Sample records for identify needed improvements

  1. Child Support; Need to Improve Efforts to Identify Fathers and Obtain Support Orders.

    DTIC Science & Technology

    1987-04-01

    34 Reduces the stigma of illegitimacy and helps give the child a sense of identity. • Increases the child’s opportunity to develop a close parental...A179 979 CHILD SUPPORT; NEED TO IMPROVE EFFORTS TO IDENTIFY 1/1 FATHERS AND OBTAIN SUPPORT ORDERS(U) GENERAL ACCOUNTING OFFICE WASHINGTON DC HUNAN...April 30, 1987 The Honorable Otis R. Bowen, M.D. The Secretary of Health and Human Services Dear Mr. Secretary: This report discusses child support

  2. Hospital-based perinatal nurses identify the need to improve nursing care of adolescent mothers.

    PubMed

    Peterson, Wendy E; Davies, Barbara; Rashotte, Judy; Salvador, Anne; Trépanier, Marie-Josée

    2012-01-01

    To determine whether hospital-based perinatal nurses with expertise in adolescent mother-friendly care identify a need to improve inpatient nursing care of adolescent mothers and how well perinatal units support nurses' capacity to provide adolescent mother-friendly care. A key informant survey of nurses from eight perinatal units at three hospitals (four separate sites) in a Canadian city. Perinatal nurses expert in the care of adolescent mothers were identified by their managers and colleagues. These nurses and all perinatal clinical educators were invited to participate. Twenty-seven of 34 potential key informants completed the survey. Key informants rated their own skill in caring for adolescent mothers higher (median 8.0) than they rated the skill of other nurses (median 6.0) on their units. They attributed their expertise working with adolescent mothers to their clinical and life experiences and their ability to develop rapport with adolescents. A common reason for the assigned lower peer-group ratings was the judgmental manner in which some nurses care for adolescent mothers. Key informants also identified that hospital-based perinatal nurses lack adequate knowledge of community-based resources for adolescent mothers, educational programs related to adolescent mother-friendly care were insufficient, and policies to inform the nursing care of adolescent mothers were not available or known to them. A minority of perinatal nurses have expertise in adolescent mother-friendly care. There is a need for perinatal unit-level interventions to support the development of nurses' skills in caring for adolescent mothers and their knowledge of community-based resources. Peer mentoring and self-reflective practice are promising strategies. © 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  3. Using Geographical Information Systems to Identify Populations in Need of Improved Accessibility to Antivenom Treatment for Snakebite Envenoming in Costa Rica

    PubMed Central

    Hansson, Erik; Sasa, Mahmood; Mattisson, Kristoffer; Robles, Arodys; Gutiérrez, José María

    2013-01-01

    Introduction Snakebite accidents are an important health problem in rural areas of tropical countries worldwide, including Costa Rica, where most bites are caused by the pit-viper Bothrops asper. The treatment of these potentially fatal accidents is based on the timely administration of specific antivenom. In many regions of the world, insufficient health care systems and lack of antivenom in remote and poor areas where snakebites are common, means that efficient treatment is unavailable for many snakebite victims, leading to unnecessary mortality and morbidity. In this study, geographical information systems (GIS) were used to identify populations in Costa Rica with a need of improved access to antivenom treatment: those living in areas with a high risk of snakebites and long time to reach antivenom treatment. Method/Principal Findings Populations living in areas with high risk of snakebites were identified using two approaches: one based on the district-level reported incidence, and another based on mapping environmental factors favoring B. asper presence. Time to reach treatment using ambulance was estimated using cost surface analysis, thereby enabling adjustment of transportation speed by road availability and quality, topography and land use. By mapping populations in high risk of snakebites and the estimated time to treatment, populations with need of improved treatment access were identified. Conclusion/Significance This study demonstrates the usefulness of GIS for improving treatment of snakebites. By mapping reported incidence, risk factors, location of existing treatment resources, and the time estimated to reach these for at-risk populations, rational allocation of treatment resources is facilitated. PMID:23383352

  4. Using geographical information systems to identify populations in need of improved accessibility to antivenom treatment for snakebite envenoming in Costa Rica.

    PubMed

    Hansson, Erik; Sasa, Mahmood; Mattisson, Kristoffer; Robles, Arodys; Gutiérrez, José María

    2013-01-01

    Snakebite accidents are an important health problem in rural areas of tropical countries worldwide, including Costa Rica, where most bites are caused by the pit-viper Bothrops asper. The treatment of these potentially fatal accidents is based on the timely administration of specific antivenom. In many regions of the world, insufficient health care systems and lack of antivenom in remote and poor areas where snakebites are common, means that efficient treatment is unavailable for many snakebite victims, leading to unnecessary mortality and morbidity. In this study, geographical information systems (GIS) were used to identify populations in Costa Rica with a need of improved access to antivenom treatment: those living in areas with a high risk of snakebites and long time to reach antivenom treatment. Populations living in areas with high risk of snakebites were identified using two approaches: one based on the district-level reported incidence, and another based on mapping environmental factors favoring B. asper presence. Time to reach treatment using ambulance was estimated using cost surface analysis, thereby enabling adjustment of transportation speed by road availability and quality, topography and land use. By mapping populations in high risk of snakebites and the estimated time to treatment, populations with need of improved treatment access were identified. This study demonstrates the usefulness of GIS for improving treatment of snakebites. By mapping reported incidence, risk factors, location of existing treatment resources, and the time estimated to reach these for at-risk populations, rational allocation of treatment resources is facilitated.

  5. Community Engagement for Identifying Cancer Education Needs in Puerto Rico.

    PubMed

    Jiménez, Julio; Ramos, Axel; Ramos-Rivera, Francisco E; Gwede, Clement; Quinn, Gwendolyn P; Vadaparampil, Susan; Brandon, Thomas; Simmons, Vani; Castro, Eida

    2018-02-01

    Cancer is the leading cause of death in Puerto Rico, suggesting a need for improved strategies, programs, and resources devoted to cancer prevention. Enhanced prevention needs in Puerto Rico were initially identified in pilot studies conducted by the Ponce School of Medicine (PSM) in collaboration with the H. Lee Moffitt Cancer Center (MCC). In the current study, we used community engagement to identify specific needs in cancer prevention and education and strategies to create culturally attuned, effective cancer prevention education programs. A total of 37 participants attended a community forum and were assigned to one of three discussion groups: patients/survivors (n = 14); family/caregivers (n = 11); or healthcare providers (n = 12). Most participants were women (73 %), over 35 years of age, and a majority were married (58 %) and had a university education (81 %). The sessions were recorded and transcribed and analyzed for key themes. Participants wanted improved awareness of cancer prevention in Puerto Rico and believed cancer prevention education should start early, ideally in elementary school. Participants also stressed the importance of creating partnerships with private and government agencies to coordinate educational efforts. Suggested strategies included outreach to communities with limited resources, incorporating the testimony of cancer survivors, and utilizing social media to disseminate cancer prevention information.

  6. 25 CFR 170.149 - How do tribes identify transit needs?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 25 Indians 1 2012-04-01 2011-04-01 true How do tribes identify transit needs? 170.149 Section 170.149 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER INDIAN RESERVATION... do tribes identify transit needs? Tribes identify transit needs during the tribal transportation...

  7. 25 CFR 170.149 - How do tribes identify transit needs?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 25 Indians 1 2013-04-01 2013-04-01 false How do tribes identify transit needs? 170.149 Section 170.149 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER INDIAN RESERVATION... do tribes identify transit needs? Tribes identify transit needs during the tribal transportation...

  8. 25 CFR 170.149 - How do tribes identify transit needs?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 25 Indians 1 2014-04-01 2014-04-01 false How do tribes identify transit needs? 170.149 Section 170.149 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER INDIAN RESERVATION... do tribes identify transit needs? Tribes identify transit needs during the tribal transportation...

  9. 25 CFR 170.149 - How do tribes identify transit needs?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false How do tribes identify transit needs? 170.149 Section 170.149 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER INDIAN RESERVATION... do tribes identify transit needs? Tribes identify transit needs during the tribal transportation...

  10. 25 CFR 170.149 - How do tribes identify transit needs?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 1 2011-04-01 2011-04-01 false How do tribes identify transit needs? 170.149 Section 170.149 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER INDIAN RESERVATION... do tribes identify transit needs? Tribes identify transit needs during the tribal transportation...

  11. Identifying and addressing the support needs of family caregivers of people with motor neurone disease using the Carer Support Needs Assessment Tool.

    PubMed

    Aoun, Samar M; Deas, Kathleen; Kristjanson, Linda J; Kissane, David W

    2017-02-01

    Family caregivers of people with motor neurone disease (MND) experience adverse health outcomes as a result of their caregiving experience. This may be alleviated if their support needs are identified and addressed in a systematic and timely manner. The objective of the present study was to assess the feasibility and relevance of the Carer Support Needs Assessment Tool (CSNAT) in home-based care during the period of caregiving from the perspectives of the family caregivers of people with MND and their service providers. The study was conducted during 2014 in Western Australia. Some 30 family caregivers and 4 care advisors participated in trialing the CSNAT intervention, which involved two visits from care advisors (6-8 weeks apart) to identify and address support needs. The feedback from family caregivers was obtained via telephone interviews and that of care advisors via a self-administered questionnaire. A total of 24 caregivers completed the study (80% completion rate) and identified the highest support priorities as "knowing what to expect in the future," "knowing who to contact if concerned," and "equipment to help care." The majority found that this assessment process adequately addressed their needs and gave them a sense of validation, reassurance, and empowerment. Care advisors advocated the CSNAT approach as an improvement over standard practice, allowing them to more clearly assess needs, to offer a more structured follow-up, and to focus on the caregiver and family. The CSNAT approach for identifying and addressing family caregivers' support needs was found to be relevant and feasible by MND family caregivers and care advisors. The tool provided a formal structure to facilitate discussions with family caregivers and thus enable needs to be addressed. Such discussions can also inform an evidence base for the ongoing development of services, ensuring that new and improved services are designed to meet the explicit needs of the family caregivers of people

  12. Defense Civil Support: DOD Needs to Identify National Guards Cyber Capabilities and Address Challenges in Its Exercises

    DTIC Science & Technology

    2016-09-01

    Congress. Consequently, as prepared now, this report does not help DOD leaders identify assets that could be used in a cyber crisis scenario...Guidance. GAO-13-128. Washington, D.C.: October 24, 2012. Defense Cyber Efforts: Management Improvements Needed to Enhance Programs Protecting the...DEFENSE CIVIL SUPPORT DOD Needs to Identify National Guard’s Cyber Capabilities and Address Challenges in Its

  13. Toward a patient-centered ambulatory after-visit summary: Identifying primary care patients' information needs.

    PubMed

    Clarke, Martina A; Moore, Joi L; Steege, Linsey M; Koopman, Richelle J; Belden, Jeffery L; Canfield, Shannon M; Kim, Min S

    2018-09-01

    The purpose of this study was to determine the information needs of primary care patients as they review clinic visit notes to inform information that should be contained in an after-visit summary (AVS). We collected data from 15 patients with an acute illness and 14 patients with a chronic disease using semi-structured interviews. The acute patients reviewed seven major sections, and chronic patients reviewed eight major sections of a simulated, but realistic visit note to identify relevant information needs for their AVS. Patients in the acute illness group identified the Plan, Assessment and History of Present Illness the most as important note sections, while patients in the chronic care group identified Significant Lab Data, Plan, and Assessment the most as important note sections. This study was able to identify primary care patients' information needs after clinic visit. Primary care patients have information needs pertaining to diagnosis and treatment, which may be the reason why both patient groups identified Plan and Assessment as important note sections. Future research should also develop and assess an AVS based on the information gathered in this study and evaluate its usefulness among primary care patients. The results of this study can be used to inform the development of an after-visit summary that assists patients to fully understand their treatment plan, which may improve treatment adherence.

  14. Biodiversity and Climate Modeling Workshop Series: Identifying gaps and needs for improving large-scale biodiversity models

    NASA Astrophysics Data System (ADS)

    Weiskopf, S. R.; Myers, B.; Beard, T. D.; Jackson, S. T.; Tittensor, D.; Harfoot, M.; Senay, G. B.

    2017-12-01

    At the global scale, well-accepted global circulation models and agreed-upon scenarios for future climate from the Intergovernmental Panel on Climate Change (IPCC) are available. In contrast, biodiversity modeling at the global scale lacks analogous tools. While there is great interest in development of similar bodies and efforts for international monitoring and modelling of biodiversity at the global scale, equivalent modelling tools are in their infancy. This lack of global biodiversity models compared to the extensive array of general circulation models provides a unique opportunity to bring together climate, ecosystem, and biodiversity modeling experts to promote development of integrated approaches in modeling global biodiversity. Improved models are needed to understand how we are progressing towards the Aichi Biodiversity Targets, many of which are not on track to meet the 2020 goal, threatening global biodiversity conservation, monitoring, and sustainable use. We brought together biodiversity, climate, and remote sensing experts to try to 1) identify lessons learned from the climate community that can be used to improve global biodiversity models; 2) explore how NASA and other remote sensing products could be better integrated into global biodiversity models and 3) advance global biodiversity modeling, prediction, and forecasting to inform the Aichi Biodiversity Targets, the 2030 Sustainable Development Goals, and the Intergovernmental Platform on Biodiversity and Ecosystem Services Global Assessment of Biodiversity and Ecosystem Services. The 1st In-Person meeting focused on determining a roadmap for effective assessment of biodiversity model projections and forecasts by 2030 while integrating and assimilating remote sensing data and applying lessons learned, when appropriate, from climate modeling. Here, we present the outcomes and lessons learned from our first E-discussion and in-person meeting and discuss the next steps for future meetings.

  15. Army Needs to Identify Government Purchase Card High-Risk Transactions

    DTIC Science & Technology

    2012-01-20

    Purchase Card Program Data Mining Process Needs Improvement 11...Mining Process Needs Improvement The 17 transactions that were noncompliant occurred because cardholders ignored the GPC business rules so the...Scope and Methodology 16 Use of Computer- Processed Data 16 Use of Technical Assistance 17 Prior Coverage

  16. Identifying Key Early Literacy and School Readiness Issues: Exploring a Strategy for Assessing Community Needs

    ERIC Educational Resources Information Center

    Weigel, Daniel J.; Martin, Sally S.

    2006-01-01

    Much effort has been expended in developing intervention programs to help improve the early literacy and school readiness skills of young children. This article presents the results of a needs assessment project aimed at identifying priorities for community intervention programs aimed at ensuring that young children enter school ready to learn. A…

  17. Identifying Home Care Clinicians’ Information Needs for Managing Fall Risks

    PubMed Central

    Alhuwail, Dari

    2016-01-01

    Summary Objectives To help manage the risk of falls in home care, this study aimed to (i) identify home care clinicians’ information needs and how they manage missing or inaccurate data, (ii) identify problems that impact effectiveness and efficiency associated with retaining, exchanging, or processing information about fall risks in existing workflows and currently adopted health information technology (IT) solutions, and (iii) offer informatics-based recommendations to improve fall risk management interventions. Methods A case study was carried out in a single not-for-profit suburban Medicare-certified home health agency with three branches. Qualitative data were collected over a six month period through observations, semi-structured interviews, and focus groups. The Framework method was used for analysis. Maximum variation sampling was adopted to recruit a diverse sample of clinicians. Results Overall, the information needs for fall risk management were categorized into physiological, care delivery, educational, social, environmental, and administrative domains. Examples include a brief fall-related patient history, weight-bearing status, medications that affect balance, availability of caregivers at home, and the influence of patients’ cultures on fall management interventions. The unavailability and inaccuracy of critical information related to fall risks can delay necessary therapeutic services aimed at reducing patients’ risk for falling and thereby jeopardizing their safety. Currently adopted IT solutions did not adequately accommodate data related to fall risk management. Conclusion The results highlight the essential information for fall risk management in home care. Home care workflows and health IT solutions must effectively and efficiently retain, exchange, and process information necessary for fall risk management. Interoperability and integration of the various health IT solutions to make data sharing accessible to all clinicians is critical

  18. Unmet health needs identified by Haitian women as priorities for attention: a qualitative study.

    PubMed

    Peragallo Urrutia, Rachel; Merisier, Delson; Small, Maria; Urrutia, Eugene; Tinfo, Nicole; Walmer, David K

    2012-06-01

    This 2009 qualitative study investigated Haitian women's most pressing health needs, barriers to meeting those needs and proposed solutions, and how they thought the community and outside organizations should be involved in addressing their needs. The impetus for the study was to get community input into the development of a Family Health Centre in Leogane, Haiti. Individual interviews and focus group discussions were conducted with 52 adult women in six communities surrounding Leogane. The most pressing health needs named by the women were accessible, available and affordable health care, potable water, enough food to eat, improved economy, employment, sanitation and education, including health education. Institutional corruption, lack of infrastructure and social organization, the cost of health care, distance from services and lack of transport as barriers to care were also important themes. The involvement of foreign organizations and local community groups, including grassroots women's groups who would work in the best interests of other women, were identified as the most effective solutions. Organizations seeking to improve women's health care in Haiti should develop services and interventions that prioritize community partnership and leadership, foster partnerships with government, and focus on public health needs. Copyright © 2012 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  19. Identifying needs and barriers to diabetes education in patients with diabetes.

    PubMed

    Rafique, Ghazala; Shaikh, Furqan

    2006-08-01

    To assess the needs, awareness and barriers to diabetes education for self management and to facilitate the initiation of an education programme promoting self care among diabetics and their families. A qualitative study was conducted among adult diabetics attending outpatient clinics in a tertiary care teaching hospital in Karachi, Pakistan. Semi-structured interviews were conducted on 27 subjects (11 men; 16 women) to identify dominant themes and priority issues. Participants displayed great deal of variation with respect to level of knowledge and motivation for education. Most believed that diabetes was caused by stress. Family was perceived to be a source of positive support. Relative ease of adherence to pharmacological regimens as compared to diet and exercise was reported. Participants expressed frustration at chronicity of disease and fear of developing certain specific complications and inheritance by their children. Barriers to enhancing knowledge included 'No need for further information', distance from training institutions and other priorities. Knowledge, beliefs and fears about diabetes, family influence and accessibility of healthcare, affects management behaviours and learning. Understanding needs and expectations of people with diabetes is essential in initiating and improving the outcomes of education programme for diabetes self care.

  20. Job Performance: Improvement Needed

    ERIC Educational Resources Information Center

    Goodman, Jacob

    1974-01-01

    Personnel directors of 38 business firms responded to a questionnaire rating 24 employee traits related to competencies, attitudes, skills, and personality which needed improvement. Five traits were common among the rank order one to five to both retailer and commercial and service organization respondents: oral communication, initiative,…

  1. Improved Newborn Hearing Screening Follow-up Results in More Infants Identified

    PubMed Central

    Alam, Suhana; Gaffney, Marcus; Eichwald, John

    2015-01-01

    Longitudinal research suggests that efforts at the national, state, and local levels are leading to improved follow-up and data reporting. Data now support the assumption that the number of deaf or hard-of-hearing infants identified through newborn hearing screening increases with a reduction in the number of infants lost to follow-up. Documenting the receipt of services has made a noticeable impact on reducing lost to follow-up rates and early identification of infants with hearing loss; however, continued improvement and monitoring of services are still needed. PMID:23803975

  2. Improved newborn hearing screening follow-up results in more infants identified.

    PubMed

    Alam, Suhana; Gaffney, Marcus; Eichwald, John

    2014-01-01

    Longitudinal research suggests that efforts at the national, state, and local levels are leading to improved follow-up and data reporting. Data now support the assumption that the number of deaf or hard-of-hearing infants identified through newborn hearing screening increases with a reduction in the number of infants lost to follow-up. Documenting the receipt of services has made a noticeable impact on reducing lost to follow-up rates and early identification of infants with hearing loss; however, continued improvement and monitoring of services are still needed.

  3. Getting what they need when they need it. Identifying barriers to information needs of family caregivers to manage dementia-related behavioral symptoms.

    PubMed

    Werner, Nicole E; Stanislawski, Barbara; Marx, Katherine A; Watkins, Daphne C; Kobayashi, Marissa; Kales, Helen; Gitlin, Laura N

    2017-02-22

    Consumer health informatics (CHI) such as web-based applications may provide the platform for enabling the over 15 million family caregivers of patients with Alzheimer's Disease or related dementias the information they need when they need it to support behavioral symptom management. However, for CHI to be successful, it is necessary that it be designed to meet the specific information needs of family caregivers in the context in which caregiving occurs. A sociotechnical systems approach to CHI design can help to understand the contextual complexities of family caregiving and account for those complexities in the design of CHI for family caregivers. This study used a sociotechnical systems approach to identify barriers to meeting caregivers' information needs related to the management of dementia-related behavioral symptoms, and to derive design implications that overcome barriers for caregiver-focused web-based platforms. We have subsequently used these design implications to inform the development of a web-based platform, WeCareAdvisor,TM which provides caregivers with information and an algorithm by which to identify and manage behavioral symptoms for which they seek management strategies. We conducted 4 focus groups with family caregivers (N=26) in a Midwestern state. Qualitative content analysis of the data was guided by a sociotechnical systems framework. We identified nine categories of barriers that family caregivers confront in obtaining needed information about behavioral symptom management from which we extrapolated design implications for a web-based platform. Based on interactions within the sociotechnical system, three critical information needs were identified: 1) timely access to information, 2) access to information that is tailored or specific to caregiver's needs and contexts, and 3) usable information that can directly inform how caregivers' manage behaviors. The sociotechnical system framework is a useful approach for identifying information

  4. Chemical Weapons Disposal: Improvements Needed in Program Accountability and Financial Management

    DTIC Science & Technology

    2000-05-01

    United States General Accounting Office PAQ Report to Congressional Committees May 2000 CHEMICAL WEAPONS DISPOSAL Improvements Needed in Program...warfare materiel, and former production facilities and identify and locate buried chemical warfare materiel. Alternative Technologies and Approaches...production facilities, and buried chemical warfare materiel. These items are described in table 1. Table 1: Nonstockpile Chemical Materiel Category

  5. Facing the dilemma of patient-centred psoriasis care: a qualitative study identifying patient needs in dermatological outpatient clinics.

