

    PubMed

    Becker, Sara J; Squires, Daniel D; Strong, David R; Barnett, Nancy P; Monti, Peter M; Petry, Nancy M

    2016-01-01

    Few prospective studies have evaluated theory-driven approaches to the implementation of evidence-based opioid treatment. This study compared the effectiveness of an implementation model (Science to Service Laboratory; SSL) to training as usual (TAU) in promoting the adoption of contingency management across a multisite opioid addiction treatment program. We also examined whether the SSL affected putative mediators of contingency management adoption (perceived innovation characteristics and organizational readiness to change). Sixty treatment providers (39 SSL, 21 TAU) from 15 geographically diverse satellite clinics (7 SSL, 8 TAU) participated in the 12-month study. Both conditions received didactic contingency management training and those in the predetermined experimental region received 9 months of SSL-enhanced training. Contingency management adoption was monitored biweekly, whereas putative mediators were measured at baseline, 3 months, and 12 months. Relative to providers in the TAU region, treatment providers in the SSL region had comparable likelihood of contingency management adoption in the first 20 weeks of the study, and then significantly higher likelihood of adoption (odds ratios = 2.4-13.5) for the remainder of the study. SSL providers also reported higher levels of one perceived innovation characteristic (Observability) and one aspect of organizational readiness to change (Adequacy of Training Resources), although there was no evidence that the SSL affected these putative mediators over time. Results of this study indicate that a fully powered randomized trial of the SSL is warranted. Considerations for a future evaluation are discussed.

  7. Improving Maintenance Data Collection Via Point-of- Maintenance (POMX) Implementation

    DTIC Science & Technology

    2006-03-01

    accurate documentation, (3) identifying and correcting the root causes for poor data integrity, and (4) educating the unit on the critical need for data ...the validity of the results. The data in this study were analyzed using the SAS JMP 6.0 statistical software package. The results for the tests...traditional keyboard data entry methods at a computer terminal. These terminals are typically located in the aircraft maintenance unit (AMU) facility , away

  8. Improving Maintenance Data Collection Via Point-Of-Maintenance (POMX) Implementation

    DTIC Science & Technology

    2006-03-01

    accurate documentation, (3) identifying and correcting the root causes for poor data integrity, and (4) educating the unit on the critical need for data ...the validity of the results. The data in this study were analyzed using the SAS JMP 6.0 statistical software package. The results for the tests...traditional keyboard data entry methods at a computer terminal. These terminals are typically located in the aircraft maintenance unit (AMU) facility , away

  9. 45 CFR Appendix B to Part 1355 - Adoption Data Elements

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES GENERAL Pt. 1355, App. B Appendix B... in This Adoption? ____ Yes: 1 No: 2 II. Child's Demographic Information A. Date of Birth __(mo...

  10. 45 CFR Appendix B to Part 1355 - Adoption Data Elements

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES GENERAL Pt. 1355, App. B Appendix B... in This Adoption? ____ Yes: 1 No: 2 II. Child's Demographic Information A. Date of Birth __(mo...

  11. Does competition by health maintenance organizations affect the adoption of cost-containment measures by fee-for-service plans?

    PubMed

    Joesch, J M; Wickizer, T M; Feldstein, P J

    1998-06-01

    How groups insured by fee-for-service health plans react to increased competition from health maintenance organizations (HMOs) is an unresolved question. We investigated whether groups insured by indemnity plans respond to HMO market competition by changing selected health insurance features, such as deductible amounts, stop loss levels, and coinsurance rates, or by adopting utilization management or preferred provider organization (PPO) benefit options. We collected benefit design data for the years 1985 through 1992 from 95 insured groups in 62 US metropolitan statistical areas. Multivariate hazard analysis showed that groups located in markets with higher rates of change in HMO enrollment were less likely to increase deductibles or stop loss levels. Groups located in markets with higher HMO enrollment were more likely to adopt utilization management or PPO benefit options. A group located in a market with an HMO penetration rate of 20% was 65% more likely to have included a PPO option as part of its insurance benefit plan than a group located in a market with an HMO penetration rate of 15% (p < 0.05). Concern about possible adverse selection effects may deter some fee-for-service groups from changing their health insurance coverage. Under some conditions, however, groups insured under fee-for-service plans do respond to managed care competition by changing their insurance benefits to achieve greater cost containment.

  12. Barriers to implementing evidence-based clinical guidelines: A survey of early adopters

    PubMed Central

    Spallek, Heiko; Song, Mei; Polk, Deborah E; Bekhuis, Tanja; Frantsve-Hawley, Julie; Aravamudhan, Krishna

    2010-01-01

    Objective The purpose of this study is to identify barriers that early-adopting dentists perceive as common and challenging when implementing recommendations from evidence-based (EB) clinical guidelines. Method This is a cross-sectional study. Dentists who attended the 2008 Evidence-based Dentistry Champion Conference were eligible for inclusion. Forty-three dentists (34%) responded to a 22-item questionnaire administered online. Two investigators independently coded and categorized responses to open-ended items. Descriptive statistics were computed to assess the frequency of barriers and perceived challenges. Results The most common barriers to implementation are difficulty in changing current practice model, resistance and criticism from colleagues, and lack of trust in evidence or research. Barriers perceived as serious problems have to do with lack of up-to-date evidence, lack of clear answers to clinical questions, and contradictory information in the scientific literature. Conclusions Knowledge of barriers will help improve translation of biomedical research for dentists. Information in guidelines needs to be current, clear, and simplified for use at chairside; dentists’ fears need to be addressed. PMID:21093800

  13. Implementation of a central line maintenance care bundle in hospitalized pediatric oncology patients.

    PubMed

    Rinke, Michael L; Chen, Allen R; Bundy, David G; Colantuoni, Elizabeth; Fratino, Lisa; Drucis, Kim M; Panton, Stephanie Y; Kokoszka, Michelle; Budd, Alicia P; Milstone, Aaron M; Miller, Marlene R

    2012-10-01

    To investigate whether a multidisciplinary, best-practice central line maintenance care bundle reduces central line-associated blood stream infection (CLABSI) rates in hospitalized pediatric oncology patients and to further delineate the epidemiology of CLABSIs in this population. We performed a prospective, interrupted time series study of a best-practice bundle addressing all areas of central line care: reduction of entries, aseptic entries, and aseptic procedures when changing components. Based on a continuous quality improvement model, targeted interventions were instituted to improve compliance with each of the bundle elements. CLABSI rates and epidemiological data were collected for 10 months before and 24 months after implementation of the bundle and compared in a Poisson regression model. CLABSI rates decreased from 2.25 CLABSIs per 1000 central line days at baseline to 1.79 CLABSIs per 1000 central line days during the intervention period (incidence rate ratio [IRR]: 0.80, P = .58). Secondary analyses indicated CLABSI rates were reduced to 0.81 CLABSIs per 1000 central line days in the second 12 months of the intervention (IRR: 0.36, P = .091). Fifty-nine percent of infections resulted from Gram-positive pathogens, 37% of patients with a CLABSI required central line removal, and patients with Hickman catheters were more likely to have a CLABSI than patients with Infusaports (IRR: 4.62, P = .02). A best-practice central line maintenance care bundle can be implemented in hospitalized pediatric oncology patients, although long ramp-up times may be necessary to reap maximal benefits. Further research is needed to determine if this CLABSI rate reduction can be sustained and spread.

  14. To adopt is to adapt: the process of implementing the ICF with an acute stroke multidisciplinary team in England.

    PubMed

    Tempest, Stephanie; Harries, Priscilla; Kilbride, Cherry; De Souza, Lorraine

    2012-01-01

    The success of the International Classification of Functioning, Disability and Health (ICF) depends on its uptake in clinical practice. This project aimed to explore ways the ICF could be used with an acute stroke multidisciplinary team and identify key learning from the implementation process. Using an action research approach, iterative cycles of observe, plan, act and evaluate were used within three phases: exploratory; innovatory and reflective. Thematic analysis was undertaken, using a model of immersion and crystallisation, on data collected via interview and focus groups, e-mail communications, minutes from relevant meetings, field notes and a reflective diary. Two overall themes were determined from the data analysis which enabled implementation. There is a need to: (1) adopt the ICF in ways that meet local service needs; and (2) adapt the ICF language and format. The empirical findings demonstrate how to make the ICF classification a clinical reality. First, we need to adopt the ICF as a vehicle to implement local service priorities e.g. to structure a multidisciplinary team report, thus enabling ownership of the implementation process. Second, we need to adapt the ICF terminology and format to make it acceptable for use by clinicians.

  15. Cryogenics maintenance strategy

    NASA Astrophysics Data System (ADS)

    Cruzat, Fabiola

    2012-09-01

    ALMA is an interferometer composed of 66 independent systems, with specific maintenance requirements for each subsystem. To optimize the observation time and reduce downtime maintenance, requirements are very demanding. One subsystem with high maintenance efforts is cryogenics and vacuum. To organize the maintenance, the Cryogenic and Vacuum department is using and implementing different tools. These are monitoring and problem reporting systems and CMMS. This leads to different maintenance approaches: Preventive Maintenance, Corrective Maintenance and Condition Based Maintenance. In order to coordinate activities with other departments the preventive maintenance schedule is kept as flexible as systems allow. To cope with unavoidable failures, the team has to be prepared to work under any condition with the spares on time. Computerized maintenance management system (CMMS) will help to manage inventory control for reliable spare part handling, the correct record of work orders and traceability of maintenance activities. For an optimized approach the department is currently evaluating where preventive or condition based maintenance applies to comply with the individual system demand. Considering the change from maintenance contracts to in-house maintenance will help to minimize costs and increase availability of parts. Due to increased number of system and tasks the cryo team needs to grow. Training of all staff members is mandatory, in depth knowledge must be built up by doing complex maintenance activities in the Cryo group, use of advanced computerized metrology systems.

  16. 45 CFR Appendix B to Part 1355 - Adoption Data Elements

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES GENERAL Pt. 1355, App. B Appendix B... Have any Involvement in This Adoption? __ Yes: 1 No: 2 II. Child's Demographic Information A. Date of...

  17. 45 CFR Appendix B to Part 1355 - Adoption Data Elements

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES GENERAL Pt. 1355, App. B Appendix B... Have any Involvement in This Adoption? __ Yes: 1 No: 2 II. Child's Demographic Information A. Date of...

  18. 45 CFR Appendix B to Part 1355 - Adoption Data Elements

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES GENERAL Pt. 1355, App. B Appendix B... Have any Involvement in This Adoption? __ Yes: 1 No: 2 II. Child's Demographic Information A. Date of...

  19. Estimating the impact of enterprise resource planning project management decisions on post-implementation maintenance costs: a case study using simulation modelling

    NASA Astrophysics Data System (ADS)

    Fryling, Meg

    2010-11-01

    Organisations often make implementation decisions with little consideration for the maintenance phase of an enterprise resource planning (ERP) system, resulting in significant recurring maintenance costs. Poor cost estimations are likely related to the lack of an appropriate framework for enterprise-wide pre-packaged software maintenance, which requires an ongoing relationship with the software vendor (Markus, M.L., Tanis, C., and Fenema, P.C., 2000. Multisite ERP implementation. CACM, 43 (4), 42-46). The end result is that critical project decisions are made with little empirical data, resulting in substantial long-term cost impacts. The product of this research is a formal dynamic simulation model that enables theory testing, scenario exploration and policy analysis. The simulation model ERPMAINT1 was developed by combining and extending existing frameworks in several research domains, and by incorporating quantitative and qualitative case study data. The ERPMAINT1 model evaluates tradeoffs between different ERP project management decisions and their impact on post-implementation total cost of ownership (TCO). Through model simulations a variety of dynamic insights were revealed that could assist ERP project managers. Major findings from the simulation show that upfront investments in mentoring and system exposure translate to long-term cost savings. The findings also indicate that in addition to customisations, add-ons have a significant impact on TCO.

  20. A Pragmatic Application of the RE-AIM Framework for Evaluating the Implementation of Physical Activity as a Standard of Care in Health Systems.

    PubMed

    Stoutenberg, Mark; Galaviz, Karla I; Lobelo, Felipe; Joy, Elizabeth; Heath, Gregory W; Hutber, Adrian; Estabrooks, Paul

    2018-05-10

    Exercise is Medicine (EIM) is an initiative that seeks to integrate physical activity assessment, prescription, and patient referral as a standard in patient care. Methods to assess this integration have lagged behind its implementation. The purpose of this work is to provide a pragmatic framework to guide health care systems in assessing the implementation and impact of EIM. A working group of experts from health care, public health, and implementation science convened to develop an evaluation model based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. The working group aimed to provide pragmatic guidance on operationalizing EIM across the different RE-AIM dimensions based on data typically available in health care settings. The Reach of EIM can be determined by the number and proportion of patients that were screened for physical inactivity, received brief counseling and/or a physical activity prescription, and were referred to physical activity resources. Effectiveness can be assessed through self-reported changes in physical activity, cardiometabolic biometric factors, incidence/burden of chronic disease, as well as health care utilization and costs. Adoption includes assessing the number and representativeness of health care settings that adopt any component of EIM, and Implementation involves assessing the extent to which health care teams implement EIM in their clinic. Finally, Maintenance involves assessing the long-term effectiveness (patient level) and sustained implementation (clinic level) of EIM in a given health care setting. The availability of a standardized, pragmatic, evaluation framework is critical in determining the impact of implementing EIM as a standard of care across health care systems.

  1. Adoptive immunotherapy against ovarian cancer.

    PubMed

    Mittica, Gloria; Capellero, Sonia; Genta, Sofia; Cagnazzo, Celeste; Aglietta, Massimo; Sangiolo, Dario; Valabrega, Giorgio

    2016-05-17

    The standard front-line therapy for epithelial ovarian cancer (EOC) is combination of debulking surgery and platinum-based chemotherapy. Nevertheless, the majority of patients experience disease recurrence. Although extensive efforts to find new therapeutic options, cancer cells invariably develop drug resistance and disease progression. New therapeutic strategies are needed to improve prognosis of patients with advanced EOC.Recently, several preclinical and clinical studies investigated feasibility and activity of adoptive immunotherapy in EOC. Our aim is to highlight prospective of adoptive immunotherapy in EOC, focusing on HLA-restricted Tumor Infiltrating Lymphocytes (TILs), and MHC-independent immune effectors such as natural killer (NK), and cytokine-induced killer (CIK). Adoptive cell therapy (ACT) has shown activity in several pre-clinical models. Available preclinical and clinical data suggest that adoptive cell therapy may provide the best benefit in settings of low tumor burden, minimal residual disease, or maintenance therapy. Further studies are needed to better define the optimal clinical setting.

  2. Implementation of a children's hospital-wide central venous catheter insertion and maintenance bundle.

    PubMed

    Helder, Onno; Kornelisse, René; van der Starre, Cynthia; Tibboel, Dick; Looman, Caspar; Wijnen, René; Poley, Marten; Ista, Erwin

    2013-10-14

    Central venous catheter-associated bloodstream infections in children are an increasingly recognized serious safety problem worldwide, but are often preventable. Central venous catheter bundles have proved effective to prevent such infections. Successful implementation requires changes in the hospital system as well as in healthcare professionals' behaviour. The aim of the study is to evaluate process and outcome of implementation of a state-of-the-art central venous catheter insertion and maintenance bundle in a large university children's hospital. An interrupted time series design will be used; the study will encompass all children who need a central venous catheter. New state-of-the-art central venous catheter bundles will be developed. The Pronovost-model will guide the implementation process. We developed a tailored multifaceted implementation strategy consisting of reminders, feedback, management support, local opinion leaders, and education. Primary outcome measure is the number of catheter-associated infections per 1000 line-days. The process outcome is degree of adherence to use of these central venous catheter bundles is the secondary outcome. A cost-effectiveness analysis is part of the study. Outcomes will be monitored during three periods: baseline, pre-intervention, and post-intervention for over 48 months. This model-based implementation strategy will reveal the challenges of implementing a hospital-wide safety program. This work will add to the body of knowledge in the field of implementation. We postulate that healthcare workers' willingness to shift from providing habitual care to state-of-the-art care may reflect the need for consistent care improvement. Trial registration: Dutch trials registry, trial # 3635. Dutch trials registry (http://www.trialregister.nl), trial # 3635.

  3. Dissemination and Implementation Strategies of Lower Extremity Preventive Training Programs in Youth: A Clinical Review.

    PubMed

    DiStefano, Lindsay J; Frank, Barnett S; Root, Hayley J; Padua, Darin A

    Neuromuscular preventive training programs effectively reduce injury and improve performance in youth athletes. However, program effectiveness is directly linked to program compliance, fidelity, and dosage. Preventive training programs are not widely adopted by youth sport coaches. One way to promote widespread dissemination and compliance is to identify implementation strategies that influence program adoption and maintenance. It is unknown how previously published programs have followed the elements of an implementation framework. The objective of this review was to evaluate how elements of the 7 steps of implementation, developed by Padua et al, have been performed in the evidence of lower extremity preventive training programs. A systematic review of the literature from 1996 through September 2016 was conducted using electronic databases. Investigations that documented implementation of a sport team-based neuromuscular preventive training program in youth athletes and measured lower extremity injury rates were included. Clinical review. Level 4. A total of 12 studies met the inclusion criteria and were reviewed. Information regarding the completion of any of the 7 steps within the implementation framework developed by Padua et al was extracted. None of the 12 articles documented completion of all 7 steps. While each study addressed some of the 7 steps, no study addressed maintenance or an exit strategy for youth athletes. Program implementation appears limited in obtaining administrative support, utilizing an interdisciplinary implementation team, and monitoring or promoting fidelity of the intervention. Despite strong evidence supporting the effectiveness of preventive training programs in youth athletes, there is a gap between short-term improvements and long-term implementation strategies. Future interventions should include all 7 steps of the implementation framework to promote transparent dissemination of preventive training programs.

  4. To adopt is to adapt: the process of implementing the ICF with an acute stroke multidisciplinary team in England

    PubMed Central

    Tempest, Stephanie; Harries, Priscilla; Kilbride, Cherry; De Souza, Lorraine

    2012-01-01

    Purpose: The success of the International Classifcation of Functioning, Disability and Health (ICF) depends on its uptake in clinical practice. This project aimed to explore ways the ICF could be used with an acute stroke multidisciplinary team and identify key learning from the implementation process. Method: Using an action research approach, iterative cycles of observe, plan, act and evaluate were used within three phases: exploratory; innovatory and refective. Thematic analysis was undertaken, using a model of immersion and crystallisation, on data collected via interview and focus groups, e-mail communications, minutes from relevant meetings, feld notes and a refective diary. Results: Two overall themes were determined from the data analysis which enabled implementation. There is a need to: (1) adopt the ICF in ways that meet local service needs; and (2) adapt the ICF language and format. Conclusions: The empirical fndings demonstrate how to make the ICF classifcation a clinical reality. First, we need to adopt the ICF as a vehicle to implement local service priorities e.g. to structure a multidisciplinary team report, thus enabling ownership of the implementation process. Second, we need to adapt the ICF terminology and format to make it acceptable for use by clinicians. PMID:22372376

  5. Implementation of laparoscopic hysterectomy: maintenance of skills after a mentorship program.

    PubMed

    Twijnstra, A R H; Blikkendaal, M D; Kolkman, W; Smeets, M J G H; Rhemrev, J P T; Jansen, F W

    2010-01-01

    To evaluate the implementation and maintenance of advanced laparoscopic skills after a structured mentorship program in laparoscopic hysterectomy (LH). Cohort retrospective analysis of 104 successive LHs performed by two gynecologists during and after a mentorship program. LHs were compared for indication, patient characteristics and intraoperative characteristics. As a frame of reference, 94 LHs performed by the mentor were analyzed. With regard to indication, blood loss and adverse outcomes, both trainees performed LHs during their mentorship program comparable with the LHs performed by the mentor. The difference in mean operating time between trainees and mentor was not clinically significant. Both trainees progressed along a learning curve, while operating time remained statistically constant and comparable to that of the mentor. After completing the mentorship program, both gynecologists maintained their acquired skills as blood loss, adverse outcome rates and operating time were comparable with the results during their traineeship. A mentorship program is an effective and durable tool for implementing a new surgical procedure in a teaching hospital with respect to patient safety aspects, as indications, operating time and adverse outcome rates are comparable to those of the mentor in his own hospital during and after completing the mentorship program. Copyright © 2010 S. Karger AG, Basel.

  6. Organizational learning in the implementation and adoption of national electronic health records: case studies of two hospitals participating in the National Programme for Information Technology in England.

    PubMed

    Takian, Amirhossein; Sheikh, Aziz; Barber, Nicholas

    2014-09-01

    To explore the role of organizational learning in enabling implementation and supporting adoption of electronic health record systems into two English hospitals. In the course of conducting our prospective and sociotechnical evaluation of the implementation and adoption of electronic health record into 12 "early adopter" hospitals across England, we identified two hospitals implementing virtually identical versions of the same "off-the-shelf" software (Millennium) within a comparable timeframe. We undertook a longitudinal qualitative case study-based analysis of these two hospitals (referred to hereafter as Alpha and Omega) and their implementation experiences. Data included the following: 63 in-depth interviews with various groups of internal and external stakeholders; 41-h on-site observation; and content analysis of 218 documents of various types. Analysis was both inductive and deductive, the latter being informed by the "sociotechnical changing" theoretical perspective. Although Alpha and Omega shared a number of contextual similarities, our evaluation revealed fundamental differences in visions of electronic health record and the implementation strategy between the hospitals, which resulted in distinct local consequences of electronic health record implementation and impacted adoption. Both hospitals did not, during our evaluation, see the hoped-for benefits to the organization as a result of the introduction of electronic health record, such as speeding-up tasks. Nonetheless, the Millennium software worked out to be easier to use at Omega. Interorganizational learning was at the heart of this difference. Despite the turbulent overall national "roll out" of electronic health record systems into the English hospitals, considerable opportunities for organizational learning were offered by sequential delivery of the electronic health record software into "early adopter" hospitals. We argue that understanding the process of organizational learning and its

  7. Creation of an instrument maintenance program at W. M. Keck Observatory

    NASA Astrophysics Data System (ADS)

    Hill, G. M.; Kwok, S. H.; Mader, J. A.; Wirth, G. D.; Dahm, S. E.; Goodrich, R. W.

    2014-08-01

    Until a few years ago, the W. M. Keck Observatory (WMKO) did not have a systematic program of instrument maintenance at a level appropriate for a world-leading observatory. We describe the creation of such a program within the context of WMKO's lean operations model which posed challenges but also guided the design of the system and resulted in some unique and notable capabilities. These capabilities and the flexibility of the system have led to its adoption across the Observatory for virtually all PM's. The success of the Observatory in implementing the program and its impact on instrument reliability are presented. Lessons learned are reviewed and strategic implications discussed.

  8. The adoption and implementation of an evidence based practice in child and family mental health services organizations: a pilot study of functional family therapy in New York State.

    PubMed

    Zazzali, James L; Sherbourne, Cathy; Hoagwood, Kimberly Eaton; Greene, Deborah; Bigley, Michael F; Sexton, Thomas L

    2008-03-01

    Numerous challenges persist in providing evidence-based treatments to children and families in community-based settings. Functional Family Therapy (FFT), one such evidence-based treatment, is a family prevention and intervention program for adolescents with conduct disorder or oppositional defiant disorder. This paper presents pilot data in support of a conceptual framework explaining the adoption and implementation of FFT in a small sample of family and child mental health services organizations in New York State. The conceptual framework is grounded in the diffusion of innovations and the organizational behavior literatures, as well as previously published accounts of the adoption and implementation of evidence-based treatments in mental health. Pilot study data demonstrated that factors associated with the adoption of FFT included: The program fitting with the mission of the organization, as well as the organization having a strong interest in evidence-based treatments. Once a decision to adopt FFT was made, the degree to which it fit with organizational characteristics (e.g., available resource sets, organizational structure, and culture) influenced the ease with which it was implemented. Implications for the adoption and implementation of other evidence-based treatments are discussed.

  9. A Pragmatic Application of the RE-AIM Framework for Evaluating the Implementation of Physical Activity as a Standard of Care in Health Systems

    PubMed Central

    Galaviz, Karla I.; Lobelo, Felipe; Joy, Elizabeth; Heath, Gregory W.; Hutber, Adrian; Estabrooks, Paul

    2018-01-01

    Introduction Exercise is Medicine (EIM) is an initiative that seeks to integrate physical activity assessment, prescription, and patient referral as a standard in patient care. Methods to assess this integration have lagged behind its implementation. Purpose and Objectives The purpose of this work is to provide a pragmatic framework to guide health care systems in assessing the implementation and impact of EIM. Evaluation Methods A working group of experts from health care, public health, and implementation science convened to develop an evaluation model based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. The working group aimed to provide pragmatic guidance on operationalizing EIM across the different RE-AIM dimensions based on data typically available in health care settings. Results The Reach of EIM can be determined by the number and proportion of patients that were screened for physical inactivity, received brief counseling and/or a physical activity prescription, and were referred to physical activity resources. Effectiveness can be assessed through self-reported changes in physical activity, cardiometabolic biometric factors, incidence/burden of chronic disease, as well as health care utilization and costs. Adoption includes assessing the number and representativeness of health care settings that adopt any component of EIM, and Implementation involves assessing the extent to which health care teams implement EIM in their clinic. Finally, Maintenance involves assessing the long-term effectiveness (patient level) and sustained implementation (clinic level) of EIM in a given health care setting. Implications for Public Health The availability of a standardized, pragmatic, evaluation framework is critical in determining the impact of implementing EIM as a standard of care across health care systems. PMID:29752803

  10. Accumulating Data to Optimally Predict Obesity Treatment (ADOPT) Core Measures: Psychosocial Domain.

    PubMed

    Sutin, Angelina R; Boutelle, Kerri; Czajkowski, Susan M; Epel, Elissa S; Green, Paige A; Hunter, Christine M; Rice, Elise L; Williams, David M; Young-Hyman, Deborah; Rothman, Alexander J

    2018-04-01

    Within the Accumulating Data to Optimally Predict obesity Treatment (ADOPT) Core Measures Project, the psychosocial domain addresses how psychosocial processes underlie the influence of obesity treatment strategies on weight loss and weight maintenance. The subgroup for the psychosocial domain identified an initial list of high-priority constructs and measures that ranged from relatively stable characteristics about the person (cognitive function, personality) to dynamic characteristics that may change over time (motivation, affect). This paper describes (a) how the psychosocial domain fits into the broader model of weight loss and weight maintenance as conceptualized by ADOPT; (b) the guiding principles used to select constructs and measures for recommendation; (c) the high-priority constructs recommended for inclusion; (d) domain-specific issues for advancing the science; and (e) recommendations for future research. The inclusion of similar measures across trials will help to better identify how psychosocial factors mediate and moderate the weight loss and weight maintenance process, facilitate research into dynamic interactions with factors in the other ADOPT domains, and ultimately improve the design and delivery of effective interventions. © 2018 The Obesity Society.

  11. The Value of Successful MBSE Adoption

    NASA Technical Reports Server (NTRS)

    Parrott, Edith

    2016-01-01

    The value of successful adoption of Model Based System Engineering (MBSE) practices is hard to quantify. Most engineers and project managers look at the success in terms of cost. But there are other ways to quantify the value of MBSE and the steps necessary to achieve adoption. The Glenn Research Center (GRC) has been doing Model-Based Engineering (design, structural, etc.) for years, but the system engineering side has not. Since 2010, GRC has been moving from documents centric to MBSE/SysML. Project adoption of MBSE has been slow, but is steadily increasing in both MBSE usage and complexity of generated products. Sharing of knowledge of lessons learned in the implementation of MBSE/SysML is key for others who want to be successful. Along with GRC's implementation, NASA is working hard to increase the successful implementation of MBSE across all the other centers by developing guidelines, templates and libraries for projects to utilize. This presentation will provide insight into recent GRC and NASA adoption efforts, lessons learned and best practices.

  12. Adoption: Pediatric, Legislative and Social Issues

    PubMed Central

    Davis, Joseph H.; Brown, Dirck W.

    1981-01-01

    Physicians may find themselves involved in many phases of the adoption process, ranging from advising infertile couples who wish to adopt a child to caring for adopted children, adolescents or adults. Recent legislation has been aimed at making it possible for children to be adopted who have been receiving foster care and at providing financial assistance to implement the adoption of children with handicaps and with medical problems. The adoption process is becoming more open. Adoptees are searching for and finding their biological parents and all parties in the “adoption triangle” are developing relationships with one another. PMID:7257384

  13. Implementing an Evidence-Based Fall Prevention Intervention in Community Senior Centers.

    PubMed

    Li, Fuzhong; Harmer, Peter; Fitzgerald, Kathleen

    2016-11-01

    To evaluate the impact of implementing an evidence-based fall prevention intervention in community senior centers. We used a single-group design to evaluate the Tai Ji Quan: Moving for Better Balance (TJQMBB) program's adoption, population reach, implementation, effectiveness, and maintenance among 36 senior centers in 4 Oregon counties between 2012 and 2016. The primary outcome measure, as part of the effectiveness evaluation, was number of falls as ascertained by self-report. Trained TJQMBB instructors delivered the program to community-dwelling older adults for 48 weeks, with a 6-month postintervention follow-up. TJQMBB was adopted by 89% of the senior centers approached and reached 90% of the target population. The program resulted in a 49% reduction in the total number of falls and improved physical performance. Participation was well maintained after the program's completion. The average cost-effectiveness ratio for the 48-week program implementation was $917 per fall prevented and $676 per fall prevented for multiple falls. TJQMBB is an effective public health program that can be broadly implemented in community senior centers for primary prevention of falls among community-dwelling older adults.

  14. Lessons learned from implementing the HIV infant tracking system (HITSystem): A web-based intervention to improve early infant diagnosis in Kenya.

    PubMed

    Finocchario-Kessler, S; Odera, I; Okoth, V; Bawcom, C; Gautney, B; Khamadi, S; Clark, K; Goggin, K

    2015-12-01

    Guided by the RE-AIM model, we describe preliminary data and lessons learned from multiple serial implementations of an eHealth intervention to improve early infant diagnosis (EID) of HIV in Kenya. We describe the reach, effectiveness, adoption, implementation and maintenance of the HITSystem, an eHealth intervention that links key stakeholders to improve retention and outcomes in EID. Our target community includes mother-infant pairs utilizing EID services and government health care providers and lab personnel. We also explore our own role as program and research personnel supporting the dissemination and scale up of the HITSystem in Kenya. Key findings illustrate the importance of continual adaptation of the HITSystem interface to accommodate varied stakeholders' workflows in different settings. Surprisingly, technology capacity and internet connectivity posed minimal short-term challenges. Early and sustained ownership of the HITSystem among stakeholders proved critical to reach, effectiveness and successful adoption, implementation and maintenance. Preliminary data support the ability of the HITSystem to improve EID outcomes in Kenya. Strong and sustained collaborations with stakeholders improve the quality and reach of eHealth public health interventions. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Adoption and implementation of a computer-delivered HIV/STD risk-reduction intervention for African American adolescent females seeking services at county health departments: implementation optimization is urgently needed.

    PubMed

    DiClemente, Ralph J; Bradley, Erin; Davis, Teaniese L; Brown, Jennifer L; Ukuku, Mary; Sales, Jessica M; Rose, Eve S; Wingood, Gina M

    2013-06-01

    Although group-delivered HIV/sexually transmitted disease (STD) risk-reduction interventions for African American adolescent females have proven efficacious, they require significant financial and staffing resources to implement and may not be feasible in personnel- and resource-constrained public health clinics. We conducted a study assessing adoption and implementation of an evidence-based HIV/STD risk-reduction intervention that was translated from a group-delivered modality to a computer-delivered modality to facilitate use in county public health departments. Usage of the computer-delivered intervention was low across 8 participating public health clinics. Further investigation is needed to optimize implementation by identifying, understanding, and surmounting barriers that hamper timely and efficient implementation of technology-delivered HIV/STD risk-reduction interventions in county public health clinics.

  16. Adoption and Implementation of a Computer-delivered HIV/STD Risk-Reduction Intervention for African American Adolescent Females Seeking Services at County Health Departments: Implementation Optimization is Urgently Needed

    PubMed Central

    DiClemente, Ralph J.; Bradley, Erin; Davis, Teaniese L.; Brown, Jennifer L.; Ukuku, Mary; Sales, Jessica M.; Rose, Eve S.; Wingood, Gina M.

    2013-01-01

    Although group-delivered HIV/STD risk-reduction interventions for African American adolescent females have proven efficacious, they require significant financial and staffing resources to implement and may not be feasible in personnel- and resource-constrained public health clinics. We conducted a study assessing adoption and implementation of an evidence-based HIV/STD risk-reduction intervention that was translated from a group-delivered modality to a computer-delivered modality to facilitate use in county public health departments. Usage of the computer-delivered intervention was low across eight participating public health clinics. Further investigation is needed to optimize implementation by identifying, understanding and surmounting barriers that hamper timely and efficient implementation of technology-delivered HIV/STD risk-reduction interventions in county public health clinics. PMID:23673891

  17. Adoption and sustained use of cleaner cooking fuels in rural India: a case control study protocol to understand household, network, and organizational drivers.

    PubMed

    Kumar, Praveen; Dhand, Amar; Tabak, Rachel G; Brownson, Ross C; Yadama, Gautam N

    2017-01-01

    Implementing efficient stoves and clean fuels in low and middle-income countries are critical for improving health of poor women and children and improve the environment. Cleaner biomass stoves, however, perform poorly against the World Health Organization's indoor air quality guidelines. This has shifted the focus to systematic dissemination and implementation of cleaner cooking systems such as liquefied petroleum gas (LPG) among poor communities. Even when there is some uptake of LPG by poor communities, its sustained use has been low. Concurrent use of LPG with traditional biomass cookstoves compromises reductions in household air pollution and limits health and environmental dividends. Therefore understanding key drivers of adoption and sustained implementation of clean fuels among the poor is critical. There is a significant gap, however, in the research to understand determinants and sustained exclusive use of clean fuels in rural poor communities. Using a case control study design, this study will explore the impact of affordability, accessibility, and awareness on adoption and sustained use of LPG among rural poor communities of India. The study uses a multistage random sampling to collect primary data from 510 households. Case group or LPG adopters constitute 255 households while control group or non-LPG adopters constitute the remaining 255 households. The study will deploy sophisticated stove use monitoring sensors in each of the stoves in 100 case group households to monitor stove use and stacking behavior (using clean and traditional systems of cooking) of participants for 12 months. Moreover, this will be the first study to explore the impact of personal social networks striated by gender on LPG adoption. This study is guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) implementation science evaluation framework. Lessons from this study will feed into a larger discussion on developing a pro-poor strategy to foster

  18. Examining maintenance responsibilities.

    PubMed

    Lam, K C

    2001-06-01

    This paper has examined the important responsibilities of the two organisations involved in the provision of maintenance service for the vital building services in many of our highly serviced buildings. The issues raised could be put to beneficial use in both clients and maintenance providers. All in all, the clients should work closely with their maintenance providers. Engineering services in buildings will not perform satisfactorily and efficiently if both parties do not work together and understand the maintenance tasks based on a business partnering mode. Put forward is the view that the management of the activities involved in the operation and maintenance process is a "shared commitment/involvement" between the client and the maintenance provider. It is obvious that many factors can influence the continued effectiveness of a quality maintenance scheme set up by client and provider. Some of these factors are: Change in key personnel Updates in technology Amendments to engineering practice Implementation of legislative requirements Changes in operation by client or provider Change of use of building Passage of time These factors must be fully reviewed by both parties from time to time, and necessary actions taken. A cooperative team working relationship and improved communication should be fostered by the client and his provider for the best management of services maintenance. This arrangement will contribute to better building services systems with continuous improvement; improved value for clients and higher return for the maintenance provider.

  19. Analyzing machine noise for real time maintenance

    NASA Astrophysics Data System (ADS)

    Yamato, Yoji; Fukumoto, Yoshifumi; Kumazaki, Hiroki

    2017-02-01

    Recently, IoT technologies have been progressed and applications of maintenance area are expected. However, IoT maintenance applications are not spread in Japan yet because of one-off solution of sensing and analyzing for each case, high cost to collect sensing data and insufficient maintenance automation. This paper proposes a maintenance platform which analyzes sound data in edges, analyzes only anomaly data in cloud and orders maintenance automatically to resolve existing technology problems. We also implement a sample application and compare related work.

  20. Facilities maintenance handbook

    NASA Technical Reports Server (NTRS)

    1991-01-01

    This handbook is a guide for facilities maintenance managers. Its objective is to set minimum facilities maintenance standards. It also provides recommendations on how to meet the standards to ensure that NASA maintains its facilities in a manner that protects and preserves its investment in the facilities in a cost-effective manner while safely and efficiently performing its mission. This handbook implements NMI 8831.1, which states NASA facilities maintenance policy and assigns organizational responsibilities for the management of facilities maintenance activities on all properties under NASA jurisdiction. It is a reference for facilities maintenance managers, not a step-by-step procedural manual. Because of the differences in NASA Field Installation organizations, this handbook does not assume or recommend a typical facilities maintenance organization. Instead, it uses a systems approach to describe the functions that should be included in any facilities maintenance management system, regardless of its organizational structure. For documents referenced in the handbook, the most recent version of the documents is applicable. This handbook is divided into three parts: Part 1 specifies common definitions and facilities maintenance requirements and amplifies the policy requirements contained in NMI 8831. 1; Part 2 provides guidance on how to meet the requirements of Part 1, containing recommendations only; Part 3 contains general facilities maintenance information. One objective of this handbook is to fix commonality of facilities maintenance definitions among the Centers. This will permit the application of uniform measures of facilities conditions, of the relationship between current replacement value and maintenance resources required, and of the backlog of deferred facilities maintenance. The utilization of facilities maintenance system functions will allow the Centers to quantitatively define maintenance objectives in common terms, prepare work plans, and

  1. Policy implementation of methadone maintenance treatment and HIV infection: evidence from Hubei province, China

    PubMed Central

    2013-01-01

    To view methadone maintenance treatment (MMT) globally, it is necessary to accumulate data on MMT policy implementation under different health service systems. The aim of the current study is to provide empirical evidence about policy implementation of MMT and HIV infection control, as well as recommendations for improvement of MMT in the future. Based on China’s national policy framework of MMT, policy implementation of MMT in Hubei province has two objectives: 1) to create linkages between health and public security, and 2) to provide integrated services for management of drug abusers. From 2007 to 2011, following the establishment of MMT clinics that provide methadone as well as HIV prevention services, the proportion of HIV infection among drug abusers decreased relatively quickly (12.12% → 5.77% → 5.19% → 2.39% → 2.04%). However, high drop-out rate and poor information management have been identified as particular problems which now need to be addressed. Furthermore, client drop-out from MMT programs may reflect social issues the clients encounter, and consequently, sustainable MMT development requires incorporation of social measures that help MMT clients return to society without discrimination, especially through family cooperation and employment opportunities. PMID:24188659

  2. Analysis of State Laws and Policies Following the Implementation of the Fostering Connections to Success and Increasing Adoptions Act

    ERIC Educational Resources Information Center

    Perfect, Michelle M.; Stoll, Katherine A.; Thompson, Kristin C.; Scott, Roxanne E.

    2013-01-01

    The Fostering Connections to Success and Increasing Adoptions Act was implemented in 2008 (P.L. 110-351) in an effort to meet the needs of youth in foster care, including issues related to educational stability, educational services to support stability, and transition into higher education or the workforce. This article examines the written laws,…

  3. A qualitative study assessing the acceptability and adoption of implementing a results based financing intervention to improve maternal and neonatal health in Malawi.

    PubMed

    Wilhelm, Danielle J; Brenner, Stephan; Muula, Adamson S; De Allegri, Manuela

    2016-08-17

    Results Based Financing (RBF) interventions have recently gained significant momentum, especially in sub-Saharan Africa. However, most of the research has focused on the evaluation of the impacts of this approach, providing little insight into how the contextual circumstances surrounding the implementation have contributed to its success or failure. This study aims to fill a void in the current literature on RBF by focusing explicitly on the process of implementing a RBF intervention rather than on its impact. Specifically, this study focuses on the acceptability and adoption of the RBF intervention's implementation among local and international key stakeholders with the aim to inform further implementation. The Results Based Financing for Maternal and Neonatal Health (RBF4MNH) Initiative is currently being implemented in Malawi. Our study employed an exploratory cross-sectional qualitative design to explore the factors affecting the acceptability and adoption of the intervention's implementation. Purposeful sampling techniques were used to identify each key stakeholder who participated in all or parts of the implementation process. In-depth interviews were conducted and analyzed using a deductive open coding approach. The final interpretation of the findings emerged through active discussion among the co-authors. Despite encountering several challenges, such as delay in procurement of equipment and difficulties in arranging local bank accounts, all stakeholders responded positively to the RBF4MNH Initiative. Stakeholders' acceptance of the RBF4MNH Initiative grew stronger over time as understanding of the intervention improved and was supported by early inclusion during the design and implementation process. In addition, stakeholders took on functions not directly incentivized by the intervention, suggesting that they turned adoption into actual ownership. All stakeholders raised concerns that the intervention may not be sustainable after its initial program phase

  4. The American College of Surgeons/Association of Program Directors in Surgery National Skills Curriculum: adoption rate, challenges and strategies for effective implementation into surgical residency programs.

    PubMed

    Korndorffer, James R; Arora, Sonal; Sevdalis, Nick; Paige, John; McClusky, David A; Stefanidis, Dimitris

    2013-07-01

    The American College of Surgeons/Association of Program Directors in Surgery (ACS/APDS) National Skills Curriculum is a 3-phase program targeting technical and nontechnical skills development. Few data exist regarding the adoption of this curriculum by surgical residencies. This study attempted to determine the rate of uptake and identify implementation enablers/barriers. A web-based survey was developed by an international expert panel of surgical educators (5 surgeons and 1 psychologist). After piloting, the survey was sent to all general surgery program directors via email link. Descriptive statistics were used to determine the residency program characteristics and perceptions of the curriculum. Implementation rates for each phase and module were calculated. Adoption barriers were identified quantitatively and qualitatively using free text responses. Standardized qualitative methodology of emergent theme analysis was used to identify strategies for success and details of support required for implementation. Of the 238 program directors approached, 117 (49%) responded to the survey. Twenty-one percent (25/117) were unaware of the ACS/APDS curriculum. Implementation rates for were 36% for phase I, 19% for phase II, and 16% for phase III. The most common modules adopted were the suturing, knot-tying, and chest tube modules of phase I. Over 50% of respondents identified lack of faculty protected time, limited personnel, significant costs, and resident work-hour restrictions as major obstacles to implementation. Strategies for effective uptake included faculty incentives, adequate funding, administrative support, and dedicated time and resources. Despite the availability of a comprehensive curriculum, its diffusion into general surgery residency programs remains low. Obstacles related to successful implementation include personnel, learner, and administrative issues. Addressing these issues may improve the adoption rate of the curriculum. Copyright © 2013 Mosby, Inc

  5. Factors influencing the adoption and implementation of teledentistry in the UK, with a focus on orthodontics.

    PubMed

    Patel, Reena N; Antonarakis, Gregory S

    2013-10-01

    Utilizing Rogers' diffusion of innovation theory, this study aims to develop a better understanding of the challenges faced in teledental projects, and outline the factors that impact upon the adoption and implementation of teledental projects, with a focus on orthodontics, thus attempting to provide an explanation for the low uptake in the UK, as well as to suggest factors to encourage success. A literature search was carried out to obtain information concerning teledentistry (and telemedicine) from both primary and secondary research sources. Using the relevant information obtained, Rogers' diffusion of innovation theory was used as a framework, which was subsequently applied to the key stakeholder groups of a healthcare organization. The model describes five characteristics of an innovation: relative advantage, compatibility, complexity, trialability and observability. These attributes are discussed in the context of key stakeholder groups within a healthcare organization: clinicians, patients, hospital managers, and healthcare decision-makers and funders. Each stakeholder group is motivated by different values and experiences, which in turn influence their decision to adopt a new technology. Implementing teledental applications necessitates full comprehension and consideration of the healthcare environment and also a commitment to completely integrate teledentistry within that environment. This is a process that demands strategic alignment with clinical and organizational goals, clinical engagement and strong political support. The challenges within each stakeholder group must be specifically targeted. © 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Innovation adoption: a review of theories and constructs.

