Using a Mixed-Methods RE-AIM Framework to Evaluate Community Health Programs for Older Latinas.

PubMed

Schwingel, Andiara; Gálvez, Patricia; Linares, Deborah; Sebastião, Emerson

2017-06-01

This study used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate a promotora-led community health program designed for Latinas ages 50 and older that sought to improve physical activity, nutrition, and stress management. A mixed-methods evaluation approach was administered at participant and organizational levels with a focus on the efficacy, adoption, implementation, and maintenance components of the RE-AIM theoretical model. The program was shown to be effective at improving participants' eating behaviors, increasing their physical activity levels, and lowering their depressive symptoms. Promotoras felt motivated and sufficiently prepared to deliver the program. Some implementation challenges were reported. More child care opportunities and an increased focus on mental well-being were suggested. The promotora delivery model has promise for program sustainability with both promotoras and participants alike expressing interest in leading future programs.

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…

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.

Physical activity interventions to promote positive youth development among indigenous youth: a RE-AIM review.

PubMed

Baillie, Colin P T; Galaviz, Karla I; Emiry, Kevin; Bruner, Mark W; Bruner, Brenda G; Lévesque, Lucie

2017-03-01

Physical activity (PA) programs are a promising strategy to promote positive youth development (PYD). It is not known if published reports provide sufficient information to promote the implementation of effective PYD in indigenous youth. The purpose of this study was to assess the extent to which published literature on PA programs that promote PYD in indigenous youth report on RE-AIM (reach, effectiveness, adoption, implementation, maintenance) indicators. A systematic literature search was conducted to identify articles reporting on PA programs that promote PYD in indigenous youth. The search yielded 8084 articles. A validated 21-item RE-AIM abstraction tool assessing internal and external validity factors was used to extract data from 10 articles meeting eligibility criteria. The most commonly reported dimensions were effectiveness (73 %), adoption (48 %), and maintenance (43 %). Reach (34 %) and implementation (30 %) were less often reported. Published research provides insufficient information to inform real-world implementation of PA programs to promote PYD in indigenous youth.

Translation of alcohol screening and brief intervention guidelines to pediatric trauma centers.

PubMed

Mello, Michael J; Bromberg, Julie; Baird, Janette; Nirenberg, Ted; Chun, Thomas; Lee, Christina; Linakis, James G

2013-10-01

As part of the American College of Surgeons verification to be a Level 1 trauma center, centers are required to have the capacity to identify trauma patients with risky alcohol use and provide an intervention. Despite supporting scientific evidence and national policy statements encouraging alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT), barriers still exist, which prevent the integration of SBIRT into clinical care. Study objectives of this multisite translational research study were to identify best practices for integrating SBIRT services into routine care for pediatric trauma patients, to measure changes in practice with adoption and implementation of a SBIRT policy, and to define barriers and opportunities for adoption and implementation of SBIRT services at pediatric trauma centers. This translational research study was conducted at seven US pediatric trauma centers during a 3-year period. Changes in SBIRT practice were measured through self-report and medical record review at three different study phases, namely, adoption, implementation, and maintenance phases. According to medical record review, at baseline, 11% of eligible patients were screened and received a brief intervention (if necessary) across all sites. After completion of the SBIRT technical assistance activities, all seven participating trauma centers had effectively developed, adopted, and implemented SBIRT policies for injured adolescent inpatients. Furthermore, across all sites, 73% of eligible patients received SBIRT services after both the implementation and maintenance phases. Opportunities and barriers for successful integration were identified. This model may serve as method for translating SBIRT services into practice within pediatric trauma centers.

National Dissemination of StrongWomen–Healthy Hearts: A Community-Based Program to Reduce Risk of Cardiovascular Disease Among Midlife and Older Women

PubMed Central

Seguin, Rebecca A.; Chui, Kenneth K. H.; Clark, Valerie; Corbin, Marilyn A.; Goldberg, Jeanne P.; Heidkamp-Young, Eleanor; Lichtenstein, Alice H.; Wiker, Nancy; Nelson, Miriam E.

2015-01-01

Objectives. We describe the national dissemination of an evidence-based community cardiovascular disease prevention program for midlife and older women using the RE-AIM (reach effectiveness adoption implementation maintenance) framework and share key lessons learned during translation. Methods. In a 2010 to 2014 collaboration between the StrongWomen program and the National Extension Association of Family and Consumer Sciences, we assessed reach, adoption, implementation, and maintenance using survey methods, and we assessed effectiveness using a pretest–posttest within-participants design, with weight change as the primary outcome. Results. Overall reach into the population was 15 per 10 000. Of 85 trained leaders, 41 (48%) adopted the program. During the 12-week intervention, weight decreased by 0.5 kilograms, fruit and vegetable intake increased by 2.1 servings per day, and physical activity increased by 1238 metabolic equivalent (MET)-minutes per week (all P < .001). Average fidelity score was 4.7 (out of possible 5). Eleven of 41 adopting leaders (27%) maintained the program. Conclusions. The StrongWomen–Healthy Hearts program can be implemented with high fidelity in a variety of settings while remaining effective. These data provide direction for program modification to improve impact as dissemination continues. PMID:26469644

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...

Beyond Strength: Participant Perspectives on the Benefits of an Older Adult Exercise Program

ERIC Educational Resources Information Center

Kohn, Marlana; Belza, Basia; Petrescu-Prahova, Miruna; Miyawaki, Christina E.

2016-01-01

This study examines the expected and experienced benefits among participants in Enhance®Fitness (EF), an evidence-based group physical activity program for older adults. We also describe the implications for program dissemination (reach, implementation, and maintenance) within the RE-AIM (reach, effectiveness, adoption, implementation, and…

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.

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.

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

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

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.

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…

Talking Health, A pragmatic randomized-controlled health literacy trial targeting sugar-sweetened beverage consumption among adults: Rationale, design & methods

PubMed Central

Zoellner, Jamie; Chen, Yvonnes; Davy, Brenda; You, Wen; Hedrick, Valisa; Corsi, Terri; Estabrooks, Paul

2014-01-01

High consumption of sugar-sweetened beverages (SSB) contributes to a wide range of poor health outcomes. Further, few US adults drink less than the recommended ≤8 ounces per day; and individuals with low socioeconomic, low health literacy status, and in rural areas are even less likely to meet recommendations. Unfortunately, few SSB behavioral interventions exist targeting adults, and none focus on low health literacy in rural areas. Talking Health, a type 1 effectiveness-implementation hybrid trial targeting adults in rural southwest Virginia, was developed using the RE-AIM planning and evaluation framework (reach, effectiveness, adoption, implementation, maintenance). The primary aim of this pragmatic randomized-controlled trial was to determine the effectiveness of a scalable 6-month intervention aimed at decreasing SSB consumption (SIPsmartER) when compared to a matched contact physical activity promotion control group (MoveMore). SIPsmartER was developed based upon the Theory of Planned Behavior and uses health literacy strategies to improve comprehension of the intervention content among participants. MoveMore is based on a research-tested intervention that was adapted to address all theory of planned behavior constructs and health literacy principles. Secondary aims include additional health outcomes (e.g., physical activity, weight) and reach, adoption, implementation, and maintenance indicators. This paper highlights the opportunities and considerations for developing health behavior trials that aim to determine intervention effectiveness, provide all study participants an opportunity to benefit from research participation, and collect key information on reach and the potential for organizational adoption, implementation, and maintenance with the longer-term goal of speeding translation into practice settings. PMID:24246819

Using the RE-AIM framework to evaluate a school-based municipal programme tripling time spent on PE.

PubMed

Nielsen, Jonas Vestergaard; Skovgaard, Thomas; Bredahl, Thomas Viskum Gjelstrup; Bugge, Anna; Wedderkopp, Niels; Klakk, Heidi

2018-06-01

Documenting the implementation of effective real-world programmes is considered an important step to support the translation of evidence into practice. Thus, the aim of this study was to identify factors influencing the adoption, implementation and maintenance of the Svendborgproject (SP) - an effective real-world programme comprising schools to implement triple the amount of physical education (PE) in pre-school to sixth grade in six primary schools in the municipality of Svendborg, Denmark. SP has been maintained for ten years and scaled up to all municipal schools since it was initiated in 2008. The Reach, Effectiveness, Adoption, Implementation and Maintenance framework (RE-AIM) was applied as an analytic tool through a convergent mixed method triangulation design. Results show that SP has been implemented with high fidelity and become an established part of the municipality and school identity. The successful implementation and dissemination of the programme has been enabled through the introduction of a predominantly bottom-up approach combined with simple non-negotiable requirements. The results show that this combination has led to a better fit of programmes to the individual school context while still obtaining high implementation fidelity. Finally, the early integration of research has legitimated and benefitted the programme. Copyright © 2018 Elsevier Ltd. All rights reserved.

Mixed method evaluation of the Virtual Traveller physically active lesson intervention: An analysis using the RE-AIM framework.

PubMed

Norris, E; Dunsmuir, S; Duke-Williams, O; Stamatakis, E; Shelton, N

2018-02-02

Physically active lessons integrating movement into academic content are a way to increase children's physical activity levels. Virtual Traveller was a physically active lesson intervention set in Year 4 (aged 8-9) primary school classes in Greater London, UK. Implemented by classroom teachers, it was a six-week intervention providing 10-min physically active Virtual Field Trips three times a week. The aim of this paper is to report the process evaluation of the Virtual Traveller randomized controlled trial according to RE-AIM framework criteria (Reach, Effectiveness, Adoption, Implementation and Maintenance). A mixed methods approach to evaluation was conducted with five intervention group classes. Six sources of data were collected via informed consent logs, teacher session logs, teacher and pupil questionnaires, teacher interviews and pupil focus groups. High participation and low attrition rates were identified (Reach) alongside positive evaluations of Virtual Traveller sessions from pupil and teachers (Effectiveness). Participants were from more deprived and ethnic backgrounds than local and national averages, with Virtual Traveller having the potential to be a free intervention (Adoption). 70% of sessions were delivered overall (Implementation) but no maintenance of the programme was evident at three month follow-up (Maintenance). Mixed method evaluation of Virtual Traveller showed potential for it to be implemented as a low-cost physically active lesson intervention in UK primary schools. Copyright © 2018 Elsevier Ltd. All rights reserved.

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

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.

A systematic RE-AIM review to assess sugar-sweetened beverage interventions for children and adolescents across the socio-ecological model

PubMed Central

Porter, Kathleen; Estabrooks, Paul; Zoellner, Jamie

2016-01-01

Background Sugar-sweetened beverage (SSB) consumption among children and adolescents is a determinant of childhood obesity. Many programs to reduce consumption across the socio-ecological model report significant positive results; however, the generalizability of the results, including whether reporting differences exist among socio-ecological strategy levels, is unknown. Objectives This systematic review aims to (1) examine the extent to which studies reported internal and external validity indicators defined by RE-AIM (reach, effectiveness, adoption, implementation, maintenance) and (2) assess reporting differences by socio-ecological level: intrapersonal/interpersonal (Level 1), environmental/policy (Level 2), multi-level (Combined Level). Methods Six major databases (PubMed, Web of Science, Cinahl, CAB Abstracts, ERIC, and Agiricola) systematic literature review was conducted to identify studies from 2004–2015 meeting inclusion criteria (targeting children aged 3–12, adolescents 13–17, and young adults 18 years, experimental/quasi-experimental, substantial SSB component). Interventions were categorized by socio-ecological level, and data were extracted using a validated RE-AIM protocol. A one-way ANOVA assessed differences between levels. Results There were 55 eligible studies (N) accepted, including 21 Level 1, 18 Level 2, and 16 Combined Level studies. Thirty-six (65%) were conducted in the USA, 19 (35%) internationally, and 39 (71%) were implemented in schools. Across levels, reporting averages were low for all RE-AIM dimensions (reach=29%, efficacy/effectiveness=45%, adoption=26%, implementation=27%, maintenance=14%). Level 2 studies had significantly lower reporting on reach and effectiveness (10% and 26%, respectively) compared to Level 1 (44%, 57%) or Combined Level studies (31%, 52%) (p<0.001). Adoption, implementation, and maintenance reporting did not vary among levels. Conclusion Interventions to reduce SSB in children and adolescents across the socio-ecological spectrum do not provide the necessary information for dissemination and implementation in community nutrition settings. Future interventions should address both internal and external validity to maximize population impact. PMID:27262383

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.

Reaching those most in need: a review of diabetes self-management interventions in disadvantaged populations.

PubMed

Eakin, Elizabeth G; Bull, Sheana S; Glasgow, Russell E; Mason, Mondi

2002-01-01

There has been increased recognition of the importance of developing diabetes self-management education (DSME) interventions that are effective with under-served and minority populations. Despite several recent studies in this area, there is to our knowledge no systematic review or synthesis of what has been learned from this research. An electronic literature search identified five formative evaluations and ten controlled DSME intervention trials focused on under-served (low-income, minority or aged) populations. The RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) evaluation framework was used to evaluate the controlled studies on the dimensions of reach, efficacy, adoption, implementation, and maintenance. Fifty percent of the studies identified reported on the percentage of patients who participated, and the percentages were highly variable. The methodological quality of the articles was generally good and the short-term results were encouraging, especially on behavioral outcomes. Data on adoption (representativeness of settings and clinicians who participate) and implementation were almost never reported. Studies of modalities in addition to group meetings are needed to increase the reach of DSME with under-served populations. The promising formative evaluation work that has been conducted needs to be extended for more systematic study of the process of intervention implementation and adaptation with special populations. Studies that explicitly address the community context and that address multiple issues related to public health impact of DSME interventions are recommended to enhance long-term results. Copyright 2002 John Wiley & Sons, Ltd.

Barriers to electronic prescribing: Nebraska pharmacists' perspective.

PubMed

Lander, Lina; Klepser, Donald G; Cochran, Gary L; Lomelin, Daniel E; Morien, Marsha

2013-01-01

Electronic prescribing (e-prescribing) and its accompanying clinical decision support capabilities have been promoted as means for reducing medication errors and improving efficiency. The objectives of this study were to identify the barriers to adoption of e-prescribing among nonparticipating Nebraska pharmacies and to describe how the lack of pharmacy participation impacts the ability of physicians to meet meaningful use criteria. We interviewed pharmacists and/or managers from nonparticipating pharmacies to determine barriers to the adoption of e-prescribing. We used open-ended questions and a structured questionnaire to capture participants' responses. Of the 23 participants, 10 (43%) reported plans to implement e-prescribing sometime in the future but delayed participation due to transaction fees and maintenance costs, as well as lack of demand from customers and prescribers to implement e-prescribing. Nine participants (39%) reported no intention to e-prescribe in the future, citing start-up costs for implementing e-prescribing, transaction fees and maintenance costs, happiness with the current system, and lack of understanding about e-prescribing's benefits and how to implement e-prescribing. The barriers to e-prescribing identified by both late adopters and those not willing to accept e-prescriptions were similar and were mainly initial costs and transaction fees associated with each new prescription. For some rural pharmacies, not participating in e-prescribing may be a rational business decision. To increase participation, waiving or reimbursing transaction fees, based on demographic or financial characteristics of the pharmacy, may be warranted. © 2012 National Rural Health Association.

The StrongWomen-Healthy Hearts program in Pennsylvania: RE-AIM analysis.

PubMed

Folta, Sara C; Lichtenstein, Alice H; Seguin, Rebecca A; Goldberg, Jeanne P; Corbin, Marilyn A; Wiker, Nancy; Gauker, Jodi; Chui, Kenneth; Nelson, Miriam E

2015-03-01

Dissemination of evidence-based programs is needed to reduce CVD risk among midlife and older women. The aim of this study is to examine the public health impact of StrongWomen-Healthy Hearts in Pennsylvania using the RE-AIM framework. Reach, adoption, implementation, and maintenance were assessed using qualitative and quantitative measures; effectiveness was assessed using a pretest-posttest within-participants design. Reach into the target population was 5 in 100,000. Compared to the target population, a greater percentage of participants were white, married, middle-class, and had a graduate degree. Effectiveness was demonstrated (weight loss -2.0 kg, p < 0.001). Adoption among trained leaders was high (83.3 %), as was fidelity in implementation (average score 9.3 of 10). No leaders maintained the program. To increase impact of the StrongWomen-Healthy Hearts Program, it will be important to lower the costs and modify the recruitment and training strategies to better reach low-income and minority women. Such strategies may also improve program maintenance.

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

40 CFR 51.350 - Applicability.

Code of Federal Regulations, 2010 CFR

2010-07-01

... applicable areas in detail and, consistent with § 51.372 of this subpart, shall include the legal authority... 40 Protection of Environment 2 2010-07-01 2010-07-01 false Applicability. 51.350 Section 51.350... PREPARATION, ADOPTION, AND SUBMITTAL OF IMPLEMENTATION PLANS Inspection/Maintenance Program Requirements § 51...

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

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

40 CFR 51.371 - On-road testing.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 2 2010-07-01 2010-07-01 false On-road testing. 51.371 Section 51.371... PREPARATION, ADOPTION, AND SUBMITTAL OF IMPLEMENTATION PLANS Inspection/Maintenance Program Requirements § 51.371 On-road testing. On-road testing is defined as testing of vehicles for conditions impacting the...

Universal Adolescent Depression Prevention Programs: A Review

ERIC Educational Resources Information Center

Carnevale, Teresa D.

2013-01-01

Although the subject of adolescent depression has gained significant attention, little is being done in the way of primary prevention. The purpose of this article is to conduct a review of the literature through the lens of the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. This review was conducted utilizing several…

RE-AIM Checklist for Integrating and Sustaining Tier 2 Social-Behavioral Interventions

ERIC Educational Resources Information Center

Cheney, Douglas A.; Yong, Minglee

2014-01-01

Even though evidence-based Tier 2 programs are now more commonly available, integrating and sustaining these interventions in schools remain challenging. RE-AIM, which stands for Reach, Effectiveness, Adoption, Implementation, and Maintenance, is a public health framework used to maximize the effectiveness of health promotion programs in…

Measurement properties of a novel survey to assess stages of organizational readiness for evidence-based interventions in community chronic disease prevention settings

PubMed Central

2012-01-01

Background There is a great deal of variation in the existing capacity of primary prevention programs and policies addressing chronic disease to deliver evidence-based interventions (EBIs). In order to develop and evaluate implementation strategies that are tailored to the appropriate level of capacity, there is a need for an easy-to-administer tool to stage organizational readiness for EBIs. Methods Based on theoretical frameworks, including Rogers’ Diffusion of Innovations, we developed a survey instrument to measure four domains representing stages of readiness for EBI: awareness, adoption, implementation, and maintenance. A separate scale representing organizational climate as a potential mediator of readiness for EBIs was also included in the survey. Twenty-three questions comprised the four domains, with four to nine items each, using a seven-point response scale. Representatives from obesity, asthma, diabetes, and tobacco prevention programs serving diverse populations in the United States were surveyed (N = 243); test-retest reliability was assessed with 92 respondents. Results Confirmatory factor analysis (CFA) was used to test and refine readiness scales. Test-retest reliability of the readiness scales, as measured by intraclass correlation, ranged from 0.47–0.71. CFA found good fit for the five-item adoption and implementation scales and resulted in revisions of the awareness and maintenance scales. The awareness scale was split into two two-item scales, representing community and agency awareness. The maintenance scale was split into five- and four-item scales, representing infrastructural maintenance and evaluation maintenance, respectively. Internal reliability of scales (Cronbach’s α) ranged from 0.66–0.78. The model for the final revised scales approached good fit, with most factor loadings >0.6 and all >0.4. Conclusions The lack of adequate measurement tools hinders progress in dissemination and implementation research. These preliminary results help fill this gap by describing the reliability and measurement properties of a theory-based tool; the short, user-friendly instrument may be useful to researchers and practitioners seeking to assess organizational readiness for EBIs across a variety of chronic disease prevention programs and settings. PMID:22800294

Measurement properties of a novel survey to assess stages of organizational readiness for evidence-based interventions in community chronic disease prevention settings.

PubMed

Stamatakis, Katherine A; McQueen, Amy; Filler, Carl; Boland, Elizabeth; Dreisinger, Mariah; Brownson, Ross C; Luke, Douglas A

2012-07-16

There is a great deal of variation in the existing capacity of primary prevention programs and policies addressing chronic disease to deliver evidence-based interventions (EBIs). In order to develop and evaluate implementation strategies that are tailored to the appropriate level of capacity, there is a need for an easy-to-administer tool to stage organizational readiness for EBIs. Based on theoretical frameworks, including Rogers' Diffusion of Innovations, we developed a survey instrument to measure four domains representing stages of readiness for EBI: awareness, adoption, implementation, and maintenance. A separate scale representing organizational climate as a potential mediator of readiness for EBIs was also included in the survey. Twenty-three questions comprised the four domains, with four to nine items each, using a seven-point response scale. Representatives from obesity, asthma, diabetes, and tobacco prevention programs serving diverse populations in the United States were surveyed (N=243); test-retest reliability was assessed with 92 respondents. Confirmatory factor analysis (CFA) was used to test and refine readiness scales. Test-retest reliability of the readiness scales, as measured by intraclass correlation, ranged from 0.47-0.71. CFA found good fit for the five-item adoption and implementation scales and resulted in revisions of the awareness and maintenance scales. The awareness scale was split into two two-item scales, representing community and agency awareness. The maintenance scale was split into five- and four-item scales, representing infrastructural maintenance and evaluation maintenance, respectively. Internal reliability of scales (Cronbach's α) ranged from 0.66-0.78. The model for the final revised scales approached good fit, with most factor loadings >0.6 and all >0.4. The lack of adequate measurement tools hinders progress in dissemination and implementation research. These preliminary results help fill this gap by describing the reliability and measurement properties of a theory-based tool; the short, user-friendly instrument may be useful to researchers and practitioners seeking to assess organizational readiness for EBIs across a variety of chronic disease prevention programs and settings.

Sustainability via Active Garden Education (SAGE): results from two feasibility pilot studies.

PubMed

Lee, Rebecca E; Parker, Nathan H; Soltero, Erica G; Ledoux, Tracey A; Mama, Scherezade K; McNeill, Lorna

2017-03-10

Low physical activity (PA) and fruit and vegetable (F&V) consumption in early childhood are continued public health challenges. This manuscript describes outcomes from two pilot studies for Sustainability via Active Garden Education (SAGE), a program designed to increase PA and F&V consumption among 3 to 5 year old children. SAGE was developed using community-based participatory research (CBPR) and delivered to children (N = 89) in early care and education centers (ECEC, N = 6) in two US cities. Children participated in 12 one-hour sessions that included songs, games, and interactive learning activities involving garden maintenance and taste tests. We evaluated reach, efficacy, adoption, implementation, and potential for maintenance of SAGE following the RE-AIM framework. Reach was evaluated by comparing demographic characteristics among SAGE participants and residents of target geographic areas. Efficacy was evaluated with accelerometer-measured PA, F&V consumption, and eating in the absence of hunger among children, parenting practices regarding PA, and home availability of F&V. Adoption was evaluated by the number of ECEC that participated relative to the number of ECEC that were recruited. Implementation was evaluated by completion rates of planned SAGE lessons and activities, and potential for maintenance was evaluated with a parent satisfaction survey. SAGE reached ECEC in neighborhoods representing a wide range of socioeconomic status, with participants' sociodemographic characteristics representing those of the intervention areas. Children significantly increased PA during SAGE lessons compared to usual lessons, but they also consumed more calories in the absence of hunger in post- vs. pre-intervention tests (both p < .05). Parent reports did not suggest changes in F&V consumption, parenting PA practices, or home F&V availability, possibly due to low parent engagement. ECEC had moderate-to-high implementation of SAGE lessons and curriculum. Potential for maintenance was strong, with parents rating SAGE favorably and reporting increases in knowledge about PA and nutrition guidelines for young children. SAGE successfully translated national PA guidelines to practice for young children but was less successful with nutrition guidelines. High adoption and implementation and favorable parent reports suggest high potential for program sustainability. Further work to engage parents and families of young children in ECEC-based PA and nutrition programming is needed.

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.

Fidelity to and comparative results across behavioral interventions evaluated through the RE-AIM framework: a systematic review.

PubMed

Harden, Samantha M; Gaglio, Bridget; Shoup, Jo Ann; Kinney, Kimberlee A; Johnson, Sallie Beth; Brito, Fabiana; Blackman, Kacie C A; Zoellner, Jamie M; Hill, Jennie L; Almeida, Fabio A; Glasgow, Russell E; Estabrooks, Paul A

2015-11-08

The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was developed to determine potential public health impact of interventions (i.e., programs, policy, and practice). The purpose of this systematic review was to determine (1) comparative results across accurately reported RE-AIM indicators, (2) relevant information when there remains under-reporting or misclassification of data across each dimension, (3) the degree to which authors intervened to improve outcomes related to each dimension, and (4) the number of articles reporting RE-AIM dimensions for a given study. In April 2013, a systematic search of the RE-AIM framework was completed in PubMed, PSYCHInfo, EbscoHost, Web of Science, and Scopus. Evidence was analyzed until January 2015. Eighty-two interventions that included empirical data related to at least one of the RE-AIM dimensions were included in the review. Across these interventions, they reached a median sample size of 320 participants (M = 4894 ± 28,256). Summarizing the effectiveness indicators, we found that: the average participation rate was 45 % (±28 %), 89 % of the interventions reported positive changes in the primary outcome and 11 interventions reported broader outcomes (e.g., quality of life). As for individual-level maintenance, 11 % of studies showed effects ≥6 months post-program. Average setting and staff adoption rates were 75 % (±32 %) and 79 % (±28 %), respectively. Interventions reported being delivered as intended (82 % (±16 %)) and 22 % intervention reported adaptations to delivery. There were insufficient data to determine average maintenance at the organizational level. Data on costs associated with each dimension were infrequent and disparate: four studies reported costs of recruitment, two reported intervention costs per participant, and two reported adoption costs. The RE-AIM framework has been employed in a variety of populations and settings for the planning, delivery, and evaluation of behavioral interventions. This review highlights inconsistencies in the degree to which authors reported each dimension in its entirety as well as inaccuracies in reporting indicators within each dimension. Further, there are few interventions that aim to improve outcomes related to reach, adoption, implementation, and maintenance.

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. Organisational factors (e.g. staffing and management changes, budget cuts) impeded long-term implementation. The findings from this study can be used for the development of successful implementation strategies for the Veder contact method and other person-centred care methods. © 2016 John Wiley & Sons Ltd.

National dissemination of StrongWomen – Healthy Hearts: A community-based program to reduce risk of cardiovascular disease among midlife and older women

USDA-ARS?s Scientific Manuscript database

Objective: We describe the national dissemination of an evidence-based community cardiovascular disease prevention program for midlife and older women using the RE-AIM (reach effectiveness adoption implementation maintenance) framework and share key lessons learned during translation. Methods: In a ...

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

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 intervention had reasonable adoption, though reach could have been better. Implementation was strong across both study groups, suggesting the promise of using web-based methods to disseminate and implement evidence-based interventions in faith-based settings and other areas where community health educators work to eliminate health disparities.

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,…

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.

Intervening in the local health system to improve diabetes care: lessons from a health service experiment in a poor urban neighborhood in India.

PubMed

Bhojani, Upendra; Kolsteren, Patrick; Criel, Bart; De Henauw, Stefaan; Beerenahally, Thriveni S; Verstraeten, Roos; Devadasan, Narayanan

2015-01-01

Many efficacious health service interventions to improve diabetes care are known. However, there is little evidence on whether such interventions are effective while delivered in real-world resource-constrained settings. To evaluate an intervention aimed at improving diabetes care using the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, and maintenance) framework. A quasi-experimental study was conducted in a poor urban neighborhood in South India. Four health facilities delivered the intervention (n=163 diabetes patients) and the four matched facilities served as control (n=154). The intervention included provision of culturally appropriate education to diabetes patients, use of generic medications, and standard treatment guidelines for diabetes management. Patients were surveyed before and after the 6-month intervention period. We did field observations and interviews with the doctors at the intervention facilities. Quantitative data were used to assess the reach of the intervention and its effectiveness on patients' knowledge, practice, healthcare expenditure, and glycemic control through a difference-in-differences analysis. Qualitative data were analyzed thematically to understand adoption, implementation, and maintenance of the intervention. Reach: Of those who visited intervention facilities, 52.3% were exposed to the education component and only 7.2% were prescribed generic medications. The doctors rarely used the standard treatment guidelines for diabetes management. The intervention did not have a statistically and clinically significant impact on the knowledge, healthcare expenditure, or glycemic control of the patients, with marginal reduction in their practice score. Adoption: All the facilities adopted the education component, while all but one facility adopted the prescription of generic medications. There was poor implementation of the intervention, particularly with regard to the use of generic medications and the standard treatment guidelines. Doctors' concerns about the efficacy, quality, availability, and acceptability by patients of generic medications explained limited prescriptions of generic medications. The patients' perception that ailments should be treated through medications limited the use of non-medical management by the doctors in early stages of diabetes. The other reason for the limited use of the standard treatment guidelines was that these doctors mainly provided follow-up care to patients who were previously put on a given treatment plan by specialists. Maintenance: The intervention facilities continued using posters and television monitors for health education after the intervention period. The use of generic medications and standard treatment guidelines for diabetes management remained very limited. Implementing efficacious health service intervention in a real-world resource-constrained setting is challenging and may not prove effective in improving patient outcomes. Interventions need to consider patients' and healthcare providers' experiences and perceptions and how macro-level policies translate into practice within local health systems.

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.

Beyond Strength: Participant Perspectives on the Benefits of an Older Adult Exercise Program.

PubMed

Kohn, Marlana; Belza, Basia; Petrescu-Prahova, Miruna; Miyawaki, Christina E

2016-06-01

This study examines the expected and experienced benefits among participants in Enhance®Fitness (EF), an evidence-based group physical activity program for older adults. We also describe the implications for program dissemination (reach, implementation, and maintenance) within the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Twenty semistructured interviews were conducted with EF participants enrolled from 2005 to 2012. Interviews were digitally recorded, professionally transcribed, and analyzed using a deductive approach. Participants were motivated to join EF for expected physical benefits and the social environment of a group-based class. Actualized benefits of participation included physical, social, functional, and improved self-image/sense of well-being. Participants valued the practical application of class exercises to daily activities that support independent living, such as lifting objects and completing household chores. Organizations looking to implement EF or improve existing EF classes can improve program reach, implementation, and maintenance by incorporating participants' expressed motivations and valued benefits in program marketing and by improving organizational support to meet participant needs. EF class instructors can tailor their classes to engage participants based on their motivations. Understanding participants' motivations and valued benefits can improve EF dissemination by meeting participant needs with tailored class offerings and organizational needs informed by participant insights that aid program sustainability. © 2015 Society for Public Health Education.

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

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.

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...

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...

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...

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...

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...

Evaluating an insurance-sponsored weight management program with the RE-AIM Model, West Virginia, 2004-2008.

PubMed

Abildso, Christiaan G; Zizzi, Sam J; Reger-Nash, Bill

2010-05-01

Evaluations of weight management programs in real-world settings are lacking. The RE-AIM model (reach, effectiveness, adoption, implementation, maintenance) was developed to address this deficiency. Our primary objective was to evaluate a 12-week insurance-sponsored weight management intervention by using the RE-AIM model, including short-term and long-term individual outcomes and setting-level implementation factors. Our secondary objective was to critique the RE-AIM model and its revised calculation methods. We created operational definitions for components of the 5 RE-AIM indices and used standardized effect size values from various statistical procedures to measure multiple components or outcomes within each index. We used chi(2) analysis to compare categorical variables and repeated-measures analysis of variance to assess the magnitude of outcome changes over time. On the basis of data for 1,952 participants and surveys completed by administrators at 23 sites, RE-AIM indices ranging from 0 to 100 revealed low program reach and adoption (5.4 and 8.8, respectively), moderate effectiveness (43.8), high implementation (91.4), low to moderate individual maintenance (21.2), and moderate to high site maintenance (77.8). Median (interquartile range) weight loss was 13 lb (6.5-21.4 lb) among participants who completed phase I (12 weeks; 76.5%) and 15 lb (6.1-30.3 lb) among those who completed phase II (1 year; 45.7%). This program had a significant, positive effect on participants and has been sustainable but needs to be expanded for more public health benefit. The RE-AIM model provided a useful framework to determine program strengths and weaknesses and to present them to the insurance agency and public health decision makers.

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.

Evaluation of a theory-driven e-learning intervention for future oral healthcare providers on secondary prevention of disordered eating behaviors.

PubMed

DeBate, Rita D; Severson, Herbert H; Cragun, Deborah L; Gau, Jeff M; Merrell, Laura K; Bleck, Jennifer R; Christiansen, Steve; Koerber, Anne; Tomar, Scott L; McCormack Brown, Kelli R; Tedesco, Lisa A; Hendricson, William

2013-06-01

Oral healthcare providers have a clinical opportunity for early detection of disordered eating behaviors because they are often the first health professionals to observe overt oral and physical signs. Curricula regarding early recognition of this oral/systemic medical condition are limited in oral health educational programs. Web-based learning can supplement and reinforce traditional learning and has the potential to develop skills. The study purpose was to determine the efficacy of a theory-driven Web-based training program to increase the capacity of oral health students to perform behaviors related to the secondary prevention of disordered eating behaviors. Using the Reach, Effectiveness, Adoption, Implementation and Maintenance evaluation framework, a longitudinal group-randomized controlled trial involving 27 oral health classes from 12 oral health education programs in the United States was implemented to assess the efficacy of the Web-based training on attitudes, knowledge, self-efficacy and skills related to the secondary prevention of disordered eating behaviors. Mixed-model analysis of covariance indicated substantial improvements among students in the intervention group (effect sizes: 0.51-0.83) on all six outcomes of interest. Results suggest that the Web-based training program may increase the capacity of oral healthcare providers to deliver secondary prevention of disordered eating behaviors. Implications and value of using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework are discussed.

Evaluation of a theory-driven e-learning intervention for future oral healthcare providers on secondary prevention of disordered eating behaviors

PubMed Central

DeBate, Rita D.; Severson, Herbert H.; Cragun, Deborah L.; Gau, Jeff M.; Merrell, Laura K.; Bleck, Jennifer R.; Christiansen, Steve; Koerber, Anne; Tomar, Scott L.; McCormack Brown, Kelli R.; Tedesco, Lisa A.; Hendricson, William

2013-01-01

Oral healthcare providers have a clinical opportunity for early detection of disordered eating behaviors because they are often the first health professionals to observe overt oral and physical signs. Curricula regarding early recognition of this oral/systemic medical condition are limited in oral health educational programs. Web-based learning can supplement and reinforce traditional learning and has the potential to develop skills. The study purpose was to determine the efficacy of a theory-driven Web-based training program to increase the capacity of oral health students to perform behaviors related to the secondary prevention of disordered eating behaviors. Using the Reach, Effectiveness, Adoption, Implementation and Maintenance evaluation framework, a longitudinal group-randomized controlled trial involving 27 oral health classes from 12 oral health education programs in the United States was implemented to assess the efficacy of the Web-based training on attitudes, knowledge, self-efficacy and skills related to the secondary prevention of disordered eating behaviors. Mixed-model analysis of covariance indicated substantial improvements among students in the intervention group (effect sizes: 0.51–0.83) on all six outcomes of interest. Results suggest that the Web-based training program may increase the capacity of oral healthcare providers to deliver secondary prevention of disordered eating behaviors. Implications and value of using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework are discussed. PMID:23564725

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 uptake and sustained use of cleaner cooking systems such as LPG. Understanding the determinants of adoption and sustained use of cleaner cooking systems through the RE-AIM framework will expand our insights on implementation of cleaner cooking systems among poor communities and will advance implementation science in the clean cooking sector. A thorough study of such implementation strategies is crucial to realize multiple UN Sustainable Development Goals on global health, climate change, and energy security.