    PubMed

    Khoury, L R; Skov, L; Møller, T

    2017-08-01

    Caregivers must be aware of patients' current needs by providing care responsive to patients' values and preferences and by identifying what approach improves and encourages patients to participate in their treatment and disease management. Patients with psoriasis healthcare needs perhaps change as medical knowledge improves, new drugs emerge and the healthcare system improves its efficiency as a result of constant structural development. To explore the unmet needs and health perceptions of people with psoriasis, regarding interaction with clinicians and the structure inherent to consultations in a hospital outpatient dermatological clinic. A qualitative investigation with data generated from semi-structured interviews. Transcriptions were subsequently analysed using the template analysis method. Sixteen patients with psoriasis were interviewed. Challenges and dilemmas of patient-centred psoriasis care were identified. Patients have a strong need to be met as individuals as the burden of living with psoriasis goes beyond the skin. Patients strive for efficient treatment and ultimately dream of being cured of psoriasis. They prefer individualized health education in order to adjust their knowledge and self-management skills. These central issues are as yet rarely addressed in clinical consultations. Consultations with a standardized structure do not match the individual challenges and healthcare needs of patients with psoriasis. In order to achieve a more patient-centred approach, health professionals should implement minor structural changes to dermatological services to meet patients' current needs and invite dialogue about the patients' emotional well-being and concerns that go beyond biomedical factors, as well as offer individualized health education. © 2016 British Association of Dermatologists.

  6. Identifying children with Special Health Care Needs in Alexandria, Egypt.

    PubMed

    Wahdan, Iman H; El-Nimr, Nessrin A

    2018-05-23

    In developing countries, obtaining reliable prevalence rates for children with special health care needs (CSHCN) is challenging. One of the tools used to identify CSHCN is the CSHCN Screener (not available in Arabic). The aim is to test the feasibility of using an Arabic version of CSHCN screener in identifying CSHCN in the Egyptian setup and to estimate their prevalence in Alexandria. A community-based survey was conducted among a representative sample of children using a multistage cluster sampling technique. A pre-designed interviewing questionnaire and the Arabic translation of CSHCN screener were used. The prevalence of CSHCN was 12.2% and 91.8% of them had the three domains of health care needs. The most prevalent conditions requiring special health care were sensory and cognitive impairments and impaired mobility. Type of family was the only significant factor associated with special health care needs. It is concluded that the screener can easily be used and help in identifying the majority of children that need to be the focus of the National health care services. It is recommended that the school health services add the screener to assist depicting the existing gaps in the health care system.

  7. Regional variation in identified cancer care needs of early-career oncologists in China, India, and Pakistan.

    PubMed

    Lyerly, H Kim; Fawzy, Maria R; Aziz, Zeba; Nair, Reena; Pramesh, C S; Parmar, Vani; Parikh, Purvish M; Jamal, Rozmin; Irumnaz, Azizunissa; Ren, Jun; Stockler, Martin R; Abernethy, Amy P

    2015-05-01

    Cancer incidence and mortality is increasing in the developing world. Inequities between low-, middle-, and high-income countries affect disease burden and the infrastructure needs in response to cancer. We surveyed early-career oncologists attending workshops in clinical research in three countries with emerging economies about their perception of the evolving cancer burden. A cross-sectional survey questionnaire was distributed at clinical trial concept development workshops held in Beijing, Lahore, Karachi, and Mumbai at major hospitals to acquire information regarding home-country health conditions and needs. A total of 100 respondents participated in the workshops held at major hospitals in the region (India = 29, China = 25, Pakistan = 42, and other = 4). Expected consensus on many issues (e.g., emergence of cancer as a significant health issue) was balanced with significant variation in priorities, opportunities, and challenges. Chinese respondents prioritized improvements in cancer-specific care and palliative care, Indian respondents favored improved cancer detection and advancing research in cancer care, and Pakistani respondents prioritized awareness of cancer and improvements in disease detection and cancer care research. For all, the most frequently cited opportunity was help in improving professional cancer education and training. Predominantly early-career oncologists attending clinical research workshops (in China, India, and Pakistan) identified needs for increasing clinical cancer research, professional education, and public awareness of cancer. Decision makers supporting efforts to reduce the burden of cancer worldwide will need to factor the specific needs and aspirations of health care providers in their country in prioritizing health policies and budgets. ©AlphaMed Press.

  8. Identifying HIV/AIDS primary care development needs.

    PubMed

    Foong, Andrew L S; Ng, S F; Lee, Christopher K C

    2005-04-01

    This paper reports a study aimed at identifying the primary health care experiences of people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in Malaysia. The rationale behind the study was to enable informed action for developing more responsive and effective primary care. Reports such as from the World Health Organisation forecast sharp escalations in the incidence of HIV/AIDS in Malaysia and the Asia-Pacific region within the next few years. With sparse information on the course of infection on the local population and an understanding of health care needs of those afflicted, health services would be ill-prepared for projected increases. Semi-structured interviews were conducted with a convenience sample of 99 patients attending two major HIV/AIDS clinics in Malaysia. Several gaps in care provision were highlighted, such as with treatment/consultation facilities and availability and accessibility of information. What is also evident is that there are a number of good support services available but not well publicized to those in need of them. That includes health professionals who could be making appropriate referrals. The lack of communications and inter-professional working appears to be part of the problem. The findings provide baseline data and preliminary insights to government and other service providers towards advancing, optimizing and refining existing policies and infrastructure. Although the availability of a number of primary care facilities have been identified, the study indicates the need for more effective co-ordinated efforts with clear leadership to pull together scarce resources towards the aim of some degree of seamless primary care provision. It is suggested that nurses would be well placed for such a role in view of the nature of their education and training that helps prepare them for the multi-faceted role.

  9. Southwest Region: A Report Identifying and Addressing the Educational Needs

    ERIC Educational Resources Information Center

    US Department of Education, 2011

    2011-01-01

    The Educational Technical Assistance Act of 2002, authorized the Southwest Regional Advisory Committee (RAC), whose members represent the states of Arkansas, Louisiana, New Mexico, Oklahoma, and Texas, to identify and prioritize the region's educational needs and recommend how those needs can be met. The Southwest RAC conducted three public…

  10. Identifying unmet needs in older patients--nurse-GP collaboration in general practice.

    PubMed

    Williams, Ian D; O'Doherty, Lorna J; Mitchell, Geoffrey K; Williams, Karen E

    2007-09-01

    Australia's rapidly aging population has a high prevalence of chronic disease and disability, leading to an increased social and economic burden. The Enhanced Primary Care program seeks to reduce this burden by promoting preventive and coordinated care. This study aimed to identify unmet needs in community dwelling general practice patients aged 75 years and over through annual health assessments performed by a general practitioner-nurse team. Community dwelling patients of a large suburban general practice aged 75 years and over were invited to participate. Five hundred and forty-six consecutive, eligible patients were recruited. Data were collected by GP-nurse teams on physical and psychosocial variables using a combination of physical examination, self reporting, and rating scales. Fifty percent of the women and 25% of the men lived alone. Over 90% of participants reported one or more health problems, with musculoskeletal issues being most common. Men rated their health more poorly than women. Incontinence affected one-third of patients, mainly women. Women reported more psychological distress. There were age and gender differences in activities of daily living (ADL). Mobility, ADL, visual impairment, bowel problems, use of sleep medications and psychological wellbeing were strongly associated to self reported health. Health assessments were effective in identifying significant physical and psychosocial problems in older adults. The importance of such assessments is underscored by strong associations between various domains and perceived general health. Collaboration between a GP and a practice based community nurse represents a potential solution to identifying (and responding to) unmet physical and psychosocial needs to improve quality of life in community dwelling older adults.

  11. Systematic Review to Identify Skill Needs for Agrifood Nanotechnology Workforce

    ERIC Educational Resources Information Center

    Yawson, Robert M.

    2017-01-01

    As nanotechnology continues to advance in food and agriculture, there is the need for pragmatic decisions as to how to prepare the workforce. A comprehensive systematic evidence review (SER) and analysis of the literature to identify skill needs for the emerging agrifood nanotechnology sector and to determine how agricultural education can…

  12. Improving public health evaluation: a qualitative investigation of practitioners' needs.

    PubMed

    Denford, Sarah; Lakshman, Rajalakshmi; Callaghan, Margaret; Abraham, Charles

    2018-01-30

    In 2011, the House of Lords published a report on Behaviour Change, in which they report that "a lot more could, and should, be done to improve the evaluation of interventions." This study aimed to undertake a needs assessment of what kind of evaluation training and materials would be of most use to UK public health practitioners by conducting interviews with practitioners about everyday evaluation practice and needed guidance and materials. Semi-structured interviews were conducted with 32 public health practitioners in two UK regions, Cambridgeshire and the South West. Participants included directors of public health, consultants in public health, health improvement advisors, public health intelligence, and public health research officers. A topic guide included questions designed to explore participants existing evaluation practice and their needs for further training and guidance. Data were analysed using thematic analyses. Practitioners highlighted the need for evaluation to defend the effectiveness of existing programs and protect funding provisions. However, practitioners often lacked training in evaluation, and felt unqualified to perform such a task. The majority of practitioners did not use, or were not aware of many existing evaluation guidance documents. They wanted quality-assured, practical guidance that relate to the real world settings in which they operate. Practitioners also mentioned the need for better links and support from academics in public health. Whilst numerous guidance documents supporting public health evaluation exist, these documents are currently underused by practitioners - either because they are not considered useful, or because practitioners are not aware of them. Integrating existing guides into a catalogue of guidance documents, and developing a new-quality assured, practical and useful document may support the evaluation of public health programs. This in turn has the potential to identify those programs that are effective

  13. Anesthesiology leadership rounding: identifying opportunities for improvement.

    PubMed

    Gravenstein, Dietrich; Ford, Susan; Enneking, F Kayser

    2012-01-01

    Rounding that includes participation of individuals with authority to implement changes has been advocated as important to the transformation of an institution into a high-quality and safe organization. We describe a Department of Anesthesiology's experience with leadership rounding. The Department Chair or other senior faculty designate, a quality coordinator, up to four residents, the ward charge nurse, and patient nurses participated in rounds at bedsides. During a 23-month period, 14 significant opportunities to improve care were identified. Nurses identified 5 of these opportunities, primary team physicians 2, the rounding team 4, and patients or their family members another 3. The anesthesiology service had sole or shared responsibility for 10 improvements. A variety of organizations track specific measures across all phases of the patient experience to gauge quality of care. Chart auditing tools for detecting threats to safety are often used. These measures and tools missed opportunities for improvement that were discovered only through rounding. We conclude that the introduction of leadership rounding by an anesthesiology service can identify opportunities for improving quality that are not captured by conventional efforts.

  14. Identifying and Tracing User Needs

    NASA Astrophysics Data System (ADS)

    To, C.; Tauer, E.

    2017-12-01

    Providing adequate tools to the user community hinges on reaching the specific goals and needs behind the intended application of the tool. While the approach of leveraging user-supplied inputs and use cases to identify those goals is not new, there frequently remains the challenge of tracing those use cases through to implementation in an efficient and manageable fashion. Processes can become overcomplicated very quickly, and additionally, explicitly mapping progress towards the achievement of the user demands can become overwhelming when hundreds of use-cases are at play. This presentation will discuss a demonstrated use-case approach that has achieved an initial success with a tool re-design and deployment, the means to apply use cases in the generation of a roadmap for future releases over time, and the ability to include and adjust to new user requirements and suggestions with minimal disruption to the traceability. It is hoped that the findings and lessons learned will help make use case employment easier for others seeking to create user-targeted capabilities.

  15. Social support needs identified by mothers affected by intimate partner violence.

    PubMed

    Letourneau, Nicole; Morris, Catherine Young; Stewart, Miriam; Hughes, Jean; Critchley, Kim A; Secco, Loretta

    2013-09-01

    In order to offer optimal supports and services for mothers affected by intimate partner violence (IPV), an understanding of these mothers' perceptions of support needs, resources, barriers to support, and preferences for support intervention is warranted. Moreover, the growing recognition of the effects of IPV on maternal-infant relationships and of the importance of these early relationships to long-term child health outcomes suggests interventions are needed to support optimal maternal-infant relationships in these families. Thus, 64 mothers exposed to IPV when their infants were below 12 months of age participated in a retrospective qualitative study to identify mothers' support needs, resources, barriers to support, and preferences for specific support interventions to promote optimal mother-infant relationships. Participants identified both personal needs (including needs for leaving or staying with the violent partner), along with intertwined needs to care for, and help, their infants cope with the experience of violence. Mothers reported that integrated services that include information and practical support from professionals with emotional and affirmation support from peers would promote positive, nurturing mother-infant relationships and healthy child development.

  16. Identifying supportive care needs of women with ovarian cancer.

    PubMed

    Fitch, Margaret I; Steele, Rose

    2010-01-01

    Women diagnosed with ovarian cancer may experience many shortterm and long-term effects from cancer and its treatment. Cancer has more than a physical impact, yet there is a lack of information about the types of needs these women have and whether they want help in meeting their needs. The main purpose of this cross-sectional, descriptive study was to identify the supportive care needs (physical, emotional, social, informational, spiritual, psychological and practical) of women with ovarian cancer who attended a comprehensive, outpatient cancer centre. A further purpose was to determine if women wanted assistance in meeting those needs. A total of 50 women diagnosed with ovarian cancer participated in this study by completing a self-report questionnaire (The Supportive Care Needs Survey). The data indicated that a range of supportive care needs remained unmet for this patient group. Eight of the top 10 most frequently reported needs were psychosocial, such as fears about the cancer returning or spreading. The women also expressed a range of difficulty in managing their needs. However, despite this reality, significant numbers of women indicated they did not wish to have assistance from the clinic staff with some needs. Suggestions for practice and future research are offered to assist oncology nurses in providing care to these women.

  17. Identifying research needs for improved management of social impacts in wilderness recreation

    Treesearch

    Gordon R. Cessford

    2000-01-01

    This paper summarizes the social impact research and information needs derived from a workshop of over 50 recreation management staff in the New Zealand Department of Conservation. The overall objective was to establish the basis for developing a research plan underpinning social impact management. After scoping the diversity of social impact issues, the workshop...

  18. Identifying atmospheric monitoring needs for Space Station Freedom

    NASA Technical Reports Server (NTRS)

    Casserly, Dennis M.

    1989-01-01

    The atmospheric monitoring needs for Space Station Freedom were identified by examining the following from an industrial hygiene perspective: the experiences of past missions; ground based tests of proposed life support systems; the unique experimental and manufacturing facilities; the contaminant load model; metabolic production; and a fire. A target list of compounds to be monitored is presented and information is provided relative to the frequency of analysis, concentration ranges, and locations for monitoring probes.

  19. Identifying the Educational Needs of Menopausal Women: A Feasibility Study

    PubMed Central

    Trudeau, Kimberlee J.; Ainscough, Jessica L.; Trant, Meredith; Starker, Joan; Cousineau, Tara

    2013-01-01

    Background The goal of this project was to identify the educational needs of menopausal women and test the feasibility of an online self management program based on social learning theory. Methods The four stages included: (1) a needs assessment using a) focus groups with 24 women ages 40 – 55 and b) phone interviews with eight health experts, (2) the use of concept mapping methodology for quantifying qualitative data from Stage 1 to identify the core programmatic concepts, (3) development of a demonstration program, and (4) a pilot study with 35 women and nine health experts to assess knowledge gained and program satisfaction. Results Results show that women desire more information about normalcy of menopause and symptom management, found the program to meet a need for menopausal education otherwise perceived as unavailable, and they significantly increased their menopausal knowledge after brief exposure (t34= 3.64, p = .001). Conclusions This project provides support for an online health education program for menopausal women and content ideas for inclusion in women’s health education curriculum. PMID:21185735

  20. Identified Palliative Care Approach Needs with SPICT in Family Practice: A Preliminary Observational Study.

    PubMed

    Hamano, Jun; Oishi, Ai; Kizawa, Yoshiyuki

    2018-02-09

    Identifying patients who require palliative care approach is challenging for family physicians, even though several identification tools have been developed for this purpose. To explore the prevalence and characteristics of family practice patients who need palliative care approach as determined using Supportive and Palliative Care Indicators Tool (SPICT™, April 2015) in Japan. Single-center cross-sectional study. We enrolled all patients ≥65 years of age who visited the chief researcher's outpatient clinic in October 2016. We used Japanese version of SPICT (SPICT-J) to identify patients who need palliative care approach. We assessed patients' backgrounds and whether they had undergone advance care planning with their family physicians. This study included 87 patients (61 females) with a mean age of 79.0 ± 7.4 years. Eight patients (9.2%) were identified as needing palliative care approach. The mean age of patients who needed this approach was 82.3 ± 8.3 years and main underlying conditions were heart/vascular disease (37.5%), dementia/frailty (25.0%), and respiratory disease (12.5%). Only two of eight patients identified as needing palliative care approach had discussed advance care planning with their family physicians. In family practice, 9.2% of outpatients ≥65 years of age were identified as needing palliative care approach. Family physicians should carefully evaluate whether outpatients need palliative care approach.

  1. Examining the need assessment process by identifying the need profiles of elderly care recipients in the Ten-year Long-Term Care Project (TLTCP) of Taiwan.

    PubMed

    Liu, Li-Fan; Yao, Hui-Ping

    2014-12-01

    To deal with the increasing long-term care (LTC) needs of elderly people in Taiwan, the government launched the Ten-year Long-term Care Project (TLTCP) in 2007, and through the care management system, care plans for those in need were distributed and implemented by care managers according to the single assessment process. Based on the emphasis of linking the right need assessment to the care plan, this study aimed to explore the need profiles of LTC recipients with regard to their health indicators to serve as a validity check on the identified dependency levels and care plans in the current care management system. A model based on latent class analysis (LCA) was used for dealing with the issue of health heterogeneity. LCA provides an empirical method that examines the interrelationships among health indicators and characterizes the underlying set of mutually exclusive latent classes that account for the observed indicators. The analysis included a total of 2901 elderly care recipients in the LTC dataset from a southern city, 1 of the 5 major metropolitan areas in Taiwan. The identified dependency levels of the samples and their care plans in need assessment were compared and discussed. Four need profiles were explored in the LTC dataset. Apart from the low (LD) (32.95%) and moderate dependent groups (MD) (17.48%), there were 2 groups identified among the high-dependency levels, including the severe physical and psychological dependency (SPP) (26.37%) and the comorbidities and severe dependency (CSD) groups (23.20%), which in sum were approximately identified as high dependency (HD) by care managers in the LTC dataset. In addition, the CSD group currently costs more for their care plans on average in LTC services (NT. 277,081.15, approximately 9200 USD) than the SPP group (NT. 244,084.21) and the other groups. Need assessment is a key to success in care management in LTC. The results of this study showed the importance of focusing on multifacet indicators

  2. Need for Improvement of Rural School Facilities.

    ERIC Educational Resources Information Center

    Hodges, V. Pauline

    The Government Accounting Agency estimates that one third of the nation's schools are in need of extensive repairs or replacement of one or more buildings. The condition of America's rural schools are at a crisis stage and need to be improved to continue to educate rural youth. This paper profiles the state of rural schools' infrastructure, rural…

  3. Identifying the educational needs of menopausal women: a feasibility study.

    PubMed

    Trudeau, Kimberlee J; Ainscough, Jessica L; Trant, Meredith; Starker, Joan; Cousineau, Tara M

    2011-01-01

    The goal of this project was to identify the educational needs of menopausal women and test the feasibility of an online self management program based on social learning theory. The four stages included 1) a needs assessment using a) focus groups with 24 women ages 40 to 55 and b) phone interviews with eight health experts; 2) the use of concept mapping methodology for quantifying qualitative data from stage 1 to identify the core programmatic concepts; 3) development of a demonstration program; and 4) a pilot study with 35 women and 9 health experts to assess knowledge gained and program satisfaction. Results show that women desire more information about normalcy of menopause and symptom management and found the program to meet a need for menopausal education otherwise perceived as unavailable. The women significantly increased their menopausal knowledge after brief exposure (t(34) = 3.64; p = .001). This project provides support for an online health education program for menopausal women and content ideas for inclusion in women's health education curriculum. Copyright © 2011 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  4. Do Mental Health Outpatient Services Meet Users' Needs? Trial to Identify Factors Associated with Higher Needs for Care.

    PubMed

    Dobrzynska, Ewelina; Rymaszewska, Joanna; Biecek, Przemyslaw; Kiejna, Andrzej

    2016-05-01

    The study was conducted to investigate the extent to which services meet patients' needs and identify the factors associated with higher needs. 174 outpatients were assessed using CANSAS, BPRS and GSDS. The total number of unmet needs in persons with psychotic, eating, personality and affective disorders was higher than in patients with anxiety disorders. Being single, positive symptoms, depression/anxiety, hospitalizations and high social disability accounted for 50 % of the variance in level of unmet need. Persons with eating and personality disorders reported similar level of unmet needs to those with psychotic and affective disorders. The best correlates of unmet needs were depression/anxiety and social disability.

  5. Identifying Health Needs in Peru Through Use of a Community Survey.

    PubMed

    Renn, McCartney; Steffen, Lori

    2016-11-01

    Students and faculty from a Midwestern college conducted a neighborhood community needs assessment in an impoverished area of a Peruvian city to identify health needs of residents. Students interviewed residents in their homes, asking about the need for medical, dental, and ophthalmic care and screening for chronic conditions such as diabetes, heart disease, and tuberculosis. The survey provided necessary information to medical mission workers and allowed students to directly observe family living conditions while assessing psychosocial needs of the families interviewed. The challenges of this survey included differing expectations, language barriers, recruiting neighborhood volunteers, safety risks to students, and mistrust by neighborhood residents.

  6. The experiences and support needs of people with intellectual disabilities who identify as LGBT: A review of the literature.