    PubMed

    Wisdom, Jennifer P; Chor, Ka Ho Brian; Hoagwood, Kimberly E; Horwitz, Sarah M

    2014-07-01

    Many theoretical frameworks seek to describe the dynamic process of the implementation of innovations. Little is known, however, about factors related to decisions to adopt innovations and how the likelihood of adoption of innovations can be increased. Using a narrative synthesis approach, this paper compared constructs theorized to be related to adoption of innovations proposed in existing theoretical frameworks in order to identify characteristics likely to increase adoption of innovations. The overall goal was to identify elements across adoption frameworks that are potentially modifiable and, thus, might be employed to improve the adoption of evidence-based practices. The review identified 20 theoretical frameworks that could be grouped into two broad categories: theories that mainly address the adoption process (N = 10) and theories that address adoption within the context of implementation, diffusion, dissemination, and/or sustainability (N = 10). Constructs of leadership, operational size and structure, innovation fit with norms and values, and attitudes/motivation toward innovations each are mentioned in at least half of the theories, though there were no consistent definitions of measures for these constructs. A lack of precise definitions and measurement of constructs suggests further work is needed to increase our understanding of adoption of innovations.

  7. A randomized matched-pairs study of feasibility, acceptability, and effectiveness of systems consultation: a novel implementation strategy for adopting clinical guidelines for Opioid prescribing in primary care.

    PubMed

    Quanbeck, Andrew; Brown, Randall T; Zgierska, Aleksandra E; Jacobson, Nora; Robinson, James M; Johnson, Roberta A; Deyo, Brienna M; Madden, Lynn; Tuan, Wen-Jan; Alagoz, Esra

    2018-01-25

    This paper reports on the feasibility, acceptability, and effectiveness of an innovative implementation strategy named "systems consultation" aimed at improving adherence to clinical guidelines for opioid prescribing in primary care. While clinical guidelines for opioid prescribing have been developed, they have not been widely implemented, even as opioid abuse reaches epidemic levels. We tested a blended implementation strategy consisting of several discrete implementation strategies, including audit and feedback, academic detailing, and external facilitation. The study compares four intervention clinics to four control clinics in a randomized matched-pairs design. Each systems consultant aided clinics on implementing the guidelines during a 6-month intervention consisting of monthly site visits and teleconferences/videoconferences. The mixed-methods evaluation employs the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Quantitative outcomes are compared using time series analysis. Qualitative methods included focus groups, structured interviews, and ethnographic field techniques. Seven clinics were randomly approached to recruit four intervention clinics. Each clinic designated a project team consisting of six to eight staff members, each with at least one prescriber. Attendance at intervention meetings was 83%. More than 80% of staff respondents agreed or strongly agreed with the statements: "I am more familiar with guidelines for safe opioid prescribing" and "My clinic's workflow for opioid prescribing is easier." At 6 months, statistically significant improvements were noted in intervention clinics in the percentage of patients with mental health screens, treatment agreements, urine drug tests, and opioid-benzodiazepine co-prescribing. At 12 months, morphine-equivalent daily dose was significantly reduced in intervention clinics compared to controls. The cost to deliver the strategy was $7345 per clinic. Adaptations were

  8. Research on large equipment maintenance system in life cycle

    NASA Astrophysics Data System (ADS)

    Xu, Xiaowei; Wang, Hongxia; Liu, Zhenxing; Zhang, Nan

    2017-06-01

    In order to change the current disadvantages of traditional large equipment maintenance concept, this article plans to apply the technical method of prognostics and health management to optimize equipment maintenance strategy and develop large equipment maintenance system. Combined with the maintenance procedures of various phases in life cycle, it concluded the formulation methods of maintenance program and implement plans of maintenance work. In the meantime, it takes account into the example of the dredger power system of the Waterway Bureau to establish the auxiliary platform of ship maintenance system in life cycle.

  9. Enhance®Fitness Dissemination and Implementation,: 2010-2015: A Scoping Review.

    PubMed

    Petrescu-Prahova, Miruna G; Eagen, Thomas J; Fishleder, Sarah L; Belza, Basia

    2017-03-01

    Physical activity has many benefits for older adult physical and mental health. Enhance ® Fitness (EF) is an evidence-based group exercise program delivered by community-based organizations. The purpose of this study was to review recent evidence on the dissemination and implementation of EF. A scoping review of qualitative and quantitative studies with EF as main focus was conducted. CINAHL, PubMed, PubMed Central, SCOPUS, Web of Science, PsycINFO, and Google Scholar were searched between October and November 2015 for data-based studies on EF published in 2010-2015. Two team members abstracted each paper independently using a data abstraction tool. Results were summarized using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Seventeen publications met inclusion criteria. EF has reached and is effective across a broad population base, including individuals with low SES and diverse ethnic/racial backgrounds. EF participation may be associated with reduced risk for falls requiring medical care, and is associated with fewer hospital admissions. Analyses of medical cost savings from EF participation and program implementation costs suggest economic benefits of EF implementation for communities. Organization-level maintenance is facilitated by program-specific and organizational factors, such as instructor training and funding. Individual-level maintenance is facilitated by program structure, absence of pain, and increased quality of life. More-rigorous evidence is needed about the association between participation in EF and conditions such as falls. Evaluation of program fidelity, adaptations, and sustainability is limited; more-systematic examination across population groups and types of organizations would help ensure older adults continue to benefit from EF participation. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  10. Innovation Adoption: A Review of Theories and Constructs

    PubMed Central

    Chor, Ka Ho Brian; Hoagwood, Kimberly E.; Horwitz, Sarah M.

    2013-01-01

    Many theoretical frameworks seek to describe the dynamic process of the implementation of innovations. Little is known, however, about factors related to decisions to adopt innovations and how the likelihood of adoption of innovations can be increased. Using a narrative synthesis approach, this paper compared constructs theorized to be related to adoption of innovations proposed in existing theoretical frameworks in order to identify characteristics likely to increase adoption of innovations. The overall goal was to identify elements across adoption frameworks that are potentially modifiable and, thus, might be employed to improve the adoption of evidence-based practices. The review identified 20 theoretical frameworks that could be grouped into two broad categories: theories that mainly address the adoption process (N = 10) and theories that address adoption within the context of implementation, diffusion, dissemination, and/or sustainability (N = 10). Constructs of leadership, operational size and structure, innovation fit with norms and values, and attitudes/motivation toward innovations each are mentioned in at least half of the theories, though there were no consistent definitions of measures for these constructs. A lack of precise definitions and measurement of constructs suggests further work is needed to increase our understanding of adoption of innovations. PMID:23549911

  11. 32 CFR 2402.10 - Maintenance of statistics.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 6 2013-07-01 2013-07-01 false Maintenance of statistics. 2402.10 Section 2402.10 National Defense Other Regulations Relating to National Defense OFFICE OF SCIENCE AND TECHNOLOGY POLICY REGULATIONS IMPLEMENTING THE FREEDOM OF INFORMATION ACT § 2402.10 Maintenance of statistics. (a...

  12. 29 CFR 2201.10 - Maintenance of statistics.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 9 2011-07-01 2011-07-01 false Maintenance of statistics. 2201.10 Section 2201.10 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH REVIEW COMMISSION REGULATIONS IMPLEMENTING THE FREEDOM OF INFORMATION ACT § 2201.10 Maintenance of statistics. (a) The FOIA Disclosure...

  13. 29 CFR 2201.10 - Maintenance of statistics.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 9 2010-07-01 2010-07-01 false Maintenance of statistics. 2201.10 Section 2201.10 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH REVIEW COMMISSION REGULATIONS IMPLEMENTING THE FREEDOM OF INFORMATION ACT § 2201.10 Maintenance of statistics. (a) The FOIA Disclosure...

  14. On-Orbit Maintenance Operations Strategy for the International Space Station - Concept and Implementation

    NASA Technical Reports Server (NTRS)

    Patterson, Linda P.

    2001-01-01

    The International Space Station (ISS) has an operational mission and profile that makes it a Logistics and Maintenance (L&M) support challenge different from previous programs. It is permanently manned, assembled on orbit, and multi-national. With this technical and operational challenge, a unique approach is needed to support the hardware and crew. The key is the integration of on-orbit and ground analysis, supply, maintenance, and crew training into a coherent functional process that supports ISS goals and objectives. To integrate all the necessary aspects of hardware and personnel to support on-orbit maintenance, a myriad of products and processes must be created and coordinated, such that the right resources are in the right place at the right time to ensure continued ISS functionality. This paper will familiarize the audience with ISS On-Orbit Maintenance (OOM) concepts and capabilities for different maintenance tasks and discuss some of the logic behind their selection. It will also identify the operational maintenance support responsibility split between the U.S. and the various International Partners (IPs).

  15. Qualitative Assessment of Smoke-Free Policy Implementation in Low-Income Housing: Enhancing Resident Compliance.

    PubMed

    Anthony, Jodi; Goldman, Roberta; Rees, Vaughan W; Frounfelker, Rochelle L; Davine, Jessica; Keske, Robyn R; Brooks, Daniel R; Geller, Alan C

    2018-01-01

    As public housing agencies and other low-income housing providers adopt smoke-free policies, data are needed to inform implementation approaches that support compliance. Focused ethnography used including qualitative interviews with staff, focus groups with residents, and property observations. Four low-income housing properties in Massachusetts, 12 months postpolicy adoption. Individual interviews (n = 17) with property staff (managers, resident service coordinators, maintenance, security, and administrators) and focus groups with resident smokers (n = 28) and nonsmokers (n = 47). Informed by the social-ecological model: intrapersonal, interpersonal, organizational, and community factors relating to compliance were assessed. Utilized MAXQDA in a theory-driven immersion/crystallization analytic process with cycles of raw data examination and pattern identification until no new themes emerged. Self-reported secondhand smoke exposure (SHSe) was reduced but not eliminated. Challenges included relying on ambivalent maintenance staff and residents to report violations, staff serving as both enforcers and smoking cessation counsellors, and inability to enforce on nights and weekends. Erroneous knowledge of the policy, perception that SHSe is not harmful to neighbors, as well as believing that smokers were losing their autonomy and being unfairly singled out when other resident violations were being unaddressed, hindered policy acceptance among resident smokers. The greatest challenge to compliance was the lack of allowable outdoor smoking areas that may have reduced the burden of the policy on smokers. Smoke-free policy implementation to support compliance could be enhanced with information about SHSe for smokers and nonsmokers, cessation support from external community partners, discussion forums for maintenance staff, resident inclusion in decision-making, and framing the policy as part of a broader wellness initiative.

  16. An empirical analysis of ERP adoption by oil and gas firms

    NASA Astrophysics Data System (ADS)

    Romero, Jorge

    2005-07-01

    Despite the growing popularity of enterprise-resource-planning (ERP) systems for the information technology infrastructure of large and medium-sized businesses, there is limited empirical evidence on the competitive benefits of ERP implementations. Case studies of individual firms provide insights but do not provide sufficient evidence to draw reliable inferences and cross-sectional studies of firms in multiple industries provide a broad-brush perspective of the performance effects associated with ERP installations. To narrow the focus to a specific competitive arena, I analyze the impact of ERP adoption on various dimensions of performance for firms in the Oil and Gas Industry. I selected the Oil and Gas Industry because several companies installed a specific type of ERP system, SAP R/3, during the period from 1990 to 2002. In fact, SAP was the dominant provider of enterprise software to oil and gas companies during this period. I evaluate performance of firms that implemented SAP R/3 relative to firms that did not adopt ERP systems in the pre-implementation, implementation and post-implementation periods. My analysis takes two different approaches, the first from a financial perspective and the second from a strategic perspective. Using the Sloan (General Motors) model commonly applied in financial statement analysis, I examine changes in performance for ERP-adopting firms versus non-adopting firms along the dimensions of asset utilization and return on sales. Asset utilization is more closely aligned with changes in leanness of operations, and return on sales is more closely aligned with customer-value-added. I test hypotheses related to the timing and magnitude of the impact of ERP implementation with respect to leanness of operations and customer value added. I find that SAP-adopting companies performed relatively better in terms of asset turnover than non-SAP-adopting companies during both the implementation and post-implementation periods and that SAP-adopting

  17. Implementation of the Veder contact method in daily nursing home care for people with dementia: a process analysis according to the RE-AIM framework.

    PubMed

    Boersma, Petra; van Weert, Julia C M; van Meijel, Berno; Dröes, Rose-Marie

    2017-02-01

    To perform a process analysis of the implementation of the Veder contact method for gaining insight into factors that influence successful implementation. Research showed that the original Veder method, which is a 'living-room theatre performance' provided by actors, positively influenced mood and quality of life of people with dementia. Training caregivers to execute such 'performances' and accomplish the same effects as actors proved difficult. However, key elements of the method were considered suitable for application in daily care, resulting in the development of a modified version of the method, named the Veder contact method. The Veder contact method combines elements from existing psychosocial interventions, e.g. reminiscence, validation and neuro-linguistic-programming with theatrical, poetic and musical communication, and applies this into daily care. For this process analysis a multiple case study design was used with the nursing home ward (n = 6) as the unit of analysis. Eight focus groups with caregivers (n = 42) and 12 interviews with stakeholders were held. Using the Reach, Effectiveness, Adoption, Implementation, Maintenance framework, a thematic analysis was conducted. The reach of the intervention (43-86%) and aspects of implementation-effectiveness (e.g. increased experienced reciprocity in contact with residents) facilitated implementation. For adoption and implementation, both facilitators (e.g. development of competences, feasibility of the Veder contact method without requiring extra time investment) and barriers (e.g. insufficient support of management, resistance of caregivers against the Veder contact method, organisational problems) were identified. Little effort was put into maintenance: only one nursing home developed a long-term implementation strategy. The Veder contact method can be applied in daily care without additional time investments. Although adopted by many caregivers, some were reluctant using the Veder contact method

  18. Road Maintenance in Africa: Approaches and Perspectives

    NASA Astrophysics Data System (ADS)

    M, Mostafa Hassan

    2018-06-01

    In Africa, roads are the dominant mode of passenger and freight transport, for which the need is growing rapidly. It is noticeable that most of the African countries do not do enough to ensure the sustainability of road infrastructure as it has been widely reported that roads are affected, to varying degrees, by premature deterioration. Most of the African countries have adopted institutional reforms, notably entailing the creation of road funds and road agencies, and made significant progress on road maintenance. However, many challenges remain to be addressed in all of them to ensure appropriate maintenance. Although spending on road maintenance has increased over time in all African countries it remains insufficient to cover the needs. Poorly maintained roads constrain mobility, significantly raise vehicle operating costs, increase accident rates and their associated human and property costs, and aggravate isolation, poverty, poor health, and illiteracy in rural communities. This paper focuses, in particular, on road maintenance in some African countries considering types of road maintenance and the different approaches aiming at a comparison to reflect on similarities and differences.

  19. Implementation of sustainability in bridge design, construction and maintenance.

    DOT National Transportation Integrated Search

    2012-12-01

    The focus of this research is to develop a framework for more sustainable design and construction : processes for new bridges, and sustainable maintenance practices for existing bridges. The framework : includes a green rating system for bridges. The...

  20. Adoption, implementation and prioritization of specialist outreach policy in Australia: a national perspective.

    PubMed

    O'Sullivan, Belinda G; Joyce, Catherine M; McGrail, Matthew R

    2014-07-01

    The World Health Organization has endorsed the use of outreach to promote: efficient redeployment of the health-care workforce; continuity of care at the local level; and professional support for local, rural, health-care workers. Australia is the only country that has had, since 2000, a sustained national policy on outreach for subsidizing medical specialist outreach to rural areas. This paper describes the adoption, implementation and prioritization of a national specialist outreach policy in Australia. Adoption of the national policy followed a long history of successful outreach, largely driven by the professional interest and personal commitment of the workforce. Initially the policy supported only new outreach services but concerns about the sustainability of existing services resulted in eligibility for funding being extended to all specialist services. The costs of travel, travel time, accommodation, professional support, staff relief at specialists' primary practices and equipment hire were subsidized. Over time, a national political commitment to the equitable treatment of indigenous people resulted in more targeted support for outreach in remote areas. Current priorities are: (i) establishing team-based outreach services; (ii) improving local staff's skills; (iii) achieving local coordination; and (iv) conducting a nationally consistent needs assessment. The absence of subsidies for specialists' clinical work can discourage private specialists from providing services in remote areas where clinical throughput is low. To be successful, outreach policy must harmonize with the interests of the workforce and support professional autonomy. Internationally, the development of outreach policy must take account of the local pay and practice conditions of health workers.

  1. Adoption, implementation and prioritization of specialist outreach policy in Australia: a national perspective

    PubMed Central

    Joyce, Catherine M; McGrail, Matthew R

    2014-01-01

    Abstract The World Health Organization has endorsed the use of outreach to promote: efficient redeployment of the health-care workforce; continuity of care at the local level; and professional support for local, rural, health-care workers. Australia is the only country that has had, since 2000, a sustained national policy on outreach for subsidizing medical specialist outreach to rural areas. This paper describes the adoption, implementation and prioritization of a national specialist outreach policy in Australia. Adoption of the national policy followed a long history of successful outreach, largely driven by the professional interest and personal commitment of the workforce. Initially the policy supported only new outreach services but concerns about the sustainability of existing services resulted in eligibility for funding being extended to all specialist services. The costs of travel, travel time, accommodation, professional support, staff relief at specialists’ primary practices and equipment hire were subsidized. Over time, a national political commitment to the equitable treatment of indigenous people resulted in more targeted support for outreach in remote areas. Current priorities are: (i) establishing team-based outreach services; (ii) improving local staff’s skills; (iii) achieving local coordination; and (iv) conducting a nationally consistent needs assessment. The absence of subsidies for specialists’ clinical work can discourage private specialists from providing services in remote areas where clinical throughput is low. To be successful, outreach policy must harmonize with the interests of the workforce and support professional autonomy. Internationally, the development of outreach policy must take account of the local pay and practice conditions of health workers. PMID:25110376

  2. “The chief of the services is very enthusiastic about it”: A qualitative study of the adoption of buprenorphine for opioid addiction treatment

    PubMed Central

    Green, Carla A.; McCarty, Dennis; Mertens, Jennifer; Lynch, Frances L.; Hilde, Anadam; Firemark, Alison; Weisner, Constance M.; Pating, David; Anderson, Bradley M.

    2013-01-01

    Qualified physicians may prescribe buprenorphine to treat opioid dependence, but medication use remains controversial. We examined adoption of buprenorphine in two not-for-profit integrated health plans, over time, completing 101 semi-structured interviews with clinicians and clinician-administrators from primary and specialty care. Transcripts were reviewed, coded, and analyzed. A strong leader championing the new treatment was critical for adoption in both health plans. Once clinicians began using buprenorphine, patients’ and other clinicians’ experiences affected decisions more than did the champion. With experience, protocols developed to manage unsuccessful patients and changed to support maintenance rather than detoxification. Diffusion outside addiction and mental health settings was nonexistent; primary care clinicians cited scope-of-practice issues and referred patients to specialty care. With greater diffusion came questions about long-term use and safety. Recognizing how implementation processes develop may suggest where, when, and how to best expend resources to increase adoption of such treatments. PMID:24268947

  3. Organizational issues in the implementation and adoption of health information technology innovations: an interpretative review.

    PubMed

    Cresswell, Kathrin; Sheikh, Aziz

    2013-05-01

    Implementations of health information technologies are notoriously difficult, which is due to a range of inter-related technical, social and organizational factors that need to be considered. In the light of an apparent lack of empirically based integrated accounts surrounding these issues, this interpretative review aims to provide an overview and extract potentially generalizable findings across settings. We conducted a systematic search and critique of the empirical literature published between 1997 and 2010. In doing so, we searched a range of medical databases to identify review papers that related to the implementation and adoption of eHealth applications in organizational settings. We qualitatively synthesized this literature extracting data relating to technologies, contexts, stakeholders, and their inter-relationships. From a total body of 121 systematic reviews, we identified 13 systematic reviews encompassing organizational issues surrounding health information technology implementations. By and large, the evidence indicates that there are a range of technical, social and organizational considerations that need to be deliberated when attempting to ensure that technological innovations are useful for both individuals and organizational processes. However, these dimensions are inter-related, requiring a careful balancing act of strategic implementation decisions in order to ensure that unintended consequences resulting from technology introduction do not pose a threat to patients. Organizational issues surrounding technology implementations in healthcare settings are crucially important, but have as yet not received adequate research attention. This may in part be due to the subjective nature of factors, but also due to a lack of coordinated efforts toward more theoretically-informed work. Our findings may be used as the basis for the development of best practice guidelines in this area. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  4. Multi-objective group scheduling optimization integrated with preventive maintenance

    NASA Astrophysics Data System (ADS)

    Liao, Wenzhu; Zhang, Xiufang; Jiang, Min

    2017-11-01

    This article proposes a single-machine-based integration model to meet the requirements of production scheduling and preventive maintenance in group production. To describe the production for identical/similar and different jobs, this integrated model considers the learning and forgetting effects. Based on machine degradation, the deterioration effect is also considered. Moreover, perfect maintenance and minimal repair are adopted in this integrated model. The multi-objective of minimizing total completion time and maintenance cost is taken to meet the dual requirements of delivery date and cost. Finally, a genetic algorithm is developed to solve this optimization model, and the computation results demonstrate that this integrated model is effective and reliable.

  5. Study protocol for "Study of Practices Enabling Implementation and Adaptation in the Safety Net (SPREAD-NET)": a pragmatic trial comparing implementation strategies.

    PubMed

    Gold, Rachel; Hollombe, Celine; Bunce, Arwen; Nelson, Christine; Davis, James V; Cowburn, Stuart; Perrin, Nancy; DeVoe, Jennifer; Mossman, Ned; Boles, Bruce; Horberg, Michael; Dearing, James W; Jaworski, Victoria; Cohen, Deborah; Smith, David

    2015-10-16

    Little research has directly compared the effectiveness of implementation strategies in any setting, and we know of no prior trials directly comparing how effectively different combinations of strategies support implementation in community health centers. This paper outlines the protocol of the Study of Practices Enabling Implementation and Adaptation in the Safety Net (SPREAD-NET), a trial designed to compare the effectiveness of several common strategies for supporting implementation of an intervention and explore contextual factors that impact the strategies' effectiveness in the community health center setting. This cluster-randomized trial compares how three increasingly hands-on implementation strategies support adoption of an evidence-based diabetes quality improvement intervention in 29 community health centers, managed by 12 healthcare organizations. The strategies are as follows: (arm 1) a toolkit, presented in paper and electronic form, which includes a training webinar; (arm 2) toolkit plus in-person training with a focus on practice change and change management strategies; and (arm 3) toolkit, in-person training, plus practice facilitation with on-site visits. We use a mixed methods approach to data collection and analysis: (i) baseline surveys on study clinic characteristics, to explore how these characteristics impact the clinics' ability to implement the tools and the effectiveness of each implementation strategy; (ii) quantitative data on change in rates of guideline-concordant prescribing; and (iii) qualitative data on the "how" and "why" underlying the quantitative results. The outcomes of interest are clinic-level results, categorized using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, within an interrupted time-series design with segmented regression models. This pragmatic trial will compare how well each implementation strategy works in "real-world" practices. Having a better understanding of how different

  6. Assessing Integrated Pest Management Adoption: Measurement Problems and Policy Implications

    NASA Astrophysics Data System (ADS)

    Puente, Molly; Darnall, Nicole; Forkner, Rebecca E.

    2011-11-01

    For more than a decade, the U.S. government has promoted integrated pest management (IPM) to advance sustainable agriculture. However, the usefulness of this practice has been questioned because of lagging implementation. There are at least two plausible rationales for the slow implementation: (1) growers are not adopting IPM—for whatever reason—and (2) current assessment methods are inadequate at assessing IPM implementation. Our research addresses the second plausibility. We suggest that the traditional approach to measuring IPM implementation on its own fails to assess the distinct, biologically hierarchical components of IPM, and instead aggregates growers' management practices into an overall adoption score. Knowledge of these distinct components and the extent to which they are implemented can inform government officials as to how they should develop targeted assistance programs to encourage broader IPM use. We address these concerns by assessing the components of IPM adoption and comparing our method to the traditional approach alone. Our results indicate that there are four distinct components of adoption—weed, insect, general, and ecosystem management—and that growers implement the first two components significantly more often than the latter two. These findings suggest that using a more nuanced measure to assess IPM adoption that expands on the traditional approach, allows for a better understanding of the degree of IPM implementation.

  7. Predictors of Relationship Dissolution in Lesbian, Gay, and Heterosexual Adoptive Parents

    PubMed Central

    Goldberg, Abbie E.; Garcia, Randi

    2015-01-01

    Little work has examined relationship dissolution or divorce in adoptive parents or same-sex parent couples. The current study examined predictors of relationship dissolution across the first 5 years of parenthood among a sample of heterosexual, lesbian, and gay male adoptive couples. Of the 190 couples in the study, 15 (7.9%) dissolved their relationships during the first 5 years of adoptive parenthood. Specifically, 7 of 57 lesbian couples (12.3%), 1 of 49 gay male couples (2.0%), and 7 of 84 heterosexual couples (8.3%) dissolved their unions. Results of our logistic regression analysis revealed that the odds of relationship dissolution were significantly higher for (a) couples who adopted a non-infant (i.e., older) child); (b) participants who reported feeling less prepared for the adoption, three months post-adoptive placement; and (c) couples in which both partners reported very low, or very high, pre-adoption levels of relationship maintenance behaviors. Findings have implications for adoption professionals seeking to support same-sex and heterosexual prospective adopters, as well as societal debates and policy regarding same-sex relationships and parenting. PMID:26053348

  8. Making sense of evidence in management decisions: the role of research-based knowledge on innovation adoption and implementation in healthcare. study protocol.

    PubMed

    Kyratsis, Yiannis; Ahmad, Raheelah; Holmes, Alison

    2012-03-21

    We know that patient care can be improved by implementing evidence-based innovations and applying research findings linked to good practice. Successfully implementing innovations in complex organisations, such as the UK's National Health Service (NHS), is often challenging as multiple contextual dynamics mediate the process. Research studies have explored the challenges of introducing innovations into healthcare settings and have contributed to a better understanding of why potentially useful innovations are not always implemented in practice, even if backed by strong evidence. Mediating factors include health policy and health system influences, organisational factors, and individual and professional attitudes, including decision makers' perceptions of innovation evidence. There has been limited research on how different forms of evidence are accessed and utilised by organisational decision makers during innovation adoption. We also know little about how diverse healthcare professionals (clinicians, administrators) make sense of evidence and how this collective sensemaking mediates the uptake of innovations. The study will involve nine comparative case study sites of acute care organisations grouped into three regional clusters across England. Each of the purposefully selected sites represents a variety of trust types and organisational contexts. We will use qualitative methods, in-depth interviews, observation of key meetings, and systematic analysis of relevant secondary data to understand the rationale and challenges involved in sourcing and utilising innovation evidence in the empirical setting of infection prevention and control. We will use theories of innovation adoption and sensemaking in organisations to interpret the data. The research will provide lessons for the uptake and continuous use of innovations in the English and international health systems. Unlike most innovation studies, which involve single-level analysis, our study will explore the

  9. Best practices and performance assessment for preventive maintenance treatments for Virginia pavements.

    DOT National Transportation Integrated Search

    2015-08-01

    Preventive maintenance has the potential to improve network condition by retarding future pavement deterioration. This : report outlines guidelines for implementing a preventive maintenance policy for bituminous pavements. : Preventive maintenance tr...

  10. Tier II Interventions within the Framework of School-Wide Positive Behavior Support: Essential Features for Design, Implementation, and Maintenance.

    PubMed

    Anderson, Cynthia M; Borgmeier, Chris

    2010-01-01

    To meet the complex social behavioral and academic needs of all students, schools benefit from having available multiple evidence-based interventions of varying intensity. School-wide positive behavior support provides a framework within which a continuum of evidence-based interventions can be implemented in a school. This framework includes three levels or tiers of intervention; Tier I (primary or universal), Tier II (secondary or targeted), and Tier III (tertiary or individualized) supports. In this paper we review the logic behind school-wide positive behavior support and then focus on Tier II interventions, as this level of support has received the least attention in the literature. We delineate the key features of Tier II interventions as implemented within school-wide positive behavior support, provide guidelines for matching Tier II interventions to school and student needs, and describe how schools plan for implementation and maintenance of selected interventions.

  11. A Review of Studies on the System-Wide Implementation of Evidence-Based Psychotherapies for Posttraumatic Stress Disorder in the Veterans Health Administration.

    PubMed

    Rosen, C S; Matthieu, M M; Wiltsey Stirman, S; Cook, J M; Landes, S; Bernardy, N C; Chard, K M; Crowley, J; Eftekhari, A; Finley, E P; Hamblen, J L; Harik, J M; Kehle-Forbes, S M; Meis, L A; Osei-Bonsu, P E; Rodriguez, A L; Ruggiero, K J; Ruzek, J I; Smith, B N; Trent, L; Watts, B V

    2016-11-01

    Since 2006, the Veterans Health Administration (VHA) has instituted policy changes and training programs to support system-wide implementation of two evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD). To assess lessons learned from this unprecedented effort, we used PubMed and the PILOTS databases and networking with researchers to identify 32 reports on contextual influences on implementation or sustainment of EBPs for PTSD in VHA settings. Findings were initially organized using the exploration, planning, implementation, and sustainment framework (EPIS; Aarons et al. in Adm Policy Ment Health Health Serv Res 38:4-23, 2011). Results that could not be adequately captured within the EPIS framework, such as implementation outcomes and adopter beliefs about the innovation, were coded using constructs from the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework (Glasgow et al. in Am J Public Health 89:1322-1327, 1999) and Consolidated Framework for Implementation Research (CFIR; Damschroder et al. in Implement Sci 4(1):50, 2009). We highlight key areas of progress in implementation, identify continuing challenges and research questions, and discuss implications for future efforts to promote EBPs in large health care systems.

  12. Design and Implementation of an Interactive Website to Support Long-Term Maintenance of Weight Loss

    PubMed Central

    Stevens, Victor J; Brantley, Phillip J; Erlinger, Thomas P; Myers, Valerie H; Champagne, Catherine M; Bauck, Alan; Samuel-Hodge, Carmen D; Hollis, Jack F

    2008-01-01

    Background For most individuals, long-term maintenance of weight loss requires long-term, supportive intervention. Internet-based weight loss maintenance programs offer considerable potential for meeting this need. Careful design processes are required to maximize adherence and minimize attrition. Objective This paper describes the development, implementation and use of a Web-based intervention program designed to help those who have recently lost weight sustain their weight loss over 1 year. Methods The weight loss maintenance website was developed over a 1-year period by an interdisciplinary team of public health researchers, behavior change intervention experts, applications developers, and interface designers. Key interactive features of the final site include social support, self-monitoring, written guidelines for diet and physical activity, links to appropriate websites, supportive tools for behavior change, check-in accountability, tailored reinforcement messages, and problem solving and relapse prevention training. The weight loss maintenance program included a reminder system (automated email and telephone messages) that prompted participants to return to the website if they missed their check-in date. If there was no log-in response to the email and telephone automated prompts, a staff member called the participant. We tracked the proportion of participants with at least one log-in per month, and analyzed log-ins as a result of automated prompts. Results The mean age of the 348 participants enrolled in an ongoing randomized trial and assigned to use the website was 56 years; 63% were female, and 38% were African American. While weight loss data will not be available until mid-2008, website use remained high during the first year with over 80% of the participants still using the website during month 12. During the first 52 weeks, participants averaged 35 weeks with at least one log-in. Email and telephone prompts appear to be very effective at helping

  13. Design and implementation of an interactive website to support long-term maintenance of weight loss.

    PubMed

    Stevens, Victor J; Funk, Kristine L; Brantley, Phillip J; Erlinger, Thomas P; Myers, Valerie H; Champagne, Catherine M; Bauck, Alan; Samuel-Hodge, Carmen D; Hollis, Jack F

    2008-01-25

    For most individuals, long-term maintenance of weight loss requires long-term, supportive intervention. Internet-based weight loss maintenance programs offer considerable potential for meeting this need. Careful design processes are required to maximize adherence and minimize attrition. This paper describes the development, implementation and use of a Web-based intervention program designed to help those who have recently lost weight sustain their weight loss over 1 year. The weight loss maintenance website was developed over a 1-year period by an interdisciplinary team of public health researchers, behavior change intervention experts, applications developers, and interface designers. Key interactive features of the final site include social support, self-monitoring, written guidelines for diet and physical activity, links to appropriate websites, supportive tools for behavior change, check-in accountability, tailored reinforcement messages, and problem solving and relapse prevention training. The weight loss maintenance program included a reminder system (automated email and telephone messages) that prompted participants to return to the website if they missed their check-in date. If there was no log-in response to the email and telephone automated prompts, a staff member called the participant. We tracked the proportion of participants with at least one log-in per month, and analyzed log-ins as a result of automated prompts. The mean age of the 348 participants enrolled in an ongoing randomized trial and assigned to use the website was 56 years; 63% were female, and 38% were African American. While weight loss data will not be available until mid-2008, website use remained high during the first year with over 80% of the participants still using the website during month 12. During the first 52 weeks, participants averaged 35 weeks with at least one log-in. Email and telephone prompts appear to be very effective at helping participants sustain ongoing website use

  14. Does the early adopter catch the worm or choke on it? A reflective journey of the challenges of technology adoption in a health sciences education institution.

    PubMed

    Botha-Ravyse, Chrisna; Blignaut, Seugnet

    2017-01-01

    Early adoption of technology is a struggle well known to early adopters and now to me. Since the demand to use and implement technology in health professions' education has increased, I have been led to adopt various technologies, leading to many headaches. This paper addresses my experiences in developing and implementing technology in health science classrooms in a setting not adequately equipped to do so. After reflecting on my experiences, I conclude that it is crucial that systems help innovators and early adopters as they work to develop and implement teaching and learning technology. Technical decisions should address the needs of the higher education educator. In addition, once an institution chooses a specific technological approach, such as using e-guides, there should be resources in place to support the forerunners of these initiatives.

  15. Using Implementation and Dissemination Concepts to Spread 21st-century Well-Child Care at a Health Maintenance Organization

    PubMed Central

    Beck, Arne; Bergman, David A; Rahm, Alanna K; Dearing, James W; Glasgow, Russell E

    2009-01-01

    We describe here the use of a conceptual framework for implementing and disseminating in a Health Maintenance Organization an evidence-based model of well-child care (WCC) that includes developmental and preventive services recommended by the American Academy of Pediatrics. Twenty-first Century WCC is a parent-centered, team-based, primary care model that combines online previsit assessments—completed by parents and caregivers regarding clinic-based weight, growth, and development assessments—with vaccinations and anticipatory guidance. Nurses, nurse practitioners, developmental specialists, and pediatricians all play roles in the WCC model. Patient and clinician interaction, health records, and resources are all facilitated through a Web-based diagnostic, management, tracking, and resource information tool. Implementation and dissemination concepts and their attendant practices and tools can reliably be used to augment strategic decisions about how to best disseminate and implement innovations in health care delivery. Unlike innovations that are embedded only in technical systems, validated models of team-based health care have multiple components that must be made compatible with complex sociotechnical systems. Interpersonal communication, work, coordination, and judgment are key processes that affect implementation quality. Implementation can involve tailoring to a particular site and customizing either the model or the organizational context to accommodate it. PMID:20740083

  16. Understanding the implementation and adoption of an information technology intervention to support medicine optimisation in primary care: qualitative study using strong structuration theory.

    PubMed

    Jeffries, Mark; Phipps, Denham; Howard, Rachel L; Avery, Anthony; Rodgers, Sarah; Ashcroft, Darren

    2017-05-10

    Using strong structuration theory, we aimed to understand the adoption and implementation of an electronic clinical audit and feedback tool to support medicine optimisation for patients in primary care. This is a qualitative study informed by strong structuration theory. The analysis was thematic, using a template approach. An a priori set of thematic codes, based on strong structuration theory, was developed from the literature and applied to the transcripts. The coding template was then modified through successive readings of the data. Clinical commissioning group in the south of England. Four focus groups and five semi-structured interviews were conducted with 18 participants purposively sampled from a range of stakeholder groups (general practitioners, pharmacists, patients and commissioners). Using the system could lead to improved medication safety, but use was determined by broad institutional contexts; by the perceptions, dispositions and skills of users; and by the structures embedded within the technology. These included perceptions of the system as new and requiring technical competence and skill; the adoption of the system for information gathering; and interactions and relationships that involved individual, shared or collective use. The dynamics between these external, internal and technological structures affected the adoption and implementation of the system. Successful implementation of information technology interventions for medicine optimisation will depend on a combination of the infrastructure within primary care, social structures embedded in the technology and the conventions, norms and dispositions of those utilising it. Future interventions, using electronic audit and feedback tools to improve medication safety, should consider the complexity of the social and organisational contexts and how internal and external structures can affect the use of the technology in order to support effective implementation. © Article author(s) (or their

  17. Computer-aided acquisition and logistics support (CALS): Concept of Operations for Depot Maintenance

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Bourgeois, N.C.; Greer, D.K.

    1993-04-01

    This CALS Concept of Operations for Depot Maintenance provides the foundation strategy and the near term tactical plan for CALS implementation in the depot maintenance environment. The user requirements enumerated and the overarching architecture outlined serve as the primary framework for implementation planning. The seamless integration of depot maintenance business processes and supporting information systems with the emerging global CALS environment will be critical to the efficient realization of depot user's information requirements, and as, such will be a fundamental theme in depot implementations.

  18. Integrating addiction treatment into primary care using mobile health technology: protocol for an implementation research study

    PubMed Central

    2014-01-01

    Background Healthcare reform in the United States is encouraging Federally Qualified Health Centers and other primary-care practices to integrate treatment for addiction and other behavioral health conditions into their practices. The potential of mobile health technologies to manage addiction and comorbidities such as HIV in these settings is substantial but largely untested. This paper describes a protocol to evaluate the implementation of an E-Health integrated communication technology delivered via mobile phones, called Seva, into primary-care settings. Seva is an evidence-based system of addiction treatment and recovery support for patients and real-time caseload monitoring for clinicians. Methods/Design Our implementation strategy uses three models of organizational change: the Program Planning Model to promote acceptance and sustainability, the NIATx quality improvement model to create a welcoming environment for change, and Rogers’s diffusion of innovations research, which facilitates adaptations of innovations to maximize their adoption potential. We will implement Seva and conduct an intensive, mixed-methods assessment at three diverse Federally Qualified Healthcare Centers in the United States. Our non-concurrent multiple-baseline design includes three periods — pretest (ending in four months of implementation preparation), active Seva implementation, and maintenance — with implementation staggered at six-month intervals across sites. The first site will serve as a pilot clinic. We will track the timing of intervention elements and assess study outcomes within each dimension of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, including effects on clinicians, patients, and practices. Our mixed-methods approach will include quantitative (e.g., interrupted time-series analysis of treatment attendance, with clinics as the unit of analysis) and qualitative (e.g., staff interviews regarding adaptations to implementation

  19. Integrating addiction treatment into primary care using mobile health technology: protocol for an implementation research study.

    PubMed

    Quanbeck, Andrew R; Gustafson, David H; Marsch, Lisa A; McTavish, Fiona; Brown, Randall T; Mares, Marie-Louise; Johnson, Roberta; Glass, Joseph E; Atwood, Amy K; McDowell, Helene

    2014-05-29

    Healthcare reform in the United States is encouraging Federally Qualified Health Centers and other primary-care practices to integrate treatment for addiction and other behavioral health conditions into their practices. The potential of mobile health technologies to manage addiction and comorbidities such as HIV in these settings is substantial but largely untested. This paper describes a protocol to evaluate the implementation of an E-Health integrated communication technology delivered via mobile phones, called Seva, into primary-care settings. Seva is an evidence-based system of addiction treatment and recovery support for patients and real-time caseload monitoring for clinicians. Our implementation strategy uses three models of organizational change: the Program Planning Model to promote acceptance and sustainability, the NIATx quality improvement model to create a welcoming environment for change, and Rogers's diffusion of innovations research, which facilitates adaptations of innovations to maximize their adoption potential. We will implement Seva and conduct an intensive, mixed-methods assessment at three diverse Federally Qualified Healthcare Centers in the United States. Our non-concurrent multiple-baseline design includes three periods - pretest (ending in four months of implementation preparation), active Seva implementation, and maintenance - with implementation staggered at six-month intervals across sites. The first site will serve as a pilot clinic. We will track the timing of intervention elements and assess study outcomes within each dimension of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, including effects on clinicians, patients, and practices. Our mixed-methods approach will include quantitative (e.g., interrupted time-series analysis of treatment attendance, with clinics as the unit of analysis) and qualitative (e.g., staff interviews regarding adaptations to implementation protocol) methods, and assessment of

  20. The economy of preventive maintenance of concrete bridges : final report.

    DOT National Transportation Integrated Search

    2016-03-01

    The most economical approach to maintain existing concrete bridges is by adopting an active preventive maintenance : approach. An in-depth investigation of the combined deterioration effects of various deterioration mechanisms is needed : to establis...

  1. 40 CFR 52.241 - Inspection and maintenance program.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS California § 52.241 Inspection and maintenance program. (a) [Reserved] (b) Approval. On June 5, 2009, the California Air Resources Board submitted a revision to the California Motor Vehicle Inspection and Maintenance Program (2009 I/M Revision) to satisfy...

  2. 40 CFR 52.241 - Inspection and maintenance program.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS California § 52.241 Inspection and maintenance program. (a) [Reserved] (b) Approval. On June 5, 2009, the California Air Resources Board submitted a revision to the California Motor Vehicle Inspection and Maintenance Program (2009 I/M Revision) to satisfy...