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.

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.

Using the RE-AIM framework to evaluate a community-based summer camp for children with obesity: a prospective feasibility study.

PubMed

Burke, Shauna M; Shapiro, Sheree; Petrella, Robert J; Irwin, Jennifer D; Jackman, Michelle; Pearson, Erin S; Prapavessis, Harry; Shoemaker, Joel Kevin

2015-01-01

Increasing rates of childhood overweight and obesity highlight a need for the evaluation of lifestyle interventions. The purpose of the study was to determine the Reach, Effectiveness, Adoption, Implementation and Maintenance of a novel family-focused program targeting children with obesity (i.e., the Children's Health and Activity Modification Program [C.H.A.M.P.]) using the RE-AIM framework, an evaluation tool for community-based health interventions. A single-centre, single cohort interventional feasibility study was conducted over the course of two years. Children with obesity and their families completed a 4-week group-based lifestyle intervention in Year 1 (n = 15; M age = 10.6; 53% female) and/or Year 2 (n = 25; M age = 10.6; 56% female). Outcome variables were measured pre- and post-intervention, as well as 6- and 12-months following completion of the formal program. Overall, C.H.A.M.P. had high reach in terms of participant representativeness. In addition, participation in the program was associated with significantly improved standardized body mass index (BMI-z), body fat percentage, lean mass percentage, and child- and parent-proxy reported quality of life (QOL; effectiveness/individual maintenance). Furthermore, a number of community partnerships were built, strengthened, and maintained prior to, during, and following implementation of the two-year program (adoption/setting maintenance, respectively). Finally, the intervention was delivered as intended as evidenced by high adherence to the schedule, attendance rates, and cost effectiveness (implementation). Based on RE-AIM metrics, C.H.A.M.P. appears to be a promising childhood obesity program. The findings reported will inform researchers and practitioners on how to design and implement future community-based programs addressing pediatric obesity. ISRCTN Registry, Study ID ISRCTN13143236. Registered 27 March 2015.

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.

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 studies to extensively and continuously monitor the natural course of the implementation process of a WHPP by a formative evaluation using a mix of quantitative and qualitative methods on different organizational levels (i.e. management, project group, employees) with an embedded scientist on site. NTR2861.

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: Plans to continue activities were mainly dependent on identifying continued funding. RE-AIM provided a useful framework for evaluating Walking Works. No changes in walking behaviour were observed. This may have been due to barriers in using walking champions to deliver activities, programme components not being delivered as intended, the types of activities delivered, or lack of awareness and participation by employees. Recommendations are provided for researchers and practitioners implementing future whole-workplace walking programmes.

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.

Disseminating hypnosis to health care settings: Applying the RE-AIM framework

PubMed Central

Yeh, Vivian M.; Schnur, Julie B.; Montgomery, Guy H.

2014-01-01

Hypnosis is a brief intervention ready for wider dissemination in medical contexts. Overall, hypnosis remains underused despite evidence supporting its beneficial clinical impact. This review will evaluate the evidence supporting hypnosis for dissemination using guidelines formulated by Glasgow and colleagues (1999). Five dissemination dimensions will be considered: Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM). Reach In medical settings, hypnosis is capable of helping a diverse range of individuals with a wide variety of problems. Efficacy There is evidence supporting the use of hypnosis for chronic pain, acute pain and emotional distress arising from medical procedures and conditions, cancer treatment-related side-effects and irritable bowel syndrome. Adoption Although hypnosis is currently not a part of mainstream clinical practices, evidence suggests that patients and healthcare providers are open to trying hypnosis, and may become more so when educated about what hypnosis can do. Implementation Hypnosis is a brief intervention capable of being administered effectively by healthcare providers. Maintenance Given the low resource needs of hypnosis, opportunities for reimbursement, and the ability of the intervention to potentially help medical settings reduce costs, the intervention has the qualities necessary to be integrated into routine care in a self-sustaining way in medical settings. In sum, hypnosis is a promising candidate for further dissemination. PMID:25267941

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.

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.

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

Training survey -- educational profile for Hanford HANDI 2000 project

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

Wilson, D.

Fluor Daniel Hanford, Inc. (FDH) is currently adopting streamlined business processes through integrated software solutions. Replacing the legacy software (current/replacement systems, attached) also avoids significant maintenance required to resolve Year 2000 issues. This initiative is being referred to as `HANDI 2000`. The software being implemented in the first phase of this project includes Indus International`s PASSPORT Software, Peoplesoft and Primavera P3 Software. The project, which encompasses all the system replacements that will occur, has been named `HANDI 2000.` The PASSPORT applications being implemented are Inventory Management, Purchasing, Contract Management, Accounts Payable, and MSDS (Material Safety Data Sheets).

Minority acculturation and peer rejection: Costs of acculturation misfit with peer-group norms.

PubMed

Celeste, Laura; Meeussen, Loes; Verschueren, Karine; Phalet, Karen

2016-09-01

How do minority adolescents' personal acculturation preferences and peer norms of acculturation affect their social inclusion in school? Turkish and Moroccan minority adolescents (N = 681) reported their preferences for heritage culture maintenance, mainstream culture adoption, and their experiences of peer rejection as a key indicator of adjustment problems. Additionally, we aggregated peer acculturation norms of maintenance and adoption within ethnically diverse classrooms (N = 230 in 50 Belgian schools), distinguishing between co-ethnic (Turkish or Moroccan classmates only, N = 681) and cross-ethnic norms (also including N = 1,930 other classmates). Cross-ethnic peer-group norms (of adoption and maintenance) and co-ethnic norms (of maintenance, marginally) predicted minority experiences of peer rejection (controlling for ethnic composition). Moreover, misfit of minorities' own acculturation preferences with both cross-ethnic and co-ethnic peer-group norms was harmful. When cross-ethnic norms stressed adoption, 'integrationist' minority youth - who combined culture adoption with maintenance - experienced most peer rejection. Yet, when co-ethnic peers stressed maintenance, 'assimilationist' minority youth experienced most rejection. In conclusion, acculturation misfit with peer-group norms is a risk factor for minority inclusion in ethnically diverse environments. © 2016 The British Psychological Society.

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 for a large randomized clinical trial that will test the strategy against other implementation strategies, such as audit/feedback and academic detailing, used to close the gap between knowledge and practice. The systems consultation approach has the potential to shorten the famously long time it takes to implement evidence-based practices and clinical guidelines in healthcare.

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.

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.

Navy/Marine Corps Manager’s Desktop Guide for CALS Implementation. 2nd Edition

DTIC Science & Technology

1993-06-30

significant process and productivity that CALS initiatives are providing within the Navy infrastructure. CALS programs are on-line and working in today’s Navy...era of declining budgets, CALS is most important in enhancing logistic support productivity to maintain operations and improve readiness. Our...is to be accomplished through the general adoption of a set of procedures and staridards for the production , access, management, maintenance, and

Time for a second look at SOX compliance.

PubMed

Bigalke, John T; Burrill, Stephen J

2007-08-01

Incentives for tax-exempt healthcare organizations to comply with the Sarbanes-Oxley Act (SOX) abound from many quarters, including government, various associations, and the capital markets. New proposals from the Securities and Exchange Commission and the Public Company Accountability Oversight Board will streamline the processes of SOX compliance, even as the cost of compliance is dropping. Voluntary SOX compliance can best be achieved by adopting a four-phased control rationalization approach to implementation and maintenance.

45 CFR 1356.20 - State plan document and submission requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES... (FFP) in the costs of foster care maintenance payments and adoption assistance under this part, a State... and standards for the data reporting system for foster care and adoption (§ 1355.40 of this chapter...

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.

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.

The Maine Savvy Caregiver Project: translating an evidence-based dementia family caregiver program within the RE-AIM Framework.

PubMed

Samia, Linda W; Aboueissa, AbouEl-Makarim; Halloran, Jan; Hepburn, Kenneth

2014-01-01

This article presents findings of a 3-year Savvy Caregiver Program translational study designed with the RE-AIM framework to create a statewide sustainable infrastructure and improve dementia family caregiver outcomes in one rural state. The RE-AIM dimensions--reach, effectiveness, adoption, implementation and maintenance--were evaluated using mixed methods. The program reached 770 caregivers and 87.7% (n = 676) participated in the study with 60.5% (n = 409) residing in rural locations. Participants demonstrated improved confidence, fewer depressive symptoms, and better managed their situation. Trainer resources, partnerships, and adequate planning were essential for program adoption and sustainability. Implications for replication are discussed.

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 expressly granted.

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 protocol) methods, and assessment of implementation costs. Discussion If implementation is successful, the field will have a proven technology that helps Federally Qualified Health Centers and affiliated organizations provide addiction treatment and recovery support, as well as a proven strategy for implementing the technology. Seva also has the potential to improve core elements of addiction treatment, such as referral and treatment processes. A mobile technology for addiction treatment and accompanying implementation model could provide a cost-effective means to improve the lives of patients with drug and alcohol problems. Trial registration ClinicalTrials.gov (NCT01963234). PMID:24884976

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 implementation costs. If implementation is successful, the field will have a proven technology that helps Federally Qualified Health Centers and affiliated organizations provide addiction treatment and recovery support, as well as a proven strategy for implementing the technology. Seva also has the potential to improve core elements of addiction treatment, such as referral and treatment processes. A mobile technology for addiction treatment and accompanying implementation model could provide a cost-effective means to improve the lives of patients with drug and alcohol problems. ClinicalTrials.gov (NCT01963234).

A RE-AIM evaluation of evidence-based multi-level interventions to improve obesity-related behaviours in adults: a systematic review (the SPOTLIGHT project).

PubMed

Compernolle, Sofie; De Cocker, Katrien; Lakerveld, Jeroen; Mackenbach, Joreintje D; Nijpels, Giel; Oppert, Jean-Michel; Rutter, Harry; Teixeira, Pedro J; Cardon, Greet; De Bourdeaudhuij, Ilse

2014-12-06

This systematic literature review describes the potential public health impact of evidence-based multi-level interventions to improve obesity-related behaviours in adults, using the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework. Electronic databases (PubMed, Embase, and The Cochrane Library) were searched to identify intervention studies published between January 2000 and October 2013. The following inclusion criteria were used: (1) the study included at least one outcome measure assessing obesity-related behaviours (i.e. diet, physical activity or sedentary behaviour), (2) the study collected data over at least one year and (3) the study's intervention targeted adults, was conducted in a specified geographical area or worksite, and was multi-level (i.e. targeting both individual and environmental level). Evidence of RE-AIM of the selected interventions was assessed. Potential public health impact of an intervention was evaluated if information was provided on at least four of the five RE-AIM dimensions. Thirty-five multi-level interventions met the inclusion criteria. RE-AIM evaluation revealed that the included interventions generally had the potential to: reach a large number of people (on average 58% of the target population was aware of the intervention); achieve the assumed goals (89% found positive outcomes); be broadly adopted (the proportion of intervention deliverers varied from 9% to 92%) and be sustained (sixteen interventions were maintained). The highest potential public health impact was found in multi-level interventions that: 1) focused on all levels at the beginning of the planning process, 2) guided the implementation process using diffusion theory, and 3) used a website to disseminate the intervention. Although most studies underreported results within the RE-AIM dimensions, the reported Reach, Effectiveness, Adoption, Implementation and Maintenance were positively evaluated. However, more information on external validity and sustainability is needed in order to take informed decisions on the choice of interventions that should be implemented in real-world settings to accomplish long-term changes in obesity-related behaviours.

“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

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.

The Prospect of Internet of Things and Big Data Analytics in Transportation System

NASA Astrophysics Data System (ADS)

Noori Hussein, Waleed; Kamarudin, L. M.; Hussain, Haider N.; Zakaria, A.; Badlishah Ahmed, R.; Zahri, N. A. H.

2018-05-01

Internet of Things (IoT); the new dawn technology that describes how data, people and interconnected physical objects act based on communicated information, and big data analytics have been adopted by diverse domains for varying purposes. Manufacturing, agriculture, banks, oil and gas, healthcare, retail, hospitality, and food services are few of the sectors that have adopted and massively utilized IoT and big data analytics. The transportation industry is also an early adopter, with significant attendant effects on its processes of tracking shipment, freight monitoring, and transparent warehousing. This is recorded in countries like England, Singapore, Portugal, and Germany, while Malaysia is currently assessing the potentials and researching a purpose-driven adoption and implementation. This paper, based on review of related literature, presents a summary of the inherent prospects in adopting IoT and big data analytics in the Malaysia transportation system. Efficient and safe port environment, predictive maintenance and remote management, boundary-less software platform and connected ecosystem, among others, are the inherent benefits in the IoT and big data analytics for the Malaysia transportation system.

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.

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.

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.

A 3-Month Jump-Landing Training Program: A Feasibility Study Using the RE-AIM Framework

PubMed Central

Aerts, Inne; Cumps, Elke; Verhagen, Evert; Mathieu, Niels; Van Schuerbeeck, Sander; Meeusen, Romain

2013-01-01

Context: Evaluating the translatability and feasibility of an intervention program has become as important as determining the effectiveness of the intervention. Objective: To evaluate the applicability of a 3-month jump-landing training program in basketball players, using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Design: Randomized controlled trial. Setting: National and regional basketball teams. Patients or Other Participants: Twenty-four teams of the second highest national division and regional basketball divisions in Flanders, Belgium, were randomly assigned (1:1) to a control group and intervention group. A total of 243 athletes (control group = 129, intervention group = 114), ages 15 to 41 years, volunteered. Intervention(s): All exercises in the intervention program followed a progressive development, emphasizing lower extremity alignment during jump-landing activities. Main Outcome Measure(s): The results of the process evaluation of the intervention program were based on the 5 dimensions of the RE-AIM framework. The injury incidence density, hazard ratios, and 95% confidence intervals were determined. Results: The participation rate of the total sample was 100% (reach). The hazard ratio was different between the intervention group and the control group (0.40 [95% confidence interval = 0.16, 0.99]; effectiveness). Of the 12 teams in the intervention group, 8 teams (66.7%) agreed to participate in the study (adoption). Eight of the participating coaches (66.7%) felt positively about the intervention program and stated that they had implemented the training sessions of the program as intended (implementation). All coaches except 1 (87.5%) intended to continue the intervention program the next season (maintenance). Conclusions: Compliance of the coaches in this coach-supervised jump-landing training program was high. In addition, the program was effective in preventing lower extremity injuries. PMID:23675788

Mall Walking Program Environments, Features, and Participants: A Scoping Review.

PubMed

Farren, Laura; Belza, Basia; Allen, Peg; Brolliar, Sarah; Brown, David R; Cormier, Marc L; Janicek, Sarah; Jones, Dina L; King, Diane K; Marquez, David X; Rosenberg, Dori E

2015-08-13

Walking is a preferred and recommended physical activity for middle-aged and older adults, but many barriers exist, including concerns about safety (ie, personal security), falling, and inclement weather. Mall walking programs may overcome these barriers. The purpose of this study was to summarize the evidence on the health-related value of mall walking and mall walking programs. We conducted a scoping review of the literature to determine the features, environments, and benefits of mall walking programs using the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance). The inclusion criteria were articles that involved adults aged 45 years or older who walked in indoor or outdoor shopping malls. Exclusion criteria were articles that used malls as laboratory settings or focused on the mechanics of walking. We included published research studies, dissertations, theses, conference abstracts, syntheses, nonresearch articles, theoretical papers, editorials, reports, policy briefs, standards and guidelines, and nonresearch conference abstracts and proposals. Websites and articles written in a language other than English were excluded. We located 254 articles on mall walking; 32 articles met our inclusion criteria. We found that malls provided safe, accessible, and affordable exercise environments for middle-aged and older adults. Programmatic features such as program leaders, blood pressure checks, and warm-up exercises facilitated participation. Individual benefits of mall walking programs included improvements in physical, social, and emotional well-being. Limited transportation to the mall was a barrier to participation. We found the potential for mall walking programs to be implemented in various communities as a health promotion measure. However, the research on mall walking programs is limited and has weak study designs. More rigorous research is needed to define best practices for mall walking programs' reach, effectiveness, adoption, implementation, and maintenance.

Mall Walking Program Environments, Features, and Participants: A Scoping Review

PubMed Central

Belza, Basia; Allen, Peg; Brolliar, Sarah; Brown, David R.; Cormier, Marc L.; Janicek, Sarah; Jones, Dina L.; King, Diane K.; Marquez, David X.; Rosenberg, Dori E.

2015-01-01

Introduction Walking is a preferred and recommended physical activity for middle-aged and older adults, but many barriers exist, including concerns about safety (ie, personal security), falling, and inclement weather. Mall walking programs may overcome these barriers. The purpose of this study was to summarize the evidence on the health-related value of mall walking and mall walking programs. Methods We conducted a scoping review of the literature to determine the features, environments, and benefits of mall walking programs using the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance). The inclusion criteria were articles that involved adults aged 45 years or older who walked in indoor or outdoor shopping malls. Exclusion criteria were articles that used malls as laboratory settings or focused on the mechanics of walking. We included published research studies, dissertations, theses, conference abstracts, syntheses, nonresearch articles, theoretical papers, editorials, reports, policy briefs, standards and guidelines, and nonresearch conference abstracts and proposals. Websites and articles written in a language other than English were excluded. Results We located 254 articles on mall walking; 32 articles met our inclusion criteria. We found that malls provided safe, accessible, and affordable exercise environments for middle-aged and older adults. Programmatic features such as program leaders, blood pressure checks, and warm-up exercises facilitated participation. Individual benefits of mall walking programs included improvements in physical, social, and emotional well-being. Limited transportation to the mall was a barrier to participation. Conclusion We found the potential for mall walking programs to be implemented in various communities as a health promotion measure. However, the research on mall walking programs is limited and has weak study designs. More rigorous research is needed to define best practices for mall walking programs’ reach, effectiveness, adoption, implementation, and maintenance. PMID:26270743

A 3-month jump-landing training program: a feasibility study using the RE-AIM framework.

PubMed

Aerts, Inne; Cumps, Elke; Verhagen, Evert; Mathieu, Niels; Van Schuerbeeck, Sander; Meeusen, Romain

2013-01-01

Evaluating the translatability and feasibility of an intervention program has become as important as determining the effectiveness of the intervention. To evaluate the applicability of a 3-month jump-landing training program in basketball players, using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Randomized controlled trial. National and regional basketball teams. Twenty-four teams of the second highest national division and regional basketball divisions in Flanders, Belgium, were randomly assigned (1:1) to a control group and intervention group. A total of 243 athletes (control group = 129, intervention group = 114), ages 15 to 41 years, volunteered. All exercises in the intervention program followed a progressive development, emphasizing lower extremity alignment during jump-landing activities. The results of the process evaluation of the intervention program were based on the 5 dimensions of the RE-AIM framework. The injury incidence density, hazard ratios, and 95% confidence intervals were determined. The participation rate of the total sample was 100% (reach). The hazard ratio was different between the intervention group and the control group (0.40 [95% confidence interval = 0.16, 0.99]; effectiveness). Of the 12 teams in the intervention group, 8 teams (66.7%) agreed to participate in the study (adoption). Eight of the participating coaches (66.7%) felt positively about the intervention program and stated that they had implemented the training sessions of the program as intended (implementation). All coaches except 1 (87.5%) intended to continue the intervention program the next season (maintenance). Compliance of the coaches in this coach-supervised jump-landing training program was high. In addition, the program was effective in preventing lower extremity injuries.

Evaluation of a workplace intervention to promote commuter cycling: A RE-AIM analysis

PubMed Central

2013-01-01

Background Originating from the interdisciplinary collaboration between public health and the transportation field a workplace intervention to promote commuter cycling, ‘Bike to Work: cyclists are rewarded’, was implemented. The intervention consisted of two cycling contests, an online loyalty program based on earning ‘cycling points’ and the dissemination of information through folders, newsletters, posters and a website. The study purpose was to evaluate the dissemination efforts of the program and to gain insights in whether free participation could persuade small and middle-sized companies to sign up. Methods The RE-AIM framework was used to guide the evaluation. Two months after the start of the intervention a questionnaire was send to 4880 employees. At the end of the intervention each company contact person (n = 12) was interviewed to obtain information on adoption, implementation and maintenance. Comparison analyses between employees aware and unaware of the program were conducted using independent-samples t-tests for quantitative data and chi-square tests for qualitative data. Difference in commuter cycling frequency was assessed using an ANOVA test. Non-parametric tests were used for the comparison analyses between the adopting and non-adopting companies. Results In total seven of the twelve participating companies adopted the program and all adopting companies implemented all intervention components. No significant differences were found in the mean number of employees (p = 0.15) or in the type of business sector (p = 0.92) between adopting and non-adopting companies. Five out of seven companies had the intention to continue the program. At the individual level, a project awareness of 65% was found. Employees aware of the program had a significantly more positive attitude towards cycling and reported significantly more commuter cycling than those unaware of the program (both p < 0.001). Participation was mainly because of health and environmental considerations. Conclusions The results of the dissemination study are promising. The adoption and implementation rates indicate that the ‘Bike to Work: cyclists are rewarded’ program seems to be a feasible workplace intervention. At the individual level, a higher score of commuter cycling was found among the employees aware of the program. Nevertheless, more evidence regarding long term effectiveness and sustainability of the intervention is needed. PMID:23773476

Evaluating Intervention Programs Targeting Parents to Manage Childhood Overweight and Obesity: A Systematic Review Using the RE-AIM Framework.

PubMed

Jang, Myoungock; Chao, Ariana; Whittemore, Robin

2015-01-01

Intervention programs targeting parents to manage childhood overweight and obesity have emerged based on parents influence on the health behaviors of their children. The purpose of this review was to systematically evaluate intervention programs targeting parents to manage childhood overweight and obesity using the Reach, Efficacy, Adopt, Implementation, and Maintenance (RE-AIM) framework. There was a moderate risk of bias across all studies. The overall proportion of studies (n=7) reporting on each dimension of the RE-AIM framework ranged from 78.6% (reach) to 23.8% (maintenance). The majority of intervention programs demonstrated improvement in child BMI. However intervention programs did not reach families of diverse race/ethnicity, were provided by highly trained professionals, and demonstrated high attrition, thus limiting generalizability. Copyright © 2015 Elsevier Inc. All rights reserved.

Secretos de la Buena Vida: processes of dietary change via a tailored nutrition communication intervention for Latinas

PubMed Central

Baquero, Barbara; Ayala, Guadalupe X.; Arredondo, Elva M.; Campbell, Nadia R.; Slymen, Donald J.; Gallo, Linda; Elder, John P.

2009-01-01

Secretos de la Buena Vida was a successful tailored nutrition communication intervention delivered to Latinas living along the US–Mexico border in California. The intervention was delivered over a 14-week period and consisted of three intervention conditions: weekly home visits with promotoras + weekly tailored mailed newsletters in the first condition, weekly tailored mailed newsletters in the second condition and targeted materials in the attention control condition. The current study examined what elements of the promotora + tailored newsletter and tailored newsletter-only conditions were most effective for behavioral adoption and maintenance in a sample of 238 Latina women. Process evaluation measures assessed the implementation, fidelity and dose of these two intervention conditions. Results indicate that there was high fidelity to program implementation and delivery. Perceived effort, perceived support and intervention length predicted adoption of a lower fat diet at the 15-month follow-up. In the promotora + tailored newsletter condition, married women were four times more likely to be adopters of dietary fat changes than single women. These findings highlight the importance of process evaluation measures and help us understand the mechanism by which tailored print materials and interpersonal health communication via promotoras can facilitate health behavior change. PMID:19339374

Pilot Testing of the EIT-4-BPSD Intervention.

PubMed

Resnick, Barbara; Kolanowski, Ann; Van Haitsma, Kimberly; Boltz, Marie; Galik, Elizabeth; Bonner, Alice; Vigne, Erin; Holtzman, Lauren; Mulhall, Paula M

2016-11-01

Behavioral and psychological symptoms of dementia are common in nursing home residents, and the Centers for Medicare and Medicaid Services now require that nonpharmacological interventions be used as a first-line treatment. Few staff know how to implement these interventions. The purpose of this study was to pilot test an implementation strategy, Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD), which was developed to help staff integrate behavioral interventions into routine care. The EIT-4-BPSD was implemented in 2 nursing homes, and 21 residents were recruited. A research nurse facilitator worked with facility champions and a stakeholder team to implement the 4 steps of EIT-4-BPSD. There was evidence of reach to all staff; effectiveness with improvement in residents' quality of life and a decrease in agitation; adoption based on the environment, policy, and care plan changes; and implementation and plans for maintenance beyond the 6-month intervention period. © The Author(s) 2016.

The roles of vibration analysis and infrared thermography in monitoring air-handling equipment

NASA Astrophysics Data System (ADS)

Wurzbach, Richard N.

2003-04-01

Industrial and commercial building equipment maintenance has not historically been targeted for implementation of PdM programs. The focus instead has been on manufacturing, aerospace and energy industries where production interruption has significant cost implications. As cost-effectiveness becomes more pervasive in corporate culture, even office space and labor activities housed in large facilities are being scrutinized for cost-cutting measures. When the maintenance costs for these facilities are reviewed, PdM can be considered for improving the reliability of the building temperature regulation, and reduction of maintenance repair costs. An optimized program to direct maintenance resources toward a cost effective and pro-active management of the facility can result in reduced operating budgets, and greater occupant satisfaction. A large majority of the significant rotating machinery in a large building environment are belt-driven air handling units. These machines are often poorly designed or utilized within the facility. As a result, the maintenance staff typically find themselves scrambling to replace belts and bearings, going from one failure to another. Instead of the reactive-mode maintenance, some progressive and critical institutions are adopting predictive and proactive technologies of infrared thermography and vibration analysis. Together, these technologies can be used to identify design and installation problems, that when corrected, significantly reduce maintenance and increase reliability. For critical building use, such as laboratories, research facilities, and other high value non-industrial settings, the cost-benefits of more reliable machinery can contribute significantly to the operational success.

RE-AIM evaluation of the Alcohol and Pregnancy Project: educational resources to inform health professionals about prenatal alcohol exposure and fetal alcohol spectrum disorder.

PubMed

Payne, Janet M; France, Kathryn E; Henley, Nadine; D'Antoine, Heather A; Bartu, Anne E; O'Leary, Colleen M; Elliott, Elizabeth J; Bower, Carol; Geelhoed, Elizabeth

2011-03-01

The objective was to evaluate the Alcohol and Pregnancy Project that provided health professionals in Western Australia (WA) with educational resources to inform them about prevention of prenatal alcohol exposure and fetal alcohol spectrum disorder (FASD). The authors developed, produced, and distributed educational resources to 3,348 health professionals in WA. Six months later, they surveyed 1,483 of these health professionals. The authors used the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) to evaluate the project. The educational resources were effective in producing a 31% increase in the proportion of health professionals who routinely provided pregnant women with information about the consequences of drinking alcohol during pregnancy. One hundred percent of the settings adopted the project, it reached 96.3% of the target population, it was implemented as intended, and the resources were maintained (http://www.ichr.uwa.edu.au/alcoholandpregnancy). The educational resources for health professionals have potential to contribute to reducing prenatal alcohol exposure and FASD.

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

Designing and Piloting a Program to Provide Water Filters and Improved Cookstoves in Rwanda

PubMed Central

Barstow, Christina K.; Ngabo, Fidele; Rosa, Ghislaine; Majorin, Fiona; Boisson, Sophie; Clasen, Thomas; Thomas, Evan A.

2014-01-01

Background In environmental health interventions addressing water and indoor air quality, multiple determinants contribute to adoption. These may include technology selection, technology distribution and education methods, community engagement with behavior change, and duration and magnitude of implementer engagement. In Rwanda, while the country has the fastest annual reduction in child mortality in the world, the population is still exposed to a disease burden associated with environmental health challenges. Rwanda relies both on direct donor funding and coordination of programs managed by international non-profits and health sector businesses working on these challenges. Methods and Findings This paper describes the design, implementation and outcomes of a pilot program in 1,943 households across 15 villages in the western province of Rwanda to distribute and monitor the use of household water filters and improved cookstoves. Three key program design criteria include a.) an investment in behavior change messaging and monitoring through community health workers, b.) free distributions to encourage community-wide engagement, and c.) a private-public partnership incentivized by a business model designed to encourage “pay for performance”. Over a 5-month period of rigorous monitoring, reported uptake was maintained at greater than 90% for both technologies, although exclusive use of the stove was reported in only 28.5% of households and reported water volume was 1.27 liters per person per day. On-going qualitative monitoring suggest maintenance of comparable adoption rates through at least 16 months after the intervention. Conclusion High uptake and sustained adoption of a water filter and improved cookstove was measured over a five-month period with indications of continued comparable adoption 16 months after the intervention. The design attributes applied by the implementers may be sufficient in a longer term. In particular, sustained and comprehensive engagement by the program implementer is enabled by a pay-for-performance business model that rewards sustained behavior change. PMID:24676210

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/

Effectiveness of a Scaled-Up Arthritis Self-Management Program in Oregon: Walk With Ease.

PubMed

Conte, Kathleen P; Odden, Michelle C; Linton, Natalie M; Harvey, S Marie

2016-12-01

To evaluate the effectiveness of Walk With Ease (WWE), an evidence-based arthritis self-management program that was scaled up in Oregon in 2012 to 2014. Guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, we collected participant surveys and attendance records and conducted observations. Preprogram and postprogram, participants self-reported pain and fatigue (scale: 0-10 points; high scores indicate more pain and fatigue) and estimated episodes of physical activity per week in the last month. Recruitment successfully reached the targeted population-sedentary adults with arthritis (n = 598). Participants reported significant reduction in pain (-0.47 points; P = .006) and fatigue (-0.58 points; P = .021) and increased physical activity (0.86 days/week; P < .001). WWE was adopted by workplaces and medical, community, faith, and retirement centers. Most WWE programs were delivered with high fidelity; average attendance was 47%. WWE is suitable for implementation by diverse organizations. Effect sizes for pain and fatigue were less than those in the original WWE studies, but this is to be expected for a large-scale implementation. Public Health Implications. WWE can be effectively translated to diverse, real-world contexts to help sedentary adults increase physical activity and reduce pain and fatigue.

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.

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.

From environment to sustainable development: China's strategies for ESD in basic education

NASA Astrophysics Data System (ADS)

Zhang, Tiedao

2010-06-01

This paper intends to provide an overview of the reorientation of education in China in the period 1998-2009 with regard to development issues. During this time, the focus has shifted gradually from the environment and health to education for sustainable development. The article centres on highlighting the main interventions and strategies adopted by China's schools to make this reorientation possible, including: the introduction of new visions of sustainable development and project planning; the establishment of organisational mechanisms and capacity-building measures for their implementation in the field; the integration of ESD into teaching and learning processes; the maintenance of an action-research mechanism for innovations; and the sharing of lessons with both the national and the international community in order to make the implementation of ESD more effective.

Auto Therapy: Using Automobiles as Vehicles for Reminiscence With Older Adults.

PubMed

Anderson, Keith A; Weber, Katherine V

2015-01-01

Reminiscence can be beneficial for older adults and contribute to well-being and ego integrity. In this exploratory pilot study, researchers assessed the feasibility and tolerability of a novel reminiscence intervention using automobiles as the focal point. Nineteen older adults (N = 19) were asked to reminisce using photographs of automobiles from across their lifespan. The RE-AIM framework was used to assess the intervention in terms of reach, effectiveness, adoption, implementation, and maintenance. The intervention was well-received, quickly established rapport, and effectively fostered reminiscence. Social workers may find this intervention useful in helping older adults to explore their lives.

Health Behavior Change for Obesity Management

PubMed Central

Teixeira, Pedro J.; Marques, Marta M.

2018-01-01

Health behavior change is central in obesity management. Due to its complexity, there has been a growing body of research on: i) the factors that predict the adoption and maintenance of health behaviors, ii) the development and testing of theories that conceptualize relationships among these factors and with health behaviors, and iii) how these factors can be implemented in effective behavior change interventions, considering characteristics of the content (techniques) and delivery. This short review provides an overview of advances in behavior change science theories and methods, focusing on obesity management, and includes a discussion of the main challenges imposed by this research field. PMID:29237167

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 and test a tailored, enhanced implementation strategy. ClinicalTrials.gov, NCT03075085.

The feasibility of paper-based Tracking Codes and electronic medical record systems to monitor tobacco-use assessment and intervention in an Individual Practice Association (IPA) Model health maintenance organization (HMO).

PubMed

Bentz, Charles J; Davis, Nancy; Bayley, Bruce

2002-01-01

Despite evidence of its effectiveness, tobacco cessation is not systematically addressed in routine healthcare settings. Its measurement is part of the problem. A pilot study was designed to develop and implement two different tobacco tracking systems in two independent primary care offices that participated in an IPA Model health maintenance organization in Portland, Oregon. The first clinic, which utilized a paper-based charting system, implemented CPT-like tracking codes to measure and report tobacco-cessation activities, which were eventually included in the managed-care organization's (MCO) claims database. The second clinic implemented an electronic tracking system based on its computerized electronic medical record (EMR) charting system. This paper describes the pilot study, including the processes involved in building provider acceptance for the new tracking systems in these two clinics, the barriers and successes encountered during implementation, and the resources expended by the clinics and by the MCO during the pilot. The findings from the 3-month implementation period were that documentation of tobacco-use status remained stable at 42-45% in the paper-based clinic and increased from 79% to 88% in the EMR clinic. This pilot study demonstrated that Tracking Codes are a feasible preventive-care tracking system in paper-based medical offices. However, high levels of effort and support are needed, and a critical mass of insurers and health plans would need to adopt Tracking Codes before widespread use could be expected. Results of the EMR-based tracking system are also reviewed and discussed.

Rapid reduction of central line infections in hospitalized pediatric oncology patients through simple quality improvement methods.

PubMed

Choi, Sung W; Chang, Lawrence; Hanauer, David A; Shaffer-Hartman, Jacqueline; Teitelbaum, Daniel; Lewis, Ian; Blackwood, Alex; Akcasu, Nur; Steel, Janell; Christensen, Joy; Niedner, Matthew F

2013-02-01

Pediatric hematology-oncology (PHO) patients are at significant risk for developing central line-associated bloodstream infections (CLA-BSIs) due to their prolonged dependence on such catheters. Effective strategies to eliminate these preventable infections are urgently needed. In this study, we investigated the implementation of bundled central line maintenance practices and their effect on hospital-acquired CLA-BSIs. CLA-BSI rates were analyzed within a single-institution's PHO unit between January 2005 and June 2011. In May 2008, a multidisciplinary quality improvement team developed techniques to improve the PHO unit's safety culture and implemented the use of catheter maintenance practices tailored to PHO patients. Data analysis was performed using time-series methods to evaluate the pre- and post-intervention effect of the practice changes. The pre-intervention CLA-BSI incidence was 2.92 per 1,000-patient days (PD) and coagulase-negative Staphylococcus was the most prevalent pathogen (29%). In the post-intervention period, the CLA-BSI rate decreased substantially (45%) to 1.61 per 1,000-PD (P < 0.004). Early on, blood and marrow transplant (BMT) patients had a threefold higher CLA-BSI rate compared to non-BMT patients (P < 0.033). With additional infection control countermeasures added to the bundled practices, BMT patients experienced a larger CLA-BSI rate reduction such that BMT and non-BMT CLA-BSI rates were not significantly different post-intervention. By adopting and effectively implementing uniform maintenance catheter care practices, learning multidisciplinary teamwork, and promoting a culture of patient safety, the CLA-BSI incidence in our study population was significantly reduced and maintained. Copyright © 2012 Wiley Periodicals, Inc.