    PubMed

    McCann, Edward; Lee, Regina; Brown, Michael

    2016-10-01

    People who identify as lesbian, gay, bisexual and transgender (LGBT) can face many challenges in society including accessing education, care and support appropriate to individual needs. However, there is a growing and evolving evidence base about the specific needs of people with intellectual disabilities (ID) in this regard. The aim of this review was to explore the experiences of people with ID who identified as LGBT through an examination of studies that addressed their views and highlighted specific issues, concerns and service responses. A comprehensive search of relevant databases from February 1995 to February 2015 was conducted. Studies were identified that met specific criteria that included: empirical peer reviewed studies, the use of recognised research methods and focused on people with ID whom identified as LGBT. The search yielded 161 papers in total. The search was narrowed and 37 papers were screened using rigorous inclusion and exclusion criteria. Finally, 14 papers were considered suitable for the review. The data were analysed and key themes identified that included accessing health services, gender and sexual identity, attitudes of people with ID regarding their LGBT status, and education, supports and therapeutic interventions. There is a need for service providers and carers to be more responsive to the concerns of people with ID who identify as LGBT to improve their health and well-being by reducing stigma and discrimination and by increasing awareness of their care and support needs. The implications are discussed in terms of policy, education, research and practice developments. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Randomized Multilevel Intervention to Improve Outcomes of Residents in Nursing Homes in Need of Improvement

    PubMed Central

    Rantz, Marilyn J.; Nahm, Helen E.; Zwygart-Stauffacher, Mary; Hicks, Lanis; Mehr, David; Flesner, Marcia; Petroski, Gregory F.; Madsen, Richard W.; Scott-Cawiezell, Jill

    2012-01-01

    Purpose A comprehensive multilevel intervention was tested to build organizational capacity to create and sustain improvement in quality of care and subsequently improve resident outcomes in nursing homes in need of improvement. Intervention facilities (n=29) received a two-year multilevel intervention with monthly on-site consultation from expert nurses with graduate education in gerontological nursing. Attention control facilities (n=29) that also needed to improve resident outcomes received monthly information about aging and physical assessment of elders. Design and Methods Randomized clinical trial of nursing homes in need of improving resident outcomes of bladder and bowel incontinence, weight loss, pressure ulcers, and decline in activities of daily living (ADL). It was hypothesized that following the intervention, experimental facilities would have better resident outcomes, higher quality of care, higher staff retention, more organizational attributes of improved working conditions than control facilities, similar staffing and staff mix, and lower total and direct care costs. Results The intervention did improve quality of care (p=0.02); there were improvements in pressure ulcers (p=0.05), weight loss (p=0.05). Staff retention, organizational working conditions, staffing, and staff mix and most costs were not affected by the intervention. Leadership turnover was surprisingly excessive in both intervention and control groups. Implications Some facilities that are in need of improving quality of care and resident outcomes are able to build the organizational capacity to improve while not increasing staffing or costs of care. Improvement requires continuous supportive consultation and leadership willing to involve staff and work together to build the systematic improvements in care delivery needed. PMID:21816681

  8. Addressing women's health needs and improving birth outcomes: results from a peer-to-peer state Medicaid learning project.

    PubMed

    Johnson, Kay

    2012-08-01

    High rates of maternal mortality, infant mortality, and preterm births, as well as continuing disparities in pregnancy outcomes, have prompted a number of state Medicaid agencies to focus on improving the quality and continuity of care delivered to women of childbearing age. As part of a peer-to-peer learning project, seven Medicaid agencies worked to develop the programs, policies, and infrastructures needed to identify and reduce women's health risks either prior to or between pregnancies. The states also identified public health strategies. These strategies led to a policy checklist to help leaders in other states identify improvement opportunities that fit within their programs' eligibility requirements, quality improvement objectives, and health system resources. Many of the identified programs and policies may help states use the upcoming expansion of the Medicaid program to improve women's health and thereby reduce adverse birth outcomes.

  9. Identifying unmet clinical need in hypertrophic cardiomyopathy using national electronic health records.

    PubMed

    Pujades-Rodriguez, Mar; Guttmann, Oliver P; Gonzalez-Izquierdo, Arturo; Duyx, Bram; O'Mahony, Constantinos; Elliott, Perry; Hemingway, Harry

    2018-01-01

    To evaluate unmet clinical need in unselected hypertrophic cardiomyopathy (HCM) patients to determine the risk of a wide range of subsequent cardiovascular disease endpoints and safety endpoints relevant for trial design. Population based cohort (CALIBER, linked primary care, hospital and mortality records in England, period 1997-2010), all people diagnosed with HCM were identified and matched by age, sex and general practice with ten randomly selected people without HCM. Random-effects Poisson models were used to assess the associations between HCM and cardiovascular diseases and bleeding. Among 3,290,455 eligible people a diagnosis of hypertrophic cardiomyopathy was found in 4 per 10,000. Forty-one percent of the 1,160 individuals with hypertrophic cardiomyopathy were women and the median age was 57 years. The median follow-up was 4.0 years. Compared to general population controls, people with HCM had higher risk of ventricular arrhythmia (incidence rate ratio = 23.53, [95% confidence interval 12.67-43.72]), cardiac arrest or sudden cardiac death (6.33 [3.69-10.85]), heart failure (4.31, [3.30-5.62]), and atrial fibrillation (3.80 [3.04-4.75]). HCM was also associated with a higher incidence of myocardial infarction ([MI] 1.90 [1.27-2.84]) and coronary revascularisation (2.32 [1.46-3.69]).The absolute Kaplan-Meier risks at 3 years were 8.8% for the composite endpoint of cardiovascular death or heart failure, 8.4% for the composite of cardiovascular death, stroke or myocardial infarction, and 1.5% for major bleeding. Our study identified major unmet need in HCM and highlighted the importance of implementing improved cardiovascular prevention strategies to increase life-expectancy of the contemporary HCM population. They also show that national electronic health records provide an effective method for identifying outcomes and clinically relevant estimates of composite efficacy and safety endpoints essential for trial design in rare diseases.

  10. Identifying Decision-Makers’ Science Needs for Adaptation to Climate-Related Impacts on Forest Ecosystem Services

    NASA Astrophysics Data System (ADS)

    Gordon, E.; Lukas, J.

    2009-12-01

    Through the Western Water Assessment RISA program, we are conducting a research project that will produce science synthesis information to help local, state, and federal decision-makers in Colorado and Wyoming develop adaptation strategies to deal with climate-related threats to forest ecosystem services, in particular bark beetle infestations and stand-replacing wildfires. We begin by using the problem orientation framework, a policy sciences methodology, to understand how decision-makers can most effectively address policy problems that threaten the attainment of socially accepted goals. By applying this framework to the challenges facing decision-makers, we more accurately identify specific areas where scientific research can improve decision-making. WWA researchers will next begin to connect decision-makers with relevant scientific literature and identify specific areas of future scientific research that will be most effective at addressing their needs.

  11. Training Needs Analysis. A Resource for Identifying Training Needs, Selecting Training Strategies, and Developing Training Plans.

    ERIC Educational Resources Information Center

    Bartram, Sharon; Gibson, Brenda

    Designed as a practical tool for trainers, this manual contains 22 instruments and documents for gathering and processing information about training and development issues within an organization. Part one of the two-part manual examines the process of identifying and analyzing training needs. It reviews the different types of information the…

  12. The Dementia Services Mini-Screen: A Simple Method to Identify Patients and Caregivers Needing Enhanced Dementia Care Services

    PubMed Central

    Borson, Soo; Scanlan, James M.; Sadak, Tatiana; Lessig, Mary; Vitaliano, Peter

    2014-01-01

    Objective The National Alzheimer’s Plan calls for targeted health system change to improve outcomes for persons with dementia and their family caregivers. We explored whether dementia-specific service needs and gaps could be predicted from simple information that can be readily acquired in routine medical care settings. Method Primary family caregivers for cognitively impaired older adults (n=215) were asked about current stress, challenging patient behaviors, and prior-year needs and gaps in 16 medical and psychosocial services. Demographic data, caregiver stress, and patient clinical features were evaluated in regression analyses to identify unique predictors of service needs and gaps. Results Caregiver stress and patient behavior problems together accounted for an average of 24% of the whole-sample variance in total needs and gaps. Across all analyses, including total, medical, and psychosocial services needs and gaps, all other variables combined (comorbid chronic disease, dementia severity, age, caregiver relationship, and residence) accounted for an accounted for a mean of 3%, with no variable yielding more than 4% in any equation. We combined stress and behavior problem indicators into a simple screen. In early/mild dementia dyads (n=111) typical in primary care settings, the screen identified gaps in total and psychosocial care in 84% and 77%, respectively, of those with high stress/high behavior problems vs. 25% and 23%, respectively, of those with low stress/low behavior problems. Medical care gaps were dramatically higher in high stress/high behavior problem dyads (66%) than all others (12%). Conclusion A simple tool (likely completed in 1–2 minutes) which combines caregiver stress and patient behavior problems, the Dementia Services Mini-Screen, could help clinicians rapidly identify high need, high gap dyads. Health care systems could use it to estimate population needs for targeted dementia services and facilitate their development. PMID:24315560

  13. Identifying the Needs of Adult Women in Distance Learning Programs.

    ERIC Educational Resources Information Center

    Furst-Bowe, Julie

    A study examined reasons that adult female students are motivated to enroll in distance learning programs, described their perceptions of the courses, and identified barriers these women face as they attempt to progress through their degree programs. Results of focus groups with 40 returning adult women were analyzed. Their needs were grouped into…

  14. A Need for Better Studies to Identify Those Populations at ...

    EPA Pesticide Factsheets

    This invited editorial on a paper accepted for publication in the Journal of Pediatrics details scientific advances needed to improve the identification of those populations at greatest risk of a pollutant-related health effect with a primary focus on air pollution. Invited editorial on a paper dealing with at-risk populations.

  15. Public reporting needed to improve the health of Tennesseans.

    PubMed

    Bailey, James E; Gibson, Deborah

    2005-11-01

    Tennessee providers are recognizing an urgent need for a new and improved model of healthcare, characterized by transparent accountability to consumers. Meaningful health system improvements will require broad public disclosure of healthcare performance data at the hospital, clinic and community levels using nationally recognized standards. All Tennessee communities need a routine community health report card, to help their citizens to work together toward their most important health goals.

  16. Discrimination and resilience and the needs of people who identify as Transgender: A narrative review of quantitative research studies.

    PubMed

    McCann, Edward; Brown, Michael

    2017-12-01

    To examine discrimination and resilience experiences of people who identify as transgender and establish potential health service responses. People who identify as transgender face many challenges in society in terms of the knowledge, understanding and acceptance of a person's gender identity. A narrative review of quantitative empirical research. A comprehensive search of CINAHL, MEDLINE, PsycINFO and Sociological Abstracts electronic databases from 2006-2016 was conducted. The search yielded 1,478 papers and following the application of rigorous inclusion and exclusion criteria a total of 19 papers were included in the review. The findings reveal that there is a need to ensure that the needs of transgender people are represented, fully integrated and clearly linked to outcomes that improve their health and quality of life. Discrimination experiences can result in poorer health outcomes; however, many people have developed resilience and positive coping strategies. Nurses need to recognise and respond appropriately to the care and treatment needs of this population. Comprehensive nursing assessments and plans of care that encompass all aspects of the person should be in place supported by clear policy guidelines and evidence-based research. The education requirements of practitioners are outlined. © 2017 John Wiley & Sons Ltd.

  17. Addressing basic resource needs to improve primary care quality: a community collaboration programme.

    PubMed

    Berkowitz, Seth A; Hulberg, A Catherine; Hong, Clemens; Stowell, Brian J; Tirozzi, Karen J; Traore, Carine Y; Atlas, Steven J

    2016-03-01

    Unmet basic resource needs, such as difficulty affording healthcare, medications, food and housing, may contribute to worse healthcare quality indicators, but interventions are hampered by lack of specific knowledge regarding the distribution of unmet basic resource needs and their association with priority clinical conditions and health service use patterns. Cross-sectional study of primary care patients in two urban academic practices from 1 October 2013 to 30 April 2014. Patients were screened for unmet needs and enrolled in a programme to link them with community resources. Key measures included patient report of unmet basic resource needs, clinical conditions prioritised by quality improvement programmes (hypertension, diabetes and depression), and health service use patterns such as frequent emergency department (ED) visits (>2 in the preceding year) and frequent clinic 'no-shows' (>1 in the preceding year). 416 patients with unmet needs were included, and compared with 2750 patients who did not report needs. The most common types of needs reported were: difficulties affording healthcare (46.5%), food (40.1%) and utilities (36.3%). Patients who reported unmet needs were more likely to have depression (17.8% vs 9.5%, p<0.0001), diabetes (32.7% vs 20.4%, p<0.0001), hypertension (54.3% vs 46.3%, p=0.002), be frequent ED users (11.3% vs 5.4%, p<0.0001), and have frequent 'no-shows' to clinic (21.6% vs 11.9%, p<0.0001). Difficulty affording healthcare and food are particularly common needs among patients with priority conditions. Strategies to identify and address unmet needs as part of routine care may be an important way to improve healthcare quality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  18. 75 FR 29560 - Identifying Unmet Public Health Needs and Facilitating Innovation in Medical Device Development...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-26

    ...] Identifying Unmet Public Health Needs and Facilitating Innovation in Medical Device Development; Notice of... entitled ``Identifying Unmet Public Health Needs and Facilitating Innovation in Medical Device Development... an initiative to proactively facilitate medical device innovation to address unmet public health...

  19. Faculty development to improve teaching at a health sciences center: a needs assessment.

    PubMed

    Scarbecz, Mark; Russell, Cynthia K; Shreve, Robert G; Robinson, Melissa M; Scheid, Cheryl R

    2011-02-01

    There has been increasing interest at health science centers in improving the education of health professionals by offering faculty development activities. In 2007-08, as part of an effort to expand education-related faculty development offerings on campus, the University of Tennessee Health Science Center surveyed faculty members in an effort to identify faculty development activities that would be of interest. Factor analysis of survey data indicated that faculty interests in the areas of teaching and learning can be grouped into six dimensions: development of educational goals and objectives, the use of innovative teaching techniques, clinical teaching, improving traditional teaching skills, addressing teaching challenges, and facilitating participation. There were significant differences in the level of interest in education-related faculty development activities by academic rank and by the college of appointment. Full professors expressed somewhat less interest in faculty development activities than faculty members of lower ranks. Faculty members in the Colleges of Medicine and Dentistry expressed somewhat greater interest in faculty development to improve traditional teaching skills. The policy implications of the survey results are discussed, including the need for faculty development activities that target the needs of specific faculty groups.

  20. Identifying research needs for wheelchair transfers in the built environment.

    PubMed

    Crytzer, Theresa Marie; Cooper, Rory; Jerome, Genevieve; Koontz, Alicia

    2017-02-01

    The purpose of this study is to describe the results of focus groups held during the Independent Wheelchair Transfer (IWT) Workgroup. The aims were to facilitate exchange of ideas on (1) the impact of the built environment on the wheelchair transfer process within the community (i.e. moving from wheelchair to and from other surfaces (e.g. furniture, toilet seat, bath bench, car seat) to participate in daily activities), (2) wheelchair users' needs during transfers in the built environment, and (3) future research directions. Live web-based conferencing using Adobe Connect technology (Clarix Technologies, Inc., Pittsford, NY) was utilized to conduct three focus groups composed of experts in the field of assistive technology. Investigators independently reviewed focus group meeting transcripts and used qualitative methods to identify main themes. Thirty-one experts in assistive technology and related fields participated in focus groups. Nine main themes were found including the effect of transfer skills training, space considerations in the built environment, wheelchair configuration, and the interaction between the built environment, user preferences, and transfer techniques. All groups raised issues about the transfer process in areas of the built environment with limited access, the effect of wheelchair users' transfer techniques, and user preferences during transfers. The area of independent transfers is multi-faceted and several factors require consideration when contemplating environmental changes to improve accessibility for wheelchair users. Obvious opportunity exists for research which could lead to advances in transfer technology, environments, and techniques for wheelchair users. Implications for Rehabilitation Tremendous opportunities for research collaborations in the field of assistive technology: To develop new terminology to describe wheelchair transfers. To improve the design of the built environment for wheelchair users. To investigate wheelchair

  1. Identifying and responding to customer needs at the Kennedy Space Center

    NASA Technical Reports Server (NTRS)

    Ferguson, E. B.

    1993-01-01

    The Patient Questionnaire Program at the Kennedy Space Center (KSC) has been in place for several years. It has helped to identify customer perceptions and needs. The questionnaire is presented and the survey results are discussed with respect to total quality management.

  2. Public Health Workforce Self-Identified Training Needs by Jurisdiction and Job Type.

    PubMed

    Yeager, Valerie A; Wisniewski, Janna M; Chapple-McGruder, Theresa; Castrucci, Brian; Gould, Elizabeth

    2018-06-21

    Ensuring adequate and appropriate training of the workforce is a crucial priority for governmental public health. This is particularly important, given the diverse backgrounds of the public health workforce; the vast majority (approximately 83%) do not have formal training in public health, and those that do have formal training in public health have limited training in management and other essential organizational skills. The purpose of this article is to identify training needs among public health workers in specific job types and settings. This cross section study used 2014 data from the Public Health Workforce Interests and Needs Survey. Qualitative analyses were used to code open-ended responses to questions about training needs. Needs are stratified across job types and jurisdiction. Eight main themes or skill areas were identified with the largest proportion indicating a need for management/leadership skills (28.2%). The second most frequent need was communication skills (21.3%). Across the 9 job types examined, general management skills were either the first or second training need for 7 job types. Among individuals who already have leadership/management positions, budgeting was the most common training need. Findings from this study can inform targeted strategies to address training needs for specific types of employees. Such strategies can influence the efficiency and effectiveness of public health efforts and employee satisfaction. As new public health frameworks-like Public Health 3.0 and the Chief Health Strategist-are advanced nationally, it is necessary to ensure that the workforce has the skills and abilities to implement these frameworks.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission

  3. Identifying the substance abuse treatment needs of caregivers involved with child welfare.

    PubMed

    Chuang, Emmeline; Wells, Rebecca; Bellettiere, John; Cross, Theodore P

    2013-07-01

    Parental substance use significantly increases risk of child maltreatment, but is often under-identified by child protective services. This study examined how agency use of standardized substance use assessments and child welfare investigative caseworker education, experience, and caseload affected caseworkers' identification of parental substance abuse treatment needs. Data are from a national probability sample of permanent, primary caregivers involved with child protective services whose children initially remained at home and whose confidential responses on two validated instruments indicated harmful substance use or dependence. Investigative caseworkers reported use of a formal assessment in over two thirds of cases in which substance use was accurately identified. However, weighted logistic regression indicated that agency provision of standardized assessment instruments was not associated with caseworker identification of caregiver needs. Caseworkers were also less likely to identify substance abuse when their caseloads were high and when caregivers were fathers. Implications for agency practice are discussed. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Identifying the Substance Abuse Treatment Needs of Caregivers Involved with Child Welfare

    PubMed Central

    Wells, Rebecca; Bellettiere, John; Cross, Theodore P.

    2013-01-01

    Parental substance use significantly increases risk of child maltreatment, but is often under-identified by child protective services. This study examined how agency use of standardized substance use assessments and child welfare investigative caseworker education, experience, and caseload affected caseworkers’ identification of parental substance abuse treatment needs. Data are from a national probability sample of permanent, primary caregivers involved with child protective services whose children initially remained at home and whose confidential responses on two validated instruments indicated harmful substance use or dependence. Investigative caseworkers reported use of a formal assessment in over two thirds of cases in which substance use was accurately identified. However, weighted logistic regression indicated that agency provision of standardized assessment instruments was not associated with caseworker identification of caregiver needs. Caseworkers were also less likely to identify substance abuse when their caseloads were high and when caregivers were fathers. Implications for agency practice are discussed. PMID:23453481

  5. Development and pilot test of a process to identify research needs from a systematic review.

    PubMed

    Saldanha, Ian J; Wilson, Lisa M; Bennett, Wendy L; Nicholson, Wanda K; Robinson, Karen A

    2013-05-01

    To ensure appropriate allocation of research funds, we need methods for identifying high-priority research needs. We developed and pilot tested a process to identify needs for primary clinical research using a systematic review in gestational diabetes mellitus. We conducted eight steps: abstract research gaps from a systematic review using the Population, Intervention, Comparison, Outcomes, and Settings (PICOS) framework; solicit feedback from the review authors; translate gaps into researchable questions using the PICOS framework; solicit feedback from multidisciplinary stakeholders at our institution; establish consensus among multidisciplinary external stakeholders on the importance of the research questions using the Delphi method; prioritize outcomes; develop conceptual models to highlight research needs; and evaluate the process. We identified 19 research questions. During the Delphi method, external stakeholders established consensus for 16 of these 19 questions (15 with "high" and 1 with "medium" clinical benefit/importance). We pilot tested an eight-step process to identify clinically important research needs. Before wider application of this process, it should be tested using systematic reviews of other diseases. Further evaluation should include assessment of the usefulness of the research needs generated using this process for primary researchers and funders. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Identifying Health Promotion Needs Among Dominican-American Adolescents.

    PubMed

    Champion, Jane Dimmitt; Roye, Carol F

    Immigration from the Dominican Republic to the United States has grown rapidly. Yet, although adolescent pregnancy and obesity are common concerns among Hispanics, little is known specifically about Dominican adolescent health. This study was undertaken to assess Dominican-American adolescents' health concerns and their perceptions about their health promotion needs. Dominican-American adolescents (N=25) were recruited in a pediatric clinic in New York City which primarily serves a Dominican population. Eligibility criteria included age 13-21years, self-identifying as Dominican ethnicity, and able to speak and read English. They completed a questionnaire, with demographic questions and questions about their risk behaviors including sexual and substance use. After completing the questionnaire, they participated in a semi-structured interview addressing their health education experiences and suggestions for such programs. Quantitative data were analyzed using frequencies to provide a demographic and behavioral profile. Qualitative data were analyzed using thematic analysis. Twenty-five adolescents, ages 13-21years, (female N=19, male N=6) participated in the study. Most were in school (92%) and were sexually experienced (68%). Programmatic preferences included in-person programs rather than online. They spontaneously addressed the importance of cultural issues, and the need to address several issues in addition to sexuality, including obesity and substance use. Programming for this population should address a broad conceptualization of health, and incorporate Dominican cultural issues. Nurses working with adolescents of Dominican origin, should provide health education that incorporates the specific needs of this population, including culturally congruent face-to-face interventions. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Engineering Student to Technical Employee: Identifying Graduates' Needs in the Transition.

    ERIC Educational Resources Information Center

    Trainor, Michalene; Varma, Gale H.