  3. 40 CFR 52.241 - Inspection and maintenance program.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS California § 52.241 Inspection and maintenance program. (a) [Reserved] (b) Approval. On June 5, 2009, the California Air Resources Board submitted a revision to the California Motor Vehicle Inspection and Maintenance Program (2009 I/M Revision) to satisfy...

  4. 40 CFR 52.241 - Inspection and maintenance program.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS California § 52.241 Inspection and maintenance program. (a) [Reserved] (b) Approval. On June 5, 2009, the California Air Resources Board submitted a revision to the California Motor Vehicle Inspection and Maintenance Program (2009 I/M Revision) to satisfy...

  5. Research and recommendations for a statewide sign retroreflectivity maintenance program.

    DOT National Transportation Integrated Search

    2012-04-01

    This study evaluated TxDOT's current sign retroreflectivity maintenance practices, assessed their : effectiveness, and recommended statewide sign retroreflectivity maintenance practices that could be easily : and effectively implemented to ensure tha...

  6. Preventative maintenance program for bridges.

    DOT National Transportation Integrated Search

    2015-07-01

    The Kentucky Transportation Cabinets (KYTC) bridge inventory is rapidly aging. As such, the Cabinet : needs to identify and implement relevant preventative maintenance (PM) actions to extend the useful : service lives of those structures. Maintena...

  7. No longer lost in translation: the art and science of sports injury prevention implementation research.

    PubMed

    Finch, Caroline F

    2011-12-01

    It is now understood that sports injury interventions will not have significant public health impact if they are not widely accepted and adopted by target sports participants. Although there has been increasing recognition of the need for intervention studies conducted within the real-world context of sports delivery, very few studies have been conducted in this important area. A major reason for this is that there are significant challenges in conducting implementation research; the more traditional sports medicine approaches may not be fully appropriate and new ways of thinking about how to design, conduct and report such research is needed. Moreover, real-world implementation of sports injury interventions and evaluation of their effectiveness needs to start to take into account the broad ecological context in which they are introduced, as well as considering the best way to translate this knowledge to reach the audiences who most need to benefit from such research. This overview paper provides perspectives and guidance on the design, conduct and evaluation of sports injury intervention implementation studies, including better understanding of the complexity of the ecological settings for intervention delivery. Some conceptual approaches that could be adopted in future implementation studies are discussed; particular emphasis is given to intervention mapping as a tool to assist intervention development, diffusion of innovations theory to guide the planning of intervention strategies and the RE-AIM (reach, effectiveness, adoption, implementation and maintenance) framework for programme evaluation and programme design. Finally, a broad agenda for this emerging important field of sports medicine research is outlined.

  8. Design and implementation of a factorial randomized controlled trial of methadone maintenance therapy and an evidence-based behavioral intervention for incarcerated people living with HIV and opioid dependence in Malaysia.

    PubMed

    Bazazi, Alexander R; Wickersham, Jeffrey A; Wegman, Martin P; Culbert, Gabriel J; Pillai, Veena; Shrestha, Roman; Al-Darraji, Haider; Copenhaver, Michael M; Kamarulzaman, Adeeba; Altice, Frederick L

    2017-08-01

    Incarcerated people living with HIV and opioid dependence face enormous challenges to accessing evidence-based treatment during incarceration and after release into the community, placing them at risk of poor HIV treatment outcomes, relapse to opioid use and accompanying HIV transmission risk behaviors. Here we describe in detail the design and implementation of Project Harapan, a prospective clinical trial conducted among people living with HIV and opioid dependence who transitioned from prison to the community in Malaysia from 2010 to 2014. This trial involved 2 interventions: within-prison initiation of methadone maintenance therapy and an evidence-based behavioral intervention adapted to the Malaysian context (the Holistic Health Recovery Program for Malaysia, HHRP-M). Individuals were recruited and received the interventions while incarcerated and were followed for 12months after release to assess post-release HIV transmission risk behaviors and a range of other health-related outcomes. Project Harapan was designed as a fully randomized 2×2 factorial trial where individuals would be allocated in equal proportions to methadone maintenance therapy and HHRP-M, methadone maintenance therapy alone, HHRP-M alone, or control. Partway through study implementation, allocation to methadone maintenance therapy was changed from randomization to participant choice; randomization to HHRP-M continued throughout. We describe the justification for this study; the development and implementation of these interventions; changes to the protocol; and screening, enrollment, treatment receipt, and retention of study participants. Logistical, ethical, and analytic issues associated with the implementation of this study are discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Implementation of an open adoption research data management system for clinical studies.

    PubMed

    Müller, Jan; Heiss, Kirsten Ingmar; Oberhoffer, Renate

    2017-07-06

    Research institutions need to manage multiple studies with individual data sets, processing rules and different permissions. So far, there is no standard technology that provides an easy to use environment to create databases and user interfaces for clinical trials or research studies. Therefore various software solutions are being used-from custom software, explicitly designed for a specific study, to cost intensive commercial Clinical Trial Management Systems (CTMS) up to very basic approaches with self-designed Microsoft ® databases. The technology applied to conduct those studies varies tremendously from study to study, making it difficult to evaluate data across various studies (meta-analysis) and keeping a defined level of quality in database design, data processing, displaying and exporting. Furthermore, the systems being used to collect study data are often operated redundantly to systems used in patient care. As a consequence the data collection in studies is inefficient and data quality may suffer from unsynchronized datasets, non-normalized database scenarios and manually executed data transfers. With OpenCampus Research we implemented an open adoption software (OAS) solution on an open source basis, which provides a standard environment for state-of-the-art research database management at low cost.

  10. The adoption and implementation of RFID technologies in healthcare: a literature review.

    PubMed

    Yao, Wen; Chu, Chao-Hsien; Li, Zang

    2012-12-01

    Radio Frequency Identification (RFID) technology not only offers tracking capability to locate equipment, supplies and people in real time, but also provides efficient and accurate access to medical data for health professionals. However, the reality of RFID adoption in healthcare is far behind earlier expectation. This study reviews literature on the use of RFID in healthcare/hospitals following a formal innovation-decision framework. We aim to identify the common applications, potential benefits, barriers, and critical success factors. Our study facilitates quick assessment and provides guidance for researchers and practitioners in adopting RFID in medical arenas. Many earlier adopters in healthcare found RFID to be functional and useful in such areas as asset tracking and patient identification. Major barriers to adoption include technological limitations, interference concerns, prohibitive costs, lack of global standards and privacy concerns. Better designed RFID systems with low cost and privacy issues addressed are needed to increase acceptance of RFID in healthcare.

  11. Building a house on shifting sand: methodological considerations when evaluating the implementation and adoption of national electronic health record systems

    PubMed Central

    2012-01-01

    Background A commitment to Electronic Health Record (EHR) systems now constitutes a core part of many governments’ healthcare reform strategies. The resulting politically-initiated large-scale or national EHR endeavors are challenging because of their ambitious agendas of change, the scale of resources needed to make them work, the (relatively) short timescales set, and the large number of stakeholders involved, all of whom pursue somewhat different interests. These initiatives need to be evaluated to establish if they improve care and represent value for money. Methods Critical reflections on these complexities in the light of experience of undertaking the first national, longitudinal, and sociotechnical evaluation of the implementation and adoption of England’s National Health Service’s Care Records Service (NHS CRS). Results/discussion We advance two key arguments. First, national programs for EHR implementations are likely to take place in the shifting sands of evolving sociopolitical and sociotechnical and contexts, which are likely to shape them in significant ways. This poses challenges to conventional evaluation approaches which draw on a model of baseline operations → intervention → changed operations (outcome). Second, evaluation of such programs must account for this changing context by adapting to it. This requires careful and creative choice of ontological, epistemological and methodological assumptions. Summary New and significant challenges are faced in evaluating national EHR implementation endeavors. Based on experiences from this national evaluation of the implementation and adoption of the NHS CRS in England, we argue for an approach to these evaluations which moves away from seeing EHR systems as Information and Communication Technologies (ICT) projects requiring an essentially outcome-centred assessment towards a more interpretive approach that reflects the situated and evolving nature of EHR seen within multiple specific settings and

  12. Building a house on shifting sand: methodological considerations when evaluating the implementation and adoption of national electronic health record systems.

    PubMed

    Takian, Amirhossein; Petrakaki, Dimitra; Cornford, Tony; Sheikh, Aziz; Barber, Nicholas

    2012-04-30

    A commitment to Electronic Health Record (EHR) systems now constitutes a core part of many governments' healthcare reform strategies. The resulting politically-initiated large-scale or national EHR endeavors are challenging because of their ambitious agendas of change, the scale of resources needed to make them work, the (relatively) short timescales set, and the large number of stakeholders involved, all of whom pursue somewhat different interests. These initiatives need to be evaluated to establish if they improve care and represent value for money. Critical reflections on these complexities in the light of experience of undertaking the first national, longitudinal, and sociotechnical evaluation of the implementation and adoption of England's National Health Service's Care Records Service (NHS CRS). We advance two key arguments. First, national programs for EHR implementations are likely to take place in the shifting sands of evolving sociopolitical and sociotechnical and contexts, which are likely to shape them in significant ways. This poses challenges to conventional evaluation approaches which draw on a model of baseline operations → intervention → changed operations (outcome). Second, evaluation of such programs must account for this changing context by adapting to it. This requires careful and creative choice of ontological, epistemological and methodological assumptions. New and significant challenges are faced in evaluating national EHR implementation endeavors. Based on experiences from this national evaluation of the implementation and adoption of the NHS CRS in England, we argue for an approach to these evaluations which moves away from seeing EHR systems as Information and Communication Technologies (ICT) projects requiring an essentially outcome-centred assessment towards a more interpretive approach that reflects the situated and evolving nature of EHR seen within multiple specific settings and reflecting a constantly changing milieu of policies

  13. Adoption of dental innovations

    PubMed Central

    Ramoni, Rachel B.; Etolue, Jini; Tokede, Oluwabunmi; McClellan, Lyle; Simmons, Kristen; Yansane, Alfa; White, Joel M.; Walji, Muhammad F.; Kalenderian, Elsbeth

    2017-01-01

    Background Standardized dental diagnostic terminologies (SDDxTs) were introduced decades ago. Their use has been on the rise, accompanying the adoption of electronic health records (EHRs). One of the most broadly used terminologies is the Dental Diagnostic System (DDS). Our aim was to assess the adoption of SDDxTs by US dental schools by using the Rogers diffusion of innovations framework, focusing on the DDS. Methods The authors electronically surveyed clinic deans in all US dental schools (n = 61) to determine use of an EHR and SDDxT, perceived barriers to adoption of an SDDxT, and the effect of implementing an SDDxT on clinical productivity. Results The response rate was 57%. Of the 35 responses, 91% reported using an EHR to document patient care, with 84% using axiUm, and 69% reported using an SDDxT to document patient diagnoses; 41% used the DDS. Fifty-four percent of those who did not use an SDDxT had considered adopting the DDS, but 39% had not, citing barriers such as complexity and compatibility. Conclusions Adoption of an SDDxT, particularly the DDS, is on the rise. Nevertheless, a large number of institutions are in the Rogers late majority and laggards categories with respect to adoption. Several factors may discourage adoption, including the inability to try out the terminology on a small scale, poor usability within the EHR, the fact that it would be a cultural shift in practice, and a perception of unclear benefits. However, the consolidation of the DDS and American Dental Association terminology efforts stands to encourage adoption. PMID:28364948

  14. Facilitators and barriers for the adoption, implementation and monitoring of child safety interventions: a multinational qualitative analysis.

    PubMed

    Scholtes, Beatrice; Schröder-Bäck, Peter; MacKay, J Morag; Vincenten, Joanne; Förster, Katharina; Brand, Helmut

    2017-06-01

    The efficiency and effectiveness of child safety interventions are determined by the quality of the implementation process. This multinational European study aimed to identify facilitators and barriers for the three phases of implementation: adoption, implementation and monitoring (AIM process). Twenty-seven participants from across the WHO European Region were invited to provide case studies of child safety interventions from their country. Cases were selected by the authors to ensure broad coverage of injury issues, age groups and governance level of implementation (eg, national, regional or local). Each participant presented their case and provided a written account according to a standardised template. Presentations and question and answer sessions were recorded. The presentation slides, written accounts and the notes taken during the workshops were analysed using thematic content analysis to elicit facilitators and barriers. Twenty-six cases (from 26 different countries) were presented and analysed. Facilitators and barriers were identified within eight general themes, applicable across the AIM process: management and collaboration; resources; leadership; nature of the intervention; political, social and cultural environment; visibility; nature of the injury problem and analysis and interpretation. The importance of the quality of the implementation process for intervention effectiveness, coupled with limited resources for child safety makes it more difficult to achieve successful actions. The findings of this study, divided by phase of the AIM process, provide practitioners with practical suggestions, where proactive planning might help increase the likelihood of effective implementation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  15. OXC management and control system architecture with scalability, maintenance, and distributed managing environment

    NASA Astrophysics Data System (ADS)

    Park, Soomyung; Joo, Seong-Soon; Yae, Byung-Ho; Lee, Jong-Hyun

    2002-07-01

    In this paper, we present the Optical Cross-Connect (OXC) Management Control System Architecture, which has the scalability and robust maintenance and provides the distributed managing environment in the optical transport network. The OXC system we are developing, which is divided into the hardware and the internal and external software for the OXC system, is made up the OXC subsystem with the Optical Transport Network (OTN) sub layers-hardware and the optical switch control system, the signaling control protocol subsystem performing the User-to-Network Interface (UNI) and Network-to-Network Interface (NNI) signaling control, the Operation Administration Maintenance & Provisioning (OAM&P) subsystem, and the network management subsystem. And the OXC management control system has the features that can support the flexible expansion of the optical transport network, provide the connectivity to heterogeneous external network elements, be added or deleted without interrupting OAM&P services, be remotely operated, provide the global view and detail information for network planner and operator, and have Common Object Request Broker Architecture (CORBA) based the open system architecture adding and deleting the intelligent service networking functions easily in future. To meet these considerations, we adopt the object oriented development method in the whole developing steps of the system analysis, design, and implementation to build the OXC management control system with the scalability, the maintenance, and the distributed managing environment. As a consequently, the componentification for the OXC operation management functions of each subsystem makes the robust maintenance, and increases code reusability. Also, the component based OXC management control system architecture will have the flexibility and scalability in nature.

  16. Design and Implementation of a Cloud Computing Adoption Decision Tool: Generating a Cloud Road.

    PubMed

    Bildosola, Iñaki; Río-Belver, Rosa; Cilleruelo, Ernesto; Garechana, Gaizka

    2015-01-01

    Migrating to cloud computing is one of the current enterprise challenges. This technology provides a new paradigm based on "on-demand payment" for information and communication technologies. In this sense, the small and medium enterprise is supposed to be the most interested, since initial investments are avoided and the technology allows gradual implementation. However, even if the characteristics and capacities have been widely discussed, entry into the cloud is still lacking in terms of practical, real frameworks. This paper aims at filling this gap, presenting a real tool already implemented and tested, which can be used as a cloud computing adoption decision tool. This tool uses diagnosis based on specific questions to gather the required information and subsequently provide the user with valuable information to deploy the business within the cloud, specifically in the form of Software as a Service (SaaS) solutions. This information allows the decision makers to generate their particular Cloud Road. A pilot study has been carried out with enterprises at a local level with a two-fold objective: to ascertain the degree of knowledge on cloud computing and to identify the most interesting business areas and their related tools for this technology. As expected, the results show high interest and low knowledge on this subject and the tool presented aims to readdress this mismatch, insofar as possible.

  17. Design and Implementation of a Cloud Computing Adoption Decision Tool: Generating a Cloud Road

    PubMed Central

    Bildosola, Iñaki; Río-Belver, Rosa; Cilleruelo, Ernesto; Garechana, Gaizka

    2015-01-01

    Migrating to cloud computing is one of the current enterprise challenges. This technology provides a new paradigm based on “on-demand payment” for information and communication technologies. In this sense, the small and medium enterprise is supposed to be the most interested, since initial investments are avoided and the technology allows gradual implementation. However, even if the characteristics and capacities have been widely discussed, entry into the cloud is still lacking in terms of practical, real frameworks. This paper aims at filling this gap, presenting a real tool already implemented and tested, which can be used as a cloud computing adoption decision tool. This tool uses diagnosis based on specific questions to gather the required information and subsequently provide the user with valuable information to deploy the business within the cloud, specifically in the form of Software as a Service (SaaS) solutions. This information allows the decision makers to generate their particular Cloud Road. A pilot study has been carried out with enterprises at a local level with a two-fold objective: to ascertain the degree of knowledge on cloud computing and to identify the most interesting business areas and their related tools for this technology. As expected, the results show high interest and low knowledge on this subject and the tool presented aims to readdress this mismatch, insofar as possible. PMID:26230400

  18. Healthier Cleaning & Maintenance: Practices and Products for Schools.

    ERIC Educational Resources Information Center

    New York State Association for Superintendents of School Buildings and Grounds, Albany.

    This paper helps all those concerned with keeping schools clean and properly maintained in adopting healthier cleaning and maintenance practices and promoting the purchase and use of environmentally preferable products which perform well and are cost effective. It explains how children are exposed to toxic chemicals in school cleaning and…

  19. Evaluation of the implementation of a whole-workplace walking programme using the RE-AIM framework.

    PubMed

    Adams, Emma J; Chalkley, Anna E; Esliger, Dale W; Sherar, Lauren B

    2017-05-18

    Promoting walking for the journey to/from work and during the working day is one potential approach to increase physical activity in adults. Walking Works was a practice-led, whole-workplace walking programme delivered by employees (walking champions). This study aimed to evaluate the implementation of Walking Works using the RE-AIM framework and provide recommendations for future delivery of whole-workplace walking programmes. Two cross sectional surveys were conducted; 1544 (28%) employees completed the baseline survey and 918 employees (21%) completed the follow-up survey. Effectiveness was assessed using baseline and follow-up data; reach, implementation and maintenance were assessed using follow-up data only. For categorical data, Chi square tests were conducted to assess differences between surveys or groups. Continuous data were analysed to test for significant differences using a Mann-Whitney U test. Telephone interviews were conducted with the lead organisation co-ordinator, eight walking champions and three business representatives at follow-up. Interviews were transcribed verbatim and analysed to identify key themes related to adoption, implementation and maintenance. Adoption: Five workplaces participated in Walking Works. Reach: 480 (52.3%) employees were aware of activities and 221 (24.1%) participated. A variety of walking activities were delivered. Some programme components were not delivered as planned which was partly due to barriers in using walking champions to deliver activities. These included the walking champions' capacity, skills, support needs, ability to engage senior management, and the number and type of activities they could deliver. Other barriers included lack of management support, difficulties communicating information about activities and challenges embedding the programme into normal business activities. Effectiveness: No significant changes in walking to/from work or walking during the working day were observed. Maintenance

  20. [The maintenance of automatic analysers and associated documentation].

    PubMed

    Adjidé, V; Fournier, P; Vassault, A

    2010-12-01

    The maintenance of automatic analysers and associated documentation taking part in the requirements of the ISO 15189 Standard and the French regulation as well have to be defined in the laboratory policy. The management of the periodic maintenance and documentation shall be implemented and fulfilled. The organisation of corrective maintenance has to be managed to avoid interruption of the task of the laboratory. The different recommendations concern the identification of materials including automatic analysers, the environmental conditions to take into account, the documentation provided by the manufacturer and documents prepared by the laboratory including procedures for maintenance.

  1. Making sense of evidence in management decisions: the role of research-based knowledge on innovation adoption and implementation in healthcare. study protocol

    PubMed Central

    2012-01-01

    Background We know that patient care can be improved by implementing evidence-based innovations and applying research findings linked to good practice. Successfully implementing innovations in complex organisations, such as the UK's National Health Service (NHS), is often challenging as multiple contextual dynamics mediate the process. Research studies have explored the challenges of introducing innovations into healthcare settings and have contributed to a better understanding of why potentially useful innovations are not always implemented in practice, even if backed by strong evidence. Mediating factors include health policy and health system influences, organisational factors, and individual and professional attitudes, including decision makers' perceptions of innovation evidence. There has been limited research on how different forms of evidence are accessed and utilised by organisational decision makers during innovation adoption. We also know little about how diverse healthcare professionals (clinicians, administrators) make sense of evidence and how this collective sensemaking mediates the uptake of innovations. Methods The study will involve nine comparative case study sites of acute care organisations grouped into three regional clusters across England. Each of the purposefully selected sites represents a variety of trust types and organisational contexts. We will use qualitative methods, in-depth interviews, observation of key meetings, and systematic analysis of relevant secondary data to understand the rationale and challenges involved in sourcing and utilising innovation evidence in the empirical setting of infection prevention and control. We will use theories of innovation adoption and sensemaking in organisations to interpret the data. The research will provide lessons for the uptake and continuous use of innovations in the English and international health systems. Discussion Unlike most innovation studies, which involve single-level analysis, our

  2. The Fostering Connections to Success and Increasing Adoptions Act: Implementation Issues and a Look Ahead at Additional Child Welfare Reforms. Working Paper

    ERIC Educational Resources Information Center

    Geen, Rob

    2009-01-01

    The passage of the Fostering Connections to Success and Increasing Adoptions Act (P.L. 110-351) represents the most significant federal child welfare reform in more than a decade. While the scope and nature of the federal reforms are far reaching, the actual impact of the legislation on children will depend largely upon how it is implemented.…

  3. Support increased adoption of green infrastructure into ...

    EPA Pesticide Factsheets

    This project will provide technical assistance to support implementation of GI in U.S. communities and information on best practices for GI approaches that protect ground water supplies. Case studies that can be more broadly applied to other communities will be conducted. The project will provide program and regional offices with guidance on GI planning, implementation, and maintenance for stormwater management and capture/aquifer storage. To share information on SSWR research projects

  4. Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care.

    PubMed

    Quanbeck, Andrew; Brown, Randall T; E Zgierska, Aleksandra; A Johnson, Roberta; Robinson, James M; Jacobson, Nora

    2016-01-27

    Adoption of evidence-based practices takes place at a glacial place in healthcare. This research will pilot test an innovative implementation strategy - systems consultation -intended to speed the adoption of evidence-based practice in primary care. The strategy is based on tenets of systems engineering and has been extensively tested in addiction treatment. Three innovations have been included in the strategy - translation of a clinical practice guideline into a checklist-based implementation guide, the use of physician peer coaches ('systems consultants') to help clinics implement the guide, and a focus on reducing variation in practices across prescribers and clinics. The implementation strategy will be applied to improving opioid prescribing practices in primary care, which may help ultimately mitigate the increasing prevalence of opioid abuse and addiction. The pilot test will compare four intervention clinics to four control clinics in a matched-pairs design. A leading clinical guideline for opioid prescribing has been translated into a checklist-based implementation guide in a systematic process that involved experts who wrote the guideline in consultation with implementation experts and primary care physicians. Two physicians with expertise in family and addiction medicine are serving as the systems consultants. Each systems consultant will guide two intervention clinics, using two site visits and follow-up communication by phone and email, to implement the translated guideline. Mixed methods will be used to test the feasibility, acceptability, and preliminary effectiveness of the implementation strategy in an evaluation that meets standards for 'fully developed use' of the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). The clinic will be the primary unit of analysis. The systems consultation implementation strategy is intended to generalize to the adoption of other clinical guidelines. This pilot test is intended to prepare

  5. Reliability Centered Maintenance - Methodologies

    NASA Technical Reports Server (NTRS)

    Kammerer, Catherine C.

    2009-01-01

    Journal article about Reliability Centered Maintenance (RCM) methodologies used by United Space Alliance, LLC (USA) in support of the Space Shuttle Program at Kennedy Space Center. The USA Reliability Centered Maintenance program differs from traditional RCM programs because various methodologies are utilized to take advantage of their respective strengths for each application. Based on operational experience, USA has customized the traditional RCM methodology into a streamlined lean logic path and has implemented the use of statistical tools to drive the process. USA RCM has integrated many of the L6S tools into both RCM methodologies. The tools utilized in the Measure, Analyze, and Improve phases of a Lean Six Sigma project lend themselves to application in the RCM process. All USA RCM methodologies meet the requirements defined in SAE JA 1011, Evaluation Criteria for Reliability-Centered Maintenance (RCM) Processes. The proposed article explores these methodologies.

  6. The Council of Academic Hospitals of Ontario (CAHO) Adopting Research to Improve Care (ARTIC) Program: Reach, Sustainability, Spread and Lessons Learned from an Implementation Funding Model

    PubMed Central

    Grouchy, Michelle; Graham, Ian D.; Shandling, Maureen; Doyle, Winnie; Straus, Sharon E.

    2016-01-01

    Despite evidence on what works in healthcare, there is a significant gap in the time it takes to bring research into practice. The Council of Academic Hospitals of Ontario's Adopting Research to Improve Care program addresses this research-to-practice gap by incorporating the following components into its funding program: strategic selection of evidence for implementation, education and training for implementation, implementation supports, executive champions and governance, and evaluation. Funded projects have been sustained (76% reported full sustainability) and spread to over 200 new sites. Lessons learned include the following: assess readiness, develop tailored implementation materials, consider characteristics of implementation supports, protect champion time and consider evaluation feasibility. PMID:27232234

  7. Market factors and electronic medical record adoption in medical practices.

    PubMed

    Menachemi, Nir; Mazurenko, Olena; Kazley, Abby Swanson; Diana, Mark L; Ford, Eric W

    2012-01-01

    Previous studies identified individual or practice factors that influence practice-based physicians' electronic medical record (EMR) adoption. Less is known about the market factors that influence physicians' EMR adoption. The aim of this study was to explore the relationship between environmental market characteristics and physicians' EMR adoption. The Health Tracking Physician Survey 2008 and Area Resource File (2008) were combined and analyzed. Binary logistic regression was used to examine the relationship between three dimensions of the market environment (munificence, dynamism, and complexity) and EMR adoption controlling for several physician and practice characteristics. In a nationally representative sample of 4,720 physicians, measures of market dynamism including increases in unemployment, odds ratio (OR) = 0.95, 95% confidence interval (CI) [0.91, 0.99], or poverty rates, OR = 0.93, 95% CI [0.89, 0.96], were negatively associated with EMR adoption. Health maintenance organization penetration, OR = 3.01, 95% CI [1.49, 6.05], another measure of dynamism, was positively associated with EMR adoption. Physicians practicing in areas with a malpractice crisis, OR = 0.82, 95% CI [0.71, 0.94], representing environmental complexity, had lower EMR adoption rates. Understanding how market factors relate to practice-based physicians' EMR adoption can assist policymakers to better target limited resources as they work to realize the national goal of universal EMR adoption and meaningful use.

  8. Portable oil bath for high-accuracy resistance transfer and maintenance

    NASA Astrophysics Data System (ADS)

    Shiota, Fuyuhiko

    1999-10-01

    A portable oil bath containing one standard resistor for high-accuracy resistance transfer and maintenance was developed and operated for seven years in the National Research Laboratory of Metrology. The aim of the bath is to save labor and apparatus for high-accuracy resistance transfer and maintenance by consistently keeping the standard resistor in an optimum environmental condition. The details of the prototype system, including its performance, are described together with some suggestions for a more practical bath design, which adopts the same concept.

  9. Using the intervention mapping protocol to develop a maintenance programme for the SLIMMER diabetes prevention intervention.

    PubMed

    Elsman, Ellen B M; Leerlooijer, Joanne N; Ter Beek, Josien; Duijzer, Geerke; Jansen, Sophia C; Hiddink, Gerrit J; Feskens, Edith J M; Haveman-Nies, Annemien

    2014-10-27

    Although lifestyle interventions have shown to be effective in reducing the risk for type 2 diabetes mellitus, maintenance of achieved results is difficult, as participants often experience relapse after the intervention has ended. This paper describes the systematic development of a maintenance programme for the extensive SLIMMER intervention, an existing diabetes prevention intervention for high-risk individuals, implemented in a real-life setting in the Netherlands. The maintenance programme was developed using the Intervention Mapping protocol. Programme development was informed by a literature study supplemented by various focus group discussions and feedback from implementers of the extensive SLIMMER intervention. The maintenance programme was designed to sustain a healthy diet and physical activity pattern by targeting knowledge, attitudes, subjective norms and perceived behavioural control of the SLIMMER participants. Practical applications were clustered into nine programme components, including sports clinics at local sports clubs, a concluding meeting with the physiotherapist and dietician, and a return session with the physiotherapist, dietician and physical activity group. Manuals were developed for the implementers and included a detailed time table and step-by-step instructions on how to implement the maintenance programme. The Intervention Mapping protocol provided a useful framework to systematically plan a maintenance programme for the extensive SLIMMER intervention. The study showed that planning a maintenance programme can build on existing implementation structures of the extensive programme. Future research is needed to determine to what extent the maintenance programme contributes to sustained effects in participants of lifestyle interventions.

  10. Integrating Models of Diffusion and Behavior to Predict Innovation Adoption, Maintenance, and Social Diffusion.

    PubMed

    Smith, Rachel A; Kim, Youllee; Zhu, Xun; Doudou, Dimi Théodore; Sternberg, Eleanore D; Thomas, Matthew B

    2018-01-01

    This study documents an investigation into the adoption and diffusion of eave tubes, a novel mosquito vector control, during a large-scale scientific field trial in West Africa. The diffusion of innovations (DOI) and the integrated model of behavior (IMB) were integrated (i.e., innovation attributes with attitudes and social pressures with norms) to predict participants' (N = 329) diffusion intentions. The findings showed that positive attitudes about the innovation's attributes were a consistent positive predictor of diffusion intentions: adopting it, maintaining it, and talking with others about it. As expected by the DOI and the IMB, the social pressure created by a descriptive norm positively predicted intentions to adopt and maintain the innovation. Drawing upon sharing research, we argued that the descriptive norm may dampen future talk about the innovation, because it may no longer be seen as a novel, useful topic to discuss. As predicted, the results showed that as the descriptive norm increased, the intention to talk about the innovation decreased. These results provide broad support for integrating the DOI and the IMB to predict diffusion and for efforts to draw on other research to understand motivations for social diffusion.

  11. From Delivery to Adoption of Physical Activity Guidelines: Realist Synthesis

    PubMed Central

    2017-01-01

    Background: Evidence-based guidelines published by health authorities for the promotion of health-enhancing physical activity (PA), continue to be implemented unsuccessfully and demonstrate a gap between evidence and policies. This review synthesizes evidence on factors influencing delivery, adoption and implementation of PA promotion guidelines within different policy sectors (e.g., health, transport, urban planning, sport, education). Methods: Published literature was initially searched using PubMed, EBSCO, Google Scholar and continued through an iterative snowball technique. The literature review spanned the period 2002–2017. The realist synthesis approach was adopted to review the content of 39 included studies. An initial programme theory with a four-step chain from evidence emersion to implementation of guidelines was tested. Results: The synthesis furthers our understanding of the link between PA guidelines delivery and the actions of professionals responsible for implementation within health services, school departments and municipalities. The main mechanisms identified for guidance implementation were scientific legitimation, enforcement, feasibility, familiarity with concepts and PA habits. Threats emerged to the successful implementation of PA guidelines at national/local jurisdictional levels. Conclusions: The way PA guidelines are developed may influence their adoption by policy-makers and professionals. Useful lessons emerged that may inform synergies between policymaking and professional practices, promoting win-win multisectoral strategies. PMID:28991184

  12. Predictors of relationship dissolution in lesbian, gay, and heterosexual adoptive parents.

    PubMed

    Goldberg, Abbie E; Garcia, Randi

    2015-06-01

    Little work has examined relationship dissolution or divorce in adoptive parents or same-sex parent couples. The current study examined predictors of relationship dissolution across the first 5 years of parenthood among a sample of heterosexual, lesbian, and gay male adoptive couples. Of the 190 couples in the study, 15 (7.9%) dissolved their relationships during the first 5 years of adoptive parenthood. Specifically, 7 of 57 lesbian couples (12.3%), 1 of 49 gay male couples (2.0%), and 7 of 84 heterosexual couples (8.3%) dissolved their unions. Results of our logistic regression analysis revealed that the odds of relationship dissolution were significantly higher for (a) couples who adopted a noninfant (i.e., older child); (b) participants who reported feeling less prepared for the adoption, 3 months postadoptive placement; and (c) couples in which both partners reported very low or very high preadoption levels of relationship maintenance behaviors. Findings have implications for adoption professionals seeking to support same-sex and heterosexual prospective adopters, as well as societal debates and policy regarding same-sex relationships and parenting. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

  13. 78 FR 7672 - Approval and Promulgation of Implementation Plans; Texas; Beaumont/Port Arthur Ozone Maintenance...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-04

    .... SUMMARY: EPA is approving a revision to the Beaumont/Port Arthur (BPA) 1997 8-hour ozone maintenance air... emissions model. The BPA 1997 8-hour ozone maintenance area consists of Hardin, Jefferson, and Orange... proposed to approve a revision to the BPA 1997 8-hour ozone maintenance air quality SIP by replacing the...

  14. Design and implementation of workflow engine for service-oriented architecture

    NASA Astrophysics Data System (ADS)

    Peng, Shuqing; Duan, Huining; Chen, Deyun

    2009-04-01

    As computer network is developed rapidly and in the situation of the appearance of distribution specialty in enterprise application, traditional workflow engine have some deficiencies, such as complex structure, bad stability, poor portability, little reusability and difficult maintenance. In this paper, in order to improve the stability, scalability and flexibility of workflow management system, a four-layer architecture structure of workflow engine based on SOA is put forward according to the XPDL standard of Workflow Management Coalition, the route control mechanism in control model is accomplished and the scheduling strategy of cyclic routing and acyclic routing is designed, and the workflow engine which adopts the technology such as XML, JSP, EJB and so on is implemented.

  15. Factors affecting adoption, implementation fidelity, and sustainability of the Redesigned Community Health Fund in Tanzania: a mixed methods protocol for process evaluation in the Dodoma region

    PubMed Central

    Kalolo, Albino; Radermacher, Ralf; Stoermer, Manfred; Meshack, Menoris; De Allegri, Manuela

    2015-01-01

    Background Despite the implementation of various initiatives to address low enrollment in voluntary micro health insurance (MHI) schemes in sub-Saharan Africa, the problem of low enrollment remains unresolved. The lack of process evaluations of such interventions makes it difficult to ascertain whether their poor results are because of design failures or implementation weaknesses. Objective In this paper, we describe a process evaluation protocol aimed at opening the ‘black box’ to evaluate the implementation processes of the Redesigned Community Health Fund (CHF) program in the Dodoma region of Tanzania. Design The study employs a cross-sectional mixed methods design and is being carried out 3 years after the launch of the Redesigned CHF program. The study is grounded in a conceptual framework which rests on the Diffusion of Innovation Theory and the Implementation Fidelity Framework. The study utilizes a mixture of quantitative and qualitative data collection tools (questionnaires, focus group discussions, in-depth interviews, and document review), and aligns the evaluation to the Theory of Intervention developed by our team. Quantitative data will be used to measure program adoption, implementation fidelity, and their moderating factors. Qualitative data will be used to explore the responses of stakeholders to the intervention, contextual factors, and moderators of adoption, implementation fidelity, and sustainability. Discussion This protocol describes a systematic process evaluation in relation to the implementation of a reformed MHI. We trust that the theoretical approaches and methodologies described in our protocol may be useful to inform the design of future process evaluations focused on the assessment of complex interventions, such as MHI schemes. PMID:26679408

  16. Product modular design incorporating preventive maintenance issues

    NASA Astrophysics Data System (ADS)

    Gao, Yicong; Feng, Yixiong; Tan, Jianrong

    2016-03-01

    Traditional modular design methods lead to product maintenance problems, because the module form of a system is created according to either the function requirements or the manufacturing considerations. For solving these problems, a new modular design method is proposed with the considerations of not only the traditional function related attributes, but also the maintenance related ones. First, modularity parameters and modularity scenarios for product modularity are defined. Then the reliability and economic assessment models of product modularity strategies are formulated with the introduction of the effective working age of modules. A mathematical model used to evaluate the difference among the modules of the product so that the optimal module of the product can be established. After that, a multi-objective optimization problem based on metrics for preventive maintenance interval different degrees and preventive maintenance economics is formulated for modular optimization. Multi-objective GA is utilized to rapidly approximate the Pareto set of optimal modularity strategy trade-offs between preventive maintenance cost and preventive maintenance interval difference degree. Finally, a coordinate CNC boring machine is adopted to depict the process of product modularity. In addition, two factorial design experiments based on the modularity parameters are constructed and analyzed. These experiments investigate the impacts of these parameters on the optimal modularity strategies and the structure of module. The research proposes a new modular design method, which may help to improve the maintainability of product in modular design.

  17. Pilot Study of Implementation of an Internet-Based Depression Prevention Intervention (CATCH-IT) for Adolescents in 12 US Primary Care Practices: Clinical and Management/Organizational Behavioral Perspectives.

    PubMed

    Eisen, Jeffrey C; Marko-Holguin, Monika; Fogel, Joshua; Cardenas, Alonso; Bahn, My; Bradford, Nathan; Fagan, Blake; Wiedmann, Peggy; Van Voorhees, Benjamin W

    2013-01-01

    To explore the implementation of CATCH-IT (Competent Adulthood Transition with Cognitive-behavioral Humanistic and Interpersonal Training), an Internet-based depression intervention program in 12 primary care sites, occurring as part of a randomized clinical trial comparing 2 versions of the intervention (motivational interview + Internet program versus brief advice + Internet program) in 83 adolescents aged 14 to 21 years recruited from February 1, 2007, to November 31, 2007. The CATCH-IT intervention model consists of primary care screening to assess risk, a primary care physician interview to encourage participation, and 14 online modules of Internet training to teach adolescents how to reduce behaviors that increase vulnerability to depressive disorders. Specifically, we evaluated this program from both a management/organizational behavioral perspective (provider attitudes and demonstrated competence) and a clinical outcomes perspective (depressed mood scores) using the RE-AIM model (Reach, Efficacy, Adoption, Implementation, and Maintenance of the intervention). While results varied by clinic, overall, clinics demonstrated satisfactory reach, efficacy, adoption, implementation, and maintenance of the CATCH-IT depression prevention program. Measures of program implementation and management predicted clinical outcomes at practices in exploratory analyses. Multidisciplinary approaches may be essential to evaluating the impact of complex interventions to prevent depression in community settings. Primary care physicians and nurses can use Internet-based programs to create a feasible and cost-effective model for the prevention of mental disorders in adolescents in primary care settings. ClinicalTrials.gov identifiers: NCT00152529 and NCT00145912.

  18. The Council of Academic Hospitals of Ontario (CAHO) Adopting Research to Improve Care (ARTIC) Program: Reach, Sustainability, Spread and Lessons Learned from an Implementation Funding Model.

    PubMed

    Moore, Julia E; Grouchy, Michelle; Graham, Ian D; Shandling, Maureen; Doyle, Winnie; Straus, Sharon E

    2016-05-01

    Despite evidence on what works in healthcare, there is a significant gap in the time it takes to bring research into practice. The Council of Academic Hospitals of Ontario's Adopting Research to Improve Care program addresses this research-to-practice gap by incorporating the following components into its funding program: strategic selection of evidence for implementation, education and training for implementation, implementation supports, executive champions and governance, and evaluation. Funded projects have been sustained (76% reported full sustainability) and spread to over 200 new sites. Lessons learned include the following: assess readiness, develop tailored implementation materials, consider characteristics of implementation supports, protect champion time and consider evaluation feasibility. Copyright © 2016 Longwoods Publishing.

  19. Predictors of the decision to adopt motivational interviewing in community health settings.

    PubMed

    Williams, Jessica Roberts; Blais, Marissa Puckett; Banks, Duren; Dusablon, Tracy; Williams, Weston O; Hennessy, Kevin D

    2014-07-01

    The purpose of this study is to concurrently examine the impact of individual and organizational characteristics on the decision to adopt the evidence-based practice (EBP) motivational interviewing (MI) among directors and staff (n = 311) in community health organizations (n = 92). Results from hierarchical linear modeling indicated that, at the individual level, attitudes toward EBPs and race each predicted directors' decisions to adopt, while gender predicted staff's decisionmaking. At the organizational level, organizational climate was inversely associated with both staff's and directors' decisions to adopt MI. Organizational barriers to implementing EBPs and use of reading materials and treatment manuals were related to directors' decision to adopt. Type of organization and staff attributes were associated with staff's decision to adopt. These findings underscore the need to tailor dissemination and implementation strategies to address differences between directors and staff in the adoption of EBPs.

  20. Adoption and use of e-invoicing in Greece

    NASA Astrophysics Data System (ADS)

    Marinagi, C.; Trivellas, P.; Reklitis, Panagiotis; Skourlas, C.

    2015-02-01

    This paper investigates the adoption and use of electronic invoices (e-invoices) in Greek organizations. The study attempts to evaluate current practices applied in implementing e-invoicing. A field research has been conducted, which is based on a structured questionnaire. The target sample consisted of 42 Greek enterprises. The main issues of the investigation include the existing invoice processing practices, the barriers that prevent the extended adoption and use of e-invoicing, the observed benefits from e-invoicing implementation, and the strategic drivers for transition to e-invoicing. Currently, the use of e-invoicing in Greece is low. However, the research results testify that the adoption of e-invoicing in Greece is promising. Even though, a number of enterprises state that benefits of e-invoicing are not clear yet, the majority of enterprises agree that there are crucial financial priorities that e-invoicing is expected to support.

  1. Protocol for the "Implementation, adoption, and utility of family history in diverse care settings" study.

    PubMed

    Wu, R Ryanne; Myers, Rachel A; McCarty, Catherine A; Dimmock, David; Farrell, Michael; Cross, Deanna; Chinevere, Troy D; Ginsburg, Geoffrey S; Orlando, Lori A

    2015-11-24

    Risk assessment with a thorough family health history is recommended by numerous organizations and is now a required component of the annual physical for Medicare beneficiaries under the Affordable Care Act. However, there are several barriers to incorporating robust risk assessments into routine care. MeTree, a web-based patient-facing health risk assessment tool, was developed with the aim of overcoming these barriers. In order to better understand what factors will be instrumental for broader adoption of risk assessment programs like MeTree in clinical settings, we obtained funding to perform a type III hybrid implementation-effectiveness study in primary care clinics at five diverse healthcare systems. Here, we describe the study's protocol. MeTree collects personal medical information and a three-generation family health history from patients on 98 conditions. Using algorithms built entirely from current clinical guidelines, it provides clinical decision support to providers and patients on 30 conditions. All adult patients with an upcoming well-visit appointment at one of the 20 intervention clinics are eligible to participate. Patient-oriented risk reports are provided in real time. Provider-oriented risk reports are uploaded to the electronic medical record for review at the time of the appointment. Implementation outcomes are enrollment rate of clinics, providers, and patients (enrolled vs approached) and their representativeness compared to the underlying population. Primary effectiveness outcomes are the percent of participants newly identified as being at increased risk for one of the clinical decision support conditions and the percent with appropriate risk-based screening. Secondary outcomes include percent change in those meeting goals for a healthy lifestyle (diet, exercise, and smoking). Outcomes are measured through electronic medical record data abstraction, patient surveys, and surveys/qualitative interviews of clinical staff. This study

  2. A Review of Software Maintenance Technology.

    DTIC Science & Technology

    1980-02-01

    LABS HONEYWELL, REF BURROUGHS, OTHERS BOOLE £ LANGUAGE "PE BABBAGE , OPERATIONAL INDEPENDENT 4.2.17 INC. IBM H M RELIABILITY MOST LARGE U. MEASUREMENT...80-13 ML llluuluunuuuuu SmeeI..... f. Maintenance Experience (1) Multiple Implementation Charles Holmes (Source 2) described two attempts at McDonnell...proprietary software monitor package distributed by Boole and Babbage , Inc., Sunnyvale, California. it has been implemented on IBM computers and is language

  3. Adopted Adolescents' Preoccupation with Adoption: The Impact on Adoptive Family Relationships.

    ERIC Educational Resources Information Center

    Kohler, Julie K.; Grotevant, Harold D.; McRoy, Ruth G.