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.

29 CFR 500.105 - DOT standards adopted by the Secretary.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Act directly concerned with the management, maintenance, operation, or driving of motor vehicles..., agents, drivers, representatives and employees directly concerned with the installation and maintenance...) Inspection and maintenance of motor vehicles (Source: 49 CFR 398.7). Every person shall systematically...

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 the context, these determinants hinder or facilitate successful implementation of eMH. Conclusions Of the 37 determinants, three were reported most frequently: (1) the acceptance of eMH concerning expectations and preferences of patients and professionals about receiving and providing eMH in routine care, (2) the appropriateness of eMH in addressing patients’ mental health disorders, and (3) the availability, reliability, and interoperability with other existing technologies such as the electronic health records are important factors for mental health care professionals to remain engaged in providing eMH to their patients in routine care. On the basis of the taxonomy of determinants of practices developed in this review, implementation-enhancing interventions can be designed and applied to achieve better implementation outcomes. Suggestions for future research and implementation practice are provided. PMID:29549072

Physical activity promotion in Latin American populations: a systematic review on issues of internal and external validity

PubMed Central

2014-01-01

The purpose of this review was to determine the degree to which physical activity interventions for Latin American populations reported on internal and external validity factors using the RE-AIM framework (reach & representativeness, effectiveness, adoption, implementation, maintenance). We systematically identified English (PubMed; EbscoHost) and Spanish (SCIELO; Biblioteca Virtual en Salud) language studies published between 2001 and 2012 that tested physical activity, exercise, or fitness promotion interventions in Latin American populations. Cross-sectional/descriptive studies, conducted in Brazil or Spain, published in Portuguese, not including a physical activity/fitness/exercise outcome, and with one time point assessment were excluded. We reviewed 192 abstracts and identified 46 studies that met the eligibility criteria (34 in English, 12 in Spanish). A validated 21-item RE-AIM abstraction tool was used to determine the quality of reporting across studies (0-7 = low, 8-14 = moderate, and 15-21 = high). The number of indicators reported ranged from 3–14 (mean = 8.1 ± 2.6), with the majority of studies falling in the moderate quality reporting category. English and Spanish language articles did not differ on the number of indicators reported (8.1 vs. 8.3, respectively). However, Spanish articles reported more across reach indicators (62% vs. 43% of indicators), while English articles reported more across effectiveness indicators (69% vs 62%). Across RE-AIM dimensions, indicators for reach (48%), efficacy/effectiveness (67%), and implementation (41%) were reported more often than indicators of adoption (25%) and maintenance (10%). Few studies reported on the representativeness of participants, staff that delivered interventions, or the settings where interventions were adopted. Only 13% of the studies reported on quality of life and/or potential negative outcomes, 20% reported on intervention fidelity, and 11% on cost of implementation. Outcomes measured after six months of intervention, information on continued delivery and institutionalization of interventions, were also seldom reported. Regardless of language of publication, physical activity intervention research for Latin Americans should increase attention to and measurement of external validity and cost factors that are critical in the decision making process in practice settings and can increase the likelihood of translation into community or clinical practice. PMID:24938641

Physical activity promotion in Latin American populations: a systematic review on issues of internal and external validity.

PubMed

Galaviz, Karla I; Harden, Samantha M; Smith, Erin; Blackman, Kacie Ca; Berrey, Leanna M; Mama, Scherezade K; Almeida, Fabio A; Lee, Rebecca E; Estabrooks, Paul A

2014-06-17

The purpose of this review was to determine the degree to which physical activity interventions for Latin American populations reported on internal and external validity factors using the RE-AIM framework (reach & representativeness, effectiveness, adoption, implementation, maintenance). We systematically identified English (PubMed; EbscoHost) and Spanish (SCIELO; Biblioteca Virtual en Salud) language studies published between 2001 and 2012 that tested physical activity, exercise, or fitness promotion interventions in Latin American populations. Cross-sectional/descriptive studies, conducted in Brazil or Spain, published in Portuguese, not including a physical activity/fitness/exercise outcome, and with one time point assessment were excluded. We reviewed 192 abstracts and identified 46 studies that met the eligibility criteria (34 in English, 12 in Spanish). A validated 21-item RE-AIM abstraction tool was used to determine the quality of reporting across studies (0-7 = low, 8-14 = moderate, and 15-21 = high). The number of indicators reported ranged from 3-14 (mean = 8.1 ± 2.6), with the majority of studies falling in the moderate quality reporting category. English and Spanish language articles did not differ on the number of indicators reported (8.1 vs. 8.3, respectively). However, Spanish articles reported more across reach indicators (62% vs. 43% of indicators), while English articles reported more across effectiveness indicators (69% vs 62%). Across RE-AIM dimensions, indicators for reach (48%), efficacy/effectiveness (67%), and implementation (41%) were reported more often than indicators of adoption (25%) and maintenance (10%). Few studies reported on the representativeness of participants, staff that delivered interventions, or the settings where interventions were adopted. Only 13% of the studies reported on quality of life and/or potential negative outcomes, 20% reported on intervention fidelity, and 11% on cost of implementation. Outcomes measured after six months of intervention, information on continued delivery and institutionalization of interventions, were also seldom reported. Regardless of language of publication, physical activity intervention research for Latin Americans should increase attention to and measurement of external validity and cost factors that are critical in the decision making process in practice settings and can increase the likelihood of translation into community or clinical practice.

40 CFR 52.2424 - Motor vehicle emissions budgets.

Code of Federal Regulations, 2010 CFR

2010-07-01

... emissions budgets. (a) Motor vehicle emissions budget for the Hampton Roads maintenance area adjusting the mobile emissions budget contained in the maintenance plan for the horizon years 2015 and beyond adopted..., 1996. (b) Motor vehicle emissions budget for the Richmond maintenance area adjusting the mobile...

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…

Interventions to improve physical activity during pregnancy: a systematic review on issues of internal and external validity using the RE-AIM framework.

PubMed

Craike, M; Hill, B; Gaskin, C J; Skouteris, H

2017-03-01

Physical activity (PA) during pregnancy has significant health benefits for the mother and her child; however, many women reduce their activity levels during pregnancy and most are not sufficiently active. Given the important health benefits of PA during pregnancy, evidence that supports research translation is vital. To determine the extent to which physical activity interventions for pregnant women report on internal and external validity factors using the RE-AIM framework (reach, efficacy/effectiveness, adoption, implementation, and maintenance). Ten databases were searched up to 1 June 2015. Eligible published papers and unpublished/grey literature were identified using relevant search terms. Studies had to report on physical activity interventions during pregnancy, including measures of physical activity during pregnancy at baseline and at least one point post-intervention. Randomised controlled trials and quasi-experimental studies that had a comparator group were included. Reporting of RE-AIM dimensions were summarised and synthesised across studies. The reach (72.1%) and efficacy/effectiveness (71.8%) dimensions were commonly reported; however, the implementation (28.9%) and adoption (23.2%) dimensions were less commonly reported and no studies reported on maintenance. This review highlights the under-reporting of issues of contextual factors in studies of physical activity during pregnancy. The translation of physical activity interventions during pregnancy could be improved through reporting of representativeness of participants, clearer reporting of outcomes, more detail on the setting and staff who deliver interventions, costing of interventions and the inclusion of process evaluations and qualitative data. The systematic review highlights the under-reporting of contextual factors in studies of physical activity during pregnancy. © 2016 Royal College of Obstetricians and Gynaecologists.

Coach development programmes to improve interpersonal coach behaviours: a systematic review using the re-aim framework.

PubMed

Evans, M Blair; McGuckin, Matthew; Gainforth, Heather L; Bruner, Mark W; Côté, Jean

2015-07-01

Although evidence supports the effectiveness of interpersonal Coach Development Programmes (CDPs), which are designed to foster coach-athlete relationships, an intervention's impact is shaped by numerous factors over and above effectiveness. The purpose of this systematic review was to examine the extent that published articles describing interpersonal CDP trials reported on indicators of internal and external validity, as conceptualised in the RE-AIM framework (ie, Reach, Effectiveness, Adoption, Implementation and Maintenance). The search strategy was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, involving a database search and supplemental manual search of key articles and journals. After initial screening, the full-text search strategy involved identifying articles describing CDP trials and then selecting a specific subgroup of articles involving interpersonal CDP trials and excluding ineligible articles. Resulting trials were coded using a 47-item sport coaching adaptation of the RE-AIM coding sheet. 17 published articles met eligibility criteria, representing 10 distinct CDP trials. After attaining coder agreement, global ratings of RE-AIM indicators within interpersonal CDP trials ranged from the low to moderate quality. Whereas indicators of effectiveness and implementation were reported to some extent across all studies, maintenance within sport organisations and a number of specific indicators from across dimensions were rarely reported. These findings inform the future design and evaluation of CDPs that have the potential to be adopted in numerous settings and reach athletes and coaches who can most benefit. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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.

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.

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...

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.

Health promotion in schools: a multi-method evaluation of an Australian School Youth Health Nurse Program.

PubMed

Banfield, Michelle; McGorm, Kelly; Sargent, Ginny

2015-01-01

Health promotion provides a key opportunity to empower young people to make informed choices regarding key health-related behaviours such as tobacco and alcohol use, sexual practices, dietary choices and physical activity. This paper describes the evaluation of a pilot School Youth Health Nurse (SYHN) Program, which aims to integrate a Registered Nurse into school communities to deliver health promotion through group education and individual sessions. The evaluation was guided by the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. The objectives were to explore: 1) whether the Program was accessible to the high school students; 2) the impacts of the Program on key stakeholders; 3) which factors affected adoption of the Program; 4) whether implementation was consistent with the Program intent; and 5) the long-term sustainability of the Program. Research included retrospective analysis of Program records, administration of a survey of student experiences and interviews with 38 stakeholders. This evaluation provided evidence that the SYHN Program is reaching students in need, is effective, has been adopted successfully in schools, is being implemented as intended and could be maintained with sustained funding. The nurses deliver an accessible and acceptable primary health care service, focused on health promotion, prevention and early intervention. After some initial uncertainty about the scope and nature of the role, the nurses are a respected source of health information in the schools, consulted on curriculum development and contributing to whole-of-school health activities. Findings demonstrate that the SYHN model is feasible and acceptable to the students and schools involved in the pilot. The Program provides health promotion and accessible primary health care in the school setting, consistent with the Health Promoting Schools framework.

Survey of Condition Indicators for Condition Monitoring Systems (Open Access)

DTIC Science & Technology

2014-09-29

Hinesburg, Vermont, 05461, USA jz@renewablenrgsystems.com ABSTRACT Currently, the wind energy industry is swiftly changing its maintenance strategy...from schedule based maintenance to predictive based maintenance . Condition monitoring systems (CMS) play an important role in the predictive... maintenance cycle. As condition monitoring systems are being adopted by more and more OEM and O&M service providers from the wind energy industry, it is

Evaluating employee assistance policy in an HMO-based alcoholism project.

PubMed

Putnam, S L; Stout, R L

1985-01-01

One aspect of successful employee assistance program (EAP) implementation is the adoption of a formal, written policy, reflecting company commitment to EAP guidelines and goals. This study of criteria predictive of such policy adoption was conducted at the occupational alcoholism project of a New England health maintenance organization (HMO). Data on nearly 400 organizations contacted by occupational program consultants (OPCs) over a 20-month period were collected by questionnaire and interview. One third of these organizations adopted employee assistance policies and set about establishing formal programs. Stepwise multiple regression is the principal method used to pinpoint the correlates of policy adoption. Two of the most important of these are the attitudes of contact persons within the organization toward alcoholism and employee assistance programs, particularly their admission of alcohol problems within their social networks; and the consultants' persistence and marketing skills. The adopting organizations also had reputations for being progressive, and actively concerned about employee welfare; they tended to be large, their executives autonomous, and their union membership rates high. Inhibiting policy acceptance were fears that a written policy would jeopardize the reputation and image of the organization, and that an employee assistance program would remove internal control of personal procedures. The adequacy of the evaluative data and methods are discussed, and recommendations are offered in the interests of streamlining the efforts of OPCs and of achieving greater penetration of targeted organizations.

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 strategies support implementation efforts could positively impact the field of implementation science, by comparing practical, generalizable methods for implementing clinical innovations in community health centers. Bridging this gap in the literature is a critical step towards the national long-term goal of effectively disseminating and implementing effective interventions into community health centers. ClinicalTrials.gov, NCT02325531.

Could autonomous motivation hold the key to successfully implementing lifestyle changes in affective disorders? A multicentre cross sectional study.

PubMed

Vancampfort, Davy; Madou, Tomas; Moens, Herman; De Backer, Tanja; Vanhalst, Patrick; Helon, Chris; Naert, Pieter; Rosenbaum, Simon; Stubbs, Brendon; Probst, Michel

2015-07-30

There is a need for theoretically-based research on the motivational processes linked to the adoption and maintenance of an active lifestyle in people with affective disorders. Within the Self-Determination Theory (SDT) framework, we investigated the SDT tenets in people with major depressive disorder or bipolar disorder by examining the factor structure of the Behavioural Regulation in Exercise Questionnaire-2 (BREQ-2) and by investigating associations between motivation, the Positive and Negative Affect Scale (PANAS) and International Physical Activity Questionnaire (IPAQ) scores. A total of 165 patients (105 ♀) (45.6 ± 14.2 years) agreed to participate. An exploratory factor analysis demonstrated sufficient convergence with the original factor for amotivation, and external and introjected regulation. The items of identified and intrinsic regulation loaded on the same factor, which was labelled autonomous regulation. Significant correlations were found between the total IPAQ score and the subscales amotivation, external regulation, introjected regulation and autonomous regulation. The relative autonomy index (RAI) was associated with the PANAS scores. Differences in RAI were found between physically inactive and active participants. Our results suggest that in people with affective disorders the level of autonomous motivation may play an important role in the adoption and maintenance of health promoting behaviours. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

45 CFR 1357.32 - State fiscal requirements (title IV-B, subpart 2, family preservation and family support services).

Code of Federal Regulations, 2010 CFR

2010-10-01

... following: Procurement; payroll; personnel functions; management, maintenance and operation of space and... SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION... title IV-B may not be used for the purchase or construction of facilities. (f) Maintenance of effort...

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.

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.

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.

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.

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

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...

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...

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...

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...

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...

National Cost-effectiveness of ASHRAE Standard 90.1-2010 Compared to ASHRAE Standard 90.1-2007

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

Thornton, Brian; Halverson, Mark A.; Myer, Michael

Pacific Northwest National Laboratory (PNNL) completed this project for the U.S. Department of Energy’s (DOE’s) Building Energy Codes Program (BECP). DOE’s BECP supports upgrading building energy codes and standards, and the states’ adoption, implementation, and enforcement of upgraded codes and standards. Building energy codes and standards set minimum requirements for energy-efficient design and construction for new and renovated buildings, and impact energy use and greenhouse gas emissions for the life of buildings. Continuous improvement of building energy efficiency is achieved by periodically upgrading energy codes and standards. Ensuring that changes in the code that may alter costs (for building components,more » initial purchase and installation, replacement, maintenance and energy) are cost-effective encourages their acceptance and implementation. ANSI/ASHRAE/IESNA Standard 90.1 is the energy standard for commercial and multi-family residential buildings over three floors.« less

Cost-effectiveness of ASHRAE Standard 90.1-2010 Compared to ASHRAE Standard 90.1-2007

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

Thornton, Brian A.; Halverson, Mark A.; Myer, Michael

Pacific Northwest National Laboratory (PNNL) completed this project for the U.S. Department of Energy’s (DOE’s) Building Energy Codes Program (BECP). DOE’s BECP supports upgrading building energy codes and standards, and the states’ adoption, implementation, and enforcement of upgraded codes and standards. Building energy codes and standards set minimum requirements for energy-efficient design and construction for new and renovated buildings, and impact energy use and greenhouse gas emissions for the life of buildings. Continuous improvement of building energy efficiency is achieved by periodically upgrading energy codes and standards. Ensuring that changes in the code that may alter costs (for building components,more » initial purchase and installation, replacement, maintenance and energy) are cost-effective encourages their acceptance and implementation. ANSI/ASHRAE/IESNA Standard 90.1 is the energy standard for commercial and multi-family residential buildings over three floors.« less

Adopt-A-Highway, Statewide M & O, Transportation & Public Facilities, State

Science.gov Websites

& Operations Search DOT&PF State of Alaska DOT&PF > Maintenance & Operations > Maintenance Subcommittee off site link FHWA Operations off site link U.S. DOT off site link Site Map Policies

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...

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…

The tug-of-war: fidelity versus adaptation throughout the health promotion program life cycle.

PubMed

Bopp, Melissa; Saunders, Ruth P; Lattimore, Diana

2013-06-01

Researchers across multiple fields have described the iterative and nonlinear phases of the translational research process from program development to dissemination. This process can be conceptualized within a "program life cycle" framework that includes overlapping and nonlinear phases: development, adoption, implementation, maintenance, sustainability or termination, and dissemination or diffusion, characterized by tensions between fidelity to the original plan and adaptation for the setting and population. In this article, we describe the life cycle (phases) for research-based health promotion programs, the key influences at each phase, and the issues related to the tug-of-war between fidelity and adaptation throughout the process using a fictionalized case study based on our previous research. This article suggests the importance of reconceptualizing intervention design, involving stakeholders, and monitoring fidelity and adaptation throughout all phases to maintain implementation fidelity and completeness. Intervention fidelity should be based on causal mechanisms to ensure effectiveness, while allowing for appropriate adaption to ensure maximum implementation and sustainability. Recommendations for future interventions include considering the determinants of implementation including contextual factors at each phase, the roles of stakeholders, and the importance of developing a rigorous, adaptive, and flexible definition of implementation fidelity and completeness.

Cost Minimization for Joint Energy Management and Production Scheduling Using Particle Swarm Optimization

NASA Astrophysics Data System (ADS)

Shah, Rahul H.

Production costs account for the largest share of the overall cost of manufacturing facilities. With the U.S. industrial sector becoming more and more competitive, manufacturers are looking for more cost and resource efficient working practices. Operations management and production planning have shown their capability to dramatically reduce manufacturing costs and increase system robustness. When implementing operations related decision making and planning, two fields that have shown to be most effective are maintenance and energy. Unfortunately, the current research that integrates both is limited. Additionally, these studies fail to consider parameter domains and optimization on joint energy and maintenance driven production planning. Accordingly, production planning methodology that considers maintenance and energy is investigated. Two models are presented to achieve well-rounded operating strategy. The first is a joint energy and maintenance production scheduling model. The second is a cost per part model considering maintenance, energy, and production. The proposed methodology will involve a Time-of-Use electricity demand response program, buffer and holding capacity, station reliability, production rate, station rated power, and more. In practice, the scheduling problem can be used to determine a joint energy, maintenance, and production schedule. Meanwhile, the cost per part model can be used to: (1) test the sensitivity of the obtained optimal production schedule and its corresponding savings by varying key production system parameters; and (2) to determine optimal system parameter combinations when using the joint energy, maintenance, and production planning model. Additionally, a factor analysis on the system parameters is conducted and the corresponding performance of the production schedule under variable parameter conditions, is evaluated. Also, parameter optimization guidelines that incorporate maintenance and energy parameter decision making in the production planning framework are discussed. A modified Particle Swarm Optimization solution technique is adopted to solve the proposed scheduling problem. The algorithm is described in detail and compared to Genetic Algorithm. Case studies are presented to illustrate the benefits of using the proposed model and the effectiveness of the Particle Swarm Optimization approach. Numerical Experiments are implemented and analyzed to test the effectiveness of the proposed model. The proposed scheduling strategy can achieve savings of around 19 to 27 % in cost per part when compared to the baseline scheduling scenarios. By optimizing key production system parameters from the cost per part model, the baseline scenarios can obtain around 20 to 35 % in savings for the cost per part. These savings further increase by 42 to 55 % when system parameter optimization is integrated with the proposed scheduling problem. Using this method, the most influential parameters on the cost per part are the rated power from production, the production rate, and the initial machine reliabilities. The modified Particle Swarm Optimization algorithm adopted allows greater diversity and exploration compared to Genetic Algorithm for the proposed joint model which results in it being more computationally efficient in determining the optimal scheduling. While Genetic Algorithm could achieve a solution quality of 2,279.63 at an expense of 2,300 seconds in computational effort. In comparison, the proposed Particle Swarm Optimization algorithm achieved a solution quality of 2,167.26 in less than half the computation effort which is required by Genetic Algorithm.

Clinical review: Checklists - translating evidence into practice

PubMed Central

2009-01-01

Checklists are common tools used in many industries. Unfortunately, their adoption in the field of medicine has been limited to equipment operations or part of specific algorithms. Yet they have tremendous potential to improve patient outcomes by democratizing knowledge and helping ensure that all patients receive evidence-based best practices and safe high-quality care. Checklist adoption has been slowed by a variety of factors, including provider resistance, delays in knowledge dissemination and integration, limited methodology to guide development and maintenance, and lack of effective technical strategies to make them available and easy to use. In this article, we explore some of the principles and possible strategies to further develop and encourage the implementation of checklists into medical practice. We describe different types of checklists using examples and explore the benefits they offer to improve care. We suggest methods to create checklists and offer suggestions for how we might apply them, using some examples from our own experience, and finally, offer some possible directions for future research. PMID:20064195

Mixed method evaluation of a community-based physical activity program using the RE-AIM framework: practical application in a real-world setting.

PubMed

Koorts, Harriet; Gillison, Fiona

2015-11-06

Communities are a pivotal setting in which to promote increases in child and adolescent physical activity behaviours. Interventions implemented in these settings require effective evaluation to facilitate translation of findings to wider settings. The aims of this paper are to i) present findings from a RE-AIM evaluation of a community-based physical activity program, and ii) review the methodological challenges faced when applying RE-AIM in practice. A single mixed-methods case study was conducted based on a concurrent triangulation design. Five sources of data were collected via interviews, questionnaires, archival records, documentation and field notes. Evidence was triangulated within RE-AIM to assess individual and organisational-level program outcomes. Inconsistent availability of data and a lack of robust reporting challenged assessment of all five dimensions. Reach, Implementation and setting-level Adoption were less successful, Effectiveness and Maintenance at an individual and organisational level were moderately successful. Only community-level Adoption was highly successful, reflecting the key program goal to provide community-wide participation in sport and physical activity. This research highlighted important methodological constraints associated with the use of RE-AIM in practice settings. Future evaluators wishing to use RE-AIM may benefit from a mixed-method triangulation approach to offset challenges with data availability and reliability.

The RE-AIM Framework: A Systematic Review of Use Over Time

PubMed Central

Shoup, Jo Ann; Glasgow, Russell E.

2013-01-01

We provided a synthesis of use, summarized key issues in applying, and highlighted exemplary applications in the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. We articulated key RE-AIM criteria by reviewing the published literature from 1999 to 2010 in several databases to describe the application and reporting on various RE-AIM dimensions. After excluding nonempirical articles, case studies, and commentaries, 71 articles were identified. The most frequent publications were on physical activity, obesity, and disease management. Four articles reported solely on 1 dimension compared with 44 articles that reported on all 5 dimensions of the framework. RE-AIM was broadly applied, but several criteria were not reported consistently. PMID:23597377

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.

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.

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.

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 trial. Practices organised their delivery of changed care to patients in ways which suited their context, emphasising the importance of flexibility in any future widespread implementation. Trial registration number NCT01425502. PMID:28283493

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 changed care to patients in ways which suited their context, emphasising the importance of flexibility in any future widespread implementation. NCT01425502. 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/.

45 CFR 1356.10 - Scope.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., adoption assistance payments, related foster care and adoption administrative and training expenditures... Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE...

45 CFR 1356.10 - Scope.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., adoption assistance payments, related foster care and adoption administrative and training expenditures... Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE...

45 CFR 1356.10 - Scope.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., adoption assistance payments, related foster care and adoption administrative and training expenditures... Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE...

Cost-Effectiveness of a Clinical Childhood Obesity Intervention.

PubMed

Sharifi, Mona; Franz, Calvin; Horan, Christine M; Giles, Catherine M; Long, Michael W; Ward, Zachary J; Resch, Stephen C; Marshall, Richard; Gortmaker, Steven L; Taveras, Elsie M

2017-11-01

To estimate the cost-effectiveness and population impact of the national implementation of the Study of Technology to Accelerate Research (STAR) intervention for childhood obesity. In the STAR cluster-randomized trial, 6- to 12-year-old children with obesity seen at pediatric practices with electronic health record (EHR)-based decision support for primary care providers and self-guided behavior-change support for parents had significantly smaller increases in BMI than children who received usual care. We used a microsimulation model of a national implementation of STAR from 2015 to 2025 among all pediatric primary care providers in the United States with fully functional EHRs to estimate cost, impact on obesity prevalence, and cost-effectiveness. The expected population reach of a 10-year national implementation is ∼2 million children, with intervention costs of $119 per child and $237 per BMI unit reduced. At 10 years, assuming maintenance of effect, the intervention is expected to avert 43 000 cases and 226 000 life-years with obesity at a net cost of $4085 per case and $774 per life-year with obesity averted. Limiting implementation to large practices and using higher estimates of EHR adoption improved both cost-effectiveness and reach, whereas decreasing the maintenance of the intervention's effect worsened the former. A childhood obesity intervention with electronic decision support for clinicians and self-guided behavior-change support for parents may be more cost-effective than previous clinical interventions. Effective and efficient interventions that target children with obesity are necessary and could work in synergy with population-level prevention strategies to accelerate progress in reducing obesity prevalence. Copyright © 2017 by the American Academy of Pediatrics.

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.

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.

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.

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 achieved by educating club personnel on the importance of recording injuries, developing clearer injury surveillance guidelines, increasing club staffing and better remunerating those who conduct surveillance, as well as offering flexible surveillance systems in a range of accessible formats. By increasing the usage of surveillance systems, data will better represent the target population and increase our understanding of the injury problem, and how to prevent it, in specific settings.

Processes and Outcomes of Developing a Continuity of Care Document for Use as a Personal Health Record by People Living with HIV/AIDS in New York City

PubMed Central

Gordon, Peter; Camhi, Eli; Hesse, Ron; Odlum, Michelle; Schnall, Rebecca; Rodriguez, Martha; Valdez, Esmerlin; Bakken, Suzanne

2015-01-01

Purpose To describe the processes and outcomes of developing and implementing a Continuity of Care Document (CCD), My Health Profile, as personal health record for persons living with HIV (PLWH) in an HIV/AIDS Special Needs Plan (SNP) in New York City. Methods Multiple qualitative and quantitative data sources were used to describe the processes and outcomes of implementing My Health Profile including focus groups, Audio Computer Assisted Self Interview (ACASI) surveys, administrative databases, chart abstraction, usage logs, and project management records. Qualitative data were thematically analyzed. Quantitative data analytic methods included descriptive and multivariate statistics. Data were triangulated and synthesized using the Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework. Results Reach SNP members are predominantly African American or Hispanic/Latino and about one third are female. A larger proportion of African Americans and smaller proportions of Hispanics/Latinos and Whites were trained to use My Health Profile. Efficacy/Effectiveness CCDs were produced for 8,249 unique members and updated on a monthly basis, 509 members were trained to use My Health Profile. Total number of member logins for 112 active users was 1,808 and the longest duration of use was 1,008 days. There were no significant differences between users and non-users of My Health Profile in clinical outcomes, perceptions of the quality of medical care, or health service utilization. Adoption My Health Profile was well-matched to organizational mission, values, and priorities related to coordination of care for a high-risk population of PLWH. Implementation Pre-implementation focus group participants identified potential barriers to use of My Health Profile including functional and computer literacy, privacy and confidentiality concerns, potential reluctance to use technology, and cognitive challenges. Key strategies for addressing barriers included a dedicated bilingual coach for recruitment, training, and support; basic computer and My Health Profile training; transparent audit trail revealing clinician and case manager access of My Health Profile, time-limited passwords for sharing My Health Profile with others at the point of need, and emergency access mechanism. Maintenance My Health Profile was integrated into routine operational activities and its sustainability is facilitated by its foundation on standards for Health Information Exchange (HIE). Conclusions Although potential barriers exist to the use of PHRs such as My Health Profile, PLWH with complex medical needs, low socioeconomic status, and limited computer experience will use such tools when a sufficient level of user support is provided and privacy and confidentiality concerns are addressed. PMID:22841825

10 CFR 455.62 - Contents of a technical assistance program.

Code of Federal Regulations, 2011 CFR

2011-01-01

... and document energy conservation maintenance and operating procedure changes and energy conservation... operating procedure changes, if any, and energy conservation measures selected in accordance with the State... conservation maintenance and operating procedure change and an estimate of the costs of adopting such energy...

10 CFR 455.62 - Contents of a technical assistance program.

Code of Federal Regulations, 2012 CFR

2012-01-01

... and document energy conservation maintenance and operating procedure changes and energy conservation... operating procedure changes, if any, and energy conservation measures selected in accordance with the State... conservation maintenance and operating procedure change and an estimate of the costs of adopting such energy...

10 CFR 455.62 - Contents of a technical assistance program.

Code of Federal Regulations, 2013 CFR

2013-01-01

... and document energy conservation maintenance and operating procedure changes and energy conservation... operating procedure changes, if any, and energy conservation measures selected in accordance with the State... conservation maintenance and operating procedure change and an estimate of the costs of adopting such energy...

10 CFR 455.62 - Contents of a technical assistance program.

Code of Federal Regulations, 2014 CFR

2014-01-01

... and document energy conservation maintenance and operating procedure changes and energy conservation... operating procedure changes, if any, and energy conservation measures selected in accordance with the State... conservation maintenance and operating procedure change and an estimate of the costs of adopting such energy...

45 CFR 1356.60 - Fiscal requirements (title IV-E).

Code of Federal Regulations, 2011 CFR

2011-10-01

... expenditures for: (i) Foster care maintenance payments as defined in section 475(4) of the Act, made in... 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...

45 CFR 1356.60 - Fiscal requirements (title IV-E).

Code of Federal Regulations, 2010 CFR

2010-10-01

... expenditures for: (i) Foster care maintenance payments as defined in section 475(4) of the Act, made in... 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...

10 CFR 455.62 - Contents of a technical assistance program.

Code of Federal Regulations, 2010 CFR

2010-01-01

... and document energy conservation maintenance and operating procedure changes and energy conservation... operating procedure changes, if any, and energy conservation measures selected in accordance with the State... conservation maintenance and operating procedure change and an estimate of the costs of adopting such energy...

Research design issues for evaluating complex multicomponent interventions in neighborhoods and communities.

PubMed

Komro, Kelli A; Flay, Brian R; Biglan, Anthony; Wagenaar, Alexander C

2016-03-01

Major advances in population health will not occur unless we translate existing knowledge into effective multicomponent interventions, implement and maintain these in communities, and develop rigorous translational research and evaluation methods to ensure continual improvement and sustainability. We discuss challenges and offer approaches to evaluation that are key for translational research stages 3 to 5 to advance optimized adoption, implementation, and maintenance of effective and replicable multicomponent strategies. The major challenges we discuss concern (a) multiple contexts of evaluation/research, (b) complexity of packages of interventions, and (c) phases of evaluation/research questions. We suggest multiple alternative research designs that maintain rigor but accommodate these challenges and highlight the need for measurement systems. Longitudinal data collection and a standardized continuous measurement system are fundamental to the evaluation and refinement of complex multicomponent interventions. To be useful to T3-T5 translational research efforts in neighborhoods and communities, such a system would include assessments of the reach, implementation, effects on immediate outcomes, and effects of the comprehensive intervention package on more distal health outcomes.

Healthy Eating for Life English as a second language curriculum: applying the RE-AIM framework to evaluate a nutrition education intervention targeting cancer risk reduction.

PubMed

Martinez, J L; Duncan, L R; Rivers, S E; Bertoli, M C; Latimer-Cheung, A E; Salovey, P

2017-12-01

Medically underserved US immigrants are at an increased risk for death from preventable or curable cancers due to economic, cultural, and/or linguistic barriers to medical care. The purpose of this study was to describe the evaluation of the pilot study of the Healthy Eating for Life (HE4L) English as a second language curriculum. The Reach, Effectiveness Adoption, Implementation, Maintenance (RE-AIM) model was used to design a mixed-methods approach to the evaluation of the HE4L curriculum. Successful implementation was dependent upon enthusiastic teacher and manager support of the curriculum, teachers' ability to flexibly apply the curriculum to meet student needs, and researcher provision of curriculum workbooks. HE4L can be implemented successfully in various adult education settings to teach healthy eating behaviors and English language principles. Scale-up of HE4L may depend on the development of an online version of the curriculum to avoid the costs associated with printing and distributing curriculum materials.

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.

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

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.

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.

The High Level Data Reduction Library

NASA Astrophysics Data System (ADS)

Ballester, P.; Gabasch, A.; Jung, Y.; Modigliani, A.; Taylor, J.; Coccato, L.; Freudling, W.; Neeser, M.; Marchetti, E.

2015-09-01

The European Southern Observatory (ESO) provides pipelines to reduce data for most of the instruments at its Very Large telescope (VLT). These pipelines are written as part of the development of VLT instruments, and are used both in the ESO's operational environment and by science users who receive VLT data. All the pipelines are highly specific geared toward instruments. However, experience showed that the independently developed pipelines include significant overlap, duplication and slight variations of similar algorithms. In order to reduce the cost of development, verification and maintenance of ESO pipelines, and at the same time improve the scientific quality of pipelines data products, ESO decided to develop a limited set of versatile high-level scientific functions that are to be used in all future pipelines. The routines are provided by the High-level Data Reduction Library (HDRL). To reach this goal, we first compare several candidate algorithms and verify them during a prototype phase using data sets from several instruments. Once the best algorithm and error model have been chosen, we start a design and implementation phase. The coding of HDRL is done in plain C and using the Common Pipeline Library (CPL) functionality. HDRL adopts consistent function naming conventions and a well defined API to minimise future maintenance costs, implements error propagation, uses pixel quality information, employs OpenMP to take advantage of multi-core processors, and is verified with extensive unit and regression tests. This poster describes the status of the project and the lesson learned during the development of reusable code implementing algorithms of high scientific quality.

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

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...

Implementing organizational physical activity and healthy eating strategies on paid time: process evaluation of the UCLA WORKING pilot study.