    1983-01-01

    Surveyed 640 engineering students, 119 college placement counselors, and 305 employers to identify needs of engineering students making the transition to employment. Results showed the majority of respondents supported the expanding help of college career development and placement offices, although most thought employee orientation was an…

  8. Identifying content for simulation-based curricula in urology: a national needs assessment.

    PubMed

    Nayahangan, Leizl Joy; Bølling Hansen, Rikke; Gilboe Lindorff-Larsen, Karen; Paltved, Charlotte; Nielsen, Bjørn Ulrik; Konge, Lars

    2017-12-01

    Simulation-based training is well recognized in the transforming field of urological surgery; however, integration into the curriculum is often unstructured. Development of simulation-based curricula should follow a stepwise approach starting with a needs assessment. This study aimed to identify technical procedures in urology that should be included in a simulation-based curriculum for residency training. A national needs assessment was performed using the Delphi method involving 56 experts with significant roles in the education of urologists. Round 1 identified technical procedures that newly qualified urologists should perform. Round 2 included a survey using an established needs assessment formula to explore: the frequency of procedures; the number of physicians who should be able to perform the procedure; the risk and/or discomfort to patients when a procedure is performed by an inexperienced physician; and the feasibility of simulation training. Round 3 involved elimination and reranking of procedures according to priority. The response rates for the three Delphi rounds were 70%, 55% and 67%, respectively. The 34 procedures identified in Round 1 were reduced to a final prioritized list of 18 technical procedures for simulation-based training. The five procedures that reached the highest prioritization were cystoscopy, transrectal ultrasound-guided biopsy of the prostate, placement of ureteral stent, insertion of urethral and suprapubic catheter, and transurethral resection of the bladder. The prioritized list of technical procedures in urology that were identified as highly suitable for simulation can be used as an aid in the planning and development of simulation-based training programs.

  9. The risk of re-identification versus the need to identify individuals in rare disease research.

    PubMed

    Hansson, Mats G; Lochmüller, Hanns; Riess, Olaf; Schaefer, Franz; Orth, Michael; Rubinstein, Yaffa; Molster, Caron; Dawkins, Hugh; Taruscio, Domenica; Posada, Manuel; Woods, Simon

    2016-11-01

    There is a growing concern in the ethics literature and among policy makers that de-identification or coding of personal data and biospecimens is not sufficient for protecting research subjects from privacy invasions and possible breaches of confidentiality due to the possibility of unauthorized re-identification. At the same time, there is a need in medical science to be able to identify individual patients. In particular for rare disease research there is a special and well-documented need for research collaboration so that data and biosamples from multiple independent studies can be shared across borders. In this article, we identify the needs and arguments related to de-identification and re-identification of patients and research subjects and suggest how the different needs may be balanced within a framework of using unique encrypted identifiers.

  10. The risk of re-identification versus the need to identify individuals in rare disease research

    PubMed Central

    Hansson, Mats G; Lochmüller, Hanns; Riess, Olaf; Schaefer, Franz; Orth, Michael; Rubinstein, Yaffa; Molster, Caron; Dawkins, Hugh; Taruscio, Domenica; Posada, Manuel; Woods, Simon

    2016-01-01

    There is a growing concern in the ethics literature and among policy makers that de-identification or coding of personal data and biospecimens is not sufficient for protecting research subjects from privacy invasions and possible breaches of confidentiality due to the possibility of unauthorized re-identification. At the same time, there is a need in medical science to be able to identify individual patients. In particular for rare disease research there is a special and well-documented need for research collaboration so that data and biosamples from multiple independent studies can be shared across borders. In this article, we identify the needs and arguments related to de-identification and re-identification of patients and research subjects and suggest how the different needs may be balanced within a framework of using unique encrypted identifiers. PMID:27222291

  11. Taking a "Snapshot": Evaluation of a Conversation Aid for Identifying Psychosocial Needs in Young Adults with Cancer.

    PubMed

    Poort, Hanneke; Souza, Phoebe M; Malinowski, Paige K; MacDougall, Katelyn M; Barysauskas, Constance M; Lau Greenberg, Teresa; Tulsky, James A; Fasciano, Karen M

    2018-05-21

    Young adults (YAs) aged 18-35 years with cancer often experience unmet psychosocial needs. We aimed to evaluate a conversation aid ("Snapshot") that offered a framework for discussing YA-specific psychosocial concerns between patients and clinicians. We developed and implemented Snapshot between 2014 and 2016 as part of a quality improvement initiative at Dana-Farber Cancer Institute. We extracted pre- and postimplementation data from chart documentation of psychosocial concerns. YAs and social workers provided qualitative feedback on the use of Snapshot in clinical care. Postintervention chart reviews revealed a significant increase in the median number of topics documented in charts after implementation of Snapshot (preintervention median = 9 [range: 1-15] vs. postintervention median = 11 [range 6-15]; p = 0.003). Overall, YAs and social workers reported that using Snapshot improved communication and consistency of psychosocial care, with documented improvement in the following domains: understanding illness (p < 0.001), sexuality and intimacy (p = 0.03), symptom burden (p = 0.003), care planning (p < 0.001), support for caregivers and children (p = 0.02), and social, work, and home changes (p = 0.05). Snapshot improved the quality of psychosocial needs assessment among YAs with cancer. Implementation was successful in reducing variability identified in the preintervention cohort and increasing the number of YA-specific psychosocial topics discussed. A standardized conversation aid has the potential to improve quality of care for YAs by enabling early identification and intervention of psychosocial issues for all patients.

  12. Interchange. Program Improvement Products Identified through Networking.

    ERIC Educational Resources Information Center

    Ohio State Univ., Columbus. National Center for Research in Vocational Education.

    This catalog lists exemplary field-based program improvement products identified by the Dissemination and Utilization Products and Services Program (D&U) at the National Center for Research in Vocational Education. It is designed to increase awareness of these products among vocational educators and to provide information about them that…

  13. Nuclear waste transportation: case studies of identifying stakeholder risk information needs.

    PubMed Central

    Drew, Christina H; Grace, Deirdre A; Silbernagel, Susan M; Hemmings, Erin S; Smith, Alan; Griffith, William C; Takaro, Timothy K; Faustman, Elaine M

    2003-01-01

    The U.S. Department of Energy (DOE) is responsible for the cleanup of our nation's nuclear legacy, involving complex decisions about how and where to dispose of nuclear waste and how to transport it to its ultimate disposal site. It is widely recognized that a broad range of stakeholders and tribes should be involved in this kind of decision. All too frequently, however, stakeholders and tribes are only invited to participate by commenting on processes and activities that are near completion; they are not included in the problem formulation stages. Moreover, it is often assumed that high levels of complexity and uncertainty prevent meaningful participation by these groups. Considering the types of information that stakeholders and tribes need to be able to participate in the full life cycle of decision making is critical for improving participation and transparency of decision making. Toward this objective, the Consortium for Risk Evaluation with Stakeholder Participation (CRESP) participated in three public processes relating to nuclear waste transportation and disposal in 1997-1998. First, CRESP organized focus groups to identify concerns about nuclear waste transportation. Second, CRESP conducted exit surveys at regional public workshops held by DOE to get input from stakeholders on intersite waste transfer issues. Third, CRESP developed visual tools to synthesize technical information and allow stakeholders and tribes with varying levels of knowledge about nuclear waste to participate in meaningful discussion. In this article we share the results of the CRESP findings, discuss common themes arising from these interactions, and comment on special considerations needed to facilitate stakeholder and tribal participation in similar decision-making processes. PMID:12611653

  14. Challenges of using quality improvement methods in nursing homes that "need improvement".

    PubMed

    Rantz, Marilyn J; Zwygart-Stauffacher, Mary; Flesner, Marcia; Hicks, Lanis; Mehr, David; Russell, Teresa; Minner, Donna

    2012-10-01

    Qualitatively describe the adoption of strategies and challenges experienced by intervention facilities participating in a study targeted to improve quality of care in nursing homes "in need of improvement". To describe how staff use federal quality indicator/quality measure (QI/QM) scores and reports, quality improvement methods and activities, and how staff supported and sustained the changes recommended by their quality improvement teams. A randomized, two-group, repeated-measures design was used to test a 2-year intervention for improving quality of care and resident outcomes in facilities in "need of improvement". Intervention group (n = 29) received an experimental multilevel intervention designed to help them: (1) use quality-improvement methods, (2) use team and group process for direct-care decision-making, (3) focus on accomplishing the basics of care, and (4) maintain more consistent nursing and administrative leadership committed to communication and active participation of staff in decision-making. A qualitative analysis revealed a subgroup of homes likely to continue quality improvement activities and readiness indicators of homes likely to improve: (1) a leadership team (nursing home administrator, director of nurses) interested in learning how to use their federal QI/QM reports as a foundation for improving resident care and outcomes; (2) one of the leaders to be a "change champion" and make sure that current QI/QM reports are consistently printed and shared monthly with each nursing unit; (3) leaders willing to involve all staff in the facility in educational activities to learn about the QI/QM process and the reports that show how their facility compares with others in the state and nation; (4) leaders willing to plan and continuously educate new staff about the MDS and federal QI/QM reports and how to do quality improvement activities; (5) leaders willing to continuously involve all staff in quality improvement committee and team activities so

  15. Voices from the Swamp: Identifying the Professional Development Needs of Principals.

    ERIC Educational Resources Information Center

    Goddard, J. Tim

    During the mid- to late-1990s, economic downturns, outmigration of residents, and school closures in Nova Scotia contributed to a lack of movement among school administrators and thus a bottleneck of candidates seeking promotion to the principalship. This paper presents findings of a study that identified the professional-development needs of…

  16. Identifying the need for curriculum change. When a rural training program needs reform.

    PubMed

    Whiteside, C; Pope, A; Mathias, R

    1997-08-01

    To identify what changes should be made in the University of British Columbia's rural family practice training program curriculum to help graduates be better prepared to practice. Two cross-sectional surveys via mailed questionnaires: one designed to measure physicians' self-reported preparedness for practice and the other to measure the importance of various rural family medicine components. Rural training program graduates and preceptors representing rural communities in British Columbia. Thirty-nine graduates of the rural training program between 1982 and 1991 and 14 community-based rural training program preceptors representing eight communities throughout the province participated in this study. Percentage of graduates of the rural program who reported themselves to be underprepared on each family practice item and preceptors' mean scores for the attributed importance to rural practice of each item on this questionnaire. A list of curriculum areas most in need of reform was created. This list included trauma, counseling skills, radiology, vacuum extraction, fracture care, exercising community leadership, cost-effective use of diagnostic tests, using community health resources, obtaining hospital privileges, ophthalmology, dermatology, otolaryngology, personal and professional growth, relationships with other physicians, and personnel issues. Using both the level of graduates' self-reported underpreparedness and the attributed importance of elements of rural practice, as indicated by the preceptor survey, we developed a list of the areas of the rural training program curriculum most in need of reform.

  17. Training needs analysis for MSMEs: how to improve training effectiveness

    NASA Astrophysics Data System (ADS)

    Rohayati, Y.; Wulandari, S.

    2017-12-01

    The study aims to analyze training needs for MSMEs in the area of Kabupaten Bandung by selecting the case of MSMEs joined in Association for Agricultural Product Process, focusing on marketing as the main topic of the training. The needs analysis was required to improve training participation and effectiveness. Both aspects are important to notice since making MSMEs participate in training is not an easy task. Similarly, the needs analysis was carried out to anticipate participants’ thoughts that the training does not give any benefits for them or is ineffective because it does not meet their needs although it was actually to help MSMEs improve their marketing knowledge expected to lead to their success. This research involved 100 MSMEs with business ages starting from less than five years to more than 15 years. Those involved MSMEs were dominated by MSMEs targeting local marketing areas. The data were collected by survey and judgmental sampling technique. By conducting a descriptive analysis, it can be concluded that the needs of SMEs on marketing training materials should focus on improving marketing skills such as product development, sales, and use of marketing media as well as discussing legal aspects such as the need for certification and product brand. The results of the study also concluded that there is a need for training that is supplemented by making visits to more successful SMEs as well as practices with on the job training methods.

  18. Meeting Unique Student Needs: Dual-Identified Students and Teacher Self-Efficacy

    ERIC Educational Resources Information Center

    Dornayi, Hassan Mohsen

    2017-01-01

    This study explored the connection between how confident teachers feel about their skills in teaching dual-identified students and the types and amounts of training they have received. Additionally, this study attempted to find out what the needs of teachers were in order to help them feel more confident in their abilities to teach these students.…

  19. Identifying and Addressing the Needs of Adolescents and Young Adults With Cancer: Summary of an Institute of Medicine Workshop

    PubMed Central

    Beaupin, Lynda K.; Demark-Wahnefried, Wendy; Fasciano, Karen; Ganz, Patricia A.; Hayes-Lattin, Brandon; Hudson, Melissa M.; Nevidjon, Brenda; Oeffinger, Kevin C.; Rechis, Ruth; Richardson, Lisa C.; Seibel, Nita L.; Smith, Ashley W.

    2015-01-01

    Cancer is the leading disease-related cause of death in adolescents and young adults (AYAs). This population faces many short- and long-term health and psychosocial consequences of cancer diagnosis and treatment, but many programs for cancer treatment, survivorship care, and psychosocial support do not focus on the specific needs of AYA cancer patients. Recognizing this health care disparity, the National Cancer Policy Forum of the Institute of Medicine convened a public workshop to examine the needs of AYA patients with cancer. Workshop participants identified many gaps and challenges in the care of AYA cancer patients and discussed potential strategies to address these needs. Suggestions included ways to improve access to care for AYAs, to deliver cancer care that better meets the medical and psychosocial needs of AYAs, to develop educational programs for providers who care for AYA cancer survivors, and to enhance the evidence base for AYAs with cancer by facilitating participation in research. PMID:25568146

  20. Identifying priorities for improving rear seat occupant protection.

    DOT National Transportation Integrated Search

    2009-03-01

    This project helped to identify priorities for improving the safety of rear seat occupants through a literature review and NASS-CDS injury analysis. The literature review covers injury patterns of rear seat occupants, new safety technologies intended...

  1. Pesticide regulations and farm worker safety: the need to improve pesticide regulations in Viet Nam.

    PubMed

    Phung, Dung Tri; Connell, Des; Miller, Greg; Rutherford, Shannon; Chu, Cordia

    2012-06-01

    Agricultural pesticide use in Viet Nam has more than tripled since 1990. However, pesticide legislation and regulations have not been developed in response to this large increase in usage, as a result of which pesticides pose a serious threat to human health and the environment. This paper identifies the need to improve pesticide regulations in Viet Nam through a comparative analysis of pesticide regulations in Viet Nam and the United States of America, where the rate of acute poisoning among agricultural workers is much lower than in Viet Nam and where information pertaining to pesticide regulations is made accessible to the public. The analysis identified several measures that would help to improve Viet Nam's pesticide regulations. These include enhancing pesticide legislation, clarifying the specific roles and active involvement of both the environmental and health sectors; performing a comprehensive risk-benefit evaluation of pesticide registration and management practices; improving regulations on pesticide suspension and cancellation, transport, storage and disposal; developing import and export policies and enhancing pesticide-related occupational safety programmes.

  2. Insights from an international stakeholder consultation to identify informational needs related to seafood safety

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

    Tediosi, Alice, E-mail: alice.tediosi@aeiforia.eu; Fait, Gabriella; Jacobs, Silke

    Food safety assessment and communication have a strong importance in reducing human health risks related to food consumption. The research carried out within the ECsafeSEAFOOD project aims to assess seafood safety issues, mainly related to non-regulated priority environmental contaminants, and to evaluate their impact on public health. In order to make the research results accessible and exploitable, and to respond to actual stakeholders' demands, a consultation with international stakeholders was performed by means of a survey. The focus was on policy and decision makers, food producers and processors, and agencies (i.e. EU and National or Regional agencies related to Foodmore » Safety or Public Health) and consumer organisations. The survey considered questions related to: seafood safety assessment and mitigation strategies, availability of data, such as the level of information on different contaminants, and communication among different stakeholder groups. Furthermore, stakeholders were asked to give their opinion on how they believe consumers perceive risks associated with environmental contaminants. The survey was distributed to 531 key stakeholders and 91 responses were received from stakeholders from 30 EU and non-EU countries. The main results show that communication between different groups of stakeholders needs to be improved and that there is a deficit of information and data in the field of seafood safety. This pertains mainly to the transfer of contaminants between the environment and seafood, and to the diversity of environmental contaminants such as plastic additives, algal toxins and hormones. On-line tools were perceived to be the most useful communication channel. - Highlights: • We consulted stakeholders to identify their needs about seafood safety. • An on-line survey was prepared and sent to gather stakeholders' opinions. • Communication among stakeholders needs to be improved. • There is a deficit of information and data in the

  3. Identify the Best Evidence for School and Student Improvement

    ERIC Educational Resources Information Center

    Thessin, Rebecca A.

    2016-01-01

    Empowering teachers to use data effectively as part of a process of instructional improvement calls for schools and districts to engage in systematic collection and analysis of evidence as part of an ongoing school improvement cycle. In research and practice, the author has identified four steps school leaders--supported by central office--must…

  4. Identifying strategies to improve access to credible and relevant information for public health professionals: a qualitative study

    PubMed Central

    LaPelle, Nancy R; Luckmann, Roger; Simpson, E Hatheway; Martin, Elaine R

    2006-01-01

    Background Movement towards evidence-based practices in many fields suggests that public health (PH) challenges may be better addressed if credible information about health risks and effective PH practices is readily available. However, research has shown that many PH information needs are unmet. In addition to reviewing relevant literature, this study performed a comprehensive review of existing information resources and collected data from two representative PH groups, focusing on identifying current practices, expressed information needs, and ideal systems for information access. Methods Nineteen individual interviews were conducted among employees of two domains in a state health department – communicable disease control and community health promotion. Subsequent focus groups gathered additional data on preferences for methods of information access and delivery as well as information format and content. Qualitative methods were used to identify themes in the interview and focus group transcripts. Results Informants expressed similar needs for improved information access including single portal access with a good search engine; automatic notification regarding newly available information; access to best practice information in many areas of interest that extend beyond biomedical subject matter; improved access to grey literature as well as to more systematic reviews, summaries, and full-text articles; better methods for indexing, filtering, and searching for information; and effective ways to archive information accessed. Informants expressed a preference for improving systems with which they were already familiar such as PubMed and listservs rather than introducing new systems of information organization and delivery. A hypothetical ideal model for information organization and delivery was developed based on informants' stated information needs and preferred means of delivery. Features of the model were endorsed by the subjects who reviewed it. Conclusion

  5. Identifying Canadian Teacher Candidates' Needs for Training in the Use of Inclusive Classroom Assessment

    ERIC Educational Resources Information Center

    Lin, Pei-Ying; Lin, Yu-Cheng

    2015-01-01

    To identify teacher candidates' needs for training in inclusive classroom assessment, the present study investigated teacher candidates' beliefs about inclusive classroom assessments for all students educated in regular classrooms, including those with special needs and English language learners. An innovative theoretical assessment model,…

  6. Sustaining Teen Pregnancy Prevention Programs in Schools: Needs and Barriers Identified by School Leaders.

    PubMed

    Craft, Lesley R; Brandt, Heather M; Prince, Mary

    2016-04-01

    To reduce teen pregnancy rates, prevention programs must be consistently available to large numbers of youth. However, prevention efforts have been historically conducted with little emphasis on ensuring program sustainability. This study examined the needs and barriers to sustaining teen pregnancy prevention (TPP) programming in schools after grant funding has ended, as identified by school leadership. A total of 11 qualitative interviews were conducted between June and September 2012 with middle school leaders from 11 schools involved in current implementation of a TPP program in South Carolina. Interviews were audio-recorded, transcribed verbatim, and thematically coded. Identified needs and barriers to sustainability varied across schools. Common barriers to program sustainability included: lack of materials and supplies, insufficient funding (at the school and district level), lack of support and/or parental opposition, and other school/district priorities. School leaders also identified several needs to continue TPP programming, including: continued funding, trainings, outcome/effectiveness data to support the program, and regularly updated curriculum. Schools with greater perceived needs and barriers may be less likely to sustain. Knowledge gained through this research may be used to inform future interventions and sustainability planning efforts, allowing us to maximize prevention programming. © 2016, American School Health Association.

  7. Needs assessment for nondestructive testing and materials characterization for improved reliability in structural ceramics for heat engines

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

    Johnson, D.R.; McClung, R.W.; Janney, M.A.

    1987-08-01

    A needs assessment was performed for nondestructive testing and materials characterization to achieve improved reliability in ceramic materials for heat engine applications. Raw materials, green state bodies, and sintered ceramics were considered. The overall approach taken to improve reliability of structural ceramics requires key inspections throughout the fabrication flowsheet, including raw materials, greed state, and dense parts. The applications of nondestructive inspection and characterization techniques to ceramic powders and other raw materials, green ceramics, and sintered ceramics are discussed. The current state of inspection technology is reviewed for all identified attributes and stages of a generalized flowsheet for advanced structuralmore » ceramics, and research and development requirements are identified and listed in priority order. 164 refs., 3 figs.« less

  8. The use of think-aloud protocols to identify a decision-making process of community pharmacists aimed at improving CMS Star Ratings scores.

    PubMed

    George, David L; Smith, Michael J; Draugalis, JoLaine R; Tolma, Eleni L; Keast, Shellie L; Wilson, Justin B

    2018-03-01

    The Center for Medicare and Medicaid Services (CMS) created the Star Rating system based on multiple measures that indicate the overall quality of health plans. Community pharmacists can impact certain Star Ratings measure scores through medication adherence and patient safety interventions. To explore methods, needs, and workflow issues of community pharmacists to improve CMS Star Ratings measures. Think-aloud protocols (TAPs) were conducted with active community retail pharmacists in Oklahoma. Each TAP was audio recorded and transcribed to documents for analysis. Analysts agreed on common themes, illuminated differences in findings, and saturation of the data gathered. Methods, needs, and workflow themes of community pharmacists associated with improving Star Ratings measures were compiled and organized to exhibit a decision-making process. Five TAPs were performed among three independent pharmacy owners, one multi-store owner, and one chain-store administrator. A thematically common 4-step process to monitor and improve CMS Star Ratings scores among participants was identified. To improve Star Ratings measures, pharmacists: 1) used technology to access scores, 2) analyzed data to strategically set goals, 3) assessed individual patient information for comprehensive assessment, and 4) decided on interventions to best impact Star Ratings scores. Participants also shared common needs, workflow issues, and benefits associated with methods used in improving Star Ratings. TAPs were useful in exploring processes of pharmacists who improve CMS Star Ratings scores. Pharmacists demonstrated and verbalized their methods, workflow issues, needs, and benefits related to performing the task. The themes and decision-making process identified to improving CMS Star Ratings scores will assist in the development of training and education programs for pharmacists in the community setting. Published by Elsevier Inc.