    2002-01-01

    Examines relationship between intensity of adopted adolescents' thinking about their adoptions and their adoptive family relationships in 135 adopted adolescents. Adolescents with extremely high levels of preoccupation reported significantly higher levels of alienation and significantly lower levels of trust for their adoptive mothers and fathers.…

  4. Implementing a Mobile Health System to Integrate the Treatment of Addiction Into Primary Care: A Hybrid Implementation-Effectiveness Study.

    PubMed

    Quanbeck, Andrew; Gustafson, David H; Marsch, Lisa A; Chih, Ming-Yuan; Kornfield, Rachel; McTavish, Fiona; Johnson, Roberta; Brown, Randall T; Mares, Marie-Louise; Shah, Dhavan V

    2018-01-30

    Despite the near ubiquity of mobile phones, little research has been conducted on the implementation of mobile health (mHealth) apps to treat patients in primary care. Although primary care clinicians routinely treat chronic conditions such as asthma and diabetes, they rarely treat addiction, a common chronic condition. Instead, addiction is most often treated in the US health care system, if it is treated at all, in a separate behavioral health system. mHealth could help integrate addiction treatment in primary care. The objective of this paper was to report the effects of implementing an mHealth system for addiction in primary care on both patients and clinicians. In this implementation research trial, an evidence-based mHealth system named Seva was introduced sequentially over 36 months to a maximum of 100 patients with substance use disorders (SUDs) in each of three federally qualified health centers (FQHCs; primary care clinics that serve patients regardless of their ability to pay). This paper reports on patient and clinician outcomes organized according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. The outcomes according to the RE-AIM framework are as follows: Reach-Seva reached 8.31% (268/3226) of appropriate patients. Reach was limited by our ability to pay for phones and data plans for a maximum of 100 patients per clinic. Effectiveness-Patients who were given Seva had significant improvements in their risky drinking days (44% reduction, (0.7-1.25)/1.25, P=.04), illicit drug-use days (34% reduction, (2.14-3.22)/3.22, P=.01), quality of life, human immunodeficiency virus screening rates, and number of hospitalizations. Through Seva, patients also provided peer support to one another in ways that are novel in primary care settings. Adoption-Patients sustained high levels of Seva use-between 53% and 60% of the patients at the 3 sites accessed Seva during the last week of the 12-month implementation period. Among

  5. Evidence-based practice implementation: the impact of public versus private sector organization type on organizational support, provider attitudes, and adoption of evidence-based practice.

    PubMed

    Aarons, Gregory A; Sommerfeld, David H; Walrath-Greene, Christine M

    2009-12-31

    The goal of this study is to extend research on evidence-based practice (EBP) implementation by examining the impact of organizational type (public versus private) and organizational support for EBP on provider attitudes toward EBP and EBP use. Both organization theory and theory of innovation uptake and individual adoption of EBP guide the approach and analyses in this study. We anticipated that private sector organizations would provide greater levels of organizational support for EBPs leading to more positive provider attitudes towards EBPs and EBP use. We also expected attitudes toward EBPs to mediate the association of organizational support and EBP use. Participants were mental health service providers from 17 communities in 16 states in the United States (n = 170). Path analyses were conducted to compare three theoretical models of the impact of organization type on organizational support for EBP and of organizational support on provider attitudes toward EBP and EBP use. Consistent with our predictions, private agencies provided greater support for EBP implementation, and staff working for private agencies reported more positive attitudes toward adopting EBPs. Organizational support for EBP partially mediated the association of organization type on provider attitudes toward EBP. Organizational support was significantly positively associated with attitudes toward EBP and EBP use in practice. This study offers further support for the importance of organizational context as an influence on organizational support for EBP and provider attitudes toward adopting EBP. The study demonstrates the role organizational support in provider use of EBP in practice. This study also suggests that organizational support for innovation is a malleable factor in supporting use of EBP. Greater attention should be paid to organizational influences that can facilitate the dissemination and implementation of EBPs in community settings.

  6. Adoption Factors of the Electronic Health Record: A Systematic Review

    PubMed Central

    2016-01-01

    Background The Health Information Technology for Economic and Clinical Health (HITECH) was a significant piece of legislation in America that served as a catalyst for the adoption of health information technology. Following implementation of the HITECH Act, Health Information Technology (HIT) experienced broad adoption of Electronic Health Records (EHR), despite skepticism exhibited by many providers for the transition to an electronic system. A thorough review of EHR adoption facilitator and barriers provides ongoing support for the continuation of EHR implementation across various health care structures, possibly leading to a reduction in associated economic expenditures. Objective The purpose of this review is to compile a current and comprehensive list of facilitators and barriers to the adoption of the EHR in the United States. Methods Authors searched Cumulative Index of Nursing and Allied Health Literature (CINAHL) and MEDLINE, 01/01/2012–09/01/2015, core clinical/academic journals, MEDLINE full text, and evaluated only articles germane to our research objective. Team members selected a final list of articles through consensus meetings (n=31). Multiple research team members thoroughly read each article to confirm applicability and study conclusions, thereby increasing validity. Results Group members identified common facilitators and barriers associated with the EHR adoption process. In total, 25 adoption facilitators were identified in the literature occurring 109 times; the majority of which were efficiency, hospital size, quality, access to data, perceived value, and ability to transfer information. A total of 23 barriers to adoption were identified in the literature, appearing 95 times; the majority of which were cost, time consuming, perception of uselessness, transition of data, facility location, and implementation issues. Conclusions The 25 facilitators and 23 barriers to the adoption of the EHR continue to reveal a preoccupation on cost, despite

  7. The ABPN Maintenance of Certification Program for psychiatrists: past history, current status, and future directions.

    PubMed

    Faulkner, Larry R; Tivnan, Patricia W; Winstead, Daniel K; Reus, Victor I; Andrade, Naleen N; Brooks, Beth Ann; Colenda, Christopher C; Mrazek, David A; Reifler, Burton V; Schneidman, Barbara

    2008-01-01

    To describe the American Board of Psychiatry and Neurology (ABPN) Maintenance of Certification Program, its underlying rationale, how it will be implemented now, and what it might look like in the future. The authors describe the philosophical foundation, specific components, and the implementation timeline of the ABPN Maintenance of Certification Program; the development of specific products that might be used by ABPN diplomates to meet its requirements; and several unanswered questions about its current status and future development. The ABPN Maintenance of Certification Program consists of specific requirements pertaining to professional standing, self-assessment and lifelong learning, performance in practice, and cognitive expertise that will be implemented incrementally over the next decade. The ABPN Maintenance of Certification Program has been implemented in a manner that is as consistent as possible with its underlying philosophical beliefs as well as the current and expected public and political concerns, diplomate needs, and the requirements of organizations responsible for licensure, credentialing, privileging, accreditation, professional development, and physician reimbursement.

  8. Costs of performance based maintenance for local roads: Case study Albania

    NASA Astrophysics Data System (ADS)

    Jokanović, Igor; Grujić, Bojana; Zeljić, Dragana; Grujić, Žarko; Svilar, Mila

    2017-12-01

    The provision and maintenance of road infrastructure is a major global business, consequently it is essential that road maintenance services are provided in the most cost effective manner. Without regular maintenance, roads can rapidly fall into disrepair, preventing realization of the longer term impacts of road improvements on development, such as increased agricultural production and growth in school enrollment, which is of particular importance for a network of local (access) roads. Inadequate local roads maintenance in Albania is proposed to be solved by implementing performance based maintenance approach for which the costing exercise is presented within the paper.

  9. Integrated sign management system : ADOT maintenance group

    DOT National Transportation Integrated Search

    2003-12-01

    The Arizona Department of Transportation (ADOT) maintains and manages an inventory of roadway signs. Before the implementation of this project, sign technicians maintained inventory records on individual laptops to track their daily sign maintenance ...

  10. Design and Implementation of the PMS Module for ’Argos’

    DTIC Science & Technology

    1989-12-01

    designing , and implementing a fully workable Planned Maintenance System (PMS). This implementation demonstrates both the capabilities and benefits such a...analyzing, designing , and implementing a fully workable Planned Maintenance System (PMS). This implementation demonstrates both the capabilities and... design and implementation. PMS is the system developed by the navy to provide each ship, department, and supervisor with the tools needed to plan

  11. Electronic health records, adoption, quality of care, legal and privacy issues and their implementation in emergency departments.

    PubMed

    Ben-Assuli, Ofir

    2015-03-01

    Recently, the healthcare sector has shown a growing interest in information technologies. Two popular health IT (HIT) products are the electronic health record (EHR) and health information exchange (HIE) networks. The introduction of these tools is believed to improve care, but has also raised some important questions and legal and privacy issues. The implementation of these systems has not gone smoothly, and still faces some considerable barriers. This article reviews EHR and HIE to address these obstacles, and analyzes the current state of development and adoption in various countries around the world. Moreover, legal and ethical concerns that may be encountered by EHR users and purchasers are reviewed. Finally, links and interrelations between EHR and HIE and several quality of care issues in today's healthcare domain are examined with a focus on EHR and HIE in the emergency department (ED), whose unique characteristics makes it an environment in which the implementation of such technology may be a major contributor to health, but also faces substantial challenges. The paper ends with a discussion of specific policy implications and recommendations based on an examination of the current limitations of these systems. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  12. Factors Affecting the Adoption of an E-Assessment System

    ERIC Educational Resources Information Center

    McCann, Ann L.

    2010-01-01

    A case study was conducted in 2006-07 to explore how one US campus implemented a centralised e-assessment system. The study specifically measured the extent of adoption by faculty members, identified their reasons for adoption and evaluated the impact on teaching and learning. The purposes of the system, entitled researching learning (REAL, a…

  13. A 'movement for improvement'? A qualitative study of the adoption of social movement strategies in the implementation of a quality improvement campaign.

    PubMed

    Waring, Justin; Crompton, Amanda

    2017-09-01

    Given the difficulties of implementing 'top-down' quality improvements, health service leaders have turned to methods that empower clinicians to co-produce 'bottom-up' improvements. This has involved the adoption of strategies and activities associated with social movements, with clinicians encouraged to participate in collective action towards the shared goal of improvement. This paper examines the adoption of social movement methods by hospital managers as a strategy for implementing a quality improvement 'campaign'. Our case study suggests that, despite the claim of empowering clinicians to develop 'bottom-up' improvements, the use of social movement methods can be more narrowly concerned with engaging clinicians in pre-determined programmes of 'top-down' change. It finds a prominent role for 'hybrid' clinical leaders and other staff representatives in the mobilisation of the campaign, especially for enrolling clinicians in change activities. The work of these 'hybrids' suggests some degree of creative mediation between clinical and managerial interests, but more often alignment with the aspirations of management. The study raises questions about the translation of social movement's theories as a strategy for managing change and re-inventing professionalism. © 2017 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.

  14. Level of Adoption of Quality Management Systems Into the Mexican Pork Industry

    NASA Astrophysics Data System (ADS)

    Maldonado-Siman, Em; Ruíz-Flores, Agustín; Núñez-Domínguez, Rafael; González-Alcorta, Mariano; Hernández-Rodríguez, Bertha Alicia

    This research studies the characteristics of the Mexican pork sector; adoption status of quality management systems, and product destinations. Ninety six percent of fifty enterprises have fully answered a questionnaire. Ninety percent are small and medium-sized, the rest are large-sized firms. Nineteen percent of them have totally adopted HACCP, sixty three percent are implementing or planning to do it, the rest have no plans to adopt it. Thirteen percent of the enterprises had ISO 9000. Thirty four percent of their sales go to supermarkets, 57% to other retail chains and 9% to exportation. Product destinations are mainly Central America, United States of America, Asia and Mexico. To improve efficiency and the quality of process it is necessary to implement HACCP. Besides, customers and legal requirements are the external factors, which result in this adoption. In the process of implementing, there are some problems, such as staff motivation and training. The results suggest that HACCP system operating is important for the Mexican pork industry. It also has relevant implications in domestic trade. It is necessary to encourage adoption of quality management systems in the sector.

  15. Understanding managerial behaviour during initial steps of a clinical information system adoption

    PubMed Central

    2011-01-01

    Background While the study of the information technology (IT) implementation process and its outcomes has received considerable attention, the examination of pre-adoption and pre-implementation stages of configurable IT uptake appear largely under-investigated. This paper explores managerial behaviour during the periods prior the effective implementation of a clinical information system (CIS) by two Canadian university multi-hospital centers. Methods Adopting a structurationist theoretical stance and a case study research design, the processes by which CIS managers' patterns of discourse contribute to the configuration of the new technology in their respective organizational contexts were longitudinally examined over 33 months. Results Although managers seemed to be aware of the risks and organizational impact of the adoption of a new clinical information system, their decisions and actions over the periods examined appeared rather to be driven by financial constraints and power struggles between different groups involved in the process. Furthermore, they largely emphasized technological aspects of the implementation, with organizational dimensions being put aside. In view of these results, the notion of 'rhetorical ambivalence' is proposed. Results are further discussed in relation to the significance of initial decisions and actions for the subsequent implementation phases of the technology being configured. Conclusions Theoretical and empirically grounded, the paper contributes to the underdeveloped body of literature on information system pre-implementation processes by revealing the crucial role played by managers during the initial phases of a CIS adoption. PMID:21682885

  16. Qualitative Analysis for Maintenance Process Assessment

    NASA Technical Reports Server (NTRS)

    Brand, Lionel; Kim, Yong-Mi; Melo, Walcelio; Seaman, Carolyn; Basili, Victor

    1996-01-01

    In order to improve software maintenance processes, we first need to be able to characterize and assess them. These tasks must be performed in depth and with objectivity since the problems are complex. One approach is to set up a measurement-based software process improvement program specifically aimed at maintenance. However, establishing a measurement program requires that one understands the problems to be addressed by the measurement program and is able to characterize the maintenance environment and processes in order to collect suitable and cost-effective data. Also, enacting such a program and getting usable data sets takes time. A short term substitute is therefore needed. We propose in this paper a characterization process aimed specifically at maintenance and based on a general qualitative analysis methodology. This process is rigorously defined in order to be repeatable and usable by people who are not acquainted with such analysis procedures. A basic feature of our approach is that actual implemented software changes are analyzed in order to understand the flaws in the maintenance process. Guidelines are provided and a case study is shown that demonstrates the usefulness of the approach.

  17. Mechatronics technology in predictive maintenance method

    NASA Astrophysics Data System (ADS)

    Majid, Nurul Afiqah A.; Muthalif, Asan G. A.

    2017-11-01

    This paper presents recent mechatronics technology that can help to implement predictive maintenance by combining intelligent and predictive maintenance instrument. Vibration Fault Simulation System (VFSS) is an example of mechatronics system. The focus of this study is the prediction on the use of critical machines to detect vibration. Vibration measurement is often used as the key indicator of the state of the machine. This paper shows the choice of the appropriate strategy in the vibration of diagnostic process of the mechanical system, especially rotating machines, in recognition of the failure during the working process. In this paper, the vibration signature analysis is implemented to detect faults in rotary machining that includes imbalance, mechanical looseness, bent shaft, misalignment, missing blade bearing fault, balancing mass and critical speed. In order to perform vibration signature analysis for rotating machinery faults, studies have been made on how mechatronics technology is used as predictive maintenance methods. Vibration Faults Simulation Rig (VFSR) is designed to simulate and understand faults signatures. These techniques are based on the processing of vibrational data in frequency-domain. The LabVIEW-based spectrum analyzer software is developed to acquire and extract frequency contents of faults signals. This system is successfully tested based on the unique vibration fault signatures that always occur in a rotating machinery.

  18. Adoption of Injectable Naltrexone in U.S. Substance Use Disorder Treatment Programs

    PubMed Central

    Aletraris, Lydia; Edmond, Mary Bond; Roman, Paul M

    2015-01-01

    Objective: Medication-assisted treatment for substance use disorders (SUDs) is not widely used in treatment programs. The aims of the current study were to document the prevalence of adoption and implementation of extended-release injectable naltrexone, the newest U.S. Food and Drug Administration–approved medication for alcohol use disorder (AUD), in U.S. treatment programs and to examine associations between organizational and patient characteristics and adoption. Method: The study used interview data from a nationally representative sample of 307 U.S. SUD treatment programs to examine adoption and implementation of injectable naltrexone. Results: Thirteen percent of programs used injectable naltrexone for AUD, and 3% of programs used it for opioid use disorder. Every treatment program that offered injectable naltrexone to its patients used it in conjunction with psychosocial treatment, particularly cognitive behavioral therapy. Multivariate logistic regression results indicated that adoption was positively associated with the provision of wraparound services, the percentage of privately insured patients, and the presence of inpatient detoxification services. For-profit status and offering inpatient services were negatively associated with adoption. Within adopting programs, an average of 4.1% of AUD patients and 7.1% of patients with opioid use disorder were currently receiving the medication, despite clinical directors’ reports of positive patient outcomes, particularly for relapsers and for those who had been noncompliant with other medications. Cost was a significant issue for the majority of adopting organizations. Conclusions: The rate of adoption of injectable naltrexone in U.S. treatment programs remains limited. Researchers should continue to examine patient, organizational, and external characteristics associated with the adoption and implementation of injectable naltrexone over time. PMID:25486403

  19. Exploring the business case for ambulatory electronic health record system adoption.

    PubMed

    Song, Paula H; McAlearney, Ann Scheck; Robbins, Julie; McCullough, Jeffrey S

    2011-01-01

    Widespread implementation and use of electronic health record (EHR) systems has been recognized by healthcare leaders as a cornerstone strategy for systematically reducing medical errors and improving clinical quality. However, EHR adoption requires a significant capital investment for healthcare providers, and cost is often cited as a barrier. Despite the capital requirements, a true business case for EHR system adoption and implementation has not been made. This is of concern, as the lack of a business case can influence decision making about EHR investments. The purpose of this study was to examine the role of business case analysis in healthcare organizations' decisions to invest in ambulatory EHR systems, and to identify what factors organizations considered when justifying an ambulatory EHR. Using a qualitative case study approach, we explored how five organizations that are considered to have best practices in ambulatory EHR system implementation had evaluated the business case for EHR adoption. We found that although the rigor of formal business case analysis was highly variable, informants across these organizations consistently reported perceiving that a positive business case for EHR system adoption existed, especially when they considered both financial and non-financial benefits. While many consider EHR system adoption inevitable in healthcare, this viewpoint should not deter managers from conducting a business case analysis. Results of such an analysis can inform healthcare organizations' understanding about resource allocation needs, help clarify expectations about financial and clinical performance metrics to be monitored through EHR systems, and form the basis for ongoing organizational support to ensure successful system implementation.

  20. 45 CFR 1356.30 - Safety requirements for foster care and adoptive home providers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... been convicted of a felony involving: (1) Child abuse or neglect; (2) Spousal abuse; (3) A crime... ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND... made on behalf of a child placed in a foster home operated under the auspices of a child placing agency...

  1. Stimulating a Sustainable Construction through Holistic BIM Adoption: The Root Causes of Recurring Low BIM Adoption in Malaysia

    NASA Astrophysics Data System (ADS)

    Mamter, S.; Abdul-Aziz, AR; Mamat, ME

    2017-06-01

    Fostering the Building Information Modelling (BIM) implementation is one of Malaysia sustainable strategies towards greener construction. Hence, the Eleventh Malaysia plan focuses on transforming construction industry through the increase of technology adoption in order to enhance construction productivity. Therefore, there is a growing and urgent demand to provide BIM competent. However, a significant number of parties are reluctant to develop and invest in BIM due to unsolved root causes. Scholars have identified barriers relating to the infancy stage of BIM adoption in Malaysia. Unfortunately, there is a lack of study to explore deeper the root causes of recurring for the barriers anticipate the low BIM adoption. This paper attempts to delve into the initiatives of BIM stake players in fostering BIM adoption and to determine the root causes of recurring barriers due to low BIM adoption. The study adopted the semi-structured interviews which involved BIM stake players as a sample population. From the findings, authors revealed four root causes of recurring barriers; absence of BIM policy and BIM compulsion, poor holistic readiness, software integration competition strategy, and reluctant in sharing knowledge. The findings espoused here are preliminary and more results are expected to emerge as the research progresses.

  2. A University--School Partnership to Examine the Adoption and Implementation of the Ohio Community Collaboration Model in One Urban School District: A Mixed-Method Case Study

    ERIC Educational Resources Information Center

    Anderson-Butcher, Dawn; Iachini, Aidyn L.; Ball, Annahita; Barke, Susan; Martin, Lloyd D.

    2016-01-01

    School improvement models are expanding to incorporate priorities around positive youth development, safe and supportive school climates, school mental health, and school-family community partnerships. A partnership was formed between researchers and district/school leaders to examine the 3-year adoption and implementation of 1 such exemplary…

  3. Pilot Study of Implementation of an Internet-Based Depression Prevention Intervention (CATCH-IT) for Adolescents in 12 US Primary Care Practices: Clinical and Management/Organizational Behavioral Perspectives

    PubMed Central

    Eisen, Jeffrey C.; Marko-Holguin, Monika; Fogel, Joshua; Cardenas, Alonso; Bahn, My; Bradford, Nathan; Fagan, Blake; Wiedmann, Peggy

    2013-01-01

    Objective: To explore the implementation of CATCH-IT (Competent Adulthood Transition with Cognitive-behavioral Humanistic and Interpersonal Training), an Internet-based depression intervention program in 12 primary care sites, occurring as part of a randomized clinical trial comparing 2 versions of the intervention (motivational interview + Internet program versus brief advice + Internet program) in 83 adolescents aged 14 to 21 years recruited from February 1, 2007, to November 31, 2007. Method: The CATCH-IT intervention model consists of primary care screening to assess risk, a primary care physician interview to encourage participation, and 14 online modules of Internet training to teach adolescents how to reduce behaviors that increase vulnerability to depressive disorders. Specifically, we evaluated this program from both a management/organizational behavioral perspective (provider attitudes and demonstrated competence) and a clinical outcomes perspective (depressed mood scores) using the RE-AIM model (Reach, Efficacy, Adoption, Implementation, and Maintenance of the intervention). Results: While results varied by clinic, overall, clinics demonstrated satisfactory reach, efficacy, adoption, implementation, and maintenance of the CATCH-IT depression prevention program. Measures of program implementation and management predicted clinical outcomes at practices in exploratory analyses. Conclusion: Multidisciplinary approaches may be essential to evaluating the impact of complex interventions to prevent depression in community settings. Primary care physicians and nurses can use Internet-based programs to create a feasible and cost-effective model for the prevention of mental disorders in adolescents in primary care settings. Trial Registration: ClinicalTrials.gov identifiers: NCT00152529 and NCT00145912 PMID:24800110

  4. Market effects on electronic health record adoption by physicians.

    PubMed

    Abdolrasulnia, Maziar; Menachemi, Nir; Shewchuk, Richard M; Ginter, Peter M; Duncan, W Jack; Brooks, Robert G

    2008-01-01

    Despite the advantages of electronic health record (EHR) systems, the adoption of these systems has been slow among community-based physicians. Current studies have examined organizational and personal barriers to adoption; however, the influence of market characteristics has not been studied. The purpose of this study was to measure the effects of market characteristics on EHR adoption by physicians. Generalized hierarchal linear modeling was used to analyze EHR survey data from Florida which were combined with data from the Area Resource File and the Florida Office of Insurance Regulation. The main outcome variable was self-reported use of EHR by physicians. A total of 2,926 physicians from practice sizes of 20 or less were included in the sample. Twenty-one percent (n = 613) indicated that they personally and routinely use an EHR system in their practice. Physicians located in counties with higher physician concentration were found to be more likely to adopt EHRs. For every one-unit increase in nonfederal physicians per 10,000 in the county, there was a 2.0% increase in likelihood of EHR adoption by physicians (odds ratio = 1.02, confidence interval = 1.00-1.03). Health maintenance organization penetration rate and poverty level were not found to be significantly related to EHR adoption. However, practice size, years in practice, Medicare payer mix, and measures of technology readiness were found to independently influence physician adoption. Market factors play an important role in the diffusion of EHRs in small medical practices. Policy makers interested in furthering the adoption of EHRs must consider strategies that would enhance the confidence of users as well as provide financial support in areas with the highest concentration of small medical practices and Medicare beneficiaries. Health care leaders should be cognizant of the market forces that enable or constrain the adoption of EHR among their practices and those of their competitors.

  5. From Language Maintenance to Bilingual Parenting: Negotiating Behavior and Language Choice at the Dinner Table in Binational-Bilingual Families

    ERIC Educational Resources Information Center

    Meyer Pitton, Liliane

    2013-01-01

    This article contributes to the study of language maintenance as an everyday activity in binational-bilingual families. By embedding the question of language maintenance into a language socialization framework and adopting a conversation-analytic approach to language alternation, three excerpts of mealtime interactions in Russian-French speaking…

  6. A particle swarm model for estimating reliability and scheduling system maintenance

    NASA Astrophysics Data System (ADS)

    Puzis, Rami; Shirtz, Dov; Elovici, Yuval

    2016-05-01

    Modifying data and information system components may introduce new errors and deteriorate the reliability of the system. Reliability can be efficiently regained with reliability centred maintenance, which requires reliability estimation for maintenance scheduling. A variant of the particle swarm model is used to estimate reliability of systems implemented according to the model view controller paradigm. Simulations based on data collected from an online system of a large financial institute are used to compare three component-level maintenance policies. Results show that appropriately scheduled component-level maintenance greatly reduces the cost of upholding an acceptable level of reliability by reducing the need in system-wide maintenance.

  7. Context sensitive solutions for construction and maintenance.

    DOT National Transportation Integrated Search

    2007-07-01

    The objective of this research was to conduct a survey to assess the state of practice related to state highway agencies (SHAs) implementing context sensitive solutions including its application in Construction and Maintenance and to prepare a worksh...

  8. Cost effectiveness of the MDOT preventive maintenance program.

    DOT National Transportation Integrated Search

    2013-04-01

    The Michigan Department of Transportations (MDOT) pavement preservation program dates back to 1992. MDOTs pavement preservation strategy is primarily implemented through its capital preventive maintenance (CPM) program, in which preventive main...

  9. Evidence of the Adoption and Implementation of a Statewide Childhood Obesity Prevention Initiative in the New York State WIC Program: The "NY Fit WIC" Process Evaluation

    ERIC Educational Resources Information Center

    Sekhobo, Jackson P.; Egglefield, Katherine; Edmunds, Lynn S.; Shackman, Gene

    2012-01-01

    Process evaluations are critical in determining whether outcome evaluations are warranted. This study assessed the extent to which a childhood obesity prevention initiative, "NY Fit WIC", was adopted and implemented by the New York State Supplemental Nutrition Program for Women, Infants and Children (WIC). Process data came from…

  10. Institutional Drivers and Barriers to Faculty Adoption of Blended Learning in Higher Education

    ERIC Educational Resources Information Center

    Porter, Wendy W.; Graham, Charles R.

    2016-01-01

    Relatively little research on blended learning (BL) addresses institutional adoption, although such research would benefit institutions of higher education in strategically adopting and implementing BL. In a prior study, the authors proposed a framework for institutional BL adoption, identifying three stages: (1) awareness/exploration, (2)…

  11. [Development and application of a medical device maintenance information platform based on BS architecture].

    PubMed

    Liu, Shenglin; Zhang, Xutian; Wang, Guohong; Zhang, Qiang

    2012-03-01

    Based on specified demands on medical devices maintenance for clinical engineers and Browser/Server architecture technology, a medical device maintenance information platform was developed, which implemented the following modules such as repair, preventive maintenance, accessories management, training, document, system management and regional cooperation. The characteristics of this system were summarized and application in increase of repair efficiency, improvement of preventive maintenance and cost control was introduced. The application of this platform increases medical device maintenance service level.

  12. Drivers and Barriers in Health IT Adoption

    PubMed Central

    Avgar, A.C.; Litwin, A.S.; Pronovost, P.J.

    2012-01-01

    Despite near (and rare) consensus that the adoption and diffusion of health information technology (health IT) will bolster outcomes for organizations, individuals, and the healthcare system as a whole, there has been surprisingly little consideration of the structures and processes within organizations that might drive the adoption and effective use of the technology. Management research provides a useful lens through which to analyze both the determinants of investment and the benefits that can ultimately be derived from these investments. This paper provides a conceptual framework for understanding health IT adoption. In doing so, this paper highlights specific organizational barriers or enablers at different stages of the adoption process – investment, implementation, and use – and at different levels of organizational decision-making – strategic, operational, and frontline. This framework will aid both policymakers and organizational actors as they make sense of the transition from paper-based to electronic systems. PMID:23646093

  13. The design of a real-time formative evaluation of the implementation process of lifestyle interventions at two worksites using a 7-step strategy (BRAVO@Work).

    PubMed

    Wierenga, Debbie; Engbers, Luuk H; van Empelen, Pepijn; Hildebrandt, Vincent H; van Mechelen, Willem

    2012-08-07

    Worksite health promotion programs (WHPPs) offer an attractive opportunity to improve the lifestyle of employees. Nevertheless, broad scale and successful implementation of WHPPs in daily practice often fails. In the present study, called BRAVO@Work, a 7-step implementation strategy was used to develop, implement and embed a WHPP in two different worksites with a focus on multiple lifestyle interventions.This article describes the design and framework for the formative evaluation of this 7-step strategy under real-time conditions by an embedded scientist with the purpose to gain insight into whether this this 7-step strategy is a useful and effective implementation strategy. Furthermore, we aim to gain insight into factors that either facilitate or hamper the implementation process, the quality of the implemented lifestyle interventions and the degree of adoption, implementation and continuation of these interventions. This study is a formative evaluation within two different worksites with an embedded scientist on site to continuously monitor the implementation process. Each worksite (i.e. a University of Applied Sciences and an Academic Hospital) will assign a participating faculty or a department, to implement a WHPP focusing on lifestyle interventions using the 7-step strategy. The primary focus will be to describe the natural course of development, implementation and maintenance of a WHPP by studying [a] the use and adherence to the 7-step strategy, [b] barriers and facilitators that influence the natural course of adoption, implementation and maintenance, and [c] the implementation process of the lifestyle interventions. All data will be collected using qualitative (i.e. real-time monitoring and semi-structured interviews) and quantitative methods (i.e. process evaluation questionnaires) applying data triangulation. Except for the real-time monitoring, the data collection will take place at baseline and after 6, 12 and 18 months. This is one of the few

  14. 45 CFR Appendix D to Part 1355 - Foster Care and Adoption Record Layouts

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 05 I.E Date of most recent periodic review 8 06 II.A Child's date of birth 8 07 II.B Sex 1 08 II.C.1... DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES GENERAL Pt...

  15. 45 CFR Appendix D to Part 1355 - Foster Care and Adoption Record Layouts

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... periodic review 8 06 II.A. Child's date of birth 8 07 II.B. Sex 1 08 II.C.1. Race 08a American Indian or... DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES GENERAL Pt...

  16. 45 CFR Appendix D to Part 1355 - Foster Care and Adoption Record Layouts

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 05 I.E Date of most recent periodic review 8 06 II.A Child's date of birth 8 07 II.B Sex 1 08 II.C.1... DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES GENERAL Pt...

  17. 45 CFR Appendix D to Part 1355 - Foster Care and Adoption Record Layouts

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... periodic review 8 06 II.A. Child's date of birth 8 07 II.B. Sex 1 08 II.C.1. Race 08a American Indian or... DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES GENERAL Pt...

  18. 45 CFR Appendix D to Part 1355 - Foster Care and Adoption Record Layouts

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 05 I.E Date of most recent periodic review 8 06 II.A Child's date of birth 8 07 II.B Sex 1 08 II.C.1... DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES GENERAL Pt...

  19. Statewide Dissemination of a Rural, Non-Chain Restaurant Intervention: Adoption, Implementation and Maintenance

    ERIC Educational Resources Information Center

    Nothwehr, F.; Haines, H.; Chrisman, M.; Schultz, U.

    2014-01-01

    The obesity epidemic calls for greater dissemination of nutrition-related programs, yet there remain few studies of the dissemination process. This study, guided by elements of the RE-AIM model, describes the statewide dissemination of a simple, point-of-purchase restaurant intervention. Conducted in rural counties of the Midwest, United States,…

  20. Implementation and adoption of nationwide electronic health records in secondary care in England: final qualitative results from prospective national evaluation in “early adopter” hospitals

    PubMed Central

    Cornford, Tony; Barber, Nicholas; Avery, Anthony; Takian, Amirhossein; Lichtner, Valentina; Petrakaki, Dimitra; Crowe, Sarah; Marsden, Kate; Robertson, Ann; Morrison, Zoe; Klecun, Ela; Prescott, Robin; Quinn, Casey; Jani, Yogini; Ficociello, Maryam; Voutsina, Katerina; Paton, James; Fernando, Bernard; Jacklin, Ann; Cresswell, Kathrin

    2011-01-01

    Objectives To evaluate the implementation and adoption of the NHS detailed care records service in “early adopter” hospitals in England. Design Theoretically informed, longitudinal qualitative evaluation based on case studies. Setting 12 “early adopter” NHS acute hospitals and specialist care settings studied over two and a half years. Data sources Data were collected through in depth interviews, observations, and relevant documents relating directly to case study sites and to wider national developments that were perceived to impact on the implementation strategy. Data were thematically analysed, initially within and then across cases. The dataset consisted of 431 semistructured interviews with key stakeholders, including hospital staff, developers, and governmental stakeholders; 590 hours of observations of strategic meetings and use of the software in context; 334 sets of notes from observations, researchers’ field notes, and notes from national conferences; 809 NHS documents; and 58 regional and national documents. Results Implementation has proceeded more slowly, with a narrower scope and substantially less clinical functionality than was originally planned. The national strategy had considerable local consequences (summarised under five key themes), and wider national developments impacted heavily on implementation and adoption. More specifically, delays related to unrealistic expectations about the capabilities of systems; the time needed to build, configure, and customise the software; the work needed to ensure that systems were supporting provision of care; and the needs of end users for training and support. Other factors hampering progress included the changing milieu of NHS policy and priorities; repeatedly renegotiated national contracts; different stages of development of diverse NHS care records service systems; and a complex communication process between different stakeholders, along with contractual arrangements that largely excluded NHS

  1. Persistent Identifiers for Data Products: Adoption, Enhancement, and Use

    NASA Astrophysics Data System (ADS)

    Downs, R. R.; Schumacher, J.; Scialdone, J.; Hansen, M.

    2016-12-01

    Persistent identifiers offer value for science and for various science community stakeholders, such as data producers, data distributers, science article authors, scientific journal publishers, research sponsors, libraries, and affiliated institutions. However, to attain the benefits of persistent identifiers, they should be assigned to disseminated data products and included within the references reported in publications that describe the studies in which the data were used. Scientific data centers, archives, digital repositories, and other data publishers also need to determine the level of aggregation, or granularity, of data products to be assigned persistent identifiers as well as the elements to be included in the landing pages to which persistent identifiers will resolve. Similarly, policies and procedures should be clear on decisions about maintenance issues, including versioning of data products and how persistent identifiers to previous versions and new locations will be maintained. With some persistent identifiers, such as Digital Object Identifiers (DOIs), which provide capabilities to link to related identifiers of other works, decisions on the establishment of links also must be clear, including links between early versions of data products and subsequent versions, links between data products and associated documentation, and links between data products and other publications that describe the data. We describe decisions for enabling the adoption and assignment of DOIs as persistent identifiers for data products disseminated by the NASA Socioeconomic Data and Applications Center (SEDAC) along with considerations for policy decisions, testing, implementation, and enhancement. The prevalence of the adoption of DOIs for citing the use of Earth science data disseminated by SEDAC also is described to provide insight into how interdisciplinary data users have engaged in the use of DOIs within their publications along with the implications of such use.

  2. Motivational indictors predicting the engagement, frequency and adequacy of rainwater tank maintenance

    NASA Astrophysics Data System (ADS)

    Mankad, Aditi; Greenhill, Murni

    2014-01-01

    Rainwater tank maintenance is a key social behavior in our changing environment, as tanks are being adopted worldwide to augment household water supplies and reduce urban water stress. The maintenance of rainwater tanks in urban areas is an important pro-environmental behavior that prevents public health issues arising from unhygienic tank use. This study examined motivational differences in maintenance behavior between householders with retrofitted and mandated (compulsory) rainwater tanks on their property (N = 1988). Results showed that retrofitted tank owners were more self-determined in their motivation than mandated owners. Amotivation and integrated regulation were both dominant predictors of engagement in tank maintenance, frequency and adequacy of tank maintenance activities. Those involved in more maintenance activity were likely driven to do so because of feelings of adherence to personal goals and values (e.g., as "sustainable" citizens), whereas individuals who experienced a lack of control and alienation from the activity were likely to view maintenance as meaningless. Thus, people with higher integrated regulation engaged in more tank maintenance activities, whereas more amotivated individuals engaged in less maintenance. As cities begin relying more on citizen self-sufficiency with respect to water and energy resources, issues relating to infrastructure maintenance and operation become paramount. Results show that motivation is important in the impetus to engage in a pro-environmental behavior as well as the frequency and accuracy with which that behavior is undertaken. Policy implications are further discussed.

  3. Implementing Content Review for Communication and Computation Prerequisites. Adopted Spring 2011

    ERIC Educational Resources Information Center

    Academic Senate for California Community Colleges, 2011

    2011-01-01

    This paper is one of a collection of papers written by the Academic Senate for California Community Colleges (ASCCC) to support the use of content review as the basis for establishing communication and computation prerequisites. "Student Success: The Case for Establishing Prerequisites Through Content Review" was adopted at the Fall 2010…

  4. Explaining variations in state foster care maintenance rates and the implications for implementing new evidence-based programs

    PubMed Central

    Goldhaber-Fiebert, Jeremy D.; Babiarz, Kimberly S.; Garfield, Rachel L.; Wulczyn, Fred; Landsverk, John; Horwitz, Sarah M.

    2013-01-01

    Background U.S. Child Welfare systems are involved in the lives of millions of children, and total spending exceeds $26 billion annually. Out-of-home foster care is a critical and expensive Child Welfare service, a major component of which is the maintenance rate paid to support housing and caring for a foster child. Maintenance rates vary widely across states and over time, but reasons for this variation are not well understood. As evidence-based programs are disseminated to state Child Welfare systems, it is important to understand what may be the important drivers in the uptake of these practices including state spending on core system areas. Data and methods We assembled a unique, longitudinal, state-level panel dataset (1990–2008) for all 50 states with annual data on foster care maintenance rates and measures of child population in need, poverty, employment, urbanicity, proportion minority, political party control of the state legislature and governorship, federal funding, and lawsuits involving state foster care systems. All monetary values were expressed in per-capita terms and inflation adjusted to 2008 dollars. We used longitudinal panel regressions with robust standard errors and state and year fixed effects to estimate the relationship between state foster care maintenance rates and the other factors in our dataset, lagging all factors by one year to mitigate the possibility that maintenance rates influenced their predictors. Exploratory analyses related maintenance rates to Child Welfare outcomes. Findings State foster care maintenance rates have increased in nominal terms, but in many states, have not kept pace with inflation, leading to lower real rates in 2008 compared to those in 1991 for 54% of states for 2 year-olds, 58% for 9 year-olds, and 65% for 16 year-olds. In multivariate analyses including socioeconomic, demographic, and political factors, monthly foster care maintenance rates declined $15 for each 1% increase in state unemployment and

  5. Explaining variations in state foster care maintenance rates and the implications for implementing new evidence-based programs.

    PubMed

    Goldhaber-Fiebert, Jeremy D; Babiarz, Kimberly S; Garfield, Rachel L; Wulczyn, Fred; Landsverk, John; Horwitz, Sarah M

    2014-04-01

    U.S. Child Welfare systems are involved in the lives of millions of children, and total spending exceeds $26 billion annually. Out-of-home foster care is a critical and expensive Child Welfare service, a major component of which is the maintenance rate paid to support housing and caring for a foster child. Maintenance rates vary widely across states and over time, but reasons for this variation are not well understood. As evidence-based programs are disseminated to state Child Welfare systems, it is important to understand what may be the important drivers in the uptake of these practices including state spending on core system areas. We assembled a unique, longitudinal, state-level panel dataset (1990-2008) for all 50 states with annual data on foster care maintenance rates and measures of child population in need, poverty, employment, urbanicity, proportion minority, political party control of the state legislature and governorship, federal funding, and lawsuits involving state foster care systems. All monetary values were expressed in per-capita terms and inflation adjusted to 2008 dollars. We used longitudinal panel regressions with robust standard errors and state and year fixed effects to estimate the relationship between state foster care maintenance rates and the other factors in our dataset, lagging all factors by one year to mitigate the possibility that maintenance rates influenced their predictors. Exploratory analyses related maintenance rates to Child Welfare outcomes. State foster care maintenance rates have increased in nominal terms, but in many states, have not kept pace with inflation, leading to lower real rates in 2008 compared to those in 1991 for 54% of states for 2 year-olds, 58% for 9 year-olds, and 65% for 16 year-olds. In multivariate analyses including socioeconomic, demographic, and political factors, monthly foster care maintenance rates declined $15 for each 1% increase in state unemployment and declined $40 if a state's governorship

  6. A comparison of physician pre-adoption and adoption views on electronic health records in Canadian medical practices.

    PubMed

    Archer, Norm; Cocosila, Mihail

    2011-08-12

    There is a major campaign involving large expenditures of public money to increase the adoption rate of electronic health record (EHR) systems in Canada. To maximize the chances of success in this effort, physician views on EHRs must be addressed, since user perceptions are key to successful implementation of technology innovations. We propose a theoretical model comprising behavioral factors either favoring or against EHR adoption and use in Canadian medical practices, from the physicians' point of view. EHR perceptions of physicians already using EHR systems are compared with those not using one, through the lens of this model. We conducted an online cross-sectional survey in both English and French among medical practitioners across Canada. Data were collected both from physicians using EHRs and those not using EHRs, and analyzed with structural equation modeling (SEM) techniques. We collected 119 responses from EHR users and 100 from nonusers, resulting in 2 valid samples of 102 and 83 participants, respectively. The theoretical adoption model explained 55.8% of the variance in behavioral intention to continue using EHRs for physicians already using them, and 66.8% of the variance in nonuser intention to adopt such systems. Perception of ease of use was found to be the strongest motivator for EHR users (total effect .525), while perceptions of usefulness and of ease of use were the key determinants for nonusers (total effect .538 and .519, respectively) to adopt the system. Users see perceived overall risk associated with EHR adoption as a major obstacle (total effect -.371), while nonusers perceive risk only as a weak indirect demotivator. Of the 13 paths of the SEM model, 5 showed significant differences between the 2 samples (at the .05 level): general doubts about using the system (P = .02), the necessity for the system to be relevant for their job (P < .001), and the necessity for the system to be useful (P = .049) are more important for EHR nonusers than

  7. Dynamic Pedagogy for Effective Training of Youths in Cell Phone Maintenance

    ERIC Educational Resources Information Center

    Ogbuanya, T. C.; Jimoh, Bakare

    2015-01-01

    The study determined dynamic pedagogies for effective training of youths in cell phone maintenance. The study was conducted in Enugu State of Nigeria. Four research questions were developed while four null hypotheses formulated were tested at 0.05 level of significance. A survey research design was adopted for the study. The population for the…

  8. [Adoption].