PubMed

Hopkins, Jammie M; Glenn, Beth A; Cole, Brian L; McCarthy, William; Yancey, Antronette

2012-06-01

Integrating organizationally targeted wellness strategies into the routine conduct of business has shown promise in engaging captive audiences at highest risk of obesity and obesity-related health consequences. This paper presents a process evaluation of the implementation of the University of California, Los Angeles, Working Out Regularly Keeps Individuals Nurtured and Going (WORKING) pilot study. WORKING focuses on integrating physical activity and nutrition practices into workplace routine during non-discretionary paid work time. The purpose of the evaluation was to assess the quality of implementation and to understand factors that facilitated or hindered organizations' full uptake of the intervention. Fifteen worksites were randomly assigned to an intervention condition. Qualitative data were gathered through routine site visits and informant interviews conducted throughout each worksite's intervention period. Worksites were classified into one of four implementation success categories based on their level of adoption and maintenance of core intervention strategies. Six key factors emerged that were related to implementation success: site layout and social climate, wellness infrastructure, number and influence of Program Champions, leadership involvement, site innovation and creativity. This pilot study has informed the conduct of WORKING II; a cluster randomized controlled trial aimed at enrolling 60-70 worksites in Los Angeles County.

Implementing organizational physical activity and healthy eating strategies on paid time: process evaluation of the UCLA WORKING pilot study

PubMed Central

Hopkins, Jammie M.; Glenn, Beth A.; Cole, Brian L.; McCarthy, William; Yancey, Antronette

2012-01-01

Integrating organizationally targeted wellness strategies into the routine conduct of business has shown promise in engaging captive audiences at highest risk of obesity and obesity-related health consequences. This paper presents a process evaluation of the implementation of the University of California, Los Angeles, Working Out Regularly Keeps Individuals Nurtured and Going (WORKING) pilot study. WORKING focuses on integrating physical activity and nutrition practices into workplace routine during non-discretionary paid work time. The purpose of the evaluation was to assess the quality of implementation and to understand factors that facilitated or hindered organizations’ full uptake of the intervention. Fifteen worksites were randomly assigned to an intervention condition. Qualitative data were gathered through routine site visits and informant interviews conducted throughout each worksite’s intervention period. Worksites were classified into one of four implementation success categories based on their level of adoption and maintenance of core intervention strategies. Six key factors emerged that were related to implementation success: site layout and social climate, wellness infrastructure, number and influence of Program Champions, leadership involvement, site innovation and creativity. This pilot study has informed the conduct of WORKING II; a cluster randomized controlled trial aimed at enrolling 60–70 worksites in Los Angeles County. PMID:22323279

78 FR 37717 - Adequacy Status of the Submitted 2009 and 2025 PM2.5

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-24

... control strategy implementation plan revision or maintenance plan was endorsed by the Governor (or his or...) Before the control strategy implementation plan or maintenance plan was submitted to EPA, consultation... maintenance: Both the 2009 and 2025 budgets are less than the on-road mobile source inventory for 2007 that...

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...

76 FR 5078 - Approval and Promulgation of Air Quality Implementation Plans: Tennessee; Approval of Section 110...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-28

...) Maintenance Plan for the 1997 8-Hour Ozone Standards for the Nashville, TN, Area AGENCY: Environmental... Tennessee State Implementation Plan (SIP) concerning the maintenance plan addressing the 1997 8-hour ozone standards for the Nashville, Tennessee 1997 8-hour ozone maintenance area, which is comprised of Davidson...

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.

SCOS 2: An object oriented software development approach

NASA Technical Reports Server (NTRS)

Symonds, Martin; Lynenskjold, Steen; Mueller, Christian

1994-01-01

The Spacecraft Control and Operations System 2 (SCOS 2), is intended to provide the generic mission control system infrastructure for future ESA missions. It represents a bold step forward in order to take advantage of state-of-the-art technology and current practices in the area of software engineering. Key features include: (1) use of object oriented analysis and design techniques; (2) use of UNIX, C++ and a distributed architecture as the enabling implementation technology; (3) goal of re-use for development, maintenance and mission specific software implementation; and (4) introduction of the concept of a spacecraft control model. This paper touches upon some of the traditional beliefs surrounding Object Oriented development and describes their relevance to SCOS 2. It gives rationale for why particular approaches were adopted and others not, and describes the impact of these decisions. The development approach followed is discussed, highlighting the evolutionary nature of the overall process and the iterative nature of the various tasks carried out. The emphasis of this paper is on the process of the development with the following being covered: (1) the three phases of the SCOS 2 project - prototyping & analysis, design & implementation and configuration / delivery of mission specific systems; (2) the close cooperation and continual interaction with the users during the development; (3) the management approach - the split between client staff, industry and some of the required project management activities; (4) the lifecycle adopted being an enhancement of the ESA PSS-05 standard with SCOS 2 specific activities and approaches defined; and (5) an examination of some of the difficulties encountered and the solutions adopted. Finally, the lessons learned from the SCOS 2 experience are highlighted, identifying those issues to be used as feedback into future developments of this nature. This paper does not intend to describe the finished product and its operation, but focusing on the journey to arrive there, concentrating therefore on the process and not the products of the SCOS 2 software development.

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.

Fuel Cells Advanced Drivetrain

DTIC Science & Technology

2010-08-09

T800 Silverado Military specific system upscale (4WD) HydroGen3 – CH2 HydroGen3 – LH2 4010 – Early Adopter Engineering Model (GEN Nadeau) Gen4...Timeline Maintenance Infrastructure Fort Belvoir, VA 2003-ongoing Full FCV and Volt Maintenance 350,700bar LH2 (Decommissioned) Volt Charging(pending

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...

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…

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.

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.

Evaluation of a large healthy lifestyle program: informing program implementation and scale-up in the prevention of obesity.

PubMed

Kozica, S L; Lombard, C B; Harrison, C L; Teede, H J

2016-11-24

The Healthy Lifestyle Program for women (HeLP-her) is a low-intensity, self-management program which has demonstrated efficacy in preventing excess weight gain in women. However, little is known about the implementation, reach, and sustainability of low-intensity prevention programs in rural settings, where risk for obesity in women is higher than urban settings. We aimed to evaluate a low-intensity healthy lifestyle program delivered to women in a rural setting to inform development of effective community prevention programs. A mixed method hybrid implementation and evaluation study, guided by the RE-AIM framework (addressing the Reach, Effectiveness, Adoption, Implementation, and Maintenance), was undertaken. Data collection tools included anthropometric measures, program checklists, questionnaires, and semi-structured interviews with participants and local stakeholders. The RE-AIM self-audit tool was applied to assess evaluation rigor. Six hundred and forty-nine women from 41 relatively socio-economic disadvantaged communities in Australia participated: mean age 39.6 years (±SD 6.7) and body mass index of 28.8 kg/m 2 (±SD 6.9). A between-group weight difference of -0.92 kg (95% CI -1.67 to -0.16) showed program effectiveness. Reach was broad across 41 towns with 62% of participants reporting influencing some of the health behaviors of their families. Strong implementation fidelity was achieved with good retention rates at 1 year (76%) and high participant satisfaction (82% of participants willing to recommend this program). Over 300 multi-level community partnerships were established supporting high adoption. Stakeholders reported potential capacity to implement and sustain the prevention program in resource poor rural settings, due to the low-intensity design and minimal resources required. Our comprehensive RE-AIM evaluation demonstrates that an evidence-based obesity prevention program can be successfully implemented in real-world settings. The program achieved broad reach, effectiveness, and satisfaction at the community and stakeholder level, revealing potential for program sustainability. The evaluation addressed implementation knowledge gaps to support future obesity prevention program scale-up. Australian and New Zealand Clinical Trial Registry ACTRN 12612000115831 [ http://www.anzctr.org.au/ ].

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.

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...

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...

Diagnostic, design and implementation of an integrated model of care in France: a bottom-up process with a continuous leadership

PubMed Central

de Stampa, Matthieu; Vedel, Isabelle; Mauriat, Claire; Bagaragaza, Emmanuel; Routelous, Christelle; Bergman, Howard; Lapointe, Liette; Cassou, Bernard; Ankri, Joel; Henrard, Jean-Claude

2010-01-01

Purpose To present an innovative bottom-up and pragmatic strategy used to implement a new integrated care model in France for community-dwelling elderly people with complex needs. Context Sustaining integrated care is difficult, in large part because of problems encountered securing the participation of health care and social service professionals and, in particular, general practitioners (GPs). Case description In the first step, a diagnostic study was conducted with face-to-face interviews to gather data on current practices from a sample of health and social stakeholders working with elderly people. In the second step, an integrated care model called Coordination Personnes Agées (COPA) was designed by the same major stakeholders in order to define its detailed characteristics based on the local context. In the third step, the model was implemented in two phases: adoption and maintenance. This strategy was carried out by a continuous and flexible leadership throughout the process, initially with a mixed leadership (clinician and researcher) followed by a double one (clinician and managers of services) in the implementation phase. Conclusions The implementation of this bottom-up and pragmatic strategy relied on establishing a collaborative dynamic among health and social stakeholders. This enhanced their involvement throughout the implementation phase, particularly among the GPs, and allowed them to support the change practices and services arrangements.

Crossing the Chasm with Classroom Response Systems

ERIC Educational Resources Information Center

Towns, Marcy H.

2010-01-01

Research and literature on the adoption of technology provides a useful lens through which to view the adoption and implementation of classroom response systems (CRS). The technology adoption life cycle describes groups of adopters in ways that are helpful in understanding the adoption and sustained implementation of CRS in chemistry departments.…

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

NHI-PharmaCloud in Taiwan--A preliminary evaluation using the RE-AIM framework and lessons learned.

PubMed

Huang, San-Kuei; Wang, Pen-Jen; Tseng, Wen-Fuh; Syu, Fei-Kai; Lee, Miaw-Chwen; Shih, Ru-Liang; Sheen, Mao-Ting; Chen, Michael S

2015-10-01

The aim of this article is to present the preliminary impact of a medication monitoring program, PharmaCloud, in Taiwan and analyze the embedded factors that have contributed to the performance thereof. This article also compared PharmaCloud with similar international programs in order to draw lessons learned. The five domains of the RE-AIM framework - reach, effectiveness, adoption, implementation, and maintenance - were examined using qualitative and quantitative data. A difference-in-differences model was applied to analyze the quantitative impact of PharmaCloud on drug utilization and drug expenses. The qualitative impact was evaluated by document analysis based on field reports from the participating medical institutions. Reach and adoption: although all of the major hospitals adopted PharmaCloud and some of the hospitals had high inquiry rates, more time and incentives are needed to raise the overall inquiry rate. Effectiveness: during the study period of 3 months, the number of medications per prescription declined in the intervention group was 0.15 more than that of the general population, and the drug expense per person declined in the intervention group was NT $567 (US $18.9) more than that of the general population. The potential savings could be between 2% and 5% of the total pharmaceutical expenditure. Medication duplication was found to have decreased more in the intervention group. a variety of innovations in care delivery are being developed in which the pharmacists play a more significant role. Maintenance: the embedded National Health Insurance would lend strong support for PharmaCloud to grow and thrive. PharmaCloud owes its effectiveness to the embedded National Health Insurance (NHI) program, which is universal and provides a comprehensive benefit package including more than 16,000 prescription drugs. An effective medication program is one that operates under the principle of universality and comprehensiveness, facilitates innovations, and has a substantial level of interoperability with the intra-hospital health information systems. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

45 CFR 1357.30 - State fiscal requirements (title IV-B, subpart 1, child welfare services).

Code of Federal Regulations, 2013 CFR

2013-10-01

... match the title IV-B, subpart 1 allotment may include foster care maintenance expenditures in any amount... (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...

45 CFR 1357.30 - State fiscal requirements (title IV-B, subpart 1, child welfare services).

Code of Federal Regulations, 2012 CFR

2012-10-01

... match the title IV-B, subpart 1 allotment may include foster care maintenance expenditures in any amount... (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...

45 CFR 1357.30 - State fiscal requirements (title IV-B, subpart 1, child welfare services).

Code of Federal Regulations, 2010 CFR

2010-10-01

... match the title IV-B, subpart 1 allotment may include foster care maintenance expenditures in any amount... (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...

45 CFR 1357.30 - State fiscal requirements (title IV-B, subpart 1, child welfare services).

Code of Federal Regulations, 2011 CFR

2011-10-01

... match the title IV-B, subpart 1 allotment may include foster care maintenance expenditures in any amount... (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...

26 CFR 1.7703-1 - Determination of marital status.

Code of Federal Regulations, 2013 CFR

2013-04-01

... legally separated under a decree of divorce or separate maintenance. The provisions of this paragraph may... apart, but no decree of divorce or separate maintenance is issued until March 1955. If A itemizes and... (1)(ii)(a) of this paragraph, a legally adopted son or daughter of an individual, a child (described...

26 CFR 1.7703-1 - Determination of marital status.

Code of Federal Regulations, 2011 CFR

2011-04-01

... legally separated under a decree of divorce or separate maintenance. The provisions of this paragraph may... apart, but no decree of divorce or separate maintenance is issued until March 1955. If A itemizes and... (1)(ii)(a) of this paragraph, a legally adopted son or daughter of an individual, a child (described...

26 CFR 1.7703-1 - Determination of marital status.

Code of Federal Regulations, 2014 CFR

2014-04-01

... legally separated under a decree of divorce or separate maintenance. The provisions of this paragraph may... apart, but no decree of divorce or separate maintenance is issued until March 1955. If A itemizes and... (1)(ii)(a) of this paragraph, a legally adopted son or daughter of an individual, a child (described...

26 CFR 1.7703-1 - Determination of marital status.

Code of Federal Regulations, 2012 CFR

2012-04-01

... legally separated under a decree of divorce or separate maintenance. The provisions of this paragraph may... apart, but no decree of divorce or separate maintenance is issued until March 1955. If A itemizes and... (1)(ii)(a) of this paragraph, a legally adopted son or daughter of an individual, a child (described...

Lead users' ideas on core features to support physical activity in rheumatoid arthritis: a first step in the development of an internet service using participatory design.

PubMed

Revenäs, Åsa; Opava, Christina H; Åsenlöf, Pernilla

2014-03-22

Despite the growing evidence of the benefits of physical activity (PA) in individuals with rheumatoid arthritis (RA), the majority is not physically active enough. An innovative strategy is to engage lead users in the development of PA interventions provided over the internet. The aim was to explore lead users' ideas and prioritization of core features in a future internet service targeting adoption and maintenance of healthy PA in people with RA. Six focus group interviews were performed with a purposively selected sample of 26 individuals with RA. Data were analyzed with qualitative content analysis and quantification of participants' prioritization of most important content. Six categories were identified as core features for a future internet service: up-to-date and evidence-based information and instructions, self-regulation tools, social interaction, personalized set-up, attractive design and content, and access to the internet service. The categories represented four themes, or core aspects, important to consider in the design of the future service: (1) content, (2) customized options, (3) user interface and (4) access and implementation. This is, to the best of our knowledge, the first study involving people with RA in the development of an internet service to support the adoption and maintenance of PA.Participants helped identifying core features and aspects important to consider and further explore during the next phase of development. We hypothesize that involvement of lead users will make transfer from theory to service more adequate and user-friendly and therefore will be an effective mean to facilitate PA behavior change.

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...

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...

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...

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...

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...

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...

The microeconomics of residential photovoltaics: Tariffs, network operation and maintenance, and ancillary services in distribution-level electricity markets

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

Boero, Riccardo; Backhaus, Scott N.; Edwards, Brian K.

Here, we develop a microeconomic model of a distribution-level electricity market that takes explicit account of residential photovoltaics (PV) adoption. The model allows us to study the consequences of most tariffs on PV adoption and the consequences of increased residential PV adoption under the assumption of economic sustainability for electric utilities. We also validated the model using U.S. data and extend it to consider different pricing schemes for operation and maintenance costs of the distribution network and for ancillary services. Results show that net metering promotes more environmental benefits and social welfare than other tariffs. But, if costs to operatemore » the distribution network increase, net metering will amplify the unequal distribution of surplus among households. In conclusion, maintaining the economic sustainability of electric utilities under net metering may become extremely difficult unless the uneven distribution of surplus is legitimated by environmental benefits.« less

The microeconomics of residential photovoltaics: Tariffs, network operation and maintenance, and ancillary services in distribution-level electricity markets

DOE PAGES

Boero, Riccardo; Backhaus, Scott N.; Edwards, Brian K.

2016-11-12

Here, we develop a microeconomic model of a distribution-level electricity market that takes explicit account of residential photovoltaics (PV) adoption. The model allows us to study the consequences of most tariffs on PV adoption and the consequences of increased residential PV adoption under the assumption of economic sustainability for electric utilities. We also validated the model using U.S. data and extend it to consider different pricing schemes for operation and maintenance costs of the distribution network and for ancillary services. Results show that net metering promotes more environmental benefits and social welfare than other tariffs. But, if costs to operatemore » the distribution network increase, net metering will amplify the unequal distribution of surplus among households. In conclusion, maintaining the economic sustainability of electric utilities under net metering may become extremely difficult unless the uneven distribution of surplus is legitimated by environmental benefits.« less

Major factors for facilitating change in behavioral strategies to reduce obesity

PubMed Central

Dalle Grave, Riccardo; Centis, Elena; Marzocchi, Rebecca; El Ghoch, Marwan; Marchesini, Giulio

2013-01-01

It is very unlikely that our obesity-promoting environment will change in the near future. It is therefore mandatory to improve our knowledge of the main factors associated with successful adoption of obesity-reducing behaviors. This may help design more powerful procedures and strategies to facilitate the adoption of healthy lifestyles in a “toxic” environment favoring the development of a positive energy balance. The aim of this review is to describe the main factors associated with successful adoption of obesity-reducing behaviors and to describe the most recent development, limits, and outcomes of lifestyle modification programs. The evidence regarding predictors of weight loss and weight loss maintenance remains largely incomplete. It is necessary to develop strategies matching treatments to patients’ needs to improve successful weight loss and its maintenance. How to detect and how to address these needs is a continuous, challenging, research problem. PMID:24124398

77 FR 12175 - Airworthiness Directives; DASSAULT AVIATION Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-29

... specified products. The MCAI states: The Maintenance Procedure (MP) 57-607, related to non destructive check... Recommended Maintenance Schedules chapter of the Aircraft Maintenance Documentation. After the implementation... maintenance program to include ``Non-Destructive Check of Flap Tracks 2 and 5,'' Maintenance Procedure 57-607...

Supportability Issues and Approaches for Exploration Missions

NASA Technical Reports Server (NTRS)

Watson, J. K.; Ivins, M. S.; Cunningham, R. A.

2006-01-01

Maintaining and repairing spacecraft systems hardware to achieve required levels of operational availability during long-duration exploration missions will be challenged by limited resupply opportunities, constraints on the mass and volume available for spares and other maintenance-related provisions, and extended communications times. These factors will force the adoption of new approaches to the integrated logistics support of spacecraft systems hardware. For missions beyond the Moon, all spares, equipment, and supplies must either be prepositioned prior to departure from Earth of human crews or carried with the crews. The mass and volume of spares must be minimized by enabling repair at the lowest hardware levels, imposing commonality and standardization across all mission elements at all hardware levels, and providing the capability to fabricate structural and mechanical spares as required. Long round-trip communications times will require increasing levels of autonomy by the crews for most operations including spacecraft maintenance. Effective implementation of these approaches will only be possible when their need is recognized at the earliest stages of the program, when they are incorporated in operational concepts and programmatic requirements, and when diligence is applied in enforcing these requirements throughout system design in an integrated way across all contractors and suppliers. These approaches will be essential for the success of missions to Mars. Although limited duration lunar missions may be successfully accomplished with more traditional approaches to supportability, those missions will offer an opportunity to refine these concepts, associated technologies, and programmatic implementation methodologies so that they can be most effectively applied to later missions.

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 that might be driven by law to be able to react consistently with expectations of policymakers.

RE-AIM Analysis of a School-Based Nutrition Education Intervention in Kindergarteners.

PubMed

Larsen, Andrew L; Liao, Yue; Alberts, Janel; Huh, Jimi; Robertson, Trina; Dunton, Genevieve F

2017-01-01

Few nutrition interventions in kindergarten classes have been evaluated, and none has been tested for program effectiveness, implementation, and dissemination. Building a Healthy Me (BHM) is a nutrition intervention for kindergarteners that is classroom-based and includes a family component. This study evaluated the public health impact of BHM in California kindergarten classrooms using the RE-AIM (reach, efficacy, adoption, implementation, and maintenance) framework. A quasi-experimental design assessed pre-to-post changes in nutrition knowledge, dietary consumption, and parent behaviors of 25 intervention classrooms (414 students, 264 parents); and postintervention differences in nutrition knowledge between the intervention classrooms and 4 control classrooms measured at postintervention only (103 students). Intervention students improved in knowledge of food groups and healthy breakfast/snack options, and scored higher than control students in food group knowledge at postintervention (ps < .05). Parents of intervention group children increased their use of food labels, and intervention group children increased intake of several healthy foods and decreased intake of candy and fried potatoes (ps < .05). The BHM program reached 41% of kindergarteners attending public schools in California, and teachers implemented most lesson material. The BHM program was effective, implemented with fidelity, and broadly disseminated, highlighting its potential public health impact for kindergarteners. © 2016, American School Health Association.

Discolouration in potable water distribution systems: a review.

PubMed

Vreeburg, J H G; Boxall, J B

2007-02-01

A large proportion of the customer contacts that drinking water supply companies receive stem from the occurrence of discoloured water. Currently, such complaints are dealt with in a reactive manner. However, water companies are being driven to implement planned activities to control discolouration prior to contacts occurring. Hence improved understanding of the dominant processes and predictive and management tools are needed. The material responsible for discolouration has a variety of origins and a range of processes and mechanisms may be associated with its accumulation within distribution systems. Irrespective of material origins, accumulation processes and mechanisms, discolouration events occur as a result of systems changes leading to mobilisation of the accumulations from within the network. Despite this conceptual understanding, there are very few published practicable tools and techniques available to aid water companies in the planned management and control of discolouration problems. Two recently developed and published, but different approaches to address this are reviewed here: the PODDS model which was developed to predict levels of turbidity as a result of change in hydraulic conditions, but which is semi-empirical and requires calibration; and the resuspension potential method which was developed to directly measure discolouration resulting from a controlled change in hydraulic conditions, providing a direct assessment of discolouration risk, although intrinsically requiring the limited generation of discoloured water within a live network. Both these methods support decision making on the need for maintenance operations. While risk evaluation and implementation of appropriate maintenance can be implemented to control discolouration risk, new material will continue to accumulate and hence an ongoing programme of maintenance is required. One sustainable measure to prevent such re-accumulation of material is the adoption of a self-cleaning threshold, an hydraulic force which a pipe experiences on a regular basis that effectively prevents the accumulation of material. This concept has been effectively employed for the design of new networks in the Netherlands. Alternatively, measures could be implemented to limit or prevent particles from entering or being generated within the network, such as by improving treatment or preventing the formation of corrosion by-products through lining or replacing ferrous pipes. The cost benefit of such capex investment or ongoing opex is uncertain as the quantification and relative significance of factors possibly leading to material accumulation are poorly understood. Hence, this is an area in need of significant further practical research and development.

Standard payload computer for the international space station

NASA Astrophysics Data System (ADS)

Knott, Karl; Taylor, Chris; Koenig, Horst; Schlosstein, Uwe

1999-01-01

This paper describes the development and application of a Standard PayLoad Computer (SPLC) which is being applied by the majority of ESA payloads accommodated on the International Space Station (ISS). The strategy of adopting of a standard computer leads to a radical rethink in the payload data handling procurement process. Traditionally, this has been based on a proprietary development with repeating costs for qualification, spares, expertise and maintenance for each new payload. Implementations have also tended to be unique with very little opportunity for reuse or utilisation of previous developments. While this may to some extent have been justified for short duration one-off missions, the availability of a standard, long term space infrastructure calls for a quite different approach. To support a large number of concurrent payloads, the ISS implementation relies heavily on standardisation, and this is particularly true in the area of payloads. Physical accommodation, data interfaces, protocols, component quality, operational requirements and maintenance including spares provisioning must all conform to a common set of standards. The data handling system and associated computer used by each payload must also comply with these common requirements, and thus it makes little sense to instigate multiple developments for the same task. The opportunity exists to provide a single computer suitable for all payloads, but with only a one-off development and qualification cost. If this is combined with the benefits of multiple procurement, centralised spares and maintenance, there is potential for great savings to be made by all those concerned in the payload development process. In response to the above drivers, the SPLC is based on the following concepts: • A one-off development and qualification process • A modular computer, configurable according to the payload developer's needs from a list of space-qualified items • An `open system' which may be added to by payload developers • Core software providing a suite of common communications services including a verified protocol implementation required to communicate with the ISS • A standardized ground support equipment and accompanying software development environment • The use of commercial hardware and software standards and products.

Processes and outcomes of developing a continuity of care document for use as a personal health record by people living with HIV/AIDS in New York City.

PubMed

Gordon, Peter; Camhi, Eli; Hesse, Ron; Odlum, Michelle; Schnall, Rebecca; Rodriguez, Martha; Valdez, Esmerlin; Bakken, Suzanne

2012-10-01

To describe the processes and outcomes of developing and implementing a Continuity of Care Document (CCD), My Health Profile, as a personal health record for persons living with HIV (PLWH) in an HIV/AIDS Special Needs Plan in New York City. Multiple qualitative and quantitative data sources were used to describe the processes and outcomes of implementing My Health Profile including focus groups, Audio Computer Assisted Self Interview (ACASI) surveys, administrative databases, chart abstraction, usage logs, and project management records. Qualitative data were thematically analyzed. Quantitative data analytic methods included descriptive and multivariate statistics. Data were triangulated and synthesized using the Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework. Reach - SNP members are predominantly African American or Hispanic/Latino and about one-third are female. A larger proportion of African Americans and smaller proportions of Hispanics/Latinos and Whites were trained to use My Health Profile.Efficacy/Effectiveness - CCDs were produced for 8249 unique members and updated on a monthly basis, 509 members were trained to use My Health Profile. Total number of member logins for 112 active users was 1808 and the longest duration of use was 1008 days. There were no significant differences between users and non-users of My Health Profile in clinical outcomes, perceptions of the quality of medical care, or health service utilization. Adoption -My Health Profile was well-matched to organizational mission, values, and priorities related to coordination of care for a high-risk population of PLWH. Implementation - Pre-implementation focus group participants identified potential barriers to use of My Health Profile including functional and computer literacy, privacy and confidentiality concerns, potential reluctance to use technology, and cognitive challenges. Key strategies for addressing barriers included a dedicated bilingual coach for recruitment, training, and support; basic computer and My Health Profile training; transparent audit trail revealing clinician and case manager access of My Health Profile, time-limited passwords for sharing My Health Profile with others at the point of need, and emergency access mechanism. Maintenance -My Health Profile was integrated into routine operational activities and its sustainability is facilitated by its foundation on standards for Health Information Exchange (HIE). Although potential barriers exist to the use of personal health records (PHRs) such as My Health Profile, PLWH with complex medical needs, low socioeconomic status, and limited computer experience will use such tools when a sufficient level of user support is provided and privacy and confidentiality concerns are addressed. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

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.

78 FR 59054 - Renewal of Approved Information Collection

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-25

... collection of information from those who wish to adopt and obtain title to wild horses and burros. The Office..., Management, and Control of Wild Horses and Burros (43 CFR part 4700). OMB Control Number: 1004-0042. Summary... maintenance (i.e., adoption) program for wild horses and burros. The BLM uses the information to determine if...

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…

76 FR 18024 - Airworthiness Directives; Bombardier, Inc. Model CL-600-2B19 (Regional Jet Series 100 & 440...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-01

... to this AD because it is part of the Bombardier CRJ Series Regional Jet Aircraft Maintenance Manual... transportation, Aircraft, Aviation safety, Incorporation by reference, Safety. Adoption of the Amendment... Task 30-11-41-820-801 of the Canadair CRJ Series Regional Jet Aircraft Maintenance Manual. (5) Within...

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 clinicians, use of the technology was less robust than use by patients, with only a handful of clinicians using Seva in each clinic and behavioral health providers making most referrals to Seva in 2 of the 3 clinics. Implementation-At 2 sites, implementation plans were realized successfully; they were delayed in the third. Maintenance-Use of Seva dropped when grant funding stopped paying for the mobile phones and data plans. Two of the 3 clinics wanted to maintain the use of Seva, but they struggled to find funding to support this. Implementing an mHealth system can improve care among primary care patients with SUDs, and patients using the system can support one another in their recovery. Among clinicians, however, implementation requires figuring out how information from the mHealth system will be used and making mHealth data available in the electronic health (eHealth) record. In addition, paying for an mHealth system remains a challenge. ©Andrew Quanbeck, David H Gustafson, Lisa A Marsch, Ming-Yuan Chih, Rachel Kornfield, Fiona McTavish, Roberta Johnson, Randall T Brown, Marie-Louise Mares, Dhavan V Shah. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 30.01.2018.

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...

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...

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...

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…

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...

Accelerating Translation of Physical Activity and Cancer Survivorship Research into Practice: Recommendations for a More Integrated and Collaborative Approach

PubMed Central

Phillips, Siobhan M.; Alfano, Catherine M.; Perna, Frank M.; Glasgow, Russell E.

2015-01-01

Physical activity has been deemed safe and effective in reducing many negative side effects of treatment for cancer survivors and promoting better overall health. However, most of this research has focused on highly controlled randomized trials and little of this research has been translated into care or policy for survivors. The purpose of the present paper is to present a research agenda for the field to accelerate the dissemination and implementation of empirically-supported physical activity interventions into care. We provide rationale for the role of basic, behavioral, clinical implementation and population scientists in moving this science forward and call for a more coordinated effort across different phases of research. In addition, we provide key strategies and examples for ongoing and future studies using the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation and Maintenance) framework and pose recommendations for collaborations between researchers and stakeholders to enhance the integration of this research into policy and practice. Overall, we recommend that physical activity and cancer survivorship research employ additional study designs, include relevant stakeholders and be more collaborative, integrated, contextual, and representative in terms of both setting and participants. PMID:24599577

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.

Investments and costs of oral health care for Family Health Care

PubMed Central

Macêdo, Márcia Stefânia Ribeiro; Chaves, Sônia Cristina Lima; Fernandes, Antônio Luis de Carvalho

2016-01-01

ABSTRACT OBJECTIVE To estimate the investments to implement and operational costs of a type I Oral Health Care Team in the Family Health Care Strategy. METHODS This is an economic assessment study, for analyzing the investments and operational costs of an oral health care team in the city of Salvador, BA, Northeastern Brazil. The amount worth of investments for its implementation was obtained by summing up the investments in civil projects and shared facilities, in equipments, furniture, and instruments. Regarding the operational costs, the 2009-2012 time series was analyzed and the month of December 2012 was adopted for assessing the monetary values in effect. The costs were classified as direct variable costs (consumables) and direct fixed costs (salaries, maintenance, equipment depreciation, instruments, furniture, and facilities), besides the indirect fixed costs (cleaning, security, energy, and water). The Ministry of Health’s share in funding was also calculated, and the factors that influence cost behavior were described. RESULTS The investment to implement a type I Oral Health Care Team was R$29,864.00 (US$15,236.76). The operational costs of a type I Oral Health Care Team were around R$95,434.00 (US$48,690.82) a year. The Ministry of Health’s financial incentives for investments accounted for 41.8% of the implementation investments, whereas the municipality contributed with a 59.2% share of the total. Regarding operational costs, the Ministry of Health contributed with 33.1% of the total, whereas the municipality, with 66.9%. Concerning the operational costs, the element of heaviest weight was salaries, which accounted for 84.7%. CONCLUSIONS Problems with the regularity in the supply of inputs and maintenance of equipment greatly influence the composition of costs, besides reducing the supply of services to the target population, which results in the service probably being inefficient. States are suggested to partake in funding, especially to cover the team’s operational cost. PMID:27463254

Toward Treatment Integrity: Developing an Approach to Measure the Treatment Integrity of a Dialectical Behavior Therapy Intervention With Homeless Youth in the Community.

PubMed

McCay, Elizabeth; Carter, Celina; Aiello, Andria; Quesnel, Susan; Howes, Carol; Johansson, Bjorn

2016-10-01

The current paper discusses an approach to measuring treatment integrity of dialectical behavioral therapy (DBT) when implemented within two programs providing services to street-involved youth in the community. Measuring treatment integrity is a critical component of effective implementation of evidence-based interventions in clinical practice, since sound treatment integrity increases confidence in client outcomes and intervention replicability. Despite being an essential part of implementation science, few studies report on treatment integrity, with limited research addressing either measurement tools or maintenance of treatment integrity. To address the lack of available treatment integrity measures, researchers in the current study developed and piloted a treatment integrity measure which pertain to the individual and group components of DBT. A total of 20 recordings were assessed using the treatment integrity measure. Results indicate that the community agency staff (e.g. youth workers, social workers & nurses) implemented the intervention as intended; increasing confidence in the outcome variables, the staffs' training and the replicability of the intervention. This article offers one approach to addressing treatment integrity when implementing evidence-based interventions, such as DBT in a community setting, and discusses the need for effective and feasible integrity measures that can be adopted in order to strengthen mental health practice in community settings. Copyright © 2016 Elsevier Inc. All rights reserved.

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.

A Formative Evaluation of a Diabetes Prevention Program Using the RE-AIM Framework in a Learning Health Care System, Utah, 2013-2015.

PubMed

Brunisholz, Kimberly D; Kim, Jaewhan; Savitz, Lucy A; Hashibe, Mia; Gren, Lisa H; Hamilton, Sharon; Huynh, Kelly; Joy, Elizabeth A

2017-07-20

Evaluation of interventions can help to close the gap between research and practice but seldom takes place during implementation. Using the RE-AIM framework, we conducted a formative evaluation of the first year of the Intermountain Healthcare Diabetes Prevention Program (DPP). Adult patients who met the criteria for prediabetes (HbA1c of 5.70%-6.49% or fasting plasma glucose of 100-125 mg/dL) were attributed to a primary care provider from August 1, 2013, through July 31, 2014. Physicians invited eligible patients to participate in the program during an office visit. We evaluated 1) reach, with data on patient eligibility, participation, and representativeness; 2) effectiveness, with data on attaining a 5% weight loss; 3) adoption, with data on providers and clinics that referred patients to the program; and 4) implementation, with data on patient encounters. We did not measure maintenance. Of the 6,862 prediabetes patients who had an in-person office visit with their provider, 8.4% of eligible patients enrolled. Likelihood of participation was higher among patients who were female, aged 70 years or older, or overweight; had depression and higher weight at study enrollment; or were prescribed metformin. DPP participants were more likely than nonparticipants to achieve a 5% weight loss (odds ratio, 1.70; 95% confidence interval, 1.29-2.25; P < .001). Providers from 7 of 8 regions referred patients to the DPP; 174 providers at 53 clinics enrolled patients. The mean number of DPP counseling encounters per patient was 2.3 (range, 1-16). The RE-AIM framework was useful for estimating the formative impact (ie, reach, effectiveness, adoption, and implementation fidelity) of a DPP-based lifestyle intervention deployed in a learning health care system.