  9. Bulk Fuel: Actions Needed to Improve DODs Fuel Consumption Budget Data

    DTIC Science & Technology

    2016-09-01

    BULK FUEL Actions Needed to Improve DOD’s Fuel Consumption Budget Data Report to Congressional Committees...16-644, a report to congressional committees. September 2016 BULK FUEL Actions Needed to Improve DOD’s Fuel Consumption Budget Data What GAO...of about $10.1 billion in fiscal year 2015 but differed from budget estimates, which officials largely attributed to changes in operations and

  10. The Contribution of Qualitative Methods for Identifying the Educational Needs of Adults

    ERIC Educational Resources Information Center

    Boz, Hayat; Dagli, Yakup

    2017-01-01

    This study addresses the contribution of applying qualitative research methods for identifying the educational activities planned for adults. The paper is based on the experience gained during in-depth interviews with 39 elderly and 33 middle-aged participants, by purposive sampling method and maximum variation technique, within a needs analysis…

  11. Engaging police to identify challenging school crossings and potential improvements.

    PubMed

    Bull, Catherine B; Von Hagen, Leigh Ann; Lubin, Andrea; Shivaraman, Gayathri; Chibbaro, Daniel

    2018-04-26

    This paper discusses the value of police officers as vital sources of information regarding pedestrian safety in their communities by presenting results from a survey of traffic safety police officers. The survey requested information on school crossings that the officers considered most challenging for pedestrians. Officers specified the intersections or mid-block locations with school crossings, and answered questions about elements of the locations, such as what makes the locations challenging, and what might be done to improve conditions at these locations. A key finding from the survey is the police officers' identification of challenging intersections or other crossing locations by criteria other than the occurrence of crashes, including reported pedestrian-vehicle near-miss incidents. A broad literature review of pedestrian safety studies provides context for the use of near-miss data in discussions of improvements to pedestrian crossings. Although not typically considered a primary resource for pedestrian safety information, police officers are most often very familiar with their communities, work in locations where pedestrian and motor vehicle traffic can be experienced and observed, and receive information from their staff and members of the public who use pedestrian crossings. The survey findings demonstrate that police officer insights and near-miss data may serve as important supplementary sources of information in the effort to identify locations in need of interventions before crash occurrence. Copyright © 2018 Elsevier Ltd. All rights reserved.

  12. Pesticide regulations and farm worker safety: the need to improve pesticide regulations in Viet Nam

    PubMed Central

    Connell, Des; Miller, Greg; Rutherford, Shannon; Chu, Cordia

    2012-01-01

    Abstract Agricultural pesticide use in Viet Nam has more than tripled since 1990. However, pesticide legislation and regulations have not been developed in response to this large increase in usage, as a result of which pesticides pose a serious threat to human health and the environment. This paper identifies the need to improve pesticide regulations in Viet Nam through a comparative analysis of pesticide regulations in Viet Nam and the United States of America, where the rate of acute poisoning among agricultural workers is much lower than in Viet Nam and where information pertaining to pesticide regulations is made accessible to the public. The analysis identified several measures that would help to improve Viet Nam’s pesticide regulations. These include enhancing pesticide legislation, clarifying the specific roles and active involvement of both the environmental and health sectors; performing a comprehensive risk–benefit evaluation of pesticide registration and management practices; improving regulations on pesticide suspension and cancellation, transport, storage and disposal; developing import and export policies and enhancing pesticide-related occupational safety programmes. PMID:22690037

  13. Nominal group technique: a brainstorming tool for identifying areas to improve pain management in hospitalized patients.

    PubMed

    Peña, Adolfo; Estrada, Carlos A; Soniat, Debbie; Taylor, Benjamin; Burton, Michael

    2012-01-01

    Pain management in hospitalized patients remains a priority area for improvement; effective strategies for consensus development are needed to prioritize interventions. To identify challenges, barriers, and perspectives of healthcare providers in managing pain among hospitalized patients. Qualitative and quantitative group consensus using a brainstorming technique for quality improvement-the nominal group technique (NGT). One medical, 1 medical-surgical, and 1 surgical hospital unit at a large academic medical center. Nurses, resident physicians, patient care technicians, and unit clerks. Responses and ranking to the NGT question: "What causes uncontrolled pain in your unit?" Twenty-seven health workers generated a total of 94 ideas. The ideas perceived contributing to a suboptimal pain control were grouped as system factors (timeliness, n = 18 ideas; communication, n = 11; pain assessment, n = 8), human factors (knowledge and experience, n = 16; provider bias, n = 8; patient factors, n = 19), and interface of system and human factors (standardization, n = 14). Knowledge, timeliness, provider bias, and patient factors were the top ranked themes. Knowledge and timeliness are considered main priorities to improve pain control. NGT is an efficient tool for identifying general and context-specific priority areas for quality improvement; teams of healthcare providers should consider using NGT to address their own challenges and barriers. Copyright © 2011 Society of Hospital Medicine.

  14. Identifying children with special health care needs: development and evaluation of a short screening instrument.

    PubMed

    Bethell, Christina D; Read, Debra; Stein, Ruth E K; Blumberg, Stephen J; Wells, Nora; Newacheck, Paul W

    2002-01-01

    Public agencies, health care plans, providers, and consumer organizations share the need to monitor the health care needs and quality of care for children with special health care needs (CSHCN). Doing so requires a definition of CSHCN and a precise methodology for operationalizing that definition. The purpose of this study was to develop an efficient and flexible consequence-based screening instrument that identifies CSHCN across populations with rates commensurate with other studies of CSHCN. The CSHCN Screener was developed using the federal Maternal and Child Health Bureau (MCHB) definition of CSHCN and building on the conceptual and empirical properties of the Questionnaire for Identifying Children with Chronic Conditions (QuICCC) and other consequence-based models for identifying CSHCN. The CSHCN Screener was administered to 3 samples: a national sample of households with children (n = 17985), children enrolled in Medicaid managed care health plans (n = 3894), and children receiving Supplemental Security Income (SSI) benefits in Washington State (n = 1550). The efficiency, impact of further item reduction, and flexibility of administration mode were evaluated. Rates and expected variation in rates across demographic groups of children positively identified by one or more of the 5 CSHCN Screener item sequences in each sample were examined and multinomial logistic regression analysis were conducted to evaluate the effect of child characteristics in predicting positive identification. The CSHCN Screener took approximately 1 minute per child to administer by telephone and 2.1 minutes per household. During self-administration, over 98% of respondents completed each of the 5 CSHCN Screener item sequences, and respondents accurately followed each of the item skip patterns 94% of the time. Mailed surveys and telephone-administered surveys led to similar rates of positive identification in the same sample. Two Screener items would have identified 80%-90% of children

  15. When a checklist is not enough: How to improve them and what else is needed.

    PubMed

    Raman, Jaishankar; Leveson, Nancy; Samost, Aubrey Lynn; Dobrilovic, Nikola; Oldham, Maggie; Dekker, Sidney; Finkelstein, Stan

    2016-08-01

    Checklists are being introduced to enhance patient safety, but the results have been mixed. The goal of this research is to understand why time-outs and checklists are sometimes not effective in preventing surgical adverse events and to identify additional measures needed to reduce these events. A total of 380 consecutive patients underwent complex cardiac surgery over a 24-month period between November 2011 and November 2013 at an academic medical center, out of a total of 529 cardiac cases. Elective isolated aortic valve replacements, mitral valve repairs, and coronary artery bypass graft surgical procedures (N = 149) were excluded. A time-out was conducted in a standard fashion in all patients in accordance with the World Health Organization surgical checklist protocol. Adverse events were classified as anything that resulted in an operative delay, nonavailability of equipment, failure of drug administration, or unexpected adverse clinical outcome. These events and their details were collected every week and analyzed using a systemic causal analysis technique using a technique called CAST (causal analysis based on systems theory). This analytic technique evaluated the sociotechnical system to identify the set of causal factors involved in the adverse events and the causal factors explored to identify reasons. Recommendations were made for the improvement of checklists and the use of system design changes that could prevent such events in the future. Thirty events were identified. The causal analysis of these 30 adverse events was carried out and actionable events classified. There were important limitations in the use of standard checklists as a stand-alone patient safety measure in the operating room setting, because of multiple factors. Major categories included miscommunication between staff, medication errors, missing instrumentation, missing implants, and improper handling of equipment or instruments. An average of 3.9 recommendations were generated for

  16. The Need for Formal Surgical Global Health Programs and Improved Mission Trip Coordination.

    PubMed

    Medoff, Sar; Freed, Jeffrey

    There is a dire need for more surgical services as part of improving global health. Conditions treatable with surgery account for 11% of the global burden of disease, with a disproportionate burden affecting low- and middle-income countries (LMICs). Less than 6% of the world's operations are performed in LMICs, with relief organizations performing nearly 250,000 operations annually in LMICs in addition to each country's domestic surgical capacity. Currently, surgical needs are not adequately met by the existing patchwork of federal and nongovernmental organizations' surgical services and surgical mission trips. Improving coordination between mission trips may have synergistic benefits for maximizing the efficacy of the individual trips and improving the overall quality of care. To establish whether cooperation between surgical mission trips can lead to operational efficiency and to identify obstacles to cooperation. In order to establish the veracity of cooperation translating into efficiency and to identify obstacles that prevent cooperation, a 50-question survey was created (see Supplement 1). The survey was sent to surgical program directors of the 147 major surgical programs in the United States and Canada with a follow-up telephone survey of 18 randomly selected programs. The survey response rate was 14%. Although 90% of respondent programs mount at least 1 mission trip per year, only one-third confirmed the existence of global health or surgical global health programs at their institution (33%). There was significant interest in cooperating with programs at other institutions (80%). When asked why they do not communicate with humanitarian aid organizations doing similar work, 53% of respondents reported a "lack of knowledge of how to find similar organizations to mine doing similar work." An additional 21% of respondents were "unaware that coordination is possible." A minority of respondent surgery programs host formal, organized surgical global health

  17. Additional Research Needs to Support the GENII Biosphere Models

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

    Napier, Bruce A.; Snyder, Sandra F.; Arimescu, Carmen

    In the course of evaluating the current parameter needs for the GENII Version 2 code (Snyder et al. 2013), areas of possible improvement for both the data and the underlying models have been identified. As the data review was implemented, PNNL staff identified areas where the models can be improved both to accommodate the locally significant pathways identified and also to incorporate newer models. The areas are general data needs for the existing models and improved formulations for the pathway models.

  18. The hepatitis C cascade of care: identifying priorities to improve clinical outcomes.

    PubMed

    Linas, Benjamin P; Barter, Devra M; Leff, Jared A; Assoumou, Sabrina A; Salomon, Joshua A; Weinstein, Milton C; Kim, Arthur Y; Schackman, Bruce R

    2014-01-01

    As highly effective hepatitis C virus (HCV) therapies emerge, data are needed to inform the development of interventions to improve HCV treatment rates. We used simulation modeling to estimate the impact of loss to follow-up on HCV treatment outcomes and to identify intervention strategies likely to provide good value for the resources invested in them. We used a Monte Carlo state-transition model to simulate a hypothetical cohort of chronically HCV-infected individuals recently screened positive for serum HCV antibody. We simulated four hypothetical intervention strategies (linkage to care; treatment initiation; integrated case management; peer navigator) to improve HCV treatment rates, varying efficacies and costs, and identified strategies that would most likely result in the best value for the resources required for implementation. Sustained virologic responses (SVRs), life expectancy, quality-adjusted life expectancy (QALE), costs from health system and program implementation perspectives, and incremental cost-effectiveness ratios (ICERs). We estimate that imperfect follow-up reduces the real-world effectiveness of HCV therapies by approximately 75%. In the base case, a modestly effective hypothetical peer navigator program maximized the number of SVRs and QALE, with an ICER compared to the next best intervention of $48,700/quality-adjusted life year. Hypothetical interventions that simultaneously addressed multiple points along the cascade provided better outcomes and more value for money than less costly interventions targeting single steps. The 5-year program cost of the hypothetical peer navigator intervention was $14.5 million per 10,000 newly diagnosed individuals. We estimate that imperfect follow-up during the HCV cascade of care greatly reduces the real-world effectiveness of HCV therapy. Our mathematical model shows that modestly effective interventions to improve follow-up would likely be cost-effective. Priority should be given to developing and

  19. Identifying the Strengths, Needs, and Barriers to Student Success for First Generation, Low-Income, First Year College Students

    ERIC Educational Resources Information Center

    Hayes, Linda A.

    2013-01-01

    This participatory action research needs assessment was to empower the students in a large urban research university to explore and to identify the strengths of the program, to identify the needs, and to identify the barriers to student success during their first year of college. Using qualitative methods of Group Level Interviews (GLA) and…

  20. Using structured and unstructured data to identify patients' need for services that address the social determinants of health.

    PubMed

    Vest, Joshua R; Grannis, Shaun J; Haut, Dawn P; Halverson, Paul K; Menachemi, Nir

    2017-11-01

    Increasingly, health care providers are adopting population health management approaches that address the social determinants of health (SDH). However, effectively identifying patients needing services that address a SDH in primary care settings is challenging. The purpose of the current study is to explore how various data sources can identify adult primary care patients that are in need of services that address SDH. A cross-sectional study described patients in need of SDH services offered by a safety-net hospital's federally qualified health center clinics. SDH services of social work, behavioral health, nutrition counseling, respiratory therapy, financial planning, medical-legal partnership assistance, patient navigation, and pharmacist consultation were offered on a co-located basis and were identified using structured billing and scheduling data, and unstructured electronic health record data. We report the prevalence of the eight different SDH service needs and the patient characteristics associated with service need. Moreover, characteristics of patients with SDH services need documented in structured data sources were compared with those documented by unstructured data sources. More than half (53%) of patients needed SDH services. Those in need of such services tended to be female, older, more medically complex, and higher utilizers of services. Structured and unstructured data sources exhibited poor agreement on patient SDH services need. Patients with SDH services need documented by unstructured data tended to be more complex. The need for SDH services among a safety-net population is high. Identifying patients in need of such services requires multiple data sources with structured and unstructured data. Copyright © 2017. Published by Elsevier B.V.

  1. White spots in pharmaceutical pipelines-EMA identifies potential areas of unmet medical needs.

    PubMed

    Papaluca, Marisa; Greco, Martina; Tognana, Enrico; Ehmann, Falk; Saint-Raymond, Agnès

    2015-05-01

    Unmet medical needs are a priority for organizations such as the WHO and major public-private initiatives, such as Innovative Medicines Initiative, were established to speed up the development of better and safer medicines for patients. To assist such projects, the EMA in its 'Road Map to 2015' considered the mapping of unmet medical needs as a priority. This study has identified medical conditions for which the EMA could not identify developments in the pharmaceutical pipelines, that is, 'white spots'. Our analysis was made using external data sources as well as mining data of the EMA. The main areas for white spots were oncology, infectious diseases and certain psychiatric conditions. According to our data and a review of literature, in a number of these white spots, diagnostic tools may even be missing. The identification of those conditions will benefit stakeholders, including regulators, research funding bodies and patients' organizations.

  2. A National Needs Assessment to Identify Technical Procedures in Vascular Surgery for Simulation Based Training.

    PubMed

    Nayahangan, L J; Konge, L; Schroeder, T V; Paltved, C; Lindorff-Larsen, K G; Nielsen, B U; Eiberg, J P

    2017-04-01

    Practical skills training in vascular surgery is facing challenges because of an increased number of endovascular procedures and fewer open procedures, as well as a move away from the traditional principle of "learning by doing." This change has established simulation as a cornerstone in providing trainees with the necessary skills and competences. However, the development of simulation based programs often evolves based on available resources and equipment, reflecting convenience rather than a systematic educational plan. The objective of the present study was to perform a national needs assessment to identify the technical procedures that should be integrated in a simulation based curriculum. A national needs assessment using a Delphi process was initiated by engaging 33 predefined key persons in vascular surgery. Round 1 was a brainstorming phase to identify technical procedures that vascular surgeons should learn. Round 2 was a survey that used a needs assessment formula to explore the frequency of procedures, the number of surgeons performing each procedure, risk and/or discomfort, and feasibility for simulation based training. Round 3 involved elimination and ranking of procedures. The response rate for round 1 was 70%, with 36 procedures identified. Round 2 had a 76% response rate and resulted in a preliminary prioritised list after exploring the need for simulation based training. Round 3 had an 85% response rate; 17 procedures were eliminated, resulting in a final prioritised list of 19 technical procedures. A national needs assessment using a standardised Delphi method identified a list of procedures that are highly suitable and may provide the basis for future simulation based training programs for vascular surgeons in training. Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  3. Attention-deficit/hyperactivity disorder: identifying high priority future research needs.

    PubMed

    Gaynes, Bradley N; Christian, Robert; Saavedra, Lissette M; Wines, Roberta; Jonas, Daniel E; Viswanathan, Meera; Ellis, Alan R; Woodell, Carol; Carey, Timothy S

    2014-03-01

    With onset often occurring before 6 years of age, attention-deficit/hyperactivity disorder (ADHD) involves attention problems, impulsivity, overactivity, and sometimes disruptive behavior. Impairment usually persists into adulthood, with an estimated worldwide prevalence in adults of 2.5%. Existing gaps in evidence concerning ADHD hinder decision-making about treatment. This article describes and prioritizes future research needs for ADHD in three areas: treatment effectiveness for at-risk preschoolers; long-term treatment effectiveness; and variability in prevalence, diagnosis, and treatment.Using a recent systematic review concerning ADHD completed by a different evidence-based practice center as a foundation, we worked with a diverse group of 12 stakeholders, who represented researchers, funders, healthcare providers, patients, and families, to identify and prioritize research needs. From an initial list of 29 evidence gaps, we enumerated 8 high-priority research needs: a) accurate, brief standardized diagnosis and assessment; b) comparative effectiveness and safety of pharmacologic treatments for children under 6 years of age; c) comparative effectiveness of different combinations of psychosocial and pharmacologic treatments for children under 6 years of age; d) case identification and measurement of prevalence and outcomes; e) comparative effectiveness of psychosocial treatment alone versus pharmacologic and combination treatments for children under 6 years of age; f) comparative long-term treatment effectiveness for people 6 years of age and older; g) relative efficacy of specific psychosocial program components for children under 6 years of age; and h) identification of person-level effect modifiers for people 6 years of age and older. In this article, we describe these future research needs in detail and discuss study designs that could be used to address them.

  4. Improving Catastrophe Modeling for Business Interruption Insurance Needs.

    PubMed

    Rose, Adam; Huyck, Charles K

    2016-10-01

    While catastrophe (CAT) modeling of property damage is well developed, modeling of business interruption (BI) lags far behind. One reason is the crude nature of functional relationships in CAT models that translate property damage into BI. Another is that estimating BI losses is more complicated because it depends greatly on public and private decisions during recovery with respect to resilience tactics that dampen losses by using remaining resources more efficiently to maintain business function and to recover more quickly. This article proposes a framework for improving hazard loss estimation for BI insurance needs. Improved data collection that allows for analysis at the level of individual facilities within a company can improve matching the facilities with the effectiveness of individual forms of resilience, such as accessing inventories, relocating operations, and accelerating repair, and can therefore improve estimation accuracy. We then illustrate the difference this can make in a case study example of losses from a hurricane. © 2016 Society for Risk Analysis.

  5. Homeless Veterans: Management Improvements Could Help VA Better Identify Supportive Housing Projects

    DTIC Science & Technology

    2016-12-01

    HOMELESS VETERANS Management Improvements Could Help VA Better Identify Supportive-Housing Projects Report to...VETERANS Management Improvements Could Help VA Better Identify Supportive-Housing Projects What GAO Found As of September 2016, for veterans who...disabled veterans. These supportive-housing EULs receive project -based HUD-VASH vouchers, which provide housing subsidies, on-site case management

  6. Persistent Identifiers for Improved Accessibility for Linked Data Querying

    NASA Astrophysics Data System (ADS)

    Shepherd, A.; Chandler, C. L.; Arko, R. A.; Fils, D.; Jones, M. B.; Krisnadhi, A.; Mecum, B.

    2016-12-01

    The adoption of linked open data principles within the geosciences has increased the amount of accessible information available on the Web. However, this data is difficult to consume for those who are unfamiliar with Semantic Web technologies such as Web Ontology Language (OWL), Resource Description Framework (RDF) and SPARQL - the RDF query language. Consumers would need to understand the structure of the data and how to efficiently query it. Furthermore, understanding how to query doesn't solve problems of poor precision and recall in search results. For consumers unfamiliar with the data, full-text searches are most accessible, but not ideal as they arrest the advantages of data disambiguation and co-reference resolution efforts. Conversely, URI searches across linked data can deliver improved search results, but knowledge of these exact URIs may remain difficult to obtain. The increased adoption of Persistent Identifiers (PIDs) can lead to improved linked data querying by a wide variety of consumers. Because PIDs resolve to a single entity, they are an excellent data point for disambiguating content. At the same time, PIDs are more accessible and prominent than a single data provider's linked data URI. When present in linked open datasets, PIDs provide balance between the technical and social hurdles of linked data querying as evidenced by the NSF EarthCube GeoLink project. The GeoLink project, funded by NSF's EarthCube initiative, have brought together data repositories include content from field expeditions, laboratory analyses, journal publications, conference presentations, theses/reports, and funding awards that span scientific studies from marine geology to marine ecosystems and biogeochemistry to paleoclimatology.

  7. Social Work Admission Assessment Tool for Identifying Patients in Need of Comprehensive Social Work Evaluation

    ERIC Educational Resources Information Center

    Boutin-Foster, Carla; Euster, Sona; Rolon, Yvette; Motal, Athena; BeLue, Rhonda; Kline, Robin; Charlson, Mary E.

    2005-01-01

    Early identification of patients who need a social work evaluation is integral to effective discharge planning. This article describes the development and application of the Social Work Admission Assessment Tool (SWAAT), a six-item scale that identifies patients with complicated discharge needs who require a social work evaluation. It addresses…

  8. Identifying the Training Needs of Heads of Department in a Newly Established University in Vietnam

    ERIC Educational Resources Information Center

    Nguyen, Thi Lan Huong

    2012-01-01

    Although middle-level academic managers really need training in order to perform their roles adequately in the very changing context of higher education, little formal training is provided, particularly in less developed countries. This paper identifies the training needs of Heads of Department in a newly established university in Vietnam as a…

  9. Enabling Teachers to Explore Grade Patterns to Identify Individual Needs and Promote Fairer Student Assessment

    ERIC Educational Resources Information Center

    Friedler, Sorelle A.; Tan, Yee Lin; Peer, Nir J.; Shneiderman, Ben

    2008-01-01

    Exploring student test, homework, and other assessment scores is a challenge for most teachers, especially when attempting to identify cross-assessment weaknesses and produce final course grades. During the course, teachers need to identify subject weaknesses in order to help students who are struggling with a particular topic. This identification…

  10. Health and Household Air Pollution from Solid Fuel Use: The Need for Improved Exposure Assessment

    PubMed Central

    Peel, Jennifer L.; Balakrishnan, Kalpana; Breysse, Patrick N.; Chillrud, Steven N.; Naeher, Luke P.; Rodes, Charles E.; Vette, Alan F.; Balbus, John M.