    ERIC Educational Resources Information Center

    Pawl, Jeree, Ed.; And Others

    1990-01-01

    This newsletter theme issue addresses adoption and the young child's life. Contributors suggest ways in which practitioners in many professions and settings can better understand and support adoptive families. The first article, "Adoption, 1990" by Barbara F. Nordhaus and Albert J. Solnit, reviews the history of adoption and notes obstacles to…

  9. Awareness of BIM adoption in Brunei

    NASA Astrophysics Data System (ADS)

    Rahman, Md Motiar

    2017-09-01

    Building Information Modelling (BIM) is getting increased attention day-by-day due to its many benefits, including clash detection, collaboration between contract parties, visualization future structure, optimized schedule and project control, waste control, design documentation, and harmonized facilities management. As such, many countries have already adopted BIM, and many other countries are exploring the potential of adopting it. However, it is still relatively new and unknown to some other countries like Brunei. This study was therefore undertaken to generate and/or gauge the awareness of Brunei construction industry participants, targeting adoption of BIM, through a structured questionnaire survey. Responses from 90 industry participants reveal that Brunei Construction industry is not well aware of BIM, lack the required technical knowledge and application in construction, and cost involvement. They are unsure about the potential benefits and barriers to implementing BIM. However, respondents are hopeful that BIM can bring the required changes in construction, willing to adopt BIM, expects cliental support with initial investment for its adoption, and believe that BIM is the future of construction project information management. On the whole, private sector was seen to be more aware on BIM than public sector. The study outcomes are expected to provide the policy makers a first-hand information on the industry awareness on BIM, which in turn help them for further exploration / examination and to design any action plan and guidelines for BIM adoption.

  10. Adopting Employees' Ideas: Moderators of the Idea Generation-Idea Implementation Link

    ERIC Educational Resources Information Center

    Da Silva, Nancy; Oldham, Greg R.

    2012-01-01

    This study examined the possibility that the relationship between the number of ideas an employee generated and the number of those ideas that were adopted by the organization was moderated by the general radicalness of the employee's ideas (i.e., the extent to which the ideas were breakthrough or groundbreaking), the employee's intention to stay,…

  11. Implementation and maintenance of patient navigation programs linking primary care with community-based health and social services: a scoping literature review.

    PubMed

    Valaitis, Ruta K; Carter, Nancy; Lam, Annie; Nicholl, Jennifer; Feather, Janice; Cleghorn, Laura

    2017-02-06

    Since the early 90s, patient navigation programs were introduced in the United States to address inequitable access to cancer care. Programs have since expanded internationally and in scope. The goals of patient navigation programs are to: a) link patients and families to primary care services, specialist care, and community-based health and social services (CBHSS); b) provide more holistic patient-centred care; and, c) identify and resolve patient barriers to care. This paper fills a gap in knowledge to reveal what is known about motivators and factors influencing implementation and maintenance of patient navigation programs in primary care that link patients to CBHSS. It also reports on outcomes from these studies to help identify gaps in research that can inform future studies. This scoping literature review involved: i) electronic database searches; ii) a web site search; iii) a search of reference lists from literature reviews; and, iv) author follow up. It included papers from Canada, the United States, the United Kingdom, Australia, New Zealand, and/or Western Europe published between January 1990 and June 2013 if they discussed navigators or navigation programs in primary care settings that linked patients to CBHSS. Of 34 papers, most originated in the United States (n = 29) while the remainder were from the United Kingdom, Canada and Australia. Motivators for initiating navigation programs were to: a) improve delivery of health and social care services; b) support and manage specific health needs or specific population needs, and; c) improve quality of life and wellbeing of patients. Eleven factors were found to influence implementation and maintenance of these patient navigation programs. These factors closely aligned with the Diffusion of Innovation in Service Organizations model, thus providing a theoretical foundation to support them. Various positive outcomes were reported for patients, providers and navigators, as well as the health and social

  12. Open adoption: adoptive parents' reactions two decades later.

    PubMed

    Siegel, Deborah H

    2013-01-01

    Unlike in the past, most adoption agencies today offer birth parents and adoptive parents the opportunity to share identifying information and have contact with each other. To understand the impacts of different open adoption arrangements, a qualitative descriptive study using a snowball sample of 44 adoptive parents throughout New England began in 1988. Every seven years these parents who adopted infants in open adoptions have participated in tape-recorded interviews to explore their evolving reactions to their open adoption experiences. This article reports the results of in-depth interviews with these parents now that their children have reached young adulthood. This longitudinal research illuminates how open adoptions change over the course of childhood and adolescence, parents' feelings about open adoption, challenges that emerge in their relationships with their children's birth families, how those challenges are managed and viewed, and parents' advice for others living with open adoption and for clinical social work practice and policy. Findings reveal that regardless of the type of openness, these adoptive parents generally feel positive about knowing the birth parents and having contact with them, are comfortable with open adoption, and see it serving the child's best interests.

  13. Strengthening Adoption Practice, Listening to Adoptive Families

    ERIC Educational Resources Information Center

    Atkinson, Anne; Gonet, Patricia

    2007-01-01

    In-depth interviews with 500 adoptive families who received postadoption services through Virginia's Adoptive Family Preservation (AFP) program paint a richly detailed picture of the challenges adoptive families face and what they need to sustain adoption for many years after finalization. Findings document the need for support in a variety of…

  14. Child-Parent Relationship Therapy for Adoptive Families

    ERIC Educational Resources Information Center

    Carnes-Holt, Kara

    2012-01-01

    Adopted children may present with a wide range of disruptive behaviors making it difficult to implement holistic therapeutic interventions. The number of primary caregivers, disrupted placements, and repeated traumatic events contribute to the overall mental health of the adoptee and greater number of occurrences increases the risk of…

  15. Value centric approaches to the design, operations and maintenance of wind turbines

    NASA Astrophysics Data System (ADS)

    Khadabadi, Madhur Aravind

    Wind turbine maintenance is emerging as an unexpectedly high component of turbine operating cost, and there is an increasing interest in managing this cost. This thesis presents an alternative view of maintenance as a value-driver, and develops an optimization algorithm to evaluate the value delivered by different maintenance techniques. I view maintenance as an operation that moves the turbine to an improved state in which it can generate more power and, thus, earn more revenue. To implement this approach, I model the stochastic deterioration of the turbine in two dimensions: the deterioration rate, and the extent of deterioration, and then use maintenance to improve the state of the turbine. The value of the turbine is the difference between the revenue from to the power generation and the costs incurred in operation and maintenance. With a focus on blade deterioration, I evaluate the value delivered by implementing two different maintenance schemes, predictive maintenance and scheduled maintenance. An example of predictive maintenance technique is the use of Condition Monitoring Systems to precisely detect deterioration. I model Condition Monitoring System (CMS) of different degrees of fidelity, where a higher fidelity CMS would allow the blade state to be determined with a higher precision. The same model is then applied for the scheduled maintenance technique. The improved state information obtained from these techniques is then used to derive an optimal maintenance strategy. The difference between the value of the turbine with and without the inspection type can be interpreted as the value of the inspection. The results indicate that a higher fidelity (and more expensive) inspection method does not necessarily yield the highest value, and, that there is an optimal level of fidelity that results in maximum value. The results also aim to inform the operator of the impact of regional parameters such as wind speed, variance and maintenance costs to the optimal

  16. Diffusion of surgical techniques in early stage breast cancer: variables related to adoption and implementation of sentinel lymph node biopsy.

    PubMed

    Vanderveen, Kimberly A; Paterniti, Debora A; Kravitz, Richard L; Bold, Richard J

    2007-05-01

    Understanding how physicians acquire and adopt new technologies for cancer diagnosis and treatment is poorly understood, yet is critical to the dissemination of evidence-based practices. Sentinel lymph node biopsy (SLNB) has recently become a standard technique for axillary staging in early breast cancer and is an ideal platform for studying medical technology diffusion. We sought to describe the timing of SLNB adoption and patterns of surgeon interactions with the following educational sources: local university training program, surgical literature, national meetings/courses, national specialty centers, and other local surgeons. A cross-sectional survey that used semistructured interviews was used to assess timing of adoption, practice patterns, and learning sources for SLNB among surgical oncologists and general surgeons in a single metropolitan area. A total of 44 eligible surgeons were identified; 38 (86%) participated. All surgical oncologists (11 of 11) and most general surgeons (26 of 27) had implemented SLNB. Surgical oncologists were older (mean 51 vs. 48 years, P = .02) and had used SLNB longer (6.1 vs. 3.3 years, P = .01) than general surgeons. By use of social network diagrams, surgical oncologists and the university training program were shown to be key intermediaries between general surgeons and national specialty centers. Surgeons in group practice tended to use more learning sources than solo practitioners. Surgical oncologists and university-based surgeons play key educational roles in disseminating new cancer treatments and therefore have a professional responsibility to educate other community physicians to increase the use of the most current, evidence-based practices.

  17. Evidence-based hamstring injury prevention is not adopted by the majority of Champions League or Norwegian Premier League football teams: the Nordic Hamstring survey.

    PubMed

    Bahr, Roald; Thorborg, Kristian; Ekstrand, Jan

    2015-11-01

    The Nordic hamstring (NH) exercise programme was introduced in 2001 and has been shown to reduce the risk of acute hamstring injuries in football by at least 50%. Despite this, the rate of hamstring injuries has not decreased over the past decade in male elite football. To examine the implementation of the NH exercise programme at the highest level of male football in Europe, the UEFA Champions League (UCL), and to compare this to the Norwegian Premier League, Tippeligaen, where the pioneer research on the NH programme was conducted. Retrospective survey. 50 professional football teams, 32 from the UCL and 18 from Tippeligaen. A questionnaire, based on the Reach, Efficacy, Adoption, Implementation and Maintenance framework, addressing key issues related to the implementation of the NH programme during three seasons from 2012 through 2014, was distributed to team medical staff using electronic survey software. The response rate was 100%. Of the 150 club-seasons covered by the study, the NH programme was completed in full in 16 (10.7%) and in part in an additional 9 (6%) seasons. Consequently, 125 (83.3%) club-seasons were classified as non-compliant. There was no difference in compliance between the UCL and Tippeligaen in any season (χ(2): 0.41 to 0.52). Adoption and implementation of the NH exercise programme at the highest levels of male football in Europe is low; too low to expect any overall effect on acute hamstring injury rates. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  18. Performance Contracting: Meeting the Challenge of Deferred Maintenance.

    ERIC Educational Resources Information Center

    Singer, Terry E.; Johnson, Mary E.

    2001-01-01

    Discusses the magnitude of the problem of deferred maintenance on today's university campuses and the solving this problem using performance-based energy efficiency retrofit as implemented by energy service companies (ESCO). Several case studies of ESCO designed retrofits are examined. (GR)

  19. When the user is not the chooser: learning from stakeholder involvement in technology adoption decisions in infection control.

    PubMed

    Ahmad, R; Kyratsis, Y; Holmes, A

    2012-07-01

    Health systems need efficient and effective innovation decisions to provide maximum benefit to patients, particularly in a climate of financial constraints. Although evidence-based innovations exist for helping to address healthcare-associated infections, the uptake and implementation of these is highly variable and in some cases very slow. To investigate innovation adoption decisions and implementation processes from an organizational perspective, focusing on the implications of stakeholder involvement during the innovation process. Thirty-eight technology adoption decisions and implementation processes were examined through 121 qualitative interviews in 12 National Health Service healthcare organizations across England. Stakeholder involvement varied across organizations with decisions highly exclusive to the infection prevention and control (IPC) team, to highly inclusive of wider organizational members. The context, including organizational culture, previous experience, and logistical factors influenced the level of stakeholder engagement. The timing of stakeholder involvement in the process impacted on: (i) the range of innovations considered; (ii) the technologies selected, and (iii) the success of technology implementation. Cases of non-adoption, discontinued adoption, and of successful implementation are presented to share learning. The potential benefits of stakeholder involvement for 'successful' innovation adoption are presented including a goal-oriented framework for involvement. Key stakeholder involvement can lead to innovation adoption and implementation compatible with structural and cultural contexts, particularly when involvement crosses the phases of initiation, decision-making and implementation. Involving members of the wider healthcare organization can raise the profile of IPC and reinforce efforts to make IPC everybody's business. Copyright © 2012 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  20. Adoption

    MedlinePlus

    ... the birth nor adoptive parents know the others' identities. Other adoptions are handled more openly. Open adoptions, ... desire to seek out more information about the identity of the birth family. Most of us (whether ...

  1. Adoptive parenting.

    PubMed

    Grotevant, Harold D; Lo, Albert Yh

    2017-06-01

    Challenges in adoptive parenting continue to emerge as adoption policies and practices evolve. We review three areas of research in adoptive parenting that reflect contemporary shifts in adoption. First, we highlight recent findings concerning openness in adoption contact arrangements, or contact between a child's families of birth and rearing. Second, we examine research regarding racial and cultural socialization in transracial and international adoptions. Finally, we review investigations of parenting experiences of lesbian and gay adoptive parents. Overall, parenting processes (e.g., supportive vs. problematic family interaction) are better predictors of child adjustment than are group differences (e.g., open vs. closed adoptions; adoption by heterosexual vs. same-sex parents). The distinctive needs of adopted children call for preparation of adoption-competent mental health, casework, education, and health care professionals. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. "Situatedness" and Variations in Student Adoption of Technology Practices: Towards a Critical Techno-Pedagogy

    ERIC Educational Resources Information Center

    Neufeld, Philip G.; Delcore, Henry D.

    2018-01-01

    Aim/Purpose: The effective adoption of an ICT across every segment of the student population may occur where the design, implementation and supports recognize and adjust for variations in adoption practices across the student population and the situatedness of the promoted ICT adoption. The goal of this study was to demonstrate methods to…

  3. A National Study of Fluoride Mouthrinse Adoption: Implications for School Health Personnel.

    ERIC Educational Resources Information Center

    Coombs, Jeanne A.; And Others

    1983-01-01

    The ongoing adoption of school-based fluoride mouthrinse programs has provided the opportunity to study issues surrounding the adoption and implementation of health technology by public schools. This article reports data on and implications of the National Study on the Diffusion of Preventive Health Measures to Schools. (Authors/CJ)

  4. Translating the evidence for emergency equipment and supplies into practice among healthcare providers in a tertiary mental health institution: a best practice implementation project.

    PubMed

    Lu, Qiufen; Ng, Hui Chin; Xie, Huiting

    2015-05-15

    In the mental health care setting, patients are more vulnerable to choking and the risk of cardiac and respiratory problems due to behavioral problems and use of rapid tranquilization. Poorly maintained, incomplete or damaged equipment in emergency trolleys have previously been documented in various articles as a major contributing factor to deaths and delayed response to resuscitation attempts. This project aimed to examine the current practices for managing emergency equipment. An evidence implementation project was undertaken by utilizing the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research Into Practice programs. Pre- and post-implementation audits were conducted in a mental health institution over 25 months. Strategies were implemented between audits to enhance adoption of the best available evidence regarding the checking and maintenance of emergency equipment. The baseline audit data showed that adherence was lowest in ensuring the functional status of emergency equipment (53%), followed by conducting regular checks for functional status, using inventory, and documenting these checks (60%). In line with the Getting Research Into Practice module, barriers such as the lack of knowledge and skills regarding emergency equipment were addressed with town hall meetings, code blue drills and education sessions. Follow-up audit results showed improvement in all areas. The greatest improvement was in documentation of emergency equipment checks, which improved by 18%, from 80% to 98%. Audits enabled the timely identification of potential lapses in the management of emergency equipment so that the barriers could be addressed, and strategies in line with the best available evidence regarding the checking and maintenance of emergency equipment were adopted. The Joanna Briggs Institute.

  5. Associate Degree Nursing Students in Family Health Maintenance: A Pilot Project.

    ERIC Educational Resources Information Center

    Conatser, Cheryl

    The report describes the implementation and continuation of a family health maintenance program for associate degree nursing students at a community college. Four specific objectives are stated supporting the overall purpose of increasing student awareness of the total health care situation of the family. Implementation of the project, which…

  6. 75 FR 62684 - Health Insurance Reform; Announcement of Maintenance Changes to Electronic Data Transaction...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-13

    ... 0938-AM50 Health Insurance Reform; Announcement of Maintenance Changes to Electronic Data Transaction Standards Adopted Under the Health Insurance Portability and Accountability Act of 1996 AGENCY: Office of... of the Health Insurance Portability and Accountability Act of 1996 standards made by the Designated...

  7. Power Grid Maintenance Scheduling Intelligence Arrangement Supporting System Based on Power Flow Forecasting

    NASA Astrophysics Data System (ADS)

    Xie, Chang; Wen, Jing; Liu, Wenying; Wang, Jiaming

    With the development of intelligent dispatching, the intelligence level of network control center full-service urgent need to raise. As an important daily work of network control center, the application of maintenance scheduling intelligent arrangement to achieve high-quality and safety operation of power grid is very important. By analyzing the shortages of the traditional maintenance scheduling software, this paper designs a power grid maintenance scheduling intelligence arrangement supporting system based on power flow forecasting, which uses the advanced technologies in maintenance scheduling, such as artificial intelligence, online security checking, intelligent visualization techniques. It implements the online security checking of maintenance scheduling based on power flow forecasting and power flow adjusting based on visualization, in order to make the maintenance scheduling arrangement moreintelligent and visual.

  8. Adapting Certified Safe Farm to North Carolina Agriculture: An Implementation Study.

    PubMed

    Storm, Julia F; LePrevost, Catherine E; Tutor-Marcom, Robin; Cope, W Gregory

    2016-01-01

    Certified Safe Farm (CSF) is a multimodal safety and health program developed and assessed through multiple controlled intervention studies in Iowa. Although developed with the intent to be broadly applicable to agriculture, CSF has not been widely implemented outside the midwestern United States. This article describes the CSF implementation process in North Carolina (NC), as piloted on a large-scale in three agriculturally diverse and productive counties of NC, and reports its effectiveness using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Implementation involved (1) capacity building through safety and health training, (2) adaptation of components of Iowa's CSF model to NC agriculture, (3) marketing and recruitment, and (4) formative evaluation, including an online survey and focus group discussion. From 2009 to 2012, 113 farms participated in at least one component of the CSF intervention, representing a NC farm participation rate of 3.1% in the study area. A major adaptation of NC implementation was the utilization of NC Cooperative Extension as the local driver of implementation in contrast to local AgriSafe clinics in Iowa. The most innovative adaptation to CSF components was the development of a defined economic incentive in the form of a cost-share program. The RE-AIM framework was found to be useful and relevant to the field of agricultural health and safety translational research. This study provides effectiveness measures and implementation alternatives useful for those considering implementing CSF. It informs current efforts to move CSF from research to practice through the National Sustainable Model CSF Program initiative.

  9. Factors influencing the adoption of self-management solutions: an interpretive synthesis of the literature on stakeholder experiences.

    PubMed

    Harvey, J; Dopson, S; McManus, R J; Powell, J

    2015-11-13

    In a research context, self-management solutions, which may range from simple book diaries to complex telehealth packages, designed to facilitate patients in managing their long-term conditions, have often shown cost-effectiveness, but their implementation in practice has frequently been challenging. We conducted an interpretive qualitative synthesis of relevant articles identified through systematic searches of bibliographic databases in July 2014. We searched PubMed (Medline/NLM), Web of Science, LISTA (EBSCO), CINAHL, Embase and PsycINFO. Coding and analysis was inductive, using the framework method to code and to categorise themes. We took a sensemaking approach to the interpretation of findings. Fifty-eight articles were selected for synthesis. Results showed that during adoption, factors identified as facilitators by some were experienced as barriers by others, and facilitators could change to barriers for the same adopter, depending on how adopters rationalise the solutions within their context when making decisions about (retaining) adoption. Sometimes, when adopters saw and experienced benefits of a solution, they continued using the solution but changed their minds when they could no longer see the benefits. Thus, adopters placed a positive value on the solution if they could constructively rationalise it (which increased adoption) and attached a negative rationale (decreasing adoption) if the solution did not meet their expectations. Key factors that influenced the way adopters rationalised the solutions consisted of costs and the added value of the solution to them and moral, social, motivational and cultural factors. Considering 'barriers' and 'facilitators' for implementation may be too simplistic. Implementers could instead iteratively re-evaluate how potential facilitators and barriers are being experienced by adopters throughout the implementation process, to help adopters to retain constructive evaluations of the solution. Implementers need to pay

  10. Adopting new medical technologies in Russian hospitals: what causes inefficiency? (qualitative study).

    PubMed

    Shishkin, Sergey; Zasimova, Liudmila

    2018-01-01

    The adoption of new medical technologies often generates losses in efficiency associated with the excess or insufficient acquisition of new equipment, an inappropriate choice (in terms of economic and clinical parameters) of medical equipment, and its poor use. Russia is a good example for exploring the problem of the ineffective adoption of new medical technologies due to the massive public investment in new equipment for medical institutions in 2006-2013. This study examines the procurement of new technologies in Russian hospitals to find the main causes of inefficiency. The research strategy was based on in-depth semistructured interviews with representatives of prominent actors (regional health care authorities, hospital executives, senior physicians). The main result is that inefficiencies arise from the contradiction between hospitals' and authorities' motivation for acquiring new technologies: hospitals tend to adopt technologies which bring benefits to their department heads and physicians and minimize maintenance and servicing costs, while the authorities' main concern is the initial cost of the technology.

  11. Root causes occurrence of low BIM adoption in Malaysia: System dynamics modelling approach

    NASA Astrophysics Data System (ADS)

    Mamter, Shahela; Aziz, Abdul Rashid Abdul; Zulkepli, Jafri

    2017-11-01

    The global implementation of BIM in the construction field is increasing worldwide. Due to the advantages offered by BIM, its implementation is considered important in the construction projects. Nevertheless, the Construction Industry Transformation Plan has reported that the adoption of Building Information Modelling (BIM) in Malaysia is still low and it is estimated at only 10 percent adoption amongst construction stake players. The barriers influencing the occurrence of low adoption BIM in Malaysia have been studied by some researchers. However, these researchers did not investigate the root causes which might lead to the recurring of the barriers to BIM adoption. Root causes that immediately occurrence of barriers, also known as precipitants or trigger causes. This conceptual paper developed the causal loop diagram (CLD) which presents the relationship between the perceived variables using system dynamic modelling approach. The findings revealed a novelty validated diagrams that design the holistic dynamic relationship on the root causes occurrence of low BIM adoption. Nonetheless, the diagram subject to more empirical testing for its practicability and further refinement upon more results expected to emerge as the research progresses.

  12. A free-ranging, feral mare equus caballus affords similar maternal care to her genetic and adopted offspring.

    PubMed

    Nuñez, Cassandra M V; Adelman, James S; Rubenstein, Daniel I

    2013-11-01

    Adoption of nongenetic offspring occurs in a variety of species but is rare in equids. We report a case of adoption by a free-ranging, feral mare Equus caballus and compare the maternal care received by her genetic offspring (born 1995) to that of her adopted offspring (born 1996) for the first 30 weeks of development. We compare five measures of care: (1) total time spent suckling, (2) mare aggression during suckling, (3) number of mare-terminated suckling bouts, (4) contact maintenance, and (5) mare-foal distance. For most behaviors, we detected no difference in the mare's treatment of the two foals; however, mare-foal distance was greater for the genetic offspring. We compare hypotheses regarding the reasons for adoption, offering postpartum physiological state as a potential driver.

  13. South African Guidelines Excellence (SAGE): Adopt, adapt, or contextualise?

    PubMed

    Dizon, J M; Grimmer, K; Louw, Q; Kredo, T; Young, T; Machingaidze, S

    2016-12-01

    Clinical practice guideline (CPG) activities must be planned carefully for efficient use of available resources and evidence-based implementation. De novo development of CPGs may sometimes 'recreate the wheel' and delay implementation. Three innovative alternatives to de novo CPG development (adopt, contextualise or adapt) are outlined, which have greater potential than de novo development to best use the limited available resources, personnel and time in settings such as South Africa.

  14. The Adoption of Roles by Primary Care Providers during Implementation of the New Chronic Disease Guidelines in Urban Mongolia: A Qualitative Study.

    PubMed

    Chimeddamba, Oyun; Ayton, Darshini; Bazarragchaa, Nansalmaa; Dorjsuren, Bayarsaikhan; Peeters, Anna; Joyce, Catherine

    2016-04-07

    (1) BACKGROUND: In 2011, new chronic disease guidelines were introduced across Mongolia. No formal advice was provided regarding role delineation. This study aimed to analyse the roles that different primary care providers adopted, and the variations in these, in the implementation of the guidelines in urban Mongolia; (2) METHODS: Ten group interviews with nurses and ten individual interviews each with practice doctors and practice directors were conducted. Data was analysed using a thematic approach based on the identified themes relevant to role delineation; (3) RESULTS: There was some variability and flexibility in role delineation. Factors involving teamwork, task rotation and practice flexibility facilitated well the guideline implementation. However, factors including expectations and decision making, nursing shortage, and training gaps adversely influenced in the roles and responsibilities. Some role confusion and dissatisfaction was identified, often associated with a lack of training or staff turnover; (4) CONCLUSIONS: Findings suggest that adequate ongoing training is required to maximize the range of roles particular provider types, especially primary care nurses, are competent to perform. Ensuring that role delineation is specified in guidelines could remove confusion and enhance implementation of such guidelines.

  15. Drivers and barriers to e-invoicing adoption in Greek large scale manufacturing industries

    NASA Astrophysics Data System (ADS)

    Marinagi, Catherine; Trivellas, Panagiotis; Reklitis, Panagiotis; Skourlas, Christos

    2015-02-01

    This paper attempts to investigate the drivers and barriers that large-scale Greek manufacturing industries experience in adopting electronic invoices (e-invoices), based on three case studies with organizations having international presence in many countries. The study focuses on the drivers that may affect the increase of the adoption and use of e-invoicing, including the customers demand for e-invoices, and sufficient know-how and adoption of e-invoicing in organizations. In addition, the study reveals important barriers that prevent the expansion of e-invoicing, such as suppliers' reluctance to implement e-invoicing, and IT infrastructures incompatibilities. Other issues examined by this study include the observed benefits from e-invoicing implementation, and the financial priorities of the organizations assumed to be supported by e-invoicing.

  16. Improving Implementation of eMental Health for Mood Disorders in Routine Practice: Systematic Review of Barriers and Facilitating Factors

    PubMed Central

    Mol, Mayke; Kleiboer, Annet; Bührmann, Leah; Finch, Tracy; Smit, Jan; Riper, Heleen

    2018-01-01

    Background Electronic mental health interventions (eMental health or eMH) can be used to increase accessibility of mental health services for mood disorders, with indications of comparable clinical outcomes as face-to-face psychotherapy. However, the actual use of eMH in routine mental health care lags behind expectations. Identifying the factors that might promote or inhibit implementation of eMH in routine care may help to overcome this gap between effectiveness studies and routine care. Objective This paper reports the results of a systematic review of the scientific literature identifying those determinants of practices relevant to implementing eMH for mood disorders in routine practice. Methods A broad search strategy was developed with high sensitivity to four key terms: implementation, mental health care practice, mood disorder, and eMH. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was applied to guide the review and structure the results. Thematic analysis was applied to identify the most important determinants that facilitate or hinder implementation of eMH in routine practice. Results A total of 13,147 articles were screened, of which 48 studies were included in the review. Most studies addressed aspects of the reach (n=33) of eMH, followed by intervention adoption (n=19), implementation of eMH (n=6), and maintenance (n=4) of eMH in routine care. More than half of the studies investigated the provision of mental health services through videoconferencing technologies (n=26), followed by Internet-based interventions (n=20). The majority (n=44) of the studies were of a descriptive nature. Across all RE-AIM domains, we identified 37 determinants clustered in six main themes: acceptance, appropriateness, engagement, resources, work processes, and leadership. The determinants of practices are expressed at different levels, including patients, mental health staff, organizations, and health care system level. Depending on

  17. Design and implementation of adoptive therapy with chimeric antigen receptor-modified T cells.

    PubMed

    Jensen, Michael C; Riddell, Stanley R

    2014-01-01

    A major advance in adoptive T-cell therapy (ACT) is the ability to efficiently endow patient's T cells with reactivity for tumor antigens through the stable or regulated introduction of genes that encode high affinity tumor-targeting T-cell receptors (TCRs) or synthetic chimeric antigen receptors (CARs). Case reports and small series of patients treated with TCR- or CAR-modified T cells have shown durable responses in a subset of patients, particularly with B-cell malignancies treated with T cells modified to express a CAR that targets the CD19 molecule. However, many patients do not respond to therapy and serious on and off-target toxicities have been observed with TCR- and CAR-modified T cells. Thus, challenges remain to make ACT with gene-modified T cells a reproducibly effective and safe therapy and to expand the breadth of patients that can be treated to include those with common epithelial malignancies. This review discusses research topics in our laboratories that focus on the design and implementation of ACT with CAR-modified T cells. These include cell intrinsic properties of distinct T-cell subsets that may facilitate preparing therapeutic T-cell products of defined composition for reproducible efficacy and safety, the design of tumor targeting receptors that optimize signaling of T-cell effector functions and facilitate tracking of migration of CAR-modified T cells in vivo, and novel CAR designs that have alternative ligand binding domains or confer regulated function and/or survival of transduced T cells. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Open Adoption: Adoptive Parents' Reactions Two Decades Later

    ERIC Educational Resources Information Center

    Siegel, Deborah H.

    2013-01-01

    Unlike in the past, most adoption agencies today offer birth parents and adoptive parents the opportunity to share identifying information and have contact with each other. To understand the impacts of different open adoption arrangements, a qualitative descriptive study using a snowball sample of 44 adoptive parents throughout New England began…

  19. Developing mobile- and BIM-based integrated visual facility maintenance management system.

    PubMed

    Lin, Yu-Cheng; Su, Yu-Chih

    2013-01-01

    Facility maintenance management (FMM) has become an important topic for research on the operation phase of the construction life cycle. Managing FMM effectively is extremely difficult owing to various factors and environments. One of the difficulties is the performance of 2D graphics when depicting maintenance service. Building information modeling (BIM) uses precise geometry and relevant data to support the maintenance service of facilities depicted in 3D object-oriented CAD. This paper proposes a new and practical methodology with application to FMM using BIM technology. Using BIM technology, this study proposes a BIM-based facility maintenance management (BIMFMM) system for maintenance staff in the operation and maintenance phase. The BIMFMM system is then applied in selected case study of a commercial building project in Taiwan to verify the proposed methodology and demonstrate its effectiveness in FMM practice. Using the BIMFMM system, maintenance staff can access and review 3D BIM models for updating related maintenance records in a digital format. Moreover, this study presents a generic system architecture and its implementation. The combined results demonstrate that a BIMFMM-like system can be an effective visual FMM tool.

  20. Developing Mobile- and BIM-Based Integrated Visual Facility Maintenance Management System

    PubMed Central

    Su, Yu-Chih

    2013-01-01

    Facility maintenance management (FMM) has become an important topic for research on the operation phase of the construction life cycle. Managing FMM effectively is extremely difficult owing to various factors and environments. One of the difficulties is the performance of 2D graphics when depicting maintenance service. Building information modeling (BIM) uses precise geometry and relevant data to support the maintenance service of facilities depicted in 3D object-oriented CAD. This paper proposes a new and practical methodology with application to FMM using BIM technology. Using BIM technology, this study proposes a BIM-based facility maintenance management (BIMFMM) system for maintenance staff in the operation and maintenance phase. The BIMFMM system is then applied in selected case study of a commercial building project in Taiwan to verify the proposed methodology and demonstrate its effectiveness in FMM practice. Using the BIMFMM system, maintenance staff can access and review 3D BIM models for updating related maintenance records in a digital format. Moreover, this study presents a generic system architecture and its implementation. The combined results demonstrate that a BIMFMM-like system can be an effective visual FMM tool. PMID:24227995

  1. Adoption and use of e-invoicing in Greece

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Marinagi, C., E-mail: marinagi@teihal.gr, E-mail: ptrivel@yahoo.com, E-mail: preklitis@yahoo.com; Trivellas, P., E-mail: marinagi@teihal.gr, E-mail: ptrivel@yahoo.com, E-mail: preklitis@yahoo.com; Reklitis, Panagiotis, E-mail: marinagi@teihal.gr, E-mail: ptrivel@yahoo.com, E-mail: preklitis@yahoo.com

    2015-02-09

    This paper investigates the adoption and use of electronic invoices (e-invoices) in Greek organizations. The study attempts to evaluate current practices applied in implementing e-invoicing. A field research has been conducted, which is based on a structured questionnaire. The target sample consisted of 42 Greek enterprises. The main issues of the investigation include the existing invoice processing practices, the barriers that prevent the extended adoption and use of e-invoicing, the observed benefits from e-invoicing implementation, and the strategic drivers for transition to e-invoicing. Currently, the use of e-invoicing in Greece is low. However, the research results testify that the adoptionmore » of e-invoicing in Greece is promising. Even though, a number of enterprises state that benefits of e-invoicing are not clear yet, the majority of enterprises agree that there are crucial financial priorities that e-invoicing is expected to support.« less

  2. Information Technology Diffusion: A Comparative Case Study of Intranet Adoption

    DTIC Science & Technology

    1999-07-01

    Information Technology Diffusion: A Comparative Case Study of Intranet Adoption George A. Zolla Jr. Naval Postgraduate School, Monterey, CA 93943...and diffusion of intranet technology is then presented. I. INTRODUCTION An intranet is an organization’s internal computer network protected from the... Information Systems (IS) strategy links to implementation [16]. More research dealing with the implementation of new technology in organizations is needed

  3. Bridging the Divide: Openness in Adoption and Post-adoption Psychosocial Adjustment among Birth and Adoptive Parents

    PubMed Central

    Ge, Xiaojia; Natsuaki, Misaki N.; Martin, David; Leve, Leslie; Neiderhiser, Jenae; Shaw, Daniel S.; Villareal, Georgette; Scaramella, Laura; Reid, John; Reiss, David

    2008-01-01

    Using 323 matched parties of birth mothers and adoptive parents, this study examined the association between the degree of adoption openness (e.g., contact and knowledge between parties) and birth and adoptive parents’ post-adoption adjustment shortly after the adoption placement (6 to 9 months). Data from birth fathers (N=112), an understudied sample, also were explored. Openness was assessed by multiple informants. Results indicated that openness was significantly related to satisfaction with adoption process among adoptive parents and birth mothers. Increased openness was positively associated with birth mothers’ post-placement adjustment as indexed by birth mothers’ self reports and the interviewers’ impression of birth mothers’ adjustment. Birth fathers’ report of openness was associated with their greater satisfaction with the adoption process and better post-adoption adjustment. PMID:18729667

  4. Primer on the Implementation of a Pharmacy Intranet Site to Improve Department Communication

    PubMed Central

    Hale, Holly J.

    2013-01-01

    Purpose: The purpose of the article is to describe the experience of selecting, developing, and implementing a pharmacy department intranet site with commentary regarding application to other institutions. Clinical practitioners and supporting staff need an effective, efficient, organized, and user-friendly communication tool to utilize and relay information required to optimize patient care. Summary: To create a functional and user-friendly department intranet site, department leadership and staff should be involved in the process from selection of product through implementation. A product that supports both document storage management and communication delivery and has the capability to be customized to provide varied levels of site access is desirable. The designation of an intranet site owner/developer within the department will facilitate purposeful site design and site maintenance execution. A well-designed and up-to-date site along with formal end-user training are essential for staff adoption and continued utilization. Conclusion: Development of a department intranet site requires a considerable time investment by several members of the department. The implementation of an intranet site can be an important step toward achieving improved communications. Staff utilization of this resource is key to its success. PMID:24421523

  5. Primer on the implementation of a pharmacy intranet site to improve department communication.

    PubMed

    Hale, Holly J

    2013-07-01

    The purpose of the article is to describe the experience of selecting, developing, and implementing a pharmacy department intranet site with commentary regarding application to other institutions. Clinical practitioners and supporting staff need an effective, efficient, organized, and user-friendly communication tool to utilize and relay information required to optimize patient care. To create a functional and user-friendly department intranet site, department leadership and staff should be involved in the process from selection of product through implementation. A product that supports both document storage management and communication delivery and has the capability to be customized to provide varied levels of site access is desirable. The designation of an intranet site owner/developer within the department will facilitate purposeful site design and site maintenance execution. A well-designed and up-to-date site along with formal end-user training are essential for staff adoption and continued utilization. Development of a department intranet site requires a considerable time investment by several members of the department. The implementation of an intranet site can be an important step toward achieving improved communications. Staff utilization of this resource is key to its success.

  6. Influences of Risk History and Adoption Preparation on Post-Adoption Services Use in U.S. Adoptions

    ERIC Educational Resources Information Center

    Wind, Leslie H.; Brooks, Devon; Barth, Richard P.

    2007-01-01

    In spite of the need for pre- and post-adoption support, studies indicate low levels of services utilization among adoptive families, particularly those involving children with special needs. This study examines the relationship between utilization of adoptions services and adoptive child and family characteristics, pre-adoptive risk history, and…

  7. Implementation of fluorescence confocal mosaicking microscopy by ``early adopter'' Mohs surgeons and dermatologists: recent progress

    NASA Astrophysics Data System (ADS)

    Jain, Manu; Rajadhyaksha, Milind; Nehal, Kishwer

    2017-02-01

    Confocal mosaicking microscopy (CMM) enables rapid imaging of large areas of fresh tissue ex vivo without the processing that is necessary for conventional histology. When performed in fluorescence mode using acridine orange (nuclear specific dye), it enhances nuclei-to-dermis contrast that enables detection of all types of basal cell carcinomas (BCCs), including micronodular and thin strands of infiltrative types. So far, this technique has been mostly validated in research settings for the detection of residual BCC tumor margins with high sensitivity of 89% to 96% and specificity of 99% to 89%. Recently, CMM has advanced to implementation and testing in clinical settings by "early adopter" Mohs surgeons, as an adjunct to frozen section during Mohs surgery. We summarize the development of CMM guided imaging of ex vivo skin tissues from bench to bedside. We also present its current state of application in routine clinical workflow not only for the assessment of residual BCC margins in the Mohs surgical setting but also for some melanocytic lesions and other skin conditions in clinical dermatology settings. Last, we also discuss the potential limitations of this technology as well as future developments. As this technology advances further, it may serve as an adjunct to standard histology and enable rapid surgical pathology of skin cancers at the bedside.

  8. 76 FR 41088 - Approval and Promulgation of Implementation Plans; Kentucky; 110(a)(1) and (2) Infrastructure...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-13

    ...EPA is taking final action to approve the December 13, 2007, submission by the Commonwealth of Kentucky, through the Kentucky Division of Air Quality (KDAQ) as demonstrating that the Commonwealth meets the state implementation plan (SIP) requirements of sections 110(a)(1) and (2) of the Clean Air Act (CAA or the Act) for the 1997 8- hour ozone national ambient air quality standards (NAAQS). Section 110(a) of the CAA requires that each state adopt and submit a SIP for the implementation, maintenance, and enforcement of each NAAQS promulgated by the EPA, which is commonly referred to as an ``infrastructure'' SIP. Kentucky certified that the Kentucky SIP contains provisions that ensure the 1997 8-hour ozone NAAQS is implemented, enforced, and maintained in Kentucky (hereafter referred to as ``infrastructure submission''). Kentucky's infrastructure submission, provided to EPA on December 13, 2007, addressed all the required infrastructure elements for the 1997 8-hour ozone NAAQS. Additionally, EPA is responding to adverse comments received on EPA's March 17, 2011, proposed approval of Kentucky's December 13, 2007, infrastructure submission.

  9. 76 FR 41100 - Approval and Promulgation of Implementation Plans; Alabama; 110(a)(1) and (2) Infrastructure...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-13

    ...EPA is taking final action to approve the December 10, 2007, submission by the State of Alabama, through the Alabama Department of Environmental Management (ADEM) as demonstrating that the State meets the state implementation plan (SIP) requirements of sections 110(a)(1) and (2) of the Clean Air Act (CAA or the Act) for the 1997 8-hour ozone national ambient air quality standards (NAAQS). Section 110(a) of the CAA requires that each state adopt and submit a SIP for the implementation, maintenance, and enforcement of each NAAQS promulgated by the EPA, which is commonly referred to as an ``infrastructure'' SIP. Alabama certified that the Alabama SIP contains provisions that ensure the 1997 8-hour ozone NAAQS is implemented, enforced, and maintained in Alabama (hereafter referred to as ``infrastructure submission''). Alabama's infrastructure submission, provided to EPA on December 10, 2007, addressed all the required infrastructure elements for the 1997 8-hour ozone NAAQS. Additionally, EPA is responding to adverse comments received on EPA's March 17, 2011, proposed approval of Alabama's December 10, 2007, infrastructure submission.

  10. 76 FR 41123 - Approval and Promulgation of Implementation Plans; Mississippi; 110(a)(1) and (2) Infrastructure...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-13

    ...EPA is taking final action to approve the December 7, 2007, submission by the State of Mississippi, through the Mississippi Department of Environmental Quality (MDEQ) as demonstrating that the State meets the implementation plan (SIP) requirements of sections 110(a)(1) and (2) of the Clean Air Act (CAA or the Act) for the 1997 8- hour ozone national ambient air quality standards (NAAQS). Section 110(a) of the CAA requires that each state adopt and submit a SIP for the implementation, maintenance, and enforcement of each NAAQS promulgated by the EPA, which is commonly referred to as an ``infrastructure'' SIP. Mississippi certified that the Mississippi SIP contains provisions that ensure the 1997 8-hour ozone NAAQS is implemented, enforced, and maintained in Mississippi (hereafter referred to as ``infrastructure submission''). Mississippi's infrastructure submission, provided to EPA on December 7, 2007, addressed all the required infrastructure elements for the 1997 8-hour ozone NAAQS. Additionally, EPA is responding to adverse comments received on EPA's March 17, 2011, proposed approval of Mississippi's December 7, 2007, infrastructure submission.