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 required to make the strategy more acceptable for primary care. Qualitatively, intervention clinics reported that chronic pain was now treated using approaches similar to those employed for other chronic conditions, such as hypertension and diabetes. The systems consultation implementation strategy demonstrated feasibility, acceptability, and effectiveness in a study involving eight primary care clinics. This multi-disciplinary strategy holds potential to mitigate the prevalence of opioid addiction and ultimately may help to improve implementation of clinical guidelines across healthcare. ClinicalTrials.gov (NCT02433496). https://clinicaltrials.gov/ct2/show/NCT02433496 Registered May 5, 2015.

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...

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…

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.

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…

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...

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...

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...

Evaluation of scaling-up of HPV self-collection offered by community health workers at home visits to increase screening among socially vulnerable under-screened women in Jujuy Province, Argentina.

PubMed

Arrossi, Silvina; Paolino, Melisa; Thouyaret, Laura; Laudi, Rosa; Campanera, Alicia

2017-02-13

Self-collection has been proposed as a strategy to increase cervical screening coverage among hard-to-reach women. However, evaluations of the implementation of this strategy on a large scale are scarce. This paper describes the process and measurement of the scaling-up of self-collection offered by community health workers during home visits as a strategy to reach under-screened women aged 30+ with public health coverage, defined as the target women. We used an adaptation of the Health System Framework to analyze key drivers of scaling-up. A content analysis approach was used to collect and analyze information from different sources. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) model was used to evaluate the impact of the strategy. HPV self-collection was scaled-up in the province of Jujuy in 2014 after a RCT (Self-collection Modality Trial, initials EMA in Spanish) was carried out locally in 2012 and demonstrated effectiveness of the strategy to increase screening uptake. Facilitators of scaling-up were the organizational capacity of the provincial health system, sustainable funding for HPV testing, and local consensus about the value of the technology. Reach: In 2014, 9% (2983/33,245) of target women were screened through self-collection in the Jujuy public health sector. Effectiveness: In 2014, 17% (n = 5657/33,245) of target women were screened with any HPV test (self-collected and clinician-collected tests) vs. 11.7% (4579/38,981) in 2013, the pre-scaling-up period (p < 0.0001). Training about the strategy was provided to 84.2% (n = 609/723) of total community health workers (CHWs). Of 414 HPV+ women, 77.5% (n = 320) had follow-up procedures. Of 113 women with positive triage, 66.4% (n = 75) had colposcopic diagnosis. Treatment was provided to 80.7% of CIN2+ women (n = 21/26). Adoption: Of trained CHWs, 69.3% (n = 422/609) had at least one woman with self-collection; 85.2% (n = 315/368) of CHWs who responded to an evaluation survey were satisfied with self-collection strategy. Maintenance: During 2015, 100.0% (723/723) CHWs were operational and 63.8% (461/723) had at least one woman with self-collection. The strategy was successfully scaled-up, with a high level of adoption among CHWs, which resulted in increased screening among socially vulnerable under-screened women.

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 describing policy and adopter characteristics and political contexts that shaped policy trajectories. An understanding of the conditions associated with successful policy adoption and diffusion can help identify receptive contexts in which to pioneer novel legislative initiatives to increase PA among children. By reviewing evidence regarding policy implementation and impact, this study can also inform amendments to existing, and development of future PA policies.

Shame, pride and eating disorders.

PubMed

Goss, Kenneth; Allan, Steven

2009-01-01

This paper explores shame and shame-based responses in eating disorders. Research linking shame with eating disorders and the possible role of shame and pride in the onset and maintenance of eating disorders is reviewed. The experience of shame is likely to be complex, dynamic and variable. However, the key to identifying shame is often via the various coping strategies adopted, which in turn may form part of a maintenance cycle for eating disorder beliefs and behaviours. An outline model of shame and pride cycles in the maintenance of eating disorders is presented with clinical implications.

Weight control behaviors of highly successful weight loss maintainers: the Portuguese Weight Control Registry.

PubMed

Santos, Inês; Vieira, Paulo N; Silva, Marlene N; Sardinha, Luís B; Teixeira, Pedro J

2017-04-01

To describe key behaviors reported by participants in the Portuguese Weight Control Registry and to determine associations between these behaviors and weight loss maintenance. A total of 388 adults participated in this cross-sectional study. Assessments included demographic information, weight history, weight loss and weight maintenance strategies, dietary intake, and physical activity. Participants lost on average 18 kg, which they had maintained for ~28 months. Their average dietary intake was 2199 kcal/day, with 33 % of energy coming from fat. About 78 % of participants engaged in levels of moderate-plus-vigorous physical activity exceeding 150 min/week (51 % above 250 min/week), with men accumulating 82 more minutes than women (p < 0.05). The most frequently reported strategies for both weight loss and maintenance were keeping healthy foods at home, consuming vegetables regularly, and having daily breakfast. Greater weight loss maintenance was associated with higher levels of physical activity, walking, weight self-monitoring, establishing specific goals, and with reduced portion size use, reduced consumption of carbohydrates, and increased consumption of protein, (p < 0.05). Results indicate that weight loss maintenance is possible through the adoption of a nutritionally-balanced diet and regular participation in physical activity, but also suggest that adopting different (and, to a degree, individualized) set of behavioral strategies is key for achieving success.

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.

Implementing and Sustaining Team-Based Telecare for Bipolar Disorder: Lessons Learned from a Model-Guided, Mixed Methods Analysis.

PubMed

Bauer, Mark S; Krawczyk, Lois; Tuozzo, Kathy; Frigand, Cara; Holmes, Sally; Miller, Christopher J; Abel, Erica; Osser, David N; Franz, Aleda; Brandt, Cynthia; Rooney, Meghan; Fleming, Jerry; Smith, Eric; Godleski, Linda

2018-01-01

Telemental health interventions have empirical support from clinical trials and structured demonstration projects. However, their implementation and sustainability under less structured clinical conditions are not well demonstrated. We conducted a follow-up analysis of the implementation and sustainability of a clinical video teleconference-based collaborative care model for individuals with bipolar disorder treated in the Department of Veterans Affairs to (a) characterize the extent of implementation and sustainability of the program after its establishment and (b) identify barriers and facilitators to implementation and sustainability. We conducted a mixed methods program evaluation, assessing quantitative aspects of implementation according to the Reach, Efficacy, Adoption, Implementation, and Maintenance implementation framework. We conducted qualitative analysis of semistructured interviews with 16 of the providers who submitted consults, utilizing the Integrated Promoting Action on Research Implementation in the Health Services implementation framework. The program demonstrated linear growth in sites (n = 35) and consults (n = 915) from late 2011 through mid-2016. Site-based analysis indicated statistically significant sustainability beyond the first year of operation. Qualitative analysis identified key facilitators, including consult content, ease of use via electronic health record, and national infrastructure. Barriers included availability of telehealth space, equipment, and staff at the sites, as well as the labor-intensive nature of scheduling. The program achieved continuous growth over almost 5 years due to (1) successfully filling a need perceived by providers, (2) developing in a supportive context, and (3) receiving effective facilitation by national and local infrastructure. Clinical video teleconference-based interventions, even multicomponent collaborative care interventions for individuals with complex mental health conditions, can grow vigorously under appropriate conditions.

Lead users’ ideas on core features to support physical activity in rheumatoid arthritis: a first step in the development of an internet service using participatory design

PubMed Central

2014-01-01

Background Despite the growing evidence of the benefits of physical activity (PA) in individuals with rheumatoid arthritis (RA), the majority is not physically active enough. An innovative strategy is to engage lead users in the development of PA interventions provided over the internet. The aim was to explore lead users’ ideas and prioritization of core features in a future internet service targeting adoption and maintenance of healthy PA in people with RA. Methods Six focus group interviews were performed with a purposively selected sample of 26 individuals with RA. Data were analyzed with qualitative content analysis and quantification of participants’ prioritization of most important content. Results Six categories were identified as core features for a future internet service: up-to-date and evidence-based information and instructions, self-regulation tools, social interaction, personalized set-up, attractive design and content, and access to the internet service. The categories represented four themes, or core aspects, important to consider in the design of the future service: (1) content, (2) customized options, (3) user interface and (4) access and implementation. Conclusions This is, to the best of our knowledge, the first study involving people with RA in the development of an internet service to support the adoption and maintenance of PA. Participants helped identifying core features and aspects important to consider and further explore during the next phase of development. We hypothesize that involvement of lead users will make transfer from theory to service more adequate and user-friendly and therefore will be an effective mean to facilitate PA behavior change. PMID:24655757

Coping with hygiene in South Africa, a water scarce country.

PubMed

Duse, A G; da Silva, M P; Zietsman, I

2003-06-01

The burden of infectious diseases may be reduced by adopting effective infection control measures. Some of these are dependent on the provision of adequate and safe water supplies for maintenance of basic standards of personal, domestic and healthcare hygiene. Consequences of scarce, and sometimes unsafe, waters supplies in South Africa are highlighted with reference to healthcare-associated infections, community acquired infectious intestinal diseases and domestic practices as infection sources. Availability of water in more than 67% of South African municipal hospitals and primary health care facilities (delivered by water tanker in 12.5% of satellite clinics, 5% from river or dam sources, 12.4% relying on rainwater) does not necessarily guarantee that it's quality is safe for utilisation. In the Northern Province and Mpumalanga, water needs to be purified prior to usage in 14.4 and 33% of satellite clinics respectively. Simple, low maintenance and low-cost interventions to maximise use and safety of limited water resources may be implemented: micro-organism (S. dysenteriae) inactivation by direct UV-exposure in sunlight abundant environments, water purification by filtration mechanisms and making use of iron pots in the community for pasteurisation, decontamination and boiling procedures. Education is paramount in promoting healthy domestic food handling practices, changing cultural perceptions of hygiene, hand-washing technique and mechanisms of domestic environmental decontamination. Water provision cannot be separated from other inter-related factors such as sanitation. Although the present government has taken initiatives to reduce the number of people not having access to water by 50% in 2002, provision of sanitation has been slower (>38% inadequate sanitation in 2002). Adoption of integrated environmental management approaches in conjunction with community participation (WASH Campaign--2002), by the government, aims to address the sanitation problems.

Prescribe for health. Improving cancer screening in physician practices serving low-income and minority populations.

PubMed

Manfredi, C; Czaja, R; Freels, S; Trubitt, M; Warnecke, R; Lacey, L

1998-01-01

To evaluate a health maintenance organization (HMO)-sponsored intervention to improve cancer screening in private physician practices serving low-income, minority populations. A randomized controlled trial with preintervention and postintervention measurements. Measurements were obtained by abstracting information from independent random samples of medical charts (N = 2316 at preintervention and 2238 at postintervention). Forty-seven primary care physician practices located in low-income and minority urban neighborhoods in Chicago, Ill. Practices were encouraged to adopt an office chart reminder system and to use a patient health maintenance card. Activities to facilitate the adoption of these items and for compliance with cancer screening guidelines included on-site training and start-up assistance visits, a physician continuing medical education seminar, and quality assurance visits with feedback to physicians. The proportions of patients with a chart-documented mammogram, clinical breast examination, Papanicolaou smear, or fecal occult blood slide test in the 2 years before preintervention and postintervention chart abstractions. Between baseline and postintervention, there was a net increase in the proportion of HMO members in the intervention, compared with the control practices, who received in the preceding 2 years a Papanicolaou smear (11.9%) and a fecal occult blood slide test (14.1%). There was a net increase in the proportion of non-HMO patients in the intervention compared with the control practices who received a clinical breast examination (15.3%) and a fecal occult blood slide test (20.2%). Implementation of an HMO-mediated, multicomponent intervention to improve cancer screening was feasible and effective for the Papanicolaou smear, fecal occult blood slide test, and the clinical breast examination, but not for mammography.

Supporting Tablet Configuration, Tracking, and Infection Control Practices in Digital Health Interventions: Study Protocol.

PubMed

Furberg, Robert D; Ortiz, Alexa M; Zulkiewicz, Brittany A; Hudson, Jordan P; Taylor, Olivia M; Lewis, Megan A

2016-06-27

Tablet-based health care interventions have the potential to encourage patient care in a timelier manner, allow physicians convenient access to patient records, and provide an improved method for patient education. However, along with the continued adoption of tablet technologies, there is a concomitant need to develop protocols focusing on the configuration, management, and maintenance of these devices within the health care setting to support the conduct of clinical research. Develop three protocols to support tablet configuration, tablet management, and tablet maintenance. The Configurator software, Tile technology, and current infection control recommendations were employed to develop three distinct protocols for tablet-based digital health interventions. Configurator is a mobile device management software specifically for iPhone operating system (iOS) devices. The capabilities and current applications of Configurator were reviewed and used to develop the protocol to support device configuration. Tile is a tracking tag associated with a free mobile app available for iOS and Android devices. The features associated with Tile were evaluated and used to develop the Tile protocol to support tablet management. Furthermore, current recommendations on preventing health care-related infections were reviewed to develop the infection control protocol to support tablet maintenance. This article provides three protocols: the Configurator protocol, the Tile protocol, and the infection control protocol. These protocols can help to ensure consistent implementation of tablet-based interventions, enhance fidelity when employing tablets for research purposes, and serve as a guide for tablet deployments within clinical settings.

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...

42 CFR 405.902 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... health care professional under a decree of divorce or separate maintenance); (2) Children (including stepchildren and legally adopted children); (3) Grandchildren; (4) Parents; and (5) Grandparents. Fiscal...

42 CFR 405.902 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... health care professional under a decree of divorce or separate maintenance); (2) Children (including stepchildren and legally adopted children); (3) Grandchildren; (4) Parents; and (5) Grandparents. Fiscal...

42 CFR 405.902 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... health care professional under a decree of divorce or separate maintenance); (2) Children (including stepchildren and legally adopted children); (3) Grandchildren; (4) Parents; and (5) Grandparents. Fiscal...

77 FR 64422 - Approval and Promulgation of Air Quality Implementation Plans; Illinois; Greif Packaging, LLC...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-22

... Promulgation of Air Quality Implementation Plans; Illinois; Greif Packaging, LLC Adjusted Standard AGENCY...) 408-2279. 4. Mail: Doug Aburano, Chief, Attainment Planning and Maintenance Section, Air Programs.... 5. Hand Delivery: Doug Aburano, Chief, Attainment Planning and Maintenance Section, Air Programs...

Experimental adoption of RCM in EDF substations

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

Heroin, G.; Aupied, J.; Sanchis, G.

1996-08-01

EDF, after testing Reliability Centered Maintenance (RCM) on systems used in nuclear power plants, has now successfully extended RCM to all of its nuclear power plants. In the light of this experience, EDF has committed itself to a pilot study on a line bay of a 400 kV substation in 1992. The RCM method as applied benefited from EDF`s policy of maintenance, introduced five years ago on all substations, which has enhanced prospects of reliability. The original feature in the selection of maintenance tasks was that it brought into play two criteria for failure assessment - frequency and seriousness -more » and two criteria for maintenance task selection - efficiency and facility. The final outcome of RCM as applied to substation maintenance is to categorize maintenance tasks into: (1) essential maintenance tasks, (2) optional tasks, depending on the type and location of the substation, as well as on factors relating to local management of maintenance policy, and (3) unnecessary tasks.« less

Training Partnership Dyads for Community-Based Participatory Research: Strategies and Lessons Learned From the Community Engaged Scholars Program

PubMed Central

Andrews, Jeannette O.; Cox, Melissa J.; Newman, Susan D.; Gillenwater, Gwen; Warner, Gloria; Winkler, Joyce A.; White, Brandi; Wolf, Sharon; Leite, Renata; Ford, Marvella E.; Slaughter, Sabra

2014-01-01

This article describes the development, implementation, evaluation framework, and initial outcomes of a unique campus–community training initiative for community-based participatory research (CBPR). The South Carolina Clinical & Translational Research Center for Community Health Partnerships, which functions as the institution’s Clinical Translational and Science Award Community Engagement Program, leads the training initiative known as the Community Engaged Scholars Program (CES-P). The CES-P provides simultaneous training to CBPR teams, with each team consisting of at least one community partner and one academic partner. Program elements include 12 months of monthly interactive group sessions, mentorship with apprenticeship opportunities, and funding for a CBPR pilot project. A modified RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework guides the process, impact, and outcome evaluation plan. Lessons learned include challenges of group instruction with varying levels of readiness among the CBPR partners, navigating the institutional review board process with community co-investigators, and finding appropriate academic investigators to match community research interests. Future directions are recommended for this promising and unique dyadic training of academic and community partners. PMID:23091303

A multi-level analysis of counselor attitudes toward the use of buprenorphine in substance abuse treatment.

PubMed

Rieckmann, Traci R; Kovas, Anne E; McFarland, Bentson H; Abraham, Amanda J

2011-12-01

Despite evidence that buprenorphine is effective and safe and offers greater access as compared with methadone, implementation for treatment of opiate dependence continues to be weak. Research indicates that legal and regulatory factors, state policies, and organizational and provider variables affect adoption of buprenorphine. This study uses hierarchical linear modeling to examine National Treatment Center Study data to identify counselor characteristics (attitudes, training, and beliefs) and organizational factors (accreditation, caseload, access to buprenorphine, and other evidence-based practices) that influence implementation of buprenorphine for treatment of opiate dependence. Analyses showed that provider training about buprenorphine, higher prevalence of opiate-dependent clients, and less treatment program emphasis on a 12-step model predicted greater counselor acceptance and perceived effectiveness of buprenorphine. Results also indicate that program use of buprenorphine for any treatment purpose (detoxification, maintenance, and/or pain management) and time (calendar year in data collection) was associated with increased diffusion of knowledge about buprenorphine among counselors and with more favorable counselor attitudes toward buprenorphine. Copyright © 2011 Elsevier Inc. All rights reserved.

Counselor Attitudes toward the Use of Buprenorphine in Substance Abuse Treatment: A Multi-level Modeling Approach

PubMed Central

Kovas, Anne E.; McFarland, Bentson H.; Abraham, Amanda J.

2012-01-01

In spite of evidence that buprenorphine is effective, safe, and offers greater access as compared with methadone, implementation for treatment of opiate dependence continues to be weak. Research indicates that legal and regulatory factors, state policies, and organizational and provider variables affect adoption of buprenorphine. This study uses hierarchical linear modeling (HLM) to examine National Treatment Center Study (NTCS) data to identify counselor characteristics (attitudes, training, beliefs) and organizational factors (accreditation, caseload, access to buprenorphine and other evidence-based practices) that influence implementation of buprenorphine for treatment of opiate dependence. Analyses showed that provider training about buprenorphine, higher prevalence of opiate dependent clients, and less treatment program emphasis on a 12-step model predicted greater counselor acceptance and perceived effectiveness of buprenorphine. Results also indicate that program use of buprenorphine for any treatment purpose (detoxification, maintenance, and/or pain management) and time (calendar year in data collection) were associated with increased diffusion of knowledge about buprenorphine among counselors and with more favorable counselor attitudes toward buprenorphine. PMID:21821379

A Modular Plug-And-Play Sensor System for Urban Air Pollution Monitoring: Design, Implementation and Evaluation.

PubMed

Yi, Wei-Ying; Leung, Kwong-Sak; Leung, Yee

2017-12-22

Urban air pollution has caused public concern globally because it seriously affects human life. Modern monitoring systems providing pollution information with high spatio-temporal resolution have been developed to identify personal exposures. However, these systems' hardware specifications and configurations are usually fixed according to the applications. They can be inconvenient to maintain, and difficult to reconfigure and expand with respect to sensing capabilities. This paper aims at tackling these issues by adopting the proposed Modular Sensor System (MSS) architecture and Universal Sensor Interface (USI), and modular design in a sensor node. A compact MSS sensor node is implemented and evaluated. It has expandable sensor modules with plug-and-play feature and supports multiple Wireless Sensor Networks (WSNs). Evaluation results show that MSS sensor nodes can easily fit in different scenarios, adapt to reconfigurations dynamically, and detect low concentration air pollution with high energy efficiency and good data accuracy. We anticipate that the efforts on system maintenance, adaptation, and evolution can be significantly reduced when deploying the system in the field.

Evaporation mitigation by floating modular devices

NASA Astrophysics Data System (ADS)

Hassan, M. M.; Peirson, W. L.

2016-05-01

Prolonged periods of drought and consequent evaporation from open water bodies in arid parts of Australia continue to be a threat to water availability for agricultural production. Over many parts of Australia, the annual average evaporation exceeds the annual precipitation by more than 5 times. Given its significance, it is surprising that no evaporation mitigation technique has gained widespread adoption to date. High capital and maintenance costs of manufactured products are a significant barrier to implementation. The use of directly recycled clean plastic containers as floating modular devices to mitigate evaporation has been investigated for the first time. A six-month trial at an arid zone site in Australia of this potential cost effective solution has been undertaken. The experiment was performed using clean conventional drinking water bottles as floating modules on the open water surface of 240-L tanks with three varying degrees of covering (nil, 34% and 68%). A systematic reduction in evaporation is demonstrated during the whole study period that is approximately linearly proportional to the covered surface. These results provide a potential foundation for robust evaporation mitigation with the prospect of implementing a cost-optimal design.

Managing livestock using animal behavior: mixed-species stocking and flerds.

PubMed

Anderson, D M; Fredrickson, E L; Estell, R E

2012-08-01

Mixed-species stocking can foster sound landscape management while offering economic and ecological advantages compared with mono-species stocking. Producers contemplating a mixed-species enterprise should reflect on several considerations before implementing this animal management strategy. Factors applicable to a particular producer's landscape must be considered together with goals and economic constraints before implementing mixed-species stocking. A major consideration when using mixed-species stocking is how to deal with predation losses, especially among small ruminants. An approach being adopted in some commercial operations capitalizes on using innate animal behaviors to form cohesive groups of two or more livestock species that consistently remain together under free-ranging conditions. These groups are referred to as flerds. The mixing of a flock of sheep and/or goats with a herd of cattle into a flerd has been shown to protect sheep and goats from coyote predation, as well as offering other husbandry advantages. Some of the added advantages include more efficient conversion of forage into animal protein. Creation of flerds, their maintenance and advantages are discussed.

A Modular Plug-And-Play Sensor System for Urban Air Pollution Monitoring: Design, Implementation and Evaluation

PubMed Central

2017-01-01

Urban air pollution has caused public concern globally because it seriously affects human life. Modern monitoring systems providing pollution information with high spatio-temporal resolution have been developed to identify personal exposures. However, these systems’ hardware specifications and configurations are usually fixed according to the applications. They can be inconvenient to maintain, and difficult to reconfigure and expand with respect to sensing capabilities. This paper aims at tackling these issues by adopting the proposed Modular Sensor System (MSS) architecture and Universal Sensor Interface (USI), and modular design in a sensor node. A compact MSS sensor node is implemented and evaluated. It has expandable sensor modules with plug-and-play feature and supports multiple Wireless Sensor Networks (WSNs). Evaluation results show that MSS sensor nodes can easily fit in different scenarios, adapt to reconfigurations dynamically, and detect low concentration air pollution with high energy efficiency and good data accuracy. We anticipate that the efforts on system maintenance, adaptation, and evolution can be significantly reduced when deploying the system in the field. PMID:29271952

An effective public health program to reduce urban heat islands in Québec, Canada.

PubMed

Beaudoin, Mélanie; Gosselin, Pierre

2016-09-01

In 2005, the Government of the Province of Québec, Canada, adopted the Climate Change Action Plan for 2006 - 2012. The Institut national de santé publique du Québec (National Institute of Public Health of Québec), charged with implementing the health adaptation component of the Plan, worked to mitigate urban heat islands (UHI) by funding and evaluating 40 pilot projects. These projects explored different methods of fighting UHIs by greening cities in a participative and mobilizing approach led mainly by non-governmental organizations and municipalities. An assessment of temperatures before and after implementing various methods demonstrated that some actions enabled significant gains of coolness and more efficiently mitigated heat (reduction of concrete/asphalt surfaces, increasing vegetation, etc.). An assessment of quality of life showed that projects were positively received by users, especially by those living in vulnerable situations. A lifecycle analysis showed that from the environmental perspective, UHI mitigation measures that do not require fertilization or maintenance are preferable. Finally, communication efforts that raise awareness of UHI and mitigation are of significant importance to program success.

Green utilities for research and eco-tourist communities, Rio Bravo, Belize, Central America

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

Jackson, O.

1997-12-31

Programme for Belize (PFB), a non-governmental organization which owns and manages the Rio Bravo Conservation and Management Area (RBCMA), a 229,000 acre section of subtropical rainforest in northwestern Belize, is developing a series of research and eco-tourism developments as sustainable development projects. Guided by a comprehensive Sustainable Infrastructure Plan completed by Caribbean Infra-Tech, Inc. (CIT) in 1995, PFB adopted an organizational goal of implementing 100% green renewable energy-based utilities for their two major development sites: La Milpa and Hill Bank stations. To date, PFB has constructed or installed over 20 kW of standalone PV power, sustainable water supply systems, recyclingmore » waste treatment systems, and a model sustainable Dormitory and Bath House facility in the RBCMA. In addition, a Resource Conservation and Management Program (RCMP), which is to guide ongoing visitor orientation, staff training, and sustainable systems operations and maintenance, is now being prepared for immediate implementation. In this paper, the design and technical performance of the solar (PV) electric power plants, PV water pumping, solar water heating and other green utility systems will be assessed.« less

Design concept of K-DEMO for near-term implementation

NASA Astrophysics Data System (ADS)

Kim, K.; Im, K.; Kim, H. C.; Oh, S.; Park, J. S.; Kwon, S.; Lee, Y. S.; Yeom, J. H.; Lee, C.; Lee, G.-S.; Neilson, G.; Kessel, C.; Brown, T.; Titus, P.; Mikkelsen, D.; Zhai, Y.

2015-05-01

A Korean fusion energy development promotion law (FEDPL) was enacted in 2007. As a following step, a conceptual design study for a steady-state Korean fusion demonstration reactor (K-DEMO) was initiated in 2012. After the thorough 0D system analysis, the parameters of the main machine characterized by the major and minor radii of 6.8 and 2.1 m, respectively, were chosen for further study. The analyses of heating and current drives were performed for the development of the plasma operation scenarios. Preliminary results on lower hybrid and neutral beam current drive are included herein. A high performance Nb3Sn-based superconducting conductor is adopted, providing a peak magnetic field approaching 16 T with the magnetic field at the plasma centre above 7 T. Pressurized water is the prominent choice for the main coolant of K-DEMO when the balance of plant development details is considered. The blanket system adopts a ceramic pebble type breeder. Considering plasma performance, a double-null divertor is the reference configuration choice of K-DEMO. For a high availability operation, K-DEMO incorporates a design with vertical maintenance. A design concept for K-DEMO is presented together with the preliminary design parameters.

Importance-satisfaction analysis for primary care physicians' perspective on EHRs in Taiwan.

PubMed

Ho, Cheng-Hsun; Wene, Hsyien-Chia; Chu, Chi-Ming; Wu, Yi-Syuan; Wang, Jen-Leng

2014-06-06

The Taiwan government has been promoting Electronic Health Records (EHRs) to primary care physicians. How to extend EHRs adoption rate by measuring physicians' perspective of importance and performance of EHRs has become one of the critical issues for healthcare organizations. We conducted a comprehensive survey in 2010 in which a total of 1034 questionnaires which were distributed to primary care physicians. The project was sponsored by the Department of Health to accelerate the adoption of EHRs. 556 valid responses were analyzed resulting in a valid response rate of 53.77%. The data were analyzed based on a data-centered analytical framework (5-point Likert scale). The mean of importance and satisfaction of four dimensions were 4.16, 3.44 (installation and maintenance), 4.12, 3.51 (product effectiveness), 4.10, 3.31 (system function) and 4.34, 3.70 (customer service) respectively. This study provided a direction to government by focusing on attributes which physicians found important but were dissatisfied with, to close the gap between actual and expected performance of the EHRs. The authorities should emphasize the potential advantages in meaningful use and provide training programs, conferences, technical assistance and incentives to enhance the national level implementation of EHRs for primary physicians.

Energy Storage System Safety: Plan Review and Inspection Checklist

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

Cole, Pam C.; Conover, David R.

Codes, standards, and regulations (CSR) governing the design, construction, installation, commissioning, and operation of the built environment are intended to protect the public health, safety, and welfare. While these documents change over time to address new technology and new safety challenges, there is generally some lag time between the introduction of a technology into the market and the time it is specifically covered in model codes and standards developed in the voluntary sector. After their development, there is also a timeframe of at least a year or two until the codes and standards are adopted. Until existing model codes andmore » standards are updated or new ones are developed and then adopted, one seeking to deploy energy storage technologies or needing to verify the safety of an installation may be challenged in trying to apply currently implemented CSRs to an energy storage system (ESS). The Energy Storage System Guide for Compliance with Safety Codes and Standards1 (CG), developed in June 2016, is intended to help address the acceptability of the design and construction of stationary ESSs, their component parts, and the siting, installation, commissioning, operations, maintenance, and repair/renovation of ESS within the built environment.« less

43 CFR 4750.3-3 - Supporting information and certification for private maintenance of more than 4 wild horses or...

Code of Federal Regulations, 2014 CFR

2014-10-01

... for private maintenance of more than 4 wild horses or burros. 4750.3-3 Section 4750.3-3 Public Lands... INTERIOR RANGE MANAGEMENT (4000) PROTECTION, MANAGEMENT, AND CONTROL OF WILD FREE-ROAMING HORSES AND BURROS... than 4 wild horses or burros. (a) An individual applying to adopt more than 4 wild horses or burros...

43 CFR 4750.3-3 - Supporting information and certification for private maintenance of more than 4 wild horses or...

Code of Federal Regulations, 2011 CFR

2011-10-01

... for private maintenance of more than 4 wild horses or burros. 4750.3-3 Section 4750.3-3 Public Lands... INTERIOR RANGE MANAGEMENT (4000) PROTECTION, MANAGEMENT, AND CONTROL OF WILD FREE-ROAMING HORSES AND BURROS... than 4 wild horses or burros. (a) An individual applying to adopt more than 4 wild horses or burros...

43 CFR 4750.3-3 - Supporting information and certification for private maintenance of more than 4 wild horses or...

Code of Federal Regulations, 2012 CFR

2012-10-01

... for private maintenance of more than 4 wild horses or burros. 4750.3-3 Section 4750.3-3 Public Lands... INTERIOR RANGE MANAGEMENT (4000) PROTECTION, MANAGEMENT, AND CONTROL OF WILD FREE-ROAMING HORSES AND BURROS... than 4 wild horses or burros. (a) An individual applying to adopt more than 4 wild horses or burros...

43 CFR 4750.3-3 - Supporting information and certification for private maintenance of more than 4 wild horses or...

Code of Federal Regulations, 2013 CFR

2013-10-01

... for private maintenance of more than 4 wild horses or burros. 4750.3-3 Section 4750.3-3 Public Lands... INTERIOR RANGE MANAGEMENT (4000) PROTECTION, MANAGEMENT, AND CONTROL OF WILD FREE-ROAMING HORSES AND BURROS... than 4 wild horses or burros. (a) An individual applying to adopt more than 4 wild horses or burros...

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...

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...

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...

The Cancer Prevention and Control Research Network: An Interactive Systems Approach to Advancing Cancer Control Implementation Research and Practice

PubMed Central

Fernández, María E.; Melvin, Cathy L.; Leeman, Jennifer; Ribisl, Kurt M.; Allen, Jennifer D.; Kegler, Michelle C.; Bastani, Roshan; Ory, Marcia G.; Risendal, Betsy C.; Hannon, Peggy A.; Kreuter, Matthew W.; Hebert, James R.

2018-01-01

Background Although cancer research has advanced at a rapid pace, a gap remains between what is known about how to improve cancer prevention and control (CPC) and what is implemented as best practices within health care systems and communities. The Cancer Prevention and Control Research Network (CPCRN), with more than 10 years of dissemination and implementation research experience, aims to accelerate the uptake and use of evidence-based CPC interventions. Methods The collective work of the CPCRN has facilitated the analysis and categorization of research and implementation efforts according to the Interactive Systems Framework for Dissemination and Implementation (ISF), providing a useful heuristic for bridging the gap between prevention research and practice. The ISF authors have called for examples of its application as input to help refine the model. Results We provide examples of how the collaborative activities supported by the CPCRN, using community-engaged processes, accelerated the synthesis and translation of evidence, built both general and innovation-specific capacity, and worked with delivery systems to advance cancer control research and practice. Conclusions The work of the CPCRN has provided real-world examples of the application of the ISF and demonstrated that synthesizing and translating evidence can increase the potential that evidence-based CPC programs will be used and that capacity building for both the support system and the delivery system is crucial for the successful implementation and maintenance of evidence-based cancer control. Impact Adoption and implementation of CPC can be enhanced by better understanding ISF systems and intervening to improve them. PMID:25155759

78 FR 48638 - Approval and Promulgation of State Implementation Plans: Alaska; Fairbanks Carbon Monoxide...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-09

... Promulgation of State Implementation Plans: Alaska; Fairbanks Carbon Monoxide Limited Maintenance Plan AGENCY: Environmental Protection Agency (EPA). ACTION: Proposed rule. SUMMARY: The EPA is proposing to approve a carbon... carbon monoxide National Ambient Air Quality Standards through the second 10- year maintenance period...

78 FR 28503 - Approval and Promulgation of Air Quality Implementation Plans; Indiana; Lake and Porter Counties...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-15

...: FRL-9812-4] Approval and Promulgation of Air Quality Implementation Plans; Indiana; Lake and Porter Counties, Indiana, 1997 8-Hour Ozone Maintenance Plan and 1997 Annual Fine Particulate Matter Maintenance Plan Revision to Approved Motor Vehicle Emissions Budgets AGENCY: Environmental Protection Agency (EPA...

78 FR 28550 - Approval and Promulgation of Air Quality Implementation Plans; Indiana; Lake and Porter Counties...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-15

...-9812-3] Approval and Promulgation of Air Quality Implementation Plans; Indiana; Lake and Porter Counties, Indiana, 1997 8-Hour Ozone Maintenance Plan and 1997 Annual Fine Particulate Matter Maintenance Plan Revisions to Approved Motor Vehicle Emissions Budgets AGENCY: Environmental Protection Agency (EPA...

78 FR 34095 - Adequacy Status of the Idaho, Northern Ada County PM10

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-06

... 10 State Implementation Plan, Maintenance Plan: Ten-Year Update (Maintenance Plan Update) are..., Northern Ada County PM 10 State Implementation Plan for Transportation Conformity Purposes AGENCY... particulate matter with an aerodynamic diameter of a nominal 10 microns or less (PM 10 ), nitrogen oxides (NOx...

78 FR 37676 - Federal Acquisition Regulation; System for Award Management Name Change, Phase 1 Implementation

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-21

....204-13 System for Award Management Maintenance. * * * * * System for Award Management Maintenance (Jul...; System for Award Management Name Change, Phase 1 Implementation AGENCY: Department of Defense (DoD... System for Award Management (SAM) database. DATES: Effective Date: July 22, 2013. FOR FURTHER INFORMATION...

77 FR 66361 - Reserve Requirements of Depository Institutions: Reserves Simplification

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-05

... simplifications related to the administration of reserve requirements: 1. Create a common two-week maintenance... earlier than it would implement the common maintenance period and the penalty-free band. The Board... effective July 12, 2012. The Board announced January 24, 2013, as the implementation date for the common two...