    2013-01-01

    Background: Nearly 3 billion people worldwide rely on solid fuel combustion to meet basic household energy needs. The resulting exposure to air pollution causes an estimated 4.5% of the global burden of disease. Large variability and a lack of resources for research and development have resulted in highly uncertain exposure estimates. Objective: We sought to identify research priorities for exposure assessment that will more accurately and precisely define exposure–response relationships of household air pollution necessary to inform future cleaner-burning cookstove dissemination programs. Data Sources: As part of an international workshop in May 2011, an expert group characterized the state of the science and developed recommendations for exposure assessment of household air pollution. Synthesis: The following priority research areas were identified to explain variability and reduce uncertainty of household air pollution exposure measurements: improved characterization of spatial and temporal variability for studies examining both short- and long-term health effects; development and validation of measurement technology and approaches to conduct complex exposure assessments in resource-limited settings with a large range of pollutant concentrations; and development and validation of biomarkers for estimating dose. Addressing these priority research areas, which will inherently require an increased allocation of resources for cookstove research, will lead to better characterization of exposure–response relationships. Conclusions: Although the type and extent of exposure assessment will necessarily depend on the goal and design of the cookstove study, without improved understanding of exposure–response relationships, the level of air pollution reduction necessary to meet the health targets of cookstove interventions will remain uncertain. Citation: Clark ML, Peel JL, Balakrishnan K, Breysse PN, Chillrud SN, Naeher LP, Rodes CE, Vette AF, Balbus JM. 2013. Health

  11. Elective surgical case cancellation in the Veterans Health Administration system: identifying areas for improvement.

    PubMed

    Argo, Joshua L; Vick, Catherine C; Graham, Laura A; Itani, Kamal M F; Bishop, Michael J; Hawn, Mary T

    2009-11-01

    This study evaluated elective surgical case cancellation (CC) rates, reasons for these cancellations, and identified areas for improvement within the Veterans Health Administration (VA) system. CC data for 2006 were collected from the scheduling software for 123 VA facilities. Surveys were distributed to 40 facilities (10 highest and 10 lowest CC rates for high- and low-volume facilities). CC reasons were standardized and piloted at 5 facilities. Of 329,784 cases scheduled by 9 surgical specialties, 40,988 (12.4%) were cancelled. CC reasons (9,528) were placed into 6 broad categories: patient (35%), work-up/medical condition change (28%), facility (20%), surgeon (8%), anesthesia (1%), and miscellaneous (8%). Survey results show areas for improvement at the facility level and a standardized list of 28 CC reasons was comprehensive. Interventions that decrease cancellations caused by patient factors, inadequate work-up, and facility factors are needed to reduce overall elective surgical case cancellations.

  12. A Needs Assessment: The Parenting Needs of Parents of Typical Children, Ages 6-10

    ERIC Educational Resources Information Center

    Cho, Charles Joon

    2012-01-01

    Programs and resources are available to parents to inform and improve their parenting skills. Despite these resources, the need for parent education continues to increase as parents find existing networks unsatisfactory or inaccessible. Parenting programs have produced inconsistent results in meeting the needs of parents. This study identifies the…

  13. Quick Reference Guide: Working with Stakeholders to Identify Potential Improvement Strategies for Program Improvement (Including the SSIP)

    ERIC Educational Resources Information Center

    Center for IDEA Early Childhood Data Systems (DaSy), 2015

    2015-01-01

    This 2015 quick reference guide is designed to assist states in understanding what information needs to be available in order for stakeholders to assist in selecting potential improvement strategies that will increase capacity of Local Education Agencies (LEAs), Early Intervention Services (EIS) programs, and practitioners to improve results for…

  14. Leading change: 1--identifying the issue.

    PubMed

    Kerridge, Joanna

    To enable sustainable change, nurses need to take the lead in managing it. Recent national initiatives have emphasised the importance of frontline staff in service improvement. The ability to influence and manage change has been identified as an essential skill for delivering new models of care. This article is the first in a three-part series designed to help nurses at all levels develop the knowledge and skills they will need to initiate and manage change. This article focuses on identifying what needs to be changed and why.

  15. Improving Education and Training for Educational Administrators and Managers: Urgent Needs.

    ERIC Educational Resources Information Center

    Hughes, M. G.

    This paper advocates giving urgent attention to improving the education and training of educational administrators and managers, realizing the need to respond to rapid and far-reaching political and social change worldwide, and to consequent change within national educational systems. The improvement of administrative structures and the…

  16. CUSTOMS SERVICE MODERNIZATION: Management Improvements Needed on High-Risk Automated Commercial Environment Project

    DTIC Science & Technology

    2002-05-01

    GAO United States General Accounting OfficeReport to Congressional CommitteesMay 2002 CUSTOMS SERVICE MODERNIZATION Management Improvements Needed...from... to) - Title and Subtitle CUSTOMS SERVICE MODERNIZATION: Management Improvements Needed on High-Risk Automated Commercial Environment... Customs management of ACE. Subject Terms Report Classification unclassified Classification of this page unclassified Classification of Abstract

  17. Identifying needs for streamflow forecasting in the Incomati basin, Southern Africa

    NASA Astrophysics Data System (ADS)

    Sunday, Robert; Werner, Micha; Masih, Ilyas; van der Zaag, Pieter

    2013-04-01

    Despite being widely recognised as an efficient tool in the operational management of water resources, rainfall and streamflow forecasts are currently not utilised in water management practice in the Incomati Basin in Southern Africa. Although, there have been initiatives for forecasting streamflow in the Sabie and Crocodile sub-basins, the outputs of these have found little use because of scepticism on the accuracy and reliability of the information, or the relevance of the information provided to the needs of the water managers. The process of improving these forecasts is underway, but as yet the actual needs of the forecasts are unclear and scope of the ongoing initiatives remains very limited. In this study questionnaires and focused group interviews were used to establish the need, potential use, benefit and required accuracy of rainfall and streamflow forecasts in the Incomati Basin. Thirty five interviews were conducted with professionals engaged in water sector and detailed discussions were held with water institutions, including the Inkomati Catchment Management Agency (ICMA), Komati Basin Water Authority (KOBWA), South African Weather Service (SAWS), water managers, dam operators, water experts, farmers and other water users in the Basin. Survey results show that about 97% of the respondents receive weather forecasts. In contrast to expectations, only 5% have access to the streamflow forecast. In the weather forecast, the most important variables were considered to be rainfall and temperature at daily and weekly time scales. Moreover, forecasts of global climatic indices such as El Niño or La Niña were neither received nor demanded. There was limited demand and/or awareness of flood and drought forecasts including the information on their linkages with global climatic indices. While the majority of respondents indicate the need and indeed use the weather forecast, the provision, communication and interpretation were in general found to be with too

  18. The Hepatitis C Cascade of Care: Identifying Priorities to Improve Clinical Outcomes

    PubMed Central

    Linas, Benjamin P.; Barter, Devra M.; Leff, Jared A.; Assoumou, Sabrina A.; Salomon, Joshua A.; Weinstein, Milton C.; Kim, Arthur Y.; Schackman, Bruce R.

    2014-01-01

    Background As highly effective hepatitis C virus (HCV) therapies emerge, data are needed to inform the development of interventions to improve HCV treatment rates. We used simulation modeling to estimate the impact of loss to follow-up on HCV treatment outcomes and to identify intervention strategies likely to provide good value for the resources invested in them. Methods We used a Monte Carlo state-transition model to simulate a hypothetical cohort of chronically HCV-infected individuals recently screened positive for serum HCV antibody. We simulated four hypothetical intervention strategies (linkage to care; treatment initiation; integrated case management; peer navigator) to improve HCV treatment rates, varying efficacies and costs, and identified strategies that would most likely result in the best value for the resources required for implementation. Main measures Sustained virologic responses (SVRs), life expectancy, quality-adjusted life expectancy (QALE), costs from health system and program implementation perspectives, and incremental cost-effectiveness ratios (ICERs). Results We estimate that imperfect follow-up reduces the real-world effectiveness of HCV therapies by approximately 75%. In the base case, a modestly effective hypothetical peer navigator program maximized the number of SVRs and QALE, with an ICER compared to the next best intervention of $48,700/quality-adjusted life year. Hypothetical interventions that simultaneously addressed multiple points along the cascade provided better outcomes and more value for money than less costly interventions targeting single steps. The 5-year program cost of the hypothetical peer navigator intervention was $14.5 million per 10,000 newly diagnosed individuals. Conclusions We estimate that imperfect follow-up during the HCV cascade of care greatly reduces the real-world effectiveness of HCV therapy. Our mathematical model shows that modestly effective interventions to improve follow-up would likely be cost

  19. Using a Functional Architecture to Identify Human-Automation Trust Needs and Design Requirements

    DTIC Science & Technology

    2016-12-01

    FUNCTIONAL ARCHITECTURE TO IDENTIFY HUMAN-AUTOMATION TRUST NEEDS AND DESIGN REQUIREMENTS by Bradley A. Johnson December 2016 Thesis Advisor...maximum 200 words) This thesis develops and analyzes the functional architecture for an “autonomous” unmanned aerial system performing an...INTENTIONALLY LEFT BLANK v ABSTRACT This thesis develops and analyzes the functional architecture for an “autonomous” unmanned aerial system

  20. Improvement of Patient- and Family-Specific Care for Children with Special Behavioral Needs in the Emergency Setting: A Behavioral Needs Education.

    PubMed

    Brynes, Nicole; Lee, Heeyoung; Ren, Dianxu; Beach, Michael

    2017-05-01

    Improvements in staff training, identification, and treatment planning for children with special health care needs who have behavioral issues are routinely recommended, but a literature review revealed no coherent plans targeted specifically toward pediatric ED staff. An educational module was delivered to emergency staff along with a survey before and after and 1 month after the intervention to examine comfort in working with children with behavioral special needs and the ability to deliver specialized care. Child life consultations in the pediatric emergency department were measured 3 months before and 3 months after the education was provided. A total of 122 staff participated and reported clinically significant improvements across all areas of care that were maintained at 1 month. To the best of our knowledge, this project represents the first quality improvement project offering behavioral needs education to emergency staff at a large pediatric hospital with an examination of its impact on staff competence, comfort, and outcomes. A large-scale educational module is a practical option for improvement in pediatric ED staff competence in caring for patients with behavioral special needs. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  1. Identifying and predicting subgroups of information needs among cancer patients: an initial study using latent class analysis.

    PubMed

    Neumann, Melanie; Wirtz, Markus; Ernstmann, Nicole; Ommen, Oliver; Längler, Alfred; Edelhäuser, Friedrich; Scheffer, Christian; Tauschel, Diethard; Pfaff, Holger

    2011-08-01

    Understanding how the information needs of cancer patients (CaPts) vary is important because met information needs affect health outcomes and CaPts' satisfaction. The goals of the study were to identify subgroups of CaPts based on self-reported cancer- and treatment-related information needs and to determine whether subgroups could be predicted on the basis of selected sociodemographic, clinical and clinician-patient relationship variables. Three hundred twenty-three CaPts participated in a survey using the "Cancer Patients Information Needs" scale, which is a new tool for measuring cancer-related information needs. The number of information need subgroups and need profiles within each subgroup was identified using latent class analysis (LCA). Multinomial logistic regression was applied to predict class membership. LCA identified a model of five subgroups exhibiting differences in type and extent of CaPts' unmet information needs: a subgroup with "no unmet needs" (31.4% of the sample), two subgroups with "high level of psychosocial unmet information needs" (27.0% and 12.0%), a subgroup with "high level of purely medical unmet information needs" (16.0%) and a subgroup with "high level of medical and psychosocial unmet information needs" (13.6%). An assessment of sociodemographic and clinical characteristics revealed that younger CaPts and CaPts' requiring psychological support seem to belong to subgroups with a higher level of unmet information needs. However, the most significant predictor for the subgroups with unmet information needs is a good clinician-patient relationship, i.e. subjective perception of high level of trust in and caring attention from nurses together with high degree of physician empathy seems to be predictive for inclusion in the subgroup with no unmet information needs. The results of our study can be used by oncology nurses and physicians to increase their awareness of the complexity and heterogeneity of information needs among CaPts and of

  2. Improving the Pharmacologic Management of Pain in Older Adults: Identifying the Research Gaps and Methods to Address Them

    PubMed Central

    Reid, M. C.; Bennett, David A.; Chen, Wen G.; Eldadah, Basil A.; Farrar, John T.; Ferrell, Bruce; Gallagher, Rollin M.; Hanlon, Joseph T.; Herr, Keela; Horn, Susan D.; Inturrisi, Charles E.; Lemtouni, Salma; Lin, Yu Woody; Michaud, Kaleb; Morrison, R. Sean; Neogi, Tuhina; Porter, Linda L.; Solomon, Daniel H.; Von Korff, Michael; Weiss, Karen; Witter, James; Zacharoff, Kevin L.

    2011-01-01

    Objective There has been a growing recognition of the need for better pharmacologic management of chronic pain among older adults. To address this need, the National Institutes of Health Pain Consortium sponsored an “Expert Panel Discussion on the Pharmacological Management of Chronic Pain in Older Adults” conference in September, 2010, to identify research gaps and strategies to address them. Specific emphasis was placed on ascertaining gaps regarding use of opioid and non-steroidal anti-inflammatory medications because of continued uncertainties regarding their risks and benefits. Design Eighteen panel members provided oral presentations; each was followed by a multidisciplinary panel discussion. Meeting transcripts and panelists’ slide presentations were reviewed to identify the gaps, and the types of studies and research methods panelists suggested could best address them. Results Fifteen gaps were identified in the areas of treatment(e.g., uncertainty regarding the long-term safety and efficacy of commonly prescribed analgesics), epidemiology (e.g., lack of knowledge regarding the course of common pain syndromes), and implementation(e.g., limited understanding of optimal strategies to translate evidence-based pain treatments into practice). Analyses of data from electronic health care databases, observational cohort studies, and ongoing cohort studies (augmented with pain and other relevant outcomes measures) were felt to be practical methods for building an age-appropriate evidence base to improve the pharmacologic management of pain in later life. Conclusions Addressing the gaps presented in the current report was judged by the panel to have substantial potential to improve the health and well being of older adults with chronic pain. PMID:21834914

  3. Application of an extreme winter storm scenario to identify vulnerabilities, mitigation options, and science needs in the Sierra Nevada mountains, USA

    USGS Publications Warehouse

    Albano, Christine M.; Dettinger, Michael; McCarthy, Maureen; Schaller, Kevin D.; Wellborn, Toby; Cox, Dale A.

    2016-01-01

    In the Sierra Nevada mountains (USA), and geographically similar areas across the globe where human development is expanding, extreme winter storm and flood risks are expected to increase with changing climate, heightening the need for communities to assess risks and better prepare for such events. In this case study, we demonstrate a novel approach to examining extreme winter storm and flood risks. We incorporated high-resolution atmospheric–hydrologic modeling of the ARkStorm extreme winter storm scenario with multiple modes of engagement with practitioners, including a series of facilitated discussions and a tabletop emergency management exercise, to develop a regional assessment of extreme storm vulnerabilities, mitigation options, and science needs in the greater Lake Tahoe region of Northern Nevada and California, USA. Through this process, practitioners discussed issues of concern across all phases of the emergency management life cycle, including preparation, response, recovery, and mitigation. Interruption of transportation, communications, and interagency coordination were among the most pressing concerns, and specific approaches for addressing these issues were identified, including prepositioning resources, diversifying communications systems, and improving coordination among state, tribal, and public utility practitioners. Science needs included expanding real-time monitoring capabilities to improve the precision of meteorological models and enhance situational awareness, assessing vulnerabilities of critical infrastructure, and conducting cost–benefit analyses to assess opportunities to improve both natural and human-made infrastructure to better withstand extreme storms. Our approach and results can be used to support both land use and emergency planning activities aimed toward increasing community resilience to extreme winter storm hazards in mountainous regions.

  4. A Screening Tool to Identify Spasticity in Need of Treatment

    PubMed Central

    Zorowitz, Richard D.; Wein, Theodore H.; Dunning, Kari; Deltombe, Thierry; Olver, John H.; Davé, Shashank J.; Dimyan, Michael A.; Kelemen, John; Pagan, Fernando L.; Evans, Christopher J.; Gillard, Patrick J.; Kissela, Brett M.

    2017-01-01

    Objective To develop a clinically useful patient-reported screening tool for health care providers to identify patients with spasticity in need of treatment regardless of etiology. Design Eleven spasticity experts participated in a modified Delphi panel and reviewed and revised 2 iterations of a screening tool designed to identify spasticity symptoms and impact on daily function and sleep. Spasticity expert panelists evaluated items pooled from existing questionnaires to gain consensus on the screening tool content. The study also included cognitive interviews of 20 patients with varying spasticity etiologies to determine if the draft screening tool was understandable and relevant to patients with spasticity. Results The Delphi panel reached an initial consensus on 21 of 47 items for the screening tool and determined that the tool should have no more than 11 to 15 items and a 1-month recall period for symptom and impact items. After 2 rounds of review, 13 items were selected and modified by the expert panelists. Most patients (n = 16 [80%]) completed the cognitive interview and interpreted the items as intended. Conclusions Through the use of a Delphi panel and patient interviews, a 13-item spasticity screening tool was developed that will be practical and easy to use in routine clinical practice. PMID:27552355

  5. Computer Security: Improvements Needed to Reduce Risk to Critical Federal Operations and Assets

    DTIC Science & Technology

    2001-11-09

    COMPUTER SECURITY Improvements Needed to Reduce Risk to Critical Federal Operations and Assets Statement of Robert F. Dacey Director, Information...Improvements Needed to Reduce Risk to Critical Federal Operations and Assets Contract Number Grant Number Program Element Number Author(s...The benefits have been enormous. Vast amounts of information are now literally at our fingertips, facilitating research on virtually every topic

  6. A qualitative focus group study to identify the needs of survivors of stage II and III colorectal cancer.

    PubMed

    Ho, Maria Y; McBride, Mary L; Gotay, Carolyn; Grunfeld, Eva; Earle, Craig C; Relova, Sharon; Tsonis, Miranda; Ruan, Jenny Y; Chang, Jennifer T; Cheung, Winson Y

    2016-12-01

    Prior survivorship research has largely focused on issues faced by survivors of childhood tumors, breast cancers, or hematologic malignancies. Relatively little is known about the needs of other prevalent survivor groups. Our aim was to identify the specific concerns of colorectal cancer (CRC) survivors in the key domains of physical functioning, psychological wellbeing, and social relationships. We conducted focus groups with stage II and III CRC survivors who had completed their primary active anti-cancer treatments. Patients were asked to describe how their diagnosis and treatment impacted their lives, to outline deficiencies in the care that they received, and to suggest ways of addressing any unmet needs. A content analysis was subsequently conducted to identify major themes. Thirty CRC survivors participated in six focus groups. Individuals reported some degree of dissatisfaction with the amount and type of diagnostic and treatment information they received at their initial clinic visit. Distress from toxicities, such as peripheral neuropathy, was also common among the survivors. Similarly, the majority faced challenges adjusting to their lives and daily activities, especially in caring for their colostomy. Having survived CRC, many survivors expressed an interest in advocacy and health promotion of CRC. CRC survivors face many barriers after their cancer treatment. Issues with colostomy are unique to this survivor group. Interventions to improve CRC survivorship care should also incorporate opportunities for patient advocacy. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  7. Development of procedures for identifying high-crash locations and prioritizing safety improvements

    DOT National Transportation Integrated Search

    2003-06-01

    The objectives of this study were to review and analyze the current procedures for identifying high-crash locations and evaluating and prioritizing roadway safety improvements at high-crash locations, and to recommend improved methods. Several tasks ...

  8. Development of procedures for identifying high-crash locations and prioritizing safety improvements.

    DOT National Transportation Integrated Search

    2003-06-01

    The objectives of this study were to review and analyze the current procedures for identifying high-crash locations and evaluating and prioritizing roadway safety improvements at high-crash locations, and to recommend improved methods. Several tasks ...

  9. Identifying strategies to improve the effectiveness of booster seat laws

    DOT National Transportation Integrated Search

    2008-05-01

    The objective of this project was to identify strategies to improve the effectiveness of booster seat laws. The project explored the possible factors that relate to the use and nonuse of booster seats, and examined the attitudes of law enforcement of...

  10. Meeting physicians' needs: a bottom-up approach for improving the implementation of medical knowledge into practice.

    PubMed

    Vaucher, Carla; Bovet, Emilie; Bengough, Theresa; Pidoux, Vincent; Grossen, Michèle; Panese, Francesco; Burnand, Bernard

    2016-07-18

    Multiple barriers to knowledge translation in medicine have been identified (ranging from information overload to abstraction of models), leading to important implementation gaps. This study aimed at assessing the suggestions of practicing physicians for possible improvements of knowledge translation (KT) effectiveness into clinical practice. We used a mixed methods design. French- German- and Italian-speaking general practitioners, psychiatrists, orthopaedic surgeons, cardiologists, and diabetologists practicing in Switzerland were interrogated through semi-structured interviews, focus group discussions, and an online survey. A total of 985 physicians from three regions of Switzerland participated in the online survey, whereas 39 participated in focus group discussions and 14 in face-to-face interviews. Physicians expressed limitations and difficulties related to KT into their daily practice. Several barriers were identified, including influence and pressure of pharmaceutical companies, non-publication of negative results, mismatch between guidelines and practice, education gaps, and insufficient collaboration between research and practice. Suggestions to overcome barriers were improving education concerning the evaluation of scientific publications, expanding applicability of guidelines, having free and easy access to independent journals, developing collaborations between research and practice, and creating tools to facilitate access to medical information. Our study provides suggestions for improving KT into daily medical practice, matching the views, needs and preferences of practicing physicians. Responding to suggestions for improvements brought up by physicians may lead to better knowledge translation, higher professional satisfaction, and better healthcare outcomes.