  11. Colorblind and Multicultural Ideologies Are Associated with Faculty Adoption of Inclusive Teaching Practices

    ERIC Educational Resources Information Center

    Aragón, Oriana R.; Dovidio, John F.; Graham, Mark J.

    2017-01-01

    Professional workshops aimed at increasing student diversity typically urge college-level science, technology, engineering, and math (STEM) educators to implement inclusive teaching practices. A model of the process by which educators adopt such practices, and the relationship between adoption and 2 ideologies of diversity is tested here. One…

  12. Factors affecting electronic health record adoption in long-term care facilities.

    PubMed

    Cherry, Barbara; Carter, Michael; Owen, Donna; Lockhart, Carol

    2008-01-01

    Electronic health records (EHRs) hold the potential to significantly improve the quality of care in long-term care (LTC) facilities, yet limited research has been done on how facilities decide to adopt these records. This study was conducted to identify factors that hinder and facilitate EHR adoption in LTC facilities. Study participants were LTC nurses, administrators, and corporate executives. Primary barriers identified were costs, the need for training, and the culture change required to embrace technology. Primary facilitators were training programs, well-defined implementation plans, government assistance with implementation costs, evidence that EHRs will improve care outcomes, and support from state regulatory agencies. These results offer a framework of action for policy makers, LTC Leaders, and researchers.

  13. The Texas Adoption Project: adopted children and their intellectual resemblance to biological and adoptive parents.

    PubMed

    Horn, J M

    1983-04-01

    Intelligence test scores were obtained from parents and children in 300 adoptive families and compared with similar measures available for the biological mothers of the same adopted children. Results supported the hypothesis that genetic variability is an important influence in the development of individual differences for intelligence. The most salient finding was that adopted children resemble their biological mothers more than they resemble the adoptive parents who reared them from birth. A small subset of the oldest adopted children did not resemble their biological mothers. The suggestion that the influence of genes declines with age is treated with caution since other adoption studies report a trend in the opposite direction.

  14. Identifying Strategies Programs Adopt to Meet Healthy Eating and Physical Activity Standards in Afterschool Programs.

    PubMed

    Weaver, Robert G; Moore, Justin B; Turner-McGrievy, Brie; Saunders, Ruth; Beighle, Aaron; Khan, M Mahmud; Chandler, Jessica; Brazendale, Keith; Randell, Allison; Webster, Collin; Beets, Michael W

    2017-08-01

    The YMCA of USA has adopted Healthy Eating and Physical Activity (HEPA) Standards for its afterschool programs (ASPs). Little is known about strategies YMCA ASPs are implementing to achieve Standards and these strategies' effectiveness. (1) Identify strategies implemented in YMCA ASPs and (2) evaluate the relationship between strategy implementation and meeting Standards. HEPA was measured via accelerometer (moderate-to-vigorous-physical-activity [MVPA]) and direct observation (snacks served) in 20 ASPs. Strategies were identified and mapped onto a capacity building framework ( Strategies To Enhance Practice [STEPs]). Mixed-effects regression estimated increases in HEPA outcomes as implementation increased. Model-implied estimates were calculated for high (i.e., highest implementation score achieved), moderate (median implementation score across programs), and low (lowest implementation score achieved) implementation for both HEPA separately. Programs implemented a variety of strategies identified in STEPs. For every 1-point increase in implementation score 1.45% (95% confidence interval = 0.33% to 2.55%, p ≤ .001) more girls accumulated 30 min/day of MVPA and fruits and/or vegetables were served on 0.11 more days (95% confidence interval = 0.11-0.45, p ≤ .01). Relationships between implementation and other HEPA outcomes did not reach statistical significance. Still regression estimates indicated that desserts are served on 1.94 fewer days (i.e., 0.40 vs. 2.34) in the highest implementing program than the lowest implementing program and water is served 0.73 more days (i.e., 2.37 vs. 1.64). Adopting HEPA Standards at the national level does not lead to changes in routine practice in all programs. Practical strategies that programs could adopt to more fully comply with the HEPA Standards are identified.

  15. Drivers and barriers to e-invoicing adoption in Greek large scale manufacturing industries

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Marinagi, Catherine, E-mail: marinagi@teihal.gr, E-mail: ptrivel@yahoo.com, E-mail: preklitis@yahoo.com; Trivellas, Panagiotis, E-mail: marinagi@teihal.gr, E-mail: ptrivel@yahoo.com, E-mail: preklitis@yahoo.com; Reklitis, Panagiotis, E-mail: marinagi@teihal.gr, E-mail: ptrivel@yahoo.com, E-mail: preklitis@yahoo.com

    2015-02-09

    This paper attempts to investigate the drivers and barriers that large-scale Greek manufacturing industries experience in adopting electronic invoices (e-invoices), based on three case studies with organizations having international presence in many countries. The study focuses on the drivers that may affect the increase of the adoption and use of e-invoicing, including the customers demand for e-invoices, and sufficient know-how and adoption of e-invoicing in organizations. In addition, the study reveals important barriers that prevent the expansion of e-invoicing, such as suppliers’ reluctance to implement e-invoicing, and IT infrastructures incompatibilities. Other issues examined by this study include the observed benefitsmore » from e-invoicing implementation, and the financial priorities of the organizations assumed to be supported by e-invoicing.« less

  16. Intercountry versus Transracial Adoption: Analysis of Adoptive Parents' Motivations and Preferences in Adoption

    ERIC Educational Resources Information Center

    Zhang, Yuanting; Lee, Gary R.

    2011-01-01

    The United States is one of the major baby-receiving countries in the world. Relatively little research has focused on why there is such a high demand for intercountry adoption. Using in-depth qualitative interviews with adoptive parents, the authors explored the reasons why Americans prefer to adopt foreign-born children instead of adopting…

  17. Progress in electronic medical record adoption in Canada.

    PubMed

    2015-12-01

    To determine the rate of adoption of electronic medical records (EMRs) by physicians across Canada, provincial incentives, and perceived benefits of and barriers to EMR adoption. Data on EMR adoption in Canada were collected from CINAHL, MEDLINE, PubMed, EMBASE, the Cochrane Library, the Health Council of Canada, Canada Health Infoway, government websites, regional EMR associations, and health professional association websites. After removal of duplicate articles, 236 documents were found matching the original search. After using the filter Canada, 12 documents remained. Additional documents were obtained from each province's EMR website and from the Canada Health Infoway website. Since 2006, Canadian EMR adoption rates have increased from about 20% of practitioners to an estimated 62% of practitioners in 2013, with substantial regional disparities ranging from roughly 40% of physicians in New Brunswick and Quebec to more than 75% of physicians in Alberta. Provincial incentives vary widely but appear to have only a weak relationship with the rate of adoption. Many adopters use only a fraction of their software's available functions. User-cited benefits to adoption include time savings, improved record keeping, heightened patient safety, and confidence in retrieved data when EMRs are used efficiently. Barriers to adoption include financial and time constraints, lack of knowledgeable support personnel, and lack of interoperability with hospital and pharmacy systems. Canadian physicians remain at the stage of EMR adoption. Progression in EMR use requires experienced, knowledgeable technical support during implementation, and financial support for the transcription of patient data from paper to electronic media. The interoperability of EMR offerings for hospitals, pharmacies, and clinics is the rate-limiting factor in achieving a unified EMR solution for Canada.

  18. Galvanising the NHS to Adopt Innovation

    PubMed Central

    Parris, Stuart; Cochrane, Gavin; Marjanovic, Sonja; Ling, Tom; Chataway, Joanna

    2016-01-01

    Abstract The Department of Health and the Wellcome Trust, in co-operation with NHS England, asked RAND Europe to conduct a limited consultation with key stakeholders about the practicality of measures and incentives proposed as part of the NHS Accelerated Access Review (AAR), which aims to assess the pathways for the development, assessment, and adoption of innovative medicines and medical technology. Through a focused engagement exercise with key healthcare stakeholders this project explored the implications of selected interim AAR propositions and feasibility of implementation for key actors, in primary and secondary care as well as commissioners and academia. Specifically, the project investigated the feasibility of implementation of three specific propositions including: a new earmarked fund to encourage AHSNs and other key innovation actors to re-design systems to embrace innovation; mobilising the influence of clinical system leaders to champion change; and encouraging secondary care organisations to take on “innovation champion” roles linked to financial incentives and a new emphasis on accountable care organisations. Data was collected on the feasibility of the three AAR propositions from a workshop with AHSN CEOs and Commercial Directors and interviews with senior NHS staff in three AHSN regions (South West, University College London Partners, and North East, North Cumbria). The study concludes with reflections on the feasibility of each recommendation and identifies factors expected to facilitate or challenge their implementation, as well as considering the wider cross cutting issues that may influence the adoption and diffusion of innovation in the NHS. PMID:28083436

  19. A Grounded Theory Study of Aircraft Maintenance Technician Decision-Making

    NASA Astrophysics Data System (ADS)

    Norcross, Robert

    related to decision-making. Recommendations included an in-depth systematic review of the Aircraft Maintenance Manuals, development of a Federal Aviation Administration approved standardized Aircraft Maintenance Technician decision-making flow diagram, and implementation of risk based decision-making training. The benefit of this study is to save the airline industry revenue by preventing poor decision-making practices that result in inefficient maintenance actions and aircraft incidents and accidents.

  20. Adoption of telemedicine: from pilot stage to routine delivery

    PubMed Central

    2012-01-01

    Background Today there is much debate about why telemedicine has stalled. Teleradiology is the only widespread telemedicine application. Other telemedicine applications appear to be promising candidates for widespread use, but they remain in the early adoption stage. The objective of this debate paper is to achieve a better understanding of the adoption of telemedicine, to assist those trying to move applications from pilot stage to routine delivery. Discussion We have investigated the reasons why telemedicine has stalled by focusing on two, high-level topics: 1) the process of adoption of telemedicine in comparison with other technologies; and 2) the factors involved in the widespread adoption of telemedicine. For each topic, we have formulated hypotheses. First, the advantages for users are the crucial determinant of the speed of adoption of technology in healthcare. Second, the adoption of telemedicine is similar to that of other health technologies and follows an S-shaped logistic growth curve. Third, evidence of cost-effectiveness is a necessary but not sufficient condition for the widespread adoption of telemedicine. Fourth, personal incentives for the health professionals involved in service provision are needed before the widespread adoption of telemedicine will occur. Summary The widespread adoption of telemedicine is a major -- and still underdeveloped -- challenge that needs to be strengthened through new research directions. We have formulated four hypotheses, which are all susceptible to experimental verification. In particular, we believe that data about the adoption of telemedicine should be collected from applications implemented on a large-scale, to test the assumption that the adoption of telemedicine follows an S-shaped growth curve. This will lead to a better understanding of the process, which will in turn accelerate the adoption of new telemedicine applications in future. Research is also required to identify suitable financial and

  1. Adopted children in their adoptive families.

    PubMed

    Schechter, M D; Holter, F R

    1975-08-01

    The adoptive process can produce unusual stresses on the child, and biologic and adoptive parents, from prenatal to postnatal life, and through the various phases of physical and pscyhological development. Because of the possibility of these children and their families falling into the "at risk" category with greater potential for psychological and social problems, the pediatrician is of primary importance in diagnosis and counseling. The pediatrician can be of major help in properly diagnosing emotional, behavioral and/or learning problems occurring in adopted children. There must be a thorough evaluation of the child and his family to understand and properly treat symptomatic behavior. The pediatrician can give advice regarding developmental milestones, and especially help the adoptive parents in appreciating their conscious and unconscious attitudes so as to enhance attachment behaviors. Pediatricians are the consultants to whom parents turn for advice regarding the timing of telling about adoption. This advice needs to be individualized according to the specific child's needs. Using a developmental conceptual framework, the pediatrician is in the best position to help the parents and their adopted children with their feelings about societal attitudes and how these can most appropriately be handled. Along this line, the pediatrician can give help and advice when and if the adoptee decides to search for his biologic parents. There is a need to clarify laws which seal the original birth certificate permitting those adoptees who wish to attain a knowledge of potentially related disease processes and an identity with his own genealogical past to do so. This would also allow the adoptee to offer his own children information about their own genetic pool and an awareness of adoption as one of the most valuable and historically significant child rearing practices.

  2. Adopting Energy Efficiency in Connected Homes

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Christensen, Dane T; Kemper, Emily

    This presentation on connected homes was presented at the 11th Rocky Mountain Utility Efficiency Exchange on September 28, 2017. The discussion covered the integration of energy efficiency measures and practices with Internet of Things (IoT) awareness and adoption of smart technologies and services via WiFi/ Bluetooth enabled home and office equipment. The presentation also describes the benefits to the home and business and benefits/challenges for the utility/implementer.

  3. Method and computer program product for maintenance and modernization backlogging

    DOEpatents

    Mattimore, Bernard G; Reynolds, Paul E; Farrell, Jill M

    2013-02-19

    According to one embodiment, a computer program product for determining future facility conditions includes a computer readable medium having computer readable program code stored therein. The computer readable program code includes computer readable program code for calculating a time period specific maintenance cost, for calculating a time period specific modernization factor, and for calculating a time period specific backlog factor. Future facility conditions equal the time period specific maintenance cost plus the time period specific modernization factor plus the time period specific backlog factor. In another embodiment, a computer-implemented method for calculating future facility conditions includes calculating a time period specific maintenance cost, calculating a time period specific modernization factor, and calculating a time period specific backlog factor. Future facility conditions equal the time period specific maintenance cost plus the time period specific modernization factor plus the time period specific backlog factor. Other embodiments are also presented.

  4. First Experiences Of ISFOC In The Maintenance Of CPV Plants

    NASA Astrophysics Data System (ADS)

    Sánchez, D.; Martínez, M.; Gil, E.; Rubio, F.; Pachón, J. L.; Banda, P.

    2010-10-01

    ISFOC CPV Plants are now working in normal operation, so ISFOC is beginning with the Maintenance. Like a first approximation, we have analyzed the incidences in the Energy generation. This analysis results that the tracker is the most vulnerable element of the installation, what it is reasonable, because it is the only mechanical element. In this business, the corrective actions for the Maintenance are very expensive; therefore it is mandatory to define a good policy for the Preventive Maintenance. With this idea, ISFOC is implementing Industrial tools (SCP) to control the Energy generation in order to maintain the Plants operating at its full potential. In this paper, we present the approach we are making to adapt the method to measure the energy generated by the concentrators and how the control charts can be used to organize the Preventive Maintenance actions. Finally, the first results are presented, where we show the potential of this method to organize the Maintenance at the same time we have initial calculations for the availability of the plants obtained with this method.

  5. Reducing maintenance costs in agreement with CNC machine tools reliability

    NASA Astrophysics Data System (ADS)

    Ungureanu, A. L.; Stan, G.; Butunoi, P. A.

    2016-08-01

    Aligning maintenance strategy with reliability is a challenge due to the need to find an optimal balance between them. Because the various methods described in the relevant literature involve laborious calculations or use of software that can be costly, this paper proposes a method that is easier to implement on CNC machine tools. The new method, called the Consequence of Failure Analysis (CFA) is based on technical and economic optimization, aimed at obtaining a level of required performance with minimum investment and maintenance costs.

  6. A mixed methods protocol for developing and testing implementation strategies for evidence-based obesity prevention in childcare: a cluster randomized hybrid type III trial.

    PubMed

    Swindle, Taren; Johnson, Susan L; Whiteside-Mansell, Leanne; Curran, Geoffrey M

    2017-07-18

    Despite the potential to reach at-risk children in childcare, there is a significant gap between current practices and evidence-based obesity prevention in this setting. There are few investigations of the impact of implementation strategies on the uptake of evidence-based practices (EBPs) for obesity prevention and nutrition promotion. This study protocol describes a three-phase approach to developing and testing implementation strategies to support uptake of EBPs for obesity prevention practices in childcare (i.e., key components of the WISE intervention). Informed by the i-PARIHS framework, we will use a stakeholder-driven evidence-based quality improvement (EBQI) process to apply information gathered in qualitative interviews on barriers and facilitators to practice to inform the design of implementation strategies. Then, a Hybrid Type III cluster randomized trial will compare a basic implementation strategy (i.e., intervention as usual) with an enhanced implementation strategy informed by stakeholders. All Head Start centers (N = 12) within one agency in an urban area in a southern state in the USA will be randomized to receive the basic or enhanced implementation with approximately 20 classrooms per group (40 educators, 400 children per group). The educators involved in the study, the data collectors, and the biostastician will be blinded to the study condition. The basic and enhanced implementation strategies will be compared on outcomes specified by the RE-AIM model (e.g., Reach to families, Effectiveness of impact on child diet and health indicators, Adoption commitment of agency, Implementation fidelity and acceptability, and Maintenance after 6 months). Principles of formative evaluation will be used throughout the hybrid trial. This study will test a stakeholder-driven approach to improve implementation, fidelity, and maintenance of EBPs for obesity prevention in childcare. Further, this study provides an example of a systematic process to develop

  7. Carrier Based Air Logistics Study: Maintenance Analysis.

    DTIC Science & Technology

    1982-01-01

    MONITORING AGENCY NAME & ADDRESS(If dIierent loan Controling 01116.) 1S. SECURITY CLASS. (of Od. report) gel Unclassified IS&. DECL ASSI IlCATION/ OOWNGRAOIN...Management System AECL Avionics Equipment Configuration List AIMD Aircraft Intermediate Maintenance Department ASO Aviation Supply Office ASW...implementation. Component-specific data, and indentured[2] relationships between components extracted from the Aviation Supply Office ( ASO ) weapon

  8. Coherence and recurrency: maintenance, control and integration in working memory

    PubMed Central

    Raffone, Antonino

    2007-01-01

    Working memory (WM), including a ‘central executive’, is used to guide behavior by internal goals or intentions. We suggest that WM is best described as a set of three interdependent functions which are implemented in the prefrontal cortex (PFC). These functions are maintenance, control of attention and integration. A model for the maintenance function is presented, and we will argue that this model can be extended to incorporate the other functions as well. Maintenance is the capacity to briefly maintain information in the absence of corresponding input, and even in the face of distracting information. We will argue that maintenance is based on recurrent loops between PFC and posterior parts of the brain, and probably within PFC as well. In these loops information can be held temporarily in an active form. We show that a model based on these structural ideas is capable of maintaining a limited number of neural patterns. Not the size, but the coherence of patterns (i.e., a chunking principle based on synchronous firing of interconnected cell assemblies) determines the maintenance capacity. A mechanism that optimizes coherent pattern segregation, also poses a limit to the number of assemblies (about four) that can concurrently reverberate. Top-down attentional control (in perception, action and memory retrieval) can be modelled by the modulation and re-entry of top-down information to posterior parts of the brain. Hierarchically organized modules in PFC create the possibility for information integration. We argue that large-scale multimodal integration of information creates an ‘episodic buffer’, and may even suffice for implementing a central executive. PMID:17901994

  9. Factors Associated with Adoption and Adoption Intentions of Nonparental Caregivers

    PubMed Central

    Bramlett, Matthew D.; Radel, Laura F.

    2016-01-01

    Data from the 2011–2012 National Survey of Children’s Health and the 2013 National Survey of Children in Nonparental Care were used to fit a multinomial logistic model comparing three groups to those who never considered adoption: those who ever considered, but are not currently planning adoption; those planning adoption; and those who adopted. Adoption may be more likely when the caregiver is a nonkin foster parent, a foster care agency was involved, and/or financial assistance is available. Those with plans to adopt but who have not adopted may face adoption barriers such as extreme poverty, lower education and being unmarried. PMID:26949328

  10. Open adoption of infants: adoptive parents' feelings seven years later.

    PubMed

    Siegel, Deborah H

    2003-07-01

    Adoptions today increasingly include contact between adoptive and birth families. What do these "open adoptions" look like? How do the participants feel about them? This article, based on part of a longitudinal study that first examined adoptive parents' perceptions of their infants' open adoptions seven years ago, explores the parents' reactions now that their children are school age. This qualitative descriptive research revealed changes in the openness in the adoptions over time and identified four dimensions along which open adoptions vary. Findings showed parents' enthusiasm for the openness in their adoptions, regardless of the type and extent of openness. Implications for social work practice, education, and policy are explored.

  11. The experience of Australian project leaders in encouraging practitioners to adopt research evidence in their clinical practice.

    PubMed

    Henderson, Amanda J; Davies, Jan; Willet, Michaela R

    2006-11-01

    This paper describes a qualitative program evaluation which sought to identify factors that either assist or impede the adoption of clinical evidence in everyday practice. Thirteen Australian projects were funded in a competitive grant program to adopt innovative strategies to improve the uptake of research evidence in everyday clinical practice. Project leaders' reports were analysed to collate common themes related to 1) critical elements in successful application of research knowledge, 2) barriers to implementing evidence, and 3) lessons for other organisations that might implement a similar project. Despite the diversity of the methods used to establish projects and the range of topics and clinical settings, many similarities were identified in the perceived critical success elements, barriers, and lessons for adopting clinical evidence. Eighteen themes emerged across the data including: leadership support; key stakeholder involvement; practice changes; communication; resources; education of staff; evaluation of outcomes; consumers; knowledge gaps; adoption/implementing staff; access to knowledge; risk assessment; collaboration; effectiveness of clinical research evidence; structure/organisation; cultural barriers; previous experiences; and information technology. Leaders of projects to adopt evidence in clinical practice identified barriers, critical success elements and lessons that impacted on their projects. A range of influences on the adoption of evidence were identified, and this knowledge can be used to assist others undertaking similar projects.

  12. Hospitious Adoption: How Hospitality Empowers Children and Transforms Adoption

    ERIC Educational Resources Information Center

    Gritter, James L.

    2009-01-01

    Building on previous books by the author, "Hospitious Adoption: How Hospitality Empowers Children and Transforms Adoption" examines the next step after open adoption. Gritter takes the approach that practicing goodwill, respect, and courage within the realm of adoption makes the process move smoother and enriches children's lives. Following a…

  13. CERN experience and strategy for the maintenance of cryogenic plants and distribution systems

    NASA Astrophysics Data System (ADS)

    Serio, L.; Bremer, J.; Claudet, S.; Delikaris, D.; Ferlin, G.; Pezzetti, M.; Pirotte, O.; Tavian, L.; Wagner, U.

    2015-12-01

    CERN operates and maintains the world largest cryogenic infrastructure ranging from ageing installations feeding detectors, test facilities and general services, to the state-of-the-art cryogenic system serving the flagship LHC machine complex. After several years of exploitation of a wide range of cryogenic installations and in particular following the last two years major shutdown to maintain and consolidate the LHC machine, we have analysed and reviewed the maintenance activities to implement an efficient and reliable exploitation of the installations. We report the results, statistics and lessons learned on the maintenance activities performed and in particular the required consolidations and major overhauling, the organization, management and methodologies implemented.

  14. Implementation science in cancer prevention and control: a decade of grant funding by the National Cancer Institute and future directions.

    PubMed

    Neta, Gila; Sanchez, Michael A; Chambers, David A; Phillips, Siobhan M; Leyva, Bryan; Cynkin, Laurie; Farrell, Margaret M; Heurtin-Roberts, Suzanne; Vinson, Cynthia

    2015-01-08

    The National Cancer Institute (NCI) has supported implementation science for over a decade. We explore the application of implementation science across the cancer control continuum, including prevention, screening, treatment, and survivorship. We reviewed funding trends of implementation science grants funded by the NCI between 2000 and 2012. We assessed study characteristics including cancer topic, position on the T2-T4 translational continuum, intended use of frameworks, study design, settings, methods, and replication and cost considerations. We identified 67 NCI grant awards having an implementation science focus. R01 was the most common mechanism, and the total number of all awards increased from four in 2003 to 15 in 2012. Prevention grants were most frequent (49.3%) and cancer treatment least common (4.5%). Diffusion of Innovations and Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) were the most widely reported frameworks, but it is unclear how implementation science models informed planned study measures. Most grants (69%) included mixed methods, and half reported replication and cost considerations (49.3%). Implementation science in cancer research is active and diverse but could be enhanced by greater focus on measures development, assessment of how conceptual frameworks and their constructs lead to improved dissemination and implementation outcomes, and harmonization of measures that are valid, reliable, and practical across multiple settings.

  15. Applying the RE-AIM Framework to Evaluate the Dissemination and Implementation of Clinical Practice Guidelines for Sexually Transmitted Infections.

    PubMed

    Jeong, Heon-Jae; Jo, Heui-Sug; Oh, Moo-Kyung; Oh, Hyung-Won

    2015-07-01

    Clinical practice guidelines (CPG) are one of the most effective ways to translate evidence of medical improvement into everyday practice. This study evaluated the dissemination and implementation of the Sexually Transmitted Infections-Korean Guidelines (STIKG) by applying the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework. A survey questionnaire was administered to clinicians via the internet. Among the 332 respondents, 190 (57.2%) stated that they were aware of STIKG and 107 (33.2%) implemented STIKG in their practice. The odds that a physician was exposed to STIKG (dissemination) were 2.61 times greater among physicians with previous training or education for any CPG than those who did not. Clinicians who indicated that STIKG were easy to understand were 4.88 times more likely to implement STIKG in their practice than those who found them not so easy. When a clinician's workplace had a supporting system for CPG use, the odds of implementation was 3.76 times higher. Perceived level of effectiveness of STIKG did not significantly influence their implementation. The findings of this study suggest that, ultimately, knowing how to engage clinicians in CPG implementation is as important as how to disseminate such guidelines; moreover, easy-to-use guidelines and institutional support are key factors.

  16. High School Teachers’ Openness to Adopting New Practices: The Role of Personal Resources and Organizational Climate

    PubMed Central

    Pas, Elise T.; Loh, Deanna; Debnam, Katrina J.; Bradshaw, Catherine P.

    2016-01-01

    Although evidence-based practices for students’ social, emotional, and behavioral health are readily available, their adoption and quality implementation in schools are of increasing concern. Teachers are vital to implementation; yet, there is limited research on teachers’ openness to adopting new practices, which may be essential to successful program adoption and implementation. The current study explored how perceptions of principal support, teacher affiliation, teacher efficacy, and burnout relate to teachers’ openness to new practices. Data came from 2,133 teachers across 51 high schools. Structural equation modeling assessed how organizational climate (i.e., principal support and teacher affiliation) related to teachers’ openness directly and indirectly via teacher resources (i.e., efficacy and burnout). Teachers with more favorable perceptions of both principal support and teacher affiliation reported greater efficacy, and, in turn, more openness; however, burnout was not significantly associated with openness. Post hoc analyses indicated that among teachers with high levels of burnout, only principal support related to greater efficacy, and in turn, higher openness. Implications for promoting teachers’ openness to new program adoption are discussed. PMID:28533823

  17. High School Teachers' Openness to Adopting New Practices: The Role of Personal Resources and Organizational Climate.

    PubMed

    Johnson, Stacy R; Pas, Elise T; Loh, Deanna; Debnam, Katrina J; Bradshaw, Catherine P

    2017-03-01

    Although evidence-based practices for students' social, emotional, and behavioral health are readily available, their adoption and quality implementation in schools are of increasing concern. Teachers are vital to implementation; yet, there is limited research on teachers' openness to adopting new practices, which may be essential to successful program adoption and implementation. The current study explored how perceptions of principal support, teacher affiliation, teacher efficacy, and burnout relate to teachers' openness to new practices. Data came from 2,133 teachers across 51 high schools. Structural equation modeling assessed how organizational climate (i.e., principal support and teacher affiliation) related to teachers' openness directly and indirectly via teacher resources (i.e., efficacy and burnout). Teachers with more favorable perceptions of both principal support and teacher affiliation reported greater efficacy, and, in turn, more openness; however, burnout was not significantly associated with openness. Post hoc analyses indicated that among teachers with high levels of burnout, only principal support related to greater efficacy, and in turn, higher openness. Implications for promoting teachers' openness to new program adoption are discussed.

  18. 78 FR 33784 - Approval and Promulgation of Implementation Plans; Kentucky: Kentucky Portion of Cincinnati...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-05

    ... Promulgation of Implementation Plans; Kentucky: Kentucky Portion of Cincinnati-Hamilton, Supplement Motor.... SUMMARY: EPA is proposing to approve a revision to the Kentucky State Implementation Plan (SIP), submitted... maintenance plan for the Kentucky portion of the Cincinnati-Hamilton, OH-KY-IN, maintenance area for the 1997...

  19. Critical Factors Influencing Decision to Adopt Human Resource Information System (HRIS) in Hospitals

    PubMed Central

    Alam, Md Golam Rabiul; Masum, Abdul Kadar Muhammad; Beh, Loo-See; Hong, Choong Seon

    2016-01-01

    The aim of this research is to explore factors influencing the management decisions to adopt human resource information system (HRIS) in the hospital industry of Bangladesh—an emerging developing country. To understand this issue, this paper integrates two prominent adoption theories—Human-Organization-Technology fit (HOT-fit) model and Technology-Organization-Environment (TOE) framework. Thirteen factors under four dimensions were investigated to explore their influence on HRIS adoption decisions in hospitals. Employing non-probability sampling method, a total of 550 copies of structured questionnaires were distributed among HR executives of 92 private hospitals in Bangladesh. Among the respondents, usable questionnaires were 383 that suggesting a valid response rate of 69.63%. We classify the sample into 3 core groups based on the HRIS initial implementation, namely adopters, prospectors, and laggards. The obtained results specify 5 most critical factors i.e. IT infrastructure, top management support, IT capabilities of staff, perceived cost, and competitive pressure. Moreover, the most significant dimension is technological dimension followed by organisational, human, and environmental among the proposed 4 dimensions. Lastly, the study found existence of significant differences in all factors across different adopting groups. The study results also expose constructive proposals to researchers, hospitals, and the government to enhance the likelihood of adopting HRIS. The present study has important implications in understanding HRIS implementation in developing countries. PMID:27494334

  20. Critical Factors Influencing Decision to Adopt Human Resource Information System (HRIS) in Hospitals.

    PubMed

    Alam, Md Golam Rabiul; Masum, Abdul Kadar Muhammad; Beh, Loo-See; Hong, Choong Seon

    2016-01-01

    The aim of this research is to explore factors influencing the management decisions to adopt human resource information system (HRIS) in the hospital industry of Bangladesh-an emerging developing country. To understand this issue, this paper integrates two prominent adoption theories-Human-Organization-Technology fit (HOT-fit) model and Technology-Organization-Environment (TOE) framework. Thirteen factors under four dimensions were investigated to explore their influence on HRIS adoption decisions in hospitals. Employing non-probability sampling method, a total of 550 copies of structured questionnaires were distributed among HR executives of 92 private hospitals in Bangladesh. Among the respondents, usable questionnaires were 383 that suggesting a valid response rate of 69.63%. We classify the sample into 3 core groups based on the HRIS initial implementation, namely adopters, prospectors, and laggards. The obtained results specify 5 most critical factors i.e. IT infrastructure, top management support, IT capabilities of staff, perceived cost, and competitive pressure. Moreover, the most significant dimension is technological dimension followed by organisational, human, and environmental among the proposed 4 dimensions. Lastly, the study found existence of significant differences in all factors across different adopting groups. The study results also expose constructive proposals to researchers, hospitals, and the government to enhance the likelihood of adopting HRIS. The present study has important implications in understanding HRIS implementation in developing countries.

  1. An intelligent tele-healthcare environment offering person-centric and wellness-maintenance services.

    PubMed

    Abidi, S S

    2001-06-01

    Worldwide healthcare delivery trends are undergoing a subtle paradigm shift--patient centered services as opposed to provider centered services and wellness maintenance as opposed to illness management. In this paper we present a Tele-Healthcare project TIDE--Tele-Healthcare Information and Diagnostic Environment. TIDE manifests an 'intelligent' healthcare environment that aims to ensure lifelong coverage of person-specific health maintenance decision-support services--i.e., both wellness maintenance and illness management services--ubiquitously available via the Internet/WWW. Taking on an all-encompassing health maintenance role--spanning from wellness to illness issues--the functionality of TIDE involves the generation and delivery of (a) Personalized, Pro-active, Persistent, Perpetual, and Present wellness maintenance services, and (b) remote diagnostic services for managing noncritical illnesses. Technically, TIDE is an amalgamation of diverse computer technologies--Artificial Intelligence, Internet, Multimedia, Databases, and Medical Informatics--to implement a sophisticated healthcare delivery infostructure.

  2. Institutional and policy issues in adopting advanced public transportation systems technology

    DOT National Transportation Integrated Search

    1995-09-01

    This project, Institutional and Policy Issues in Adopting Advanced Public Transportation Systems Technologies, aimed to study critical mass transportation issues associated with the implementation of intelligent transportation systems (ITS) in the no...

  3. Organizational Barriers to Adopting an Alcohol Screening and Brief Intervention in Community-Based Mental Health Organizations.

    PubMed

    Patterson, David A; Wolf Adelv Unegv Waya, Silver; Dulmus, Catherine N

    2012-06-01

    This paper examines two factors related to successfully implementing a brief alcohol screening throughout all community-based mental health organizations. The first issue is related to an organization's internal structures, such as culture and climate that can impede evidenced-based practice implementation. There is literature suggesting that organizational culture and climate affect decisions about whether evidence-based practices are adopted and implemented within health care agencies. Following this literature review on organizational barriers, the history and successes of adopting an alcohol screening and brief intervention are reviewed. Studying, identifying, and understanding the organizational factors associated with the successful dissemination and implementation of best practices throughout community-based mental health organizations would contribute to increasing the likelihood that an alcohol screening and brief intervention are implemented throughout mental health organizations.

  4. Organizational Barriers to Adopting an Alcohol Screening and Brief Intervention in Community-Based Mental Health Organizations

    PubMed Central

    Patterson, David A.; Wolf (Adelv unegv Waya), Silver; Dulmus, Catherine N.

    2012-01-01

    This paper examines two factors related to successfully implementing a brief alcohol screening throughout all community-based mental health organizations. The first issue is related to an organization’s internal structures, such as culture and climate that can impede evidenced-based practice implementation. There is literature suggesting that organizational culture and climate affect decisions about whether evidence-based practices are adopted and implemented within health care agencies. Following this literature review on organizational barriers, the history and successes of adopting an alcohol screening and brief intervention are reviewed. Studying, identifying, and understanding the organizational factors associated with the successful dissemination and implementation of best practices throughout community-based mental health organizations would contribute to increasing the likelihood that an alcohol screening and brief intervention are implemented throughout mental health organizations. PMID:24634639

  5. 77 FR 60661 - Approval and Promulgation of Air Quality Implementation Plans; Indiana; South Bend-Elkhart...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-04

    ... Promulgation of Air Quality Implementation Plans; Indiana; South Bend-Elkhart, Indiana Ozone Maintenance Plan..., Indiana 1997 8-hour ozone maintenance air quality State Implementation Plan (SIP) by replacing the... Vehicle Emissions Simulator (MOVES) 2010a emissions model. Indiana submitted this request to EPA for...

  6. Attitude Determination and Control System (ADCS) and Maintenance and Diagnostic System (MDS): A maintenance and diagnostic system for Space Station Freedom

    NASA Technical Reports Server (NTRS)

    Toms, David; Hadden, George D.; Harrington, Jim

    1990-01-01

    The Maintenance and Diagnostic System (MDS) that is being developed at Honeywell to enhance the Fault Detection Isolation and Recovery system (FDIR) for the Attitude Determination and Control System on Space Station Freedom is described. The MDS demonstrates ways that AI-based techniques can be used to improve the maintainability and safety of the Station by helping to resolve fault anomalies that cannot be fully determined by built-in-test, by providing predictive maintenance capabilities, and by providing expert maintenance assistance. The MDS will address the problems associated with reasoning about dynamic, continuous information versus only about static data, the concerns of porting software based on AI techniques to embedded targets, and the difficulties associated with real-time response. An initial prototype was built of the MDS. The prototype executes on Sun and IBM PS/2 hardware and is implemented in the Common Lisp; further work will evaluate its functionality and develop mechanisms to port the code to Ada.

  7. State adoption of nursing home pay-for-performance.

    PubMed

    Werner, Rachel M; Tamara Konetzka, R; Liang, Kevin

    2010-06-01

    Whereas numerous policies have been adopted to improve quality of care in nursing homes over the past several decades-with varying degrees of success-health care payment has been a largely untapped but potentially powerful policy tool to improve quality of care. Recently, however, payers have invested significant resources in the development and implementation of pay-for-performance (P4P) programs for nursing homes. The authors present results from a survey of state Medicaid agencies documenting the use and structure of P4P in nursing homes. Although the number of states that are implementing nursing home P4P is growing, the structure of these incentives varies across states, and little evidence exists to guide the planning or implementation of these initiatives.

  8. Implementation of fluorescence confocal mosaicing microscopy by "early adopter" Mohs surgeons: a review of recent progress

    NASA Astrophysics Data System (ADS)

    Jain, Manu; Rajadhyaksha, Milind; Nehal, Kishwer

    2016-03-01

    Confocal mosaicing microscopy (CMM) enables rapid imaging of large areas of fresh tissue ex vivo without the processing that is necessary for conventional histology. When performed with fluorescence mode using acridine orange (nuclear specific dye) it enhances nuclei-to-dermis contrast that enables detection of all types of BCCs including thin strands of infiltrative basal cell carcinomas (BCCs). Thus far, this technique has been mostly validated in research setting for the analysis of BCC tumor margins. Recently, CMM has been adopted and implemented in real clinical settings by some surgeons as an alternative tool to frozen section (FS) during Mohs surgery. In this review article we summarize the development of CMM guided imaging of ex vivo tissues from bench to bedside. We also present its current state of application in routine clinical workflow not only for the assessment of BCC margin but also for other skin cancers such as melanoma, SCC, and some infectious diseases where FS is not routinely performed. Lastly, we also discuss the potential limitations of this technology as well as future developments. As this technology advances further, it may serve as an adjunct to standard histology and enable rapid surgical pathology of skin cancers at the bedside.

  9. ENHANCING PRESCRIPTION DRUG INNOVATION AND ADOPTION

    PubMed Central

    Alexander, G. Caleb; O’Connor, Alec B.; Stafford, Randall S.

    2014-01-01

    The adoption and use of a new drug would ideally be guided by its Innovation and cost-effectiveness. The adoption and use of a new drug would ideally be guided by its innovation and cost-effectiveness. However, information about the relative efficacy and safety of a drug is typically incomplete even well after market entry, and various other forces create a market place in which most new drugs are little better than their older counterparts. Five proposed mechanisms are considered for promoting innovation and reducing the use of therapies ultimately found to offer poor value or have unacceptable risks. These changes range from increasing the evidence required for U.S. Food and Drug Administration approval to modifying the structure of drug reimbursement. Despite the challenges of policy implementation, the United States has a long history of successfully improving the societal value and safe use of prescription medicines. PMID:21690598

  10. Maintenance Research. Report 6. Maintenance Training.

    ERIC Educational Resources Information Center

    Louisiana State Dept. of Highways, Baton Rouge.

    The main objective of the training research phase of the maintenance management study was to develop and test training methods suitable for highway maintenance supervisors. Supervisors were trained by one of five different methods (lecture, group discussion, programed instruction, programed workshops, audiovisual instruction). The report documents…

  11. 78 FR 21281 - Approval and Promulgation of Implementation Plans; State of Missouri; Infrastructure SIP...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-10

    ...EPA is proposing action on four Missouri State Implementation Plan (SIP) submissions. First, EPA is proposing to approve portions of two SIP submissions from the State of Missouri addressing the applicable requirements of Clean Air Act (CAA) for the 1997 and 2006 National Ambient Air Quality Standards (NAAQS) for fine particulate matter (PM2.5). The CAA requires that each state adopt and submit a SIP to support implementation, maintenance, and enforcement of each new or revised NAAQS promulgated by EPA. These SIPs are commonly referred to as ``infrastructure'' SIPs. The infrastructure requirements are designed to ensure that the structural components of each state's air quality management program are adequate to meet the state's responsibilities under the CAA. EPA is also proposing to approve two additional SIP submissions from Missouri, one addressing the Prevention of Significant Deterioration (PSD) program in Missouri, and another addressing the requirements applicable to any board or body which approves permits or enforcement orders of the CAA, both of which support requirements associated with infrastructure SIPs.

  12. The role of privacy protection in healthcare information systems adoption.

    PubMed

    Hsu, Chien-Lung; Lee, Ming-Ren; Su, Chien-Hui

    2013-10-01

    Privacy protection is an important issue and challenge in healthcare information systems (HISs). Recently, some privacy-enhanced HISs are proposed. Users' privacy perception, intention, and attitude might affect the adoption of such systems. This paper aims to propose a privacy-enhanced HIS framework and investigate the role of privacy protection in HISs adoption. In the proposed framework, privacy protection, access control, and secure transmission modules are designed to enhance the privacy protection of a HIS. An experimental privacy-enhanced HIS is also implemented. Furthermore, we proposed a research model extending the unified theory of acceptance and use of technology by considering perceived security and information security literacy and then investigate user adoption of a privacy-enhanced HIS. The experimental results and analyses showed that user adoption of a privacy-enhanced HIS is directly affected by social influence, performance expectancy, facilitating conditions, and perceived security. Perceived security has a mediating effect between information security literacy and user adoption. This study proposes several implications for research and practice to improve designing, development, and promotion of a good healthcare information system with privacy protection.

  13. 75 FR 54805 - Approval and Promulgation of Air Quality Implementation Plans; Minnesota; Carbon Monoxide (CO...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-09

    ... Promulgation of Air Quality Implementation Plans; Minnesota; Carbon Monoxide (CO) Limited Maintenance Plan for... June 16, 2010, to revise the Minnesota State Implementation Plan (SIP) for carbon monoxide (CO) under the Clean Air Act (CAA). The State has submitted a limited maintenance plan for CO showing continued...