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…

Cluster man/system design requirements and verification. [for Skylab program

NASA Technical Reports Server (NTRS)

Watters, H. H.

1974-01-01

Discussion of the procedures employed for determining the man/system requirements that guided Skylab design, and review of the techniques used for implementing the man/system design verification. The foremost lesson learned from the design need anticipation and design verification experience is the necessity to allow for human capabilities of in-flight maintenance and repair. It is now known that the entire program was salvaged by a series of unplanned maintenance and repair events which were implemented in spite of poor design provisions for maintenance.

Applying RE-AIM to the evaluation of FUEL Your Life : a worksite translation of DPP.

PubMed

Brace, Andrea M; Padilla, Heather M; DeJoy, David M; Wilson, Mark G; Vandenberg, Robert J; Davis, Marsha

2015-01-01

Weight management programs are becoming increasingly common in workplace settings; however, few target middle-aged men. The purpose of this article is to describe the process evaluation of a worksite translation of the Diabetes Prevention Program in a predominantly middle-aged male population. The translated program, FUEL Your Life, was largely self-directed, with support from peer health coaches and occupational health nurses. The RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) framework was used to examine the factors that influenced program implementation using data from an environmental assessment, participant surveys, peer health coach surveys, and occupational health nurse interviews. An overwhelming majority of the employees who enrolled in the study were overweight or obese (92%). Overall, the program was effective for weight maintenance; those with higher levels of participation and engagement had better weight loss outcomes. The peer health coach and family elements of the intervention were underused. The program was successful in reaching the intended population; however, the program had limited success in engaging this population. Not surprisingly, weight loss was a function of participant engagement and participation. Increasing participant engagement and participation is important to the success of weight management interventions translated to the worksite setting. Garnering buy-in and support from management can serve to increase the perceived importance of weight management in worksites. With management support, weight management protocols could be integrated as a component of the mandatory safety and health assessments already in place, fostering promotion of healthy weight in the workforce. © 2014 Society for Public Health Education.

45 CFR 160.104 - Modifications.

Code of Federal Regulations, 2010 CFR

2010-10-01

... paragraph (b) of this section, the Secretary may adopt a modification to a standard or implementation specification adopted under this subchapter no more frequently than once every 12 months. (b) The Secretary may adopt a modification at any time during the first year after the standard or implementation...

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.

Care of the abandoned child.

PubMed

Raghunath, M

1991-01-01

Care of abandoned children in India is discussed in terms of reasons for abandonment, the physical condition of the children, and legal categories. The options available currently are the cottage system, sponsorship programs, foster care, or adoption. Child-care and rehabilitation that may be necessary is specified as is the importance of maintaining records. The gaps in child-care are exposed. The role of nongovernmental organization (NGOs) and new legislation in closing the gaps is presented. Abandonment is usually a direct result of poverty, but it can also be caused by mental or physical handicaps or illegitimacy. The numbers of abandoned children may reach 2 million. 40-60% of abandoned infants die during monsoons and summers. The legal categories are privately abandoned, children on remand, or court-committed children. The cottage system emphasizes deinstitutionalization, but there remains a great demand for care. Sponsorship aims to strengthen the family unit to prevent abandonment. Foster care provides an alternative family substitute, but is known only theoretically. Childcare may involve instant hospitalization, care is an institution, or foster care with a suitable family. Nursery care requires discipline in hygiene, sanitation, maintenance of individual medical records, and a general cheerful atmosphere. Records are important for the child in later life and for adoption. Rehabilitation is a sociolegal process which must be done properly or it can jeopardize a child's future security. Despite the Supreme Court guidelines of 1984, there is no uniform system of adoption practices, and the child's interests are overlooked when adoptions are promoted. NGOs play an important role in making social welfare programs work. However their efforts are of limited help without government support and legislation. There is a lack of proper legislation which is outside the control of political and religious interests; e.g., Hindu law only permits adoption of one child of each sex. Malpractice exists because of the lack of uniform legislation and implementation, and restrictive and delaying tactics are just as harmful to the child. Trafficking in children to foreigners is still profitable. Suggestions include uniform and appropriate legislation, collaborative effort of NGOs and government-endorsed implementation, promotion of innovative and preventive measures to reduce abandonment, and development of an extensive program to provide safeguards against the exploitation of women.

Evaluation of the Coaches Educators training implementation of the PAPA project: A comparison between Norway and France.

PubMed

Van Hoye, A; Larsen, T; Sovik, M; Wold, B; Heuzé, J-P; Samdal, O; Ommundsen, Y; Sarrazin, P

2015-10-01

This study cross-culturally compares the implementation process of the Empowering Coaching™ training program to grassroots coaches (GCs) by trained Coach Educators (CEs) from the Promoting Adolescent Physical Activity project in Norway and France. This program targets children's health through coach training to create a more positive environment. Using the RE-AIM framework, indicators of implementation processes at staff level were defined for adoption, implementation, and maintenance. CEs (n = 18) were interviewed about their professional use of the training, and video-filmed delivering the intervention trial workshops. GCs (n = 185) responded to a questionnaire after the workshops. Results showed that CEs were keen to participate in this project (16/18; 89%), to stay involved (12/16; 75%), and to diffuse the principles after the research project (12/12; 100%). CE training seemed effective as results indicated that CEs applied the principles of the program during the workshops and covered a high degree of the content (78%). Cross-cultural differences were found as the French Football Federation CE dropped out of the program, as Norwegian CEs delivered the content with higher fidelity and had higher enjoyment and pace scores than French CEs. More indicators are needed to use the RE-AIM framework for cross-cultural comparison. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

45 CFR 1355.39 - Administrative and judicial review.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 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...

Implementing a Nitrogen-Based Model for Autotrophic Respiration Using Satellite and Field Observations

NASA Technical Reports Server (NTRS)

Choudhury, Bhaskar J.; Houser, Paul (Technical Monitor)

2001-01-01

The rate of carbon accumulation by terrestrial plant communities in a process-level, mechanistic modeling is the difference of the rate of gross photosynthesis by a canopy (A(sub g)) and autotrophic respiration (R) of the stand. Observations for different biomes often show that R to be a large and variable fraction of A(sub g), ca. 35% to 75%, although other studies suggest the ratio of R and A(sub g) to be less variable. Here, R has been calculated according to the two compartment model as being the sum of maintenance and growth components. The maintenance respiration of foliage and living fine roots for different biomes has been determined objectively from observed nitrogen content of these organs. The sapwood maintenance respiration is based on pipe theory, and checked against an independently derived equation considering sapwood biomass and its maintenance coefficient. The growth respiration has been calculated from the difference of A(sub g) and maintenance respiration. The A(sub g) is obtained as the product of biome-specific radiation use efficiency for gross photosynthesis under unstressed conditions and intercepted photosynthetically active radiation, and adjusted for stress. Calculations have been done using satellite and ground observations for 36 consecutive months (1987-1989) over large contiguous areas (ca. 10(exp 5) sq km) of boreal forests, crop land, temperate deciduous forest, temperate grassland, tropical deciduous forest, tropical evergreen forest, tropical savanna, and tundra. The ratio of annual respiration and gross photosynthesis, (R/A(sub g)), is found to be 0.5-0.6 for temperate and cold adopted biome areas, but somewhat higher for tropical biome areas (0.6-0.7). Interannual variation of the fluxes is found to be generally less than 15%. Calculated fluxes are compared with observations and several previous estimates. Results of sensitivity analysis are presented for uncertainties in parameterization and input data. It is found that uncertainty in determining maintenance respiration for tropical biomes is such that R/A(sub g) for these biomes could be similar to that for temperate biomes.

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.

75 FR 1543 - Approval and Promulgation of Implementation Plans; Puerto Rico; Guaynabo PM10

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-12

...] Approval and Promulgation of Implementation Plans; Puerto Rico; Guaynabo PM 10 Limited Maintenance Plan and... approving the Limited Maintenance Plan for the Municipality of Guaynabo nonattainment area in Puerto Rico and the request by the Commonwealth of Puerto Rico to redesignate the area from nonattainment to...

78 FR 6035 - Approval and Promulgation of Air Quality Implementation Plans; Ohio and Indiana; Cincinnati...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-29

... MOBILE6.2 emissions model. The ozone maintenance plan established 2015 and 2020 budgets for the Ohio and...-9773-5] Approval and Promulgation of Air Quality Implementation Plans; Ohio and Indiana; Cincinnati-Hamilton, OH; Ohio and Indiana 1997 8-Hour Ozone Maintenance Plan Revisions to Approved Motor Vehicle...

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…

78 FR 4341 - Approval and Promulgation of Implementation Plans and Designation of Areas for Air Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-22

... Alabama Department of Environmental Management (ADEM), Air Division, to redesignate the Birmingham fine... implementation plan (SIP) to include the 1997 Annual PM 2.5 maintenance plan for the Birmingham Area that... action also approves the 2009 emissions inventory submitted with the maintenance plan. DATES: Effective...

78 FR 5306 - Approval and Promulgation of Implementation Plans and Designation of Areas for Air Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-25

... the Alabama Department of Environmental Management (ADEM), Air Division, to redesignate the Birmingham... implementation plan (SIP) to include the 2006 24-hour PM 2.5 maintenance plan for the Birmingham Area that... action also approves the 2009 emissions inventory submitted with the maintenance plan. DATES: Effective...

A cluster randomized Hybrid Type III trial testing an implementation support strategy to facilitate the use of an evidence-based practice in VA homeless programs.

PubMed

Smelson, David A; Chinman, Matthew; McCarthy, Sharon; Hannah, Gordon; Sawh, Leon; Glickman, Mark

2015-05-28

The Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program is one of the largest initiatives to end Veteran homelessness. However, mental health and substance use disorders continue to reduce client stability and impede program success. HUD-VASH programs do not consistently employ evidence-based practices that address co-occurring mental health and substance use disorders. This paper presents a study protocol to evaluate the implementation of an evidence-based, co-occurring disorder treatment called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking-Veterans Edition (MISSION-Vet) in HUD-VASH using an implementation strategy called Getting To Outcomes (GTO). In three large VA Medical Centers, this Hybrid Type III trial will randomize case managers and their clients by HUD-VASH sub-teams to receive either MISSION-Vet Implementation as Usual (IU-standard training and access to the MISSION-Vet treatment manuals) or MISSION-Vet implementation augmented by GTO. In addition to testing GTO, effectiveness of the treatment (MISSION-Vet) will be assessed using existing Veteran-level data from the HUD-VASH data monitoring system. This project will compare GTO and IU case managers and their clients on the following variables: (1) fidelity to the MISSION-Vet intervention; (2) proportion of time the Veteran is housed; (3) mental health, substance use, and functional outcomes among Veterans; and (4) factors key to the successful deployment of a new treatment as specified by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model. This project is an important step for developing an implementation strategy to increase adoption of evidence-based practice use in VA homeless programs, and to further examine efficacy of MISSION-Vet in HUD-VASH. This project has important implications for program managers, policy makers, and researchers within the homelessness field. VA Central IRB approval for this study was granted in October 2011. The three sites were trained on MISSION-Vet and GTO in the first half of 2013. The first GTO planning meetings began after training occurred, between January 2013 and November 2013, across the three sites. The data collection-via a fidelity measure embedded into the VA Computerized Patient Record System-began as each site initiated MISSION-Vet, between April 2013 and January 2014. ClinicalTrials.gov: NCT01430741.

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.

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...

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...

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 firms outperformed non-SAP-adopting firms in terms of return on sales during the post-implementation period. These findings indicate that the impact of ERP implementation on return on sales occurred after an assimilation period. I perform an analysis of the impact of ERP in the Oil and Gas Industry using strategic performance metrics described in Banker et al. (1996) including profitability, productivity, price recovery, product mix, and capacity utilization. My results show that the benefits obtained from ERP implementation in terms of productivity and capacity utilization are persistently positive during and after the installation.

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 implement the NGSS is highly nuanced. The most significant factor influencing motivation to adopt or implement the NGSS at each level is related to assessment. The reasons assessment affects motivation is different at each level. Key Finding 3 - Each interviewee at each level demonstrated awareness that the NGSS are significantly different from prior standards in some way. While teachers and SSCs sometimes cited the science practices as the critical difference, they were not able to meaningfully elaborate on what "science practices" are. Conversely, the District Coordinators demonstrated a deeper level of awareness and were able to comment more specifically on the practices and how they would affect science education in their state. Key Finding 4 - Regardless of level, the better a participant reflected an awareness of epistemology, the more likely they were to advocate for adoption and implementation of the NGSS. Similarly, the better a participant reflected an awareness of epistemology, the more likely they were motivated to consider adoption and implementation of the NGSS. The implications of the findings in this current study can; inform the supplemental materials and dissemination of information by standards writers, help policy makers engage stakeholders appropriately at each level by illustrating how national reform efforts play out in local-control states, and aid school based employees by identifying how and where they can participate in state level policy discussion and where their input could be valuable.

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 for sustainable e-Health adoption. Conclusions Rural e-Health implementation is an emerging, rapidly developing, field. Too often, e-Health adoption fails due to underestimating implementation factors and their interactions. We argue that rural e-Health implementation only leads to sustainable adoption (i.e. it “sticks”) when the implementation carefully considers and aligns the e-Health content (the “clicks”), the pre-existing structures in the context (the “bricks”), and the interventions in the implementation process (the “tricks”). PMID:23311452

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.

36 CFR 1222.34 - How must agencies maintain records?

Code of Federal Regulations, 2010 CFR

2010-07-01

... ADMINISTRATION RECORDS MANAGEMENT CREATION AND MAINTENANCE OF FEDERAL RECORDS Agency Recordkeeping Requirements § 1222.34 How must agencies maintain records? Agencies must implement a records maintenance program so... electronic records, segregable. Agency records maintenance programs must: (a) Institute procedures for...

Healthy caregivers-healthy children (HC2) phase 2: Integrating culturally sensitive childhood obesity prevention strategies into childcare center policies.

PubMed

Messiah, Sarah E; Lebron, Cynthia; Moise, Rhoda; Sunil Mathew, M; Sardinas, Krystal; Chang, Catherina; Palenzuela, Joanne; Walsh, Jennifer; Shelnutt, Karla P; Spector, Rachel; Altare, Fiorella; Natale, Ruby

2017-02-01

Despite the high prevalence of obesity among preschool-aged children, most states lack childcare center (CCC) nutrition and physical activity policies. The Healthy Caregivers, Healthy Children (HC) Phase 2 project is examining the relationship between the CCC nutrition and physical activity environment and child dietary intake/physical activity patterns and body mass index (BMI). A total of 24 "Quality Counts" (Miami Dade County, Florida's Quality Rating Improvement System [QRIS)]) CCCs serving low resource families with ≥50 2-to-5year olds attending have been randomized to either intervention (n=12) or control (n=12). The HC2 intervention arm CCCs receive implementation of a daily curricula for (1) teachers/parents; (2) children; (3) snack, beverage, physical activity, and screen time policies; and (4) technical assistance with menu modifications. Control arm schools receive an attention control safety curriculum. HC2 is delivered once a month in year 1, quarterly in year 2 and will be disseminated throughout the Quality Counts network in year 3. Primary outcome measures include the Environment and Policy Assessment and Observation tool (EPAO), standardized dietary intake and physical activity patterns surveys, and child BMI. The 'Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM)' framework will guide the interpretation of outcome measures. CCCs are in need of evidence-based standardized nutrition and physical activity policies. The intersection of RE-AIM and early childhood obesity prevention in the childcare setting could generate robust and new information to the field about potential barriers, facilitators, adoption, and sustainability in this setting. Copyright © 2016 Elsevier Inc. All rights reserved.

Mentoring Programs for Underrepresented Minority Faculty in Academic Medical Centers: A Systematic Review of the Literature

PubMed Central

Beech, Bettina M.; Calles-Escandon, Jorge; Hairston, Kristen G.; Langdon, Sarah E.; Latham-Sadler, Brenda A.; Bell, Ronny A.

2013-01-01

Purpose Mentoring is critical for career advancement in academic medicine. However, underrepresented minority (URM) faculty often receive less mentoring than their nonminority peers. The authors conducted a comprehensive review of published mentoring programs designed for URM faculty to identify “promising practices.” Method Databases (PubMed, PsycINFO, ERIC, PsychLit, Google Scholar, Dissertations Abstracts International, CINHAL, Sociological Abstracts) were searched for articles describing URM faculty mentoring programs. The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) formed the model for analyzing programs. Results The search identified 73 citations. Abstract reviews led to retrieval of 38 full-text articles for assessment; 18 articles describing 13 programs were selected for review. The reach of these programs ranged from 7 to 128 participants. Most evaluated programs on the basis of the number of grant applications and manuscripts produced or satisfaction with program content. Programs offered a variety of training experiences, and adoption was relatively high, with minor changes made for implementing the intended content. Barriers included time-restricted funding, inadequate evaluation due to few participants, significant time commitments required from mentors, and difficulty in addressing institutional challenges faced by URM faculty. Program sustainability was a concern because programs were supported through external funds, with minimal institutional support. Conclusions Mentoring is an important part of academic medicine, particularly for URM faculty who often experience unique career challenges. Despite this need, relatively few publications exist to document mentoring programs for this population. Institutionally supported mentoring programs for URM faculty are needed, along with detailed plans for program sustainability. PMID:23425989

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…

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…

Promoters and Barriers to Implementation of Tracheal Intubation Airway Safety Bundle: A Mixed-Method Analysis.

PubMed

Finn Davis, Katherine; Napolitano, Natalie; Li, Simon; Buffman, Hayley; Rehder, Kyle; Pinto, Matthew; Nett, Sholeen; Jarvis, J Dean; Kamat, Pradip; Sanders, Ronald C; Turner, David A; Sullivan, Janice E; Bysani, Kris; Lee, Anthony; Parker, Margaret; Adu-Darko, Michelle; Giuliano, John; Biagas, Katherine; Nadkarni, Vinay; Nishisaki, Akira

2017-10-01

To describe promoters and barriers to implementation of an airway safety quality improvement bundle from the perspective of interdisciplinary frontline clinicians and ICU quality improvement leaders. Mixed methods. Thirteen PICUs of the National Emergency Airway Registry for Children network. Remote or on-site focus groups with interdisciplinary ICU staff. Two semistructured interviews with ICU quality improvement leaders with quantitative and qualitative data-based feedbacks. Bundle implementation success (compliance) was defined as greater than or equal to 80% use for tracheal intubations for 3 consecutive months. ICUs were classified as early or late adopters. Focus group discussions concentrated on safety concerns and promoters and barriers to bundle implementation. Initial semistructured quality improvement leader interviews assessed implementation tactics and provided recommendations. Follow-up interviews assessed degree of acceptance and changes made after initial interview. Transcripts were thematically analyzed and contrasted by early versus late adopters. Median duration to achieve success was 502 days (interquartile range, 182-781). Five sites were early (median, 153 d; interquartile range, 146-267) and eight sites were late adopters (median, 783 d; interquartile range, 773-845). Focus groups identified common "promoter" themes-interdisciplinary approach, influential champions, and quality improvement bundle customization-and "barrier" themes-time constraints, competing paperwork and quality improvement activities, and poor engagement. Semistructured interviews with quality improvement leaders identified effective and ineffective tactics implemented by early and late adopters. Effective tactics included interdisciplinary quality improvement team involvement (early adopter: 5/5, 100% vs late adopter: 3/8, 38%; p = 0.08); ineffective tactics included physician-only rollouts, lack of interdisciplinary education, lack of data feedback to frontline clinicians, and misconception of bundle as research instead of quality improvement intervention. Implementation of an airway safety quality improvement bundle with high compliance takes a long time across diverse ICUs. Both early and late adopters identified similar promoter and barrier themes. Early adopter sites customized the quality improvement bundle and had an interdisciplinary quality improvement team approach.

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.

[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.

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.

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.

The Path to Convergence: Design, Coordination and Social Issues in the Implementation of a Middleware Data Broker.

NASA Astrophysics Data System (ADS)

Slota, S.; Khalsa, S. J. S.

2015-12-01

Infrastructures are the result of systems, networks, and inter-networks that accrete, overlay and segment one another over time. As a result, working infrastructures represent a broad heterogeneity of elements - data types, computational resources, material substrates (computing hardware, physical infrastructure, labs, physical information resources, etc.) as well as organizational and social functions which result in divergent outputs and goals. Cyber infrastructure's engineering often defaults to a separation of the social from the technical that results in the engineering succeeding in limited ways, or the exposure of unanticipated points of failure within the system. Studying the development of middleware intended to mediate interactions among systems within an earth systems science infrastructure exposes organizational, technical and standards-focused negotiations endemic to a fundamental trait of infrastructure: its characteristic invisibility in use. Intended to perform a core function within the EarthCube cyberinfrastructure, the development, governance and maintenance of an automated brokering system is a microcosm of large-scale infrastructural efforts. Points of potential system failure, regardless of the extent to which they are more social or more technical in nature, can be considered in terms of the reverse salient: a point of social and material configuration that momentarily lags behind the progress of an emerging or maturing infrastructure. The implementation of the BCube data broker has exposed reverse salients in regards to the overall EarthCube infrastructure (and the role of middleware brokering) in the form of organizational factors such as infrastructural alignment, maintenance and resilience; differing and incompatible practices of data discovery and evaluation among users and stakeholders; and a preponderance of local variations in the implementation of standards and authentication in data access. These issues are characterized by their role in increasing tension or friction among components that are on the path to convergence and may help to predict otherwise-occluded endogenous points of failure or non-adoption in the infrastructure.

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 different sorts of behaviours. Sustainable behaviour such as use of diagnostics will be influenced by moral motives, while management behaviour such as treatment is raised by more economic motives. Finally, not only performing, but also maintaining behaviour is important to fully address the adoption of sustainable control. As such, to maintain the adoption on farm, planning could be an important contribution. These insights can be used by animal health organizations and industry by exploiting motivations, social norms and planning to encourage the uptake of diagnostic approaches in GIN control. Copyright © 2018 Elsevier B.V. All rights reserved.

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.

A Brief Report: Lessons Learned and Preliminary Findings of Progreso en Salud, an HIV Risk Reduction Intervention for Latina Seasonal Farmworkers.

PubMed

Kanamori, Mariano; De La Rosa, Mario; Diez, Stephanie; Weissman, Jessica; Trepka, Mary Jo; Sneij, Alicia; Schmidt, Peter; Rojas, Patria

2016-12-30

Throughout the past decade, HIV rates in Florida-particularly South Florida, where many Latina seasonal farmworkers reside and work-have ranked among the highest in the nation. In this brief report, we delineate important lessons learned and preliminary findings from the implementation of the HIV prevention intervention Progreso en Salud (Progress in Health). Among the 114 Latina seasonal farmworker participants, there were significant increases from baseline to 6-month follow-up in the percentages of overall condom use, HIV testing, HIV/AIDS-related communications with friends, HIV knowledge, condom use self-efficacy, and correct use of condoms. Lessons learned from this study can be used to inform future HIV intervention strategies to improve the adoption and maintenance of HIV risk reduction behaviors among high-risk Latina seasonal workers and other high-risk underserved populations. Future research is needed to support our findings.

An overview and discussion of the Patient-Centered Outcomes Research Institute's decision aid portfolio.

PubMed

Gayer, Christopher C; Crowley, Matthew J; Lawrence, William F; Gierisch, Jennifer M; Gaglio, Bridget; Williams, John W; Myers, Evan R; Kendrick, Amy; Slutsky, Jean; Sanders, Gillian D

2016-07-01

Decision aids (DAs) help patients make informed healthcare decisions in a manner consistent with their values and preferences. Despite their promise, DAs developed with public research dollars are not being implemented and adopted in real-world patient care settings at a rate consistent with which they are being developed. To appraise the sum of the parts of the portfolio and create a strategic imperative surrounding future funding, the Patient-Centered Outcomes Research Institute (PCORI) tasked the Duke Evidence Synthesis Group with evaluating its DA portfolio. This paper describes PCORI's portfolio of DAs according to the Duke Evidence Synthesis Group's analysis in the context of PCORI's mission and the field of decision science. The results revealed a diversity within PCORI's portfolio of funded DA projects. Findings support the movement toward more rigorous DA development, assessment and maintenance. PCORI's funding priorities related to DAs are clarified and comparative questions of interest are posed.

In It Together: A Qualitative Evaluation of Participant Experiences of a 10-Week, Group-Based, Workplace HIIT Program for Insufficiently Active Adults.

PubMed

Kinnafick, Florence-Emilie; Thøgersen-Ntoumani, Cecilie; Shepherd, Sam O; Wilson, Oliver J; Wagenmakers, Anton J M; Shaw, Christopher S

2018-02-01

Using guidance from the reach, efficacy, adoption, implementation, and maintenance evaluation framework, we aimed to qualitatively evaluate the participant experiences of a workplace high-intensity interval training (HIIT) intervention. Twelve previously insufficiently active individuals (four males and eight females) were interviewed once as part of three focus groups. Perceptions of program satisfaction, barriers to and facilitators of adherence, and persistence to exercise were explored. HIIT initiates interest because of its novelty, provides a sense of accomplishment, and overcomes the barriers of perceived lack of time. The feeling of relatedness between the participants can attenuate negative unpleasant responses during the HIIT sessions. HIIT, in this workplace setting, is an acceptable intervention for physically inactive adults. However, participants were reluctant to maintain the same mode of exercise, believing that HIIT sessions were for the very fit.

The right of women in property sharing in Bangladesh: Can the islamic inheritance system eliminate discrimination?

PubMed

Khan, Issa; Abdullah, Md Faruk; Rahman, Noor Naemah Abdul; Nor, Mohd Roslan Bin Mohd; Yusoff, Mohd Yakub Zulkifli Bin Mohd

2016-01-01

This study seeks to discover the best solution for women's property sharing between Islamic and current social practices in Bangladesh. A qualitative method has been adopted to achieve this goal. It is found that the majority of the women are marginalised from their property in the social practice. On the other hand, in the Islamic solution, the property is fixed for all classes of women and is based on a property sharing system called fara'id that takes into account the roles and responsibilities of man and woman in the society. Men are responsible for providing maintenance to their wives and children. Men in Islamic society should bear expenditure related to marriage. The research concludes that the Islamic solution is fair and ensures just property sharing rights for women. It suggests that the Islamic solution for property sharing should be implemented to empower women in Bangladesh.

A Brief Report: Lessons Learned and Preliminary Findings of Progreso en Salud, an HIV Risk Reduction Intervention for Latina Seasonal Farmworkers

PubMed Central

Kanamori, Mariano; De La Rosa, Mario; Diez, Stephanie; Weissman, Jessica; Trepka, Mary Jo; Sneij, Alicia; Schmidt, Peter; Rojas, Patria

2016-01-01

Throughout the past decade, HIV rates in Florida—particularly South Florida, where many Latina seasonal farmworkers reside and work—have ranked among the highest in the nation. In this brief report, we delineate important lessons learned and preliminary findings from the implementation of the HIV prevention intervention Progreso en Salud (Progress in Health). Among the 114 Latina seasonal farmworker participants, there were significant increases from baseline to 6-month follow-up in the percentages of overall condom use, HIV testing, HIV/AIDS-related communications with friends, HIV knowledge, condom use self-efficacy, and correct use of condoms. Lessons learned from this study can be used to inform future HIV intervention strategies to improve the adoption and maintenance of HIV risk reduction behaviors among high-risk Latina seasonal workers and other high-risk underserved populations. Future research is needed to support our findings. PMID:28042852

Supporting Tablet Configuration, Tracking, and Infection Control Practices in Digital Health Interventions: Study Protocol

PubMed Central

Furberg, Robert D; Zulkiewicz, Brittany A; Hudson, Jordan P; Taylor, Olivia M; Lewis, Megan A

2016-01-01

Background Tablet-based health care interventions have the potential to encourage patient care in a timelier manner, allow physicians convenient access to patient records, and provide an improved method for patient education. However, along with the continued adoption of tablet technologies, there is a concomitant need to develop protocols focusing on the configuration, management, and maintenance of these devices within the health care setting to support the conduct of clinical research. Objective Develop three protocols to support tablet configuration, tablet management, and tablet maintenance. Methods The Configurator software, Tile technology, and current infection control recommendations were employed to develop three distinct protocols for tablet-based digital health interventions. Configurator is a mobile device management software specifically for iPhone operating system (iOS) devices. The capabilities and current applications of Configurator were reviewed and used to develop the protocol to support device configuration. Tile is a tracking tag associated with a free mobile app available for iOS and Android devices. The features associated with Tile were evaluated and used to develop the Tile protocol to support tablet management. Furthermore, current recommendations on preventing health care–related infections were reviewed to develop the infection control protocol to support tablet maintenance. Results This article provides three protocols: the Configurator protocol, the Tile protocol, and the infection control protocol. Conclusions These protocols can help to ensure consistent implementation of tablet-based interventions, enhance fidelity when employing tablets for research purposes, and serve as a guide for tablet deployments within clinical settings. PMID:27350013

OFF, Open source Finite volume Fluid dynamics code: A free, high-order solver based on parallel, modular, object-oriented Fortran API

NASA Astrophysics Data System (ADS)

Zaghi, S.

2014-07-01

OFF, an open source (free software) code for performing fluid dynamics simulations, is presented. The aim of OFF is to solve, numerically, the unsteady (and steady) compressible Navier-Stokes equations of fluid dynamics by means of finite volume techniques: the research background is mainly focused on high-order (WENO) schemes for multi-fluids, multi-phase flows over complex geometries. To this purpose a highly modular, object-oriented application program interface (API) has been developed. In particular, the concepts of data encapsulation and inheritance available within Fortran language (from standard 2003) have been stressed in order to represent each fluid dynamics "entity" (e.g. the conservative variables of a finite volume, its geometry, etc…) by a single object so that a large variety of computational libraries can be easily (and efficiently) developed upon these objects. The main features of OFF can be summarized as follows: Programming LanguageOFF is written in standard (compliant) Fortran 2003; its design is highly modular in order to enhance simplicity of use and maintenance without compromising the efficiency; Parallel Frameworks Supported the development of OFF has been also targeted to maximize the computational efficiency: the code is designed to run on shared-memory multi-cores workstations and distributed-memory clusters of shared-memory nodes (supercomputers); the code's parallelization is based on Open Multiprocessing (OpenMP) and Message Passing Interface (MPI) paradigms; Usability, Maintenance and Enhancement in order to improve the usability, maintenance and enhancement of the code also the documentation has been carefully taken into account; the documentation is built upon comprehensive comments placed directly into the source files (no external documentation files needed): these comments are parsed by means of doxygen free software producing high quality html and latex documentation pages; the distributed versioning system referred as git has been adopted in order to facilitate the collaborative maintenance and improvement of the code; CopyrightsOFF is a free software that anyone can use, copy, distribute, study, change and improve under the GNU Public License version 3. The present paper is a manifesto of OFF code and presents the currently implemented features and ongoing developments. This work is focused on the computational techniques adopted and a detailed description of the main API characteristics is reported. OFF capabilities are demonstrated by means of one and two dimensional examples and a three dimensional real application.

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…

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...

78 FR 33230 - Approval and Promulgation of Implementation Plans and Designation of Areas for Air Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-04

...'') section 110(k)(3), EPA is approving a maintenance plan for the 1997 8-hour ozone standard (``San Diego 8-hour maintenance plan'') for the San Diego County 1997 ozone nonattainment area (``San Diego 8-hour... maintenance plan is included in a document titled Redesignation Request and Maintenance Plan for the 1997...

Modeling the value for money of changing clinical practice change: a stochastic application in diabetes care.

PubMed

Hoomans, Ties; Abrams, Keith R; Ament, Andre J H A; Evers, Silvia M A A; Severens, Johan L

2009-10-01

Decision making about resource allocation for guideline implementation to change clinical practice is inevitably undertaken in a context of uncertainty surrounding the cost-effectiveness of both clinical guidelines and implementation strategies. Adopting a total net benefit approach, a model was recently developed to overcome problems with the use of combined ratio statistics when analyzing decision uncertainty. To demonstrate the stochastic application of the model for informing decision making about the adoption of an audit and feedback strategy for implementing a guideline recommending intensive blood glucose control in type 2 diabetes in primary care in the Netherlands. An integrated Bayesian approach to decision modeling and evidence synthesis is adopted, using Markov Chain Monte Carlo simulation in WinBUGs. Data on model parameters is gathered from various sources, with effectiveness of implementation being estimated using pooled, random-effects meta-analysis. Decision uncertainty is illustrated using cost-effectiveness acceptability curves and frontier. Decisions about whether to adopt intensified glycemic control and whether to adopt audit and feedback alter for the maximum values that decision makers are willing to pay for health gain. Through simultaneously incorporating uncertain economic evidence on both guidance and implementation strategy, the cost-effectiveness acceptability curves and cost-effectiveness acceptability frontier show an increase in decision uncertainty concerning guideline implementation. The stochastic application in diabetes care demonstrates that the model provides a simple and useful tool for quantifying and exploring the (combined) uncertainty associated with decision making about adopting guidelines and implementation strategies and, therefore, for informing decisions about efficient resource allocation to change clinical practice.

77 FR 75865 - Approval and Promulgation of Implementation Plans and Designation of Areas for Air Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-26

... 1997 Annual PM 2.5 NAAQS maintenance plan, including the on-road motor vehicle insignificance finding... Implementation Plan (SIP) to include the 1997 Annual PM 2.5 maintenance plan for the Kentucky portion of the Huntington-Ashland Area. EPA is also approving the on-road motor vehicle insignificance finding for direct PM...

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.

36 CFR 230.37 - State priority plan-educational assistance.

Code of Federal Regulations, 2013 CFR

2013-07-01

... sessions; (8) Web site construction and maintenance; or (9) Similar activities designed to bring landowners to an informed decision point and accelerate adoption of sustainable forest practices in a State. (b...

36 CFR 230.37 - State priority plan-educational assistance.

Code of Federal Regulations, 2014 CFR

2014-07-01

... sessions; (8) Web site construction and maintenance; or (9) Similar activities designed to bring landowners to an informed decision point and accelerate adoption of sustainable forest practices in a State. (b...

36 CFR 230.37 - State priority plan-educational assistance.

Code of Federal Regulations, 2012 CFR

2012-07-01

... sessions; (8) Web site construction and maintenance; or (9) Similar activities designed to bring landowners to an informed decision point and accelerate adoption of sustainable forest practices in a State. (b...

45 CFR 162.910 - Maintenance of standards and adoption of modifications and new standards.

Code of Federal Regulations, 2011 CFR

2011-10-01

... ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS General Provisions for... developed through a process that provides for the following: (1) Open public access. (2) Coordination with...

40 CFR 52.279 - Food processing facilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

...), adopted on August 21, 1984, and submitted on October 5, 1984. (2) Bay Area Air Quality Management District... relaxations will not interfere with the attainment and maintenance of the National Ambient Air Quality...

42 CFR 476.98 - Reviewer qualifications and participation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... (other than a spouse who is legally separated under a decree of divorce or separate maintenance), child (including a legally adopted child), grandchild, parent, or grandparent. [50 FR 15330, Apr. 17, 1985, as...

42 CFR 476.98 - Reviewer qualifications and participation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... reviewer's family is a spouse (other than a spouse who is legally separated under a decree of divorce or separate maintenance), child (including a legally adopted child), grandchild, parent, or grandparent. [50...