  11. Classification tree model identifies home-based service needs of Japanese long-term care insurance consumers.

    PubMed

    Naruse, Takashi; Nagata, Satoko; Taguchi, Atsuko; Murashima, Sachiyo

    2011-01-01

    To clarify care receivers' needs and unmet needs for home help or home nursing services during daytime and/or nighttime hours, and to identify the characteristic of elders who are most likely to need home care services. We used a chi-squared automatic interaction detection technique to analyze data from 92 care management researchers, who interviewed 280 caregivers. Demographic information, assessments of the statuses and service needs of elders. We found that care receivers had more unmet needs at night than during the day. Daytime home help was needed by elders who (1) lived alone or (2) lived with just one person and whose primary caregiver was not their wife. Nighttime home help was needed by those who required assistance eating, and whose primary caregiver was male. Daytime home nursing was needed by elders who (1) received medical treatment instead of day care or (2) did not receive medical treatment, but had difficulty eating. Nighttime home nursing was needed by those who had unstable illnesses and whose medical treatments continued during the night. Our findings may help public health nurses assess community needs in order to effectively and efficiently manage health care resources. © 2011 Wiley Periodicals, Inc.

  12. The need for innovative strategies to improve immunisation services in rural Zimbabwe.

    PubMed

    Chadambuka, Addmore; Chimusoro, Anderson; Apollo, Tsitsilina; Tshimanga, Mufuta; Namusisi, Olivia; Luman, Elizabeth T

    2012-01-01

    Gokwe South, a rural district in Midlands Province, Zimbabwe, reported the lowest rate of immunisation coverage in the country in 2005: 55 per cent of children vaccinated with three doses of diphtheria/pertussis/tetanus vaccine (DPT3) and 35 per cent dropout between the first and third dose of DPT. In January 2007, the authors assessed local barriers to immunisation and proposed strategies to improve immunisation rates in the district, in the face of nationwide economic and political challenges. A situational analysis was performed to assess barriers to immunisation using focus-group discussions with health workers, key informant interviews with health management and community leaders, and desk reviews of records. Responses were categorised and solutions proposed. Health workers and key informants reported that immunisation service delivery was hampered by insufficient availability of gas for cold-chain equipment, limited transport and fuel to conduct basic activities, and inadequate staff and supervision. Improving coverage will require prioritising gas for vaccine cold-chain equipment, identifying reliable transportation or alternative transportation solutions, and increased staff, training and supervision. Local assessment is critical to pinpointing site-specific barriers, and innovative strategies are needed to overcome existing contextual challenges. © 2012 The Author(s). Disasters © Overseas Development Institute, 2012.

  13. Review of "Stuck Schools: A Framework for Identifying Schools Where Students Need Change--Now"

    ERIC Educational Resources Information Center

    Lee, Jaekyung

    2010-01-01

    The Education Trust research report "Stuck Schools" suggests a framework for identifying chronically low-performing schools in need of turnaround. The study uses Maryland and Indiana to show that some low-performing schools make progress while others remain stagnant. The report has four serious problems of reliability and validity,…

  14. Identifying and Prioritizing Information Needs and Research Priorities of Public Health Emergency Preparedness and Response Practitioners.

    PubMed

    Siegfried, Alexa L; Carbone, Eric G; Meit, Michael B; Kennedy, Mallory J; Yusuf, Hussain; Kahn, Emily B

    2017-10-01

    This study describes findings from an assessment conducted to identify perceived knowledge gaps, information needs, and research priorities among state, territorial, and local public health preparedness directors and coordinators related to public health emergency preparedness and response (PHPR). The goal of the study was to gather information that would be useful for ensuring that future funding for research and evaluation targets areas most critical for advancing public health practice. We implemented a mixed-methods approach to identify and prioritize PHPR research questions. A web survey was sent to all state, city, and territorial health agencies funded through the Public Health Emergency Preparedness (PHEP) Cooperative Agreement program and a sample of local health departments (LHDs). Three focus groups of state and local practitioners and subject matter experts from the Centers for Disease Control and Prevention (CDC) were subsequently conducted, followed by 3 meetings of an expert panel of PHPR practitioners and CDC experts to prioritize and refine the research questions. We identified a final list of 44 research questions that were deemed by study participants as priority topics where future research can inform PHPR programs and practice. We identified differences in perceived research priorities between PHEP awardees and LHD survey respondents; the number of research questions rated as important was greater among LHDs than among PHEP awardees (75%, n=33, compared to 24%, n=15). The research questions identified provide insight into public health practitioners' perceived knowledge gaps and the types of information that would be most useful for informing and advancing PHPR practice. The study also points to a higher level of information need among LHDs than among PHEP awardees. These findings are important for CDC and the PHPR research community to ensure that future research studies are responsive to practitioners' needs and provide the information

  15. Improvements Needed in Managing Scope Changes and Oversight of Construction Projects at Camp Lemonnier, Djibouti

    DTIC Science & Technology

    2016-09-30

    Improvements Needed in Managing Scope Changes and Oversight of Construction Projects at Camp Lemonnier, Djibouti S E P T E M B E R 3 0 , 2 0 1 6 Report...Improvements Needed in Managing Scope Changes and Oversight of Construction Projects at Camp Lemonnier, Djibouti Visit us at www.dodig.mil Objective We...Findings (cont’d) ii │ DODIG-2016-141 (Project No. D2014-D000RE-0157.000) Results in Brief Improvements Needed in Managing Scope Changes and Oversight

  16. Telemedicine in Neonatal Home Care: Identifying Parental Needs Through Participatory Design.

    PubMed

    Garne, Kristina; Brødsgaard, Anne; Zachariassen, Gitte; Clemensen, Jane

    2016-07-08

    For the majority of preterm infants, the last weeks of hospital admission mainly concerns tube feeding and establishment of breastfeeding. Neonatal home care (NH) was developed to allow infants to remain at home for tube feeding and establishment of breastfeeding with regular home visits from neonatal nurses. For hospitals covering large regions, home visits may be challenging, time consuming, and expensive and alternative approaches must be explored. To identify parental needs when wanting to provide neonatal home care supported by telemedicine. The study used participatory design and qualitative methods. Data were collected from observational studies, individual interviews, and focus group interviews. Two neonatal units participated. One unit was experienced in providing neonatal home care with home visits, and the other planned to offer neonatal home care with telemedicine support. A total of 9 parents with preterm infants assigned to a neonatal home care program and 10 parents with preterm infants admitted to a neonatal unit participated in individual interviews and focus group interviews, respectively. Three overall themes were identified: being a family, parent self-efficacy, and nurse-provided security. Parents expressed desire for the following: (1) a telemedicine device to serve as a "bell cord" to the neonatal unit, giving 24-hour access to nurses, (2) video-conferencing to provide security at home, (3) timely written email communication with the neonatal unit, and (4) an online knowledge base on preterm infant care, breastfeeding, and nutrition. Our findings highlight the importance of neonatal home care. NH provides parents with a feeling of being a family, supports their self-efficacy, and gives them a feeling of security when combined with nursing guidance. Parents did not request hands-on support for infant care, but instead expressed a need for communication and guidance, which could be met using telemedicine.

  17. Identifying participation needs of people with acquired brain injury in the development of a collective community smart home.

    PubMed

    Levasseur, Mélanie; Pigot, Hélène; Couture, Mélanie; Bier, Nathalie; Swaine, Bonnie; Therriault, Pierre-Yves; Giroux, Sylvain

    2016-11-01

    This study explored the personalized and collective participation needs of people with acquired brain injury (ABI) living in a future shared community smart home. An action research study was conducted with 16 persons, seven with ABI, four caregivers and five rehabilitation or smart home healthcare providers. Twelve interviews and two focus groups were conducted, audiotaped, transcribed and analyzed for content. Seventy personalized and 18 collective participation needs were reported related to daily and social activities. Personalized needs concerned interpersonal relationships, general organization of activities, leisure, housing, fitness and nutrition. Collective needs related mainly to housing, general organization of activities and nutrition. Personalized and collective participation needs of people with ABI planning to live in a community smart home are diverse and concern daily as well as social activities. Implications for Rehabilitation To meet participation needs of people with ABI, the design of smart homes must consider all categories of daily and social activities. Considering personalized and collective needs allowed identifying exclusive examples of each. As some persons with ABI had difficulty identifying their needs as well as accepting their limitations and the assistance required, rehabilitation professionals must be involved in needs identification.

  18. Identifying the educational needs of nursing staff: the role of the clinical nurse specialist in perinatal nursing.

    PubMed

    Millhaem, Toni Brown; Timm, Kathleen

    2007-01-01

    One of the priorities of the perinatal clinical nurse specialist is the identification of educational needs. This article describes the experience of 2 perinatal clinical nurse specialists and presents various methods for identifying the educational needs of perinatal nursing staff in the hospital setting.

  19. Geriatric-specific triage criteria are more sensitive than standard adult criteria in identifying need for trauma center care in injured older adults.

    PubMed

    Ichwan, Brian; Darbha, Subrahmanyam; Shah, Manish N; Thompson, Laura; Evans, David C; Boulger, Creagh T; Caterino, Jeffrey M

    2015-01-01

    We evaluate the sensitivity of Ohio's 2009 emergency medical services (EMS) geriatric trauma triage criteria compared with the previous adult triage criteria in identifying need for trauma center care among older adults. We studied a retrospective cohort of injured patients aged 16 years or older in the 2006 to 2011 Ohio Trauma Registry. Patients aged 70 years or older were considered geriatric. We identified whether each patient met the geriatric and the adult triage criteria. The outcome measure was need for trauma center care, defined by surrogate markers: Injury Severity Score greater than 15, operating room in fewer than 48 hours, any ICU stay, and inhospital mortality. We calculated sensitivity and specificity of both triage criteria for both age groups. We included 101,577 patients; 33,379 (33%) were geriatric. Overall, 57% of patients met adult criteria and 68% met geriatric criteria. Using Injury Severity Score, for older adults geriatric criteria were more sensitive for need for trauma center care (93%; 95% confidence interval [CI] 92% to 93%) than adult criteria (61%; 95% CI 60% to 62%). Geriatric criteria decreased specificity in older adults from 61% (95% CI 61% to 62%) to 49% (95% CI 48% to 49%). Geriatric criteria in older adults (93% sensitivity, 49% specificity) performed similarly to the adult criteria in younger adults (sensitivity 87% and specificity 44%). Similar patterns were observed for other outcomes. Standard adult EMS triage guidelines provide poor sensitivity in older adults. Ohio's geriatric trauma triage guidelines significantly improve sensitivity in identifying Injury Severity Score and other surrogate markers of the need for trauma center care, with modest decreases in specificity for older adults. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  20. Controls Over Army Deployable Disbursing System Payments Need Improvement

    DTIC Science & Technology

    2011-08-17

    Controls Over Army Deployable Disbursing System Payments Need Improvement Report No. D-2011-101 August 17, 2011 Report...DRIVE ARLINGTON VIRGINIA 22202-4704 August 17, 20 ll MEMORANDUM FOR UNDER SECRETARY OF DEFENSE (COMPTROLLER)/ CHI EF FINANCIAL OFFICER, DOD...We appreciate the comtes ies extended to the staff. Please direct questions to me at (703) 60 1-5868 (DSN 664-5868). p~ Q . ;n~ Patricia A. Marsh

  1. Identifying Young People's Guidance Needs through Telephone Counseling.

    ERIC Educational Resources Information Center

    Cruz, Bettylu Rasmussen; San Martin, Alfredo Hidalgo; Gutierrez, Bertha Lidia Nuno; Farias, Martha Villasenor; Mora, Iliana Sahagun

    2001-01-01

    Examined needs expressed by young people in Guadalajara in Jalisco, Mexico, during phone calls to the Mexican Social Security Institute. Differences were significant by gender and age. Findings point to the need for more programs that reinforce good health practices, including avoiding risky behaviors. (BF)

  2. Distribution of Funds and Mentoring of Finance Officers for the Afghanistan National Army Payroll Need Improvement

    DTIC Science & Technology

    2012-02-29

    National Army Payroll Need Improvement Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of...Funds and Mentoring of Finance Officers for the Afghanistan National Army Payroll Need Improvement 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c...SUBJECT: Distribution of Funds and Mentoring of Finance Officers for the Afghanistan National Army Payroll Need Improvement (Report No. DODIG-2012-058

  3. Informing Severely III Patients: Needs, Shortcomings and Strategies for Improvement

    PubMed Central

    Strohbuecker, Barbara; Gaertner, Jan; Stock, Stephanie

    2011-01-01

    Summary The scope of palliative care has expanded gradually over the last decade. Provision of palliative care is not restricted to the last months of life as in some out-dated concepts. It addresses the needs of severely ill patients in all care settings (in- and outpatients, home care, hospices). Particularly in the last years, the value of integrating palliative care early in the disease trajectory of life-threatening and incurable diseases has become increasingly acknowledged. In order for patients to fully benefit from the concept of early integration of palliative care, they need to be provided with information tailored to their disease trajectory. For example, patients and relatives need to know how symptoms such as pain, depression, fatigue, breathlessness, or anxiety can be alleviated. The patients’ knowledge and understanding will support the coping process, improve comfort and enhance patient participation and autonomy. Since information needs are highly individual and vary throughout the course of the disease, an interactive approach of assessing the patients’ needs and responding to them adequately is mandatory. In this article, the information needs of advanced cancer patients and their families are explained, shortcomings of the present information concepts are discussed, and an integrative approach to responding to patients’ information needs throughout the care pathway is advocated. PMID:21547020

  4. Ballistic Testing for Interceptor Body Armor Inserts Needs Improvement

    DTIC Science & Technology

    2011-08-01

    030, “Ballistic Testing and Product Quality Surveillance for the Interceptor Body Armor - Vest Components Need Improvement,” January 3, 2011. This...Body Armor Ballistic Inserts Interceptor Body Armor (IBA) is a modular body armor system that consists of an outer tactical vest , ballistic inserts...altitude tests was because the ceramic ballistic inserts are solid structures that are not sensitive to reduced pressure and moisture. PM SEQ offered no

  5. Identifying critical issues in recreation planning and management: improving the management-research partnership

    Treesearch

    John H. Schomaker; David W. Lime

    1988-01-01

    The "nominal group" process is a proven technique to systematically arrive at a consensus about critical information needs in recreation planning and management. Using this process, 41 managers who attended a 1983 conference on river management identified 114 specific information needs grouped under 11 general questions. Clearly, some concerns of...

  6. Identifying Teacher Needs for Promoting Education through Science as a Paradigm Shift in Science Education

    ERIC Educational Resources Information Center

    Holbrook, J.; Rannikmae, M.; Valdmann, A.

    2014-01-01

    This paper identifies an "education through science" philosophy for school science teaching at the secondary level and determines its interrelationship with approaches to student acquisition of key educational competences and the identification of teacher needs to promote meaningful learning during science lessons. Based on the…

  7. Hazardous Waste: EPA’s Generation and Management Data Need Further Improvement

    DTIC Science & Technology

    1990-02-01

    regulation published; System fully implemented inventory reporting system system partially implemented Page S0 GAO/PEMD403 E]PA’ Hardons Waste Data Need...the Page 75 GAO/PEMD4B3 EPA’s Hardons Waste Data Need Further Improvement ChSSW 4 Asuessmn t MmofN wNnO umbumma operating permit restricted the

  8. Report: Improved Management Practices Needed to Increase Use of Exchange Network

    EPA Pesticide Factsheets

    Report #2007-P-00030, August 20, 2007. EPA established a partnership with the Exchange Network’s governance bodies to assist them with accomplishing Network initiatives, more improvements are needed to ensure Network partners fully utilize the Network.

  9. Report: Improved Contract Administration Needed for the Customer Technology Solutions Contract

    EPA Pesticide Factsheets

    Report #13-P-0398, September 16, 2013. Based on our review of the WCF contract EPW08034, which ended September 2012, the EPA needs to improve its contract administration to assist in managing other similar type contracts.

  10. Harnessing a Nation's Linguistic Competence: Identifying and Addressing Needs for LOTE in the Tourism and Hospitality Industry.

    ERIC Educational Resources Information Center

    O'Neill, Shirley; Hatoss, Aniko

    2003-01-01

    Reports research that aimed to identify the foreign language and cross-cultural skill needs of workers in the tourism and hospitality industry in Australia and to develop foreign language competencies for use in industry training packages. Provides evidence for the need for foreign language skills in the industry and gives an account of the…

  11. Supporting family caregivers to identify their own needs in end-of-life care: Qualitative findings from a stepped wedge cluster trial.

    PubMed

    Aoun, Samar; Deas, Kathleen; Toye, Chris; Ewing, Gail; Grande, Gunn; Stajduhar, Kelli

    2015-06-01

    The Carer Support Needs Assessment Tool encompasses the physical, psychological, social, practical, financial, and spiritual support needs that government policies in many countries emphasize should be assessed and addressed for family caregivers during end-of-life care. To describe the experience of family caregivers of terminally ill people of the Carer Support Needs Assessment Tool intervention in home-based palliative care. This study was conducted during 2012-2014 in Silver Chain Hospice Care Service in Western Australia. This article reports on one part of a three-part evaluation of a stepped wedge cluster trial. All 233 family caregivers receiving the Carer Support Needs Assessment Tool intervention provided feedback on their experiences via brief end-of-trial semi-structured telephone interviews. Data were subjected to a thematic analysis. The overwhelming majority reported finding the Carer Support Needs Assessment Tool assessment process straightforward and easy. Four key themes were identified: (1) the practicality and usefulness of the systematic assessment; (2) emotional responses to caregiver reflection; (3) validation, reassurance, and empowerment; and (4) accessing support and how this was experienced. Family caregivers appreciated the value of the Carer Support Needs Assessment Tool intervention in engaging them in conversations about their needs, priorities, and solutions. The Carer Support Needs Assessment Tool presented a simple, yet potentially effective intervention to help palliative care providers systematically assess and address family caregivers' needs. The Carer Support Needs Assessment Tool provided a formal structure to facilitate discussions with family caregivers to enable needs to be addressed. Such discussions can also inform an evidence base for the ongoing development of services for family caregivers, ensuring that new or improved services are designed to meet the explicit needs of family caregivers. © The Author(s) 2015.

  12. Study protocol: identifying and delivering point-of-care information to improve care coordination.

    PubMed

    Hysong, Sylvia J; Che, Xinxuan; Weaver, Sallie J; Petersen, Laura A

    2015-10-19

    The need for deliberately coordinated care is noted by many national-level organizations. The Department of Veterans Affairs (VA) recently transitioned primary care clinics nationwide into Patient Aligned Care Teams (PACTs) to provide more accessible, coordinated, comprehensive, and patient-centered care. To better serve this purpose, PACTs must be able to successfully sequence and route interdependent tasks to appropriate team members while also maintaining collective situational awareness (coordination). Although conceptual frameworks of care coordination exist, few explicitly articulate core behavioral markers of coordination or the related information needs of team members attempting to synchronize complex care processes across time for a shared patient population. Given this gap, we partnered with a group of frontline primary care personnel at ambulatory care sites to identify the specific information needs of PACT members that will enable them to coordinate their efforts to provide effective, coordinated care. The study has three objectives: (1) development of measurable, prioritized point-of-care criteria for effective PACT coordination; (2) identifying the specific information needed at the point of care to optimize coordination; and (3) assessing the effect of adopting the aforementioned coordination standards on PACT clinicians' coordination behaviors. The study consists of three phases. In phase 1, we will employ the Productivity Measurement and Enhancement System (ProMES), a structured approach to performance measure creation from industrial/organizational psychology, to develop coordination measures with a design team of 6-10 primary care personnel; in phase 2, we will conduct focus groups with the phase 1 design team to identify point-of-care information needs. Phase 3 is a two-arm field experiment (n PACT = 28/arm); intervention arm PACTs will receive monthly feedback reports using the measures developed in phase 1 and attend brief monthly

  13. Pediatric crisis resource management training improves emergency medicine trainees' perceived ability to manage emergencies and ability to identify teamwork errors.

    PubMed

    Bank, Ilana; Snell, Linda; Bhanji, Farhan

    2014-12-01

    Improved pediatric crisis resource management (CRM) training is needed in emergency medicine residencies because of the variable nature of exposure to critically ill pediatric patients during training. We created a short, needs-based pediatric CRM simulation workshop with postactivity follow-up to determine retention of CRM knowledge. Our aims were to provide a realistic learning experience for residents and to help the learners recognize common errors in teamwork and improve their perceived abilities to manage ill pediatric patients. Residents participated in a 4-hour objectives-based workshop derived from a formal needs assessment. To quantify their subjective abilities to manage pediatric cases, the residents completed a postworkshop survey (with a retrospective precomponent to assess perceived change). Ability to identify CRM errors was determined via a written assessment of scripted errors in a prerecorded video observed before and 1 month after completion of the workshop. Fifteen of the 16 eligible emergency medicine residents (postgraduate year 1-5) attended the workshop and completed the surveys. There were significant differences in 15 of 16 retrospective pre to post survey items using the Wilcoxon rank sum test for non-parametric data. These included ability to be an effective team leader in general (P < 0.008), delegating tasks appropriately (P < 0.009), and ability to ensure closed-loop communication (P < 0.008). There was a significant improvement in identification of CRM errors through the use of the video assessment from 3 of the 12 CRM errors to 7 of the 12 CRM errors (P < 0.006). The pediatric CRM simulation-based workshop improved the residents' self-perceptions of their pediatric CRM abilities and improved their performance on a video assessment task.

  14. A needs assessment of health information technology for improving care coordination in three leading patient-centered medical homes.

    PubMed

    Richardson, Joshua E; Vest, Joshua R; Green, Cori M; Kern, Lisa M; Kaushal, Rainu

    2015-07-01

    We investigated ways that patient-centered medical homes (PCMHs) are currently using health information technology (IT) for care coordination and what types of health IT are needed to improve care coordination. A multi-disciplinary team of researchers conducted semi-structured telephone interviews with 28 participants from 3 PCMHs in the United States. Participants included administrators and clinicians from PCMHs, electronic health record (EHR) and health information exchange (HIE) representatives, and policy makers. Participants identified multiple barriers to care coordination using current health IT tools. We identified five areas in which health IT can improve care coordination in PCMHs: 1) monitoring patient populations, 2) notifying clinicians and other staff when specific patients move across care settings, 3) collaborating around patients, 4) reporting activities, and 5) interoperability. To accomplish these tasks, many participants described using homegrown care coordination systems separate from EHRs. The participants in this study have resources, experience, and expertise with using health IT for care coordination, yet they still identified multiple areas for improvement. We hypothesize that focusing health IT development in the five areas we identified can enable more effective care coordination. Key findings from this work are that homegrown systems apart from EHRs are currently used to support care coordination and, also, that reporting tools are key components of care coordination. New health IT that enables monitoring, notifying, collaborating, reporting, and interoperability would enhance care coordination within PCMHs beyond what current health IT enables. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  15. Case Managers' Perspectives On What They Need To Do Their Job

    PubMed Central

    Eack, Shaun M.; Greeno, Catherine G.; Christian-Michaels, Stephen; Dennis, Amy; Anderson, Carol M.