  14. Promoting Evidence-Based Practices: The Adoption of a Prevention Support System in Community Settings

    ERIC Educational Resources Information Center

    Hunter, Sarah B.; Paddock, Susan M.; Ebener, Patricia; Burkhart, A. K.; Chinman, Matthew

    2009-01-01

    Prevention support systems (PSSs) are designed to help communities implement evidence-based practices (EBPs). Little is known about the factors that influence their adoption. In this article, we examined adoption of a PSS for substance abuse prevention called Getting To Outcomes (GTO)[R] among staff in two community coalitions with varying levels…

  15. Implementation of web-based interventions by Dutch occupational health centers.

    PubMed

    Walthouwer, Michel Jean Louis; Oenema, Anke; Soetens, Katja; Lechner, Lilian; de Vries, Hein

    2017-10-01

    The aim of this qualitative study was to identify barriers and facilitators to the adoption and particularly the implementation of a web-based computer-tailored obesity prevention intervention by occupational health centers. Participants were directors of Dutch occupational health centers who had adopted and implemented the intervention for the corresponding efficacy study (n = 8) as well as non-adopters (n = 12). Individual semi-structured interviews were carried out to study barriers and facilitators related to the intervention, the user, the organization, and the socio-political environment. All interviews were carried out by telephone, audio-recorded and transcribed verbatim. The transcripts were analyzed using a directed-content approach and coded by two persons. There were important differences in perceptions between adopters and non-adopters, particularly on barriers and facilitators related to the intervention and the personal beliefs of the implementer. The relative advantages of the intervention were considered to be most important. Participants also indicated that their personal attitudinal and self-efficacy beliefs influenced their implementation efforts. Regarding the organization, the possibilities to increase profits and integrate the intervention within the organization were considered to be important facilitators for the implementation. Participants mentioned few implementation barriers and facilitators related to the socio-political environment. Strategies to improve the implementation of web-based computer-tailored interventions by occupational health centers should be tailored to implementers' unique perceptions and particularly address the perceived advantages and disadvantages of the intervention, attitudinal and self-efficacy beliefs, and the potential to increase organizations' profits and competitiveness. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  16. Supporting Special-Needs Adoptive Couples: Assessing an Intervention to Enhance Forgiveness, Increase Marital Satisfaction, and Prevent Depression

    ERIC Educational Resources Information Center

    Baskin, Thomas W.; Rhody, Margaret; Schoolmeesters, Shannon; Ellingson, Colleen

    2011-01-01

    An educational group intervention focusing on forgiveness and marriage education was implemented with adoptive parents. Couples qualified by having adopted at least one special-needs child. Data were examined for 112 adoptive parents: 54 from a treatment group that immediately received a 36-contact hour intervention and 58 from a waiting list…

  17. Pap Testing Stages of Adoption among Cambodian Immigrants

    PubMed Central

    Taylor, Victoria M.; Jackson, J. Carey; Yasui, Yutaka; Schwartz, Stephen M.; Kuniyuki, Alan; Fischer, Meredith; Tu, Shin-Ping

    2006-01-01

    Purpose We examined levels of Pap testing and factors associated with screening participation among Cambodian refugees. Methods A community-based, in-person survey was conducted in Seattle during late 1997 and early 1998. Interviews were completed by 413 women; the estimated response rate was 73%. We classified respondents into four Pap testing stages of adoption: precontemplation/contemplation (never screened), relapse (ever screened but did not plan to be screened in the future), action (ever screened and planned to be screened in the future), and maintenance (recently screened and planned to be screened in the future). Bivariate and multivariate techniques were used to examine various factors. Findings About one-quarter (24%) of the respondents has never been screened, and a further 22% had been screened but did not plan to obtain Pap tests in the future. Fifteen percent were in the action stage and 39% were in the maintenance stage. The following factors were independently associated with cervical cancer screening stages: previous physician recommendation; younger age; beliefs about Pap testing for post-menopausal women, screening for sexually inactive women, and regular checkups; provider ethnicity; prenatal care in the US; and problems finding interpreters. Conclusions Our findings confirm low Pap testing rates among Cambodian immigrants, and suggest that targeted interventions should be multifaceted. PMID:11567513

  18. Exploring information technology adoption by family physicians: survey instrument valuation.

    PubMed Central

    Dixon, D. R.; Stewart, M.

    2000-01-01

    As the information needs of family physicians become more complex, there will be a greater need to successfully implement the technologies needed to manage that information. The ability to stratify primary care physicians can enable the implementation process to be more efficient. This research tested a new instrument on 101 family physicians, and was able to stratify physicians into high, intermediate, and low information technology (IT) usage groups. It is expected that this stratification would allow managers of IT implementation to target specific adoption strategies for each group. The instrument is available from ddixon@julian.uwo.ca. PMID:11079870

  19. Electronic Health Record Adoption as a Function of Success: Implications for Meaningful Use

    ERIC Educational Resources Information Center

    Naser, Riyad J.

    2012-01-01

    Successful electronic health records (EHR) implementation has the potential to transform the entire care delivery process across the enterprise. However, the rate of EHR implementation and use among physicians has been slow. Different factors have been reported in the literature that may hinder adoption of EHR. Identifying and managing these…

  20. Implementing the IT Infrastructure for Health Reform: Adoption of Health IT among Patient-Centered Medical Home Practices

    PubMed Central

    Adler-Milstein, Julia; Cohen, Genna R.

    2013-01-01

    While health IT is thought to be critical to the success of new models of care delivery, we know little about the extent to which those pursuing these models are relying on HIT. We studied a large patient-centered medical home (PCMH) demonstration project, a new model of care delivery that has received substantial policy attention, in order to assess which types of HIT were most widely used, and how adoption rates changed over time as PCMH practices matured. We found that clinically-focused HIT tools were both widely adopted, and increasingly adopted, in PCMH practices compared to non-PCMH practices. In contrast, HIT that supports patient-engagement, patient portals and personal health records, was neither in widespread use nor more likely to be adopted over time by PCMH practices compared to other practices. This suggests that these tools may not yet support the types of patient engagement and interactions that PCMH practices seek. PMID:24551318

  1. Routine road maintenance water quality and habitat guide : best management practices

    DOT National Transportation Integrated Search

    2009-01-01

    Since June 9, 1999 the Oregon Department of Transportation (ODOT) has implemented the Routine Road Maintenance: Water Quality and Habitat Guide Best Management Practices (the Guide), and is considered the cornerstone of the ODOT'd Office of Maintenan...

  2. EVALUATION OF THE IMPLEMENTATION OF ASBESTOS OPERATIONS AND MAINTENANCE PROGRAMS IN NEW JERSEY SCHOOLS

    EPA Science Inventory

    Removal of asbestos-containing materials (ACM) was encouraged over alternative approaches of asbestos management in the past. However, in-place management and operstions nd maintenance programs are currently viewed by the EPA as the most appropriate overall strategy for managemen...

  3. Healthy depictions? Depicting adoption and adoption news events on broadcast news.

    PubMed

    Kline, Susan L; Chatterjee, Karishma; Karel, Amanda I

    2009-01-01

    Given that the public uses the media to learn about adoption as a family form, this study analyzes U.S. television news coverage of adoption between 2001 and 2005 (N = 309 stories), to identify the types of news events covered about adoption. A majority of news stories covered fraud, crime, legal disputes, and negative international adoption cases. Adoptees as defective or unhealthy were depicted more in negative news event stories, birth parents appeared less overall, and adoptive parents were most likely to have healthy depictions in positively oriented adoption experience, big family, and reunion stories. Although three quarters of the stories used primary adoption participants as news sources, one-third of the negative event stories did not contain healthy depictions of adoption participants. The authors discuss ways journalists and researchers might improve adoption news coverage.

  4. Sustainable Implementation of Interprofessional Education Using an Adoption Model Framework

    ERIC Educational Resources Information Center

    Grymonpre, Ruby E.; Ateah, Christine A.; Dean, Heather J.; Heinonen, Tuula I.; Holmqvist, Maxine E.; MacDonald, Laura L.; Ready, A. Elizabeth; Wener, Pamela F.

    2016-01-01

    Interprofessional education (IPE) is a growing focus for educators in health professional academic programs. Recommendations to successfully implement IPE are emerging in the literature, but there remains a dearth of evidence informing the bigger challenges of sustainability and scalability. Transformation to interprofessional education for…

  5. Age at placement, adoption experience and adult adopted people's contact with their adoptive and birth mothers: an attachment perspective.

    PubMed

    Howe, D

    2001-09-01

    Adoption holds particular interest for attachment researchers. Although children adopted as babies experience almost continuous care by their adoptive parents, older placed children experience at least one major change of caregiver when they join their adoptive family. Moreover, in the majority of cases, older placed children have generally suffered a pre-adoption history of abuse, neglect and/or rejection. It is now being recognized that older placed children's attachment histories and internal working models (IWMs) established in relationship with their initial carers remain active in relationship with their new carers. Transactional models have helped both researchers and practitioners to understand the dynamics of parent-child relationships in cases where insecure children with histories of neglect, abuse and rejection find themselves in new caregiving environments. The present study examines the childhood experiences of adult adopted people and their current levels of contact with their adoptive mothers, and in cases where people had searched for and found a birth relative, current levels of contact with their birth mother. Although no information was collected on the adopted adult's pre-placement history, age at placement was used as a proxy measure to examine whether older placed children reported different adoption experiences and what their current levels of contact were with their adoptive and birth mothers. The findings show that age at placement was associated with adopted people's reported experiences of being adopted and current rates of contact with their adoptive and birth mothers, with those placed at older ages most likely to report that they (1) did not feel they belonged in their adoptive families while growing up, (2) did not feel loved by their adoptive mother, (3) were least likely to remain in high-frequency contact with their adoptive mother, and (4) were least likely to remain in high-frequency contact with their birth mother. An

  6. Ethical adoption: A new imperative in the development of technology for dementia.

    PubMed

    Robillard, Julie M; Cleland, Ian; Hoey, Jesse; Nugent, Chris

    2018-06-19

    Technology interventions are showing promise to assist persons with dementia and their carers. However, low adoption rates for these technologies and ethical considerations have impeded the realization of their full potential. Building on recent evidence and an iterative framework development process, we propose the concept of "ethical adoption": the deep integration of ethical principles into the design, development, deployment, and usage of technology. Ethical adoption is founded on five pillars, supported by empirical evidence: (1) inclusive participatory design; (2) emotional alignment; (3) adoption modelling; (4) ethical standards assessment; and (5) education and training. To close the gap between adoption research, ethics and practice, we propose a set of 18 practical recommendations based on these ethical adoption pillars. Through the implementation of these recommendations, researchers and technology developers alike will benefit from evidence-informed guidance to ensure their solution is adopted in a way that maximizes the benefits to people with dementia and their carers while minimizing possible harm. Copyright © 2018 the Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

  7. 40 CFR 51.110 - Attainment and maintenance of national standards.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... PROGRAMS REQUIREMENTS FOR PREPARATION, ADOPTION, AND SUBMITTAL OF IMPLEMENTATION PLANS Control Strategy...) During developing of the plan, EPA encourages States to identify alternative control strategies, as well...

  8. 76 FR 41111 - Approval and Promulgation of Implementation Plans; South Carolina; 110(a)(1) and (2...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-13

    ...EPA is taking final action to approve the December 13, 2007, submission submitted by the State of South Carolina, through the South Carolina Department of Health and Environmental Control (SC DHEC) as demonstrating that the State meets the state implementation plan (SIP) requirements of sections 110(a)(1) and (2) of the Clean Air Act (CAA or the Act) for the 1997 8-hour ozone national ambient air quality standards (NAAQS). Section 110(a) of the CAA requires that each state adopt and submit a SIP for the implementation, maintenance, and enforcement of each NAAQS promulgated by the EPA, which is commonly referred to as an ``infrastructure'' SIP. South Carolina certified that the South Carolina SIP contains provisions that ensure the 1997 8-hour ozone NAAQS is implemented, enforced, and maintained in South Carolina (hereafter referred to as ``infrastructure submission''). South Carolina's infrastructure submission, provided to EPA on December 13, 2007, addressed all the required infrastructure elements for the 1997 8-hour ozone NAAQS. Additionally, EPA is correcting an inadvertent error and responding to adverse comments received on EPA's March 17, 2011, proposed approval of South Carolina's December 13, 2007, infrastructure submission.

  9. A systematic review of children's dietary interventions with parents as change agents: Application of the RE-AIM framework.

    PubMed

    Schlechter, Chelsey R; Rosenkranz, Richard R; Guagliano, Justin M; Dzewaltowski, David A

    2016-10-01

    Interventions targeting children's dietary behavior often include strategies that target parents as implementation agents of change, though parent involvement on intervention effectiveness is unclear. The present study systematically assessed (1) reporting of reach, effectiveness, adoption, implementation and maintenance (RE-AIM) of child dietary intervention studies with parents as change agents and (2) evaluated within these studies the comparative effectiveness of interventions with and without a parent component. The search was conducted in PubMed, PsycINFO, and Cochrane Library. Eligible studies were required to include a condition with a parental component, a comparison/control group, and target a child dietary behavior outcome. Forty-nine articles met criteria. Raters extracted RE-AIM and parent implementation information for each study. Effectiveness (72.5%) was the highest reported RE-AIM element, followed by reach (27.5%), adoption (12.5%), implementation (10%), and maintenance (2.5%). Median reporting of parent implementation was highest for adoption and enactment (20%), followed by receipt (7.5%), and maintenance (2.5%). Six studies tested comparative effectiveness of parental involvement on child dietary outcomes. Current RE-AIM reporting among children's dietary interventions is inchoate. The contribution of parental involvement on intervention effectiveness remains unclear. Increased focus should be placed on reporting of external validity information, to enable better translation of research to practical applications. Copyright © 2016. Published by Elsevier Inc.

  10. Time maintenance system for the BMDO MSX spacecraft

    NASA Technical Reports Server (NTRS)

    Hermes, Martin J.

    1994-01-01

    The Johns Hopkins University Applied Physics Laboratory (APL) is responsible for designing and implementing a clock maintenance system for the Ballistic Missile Defense Organizations (BMDO) Midcourse Space Experiment (MSX) spacecraft. The MSX spacecraft has an on-board clock that will be used to control execution of time-dependent commands and to time tag all science and housekeeping data received from the spacecraft. MSX mission objectives have dictated that this spacecraft time, UTC(MSX), maintain a required accuracy with respect to UTC(USNO) of +/- 10 ms with a +/- 1 ms desired accuracy. APL's atomic time standards and the downlinked spacecraft time were used to develop a time maintenance system that will estimate the current MSX clock time offset during an APL pass and make estimates of the clock's drift and aging using the offset estimates from many passes. Using this information, the clock's accuracy will be maintained by uplinking periodic clock correction commands. The resulting time maintenance system is a combination of offset measurement, command/telemetry, and mission planning hardware and computing assets. All assets provide necessary inputs for deciding when corrections to the MSX spacecraft clock must be made to maintain its required accuracy without inhibiting other mission objectives. The MSX time maintenance system is described as a whole and the clock offset measurement subsystem, a unique combination of precision time maintenance and measurement hardware controlled by a Macintosh computer, is detailed. Simulations show that the system estimates the MSX clock offset to less than+/- 33 microseconds.

  11. Buying Into Maintenance.

    ERIC Educational Resources Information Center

    May, Abigail

    1998-01-01

    Describes how educational institutions are recognizing the short-sightedness of deferred maintenance. Discusses the challenges facing schools as they confront maintenance costs and what they must do to address the problem. Offers advice on proactive stances toward maintenance such as computerized work control processes, maintenance zones, and…

  12. [Perception of parental socialization strategies in adoptive and non-adoptive families].

    PubMed

    Bernedo Muñoz, Isabel María; Fuentes Rebollo, María Jesús; Fernández-Molina, M; Bersabé Morán, Rosa

    2007-11-01

    Although parental socialization styles have been investigated in recent years, little research has been carried out on the issue of parental styles in adoptive families. The aim of this research is to analyse parental styles both from the point of view of the parents and of adopted and non-adopted adolescents, taking as covariables the adolescents' sex and age. The sample was made up of 55 adopted adolescents (20 boys and 35 girls with an age range of 11-17 years) and their 55 adoptive parents, and 402 non-adopted adolescents (200 boys and 202 girls with an age range of 11-17 years), and their 258 parents. Two scales evaluated parental styles: the Affect Scale and the Rules and Demands Scale. The results showed that, both from the point of view of the parents and of the adolescents, adoptive families are more affective, communicative and inductive, and less critical and indulgent than non-adoptive families. No differences were found between adopted and non-adopted adolescents on the Parents' Rigidity Scale.

  13. 14 CFR 91.1425 - CAMP: Maintenance, preventive maintenance, and alteration programs.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... RULES Fractional Ownership Operations Program Management § 91.1425 CAMP: Maintenance, preventive maintenance, and alteration programs. Each program manager who maintains program aircraft under a CAMP must... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false CAMP: Maintenance, preventive maintenance...

  14. Independent Adoptions

    ERIC Educational Resources Information Center

    Meezan, William; And Others

    1978-01-01

    This summary report of a 2-year study of independent adoptions (without agencies) conducted by the Child Welfare League of America Research Center briefly describes the findings on the risks involved for the children and the adoptive and biological parents, relevant state laws, and agency policies that tend to turn away adoptive applications. (CM)

  15. Development of maintenance composite priority index for buildings in Palestine: A pilot case study

    NASA Astrophysics Data System (ADS)

    Issa, Amjad; Awad, Riyad

    2017-11-01

    The current building maintenance practices in Palestine are not based on scientific systematic methods. Most of the municipalities use one criterion to define the maintenance priorities, which is the "worst-first" criterion. Therefore, the current practices in defining buildings maintenance plans are not dealing with the known phases that are generally followed, including those in establishing building inventories, building condition survey, detailed visual inspection, identification of the proper maintenance and rehabilitation measures, and setting priorities. Accordingly, the recent preparation of the Operation and Maintenance (O&M) Manual for Palestinian municipalities is an important step to guide them towards preparing and implementing their O&M priority-based plans, considering scare resources. During the course of preparation of the Manual, the proposed procedures were applied at ten pilot municipalities. This study aims to explore the outcome of the implementation of the 2014/2015 O&M buildings maintenance priorities at these municipalities through the development of maintenance composite priority index (PI). The new proposed priority index is a scientific tool that will identify the priority of maintenance buildings through using a systematic procedure instead of first worst one. To achieve this, analyses of the outcome of a questionnaire designed to collect relevant information from these municipalities was conducted. The maintenance priority index for buildings is calculated considering different indicators among them building status (condition), classification and importance of the building, number of beneficiaries (users), safety aspects (severity level in the building), and people complaints. The main component of the PI is the building condition index (BCI) which forms about 40% of the total weight. The physical inspection, which is the main input for calculating the BCI, is conducted on two levels; the primary level, and the secondary level. The

  16. Maintaining Sibling Relationships for Children in Foster and Adoptive Placements.

    PubMed

    James, Sigrid; Monn, Amy R; Palinkas, Lawrence A; Leslie, Laurel K

    2008-01-01

    To better understand the nature of sibling relationships among children in foster or adoptive placement and the challenges and processes involved in maintaining these relationships, we conducted an exploratory analysis of data collected from semi-structured interviews with caregivers of 14 foster and adopted children in San Diego County. We identified three patterns of placement histories and living situations which appeared to impact the degree of contact maintained with siblings: (1) children who had never lived together and were not currently placed together; (2) children who at some point lived with or were placed together with their siblings, but were now separated from them; and (3) children who had lived with their siblings all their life and were placed together with at least some of their siblings at the time of the interview. Children's current living situations and placement histories, caregivers' experiences and perceptions of feasibility and desirability of sibling contact, and the sibling relationship itself are primary determinants in the development and maintenance of contact between siblings. Implications for child welfare policy and practice are discussed.

  17. Maintaining Sibling Relationships for Children in Foster and Adoptive Placements

    PubMed Central

    James, Sigrid; Monn, Amy R.; Palinkas, Lawrence A.; Leslie, Laurel K.

    2008-01-01

    To better understand the nature of sibling relationships among children in foster or adoptive placement and the challenges and processes involved in maintaining these relationships, we conducted an exploratory analysis of data collected from semi-structured interviews with caregivers of 14 foster and adopted children in San Diego County. We identified three patterns of placement histories and living situations which appeared to impact the degree of contact maintained with siblings: (1) children who had never lived together and were not currently placed together; (2) children who at some point lived with or were placed together with their siblings, but were now separated from them; and (3) children who had lived with their siblings all their life and were placed together with at least some of their siblings at the time of the interview. Children’s current living situations and placement histories, caregivers’ experiences and perceptions of feasibility and desirability of sibling contact, and the sibling relationship itself are primary determinants in the development and maintenance of contact between siblings. Implications for child welfare policy and practice are discussed. PMID:19122749

  18. Beliefs, intentions, and beyond: A qualitative study on the adoption of sustainable gastrointestinal nematode control practices in Flanders' dairy industry.

    PubMed

    Vande Velde, F; Charlier, J; Hudders, L; Cauberghe, V; Claerebout, E

    2018-05-01

    Emerging anthelmintic resistance emphasizes the need for sustainable control approaches against gastrointestinal nematode (GIN) infections in cattle. The uptake of diagnostic methods for sustainable control could enable more informed treatments and reduce excessive anthelmintic use. Unfortunately, the adoption of such methods remains relatively poor. A better understanding of farmers' motivations and behaviour would help to develop applicable advises and communication strategies for sustainable worm control strategies. A previous study created a general model for adoption intention of GIN diagnostics on dairy farms and measured the most important factors driving this intention (Vande Velde et al., 2015). The current research aimed to dig deeper into this model for the beliefs underlying these factors, and to identify additional factors impelling this specific behaviour. Data were collected through 22 semi-structured interviews with dairy farmers. Using analytic induction analysis, data were moved between deduction and induction. Results show that the adoption process of diagnostic methods for GIN occurs through three different phases: adoption intention, actual adoption and maintenance. Low infection awareness and low priority ('top of mind') of the disease are important barriers for adopting sustainable GIN control. Secondly, farmer behaviour is guided by two important social norms: the opinion of their veterinarian and their fellow farmers. However, farmers hold an incongruent relationship with both norms throughout different stages of behaviour: they do not value other farmers' opinions as a positive reference (intention phase), but follow and mimic their behaviour as a group (action phase). The veterinarian is seen as the most important positive reference, but also the responsible actor for GIN control. As such, the farmers do not hold themselves responsible for implementing sustainable control strategies. Thirdly, different types of motivations influence

  19. Accumulating Data to Optimally Predict Obesity Treatment (ADOPT) Core Measures: Environmental Domain.

    PubMed

    Saelens, Brian E; Arteaga, S Sonia; Berrigan, David; Ballard, Rachel M; Gorin, Amy A; Powell-Wiley, Tiffany M; Pratt, Charlotte; Reedy, Jill; Zenk, Shannon N

    2018-04-01

    There is growing interest in how environment is related to adults' weight and activity and eating behaviors. However, little is known about whether environmental factors are related to the individual variability seen in adults' intentional weight loss or maintenance outcomes. The environmental domain subgroup of the Accumulating Data to Optimally Predict obesity Treatment (ADOPT) Core Measures Project sought to identify a parsimonious set of objective and perceived neighborhood and social environment constructs and corresponding measures to include in the assessment of response to adult weight-loss treatment. Starting with the home address, the environmental domain subgroup recommended for inclusion in future weight-loss or maintenance studies constructs and measures related to walkability, perceived land use mix, food outlet accessibility (perceived and objective), perceived food availability, socioeconomics, and crime-related safety (perceived and objective) to characterize the home neighborhood environment. The subgroup also recommended constructs and measures related to social norms (perceived and objective) and perceived support to characterize an individual's social environment. The 12 neighborhood and social environment constructs and corresponding measures provide a succinct and comprehensive set to allow for more systematic examination of the impact of environment on adults' weight loss and maintenance. © 2018 The Obesity Society.

  20. Depot Maintenance: Executed Workload and Maintenance Operations at DOD Depots

    DTIC Science & Technology

    2017-02-03

    Page 1 GAO-17-82R Depot Maintenance 441 G St. N.W. Washington, DC 20548 February 3, 2017 The Honorable John McCain Chairman The...Smith Ranking Member Committee on Armed Services House of Representatives Depot Maintenance : Executed Workload and Maintenance Operations at DOD...Depots The Department of Defense (DOD) uses its maintenance capabilities to maintain, overhaul, and repair its military weapon systems (such as

  1. 78 FR 34903 - Approval and Promulgation of Air Quality Implementation Plans; Ohio; 1997 8-Hour Ozone...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-11

    ... Promulgation of Air Quality Implementation Plans; Ohio; 1997 8-Hour Ozone Maintenance Plan Revision; Motor... request by Ohio to revise the 1997 8-hour ozone maintenance air quality State Implementation Plan (SIP) to... area with budgets developed using EPA's Motor Vehicle Emissions Simulator (MOVES) emissions model. Ohio...

  2. 78 FR 54200 - Approval and Promulgation of Air Quality Implementation Plans; Indiana; Maintenance Plan Update...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-03

    ... County, Indiana for Sulfur Dioxide AGENCY: Environmental Protection Agency (EPA). ACTION: Proposed rule. SUMMARY: EPA is proposing to approve a maintenance plan update for the Lake County, Indiana sulfur dioxide...

  3. 40 CFR 256.03 - State plan submission, adoption, and revision.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... WASTES GUIDELINES FOR DEVELOPMENT AND IMPLEMENTATION OF STATE SOLID WASTE MANAGEMENT PLANS Purpose... promulgation of these guidelines. (b) Prior to submission to EPA, the plan shall be adopted by the State... requirements of these guidelines; (2) Information has become available which demonstrates the inadequacy of the...

  4. 40 CFR 256.03 - State plan submission, adoption, and revision.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... WASTES GUIDELINES FOR DEVELOPMENT AND IMPLEMENTATION OF STATE SOLID WASTE MANAGEMENT PLANS Purpose... promulgation of these guidelines. (b) Prior to submission to EPA, the plan shall be adopted by the State... requirements of these guidelines; (2) Information has become available which demonstrates the inadequacy of the...

  5. 40 CFR 256.03 - State plan submission, adoption, and revision.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... WASTES GUIDELINES FOR DEVELOPMENT AND IMPLEMENTATION OF STATE SOLID WASTE MANAGEMENT PLANS Purpose... promulgation of these guidelines. (b) Prior to submission to EPA, the plan shall be adopted by the State... requirements of these guidelines; (2) Information has become available which demonstrates the inadequacy of the...

  6. 40 CFR 256.03 - State plan submission, adoption, and revision.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... WASTES GUIDELINES FOR DEVELOPMENT AND IMPLEMENTATION OF STATE SOLID WASTE MANAGEMENT PLANS Purpose... promulgation of these guidelines. (b) Prior to submission to EPA, the plan shall be adopted by the State... requirements of these guidelines; (2) Information has become available which demonstrates the inadequacy of the...

  7. 40 CFR 256.03 - State plan submission, adoption, and revision.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... WASTES GUIDELINES FOR DEVELOPMENT AND IMPLEMENTATION OF STATE SOLID WASTE MANAGEMENT PLANS Purpose... promulgation of these guidelines. (b) Prior to submission to EPA, the plan shall be adopted by the State... requirements of these guidelines; (2) Information has become available which demonstrates the inadequacy of the...

  8. Challenges Facing Adoption of Information Communication Technology in African Universities

    ERIC Educational Resources Information Center

    Murgor, Titus Kiptoo

    2015-01-01

    A significant number of the universities and higher educational institutions have adopted the latest technology and implemented it productively, for the development of skilled human resource in respective area of specialization, as part of their responsibility. Information and communication Technology (ICT) has grown tremendously around the globe…

  9. Looking good or doing better? Patterns of decoupling in the implementation of clinical directorates.

    PubMed

    Mascia, Daniele; Morandi, Federica; Cicchetti, Americo

    2014-01-01

    The interest toward hospital restructuring has risen significantly in recent years. In spite of its potential benefits, often organizational restructuring in health care produces unexpected consequences. Extant research suggests that institutional theory provides a powerful theoretical lens through which hospital restructuring can be described and explained. According to this perspective, the effectiveness of change is strongly related to the extent to which innovative arrangements, tools, or practices are adopted and implemented within hospitals. Whenever these new arrangements require a substantial modification of internal processes and practices, resistance to implementation emerges and organizational change is likely to become neutralized. This study analyzes how hospital organizations engage in decoupling by adopting but not implementing a new organizational model named clinical directorate. We collected primary data on the diffusion of the clinical directorate model, which was mandated by law in the Italian National Health Service to improve hospital services. We surveyed the adoption and implementation of the clinical directorate model by monitoring the presence of clinical governance tools (measures for the quality improvement of hospital services) within single directorates. In particular, we compared hospitals that adopted the model before (early adopters) or after (later adopters) the mandate was introduced. Hospitals were engaged in decoupling by adopting the new arrangement but not implementing internal practices and tools for quality improvement. The introduction of the law significantly affected the decoupling, with late-adopter hospitals being less likely to implement the adopted model. The present research shows that changes in quality improvement processes may vary in relation to policy makers' interventions aimed at boosting the adoption of new hospital arrangements. Hospital administrators need to be aware and identify the institutional changes

  10. Implementation and evolution of a regional chronic disease self-management program.

    PubMed

    Liddy, Clare; Johnston, Sharon; Nash, Kate; Irving, Hannah; Davidson, Rachel

    2016-08-15

    To establish a comprehensive, community-based program to improve and sustain self-management support for individuals with chronic diseases and complement office-based strategies to support behaviour change. Health service delivery organizations. The Champlain Local Health Integration Network (LHIN), a health district in Eastern Ontario. We created Living Healthy Champlain (LHC), a regional organization providing peer leader training and coordination for the group Stanford Chronic Disease Self-Management Program (CDSMP); skills training and mentorship in behaviour change approaches for health care providers; and support to organizations to integrate self-management support into routine practice. We used the RE-AIM framework to evaluate the overall program's impact by exploring its reach, effectiveness, adoption, implementation and maintenance. A total of 232 Stanford CDSMP sessions (63 during the pilot project and 169 post-pilot) have been held at 127 locations in 24 cities across the Champlain LHIN, reaching approximately 4,000 patients. The effectiveness of the service was established through ongoing evidence reviews, a focus group and a pre-post utilization study of the pilot. LHC trained over 300 peer volunteers to provide the Stanford CDSMP sessions, 98 of whom continue to activelyhost workshops. An additional 1,327 providers have been trained in other models of self-management support, such as Health Coaching and Motivational Interviewing. Over the study period, LHC grew from a small pilot project to a regional initiative with sustainable provincial funding and was adopted by the province as a model for similar service delivery across Ontario. A community-based self-management program working in partnership with primary care can be effectively and broadly implemented in support of patients living with chronic conditions.

  11. Conceptual Frameworks for the Workplace Change Adoption Process: Elements Integration from Decision Making and Learning Cycle Process.

    PubMed

    Radin Umar, Radin Zaid; Sommerich, Carolyn M; Lavender, Steve A; Sanders, Elizabeth; Evans, Kevin D

    2018-05-14

    Sound workplace ergonomics and safety-related interventions may be resisted by employees, and this may be detrimental to multiple stakeholders. Understanding fundamental aspects of decision making, behavioral change, and learning cycles may provide insights into pathways influencing employees' acceptance of interventions. This manuscript reviews published literature on thinking processes and other topics relevant to decision making and incorporates the findings into two new conceptual frameworks of the workplace change adoption process. Such frameworks are useful for thinking about adoption in different ways and testing changes to traditional intervention implementation processes. Moving forward, it is recommended that future research focuses on systematic exploration of implementation process activities that integrate principles from the research literature on sensemaking, decision making, and learning processes. Such exploration may provide the groundwork for development of specific implementation strategies that are theoretically grounded and provide a revised understanding of how successful intervention adoption processes work.

  12. PRISMA: Program of Research to Integrate the Services for the Maintenance of Autonomy. A system-level integration model in Quebec

    PubMed Central

    MacAdam, Margaret

    2015-01-01

    The Program of Research to Integrate the Services for the Maintenance of Autonomy (PRISMA) began in Quebec in 1999. Evaluation results indicated that the PRISMA Project improved the system of care for the frail elderly at no additional cost. In 2001, the Quebec Ministry of Health and Social Services made implementing the six features of the PRISMA approach a province-wide goal in the programme now known as RSIPA (French acronym). Extensive Province-wide progress has been made since then, but ongoing challenges include reducing unmet need for case management and home care services, creating incentives for increased physician participation in care planning and improving the computerized client chart, among others. PRISMA is the only evaluated international model of a coordination approach to integration and one of the few, if not the only, integration model to have been adopted at the system level by policy-makers. PMID:26417212

  13. Knowledge elicitation techniques and application to nuclear plant maintenance

    NASA Astrophysics Data System (ADS)

    Doyle, E. Kevin

    The new millennium has brought with it the opportunity of global trade which in turn requires the utmost in efficiency from each individual industry. This includes the nuclear power industry, a point which was emphasized when the electrical generation industry began to be de regulated across North America the late 1990s and re-emphasized when the northeast power grid of North America collapsed in the summer of 2003. This dissertation deals with reducing the cost of the maintenance function of Candu nuclear power plants and initiating a strong link between universities and the Canadian nuclear industry. Various forms of RCM (reliability-centred maintenance) have been the tools of choice in industry for improving the maintenance function during the last 20 years. In this project, pilot studies, conducted at Bruce Power between 1999 and 2005, and reported on in this dissertation, lay out a path to implement statistical improvements as the next step after RCM in reducing the cost of the maintenance. Elicitation protocols, designed for the age group being elicited, address the much-documented issue of a lack of data. Clear, graphical, inferential statistical interfaces are accentuated and developed to aid in building the teams required to implement the various methodologies and to help in achieving funding targets. Graphical analysis and Crow/AMSAA (army materials systems analysis activity) plots are developed and demonstrated from the point of view of justifying the expenditures of cost reduction efforts. This dissertation ultimately speaks to the great opportunity being presented by this approach at this time: of capturing the baby-boom generation's huge pool of knowledge before those people retire. It is expected that the protocols and procedures referenced here will have applicability across the many disciplines where collecting expert information from a similar age group is required.

  14. Physician Peer Assessments for Compliance with Methadone Maintenance Treatment Guidelines

    ERIC Educational Resources Information Center

    Strike, Carol; Wenghofer, Elizabeth; Gnam, William; Hillier, Wade; Veldhuizen, Scott; Millson, Margaret

    2007-01-01

    Introduction: Medical associations and licensing bodies face pressure to implement quality assurance programs, but evidence-based models are lacking. To improve the quality of methadone maintenance treatment (MMT), the College of Physicians and Surgeons of Ontario, Canada, conducts an innovative quality assurance program on the basis of peer…

  15. Adopting Health Behavior Change Theory throughout the Clinical Practice Guideline Process

    ERIC Educational Resources Information Center

    Ceccato, Natalie E.; Ferris, Lorraine E.; Manuel, Douglas; Grimshaw, Jeremy M.

    2007-01-01

    Adopting a theoretical framework throughout the clinical practice guideline (CPG) process (development, dissemination, implementation, and evaluation) can be useful in systematically identifying, addressing, and explaining behavioral influences impacting CPG uptake and effectiveness. This article argues that using a theoretical framework should…

  16. Adopted daughters and adopted daughters-in-law in Taiwan: a mortality analysis

    PubMed Central

    Seabright, Edmond; Reynolds, Adam Z.; Cao, Jingzhe (Bill); Brown, Melissa J.

    2018-01-01

    Adoption is sometimes considered paradoxical from an evolutionary perspective because the costs spent supporting an adopted child would be better spent on rearing one's own. Kin selection theory is commonly used to solve this paradox, because the adoption of closely related kin contributes to the inclusive fitness of the adoptive parent. In this paper, we perform a novel test of kin selection theory in the context of adoption by asking whether adopted daughters-in-law, who contribute directly (i.e. genealogically) to the perpetuation of their adoptive families' lineages, experience lower mortality than daughters adopted for other purposes in historical Taiwan. We show that both classes of adopted daughter suffer lower mortality than biological daughters, but that the protective effect of adoption is stronger among daughters who were not adopted with the intention of perpetuating the family lineage. We speculate as to the possible benefits of such a pattern and emphasize the need to move beyond typological definitions of adoption to understand the specific costs and benefits involved in different forms of caring for others' children. PMID:29657778

  17. Adopted daughters and adopted daughters-in-law in Taiwan: a mortality analysis.

    PubMed

    Mattison, Siobhán M; Seabright, Edmond; Reynolds, Adam Z; Cao, Jingzhe Bill; Brown, Melissa J; Feldman, Marcus W

    2018-03-01

    Adoption is sometimes considered paradoxical from an evolutionary perspective because the costs spent supporting an adopted child would be better spent on rearing one's own. Kin selection theory is commonly used to solve this paradox, because the adoption of closely related kin contributes to the inclusive fitness of the adoptive parent. In this paper, we perform a novel test of kin selection theory in the context of adoption by asking whether adopted daughters-in-law, who contribute directly (i.e. genealogically) to the perpetuation of their adoptive families' lineages, experience lower mortality than daughters adopted for other purposes in historical Taiwan. We show that both classes of adopted daughter suffer lower mortality than biological daughters, but that the protective effect of adoption is stronger among daughters who were not adopted with the intention of perpetuating the family lineage. We speculate as to the possible benefits of such a pattern and emphasize the need to move beyond typological definitions of adoption to understand the specific costs and benefits involved in different forms of caring for others' children.

  18. Informed maintenance for next generation space transportation systems

    NASA Astrophysics Data System (ADS)

    Fox, Jack J.

    2001-02-01

    system software. This paper will summarize NASA's long-term strategy, development, and implementation plans for Informed Maintenance for next generation RLVs. This will be done through a convergence into a single IM vision the work being performed throughout NASA, industry and academia. Additionally, a current status of IM development throughout NASA programs such as the Space Shuttle, X-33, X-34 and X-37 will be provided and will conclude with an overview of near-term work that is being initiated in FY00 to support NASA's 2nd Generation Reusable Launch Vehicle Program. .

  19. Informed maintenance for next generation reusable launch systems

    NASA Astrophysics Data System (ADS)

    Fox, Jack J.; Gormley, Thomas J.

    2001-03-01

    system software. This paper will summarize NASA's long-term strategy, development, and implementation plans for Informed Maintenance for next generation RLVs. This will be done through a convergence into a single IM vision the work being performed throughout NASA, industry and academia. Additionally, a current status of IM development throughout NASA programs such as the Space Shuttle, X-33, X-34 and X-37 will be provided and will conclude with an overview of near-term work that is being initiated in FY00 to support NASA's 2 nd Generation Reusable Launch Vehicle Program.

  20. Effect of the implementation of the fluvial performance standard on maintenance of bridges and culverts.

    DOT National Transportation Integrated Search

    2013-08-01

    The objective of this project was to determine what factors influence maintenance cost of Oregon Department of Transportation (ODOT) stream-crossing structures. Data acquired for the project included structure characteristics, stream characteristics,...

  1. The engine maintenance scheduling by using reliability centered maintenance method and the identification of 5S application in PT. XYZ

    NASA Astrophysics Data System (ADS)

    Sembiring, N.; Panjaitan, N.; Saragih, A. F.

    2018-02-01

    PT. XYZ is a manufacturing company that produces fresh fruit bunches (FFB) to Crude Palm Oil (CPO) and Palm Kernel Oil (PKO). PT. XYZ consists of six work stations: receipt station, sterilizing station, thressing station, pressing station, clarification station, and kernelery station. So far, the company is still implementing corrective maintenance maintenance system for production machines where the machine repair is done after damage occurs. Problems at PT. XYZ is the absence of scheduling engine maintenance in a planned manner resulting in the engine often damaged which can disrupt the smooth production. Another factor that is the problem in this research is the kernel station environment that becomes less convenient for operators such as there are machines and equipment not used in the production area, slippery, muddy, scattered fibers, incomplete use of PPE, and lack of employee discipline. The most commonly damaged machine is in the seed processing station (kernel station) which is cake breaker conveyor machine. The solution of this problem is to propose a schedule plan for maintenance of the machine by using the method of reliability centered maintenance and also the application of 5S. The result of the application of Reliability Centered maintenance method is obtained four components that must be treated scheduled (time directed), namely: for bearing component is 37 days, gearbox component is 97 days, CBC pen component is 35 days and conveyor pedal component is 32 days While after identification the application of 5S obtained the proposed corporate environmental improvement measures in accordance with the principles of 5S where unused goods will be moved from the production area, grouping goods based on their use, determining the procedure of cleaning the production area, conducting inspection in the use of PPE, and making 5S slogans.

  2. Adoptive parenting and attachment: association of the internal working models between adoptive mothers and their late-adopted children during adolescence

    PubMed Central

    Pace, Cecilia S.; Di Folco, Simona; Guerriero, Viviana; Santona, Alessandra; Terrone, Grazia

    2015-01-01

    Introduction: Recent literature has shown that the good outcome of adoption would mostly depend on the quality of adoptive parenting, which is strongly associated with the security of parental internal working models (IWMs) of attachment. Specifically, attachment states-of-mind of adoptive mothers classified as free and autonomous and without lack of resolution of loss or trauma could represent a good protective factor for adopted children, previously maltreated and neglected. While most research on adoptive families focused on pre-school and school-aged children, the aim of this study was to assess the concordance of IWMs of attachment in adoptive dyads during adolescence. Method: Our pilot-study involved 76 participants: 30 adoptive mothers (mean age = 51.5 ± 4.3), and their 46 late-adopted adolescents (mean age = 13.9 ± 1.6), who were all aged 4–9 years old at time of adoption (mean age = 6.3 ± 1.5). Attachment representations of adopted adolescents were assessed by the Friend and Family Interview (FFI), while adoptive mothers’ state-of-mind with respect to attachment was classified by the Adult Attachment Interview (AAI). Adolescents’ verbal intelligence was controlled for. Results: Late-adopted adolescents were classified as follows: 67% secure, 26% dismissing, and 7% preoccupied in the FFI, while their adoptive mothers’ AAI classifications were 70% free-autonomous, 7% dismissing, and 23% unresolved. We found a significant concordance of 70% (32 dyads) between the secure–insecure FFI and AAI classifications. Specifically adoptive mothers with high coherence of transcript and low unresolved loss tend to have late-adopted children with high secure attachment, even if the adolescents’ verbal intelligence made a significant contribution to this prediction. Discussion: Our results provides an empirical contribution to the literature concerning the concordance of attachment in adoptive dyads, highlighting the beneficial impact of highly coherent

  3. Adoptive parenting and attachment: association of the internal working models between adoptive mothers and their late-adopted children during adolescence.

    PubMed

    Pace, Cecilia S; Di Folco, Simona; Guerriero, Viviana; Santona, Alessandra; Terrone, Grazia

    2015-01-01

    Recent literature has shown that the good outcome of adoption would mostly depend on the quality of adoptive parenting, which is strongly associated with the security of parental internal working models (IWMs) of attachment. Specifically, attachment states-of-mind of adoptive mothers classified as free and autonomous and without lack of resolution of loss or trauma could represent a good protective factor for adopted children, previously maltreated and neglected. While most research on adoptive families focused on pre-school and school-aged children, the aim of this study was to assess the concordance of IWMs of attachment in adoptive dyads during adolescence. Our pilot-study involved 76 participants: 30 adoptive mothers (mean age = 51.5 ± 4.3), and their 46 late-adopted adolescents (mean age = 13.9 ± 1.6), who were all aged 4-9 years old at time of adoption (mean age = 6.3 ± 1.5). Attachment representations of adopted adolescents were assessed by the Friend and Family Interview (FFI), while adoptive mothers' state-of-mind with respect to attachment was classified by the Adult Attachment Interview (AAI). Adolescents' verbal intelligence was controlled for. Late-adopted adolescents were classified as follows: 67% secure, 26% dismissing, and 7% preoccupied in the FFI, while their adoptive mothers' AAI classifications were 70% free-autonomous, 7% dismissing, and 23% unresolved. We found a significant concordance of 70% (32 dyads) between the secure-insecure FFI and AAI classifications. Specifically adoptive mothers with high coherence of transcript and low unresolved loss tend to have late-adopted children with high secure attachment, even if the adolescents' verbal intelligence made a significant contribution to this prediction. Our results provides an empirical contribution to the literature concerning the concordance of attachment in adoptive dyads, highlighting the beneficial impact of highly coherent states-of-mind of adoptive mothers on the attachment

  4. An Investigation of Faculty Abstention or Adoption of Technology

    ERIC Educational Resources Information Center

    Gersch, Carolyn

    2017-01-01

    Although faculty members are the front line adopters of technology in education, some appear to be unhurried to accept and use technology as part of their curriculum to meet institutional and student demands. The problem was that there was not a complete understanding of how faculty members made decisions on whether or not to implement new…

  5. Implementation of the fugitive emissions system program: The OxyChem experience

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Deshmukh, A.