45 CFR 162.910 - Maintenance of standards and adoption of modifications and new standards.

Code of Federal Regulations, 2012 CFR

2012-10-01

... ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS General Provisions for... developed through a process that provides for the following: (1) Open public access. (2) Coordination with...

Suppression pheromone and cockroach rank formation

NASA Astrophysics Data System (ADS)

Kou, Rong; Chang, Huan-Wen; Chen, Shu-Chun; Ho, Hsiao-Yung

2009-06-01

Although agonistic behaviors in the male lobster cockroach ( Nauphoeta cinerea) are well known, the formation of an unstable hierarchy has long been a puzzle. In this study, we investigate how the unstable dominance hierarchy in N. cinerea is maintained via a pheromone signaling system. In agonistic interactions, aggressive posture (AP) is an important behavioral index of aggression. This study showed that, during the formation of a governing hierarchy, thousands of nanograms of 3-hydroxy-2-butanone (3H-2B) were released by the AP-adopting dominant in the first encounter fight, then during the early domination period and that this release of 3H-2B was related to rank maintenance, but not to rank establishment. For rank maintenance, 3H-2B functioned as a suppression pheromone, which suppressed the fighting capability of rivals and kept them in a submissive state. During the period of rank maintenance, as the dominant male gradually decreased his 3H-2B release, the fighting ability of the subordinate gradually developed, as shown by the increasing odds of a subordinate adopting an AP (OSAP). The OSAP was negatively correlated with the amount of 3H-2B released by the dominant and positively correlated with the number of domination days. The same OSAP could be achieved earlier by reducing the amount of 3H-2B released by the dominant indicates that whether the subordinate adopts an offensive strategy depends on what the dominant is doing.

Impacts of hospitals' innovativeness on information system outsourcing decisions.

PubMed

Park, Jae Sung

2014-04-01

The purpose of this study was to identify the effects of hospitals' innovativeness on outsourcing decision-making regarding four information system (IS) functions, namely, software programs, network maintenance, hardware systems, and PC/printer maintenance. Using the 2011 roster of the Korean Hospital Association, this study selected 311 general hospitals as a study population. After identifying the managers who were in charge of outsourcing, this study administered questionnaires. A total of 103 hospitals responded. Of the responding hospitals, 55.34% outsourced at least one IS function, whereas 88.35% outsourced at least one managerial function. IS outsourcing was motivated by the need for outside experts, but other managerial functions were outsourced for cost savings. Innovative and early adopter hospitals were 4.52 and 4.91 times more likely to outsource IS functions related with work processes (i.e., software and network maintenance) than early and late majority hospitals, respectively. IT outsourcing effectiveness significantly influenced the outsourcing decisions regarding four IS functions. Hospitals that had perceived more risks of outsourcing significantly preferred non-outsourcing on their hardware systems, but the risks of outsourcing were not significant for outsourcing decisions regarding the other IS functions. Hospitals' innovativeness also significantly explained the quantity of innovation adoptions. Innovative and early adopter hospitals did more outsourcing than early and late majority hospitals. Hospitals' innovativeness influences decision-making regarding outsourcing. Innovative hospitals are more likely to outsource their work-process-related IS functions. Thus, organizational traits, especially hospitals' innovativeness, should be considered as a key success factor for IS management.

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...

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...

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...

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...

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...

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...

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...

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…

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 approach, as the environmental supports for voluntary action are poor. Where ANGCY uptake does occur, changes to the food environment may be relatively minor. Stronger government measures may be needed to require recreational facilities to improve their food environments and to limit availability of unhealthy foods. PMID:22632384

The design and conduct of Keep It Off: An online randomized trial of financial incentives for weight-loss maintenance.

PubMed

Shaw, Pamela A; Yancy, William S; Wesby, Lisa; Ulrich, Victoria; Troxel, Andrea B; Huffman, David; Foster, Gary D; Volpp, Kevin

2017-02-01

Background Obesity continues to be a serious public health challenge. Rates are increasing worldwide, with nearly 70% of the US adults overweight or obese, leading to increased clinical and economic burden. While successful approaches for achieving weight loss have been identified, techniques for long-term maintenance of initial weight loss have largely been unsuccessful. Financial incentive interventions have been shown in several settings to be successful in motivating participants to adopt healthy behaviors. Purpose Keep It Off is a three-arm randomized controlled trial that compares the efficacy of a lottery-based incentive, traditional direct payment incentive, and control of daily feedback without any incentive for weight-loss maintenance. This design allows comparison of a traditional direct payment incentive with one based on behavioral economic principles that consider the underlying psychology of decision-making. Methods Participants were randomized in a 2:1 ratio for each active arm relative to control, with a targeted 188 participants in total. Eligible participants were those aged 30-80 who lost at least 11 lb (5 kg) during the first 4 months of participation in Weight Watchers, a national weight-loss program, with whom we partnered. The interventions lasted 6 months (Phase I); participants were followed for an additional 6 months without intervention (Phase II). The primary outcome is weight change from baseline to the end of Phase I, with the change at the end of Phase II a key secondary endpoint. Keep It Off is a pragmatic trial that recruited, consented, enrolled, and followed patients electronically. Participants were provided a wireless weight scale that electronically transmitted daily self-monitored weights. Weights were verified every 3 months at a Weight Watchers center local to the participant and electronically transmitted. Results Using the study web-based platform, we integrated recruitment, enrollment, and follow-up procedures into a digital platform that required little staff effort to implement and manage. We randomized 191 participants in less than 1 year. We describe the design of Keep It Off and implementation of enrollment. Lessons Learned We demonstrated that our pragmatic design was successful in rapid accrual of participants in a trial of interventions to maintain weight loss. Limitations Despite the nationwide reach of Weight Watchers, the generalizability of study findings may be limited by the characteristics of its members. The interventions under study are appropriate for settings where an entity, such as an employer or health insurance company, could offer them as a benefit. Conclusions Keep It Off was implemented and conducted with minimal staff effort. This study has the potential to identify a practical and effective weight-loss maintenance strategy.

The design and conduct of Keep It Off: An online randomized trial of financial incentives for weight loss maintenance

PubMed Central

Shaw, Pamela A; Yancy, William S; Wesby, Lisa; Ulrich, Victoria; Troxel, Andrea B; Huffman, David; Foster, Gary D; Volpp, Kevin

2016-01-01

Background Obesity continues to be a serious public health challenge. Rates are increasing worldwide, with nearly 70% of US adults overweight or obese, leading to increased clinical and economic burden. While successful approaches for achieving weight loss have been identified, techniques for long-term maintenance of initial weight loss have largely been unsuccessful. Financial incentive interventions have been shown in several settings to be successful in motivating participants to adopt healthy behaviors. Purpose Keep It Off is a three-arm randomized controlled trial that compares the efficacy of a lottery-based incentive, traditional direct payment incentive, and control of daily feedback without any incentive, for weight loss maintenance. This design allows comparison of a traditional direct payment incentive with one based on behavioral economic principles that consider the underlying psychology of decision-making. Methods Participants were randomized in a 2:1 ratio for each active arm relative to control, with a targeted 188 participants total. Eligible participants were those aged 30–80 who lost at least 11 pounds (lb, 5 kilograms (kg)) during the first 4 months of participation in Weight Watchers, a national weight loss program, with whom we partnered. The interventions lasted 6 months (Phase I); participants were followed for 6 additional months without intervention (Phase II). The primary outcome is weight change from baseline to the end of Phase I, with the change at the end of Phase II a key secondary endpoint. Keep It Off is a pragmatic trial that recruited, consented, enrolled and followed patients electronically. Participants were provided a wireless weight scale that electronically transmitted daily self-monitored weights. Weights were verified every 3 months at a Weight Watchers center local to the participant and electronically transmitted. Results Using the study web-based platform, we integrated recruitment, enrollment and follow-up procedures into a digital platform that required little staff effort to implement and manage. We randomized 191 participants in less than one year. We describe the design of Keep It Off and implementation of enrollment. Lessons Learned We demonstrated that our pragmatic design was successful in rapid accrual of participants in a trial of interventions to maintain weight loss. Limitations Despite the nationwide reach of Weight Watchers, the generalizability of study findings may be limited by the characteristics of its members. The interventions under study are appropriate for settings where an entity, such as an employer or health insurance company, could offer them as a benefit. Conclusions Keep It Off was implemented and conducted with minimal staff effort. This study has the potential to identify a practical and effective weight loss maintenance strategy. PMID:27646508

OHD/HL/HSEB - Hydrologic Software Engineering Branch

Science.gov Websites

analysis, design, development, testing, documentation, implementation, and maintenance of application and also responsible for the software maintenance and realtime operations of the Hydrometeorological

Air Vehicle Integration and Technology Research (AVIATR). Task Order 0003: Condition-Based Maintenance Plus Structural Integrity (CBM+SI) Demonstration (April 2011 to August 2011)

DTIC Science & Technology

2011-08-01

investigated. Implementation of this technology into the maintenance framework depends on several factors, including safety of the structural system, cost... Maintenance Parameters The F-15 Program has indicated that, in practice , maintenance actions are generally performed on flight hour multiples of 200...Risk Analysis or the Perform Cost Benefit Analysis sections of the flowchart. 4.6. Determine System Configurations The current maintenance practice

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 make a significant and sustained contribution to improving the recreational facility food environment, however one year following their release, awareness, adoption and implementation of the ANGCY remained low. A mandated policy approach could offer an efficacious, cost-effective means of improving the food environment within recreational facilities. PMID:21631946

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.

Challenges in Identifying Patients with Type 2 Diabetes for Quality-Improvement Interventions in Primary Care Settings and the Importance of Valid Disease Registries.

PubMed

Wozniak, Lisa; Soprovich, Allison; Rees, Sandra; Johnson, Steven T; Majumdar, Sumit R; Johnson, Jeffrey A

2015-10-01

Patient registries are considered an important foundation of chronic disease management, and diabetes patient registries are associated with better processes and outcomes of care. The purpose of this article is to describe the development and use of registries in the Alberta's Caring for Diabetes (ABCD) project to identify and reach target populations for quality-improvement interventions in the primary care setting. We applied the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework and expanded the definition of reach beyond the individual (i.e. patient) level to include the ability to identify target populations at an organizational level. To characterize reach and the implementation of registries, semistructured interviews were conducted with key informants, and a usual-care checklist was compiled for each participating Primary Care Network (PCN). Content analysis was used to analyze qualitative data. Using registries to identify and recruit participants for the ABCD interventions proved challenging. The quality of the registries depended on whether physicians granted PCN access to patient lists, the strategies used in development, the reliability of diagnostic information and the data elements collected. In addition, once a diabetes registry was developed, there was limited ability to update it. Proactive management of chronic diseases like diabetes requires the ability to reach targeted patients at the population level. We observed several challenges to the development and application of patient registries. Given the importance of valid registries, strong collaborations and novel strategies that involve policy-makers, PCNs and providers are needed to help find solutions to improve registry quality and resolve maintenance issues. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

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

77 FR 73560 - Approval and Promulgation of Air Quality Implementation Plans; West Virginia; Redesignation of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-11

... the Area. The maintenance plan includes an insignificance determination for the on-road motor vehicle... redesignation. The maintenance plan includes an insignificance determination for the on-road motor vehicle...) Nonattainment Area to Attainment and Approval of the Associated Maintenance Plan AGENCY: Environmental...

77 FR 61631 - Final Environmental Impact Statement for Stehekin River Corridor Implementation Plan, Lake Chelan...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-10

... management of park facilities (e.g., roads, bridges, trails, maintenance yard) in response to increased... Meadows, while retaining private access to the area via a 0.75-mile-long reduced maintenance road... maintenance and residential facilities from floodplain areas, construction of recreational facilities and...

77 FR 68076 - Approval and Promulgation of Air Quality Implementation Plans; West Virginia; Redesignation of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-15

... redesignation. The maintenance plan includes an insignificance determination for the on-road motor vehicle... and Approval of the Associated Maintenance Plan AGENCY: Environmental Protection Agency (EPA). ACTION... proposing to approve the maintenance plan SIP revision that the State submitted in conjunction with its...

78 FR 61413 - Self-Regulatory Organizations; Chicago Stock Exchange, Inc.; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-03

... Change To Adopt a Market Data Revenue Rebates Program September 27, 2013. Pursuant to Section 19(b)(1) of... Fees and Assessments (the ``Fee Schedule'') by adopting Section P to implement the Market Data Revenue... Exchange proposes to amend its Fee Schedule to adopt Section P to implement the Market Data Revenue (``MDR...

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...

Vegetable and fruit breaks in Australian primary schools: prevalence, attitudes, barriers and implementation strategies.

PubMed

Nathan, Nicole; Wolfenden, Luke; Butler, Michelle; Bell, Andrew Colin; Wyse, Rebecca; Campbell, Elizabeth; Milat, Andrew J; Wiggers, John

2011-08-01

School-based vegetable and fruit programs can increase student consumption of vegetables and fruit and have been recommended for adoption by Australian schools since 2005. An understanding of the prevalence and predictors of and the barriers to the adoption of school-based vegetable and fruit programs is necessary to maximize their adoption by schools and ensure that the health benefits of such programs to children are realized. The aim of this study was to determine Australian primary school Principals' attitudes and barriers to the implementation of vegetable and fruit breaks; the prevalence of vegetable and fruit breaks in schools and the implementation strategies used and associated with their recommended adoption (daily in at least 80% of classes). A random sample of 384 school Principals completed a 20-min telephone interview. While Principals were highly supportive of vegetable and fruit breaks, only 44% were implementing these to a recommended level. When controlling for all school characteristics, recommended vegetable and fruit break adoption was 1.9 and 2.2 times greater, respectively, in schools that had parent communication strategies and teachers trained. A substantial opportunity exists to enhance the health of children through the adoption of vegetable and fruit breaks in schools.

Importance-Satisfaction Analysis for Primary Care Physicians’ Perspective on EHRs in Taiwan †

PubMed Central

Ho, Cheng-Hsun; Wen, Hsyien-Chia; Chu, Chi-Ming; Wu, Yi-Syuan; Wang, Jen-Leng

2014-01-01

The Taiwan government has been promoting Electronic Health Records (EHRs) to primary care physicians. How to extend EHRs adoption rate by measuring physicians’ perspective of importance and performance of EHRs has become one of the critical issues for healthcare organizations. We conducted a comprehensive survey in 2010 in which a total of 1034 questionnaires which were distributed to primary care physicians. The project was sponsored by the Department of Health to accelerate the adoption of EHRs. 556 valid responses were analyzed resulting in a valid response rate of 53.77%. The data were analyzed based on a data-centered analytical framework (5-point Likert scale). The mean of importance and satisfaction of four dimensions were 4.16, 3.44 (installation and maintenance), 4.12, 3.51 (product effectiveness), 4.10, 3.31 (system function) and 4.34, 3.70 (customer service) respectively. This study provided a direction to government by focusing on attributes which physicians found important but were dissatisfied with, to close the gap between actual and expected performance of the EHRs. The authorities should emphasize the potential advantages in meaningful use and provide training programs, conferences, technical assistance and incentives to enhance the national level implementation of EHRs for primary physicians. PMID:24914640

Probabilistic durability assessment of concrete structures in marine environments: Reliability and sensitivity analysis

NASA Astrophysics Data System (ADS)

Yu, Bo; Ning, Chao-lie; Li, Bing

2017-03-01

A probabilistic framework for durability assessment of concrete structures in marine environments was proposed in terms of reliability and sensitivity analysis, which takes into account the uncertainties under the environmental, material, structural and executional conditions. A time-dependent probabilistic model of chloride ingress was established first to consider the variations in various governing parameters, such as the chloride concentration, chloride diffusion coefficient, and age factor. Then the Nataf transformation was adopted to transform the non-normal random variables from the original physical space into the independent standard Normal space. After that the durability limit state function and its gradient vector with respect to the original physical parameters were derived analytically, based on which the first-order reliability method was adopted to analyze the time-dependent reliability and parametric sensitivity of concrete structures in marine environments. The accuracy of the proposed method was verified by comparing with the second-order reliability method and the Monte Carlo simulation. Finally, the influences of environmental conditions, material properties, structural parameters and execution conditions on the time-dependent reliability of concrete structures in marine environments were also investigated. The proposed probabilistic framework can be implemented in the decision-making algorithm for the maintenance and repair of deteriorating concrete structures in marine environments.

A hybrid 3D spatial access method based on quadtrees and R-trees for globe data

NASA Astrophysics Data System (ADS)

Gong, Jun; Ke, Shengnan; Li, Xiaomin; Qi, Shuhua

2009-10-01

3D spatial access method for globe data is very crucial technique for virtual earth. This paper presents a brand-new maintenance method to index 3d objects distributed on the whole surface of the earth, which integrates the 1:1,000,000- scale topographic map tiles, Quad-tree and R-tree. Furthermore, when traditional methods are extended into 3d space, the performance of spatial index deteriorates badly, for example 3D R-tree. In order to effectively solve this difficult problem, a new algorithm of dynamic R-tree is put forward, which includes two sub-procedures, namely node-choosing and node-split. In the node-choosing algorithm, a new strategy is adopted, not like the traditional mode which is from top to bottom, but firstly from bottom to top then from top to bottom. This strategy can effectively solve the negative influence of node overlap. In the node-split algorithm, 2-to-3 split mode substitutes the traditional 1-to-2 mode, which can better concern the shape and size of nodes. Because of the rational tree shape, this R-tree method can easily integrate the concept of LOD. Therefore, it will be later implemented in commercial DBMS and adopted in time-crucial 3d GIS system.

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 enabling factors has the potential to support efforts at implementing national electronic health record implementation endeavors. © The Author(s) 2013.

Internet-Based Recording Service Solves Maintenance Reporting Problems.

ERIC Educational Resources Information Center

Noah, Marilyn

2001-01-01

Details the response to a health threat caused by illegal wastewater disposal in Wisconsin. Traces the identification of the problem, ordinances and policies adopted to guide the remedy, and subsequent monitoring of environmental quality. (DDR)

Multimodal Transportation Facility Resilience Index

DOT National Transportation Integrated Search

2017-03-21

A new paradigm for complex systems performance and maintenance decision making is developing in the form of resilience engineering. Depending on the subject area, different definitions of resilience exist. In this project, we adopt a definition appro...

Coaching patients in the use of decision and communication aids: RE-AIM evaluation of a patient support program.

PubMed

Belkora, Jeff; Volz, Shelley; Loth, Meredith; Teng, Alexandra; Zarin-Pass, Margot; Moore, Dan; Esserman, Laura

2015-05-28

Decision aids educate patients about treatment options and outcomes. Communication aids include question lists, consultation summaries, and audio-recordings. In efficacy studies, decision aids increased patient knowledge, while communication aids increased patient question-asking and information recall. Starting in 2004, we trained successive cohorts of post-baccalaureate, pre-medical interns to coach patients in the use of decision and communication aids at our university-based breast cancer clinic. From July 2005 through June 2012, we used the RE-AIM framework to measure Reach, Effectiveness, Adoption, Implementation and Maintenance of our interventions. 1. Reach: Over the study period, our program sent a total of 5,153 decision aids and directly administered 2,004 communication aids. In the most recent program year (2012), out of 1,524 eligible patient appointments, we successfully contacted 1,212 (80%); coached 1,110 (73%) in the self-administered use of decision and communication aids; sent 958 (63%) decision aids; and directly administered communication aids for 419 (27%) patients. In a 2010 survey, coached patients reported self-administering one or more communication aids in 81% of visits 2. Effectiveness: In our pre-post comparisons, decision aids were associated with increased patient knowledge and decreased decisional conflict. Communication aids were associated with increased self-efficacy and number of questions; and with high ratings of patient preparedness and satisfaction 3. Adoption: Among visitors sent decision aids, 82% of survey respondents reviewed some or all; among those administered communication aids, 86% reviewed one or more after the visit 4. Through continuous quality adaptations, we increased the proportion of available staff time used for patient support (i.e. exploitation of workforce capacity) from 29% in 2005 to 84% in 2012 5. Maintenance: The main barrier to sustainability was the cost of paid intern labor. We addressed this by testing a service learning model in which student interns work as program coaches in exchange for academic credit rather than salary. The feasibility test succeeded, and we are now expanding the use of unpaid interns. We have sustained a clinic-wide implementation of decision and communication aids through a novel staffing model that uses paid and unpaid student interns as coaches.

Outcome evaluation of a 3-year senior health and wellness initiative.

PubMed

Kuczmarksi, Marie Fanelli; Cotugna, Nancy

2009-02-01

The Wilmington Senior Center developed a 3-year multidisciplinary health and wellness initiative entitled The Time of Your Life to promote healthy aging for participants attending countywide senior centers. The purpose of this paper is to describe the development and implementation of the evaluation methodology and outcomes of this senior health and wellness project that consisted of 11 programs in total. Long-term programming can present several challenges in both implementation and evaluation, but assessing outcomes is critical to documenting program value and accountability. Participant-completed surveys and post-series focus groups were utilized as the evaluation tools. Our findings indicate that the program's objectives of increasing knowledge and motivating adoption or maintenance of a healthy lifestyle were met to varying degrees, while a third objective of assessing the usefulness of resources to inform health-related decisions was unable to be evaluated due to the cross-sectional nature of the data collection. Post-series focus groups indicated that topics of most interest to seniors were money management, medications and staying mentally and physically fit. The evaluations showed that long-term programming, while challenging, can be a successful and sustainable format for senior health education.

Costs associated with data collection and reporting for diabetes quality improvement in primary care practices: a report from SNOCAP-USA.

PubMed

West, David R; Radcliff, Tiffany A; Brown, Tiffany; Cote, Murray J; Smith, Peter C; Dickinson, W Perry

2012-01-01

Information about the costs and experiences of collecting and reporting quality measure data are vital for practices deciding whether to adopt new quality improvement initiatives or monitor existing initiatives. Six primary care practices from Colorado's Improving Performance in Practice program participated. We conducted structured key informant interviews with Improving Performance in Practice coaches and practice managers, clinicians, and staff and directly observed practices. Practices had 3 to 7 clinicians and 75 to 300 patients with diabetes, half had electronic health records, and half were members of an independent practice association. The estimated per-practice cost of implementation for the data collection and reporting for the diabetes quality improvement program was approximately $15,552 per practice (about $6.23 per diabetic patient per month). The first-year maintenance cost for this effort was approximately $9,553 per practice ($3.83 per diabetic patient per month). The cost of implementing and maintaining a diabetes quality improvement effort that incorporates formal data collection, data management, and reporting is significant and quantifiable. Policymakers must become aware of the financial and cultural impact on primary care practices when considering value-based purchasing initiatives.

Review and Prospect of BIM Policy in China

NASA Astrophysics Data System (ADS)

Liu, Bingsheng; Wang, Min; Zhang, Yutao; Liu, Rui; Wang, Anmin

2017-10-01

In the process of architectural design, construction, operation and maintenance, the problem of inefficiency and inaccuracy in information application and exchange has caused substantial waste of resources and risk in construction industry. Building Information Management provides an opportunity to address the issue. Building information modelling (BIM) has been increasingly applied in design, construction and other information management in China as its important role in reducing engineering changes, improving engineering quality, shortening project duration, saving project cost, enhancing information sharing among the participants many others. As an integration of process and product, its development and implementation need government regulation to enhance its applications effect and standardize its adoption and implementation. Especially, the government guidance affects the application and development of new technology to a great extent in China. However, relevant policy development falls behind the rapid development of its application in practice in China, which has led to many problems in construction practice. In order to develop effective BIM policy for China, this paper conducted a comprehensive review about existing BIM policy in China by analysing its status and problems, comparing it with the corresponding policy in developed countries such as the USA and UK. The expected policy development direction is also discussed and proposed.

A Climate Change Adaptation Strategy for Management of ...

EPA Pesticide Factsheets

Sea level rise is causing shoreline erosion, increased coastal flooding, and marsh vulnerability to the impact of storms. Coastal marshes provide flood abatement, carbon and nutrient sequestration, water quality maintenance, and habitat for fish, shellfish, and wildlife, including species of concern, such as the saltmarsh sparrow (Ammodramus caudacutus). We present a climate change adaptation strategy (CCAS) adopted by scientific, management, and policy stakeholders for managing coastal marshes and enhancing system resiliency. A common adaptive management approach previously used for restoration projects was modified to identify climate-related vulnerabilities and plan climate change adaptive actions. As an example of implementation of the CCAS, we describe the stakeholder plans and management actions the US Fish and Wildlife Service and partners developed to build coastal resiliency in the Narrow River Estuary, RI, in the aftermath of Superstorm Sandy. When possible, an experimental BACI (before-after, control-impact) design, described as pre- and post-sampling at the impact site and one or more control sites, was incorporated into the climate change adaptation and implementation plans. Specific climate change adaptive actions and monitoring plans are described and include shoreline stabilization, restoring marsh drainage, increasing marsh elevation, and enabling upland marsh migration. The CCAS provides a framework and methodology for successfully managing coa

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

Progress and challenges: implementation and use of health information technology among critical-access hospitals.

PubMed

Gabriel, Meghan Hufstader; Jones, Emily B; Samy, Leila; King, Jennifer

2014-07-01

Despite major national investments to support the adoption of health information technology (IT), concerns persist that barriers are inhibiting that adoption and the use of advanced health IT capabilities in rural areas in particular. Using a survey of Medicare-certified critical-access hospitals, we examined electronic health record (EHR) adoption, key EHR functionalities, telehealth, and teleradiology, as well as challenges to EHR adoption. In 2013, 89 percent of critical-access hospitals had implemented a full or partial EHR. Adoption of key EHR capabilities varied. Critical-access hospitals that had certain types of technical assistance and resources available to support health IT were more likely to have adopted health IT capabilities and less likely to report significant challenges to EHR implementation and use, compared to other hospitals in the survey. It is important to ensure that the necessary resources and support are available to critical-access hospitals, especially those that operate independently, to assist them in adopting health IT and becoming able to electronically link to the broader health care system. Project HOPE—The People-to-People Health Foundation, Inc.

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.

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.

Cross-border healthcare in Spain and the implementation of the Directive 2011/24/EU on the Application of Patient's Rights in Cross-border Healthcare.

PubMed

Requejo, M Teresa

2014-03-01

This work describes and assesses the implementation of the Cross-border Healthcare Directive in Spain. Although implementation has not yet taken place, the Government has already adopted a draft implementing regulation, on which this article is based. In addition, this article deals with a number of other rules that have been adopted in Spain, which are not strictly aimed at the implementation of the Directive but which are expected to facilitate its implementation and to help cement its effectiveness.

Tensions of network security and collaborative work practice: understanding a single sign-on deployment in a regional hospital.

PubMed

Heckle, Rosa R; Lutters, Wayne G

2011-08-01

Healthcare providers and their IT staff, working in an effort to balance appropriate accessibility with stricter security mandates, are considering the use of a single network sign-on approach for authentication and password management. Single sign-on (SSO) promises to improve usability of authentication for multiple-system users, increase compliance, and help curb system maintenance costs. However, complexities are introduced when SSO is placed within a collaborative environment. These complexities include unanticipated workflow implications that introduce greater security vulnerability for the individual user. OBJECTIVES AND METHODOLOGY: In this work, we examine the challenges of implementing a single sign-on authentication technology in a hospital environment. The aim of the study was to document the factors that affected SSO adoption within the context of use. The ultimate goal is to better inform the design of usable authentication systems within collaborative healthcare work sites. The primary data collection techniques used are ethnographically informed - observation, contextual interviews, and document review. The study included a cross-section of individuals from various departments and varying rolls. These participants were a mix of both clinical and administrative staff, as well as the Information Technology group. The field work revealed fundamental mis-matches between the technology and routine work practices that will significantly impact its effective adoption. While single sign-on was effective in the administrative offices, SSO was not a good fit for collaborative areas. The collaborative needs of the clinical staff unearthed tensions in its implementation. An analysis of the findings revealed that the workflow, activities, and physical environment of the clinical areas create increased security vulnerabilities for the individual user. The clinical users were cognizant of these vulnerabilities and this created resistance to the implementation due to a concern for privacy. From a preliminary analysis of our on-going field study at a community hospital, there appears to be a number of mismatches between the SSO vision and the realities of routine work. While we cannot conclusively say if a SSO adoption will be effective in meeting its goals in a hospital environment, we do know that it will affect the work practice and that will make the management of the SSO system problematic. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Mississippi Communities for Healthy Living: Implementing a nutrition intervention effectiveness study in a rural health disparate region.

PubMed

Connell, Carol L; Thomson, Jessica L; Huye, Holly F; Landry, Alicia S; Crook, LaShaundrea B; Yadrick, Kathy

2015-05-01

Intervention research in rural, health disparate communities presents unique challenges for study design, implementation, and evaluation. Challenges include 1) culturally appropriate intervention components, 2) participant recruitment and retention, 3) treatment cross-contamination, 4) intervention delivery and data collection, and 5) potential measurement reactivity. The purposes of this paper are to 1) detail the methods of the MCHL study and 2) report baseline demographic characteristics of study participants. The secondary aim is to determine if study participants were engaging in behavior changes after enrollment and prior to intervention initiation. MCHL was developed using the RE-AIM planning and evaluation framework (reach, effectiveness, adoption, implementation, maintenance). Intervention components were based on Roger's diffusion of innovation attributes that promote adoption of a new innovation as well as on the psychosocial constructs of social support, self-efficacy and decisional balance. Rolling enrollment data collection was used to acquire sufficient sample size and a second data collection just prior to intervention implementation assessed measurement reactivity effects. Participant outcomes included diet quality, blood pressure, weight status, and quality of life. Cluster stratified assignment to one of two treatment arms was utilized to minimize cross contamination. Generalized linear models were used to compare enrollment measures between the two treatment arms while mixed model linear regression was used to test for changes in diet quality outcomes from enrollment to pre-intervention baseline. There were no significant differences in participant demographic, anthropometric or clinical measures between the two treatment arms at enrollment. With the exception of total vegetables, none of the diet quality indicators were significantly different between enrollment and baseline timepoints. Conducting nutrition intervention research in a rural health disparate region requires flexibility in adapting the recruitment, retention, and data collection procedures while maintaining a high level of scientific rigor. Negligible research participation effects, such as measurement reactivity, were noted in this population. However, further research is needed to identify methods to successfully recruit and retain Caucasian females to participate in community-based nutrition interventions in this region. Copyright © 2015 Elsevier Inc. All rights reserved.

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.

Process-based reference conditions: An alternative approach for managed river systems

NASA Astrophysics Data System (ADS)

Grams, P.; Melis, T.; Wright, S.; Schmidt, J.; Topping, D.

2008-12-01

Physical reference conditions, whether based on historic information or the condition of nearby less impaired systems, provide necessary information that contributes to an assessment of stream condition and the nature of channel transformation. In many cases, however, the utility of this traditional 'reference' approach may end at the assessment stage and not be applicable to establishing and implementing restoration goals. Ongoing impacts such as continued existence of an upstream dam or the persistence of invasive vegetation may render restoration based on a physical reference infeasible. In these circumstances, an alternative approach is to identify and describe reference processes in place of physical reference conditions. This is the case for the Colorado River where large dams, a commitment to hydropower production, and legal mandates for regional distribution and off- channel consumption of water greatly reduce the relevance of historical conditions in setting goals for rehabilitation. In this setting, two strategies are available for setting reference conditions. One is maintenance of post-dam sediment mass balance, which attempts to ensure that the channel does not continue to degrade or aggrade and that riverine habitats do not continue to diverge from their historical condition. Post- dam sediment mass balance can be quantified at a reconnaissance or project scale. The second strategy is to define key processes that maintain the native ecosystem. These processes may, or may not, be consistent with maintenance of sediment mass balance, but they may be key to rejuvenation of spawning and rearing habitats, maintenance of historical ranges of temperature and turbidity, maintenance of a sustainable food base for the native aquatic community, or maintaining other riverine resources. Both strategies require careful monitoring of processes (e.g. sediment flux), which may add considerably to the cost and complexity of a monitoring program. An additional challenge in adopting the second strategy is that it is difficult to define when a process is adequately restored, since many ecosystem processes collectively limit recovery of populations of native communities.

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.

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 increase awareness about the need for Legionella prevention and to monitor effectiveness of maintenance procedures.

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.

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.

78 FR 12267 - Approval and Promulgation of Air Quality Implementation Plans; Charlotte, Raleigh/Durham and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-22

... maintenance plan update is for the Charlotte, Raleigh/Durham and Winston-Salem carbon monoxide (CO) maintenance areas. Specifically, the State submitted a limited maintenance plan update for CO, showing continued attainment of the 8-hour CO National Ambient Air Quality Standard for the Charlotte, Raleigh...

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...

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.

45 CFR 1356.10 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... assistance payments, related foster care and adoption administrative and training expenditures, and the... Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE...

45 CFR 1356.10 - Scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... assistance payments, related foster care and adoption administrative and training expenditures, and the... Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE...

76 FR 25787 - Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-05

... A. Hospital Inpatient Quality Reporting Program 1. Background a. Overview b. Statutory History and History of Measures Adopted for the Hospital IQR Program c. Maintenance of Technical Specifications for...

Antecedents of intra/intergroup friendships and stress levels among ethnic and religious minority members.

PubMed

Zagefka, Hanna; Mohamed, Abdinasir; Mursi, Gehad; Lay, Siugmin

2016-12-01

Two studies tested a model, whereby, identification with the minority group was predicted to impact on acculturation preferences, which in turn were proposed to impact involvement in intragroup friendships with other minority members, intergroup friendships with majority members and stress experienced by minority members. A direct path from minority identification to stress was also included in the model. The model was tested using structural equation modelling on survey data collected from Muslim women (N = 250) and from Somali minority members (N = 198) in Britain. Results supported predictions and revealed that identification was associated with more culture maintenance preference and less culture adoption preference. Culture maintenance preference was associated with involvement in intragroup friendships, and culture adoption preference was associated with involvement in intergroup friendships and increased stress. Practical applications of the findings are discussed. © 2015 International Union of Psychological Science.

The most common problem facing by the maintenance department: A case Study between Universiti Tun Hussein Onn Malaysia (UTHM) and Universiti Teknologi Malaysia (UTM)

NASA Astrophysics Data System (ADS)

Norazam Yasin, Mohd; Mohamad Zin, Rosli; Halid Abdullah, Abd; Shafiq Mahmad, Muhammad; Fikri Hasmori, Muhammad

2017-11-01

From time to time, the maintenance works become more challenging due to construction of new building and also aging of the existing buildings. University buildings without any exception require proper maintenance services to support their function requirements and this can be considered as major responsibilities to be fulfilled by the maintenance department in the universities. Maintenance department specifically will face various kinds of problems in their operation works and thus this might influence the maintenance work operations itself. This study purposely to identify the common problem facing by the maintenance department and also to examine the current status of the maintenance department. In addition, this study would also propose any suitable approach that could be implemented to overcome the problem facing by the maintenance department. To achieve the objectives of this study, a combination of deep literature study and carrying out a survey is necessary. Literature study aimed to obtain deeper information about this study, meanwhile a survey aimed at identifying the common problem facing by the maintenance department and also to provide the information of the maintenance department’s organization. Several methods will be used in analyzing the data obtained through the survey, including Microsoft Office Excel and also using mean index formula. This study has identified three categories of problem in the maintenance department, which are management problems, human resource problem, and technical problems. Following the findings, several solutions being proposed which can be implemented as the solution to the problem facing. These suggestions have the potential to improve the maintenance department work efficiency, thus could help to increase the department productivity.