    An overview is provided for the Fugitive Emissions System (FES) that has been implemented at Occidental Chemical in conjunction with the computer-based maintenance system called PassPort{reg_sign} developed by Indus Corporation. The goal of PassPort{reg_sign} FES program has been to interface with facilities data, equipment information, work standards and work orders. Along the way, several implementation hurdles had to be overcome before a monitoring and regulatory system could be standardized for the appropriate maintenance, process and environmental groups. This presentation includes step-by-step account of several case studies that developed during the implementation of the FES system.

  6. Promoting Adoption and Adaptation. A Handbook for Teacher Corps Projects.

    ERIC Educational Resources Information Center

    Center for New Schools, Inc., Chicago, IL.

    This handbook was designed to assist local Teacher Corps projects to plan and implement the Teacher Corps'"Fourth Outcome:" the adoption or adaptation of the project's educational improvement activities by other educational agencies and institutions. Section I provides an overview of seven scenarios which might be applicable to local…

  7. 78 FR 28497 - Approval and Promulgation of Air Quality Implementation Plans; Ohio; Canton-Massillon 1997 8-Hour...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-15

    ... Promulgation of Air Quality Implementation Plans; Ohio; Canton-Massillon 1997 8-Hour Ozone Maintenance Plan... the Canton-Massillon, Ohio 1997 8-hour ozone maintenance air quality State Implementation Plan (SIP... using EPA's Motor Vehicle Emissions Simulator (MOVES) emissions model. Ohio submitted the SIP revision...

  8. Adoption factors associated with electronic health record among long-term care facilities: a systematic review

    PubMed Central

    Kruse, Clemens Scott; Mileski, Michael; Alaytsev, Vyachelslav; Carol, Elizabeth; Williams, Ariana

    2015-01-01

    Objectives The Health Information Technology for Economic and Clinical Health (HITECH) Act created incentives for adopting electronic health records (EHRs) for some healthcare organisations, but long-term care (LTC) facilities are excluded from those incentives. There are realisable benefits of EHR adoption in LTC facilities; however, there is limited research about this topic. The purpose of this systematic literature review is to identify EHR adoption factors for LTC facilities that are ineligible for the HITECH Act incentives. Setting We conducted systematic searches of Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete via Ebson B. Stephens Company (EBSCO Host), Google Scholar and the university library search engine to collect data about EHR adoption factors in LTC facilities since 2009. Participants Search results were filtered by date range, full text, English language and academic journals (n=22). Interventions Multiple members of the research team read each article to confirm applicability and study conclusions. Primary and secondary outcome measures Researchers identified common themes across the literature: specifically facilitators and barriers to adoption of the EHR in LTC. Results Results identify facilitators and barriers associated with EHR adoption in LTC facilities. The most common facilitators include access to information and error reduction. The most prevalent barriers include initial costs, user perceptions and implementation problems. Conclusions Similarities span the system selection phases and implementation process; of those, cost was the most common mentioned. These commonalities should help leaders in LTC facilities align strategic decisions to EHR adoption. This review may be useful for decision-makers attempting successful EHR adoption, policymakers trying to increase adoption rates without expanding incentives and vendors that produce EHRs. PMID:25631311

  9. 47 CFR 80.1074 - Radio maintenance personnel for at-sea maintenance.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 47 Telecommunication 5 2012-10-01 2012-10-01 false Radio maintenance personnel for at-sea... System (GMDSS) General Provisions § 80.1074 Radio maintenance personnel for at-sea maintenance. (a) Ships that elect the at-sea option for maintenance of GMDSS equipment (see § 80.1105) must carry at least one...

  10. 47 CFR 80.1074 - Radio maintenance personnel for at-sea maintenance.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 5 2013-10-01 2013-10-01 false Radio maintenance personnel for at-sea... System (GMDSS) General Provisions § 80.1074 Radio maintenance personnel for at-sea maintenance. (a) Ships that elect the at-sea option for maintenance of GMDSS equipment (see § 80.1105) must carry at least one...

  11. 47 CFR 80.1074 - Radio maintenance personnel for at-sea maintenance.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 5 2014-10-01 2014-10-01 false Radio maintenance personnel for at-sea... System (GMDSS) General Provisions § 80.1074 Radio maintenance personnel for at-sea maintenance. (a) Ships that elect the at-sea option for maintenance of GMDSS equipment (see § 80.1105) must carry at least one...

  12. 47 CFR 80.1074 - Radio maintenance personnel for at-sea maintenance.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 5 2010-10-01 2010-10-01 false Radio maintenance personnel for at-sea... System (GMDSS) General Provisions § 80.1074 Radio maintenance personnel for at-sea maintenance. (a) Ships that elect the at-sea option for maintenance of GMDSS equipment (see § 80.1105) must carry at least one...

  13. 47 CFR 80.1074 - Radio maintenance personnel for at-sea maintenance.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 47 Telecommunication 5 2011-10-01 2011-10-01 false Radio maintenance personnel for at-sea... System (GMDSS) General Provisions § 80.1074 Radio maintenance personnel for at-sea maintenance. (a) Ships that elect the at-sea option for maintenance of GMDSS equipment (see § 80.1105) must carry at least one...

  14. Applying Psychological Theories to Promote Long-Term Maintenance of Health Behaviors

    PubMed Central

    Joseph, Rodney P.; Daniel, Casey L.; Thind, Herpreet; Benitez, Tanya J.; Pekmezi, Dori

    2014-01-01

    Behavioral health theory provides a framework for researchers to design, implement, and evaluate the effects of health promotion programs. However, limited research has examined theories used in interventions to promote long-term maintenance of health behaviors. The purpose of this review was to evaluate the available literature and identify prominent behavioral health theories used in intervention research to promote maintenance of health behaviors. We reviewed theories used in intervention research assessing long-term maintenance (≥ 6 months post-intervention) of physical activity, weight loss, and smoking cessation. Five prominent behavioral theories were referenced by the 34 studies included in the review: Self-Determination Theory, Theory of Planned Behavior, Social Cognitive Theory, Transtheoretical Model, and Social Ecological Model. Descriptions and examples of applications of these theories are provided. Implications for future research are discussed. PMID:28217036

  15. The Impact of Hybrid Electric Vehicles Incentives on Demand and the Determinants of Hybrid-Vehicle Adoption

    NASA Astrophysics Data System (ADS)

    Riggieri, Alison

    According to the Energy Information Administration, transportation currently accounts for over 60% of U.S. oil demand (E.I.A. 2010). Improving automobile energy efficiency could therefore reduce oil consumption and the negative environmental effects of automobile use. Subsidies for energy-efficient technologies such as hybrid-electric vehicles have gained political popularity since their introduction into the market and therefore have been implemented with increasing frequency. After the introduction of hybrid-electric vehicles into the U.S. market, the federal government initially implemented a 2000 federal tax deduction for these vehicles (later increased to a 3500 credit). Many states followed, offering various exemptions, such as high-occupancy vehicle (HOV) lane use, and excise-tax, sales-tax, and income-tax exemptions. Because not all states have implemented these subsidies, this policy topic is an ideal candidate for an outcome evaluation using an observational study postulation. States adopt incentives for different reasons based on factors that make adoption more attractive, however, so it is first necessary to identify these differences that predict policy adoption. This allows for the evaluative work to control for self selection bias. Three classes of internal determinants of policy adoption, political context, problem severity, and institutional support, and one type of external diffusion factor, are tested using logistic regression. Results suggest that the number of neighboring states that have already adopted incentives are consistently a determinant of diffusion for all three types of incentives test, HOV lane exemptions, sales-tax exemptions, and income-tax exemptions. In terms of internal factors, constituent support, a type of political context, predicts, sale-tax, income-tax, and HOV lane exemptions, but that the other two classes of determinants, problem severity and institutional support, were not universally significant across types of

  16. Adoptive Families: Out of the Shadows = Les familes adoptives: sortent de l'ombre.

    ERIC Educational Resources Information Center

    Theilheimer, Ish, Ed.

    1992-01-01

    This theme issue deals with adoption. "Adoption in Canada: A Profile," provides statistics on public and private adoption, as well as demographic characteristics on adoption applicants and children placed for adoption. It also discusses current adoption legislation. "Abandoning Ownership: A Philosophical Approach to Adoption"…

  17. Testing the evidence integration triangle for implementation of interventions to manage behavioral and psychological symptoms associated with dementia: Protocol for a pragmatic trial.

    PubMed

    Resnick, Barbara; Kolanowski, Ann; Van Haitsma, Kimberly; Galik, Elizabeth; Boltz, Marie; Ellis, Jeanette; Behrens, Liza; Flanagan, Nina M; Eshraghi, Karen J; Zhu, Shijun

    2018-06-01

    Behavioral and psychological symptoms of dementia (BPSD) include aggression, agitation, resistiveness to care, depression, anxiety, apathy, and hallucinations. BPSD are common in nursing home residents and can be ameliorated using person-centered approaches. Despite regulatory requirements, less than 2% of nursing homes consistently implement person-centered behavioral approaches. In a National Institute of Nursing Research-funded research protocol, we are implementing a pragmatic cluster randomized clinical trial designed to enable staff in nursing homes to reduce BPSD using behavioral approaches while optimizing function, preventing adverse events, and improving quality of life of residents. The implementation is based on use of the Evidence Integration Triangle (EIT), a parsimonious, community-engaged participatory framework that is well suited to the complexity and variability in the nursing home environment. A total of 50 nursing home communities will be randomized to EIT-4-BPSD or education only. Primary Aim 1 is to determine if communities exposed to EIT-4-BPSD demonstrate evidence of implementation evaluated by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) criteria. Primary Aim 2 is to evaluate the feasibility, utility, and cost of the EIT approach in EIT-4-BPSD communities. © 2018 Wiley Periodicals, Inc.

  18. 76 FR 2066 - Approval and Promulgation of Implementation Plans; Indiana; Removal of Vehicle Inspection and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-12

    ... ozone maintenance plans. The Indiana Department of Environmental Management (IDEM) submitted this... Promulgation of Implementation Plans; Indiana; Removal of Vehicle Inspection and Maintenance Programs for Clark... to allow the State to discontinue the vehicle inspection and maintenance (I/M) program in Clark and...

  19. Use of the Equity Implementation Model to Review Clinical System Implementation Efforts

    PubMed Central

    Lauer, Thomas W.; Joshi, Kailash; Browdy, Thomas

    2000-01-01

    This paper presents the equity implementation model (EIM) in the context of a case that describes the implementation of a medical scheduling system. The model is based on equity theory, a well-established theory in the social sciences that has been tested in hundreds of experimental and field studies. The predictions of equity theory have been supported in organizational, societal, family, and other social settings. Thus, the EIM helps provide a theory-based understanding for collecting and reviewing users' reactions to, and acceptance or rejection of, a new technology or system. The case study (implementation of a patient scheduling and appointment setting system in a large health maintenance organization) illustrates how the EIM can be used to examine users' reactions to the implementation of a new system. PMID:10641966

  20. 78 FR 34965 - Approval and Promulgation of Air Quality Implementation Plans; Ohio; 1997 8-Hour Ozone...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-11

    ... Promulgation of Air Quality Implementation Plans; Ohio; 1997 8-Hour Ozone Maintenance Plan Revision; Motor... request by Ohio to revise the 1997 8-hour ozone maintenance air quality State Implementation Plan (SIP...) emissions model. Ohio submitted the SIP revision request to EPA on December 7, 2012. DATES: Comments must be...

  1. Maintenance Management Update.

    ERIC Educational Resources Information Center

    Sternloff, Robert E.

    1987-01-01

    Current trends in park maintenance are overviewed, including maintenance impact statements, avoidance of cost through efficient use and national resource conservation, horticultural accomplishments that influence maintenance management, and vandalism prevention. (CB)

  2. Bridge maintenance program for the City of Columbia, Missouri : tech transfer summary.

    DOT National Transportation Integrated Search

    2017-09-01

    The primary goal of this research was to extend the service lives of bridges in Columbia, Missouri. The overarching objective of the project was to develop bridge maintenance and preservation guidelines that focus on practical and implementable techn...

  3. The ABPN Maintenance of Certification Program for Psychiatrists: Past History, Current Status, and Future Directions

    ERIC Educational Resources Information Center

    Faulkner, Larry R.; Tivnan, Patricia W.; Winstead, Daniel K.; Reus, Victor I.; Andrade, Naleen N.; Brooks, Beth Ann; Colenda, Christopher C.; Mrazek, David A.; Reifler, Burton V.; Schneidman, Barbara

    2008-01-01

    Objective: To describe the American Board of Psychiatry and Neurology (ABPN) Maintenance of Certification Program, its underlying rationale, how it will be implemented now, and what it might look like in the future. Methods: The authors describe the philosophical foundation, specific components, and the implementation timeline of the ABPN…

  4. 78 FR 28551 - Approval and Promulgation of Air Quality Implementation Plans; Ohio; Canton-Massillon 1997 8-Hour...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-15

    ... Promulgation of Air Quality Implementation Plans; Ohio; Canton-Massillon 1997 8-Hour Ozone Maintenance Plan..., Ohio, 1997 8-hour ozone maintenance air quality State Implementation Plan (SIP) under the Clean Air Act... Motor Vehicle Emissions Simulator (MOVES) emissions model. Ohio submitted the SIP revision request to...

  5. 25 CFR Appendix A to Subpart G - List of Activities Eligible for Funding Under BIA Transportation Facility Maintenance Program

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., Subpt. G, App. A Appendix A to Subpart G—List of Activities Eligible for Funding Under BIA..., or purchasing of maintenance equipment. 13. Paying utilities cost for roadway lighting and traffic signals. 14. Purchasing maintenance materials. 15. Developing, implementing, and maintaining an IRR...

  6. Research on gesture recognition of augmented reality maintenance guiding system based on improved SVM

    NASA Astrophysics Data System (ADS)

    Zhao, Shouwei; Zhang, Yong; Zhou, Bin; Ma, Dongxi

    2014-09-01

    Interaction is one of the key techniques of augmented reality (AR) maintenance guiding system. Because of the complexity of the maintenance guiding system's image background and the high dimensionality of gesture characteristics, the whole process of gesture recognition can be divided into three stages which are gesture segmentation, gesture characteristic feature modeling and trick recognition. In segmentation stage, for solving the misrecognition of skin-like region, a segmentation algorithm combing background mode and skin color to preclude some skin-like regions is adopted. In gesture characteristic feature modeling of image attributes stage, plenty of characteristic features are analyzed and acquired, such as structure characteristics, Hu invariant moments features and Fourier descriptor. In trick recognition stage, a classifier based on Support Vector Machine (SVM) is introduced into the augmented reality maintenance guiding process. SVM is a novel learning method based on statistical learning theory, processing academic foundation and excellent learning ability, having a lot of issues in machine learning area and special advantages in dealing with small samples, non-linear pattern recognition at high dimension. The gesture recognition of augmented reality maintenance guiding system is realized by SVM after the granulation of all the characteristic features. The experimental results of the simulation of number gesture recognition and its application in augmented reality maintenance guiding system show that the real-time performance and robustness of gesture recognition of AR maintenance guiding system can be greatly enhanced by improved SVM.

  7. Releasing pre-adoption birth records: the impact of Oregon's experience on its vital records department.

    PubMed

    Barfield, Wanda D; Rhodes, Julia C; Kohn, Melvin A; Hedberg, Katrina; Schoendorf, Kenneth C

    2002-01-01

    In November 1998, Oregon voters passed Ballot Measure 58, which allowed Oregon adoptees > or = 21 years of age access to their original birth records, which are sealed at adoption. The objective of this study was to evaluate the impact of the measure on the Oregon Health Division (since renamed Oregon Health Services) by assessing procedures used and resources needed after implementation of Measure 58. Vital records employees were interviewed about processing, storage, and archive retrieval procedures for pre-adoption birth records before, during, and after the implementation of Measure 58 and the effect on their usual workload. Personnel time, space, and fiscal resources used to process requests for pre-adoption records were also calculated. The Oregon Health Division began to receive requests from adoptees immediately following the passage of Measure 58 in November 1998, but due to legal challenges, they could not be processed until May 31, 2000. From June 2, 2000, through October 20, 2000, 12 staff members and two supervisors issued more than 4,700 pre-adoption birth records while also processing their normal workload, which averages more than 135,400 vital record orders annually. Due to the need for retrieval from archives, requests for pre-adoption birth records were estimated to take 75 hours to process vs. 2-3 minutes for standard requests. Each batch of approximately 75 pre-adoption birth records required approximately 12.5 person-hours from vital records staff and 3-4 person-hours from archive personnel; in addition, supervisors spent time responding to incomplete orders, informing the public and the media, and responding to concerns of adoptees, birth parents, and adoptive parents. Fewer than 1% of requests went unfilled. Implementation of Measure 58 utilized substantial resources of the Oregon Health Division. States contemplating similar legislation should consider increasing personnel and resources, preparing for intense public and media interest, and

  8. Tools and Techniques for Evaluating the Effects of Maintenance Resource Management (MRM) in Air Safety

    NASA Technical Reports Server (NTRS)

    Taylor, James C.

    2002-01-01

    This research project was designed as part of a larger effort to help Human Factors (HF) implementers, and others in the aviation maintenance community, understand, evaluate, and validate the impact of Maintenance Resource Management (MRM) training programs, and other MRM interventions; on participant attitudes, opinions, behaviors, and ultimately on enhanced safety performance. It includes research and development of evaluation methodology as well as examination of psychological constructs and correlates of maintainer performance. In particular, during 2001, three issues were addressed. First a prototype process for measuring performance was developed and used. Second an automated calculator was developed to aid the HF implementer user in analyzing and evaluating local survey data. These results include being automatically compared with the experience from all MRM programs studied since 1991. Third the core survey (the Maintenance Resource Management Technical Operations Questionnaire, or 'MRM/TOQ') was further developed and tested to include topics of added relevance to the industry.

  9. 'Adoption and attachment theory' the attachment models of adoptive mothers and the revision of attachment patterns of their late-adopted children.

    PubMed

    Pace, C S; Zavattini, G C

    2011-01-01

    This study examined the attachment patterns of late-adopted children (aged 4-7) and their adoptive mothers during the first 7- to 8-month period after adoption and aimed to evaluate the effect of adoptive mothers' attachment security on the revision of the attachment patterns of their late-adopted children. We assessed attachment patterns in 20 adoptive dyads and 12 genetically related dyads at two different times: T1 (time 1) within 2 months of adoption and T2 (time 2) 6 months after T1. The children's behavioural attachment patterns were assessed using the Separation-Reunion Procedure and the children's representational (verbal) attachment patterns using the Manchester Child Attachment Story Task. The attachment models of the adoptive mothers were classified using the Adult Attachment Interview. We found that there was a significant enhancement of the late-adopted children's attachment security across the time period considered (P= 0.008). Moreover, all the late-adopted children who showed a change from insecurity to security had adoptive mothers with secure attachment models (P= 0.044). However, the matching between maternal attachment models and late-adopted children's attachment patterns (behaviours and representations) was not significant. Our data suggest that revision of the attachment patterns in the late-adopted children is possible but gradual, and that the adoptive mothers' attachment security makes it more likely to occur. © 2010 Blackwell Publishing Ltd.

  10. 78 FR 34965 - Approval and Promulgation of Air Quality Implementation Plans; Ohio; Lima 1997 8-Hour Ozone...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-11

    ... Promulgation of Air Quality Implementation Plans; Ohio; Lima 1997 8-Hour Ozone Maintenance Plan Revision; Motor... 1997 8-hour ozone maintenance air quality State Implementation Plan (SIP) to replace the previously... Simulator (MOVES) emissions model. Ohio submitted the SIP revision request to EPA on January 11, 2013. DATES...

  11. 78 FR 34906 - Approval and Promulgation of Air Quality Implementation Plans; Ohio; Lima 1997 8-Hour Ozone...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-11

    ... Promulgation of Air Quality Implementation Plans; Ohio; Lima 1997 8-Hour Ozone Maintenance Plan Revision to... Lima, Ohio 1997 8-hour ozone maintenance air quality State Implementation Plan (SIP) to replace motor... (MOVES) emissions model. Ohio submitted the SIP revision request to EPA on January 11, 2013. DATES: This...

  12. 76 FR 28195 - Approval and Promulgation of Air Quality Implementation Plans; New Mexico; Sunland Park 1-Hour...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-16

    ... Promulgation of Air Quality Implementation Plans; New Mexico; Sunland Park 1-Hour Ozone Maintenance Plan AGENCY... the New Mexico State Implementation Plan (SIP). The revision consists of a maintenance plan for Sunland Park, New Mexico developed to ensure continued attainment of the 8-hour ozone National Ambient Air...

  13. Adoption & Foster Care

    MedlinePlus

    ... Family Life > Family Dynamics > Adoption & Foster Care Adoption & Foster Care Article Body ​Each year, many children join families through adoption and foster care. These families may face unique challenges. The ...

  14. A Thematic Analysis of Health Care Workers' Adoption of Mindfulness Practices.

    PubMed

    Valley, Morgan; Stallones, Lorann

    2018-05-01

    Mindfulness training, which teaches individuals to bring awareness and acceptance to the present moment, has been effective in improving the well-being of health care workers. Limited research examines the adoption of mindfulness practices using health behavior theories. The current study sought to conceptualize hospital health care workers' experiences in adopting mindfulness practices using the Health Belief Model (HBM), a theoretical framework used by health promotion practitioners to design and implement health behavior change interventions. Hospital health care workers in Colorado participated in an 8-week Mindfulness-Based Stress Reduction (MBSR) course. Participants ( n = 19) answered open-ended questions about their experiences adopting mindfulness practices. A theory-driven thematic analysis approach was used to analyze data with key constructs of the HBM acting as the framework for the analysis. Results showed that HBM constructs, including internal cues to action, perceived benefits and barriers, and self-efficacy, helped portray the participants' experiences and challenges in adopting and adhering to the mindfulness practices taught in the MBSR course.

  15. Accepting adoption's uncertainty: the limited ethics of pre-adoption genetic testing.

    PubMed

    Leighton, Kimberly J

    2014-06-01

    An increasing number of children are adopted in the United States from countries where both medical care and environmental conditions are extremely poor. In response to worries about the accuracy of medical histories, prospective adoptive parents increasingly request genetic testing of children prior to adoption. Though a general consensus on the ethics of pre-adoption genetic testing (PAGT) argues against permitting genetic testing on children available for adoption that is not also permitted for children in general, a view gaining traction argues for expanding the tests permitted. The reasoning behind this view is that the State has a duty to provide a child with parents who are the best "match," and thus all information that advances this end should be obtained. While the matching argument aims to promote the best interests of children, I show how it rests on the claim that what is in the best interests of children available for adoption is for prospective adoptive parents to have their genetic preferences satisfied such that the "genetics" of the children they end up adopting accurately reflects those preferences. Instead of protecting a vulnerable population, I conclude, PAGT contributes to the risks of harm such children face as it encourages people with strong genetic preferences to adopt children whose genetic backgrounds will always be uncertain.

  16. Aviation Maintenance Technology. General. G101 Aviation Mathematics and Physics. Instructor Material.

    ERIC Educational Resources Information Center

    Oklahoma State Board of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

    These instructor materials for an aviation maintenance technology course contain three instructional modules covering safety, aviation mathematics, and aviation physics. Each module may contain an introduction and module objective, specific objectives, an instructor's module implementation guide, technical information supplements, transparency…

  17. Work Flow Analysis Report Consisting of Work Management - Preventive Maintenance - Materials and Equipment

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    JENNINGS, T.L.

    The Work Flow analysis Report will be used to facilitate the requirements for implementing the Work Control module of Passport. The report consists of workflow integration processes for Work Management, Preventative Maintenance, Materials and Equipment

  18. 14 CFR 91.407 - Operation after maintenance, preventive maintenance, rebuilding, or alteration.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... flies the aircraft, makes an operational check of the maintenance performed or alteration made, and logs... maintenance, preventive maintenance, rebuilding, or alteration. (a) No person may operate any aircraft that... 14 Aeronautics and Space 2 2012-01-01 2012-01-01 false Operation after maintenance, preventive...

  19. 14 CFR 91.407 - Operation after maintenance, preventive maintenance, rebuilding, or alteration.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... flies the aircraft, makes an operational check of the maintenance performed or alteration made, and logs... maintenance, preventive maintenance, rebuilding, or alteration. (a) No person may operate any aircraft that... 14 Aeronautics and Space 2 2013-01-01 2013-01-01 false Operation after maintenance, preventive...

  20. 14 CFR 91.407 - Operation after maintenance, preventive maintenance, rebuilding, or alteration.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... flies the aircraft, makes an operational check of the maintenance performed or alteration made, and logs... maintenance, preventive maintenance, rebuilding, or alteration. (a) No person may operate any aircraft that... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Operation after maintenance, preventive...

  1. 14 CFR 91.407 - Operation after maintenance, preventive maintenance, rebuilding, or alteration.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... flies the aircraft, makes an operational check of the maintenance performed or alteration made, and logs... maintenance, preventive maintenance, rebuilding, or alteration. (a) No person may operate any aircraft that... 14 Aeronautics and Space 2 2011-01-01 2011-01-01 false Operation after maintenance, preventive...

  2. 14 CFR 91.407 - Operation after maintenance, preventive maintenance, rebuilding, or alteration.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... flies the aircraft, makes an operational check of the maintenance performed or alteration made, and logs... maintenance, preventive maintenance, rebuilding, or alteration. (a) No person may operate any aircraft that... 14 Aeronautics and Space 2 2014-01-01 2014-01-01 false Operation after maintenance, preventive...

  3. Maintenance Business Plans.

    ERIC Educational Resources Information Center

    Adams, Matt

    2002-01-01

    Discusses maintenance business plans, statements which provide accountability for facilities maintenance organizations' considerable budgets. Discusses the plan's components: statement of plan objectives, macro and detailed description of the facility assets, maintenance function descriptions, description of key performance indicators, milestone…

  4. A Study of Self-Esteem in Adopted Non-adopted Adolescents.

    ERIC Educational Resources Information Center

    Steward, Robbie J.; Lynn, Betty Jane

    This study tested the hypothesis that adopted adolescents have lower self-esteem than do non-adopted adolescents. Male and female students (N=159) between the ages of 18 and 22 were conveniently sampled from college undergraduate populations. Forty-four of the participants reported adoptive status. Each participant completed the Coopersmith…

  5. Implementation guidelines for road weather information systems

    DOT National Transportation Integrated Search

    1997-11-01

    The report presents guidelines for implementing road weather information systems (RWIS). These guidelines will assist highway agency personnel with the planning, installation, and maintenance of road weather information systems for either ice or high...

  6. Implementing injury surveillance systems alongside injury prevention programs: evaluation of an online surveillance system in a community setting.

    PubMed

    Ekegren, Christina L; Donaldson, Alex; Gabbe, Belinda J; Finch, Caroline F

    Previous research aimed at improving injury surveillance standards has focused mainly on issues of data quality rather than upon the implementation of surveillance systems. There are numerous settings where injury surveillance is not mandatory and having a better understanding of the barriers to conducting injury surveillance would lead to improved implementation strategies. One such setting is community sport, where a lack of available epidemiological data has impaired efforts to reduce injury. This study aimed to i) evaluate use of an injury surveillance system following delivery of an implementation strategy; and ii) investigate factors influencing the implementation of the system in community sports clubs. A total of 78 clubs were targeted for implementation of an online injury surveillance system (approximately 4000 athletes) in five community Australian football leagues concurrently enrolled in a pragmatic trial of an injury prevention program called FootyFirst. System implementation was evaluated quantitatively, using the RE-AIM framework, and qualitatively, via semi-structured interviews with targeted-users. Across the 78 clubs, there was 69% reach, 44% adoption, 23% implementation and 9% maintenance. Reach and adoption were highest in those leagues receiving concurrent support for the delivery of FootyFirst. Targeted-users identified several barriers and facilitators to implementation including personal (e.g. belief in the importance of injury surveillance), socio-contextual (e.g. understaffing and athlete underreporting) and systems factors (e.g. the time taken to upload injury data into the online system). The injury surveillance system was implemented and maintained by a small proportion of clubs. Outcomes were best in those leagues receiving concurrent support for the delivery of FootyFirst, suggesting that engagement with personnel at all levels can enhance uptake of surveillance systems. Interview findings suggest that increased uptake could also be

  7. Identifying Strategies Programs Adopt to Meet Healthy Eating and Physical Activity Standards in Afterschool Programs

    ERIC Educational Resources Information Center

    Weaver, Robert G.; Moore, Justin B.; Turner-McGrievy, Brie; Saunders, Ruth; Beighle, Aaron; Khan, M. Mahmud; Chandler, Jessica; Brazendale, Keith; Randell, Allison; Webster, Collin; Beets, Michael W.

    2017-01-01

    Background: The YMCA of USA has adopted Healthy Eating and Physical Activity (HEPA) Standards for its afterschool programs (ASPs). Little is known about strategies YMCA ASPs are implementing to achieve Standards and these strategies' effectiveness. Aims: (1) Identify strategies implemented in YMCA ASPs and (2) evaluate the relationship between…

  8. Implementation of a Legionella Ordinance for Multifamily Housing, Garland, Texas.

    PubMed

    Whitney, Ellen A; Blake, Sarah; Berkelman, Ruth L

    The incidence of legionellosis has sharply increased in the United States as a result of contaminated water systems. Jurisdictions across the country are considering whether to develop and implement regulations to protect individuals against Legionnaires' disease with its associated high morbidity and mortality. This article sheds light on the implementation and effectiveness of a 2005 citywide Legionella testing mandate of multifamily housing cooling towers in Garland, Texas. This ordinance has been in place for more than 10 years and represents the first of its kind in the United States to mandate routine testing of cooling towers for Legionella in multifamily housing. We utilized a mix of both qualitative and quantitative methods to explore the development, adoption, and implementation of the ordinance. Phone interviews were conducted with individuals from the City of Garland Health Department and apartment managers. Quantitative data included public health surveillance data on legionellosis. Barriers and facilitators of implementation, number and percentage of cooling towers from multifamily housing units that tested positive for Legionella by year, and number of legionellosis cases by year in Garland, Texas. Study outcomes highlight key themes that facilitated the successful implementation of the Legionella testing mandate, including the importance of timing, leadership support, stakeholder engagement, and education and outreach. The number of contaminated cooling towers was reduced over time. Mandatory monitoring for legionella in a local jurisdiction may result in reduced risk of legionellosis from cooling towers through raising awareness and education of building owners and managers about the need to prevent, detect, and remediate legionella contamination in their building water systems. Garland, Texas, broke new ground in the United States in moving toward primary prevention of legionellosis. The ordinance may be useful both in serving to educate and

  9. CONTEMPORARY SITUATIONS AND PROBLEMS OF ROAD/BRIDGE MAINTENANCE TECHNICAL COOPERATION PROJECTS

    NASA Astrophysics Data System (ADS)

    Nishimiya, Noriaki; Sanui, Kazumasa; Mizota, Yuzo

    It is widely acknowledged that roads are the most important transport infrastructure in developing countries. Unlike railroads requiring organizations and systems to operate, individuals can drive on roads. Almost all donors have assisted developing countr ies for new road constructions and rehabilitations. Report of insufficient maintenance in the developing countries, however, has been notable. As a result of the maintenance problems, deterioration of roads is pr ogressing with speed more than expected. It causes the traffic safety problems and an obstacle of economic development. JICA and other donors recognize that this situation can not be overlooked and reci pient countries are increasing their expectation of obtaining assistance on road/bridge maintenance. JICA has implemented over 10 technical cooper ation projects for road/b ridge maintenance in developing countries. JICA conducted a study to review those projects comprehensively. That study aims at obtaining problems, lessons learned and discussion material for policy making and method improvement for future similar pr ojects. This report introduces the outline of the study including additional analysis and recommendations by the authors.

  10. Clinician Attitudes Toward Adoption of Pediatric Emergency Telemedicine in Rural Hospitals.

    PubMed

    Ray, Kristin N; Felmet, Kathryn A; Hamilton, Melinda F; Kuza, Courtney C; Saladino, Richard A; Schultz, Brian R; Watson, R Scott; Kahn, Jeremy M

    2017-04-01

    Although there is growing evidence regarding the utility of telemedicine in providing care for acutely ill children in underserved settings, adoption of pediatric emergency telemedicine remains limited, and little data exist to inform implementation efforts. Among clinician stakeholders, we examined attitudes regarding pediatric emergency telemedicine, including barriers to adoption in rural settings and potential strategies to overcome these barriers. Using a sequential mixed-methods approach, we first performed semistructured interviews with clinician stakeholders using thematic content analysis to generate a conceptual model for pediatric emergency telemedicine adoption. Based on this model, we then developed and fielded a survey to further examine attitudes regarding barriers to adoption and strategies to improve adoption. Factors influencing adoption of pediatric emergency telemedicine were identified and categorized into 3 domains: contextual factors (such as regional geography, hospital culture, and individual experience), perceived usefulness of pediatric emergency telemedicine, and perceived ease of use of pediatric emergency telemedicine. Within the domains of perceived usefulness and perceived ease of use, belief in the relative advantage of telemedicine was the most pronounced difference between telemedicine proponents and nonproponents. Strategies identified to improve adoption of telemedicine included patient-specific education, clinical protocols for use, decreasing response times, and simplifying the technology. More effective adoption of pediatric emergency telemedicine among clinicians will require addressing perceived usefulness and perceived ease of use in the context of local factors. Future studies should examine the impact of specific identified strategies on adoption of pediatric emergency telemedicine and patient outcomes in rural settings.

  11. Process Evaluation of an Effective Church-Based Diet Intervention: Body & Soul

    ERIC Educational Resources Information Center

    Campbell, Marci Kramish; Resnicow, Ken; Carr, Carol; Wang, Terry; Williams, Alexis

    2007-01-01

    Body & Soul has demonstrated effectiveness as a dietary intervention among African American church members. The process evaluation assessed relationships between program exposure and implementation factors and study outcomes and characterized factors important for adoption, implementation, and maintenance. Data sources included participant surveys…

  12. International Adoption: Issues of Acknowledgement of Adoption and Birth Culture.

    ERIC Educational Resources Information Center

    Trolley, Barbara C.; And Others

    1995-01-01

    Families who adopt children internationally are faced with not only the acknowledgement of the adoption but also the recognition of the child's birth culture. Thirty-four families were surveyed to assess issues regarding the relevance, frequency, and means of acknowledgement of the adoption and of the birth culture. Findings suggest ways adoption…

  13. A Successful Implementation Strategy to Support Adoption of Decision Making in Mental Health Services.

    PubMed

    MacDonald-Wilson, Kim L; Hutchison, Shari L; Karpov, Irina; Wittman, Paul; Deegan, Patricia E

    2017-04-01

    Individual involvement in treatment decisions with providers, often through the use of decision support aids, improves quality of care. This study investigates an implementation strategy to bring decision support to community mental health centers (CMHC). Fifty-two CMHCs implemented a decision support toolkit supported by a 12-month learning collaborative using the Breakthrough Series model. Participation in learning collaborative activities was high, indicating feasibility of the implementation model. Progress by staff in meeting process aims around utilization of components of the toolkit improved significantly over time (p < .0001). Survey responses by individuals in service corroborate successful implementation. Community-based providers were able to successfully implement decision support in mental health services as evidenced by improved process outcomes and sustained practices over 1 year through the structure of the learning collaborative model.

  14. The Role of Individual Differences in Employee Adoption of TQM Orientation.

    ERIC Educational Resources Information Center

    Coyle-Shapiro, Jacqueline A. -M.; Morrow, Paula C.

    2003-01-01

    Employee surveys before and 9 and 32 months after total quality management (TQM) implementation (n=186, 166, 118) identified three individual characteristics that collectively explained the variance in and better predicted TQM adoption: organizational commitment, trust in colleagues, and importance of higher-order needs for achievement and…

  15. Desktop Publishing: Organizational Considerations for Adoption and Implementation. TDC Research Report No. 6.

    ERIC Educational Resources Information Center

    Lee, Paul

    This report explores the implementation of desktop publishing in the Minnesota Extension Service (MES) and provides a framework for its implementation in other organizations. The document begins with historical background on the development of desktop publishing. Criteria for deciding whether to purchase a desktop publishing system, advantages and…

  16. Medical Issues in Adoption

    MedlinePlus

    ... adopted child, before, during, and after the adoption. Open Adoptions If you have an open or semi-open adoption — one in which you meet the mother ... able to get substantial health information. In an open adoption, you may help arrange the birth mother's ...

  17. Adoption of computer-assisted learning in medical education: the educators' perspective.

    PubMed

    Schifferdecker, Karen E; Berman, Norm B; Fall, Leslie H; Fischer, Martin R

    2012-11-01

    Computer-assisted learning (CAL) in medical education has been shown to be effective in the achievement of learning outcomes, but requires the input of significant resources and development time. This study examines the key elements and processes that led to the widespread adoption of a CAL program in undergraduate medical education, the Computer-assisted Learning in Paediatrics Program (CLIPP). It then considers the relative importance of elements drawn from existing theories and models for technology adoption and other studies on CAL in medical education to inform the future development, implementation and testing of CAL programs in medical education. The study used a mixed-methods explanatory design. All paediatric clerkship directors (CDs) using CLIPP were recruited to participate in a self-administered, online questionnaire. Semi-structured interviews were then conducted with a random sample of CDs to further explore the quantitative results. Factors that facilitated adoption included CLIPP's ability to fill gaps in exposure to core clinical problems, the use of a national curriculum, development by CDs, and the meeting of CDs' desires to improve teaching and student learning. An additional facilitating factor was that little time and effort were needed to implement CLIPP within a clerkship. The quantitative findings were mostly corroborated by the qualitative findings. This study indicates issues that are important in the consideration and future exploration of the development and implementation of CAL programs in medical education. The promise of CAL as a method of enhancing the process and outcomes of medical education, and its cost, increase the need for future CAL funders and developers to pay equal attention to the needs of potential adopters and the development process as they do to the content and tools in the CAL program. Important questions that remain on the optimal design, use and integration of CAL should be addressed in order to adequately inform

  18. Process evaluation of the Data-driven Quality Improvement in Primary Care (DQIP) trial: case study evaluation of adoption and maintenance of a complex intervention to reduce high-risk primary care prescribing

    PubMed Central

    Dreischulte, Tobias; Guthrie, Bruce

    2017-01-01

    Objective To explore how different practices responded to the Data-driven Quality Improvement in Primary Care (DQIP) intervention in terms of their adoption of the work, reorganisation to deliver the intended change in care to patients, and whether implementation was sustained over time. Design Mixed-methods parallel process evaluation of a cluster trial, reporting the comparative case study of purposively selected practices. Setting Ten (30%) primary care practices participating in the trial from Scotland, UK. Results Four practices were sampled because they had large rapid reductions in targeted prescribing. They all had internal agreement that the topic mattered, made early plans to implement including assigning responsibility for work and regularly evaluated progress. However, how they internally organised the work varied. Six practices were sampled because they had initial implementation failure. Implementation failure occurred at different stages depending on practice context, including internal disagreement about whether the work was worthwhile, and intention but lack of capacity to implement or sustain implementation due to unfilled posts or sickness. Practice context was not fixed, and most practices with initial failed implementation adapted to deliver at least some elements. All interviewed participants valued the intervention because it was an innovative way to address on an important aspect of safety (although one of the non-interviewed general practitioners in one practice disagreed with this). Participants felt that reviewing existing prescribing did influence their future initiation of targeted drugs, but raised concerns about sustainability. Conclusions Variation in implementation and effectiveness was associated with differences in how practices valued, engaged with and sustained the work required. Initial implementation failure varied with practice context, but was not static, with most practices at least partially implementing by the end of the

  19. Process evaluation of the Data-driven Quality Improvement in Primary Care (DQIP) trial: case study evaluation of adoption and maintenance of a complex intervention to reduce high-risk primary care prescribing.

    PubMed

    Grant, Aileen; Dreischulte, Tobias; Guthrie, Bruce

    2017-03-10

    To explore how different practices responded to the Data-driven Quality Improvement in Primary Care (DQIP) intervention in terms of their adoption of the work, reorganisation to deliver the intended change in care to patients, and whether implementation was sustained over time. Mixed-methods parallel process evaluation of a cluster trial, reporting the comparative case study of purposively selected practices. Ten (30%) primary care practices participating in the trial from Scotland, UK. Four practices were sampled because they had large rapid reductions in targeted prescribing. They all had internal agreement that the topic mattered, made early plans to implement including assigning responsibility for work and regularly evaluated progress. However, how they internally organised the work varied. Six practices were sampled because they had initial implementation failure. Implementation failure occurred at different stages depending on practice context, including internal disagreement about whether the work was worthwhile, and intention but lack of capacity to implement or sustain implementation due to unfilled posts or sickness. Practice context was not fixed, and most practices with initial failed implementation adapted to deliver at least some elements. All interviewed participants valued the intervention because it was an innovative way to address on an important aspect of safety (although one of the non-interviewed general practitioners in one practice disagreed with this). Participants felt that reviewing existing prescribing did influence their future initiation of targeted drugs, but raised concerns about sustainability. Variation in implementation and effectiveness was associated with differences in how practices valued, engaged with and sustained the work required. Initial implementation failure varied with practice context, but was not static, with most practices at least partially implementing by the end of the trial. Practices organised their delivery of

  20. Study protocol Implementation of the Veder contact method (VCM) in daily nursing home care for people with dementia: an evaluation based on the RE-AIM framework.

    PubMed

    Boersma, Petra; Van Weert, Julia C M; van Meijel, Berno; van de Ven, Peter M; Dröes, Rose-Marie

    2017-07-01

    People with dementia in nursing homes benefit from person-centred care methods. Studies examining the effect of these methods often fail to report about the implementation of these methods. The present study aims to describe the implementation of the Veder contact method (VCM) in daily nursing home care. A process analysis will be conducted based on qualitative data from focus groups with caregivers and interviews with key figures. To investigate whether the implementation of VCM is reflected in the attitude and behaviour of caregivers and in the behaviour and quality of life of people with dementia, a controlled observational cohort study will be conducted. Six nursing home wards implementing VCM will be compared with six control wards providing Care As Usual. Quantitative data from caregivers and residents will be collected before (T0), and 9-12 months after the implementation (T1). Qualitative analysis and multilevel analyses will be carried out on the collected data and structured based on the constructs of the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). By using the RE-AIM framework this study introduces a structured and comprehensive way of investigating the implementation process and implementation effectiveness of person-centred care methods in daily dementia care.