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.

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...

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...

Linking secondary school physical education with community sport and recreation for girls: a process evaluation.

PubMed

Casey, Meghan M; Telford, Amanda; Mooney, Amanda; Harvey, Jack T; Eime, Rochelle M; Payne, Warren R

2014-10-06

The purpose of this study was to undertake a process evaluation to examine the reach, adoption and implementation of a school-community linked physical activity (PA) program for girls aged 12 - 15 years (School Years 7 - 9) using the RE-AIM framework. Various approaches were used to assess 'reach', 'adoption' and implementation: (a) a school environment survey of intervention schools (n = 6); (b) teacher feedback regarding the professional development component (91.1% response rate) and lesson implementation (60.8% response rate); and (c) post-intervention focus group interviews with physical education (PE) teachers (n = 29), students (n = 125), coaches (n = 13) and instructors (n = 8) regarding program experiences. Reach and Adoption: Seven schools (n = 1491 Year 7-9 female student enrolment; 70% adoption rate), five tennis clubs, eight football clubs and five leisure centres participated in the program during 2011. Program design and professional development opportunities (training, resource manual and opportunities to work with coaches and instructors during PE classes) supported implementation and student engagement in PA. However, there was a lack of individual and organisational readiness to adopt program principles. For some deliverers there were deeply embedded ideologies that were not aligned with the Game Sense teaching approach upon which the program was based. Further, cognitive components of the program such as self-management were not widely adopted as other components of the program tended to be prioritised. The program design and resources supported the success of the program, however, some aspects were not implemented as intended, which may have affected the likelihood of achieving further positive outcomes. Barriers to program implementation were identified and should be considered when designing school-community linked interventions. In particular, future programs should seek to assess and adjust for organizational readiness within the study design. For example, shared commitment and abilities of program deliverers to implement the program needs to be determined to support program implementation. ACTRN12614000446662. April 30th 2014.

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.

Translating an Evidence-Based Behavioral Intervention for Women Living with HIV into Clinical Practice: The SMART/EST Women's Program.

PubMed

Weiss, Stephen M; Tobin, Jonathan N; Lopez, Maria; Simons, Hannah; Cook, Ryan; Jones, Deborah L

2015-06-01

The process of translating scientific findings into clinical and public health settings has only recently received priority attention within the scientific community. Fueled by "Funding Opportunity Announcements" from the National Institutes of Health and Centers for Disease Control and Prevention, scientists have begun to explore the pathways to effectively "transfer" promising research accomplishments into effective and sustainable service programs within the health care delivery system. Using Glasgow's RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) model as a guide, this research team enrolled 428 socially disadvantaged, culturally diverse women living with HIV/AIDS to test the dissemination and implementation of an evidence-based behavioral intervention designed to improve and sustain the physical and emotional health of participants into the Community Health Center (CHC) setting when conducted by trained CHC staff. Findings demonstrate the ability of trained CHC staff group leaders to attain results equivalent or superior to those achieved when conducted by research staff on the three principal study outcomes: depression, medication adherence and HIV viral load. Four of five CHCs involved in the study also identified and successfully obtained funding to continue to run intervention groups, supporting the adoption and sustainability components of the translation model. This study confirmed (a) the "translatability" of the Stress Management And Relaxation Training/Emotional Supportive Therapy (SMART/EST) Women's Program, from academic to CHC settings in two geographic regions with high HIV prevalence among women, (b) the ability of local staff (using the "train the trainer" model) to successfully achieve program fidelity and clinical outcomes, and (c) the sustainability the program beyond the auspices of research support, through supportive CHC leadership securing continued program funding.

Are we having fun yet? Fostering adherence to injury preventive exercise recommendations in young athletes.

PubMed

Keats, Melanie R; Emery, Carolyn A; Finch, Caroline F

2012-03-01

Sport and recreational activities are the leading cause of injury in youth, yet there is increasing evidence that many sport-related injuries are preventable. For injury prevention strategies to be effective, individuals must understand, adopt and adhere to the recommended prevention strategy or programme. Despite the recognized importance of a behavioural approach, the inclusion of behavioural change strategies in sport injury prevention has been historically neglected. The purpose of this commentary is to outline the rationale for the inclusion and application of behavioural science in reducing the burden of injury by increasing adherence to proven prevention strategies. In an effort to provide an illustrative example of a behavioural change approach, the authors suggest a specific plan for the implementation of a neuromuscular training strategy to reduce the risk of lower limb injury in youth sport. Given the paucity of evidence in the sport injury prevention setting, and the lack of application of theoretical frameworks to predicting adoption and adherence to injury preventive exercise recommendations in youth sport, data from the related physical activity promotion domain is utilized to describe how sound, theory-based injury prevention exercise interventions in youth may be developed. While the question of how to facilitate behavioural change and optimize adherence to preventive exercise recommendations remains an ongoing challenge, the authors detail several strategies based on two prominent behavioural theories to aid the reader in conceptualizing, designing and implementing effective interventions. Despite the minimal application of behavioural theory within the field of sport injury prevention in youth, behavioural science has the potential to make a significant impact on the understanding and prevention of youth sport injury. Appropriate evaluation of adherence and maintenance components based on models of behavioural change should be a critical component of future injury prevention research and practice.

Feasibility of an implementation strategy for the integration of health promotion in routine primary care: a quantitative process evaluation.

PubMed

Sanchez, Alvaro; Grandes, Gonzalo; Cortada, Josep M; Pombo, Haizea; Martinez, Catalina; Corrales, Mary Helen; de la Peña, Enrique; Mugica, Justo; Gorostiza, Esther

2017-02-17

Process evaluation is recommended to improve the understanding of underlying mechanisms related to clinicians, patients, context and intervention delivery that may impact on trial or program results, feasibility and transferability to practice. The aim of this study was to assess the feasibility of the Prescribe Healthy Life (PVS from the Spanish "Prescribe Vida Saludable") implementation strategy for enhancing the adoption and implementation of an evidence-based health promotion intervention in primary health care. A descriptive study of 2-year implementation indicators for the PVS clinical intervention was conducted in four primary health care centers. A multifaceted collaborative modeling implementation strategy was developed to enhance the integration of a clinical intervention to promote healthy lifestyles into clinical practice. Process indicators were assessed for intervention reach, adoption, implementation, sustainability and their variability at center, practice, and patient levels. Mean rates of adoption by means of active collaboration among the three main professional categories (family physicians, nurses and administrative personnel) were 75% in all centers. Just over half of the patients that attended (n = 11650; 51.9%) were reached in terms of having their lifestyle habits assessed, while more than a third (33.7%; n = 7433) and almost 10% (n = 2175) received advice or a printed prescription for at least one lifestyle change, respectively. Only 3.7% of the target population received a repeat prescription. These process indicators significantly (p < 0.001) varied by center, lifestyle habit and patient characteristics. Sustainability of intervention components changed thorough the implementation period within centers. The implementation strategy used showed moderate-to-good performance on process indicators related to adoption, reach, and implementation of the evidence-based healthy lifestyle promotion intervention in the context of routine primary care. Sources of heterogeneity and instability in these indicators may improve our understanding of factors required to attain adequate program adoption and implementation through improved implementation strategies.

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.

Impacts of Hospitals' Innovativeness on Information System Outsourcing Decisions

PubMed Central

2014-01-01

Objectives The purpose of this study was to identify the effects of hospitals' innovativeness on outsourcing decision-making regarding four information system (IS) functions, namely, software programs, network maintenance, hardware systems, and PC/printer maintenance. Methods Using the 2011 roster of the Korean Hospital Association, this study selected 311 general hospitals as a study population. After identifying the managers who were in charge of outsourcing, this study administered questionnaires. A total of 103 hospitals responded. Results Of the responding hospitals, 55.34% outsourced at least one IS function, whereas 88.35% outsourced at least one managerial function. IS outsourcing was motivated by the need for outside experts, but other managerial functions were outsourced for cost savings. Innovative and early adopter hospitals were 4.52 and 4.91 times more likely to outsource IS functions related with work processes (i.e., software and network maintenance) than early and late majority hospitals, respectively. IT outsourcing effectiveness significantly influenced the outsourcing decisions regarding four IS functions. Hospitals that had perceived more risks of outsourcing significantly preferred non-outsourcing on their hardware systems, but the risks of outsourcing were not significant for outsourcing decisions regarding the other IS functions. Hospitals' innovativeness also significantly explained the quantity of innovation adoptions. Innovative and early adopter hospitals did more outsourcing than early and late majority hospitals. Conclusions Hospitals' innovativeness influences decision-making regarding outsourcing. Innovative hospitals are more likely to outsource their work-process-related IS functions. Thus, organizational traits, especially hospitals' innovativeness, should be considered as a key success factor for IS management. PMID:24872912

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 ...

Union-related correlates of employee referrals to an occupational alcoholism project in a health maintenance organization.

PubMed

Putnam, S L; Stout, R L

1982-03-01

A number of union-related factors, including the degree of unionization and the skill level of the work force, the quality of union-management relations, the extent of union involvement in program development, as well as the provision of supervisory training, have been found to be important in explaining occupational alcoholism program outcome. This study attempted to determine the relationship of such factors to an unusual measure of program outcome, employee referrals to the treatment component of an occupational alcoholism project housed in the counseling department of a health maintenance organization. Multiple-regression techniques were used, with data collected for unionized companies that adopted formal, written employee assistance program (EAP) policies and those that did not. The adoption of an EAP policy seems more important than any other factor in predicting referrals to treatment, In unionized companies without policies, the union-related factors bear no relationship to referrals, while in unionized companies with policies, these variables, particularly the quality of union-management relations, are strong predictors. Supervisory training has only a modest positive effect on referrals. The adoption of an employee assistance policy itself was found to be crucial to program outcome, measured by increased chances of referrals.

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 attention to factors including (a) cost: how much resource will the intervention cost the patient or professional; (b) moral: to what extent will people adhere because they want to be 'good' patients and professionals; (c) social: the expectations of patients and professionals regarding the interactive support they will receive; (d) motivational: motivations to engage with the intervention and (e) cultural: how patients and professionals learn and integrate new skills into their daily routines, practices and cultures.

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

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.

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

Evaluation of vaccine cold chain in urban health centers of municipal corporation of surat city, Western India.

PubMed

Naik, Ashish K; Rupani, Mihir P; Bansal, R K

2013-12-01

The success of immunization depends highly on the level of cold chain maintenance. The aim of the study was to assess the condition of cold chain equipment, practices adopted for cold chain maintenance and knowledge of the vaccinators. It was a cross-sectional study conducted in 20 UHCs of Surat Municipal Corporation (SMC). Cold chain equipment were observed with regards to their condition, along with the practices adopted by vaccinators for cold chain maintenance. A pre-designed and pre-tested questionnaire was used to interview the vaccinators regarding their knowledge and awareness regarding cold chain practices, management and handling. Data were entered and analyzed using Epi Info v 3.5.1. Simple proportions were calculated. Absence of separate stabilizer for deep freezers and ILRs (85%), ill-maintained temperature-record register, lack of criss-cross pattern of ice packs in deep freezer (65%), presence of things other than ice packs in deep freezer (10%) and things other than vaccines in ILR (10%) indicate poor cold chain maintenance. In addition to this, expired vaccines in ILR (5%), vaccines in the "unusable" stages of VVM (15%), lack of emergency contact number nearby in case of cold chain failure (85%), lack of inverter (85%), lack of generator (85%) and failure to note time of reconstitution on the vaccine vial at the time of vaccination (25%) indicate poor cold chain practices. Lack of knowledge of defrosting of ILR and deep freezer (45%), lack of knowledge about Shake test (40%), lack of knowledge of temperature range to be maintained in deep freezer (70%) and in ILR (15%) indicate poor knowledge of vaccinators. Cold chain maintenance and practices need improvement. Knowledge of vaccinators was overall unsatisfactory.

Maintenance fluid therapy and fluid creep impose more significant fluid, sodium, and chloride burdens than resuscitation fluids in critically ill patients: a retrospective study in a tertiary mixed ICU population.

PubMed

Van Regenmortel, Niels; Verbrugghe, Walter; Roelant, Ella; Van den Wyngaert, Tim; Jorens, Philippe G

2018-04-01

Research on intravenous fluid therapy and its side effects, volume, sodium, and chloride overload, has focused almost exclusively on the resuscitation setting. We aimed to quantify all fluid sources in the ICU and assess fluid creep, the hidden and unintentional volume administered as a vehicle for medication or electrolytes. We precisely recorded the volume, sodium, and chloride burdens imposed by every fluid source administered to 14,654 patients during the cumulative 103,098 days they resided in our 45-bed tertiary ICU and simulated the impact of important strategic fluid choices on patients' chloride burdens. In septic patients, we assessed the impact of the different fluid sources on cumulative fluid balance, an established marker of morbidity. Maintenance and replacement fluids accounted for 24.7% of the mean daily total fluid volume, thereby far exceeding resuscitation fluids (6.5%) and were the most important sources of sodium and chloride. Fluid creep represented a striking 32.6% of the mean daily total fluid volume [median 645 mL (IQR 308-1039 mL)]. Chloride levels can be more effectively reduced by adopting a hypotonic maintenance strategy [a daily difference in chloride burden of 30.8 mmol (95% CI 30.5-31.1)] than a balanced resuscitation strategy [daily difference 3.0 mmol (95% CI 2.9-3.1)]. In septic patients, non-resuscitation fluids had a larger absolute impact on cumulative fluid balance than did resuscitation fluids. Inadvertent daily volume, sodium, and chloride loading should be avoided when prescribing maintenance fluids in view of the vast amounts of fluid creep. This is especially important when adopting an isotonic maintenance strategy.

Evaluation of a pilot healthy eating intervention in restaurants and food stores of a rural community: a randomized community trial.

PubMed

Martínez-Donate, Ana P; Riggall, Ann Josie; Meinen, Amy M; Malecki, Kristen; Escaron, Anne L; Hall, Bev; Menzies, Anne; Garske, Gary; Nieto, F Javier; Nitzke, Susan

2015-02-12

Research suggests that the food environment influences individual eating practices. To date, little is known about effective interventions to improve the food environment of restaurants and food stores and promote healthy eating in rural communities. We tested "Waupaca Eating Smart " (WES), a pilot intervention to improve the food environment and promote healthy eating in restaurants and supermarkets of a rural community. WES focused on labeling, promoting, and increasing the availability of healthy foods. We conducted a randomized community trial, with two Midwestern U.S. communities randomly assigned to serve as intervention or control site. We collected process and outcome data using baseline and posttest owner and customer surveys and direct observation methods. The RE-AIM framework was used to guide the evaluation and organize the results. Seven of nine restaurants and two of three food stores invited to participate in WES adopted the intervention. On a 0-4 scale, the average level of satisfaction with WES was 3.14 (SD=0.69) for restaurant managers and 3 (SD=0.0) for store managers. On average, 6.3 (SD=1.1) out of 10 possible intervention activities were implemented in restaurants and 9.0 (SD=0.0) out of 12 possible activities were implemented in food stores. One month after the end of the pilot implementation period, 5.4 (SD=1.6) and 7.5 (SD=0.7) activities were still in place at restaurants and food stores, respectively. The intervention reached 60% of customers in participating food outlets. Restaurant food environment scores improved from 13.4 to 24.1 (p < 0.01) in the intervention community and did not change significantly in the control community. Food environment scores decreased slightly in both communities. No or minimal changes in customer behaviors were observed after a 10-month implementation period. The intervention achieved high levels of reach, adoption, implementation, and maintenance, suggesting the feasibility and acceptability of restaurant-and food store-based interventions in rural communities. Pilot outcome data indicated very modest levels of effectiveness, but additional research adequately powered to test the impact of this intervention on food environment scores and customer behaviors needs to be conducted in order to identify its potential to promote healthy eating in rural community settings.

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.

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.

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).

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.

Web 2.0 chronic disease self-management for older adults: a systematic review.

PubMed

Stellefson, Michael; Chaney, Beth; Barry, Adam E; Chavarria, Enmanuel; Tennant, Bethany; Walsh-Childers, Kim; Sriram, P S; Zagora, Justin

2013-02-14

Participatory Web 2.0 interventions promote collaboration to support chronic disease self-management. Growth in Web 2.0 interventions has led to the emergence of e-patient communication tools that enable older adults to (1) locate and share disease management information and (2) receive interactive healthcare advice. The evolution of older e-patients contributing to Web 2.0 health and medical forums has led to greater opportunities for achieving better chronic disease outcomes. To date, there are no review articles investigating the planning, implementation, and evaluation of Web 2.0 chronic disease self-management interventions for older adults. To review the planning, implementation, and overall effectiveness of Web 2.0 self-management interventions for older adults (mean age ≥ 50) with one or more chronic disease(s). A systematic literature search was conducted using six popular health science databases. The RE-AIM (Reach, Efficacy, Adoption, Implementation and Maintenance) model was used to organize findings and compute a study quality score (SQS) for 15 reviewed articles. Most interventions were adopted for delivery by multidisciplinary healthcare teams and tested among small samples of white females with diabetes. Studies indicated that Web 2.0 participants felt greater self-efficacy for managing their disease(s) and benefitted from communicating with health care providers and/or website moderators to receive feedback and social support. Participants noted asynchronous communication tools (eg, email, discussion boards) and progress tracking features (eg, graphical displays of uploaded personal data) as being particularly useful for self-management support. Despite high attrition being noted as problematic, this review suggests that greater Web 2.0 engagement may be associated with improvements in health behaviors (eg, physical activity) and health status (eg, HRQoL). However, few studies indicated statistically significant improvements in medication adherence, biological outcomes, or health care utilization. Mean SQS scores were notably low (mean=63%, SD 18%). Studies were judged to be weakest on the Maintenance dimension of RE-AIM; 13 reviewed studies (87%) did not describe any measures taken to sustain Web 2.0 effects past designated study time periods. Detailed process and impact evaluation frameworks were also missing in almost half (n=7) of the reviewed interventions. There is need for a greater understanding of the costs and benefits associated with using patient-centered Web 2.0 technologies for chronic disease self-management. More research is needed to determine whether the long-term effectiveness of these programs is sustainable among larger, more diverse samples of chronically ill patients. The effective translation of new knowledge, social technologies, and engagement techniques will likely result in novel approaches for empowering, engaging, and educating older adults with chronic disease.

Web 2.0 Chronic Disease Self-Management for Older Adults: A Systematic Review

PubMed Central

Chaney, Beth; Barry, Adam E; Chavarria, Enmanuel; Tennant, Bethany; Walsh-Childers, Kim; Sriram, P.S; Zagora, Justin

2013-01-01

Background Participatory Web 2.0 interventions promote collaboration to support chronic disease self-management. Growth in Web 2.0 interventions has led to the emergence of e-patient communication tools that enable older adults to (1) locate and share disease management information and (2) receive interactive healthcare advice. The evolution of older e-patients contributing to Web 2.0 health and medical forums has led to greater opportunities for achieving better chronic disease outcomes. To date, there are no review articles investigating the planning, implementation, and evaluation of Web 2.0 chronic disease self-management interventions for older adults. Objective To review the planning, implementation, and overall effectiveness of Web 2.0 self-management interventions for older adults (mean age ≥ 50) with one or more chronic disease(s). Methods A systematic literature search was conducted using six popular health science databases. The RE-AIM (Reach, Efficacy, Adoption, Implementation and Maintenance) model was used to organize findings and compute a study quality score (SQS) for 15 reviewed articles. Results Most interventions were adopted for delivery by multidisciplinary healthcare teams and tested among small samples of white females with diabetes. Studies indicated that Web 2.0 participants felt greater self-efficacy for managing their disease(s) and benefitted from communicating with health care providers and/or website moderators to receive feedback and social support. Participants noted asynchronous communication tools (eg, email, discussion boards) and progress tracking features (eg, graphical displays of uploaded personal data) as being particularly useful for self-management support. Despite high attrition being noted as problematic, this review suggests that greater Web 2.0 engagement may be associated with improvements in health behaviors (eg, physical activity) and health status (eg, HRQoL). However, few studies indicated statistically significant improvements in medication adherence, biological outcomes, or health care utilization. Mean SQS scores were notably low (mean=63%, SD 18%). Studies were judged to be weakest on the Maintenance dimension of RE-AIM; 13 reviewed studies (87%) did not describe any measures taken to sustain Web 2.0 effects past designated study time periods. Detailed process and impact evaluation frameworks were also missing in almost half (n=7) of the reviewed interventions. Conclusions There is need for a greater understanding of the costs and benefits associated with using patient-centered Web 2.0 technologies for chronic disease self-management. More research is needed to determine whether the long-term effectiveness of these programs is sustainable among larger, more diverse samples of chronically ill patients. The effective translation of new knowledge, social technologies, and engagement techniques will likely result in novel approaches for empowering, engaging, and educating older adults with chronic disease. PMID:23410671

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. ...

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. ...

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. ...

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. ...

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. ...

Implementation and dissemination of a transition of care program for rural veterans: a controlled before and after study.

PubMed

Leonard, Chelsea; Lawrence, Emily; McCreight, Marina; Lippmann, Brandi; Kelley, Lynette; Mayberry, Ashlea; Ladebue, Amy; Gilmartin, Heather; Côté, Murray J; Jones, Jacqueline; Rabin, Borsika A; Ho, P Michael; Burke, Robert

2017-10-23

Adapting promising health care interventions to local settings is a critical component in the dissemination and implementation process. The Veterans Health Administration (VHA) rural transitions nurse program (TNP) is a nurse-led, Veteran-centered intervention designed to improve transitional care for rural Veterans funded by VA national offices for dissemination to other VA sites serving a predominantly rural Veteran population. Here, we describe our novel approach to the implementation and evaluation = the TNP. This is a controlled before and after study that assesses both implementation and intervention outcomes. During pre-implementation, we assessed site context using a mixed method approach with data from diverse sources including facility-level quantitative data, key informant and Veteran interviews, observations of the discharge process, and a group brainstorming activity. We used the Practical Robust Implementation and Sustainability Model (PRISM) to inform our inquiries, to integrate data from all sources, and to identify factors that may affect implementation. In the implementation phase, we will use internal and external facilitation, paired with audit and feedback, to encourage appropriate contextual adaptations. We will use a modified Stirman framework to document adaptations. During the evaluation phase, we will measure intervention and implementation outcomes at each site using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). We will conduct a difference-in-differences analysis with propensity-matched Veterans and VA facilities as a control. Our primary intervention outcome is 30-day readmission and Emergency Department visit rates. We will use our findings to develop an implementation toolkit that will inform the larger scale-up of the TNP across the VA. The use of PRISM to inform pre-implementation evaluation and synthesize data from multiple sources, coupled with internal and external facilitation, is a novel approach to engaging sites in adapting interventions while promoting fidelity to the intervention. Our application of PRISM to pre-implementation and midline evaluation, as well as documentation of adaptations, provides an opportunity to identify and address contextual factors that may impede or enhance implementation and sustainability of health interventions and inform dissemination.

Legal Background of Aviation Medicine in Europe and its future development

PubMed Central

Siedenburg, J

2008-01-01

European aviation is moving into an exciting phase now, the administrative structure is changing. Aviation rules and aviation medicine will get a new structure as well. The nature of air traffic required an international scope in rulemaking – especially in such a confined continent as Europe with 41 countries, about 380 Million inhabitants and 317 billion person kilometres flown each year. For economic reasons it became necessary to develop common standards for certification of aircraft in the beginning of the 1970ies, maintenance followed later on. The Cyprus arrangement of 01 July 1990 created the JAA (Joint Aviation Authorities). Joint Aviation Requirements were drafted to replace existing national provisions and have been implemented from the end of the 1990ies. The areas of air operations and pilot licensing have been covered as well. The latter comprises of aviation medicine as well. The implementation of JAR-FCL 3, which covers the medical requirements for pilots, started from 1999 on in the several JAA member states. A detailed overview about development and structure of JAA, tools for harmonisation, rulemaking and amendment of requirements, medical standards, review procedures for contentious or marginal cases is described. Shortcomings were the fact that implementation was left to the discretion of the member states and that JAA had no executive power. This resulted in differences in safety and the EU commission concluded that aviation safety had to be regulated by the EU commission. After adoption of EU regulation 1592/2002 in 2002 common and binding requirements were to be drafted and a European aviation agency to be founded. EASA (European Aviation Safety Agency) started its work in September 2003. Finally it will take over the role of JAA completely. Whereas Certification and Maintenance were in the focus first, Flight Operations and Licensing are going to be covered as well in the near future. Essential Requirements have been drafted, outlining – inter alia – the scope of Licensing and of aeromedical aspects. However, the legislative process will most probably last at least until the end of 2007. Implementing Rules - being based on existing JAR-FCLs will be drafted soon and are going to be implemented as soon as EASA is operative for Licensing. JAR-FCL 3 will be the basis for the Implementing Rules concerning aeromedical fitness. An overview about the structure of the Agency, rulemaking procedures, philosophy of medical provisions and the transition from JAA to EASA is described. PMID:19048095

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.

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

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.

School Principals' Decision-Making Behaviour in the Management of Innovation.

ERIC Educational Resources Information Center

McGeown, Vincent

1979-01-01

A rating scale operationalized a model for the adoption and implementation of educational innovation. Phases were designated: creating a climate for change; analyzing antecedent conditions; generating alternatives; initiating change adoption; implementing change; and evaluating change outcomes. Principals' decision-making behavior was the best…

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.

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.

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.

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.

Iyengar Yoga for Motherhood: Teaching Transformation in a Nonformal Learning Environment

ERIC Educational Resources Information Center

Tate, Amy

2016-01-01

This chapter looks at ways in which pregnant women adopt the practices of Iyengar yoga, its value as a mode of transformative learning within a nonformal learning space, and the culture of body maintenance that drives practitioners.

24 CFR 5.609 - Annual income.

Code of Federal Regulations, 2013 CFR

2013-04-01

... reimbursement of out-of-pocket expenses incurred (special equipment, clothing, transportation, child care, etc..., hall monitoring, lawn maintenance, resident initiatives coordination, and serving as a member of the... excess of $480 per adopted child; (13) [Reserved] (14) Deferred periodic amounts from supplemental...

24 CFR 5.609 - Annual income.

Code of Federal Regulations, 2014 CFR

2014-04-01

... reimbursement of out-of-pocket expenses incurred (special equipment, clothing, transportation, child care, etc..., hall monitoring, lawn maintenance, resident initiatives coordination, and serving as a member of the... excess of $480 per adopted child; (13) [Reserved] (14) Deferred periodic amounts from supplemental...

24 CFR 5.609 - Annual income.

Code of Federal Regulations, 2012 CFR

2012-04-01

... reimbursement of out-of-pocket expenses incurred (special equipment, clothing, transportation, child care, etc..., hall monitoring, lawn maintenance, resident initiatives coordination, and serving as a member of the... excess of $480 per adopted child; (13) [Reserved] (14) Deferred periodic amounts from supplemental...

45 CFR 1355.30 - Other applicable regulations.

Code of Federal Regulations, 2013 CFR

2013-10-01

....30 Public Welfare Regulations Relating to Public Welfare (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 FAMILY SERVICES GENERAL § 1355.30...

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.

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.

Synthesizing Marketing, Community Engagement, and Systems Science Approaches for Advancing Translational Research

PubMed Central

Kneipp, Shawn M.; Leeman, Jennifer; McCall, Pamela; Hassmiller-Lich, Kristen; Bobashev, Georgiy; Schwartz, Todd A.; Gilmore, Robert; Riggan, Scott

2016-01-01

The adoption and implementation of evidence-based interventions (EBIs) are end goals of translational research, however, potential end-users’ perceptions of an EBI’s value have contributed to low rates of adoption. In this article, we describe our application of emerging dissemination and implementation science theoretical perspectives, community engagement, and systems science principles to develop a novel EBI dissemination approach. Using consumer-driven, graphics-rich simulation, the approach demonstrates predicted implementation effects on health and employment outcomes for socioeconomically disadvantaged women at the local level, and is designed to increase adoption interest of county program managers accountable for improving these outcomes in their communities. PMID:26244479

Synthesizing Marketing, Community Engagement, and Systems Science Approaches for Advancing Translational Research.

PubMed

Kneipp, Shawn M; Leeman, Jennifer; McCall, Pamela; Hassmiller-Lich, Kristen; Bobashev, Georgiy; Schwartz, Todd A; Gilmore, Robert; Riggan, Scott; Gil, Benjamin

2015-01-01

The adoption and implementation of evidence-based interventions (EBIs) are the goals of translational research; however, potential end-users' perceptions of an EBI value have contributed to low rates of adoption. In this article, we describe our application of emerging dissemination and implementation science theoretical perspectives, community engagement, and systems science principles to develop a novel EBI dissemination approach. Using consumer-driven, graphics-rich simulation, the approach demonstrates predicted implementation effects on health and employment outcomes for socioeconomically disadvantaged women at the local level and is designed to increase adoption interest of county program managers accountable for improving these outcomes in their communities.

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.

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.

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...

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...

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...

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...

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...

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...

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...

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...

Filling the healthcare IT gap by 2015.

PubMed

Bigalke, John T

2009-06-01

Healthcare organizations have been slow to adopt health IT. However, the government stimulus package and impending fines for hospitals that have not implemented HIT by 2015 will motivate adoption. Issues confronting healthcare executives include selection of vendors, command of privacy and security issues, and implementation of industry standards.

78 FR 46861 - Approval and Promulgation of Air Quality Implementation Plans; State of Colorado; Second Ten-Year...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-02

...) section 175A(b) second 10-year maintenance plan for the Greeley area for the carbon monoxide (CO) National Ambient Air Quality Standard (NAAQS). This limited maintenance plan (LMP) addresses maintenance of the CO..., Mailcode 8P-AR, 1595 Wynkoop Street, Denver, Colorado 80202-1129. Hand Delivery: Carl Daly, Director, Air...

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.

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

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

Staff training and outreach support for Cognitive Stimulation Therapy and its implementation in practice: a cluster randomised trial.

PubMed

Streater, Amy; Spector, Aimee; Hoare, Zoe; Aguirre, Elisa; Russell, Ian; Orrell, Martin

2017-12-01

There is evidence that Cognitive Stimulation Therapy and maintenance Cognitive Stimulation Therapy are effective in mild to moderate dementia. There is, however, little evidence available for its implementation in practice and the impact of outreach support on the sustainability of the programme. Two hundred and forty-one staff members were randomised from 63 dementia care settings between outreach support including an online forum, email, and telephone support, compared to usual Cognitive Stimulation Therapy control group. The primary outcome was average number of attendees to the Cognitive Stimulation Therapy and maintenance Cognitive Stimulation Therapy programmes. There was no difference in average number of attendees between the intervention and usual Cognitive Stimulation Therapy control groups for the Cognitive Stimulation Therapy (p = 0.82) or the maintenance Cognitive Stimulation Therapy programme (p = 0.97). Outreach support does not affect the average number of people with dementia attending the Cognitive Stimulation Therapy or maintenance Cognitive Stimulation Therapy programme. Irrespective of outreach support, the programmes remain widely implemented and yield perceived benefits for people with dementia. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Neutron Source Facility Training Simulator Based on EPICS

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

Park, Young Soo; Wei, Thomas Y.; Vilim, Richard B.

A plant operator training simulator is developed for training the plant operators as well as for design verification of plant control system (PCS) and plant protection system (PPS) for the Kharkov Institute of Physics and Technology Neutron Source Facility. The simulator provides the operator interface for the whole plant including the sub-critical assembly coolant loop, target coolant loop, secondary coolant loop, and other facility systems. The operator interface is implemented based on Experimental Physics and Industrial Control System (EPICS), which is a comprehensive software development platform for distributed control systems. Since its development at Argonne National Laboratory, it has beenmore » widely adopted in the experimental physics community, e.g. for control of accelerator facilities. This work is the first implementation for a nuclear facility. The main parts of the operator interface are the plant control panel and plant protection panel. The development involved implementation of process variable database, sequence logic, and graphical user interface (GUI) for the PCS and PPS utilizing EPICS and related software tools, e.g. sequencer for sequence logic, and control system studio (CSS-BOY) for graphical use interface. For functional verification of the PCS and PPS, a plant model is interfaced, which is a physics-based model of the facility coolant loops implemented as a numerical computer code. The training simulator is tested and demonstrated its effectiveness in various plant operation sequences, e.g. start-up, shut-down, maintenance, and refueling. It was also tested for verification of the plant protection system under various trip conditions.« less

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...

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...

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...

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...

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…

Implementations of the HL7 Context-Aware Knowledge Retrieval (“Infobutton”) Standard: Challenges, Strengths, Limitations, and Uptake

PubMed Central

Del Fiol, Guilherme; Huser, Vojtech; Strasberg, Howard R; Maviglia, Saverio M; Curtis, Clayton; Cimino, James J

2012-01-01

To support clinical decision-making,computerized information retrieval tools known as “infobuttons” deliver contextually-relevant knowledge resources intoclinical information systems.The Health Level Seven International(HL7)Context-Aware Knowledge Retrieval (Infobutton) Standard specifies a standard mechanism to enable infobuttons on a large scale. Objective To examine the experience of organizations in the course of implementing the HL7 Infobutton Standard. Method Cross-sectionalonline survey and in-depth phone interviews. Results A total of 17 organizations participated in the study.Analysis of the in-depth interviews revealed 20 recurrent themes.Implementers underscored the benefits, simplicity, and flexibility of the HL7 Infobutton Standard. Yet, participants voiced the need for easier access to standard specifications and improved guidance to beginners. Implementers predicted that the Infobutton Standard will be widely or at least fairly well adopted in the next five years, but uptake will dependlargely on adoption among electronic health record (EHR) vendors. To accelerate EHR adoption of the Infobutton Standard,implementers recommended HL7-compliant infobutton capabilities to be included in the United States Meaningful Use Certification Criteria EHR systems. Limitations Opinions and predictions should be interpreted with caution, since all the participant organizations have successfully implemented the Standard and overhalf of the organizations were actively engaged in the development of the Standard. Conclusion Overall, implementers reported a very positive experience with the HL7 Infobutton Standard.Despite indications of increasing uptake, measures should be taken to stimulate adoption of the Infobutton Standard among EHR vendors. Widespread adoption of the Infobutton standard has the potential to bring contextually relevant clinical decision support content into the healthcare provider workflow. PMID:22226933

25 CFR 502.22 - Construction and maintenance of the gaming facility, and the operation of that gaming is...

Code of Federal Regulations, 2012 CFR

2012-04-01

... protect the environment and the public health and safety, including standards under a tribal-state compact... health and safety standards adopted by the tribe in light of climate, geography, and other local...

78 FR 23105 - Airworthiness Directives; Airbus Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-18

... Directives; Airbus Airplanes AGENCY: Federal Aviation Administration (FAA), Department of Transportation (DOT). ACTION: Final rule. SUMMARY: We are adopting a new airworthiness directive (AD) for certain Airbus Model... Agency] has received a report via Airbus and Messier-Bugatti-Dowty Ltd, from a Maintenance repair...