    2013-01-01

    Objective To identify the perceived training needs of case managers working on community support teams in a community mental health center serving a semi-rural/suburban area. Methods Semi-structured interviews were conducted with 18 case managers and 3 supervisors to inquire about areas of training need in case management. Interviews were coded and analyzed for common themes regarding training needs and methods of training improvement. Results Identified training needs called for a hands-on, back to basics approach that included education on the symptoms of severe mental illness, co-morbid substance use problems, and methods of engaging consumers. A mentoring model was proposed as a potential vehicle for disseminating knowledge in these domains. Conclusions Case managers identify significant training needs that would address their basic understanding of severe mental illness. Programs targeting these needs may result in improved outcomes for case managers and the individuals with psychiatric disabilities. PMID:19346211

  16. Innovative Resources Based on ICTs and Authentic Materials to Improve EFL Students' Communicative Needs

    ERIC Educational Resources Information Center

    González Otero, Rebeca

    2016-01-01

    Our global society and our current communication needs have put a strain on English as a Foreign Language (EFL) teaching, since common resources such as textbooks may fail to adapt to the needs and interests of our students. The present action research study aims at identifying EFL students' communicative needs and developing their oral skills…

  17. Quality in-training initiative--a solution to the need for education in quality improvement: results from a survey of program directors.

    PubMed

    Kelz, Rachel R; Sellers, Morgan M; Reinke, Caroline E; Medbery, Rachel L; Morris, Jon; Ko, Clifford

    2013-12-01

    The Next Accreditation System and the Clinical Learning Environment Review Program will emphasize practice-based learning and improvement and systems-based practice. We present the results of a survey of general surgery program directors to characterize the current state of quality improvement in graduate surgical education and introduce the Quality In-Training Initiative (QITI). In 2012, a 20-item survey was distributed to 118 surgical residency program directors from ACS NSQIP-affiliated hospitals. The survey content was developed in collaboration with the QITI to identify program director opinions regarding education in practice-based learning and improvement and systems-based practice, to investigate the status of quality improvement education in their respective programs, and to quantify the extent of resident participation in quality improvement. There was a 57% response rate. Eighty-five percent of program directors (n = 57) reported that education in quality improvement is essential to future professional work in the field of surgery. Only 28% (n = 18) of programs reported that at least 50% of their residents track and analyze their patient outcomes, compare them with norms/benchmarks/published standards, and identify opportunities to make practice improvements. Program directors recognize the importance of quality improvement efforts in surgical practice. Subpar participation in basic practice-based learning and improvement activities at the resident level reflects the need for support of these educational goals. The QITI will facilitate programmatic compliance with goals for quality improvement education. Copyright © 2013 American College of Surgeons. All rights reserved.

  18. Identifying Practical Solutions to Meet America’s Fiber Needs: Proceedings from the Food & Fiber Summit

    PubMed Central

    Mobley, Amy R.; Jones, Julie Miller; Rodriguez, Judith; Slavin, Joanne; Zelman, Kathleen M.

    2014-01-01

    Fiber continues to be singled out as a nutrient of public health concern. Adequate intakes of fiber are associated with reduced risk for cardiovascular disease, cancer, diabetes, certain gastrointestinal disorders and obesity. Despite ongoing efforts to promote adequate fiber through increased vegetable, fruit and whole-grain intakes, average fiber consumption has remained flat at approximately half of the recommended daily amounts. Research indicates that consumers report increasingly attempting to add fiber-containing foods, but there is confusion around fiber in whole grains. The persistent and alarmingly low intakes of fiber prompted the “Food & Fiber Summit,” which assembled nutrition researchers, educators and communicators to explore fiber’s role in public health, current fiber consumption trends and consumer awareness data with the objective of generating opportunities and solutions to help close the fiber gap. The summit outcomes highlight the need to address consumer confusion and improve the understanding of sources of fiber, to recognize the benefits of various types of fibers and to influence future dietary guidance to provide prominence and clarity around meeting daily fiber recommendations through a variety of foods and fiber types. Potential opportunities to increase fiber intake were identified, with emphasis on meal occasions and food categories that offer practical solutions for closing the fiber gap. PMID:25006857

  19. "The Maasai Need Cows and the Cows Need Maasai," the Use of a Photovoice Approach to Assess Animal Health Needs.

    PubMed

    van der Meer, Frank; Clancy, Eoin; Thomas, Adam; Kutz, Susan; Hatfield, Jennifer; Orsel, Karin

    2015-01-01

    The Maasai pastoralists in sub-Saharan Africa depend on their livestock for income and food. Livestock production can be significantly improved by addressing animal health concerns. We explored the use of photovoice, a participatory action research method, to strengthen our understanding of the Maasai's animal health needs. Nine interviewees, representing warriors, elders, and women, identified animal, social, and human health themes. The use of photography provided a new medium for Maasai to express their needs and a focus for researcher-participant communications, thereby facilitating new insights across language and cultural barriers.

  20. A Study to Identify the Training Needs of Life Insurance Sales Representatives in Taiwan Using the Delphi Approach

    ERIC Educational Resources Information Center

    Fan, Chiang Ku; Cheng, Chen-Liang

    2006-01-01

    This article reports a study conducted to identify the needs for continuing professional development for life insurance sales representatives and to examine the competencies needed by those sales representatives. A modified Delphi technique was used. Most life insurance companies in the USA implement an education and training plan advocated by the…

  1. Defense Logistics: Improved Performance Measures and Information Needed for Assessing Asset Visibility Initiatives

    DTIC Science & Technology

    2017-03-01

    Accountability Office Highlights of GAO-17-183, a report to congressional committees March 2017 DEFENSE LOGISTICS Improved Performance Measures ...DEFENSE LOGISTICS Improved Performance Measures and Information Needed for Assessing Asset Visibility Initiatives...Report to Congressional Committees March 2017 GAO-17-183 United States Government Accountability Office United States Government

  2. Identifying Gender Minority Patients' Health And Health Care Needs In Administrative Claims Data.

    PubMed

    Progovac, Ana M; Cook, Benjamin Lê; Mullin, Brian O; McDowell, Alex; Sanchez R, Maria Jose; Wang, Ye; Creedon, Timothy B; Schuster, Mark A

    2018-03-01

    Health care utilization patterns for gender minority Medicare beneficiaries (those who are transgender or gender nonbinary people) are largely unknown. We identified gender minority beneficiaries using a diagnosis-code algorithm and compared them to a 5 percent random sample of non-gender minority beneficiaries from the period 2009-14 in terms of mental health and chronic diseases, use of preventive and mental health care, hospitalizations, and emergency department (ED) visits. Gender minority beneficiaries experienced more disability and mental illness. When we adjusted for age and mental health, we found that they used more mental health care. And when we adjusted for age and chronic conditions, we found that they were more likely to be hospitalized and to visit the ED. There were several small but significant differences in preventive care use. Findings were similar for disabled and older cohorts. These findings underscore the need to capture gender identity in health data to better address this population's health needs.

  3. Identifying the unmet health needs of patients with congenital hypogonadotropic hypogonadism using a web-based needs assessment: implications for online interventions and peer-to-peer support

    PubMed Central

    2014-01-01

    Background Patients with rare diseases such as congenital hypogonadotropic hypogonadism (CHH) are dispersed, often challenged to find specialized care and face other health disparities. The internet has the potential to reach a wide audience of rare disease patients and can help connect patients and specialists. Therefore, this study aimed to: (i) determine if web-based platforms could be effectively used to conduct an online needs assessment of dispersed CHH patients; (ii) identify the unmet health and informational needs of CHH patients and (iii) assess patient acceptability regarding patient-centered, web-based interventions to bridge shortfalls in care. Methods A sequential mixed-methods design was used: first, an online survey was conducted to evaluate health promoting behavior and identify unmet health and informational needs of CHH men. Subsequently, patient focus groups were held to explore specific patient-identified targets for care and to examine the acceptability of possible online interventions. Descriptive statistics and thematic qualitative analyses were used. Results 105 male participants completed the online survey (mean age 37 ± 11, range 19–66 years) representing a spectrum of patients across a broad socioeconomic range and all but one subject had adequate healthcare literacy. The survey revealed periods of non-adherence to treatment (34/93, 37%) and gaps in healthcare (36/87, 41%) exceeding one year. Patient focus groups identified lasting psychological effects related to feelings of isolation, shame and body-image concerns. Survey respondents were active internet users, nearly all had sought CHH information online (101/105, 96%), and they rated the internet, healthcare providers, and online community as equally important CHH information sources. Focus group participants were overwhelmingly positive regarding online interventions/support with links to reach expert healthcare providers and for peer-to-peer support. Conclusion The web

  4. A systematic approach to training: A training needs assessment

    NASA Technical Reports Server (NTRS)

    Manning, Margaret H.

    1989-01-01

    In an effort to determine the gap between the actual performance and the necessary performance of employees for the effective and efficient accomplishment of an organization's mission and goals, an organization-wide Training Needs Assessment must be conducted. The purpose of this work was to conduct a training needs analysis and prepare a NASA Langley Catalog of On-Site Training programs. The work included developing a Training Needs Assessment Survey, implementing the survey, analyzing and researching the training needs, identifying the courses to meet the needs, and preparing and designing an On-Site Training Catalog. This needs analysis attempted to identify performance weaknesses and deficits; seek out and provide opportunities for improved performance; anticipate and avoid future problems; enhance and create new strengths. The end product is a user-friendly catalog of on-site training available. The results include: top-down approach to needs assessment; improved communication with training coordinators; 98 percent return rate of the Training Needs Assessment survey; complete, newly designed, user-friendly catalog; 167 catalog descriptions advertised; 82 new courses advertised; training logo; and request for the training application form.

  5. Geriatric education for surgical residents: identifying a major need.

    PubMed

    Duane, Therèse M; Fan, Lingbo; Bohannon, Arline; Han, Jinfeng; Wolfe, Luke; Mayglothling, Julie; Whelan, James; Aboutanos, Michael; Malhotra, Ajai; Ivatury, Rao R

    2011-07-01

    This study evaluated a program designed to test and enhance residents' knowledge of geriatrics. A 2-year prospective interventional trial was conducted. Surgical residents underwent pretesting (pre) in three areas: polypharmacy, delirium, and end of life. They then received educational materials and completed a posttest within 1 month and a patient simulation examination graded by a physician observer and the patient on his or her satisfaction. Forty-nine residents (51% interns, 55% general surgery residents) participated. Seventy per cent had no prior geriatrics education. Test scores significantly improved from pretest to posttest (12.9 ± 3.1 vs 13.78 ± 3.12, P = 0.01). The scores were consistently better on poly topics and consistently worse on end-of-life topics: pretest per cent correct: polypharmacy 60, end of life 46, P = 0.007; posttest percent correct: polypharmacy 63, end of life 49, P = 0.0014. By Pearson correlation, the pretest and posttest scores did not correlate with either the observer (R = -0.16, P = 0.27 pre, R = -0.08, P = 0.59 post) or subscores (R = -0.27, P = 0.11 pre, R = -0.13, P = 0.45 post), although the observer and subscore correlated with each other (R = 0.35, P = 0.036). Performance was poor and did not correlate with better patient care by simulation. Other options for geriatric education need to be considered and evaluated.

  6. Student nurses need more than maths to improve their drug calculating skills.

    PubMed

    Wright, Kerri

    2007-05-01

    Nurses need to be able to calculate accurate drug calculations in order to safely administer drugs to their patients (NMC, 2002). Studies have shown however that nurses do not always have the necessary skills to calculate accurate drug dosages and are potentially administering incorrect dosages of drugs to their patients (Hutton, M. 1998. Nursing Mathematics: the importance of application. Nursing Standard 13(11), 35-38; Kapborg, I. 1994. Calculation and administration of drug dosage by Swedish nurses, Student Nurses and Physicians. International Journal for Quality in Health Care 6(4), 389-395; O'Shea, E. 1999. Factors contributing to medication errors: a literature review. Journal of Advanced Nursing 8, 496-504; Wilson, A. 2003. Nurses maths: researching a practical approach. Nursing Standard 17(47), 33-36). The literature indicates that in order to improve drug calculations strategies need to focus on both the mathematical skills and conceptual skills of student nurses so they can interpret clinical data into drug calculations to be solved. A study was undertaken to investigate the effectiveness of implementing several strategies which focussed on developing the mathematical and conceptual skills of student nurses to improve their drug calculation skills. The study found that implementing a range of strategies which addressed these two developmental areas significantly improved the drug calculation skills of nurses. The study also indicates that a range of strategies has the potential ensuring that the skills taught are retained by the student nurses. Although the strategies significantly improved the drug calculation skills of student nurses, the fact that only 2 students were able to achieve 100% in their drug calculation test indicates a need for further research into this area.

  7. Ballistic Testing and Product Quality Surveillance for the Interceptor Body Armor - Vest Components Need Improvement

    DTIC Science & Technology

    2011-01-03

    six contracts. Interceptor Body Armor – Vest Components IBA is a modular body armor system that consists of an OTV, ceramic plates , and components...Armor - Vest Components Need Improvement Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the...Ballistic Testing and Product Quality Surveillance for the Interceptor Body Armor - Vest Components Need Improvement 5a. CONTRACT NUMBER 5b. GRANT

  8. Clinical-Community Partnerships to Identify Patients With Food Insecurity and Address Food Needs

    PubMed Central

    Siegel, Karen R.; Calhoun, Holly; Kim, Sonia A.; Garcia, Sandra P.; Hoeting, Natalie M.; Harris, Diane M.; Khan, Laura Kettel; Smith, Bryce; Blanck, Heidi M.; Barnett, Kevin; Haddix, Anne C.

    2017-01-01

    Introduction More than 42 million people in the United States are food insecure. Although some health care entities are addressing food insecurity among patients because of associations with disease risk and management, little is known about the components of these initiatives. Methods The Systematic Screening and Assessment Method was used to conduct a landscape assessment of US health care entity–based programs that screen patients for food insecurity and connect them with food resources. A network of food insecurity researchers, experts, and practitioners identified 57 programs, 22 of which met the inclusion criteria of being health care entities that 1) screen patients for food insecurity, 2) link patients to food resources, and 3) target patients including adults aged 50 years or older (a focus of this assessment). Data on key features of each program were abstracted from documentation and telephone interviews. Results Most programs (n = 13) focus on patients with chronic disease, and most (n = 12) partner with food banks. Common interventions include referrals to or a list of food resources (n = 19), case managers who navigate patients to resources (n = 15), assistance with federal benefit applications (n = 14), patient education and skill building (n = 13), and distribution of fruit and vegetable vouchers redeemable at farmers markets (n = 8). Most programs (n = 14) routinely screen all patients. Conclusion The programs reviewed use various strategies to screen patients, including older adults, for food insecurity and to connect them to food resources. Research is needed on program effectiveness in improving patient outcomes. Such evidence can be used to inform the investments of potential stakeholders, including health care entities, community organizations, and insurers. PMID:29144894

  9. Warfarin therapy: in need of improvement after all these years

    PubMed Central

    Kimmel, Stephen E

    2010-01-01

    Background Warfarin therapy has been used clinically for over 60 years, yet continues to be problematic because of its narrow therapeutic index and large inter-individual variability in patient response. As a result, warfarin is a leading cause of serious medication-related adverse events, and its efficacy is also suboptimal. Objective To review factors that are responsible for variable response to warfarin, including clinical, environmental, and genetic factors, and to explore some possible approaches to improving warfarin therapy. Results Recent efforts have focused on developing dosing algorithms that included genetic information to try to improve warfarin dosing. These dosing algorithms hold promise, but have not been fully validated or tested in rigorous clinical trials. Perhaps equally importantly, adherence to warfarin is a major problem that should be addressed with innovative and cost-effective interventions. Conclusion Additional research is needed to further test whether interventions can be used to improve warfarin dosing and outcomes. PMID:18345947

  10. Are the special educational needs of children in their first year in primary school in Ireland being identified: a cross-sectional study.

    PubMed

    Curtin, Margaret; Baker, Denise; Staines, Anthony; Perry, Ivan J

    2014-02-19

    If the window of opportunity presented by the early years is missed, it becomes increasingly difficult to create a successful life-course. A biopsychosocial model of special educational need with an emphasis on participation and functioning moves the frame of reference from the clinic to the school and the focus from specific conditions to creating supportive environments cognisant of the needs of all children. However, evidence suggests that an emphasis on diagnosed conditions persists and that the needs of children who do not meet these criteria are not identified.The Early Development Instrument (EDI) is a well-validated, teacher-completed population-level measure of five domains of child development. It is uniquely placed, at the interface between health and education, to explore the developmental status of children with additional challenges within a typically developing population. The aim of this study was to examine the extent to which the special educational needs of children in their first year of formal education have been identified. This cross-sectional study was conducted in Ireland in 2011. EDI (teacher completed) scores were calculated for 1344 children. Data were also collected on special needs and on children identified by the teacher as needing assessment. Mean developmental scores were compared using one-way ANOVA. Eighty-three children in the sample population (6.2%) had identified special educational needs. A further 132 children were judged by the teacher as needing assessment. Children with special needs had lower mean scores than typically developing children, in all five developmental domains. Children considered by the teacher as needing assessment also had lower scores, which were not significantly different from those of children with special needs. Speech, emotional or behavioural difficulties were the most commonly reported problems among children needing further assessment. There was also a social gradient among this group. A small

  11. Information needs of residents during inpatient and outpatient rotations: identifying effective personal digital assistant applications.

    PubMed

    Barrett, James R; Strayer, Scott M; Schubart, Jane R

    2003-01-01

    resident can easily and securely be maintained on PDAs. Design of Current Studies Our current study builds on the above perceived needs: we will follow residents during portions of a clinical day. Preliminary observations in three clinical areas (Medical Intensive Care Unit (MICU), General Medicine Outpatient, and Family Medicine Outpatient) confirm the conclusions of our previous study. PDAs are used for: (1) medical references (e.g., five minute clinical consult, Infotriever) (2) pharmaceutical information (such as ePocrates), and (3) professional organization (calendar, address book). Our intention in this new study is to identify the overall flow of information and how PDAs might improve the information flow in clinical settings. We choose to observe residents in both inpatient and outpatient clinics. We anticipate that PDAs will have different uses in these two settings; preliminary observations in one outpatient clinic (Family Medicine) suggests that PDAs are used during the doctor - patient interaction, specifically to suggest the importance of smoking cessation. Preliminary observations in an inpatient clinical setting (the MICU) suggest that PDAs are primarily used outside of patient rooms, e.g. to make medical calculations and to obtain diagnostic procedures. We plan to observe residents during various parts of their days in order to develop a detailed understanding of what information sources (e.g., consultations, computer reports, paper charts) are available at different times and which sources are frequently used. This information will help us develop a pocket-sized, paper-based checksheet that the residents carry with them. The checksheet will help us identify which information sources are used, at various times and frequencies. Interviews with the residents using these checksheets should provide additional details of how utility of the resource, disadvantages of the resource, etc. Specific Goals The goals of our current study include: (1) direct observations

  12. “The Maasai Need Cows and the Cows Need Maasai,” the Use of a Photovoice Approach to Assess Animal Health Needs

    PubMed Central

    van der Meer, Frank; Clancy, Eoin; Thomas, Adam; Kutz, Susan; Hatfield, Jennifer; Orsel, Karin

    2015-01-01

    The Maasai pastoralists in sub-Saharan Africa depend on their livestock for income and food. Livestock production can be significantly improved by addressing animal health concerns. We explored the use of photovoice, a participatory action research method, to strengthen our understanding of the Maasai’s animal health needs. Nine interviewees, representing warriors, elders, and women, identified animal, social, and human health themes. The use of photography provided a new medium for Maasai to express their needs and a focus for researcher–participant communications, thereby facilitating new insights across language and cultural barriers. PMID:26664973

  13. Using a distribution and conservation status weighted hotspot approach to identify areas in need of conservation action to benefit Idaho bird species

    USGS Publications Warehouse

    Haines, Aaron M.; Leu, Matthias; Svancara, Leona K.; Wilson, Gina; Scott, J. Michael

    2010-01-01

    Identification of biodiversity hotspots (hereafter, hotspots) has become a common strategy to delineate important areas for wildlife conservation. However, the use of hotspots has not often incorporated important habitat types, ecosystem services, anthropogenic activity, or consistency in identifying important conservation areas. The purpose of this study was to identify hotspots to improve avian conservation efforts for Species of Greatest Conservation Need (SGCN) in the state of Idaho, United States. We evaluated multiple approaches to define hotspots and used a unique approach based on weighting species by their distribution size and conservation status to identify hotspot areas. All hotspot approaches identified bodies of water (Bear Lake, Grays Lake, and American Falls Reservoir) as important hotspots for Idaho avian SGCN, but we found that the weighted approach produced more congruent hotspot areas when compared to other hotspot approaches. To incorporate anthropogenic activity into hotspot analysis, we grouped species based on their sensitivity to specific human threats (i.e., urban development, agriculture, fire suppression, grazing, roads, and logging) and identified ecological sections within Idaho that may require specific conservation actions to address these human threats using the weighted approach. The Snake River Basalts and Overthrust Mountains ecological sections were important areas for potential implementation of conservation actions to conserve biodiversity. Our approach to identifying hotspots may be useful as part of a larger conservation strategy to aid land managers or local governments in applying conservation actions on the ground.

  14. Meditation acutely improves psychomotor vigilance, and may decrease sleep need

    PubMed Central

    2010-01-01

    Background A number of benefits from meditation have been claimed by those who practice various traditions, but few have been well tested in scientifically controlled studies. Among these claims are improved performance and decreased sleep need. Therefore, in these studies we assess whether meditation leads to an immediate performance improvement on a well validated psychomotor vigilance task (PVT), and second, whether longer bouts of meditation may alter sleep need. Methods The primary study assessed PVT reaction times before and after 40 minute periods of mediation, nap, or a control activity using a within subject cross-over design. This study utilized novice meditators who were current university students (n = 10). Novice meditators completed 40 minutes of meditation, nap, or control activities on six different days (two separate days for each condition), plus one night of total sleep deprivation on a different night, followed by 40 minutes of meditation. A second study examined sleep times in long term experienced meditators (n = 7) vs. non-meditators (n = 23). Experienced meditators and controls were age and sex matched and living in the Delhi region of India at the time of the study. Both groups continued their normal activities while monitoring their sleep and meditation times. Results Novice meditators were tested on the PVT before each activity, 10 minutes after each activity and one hour later. All ten novice meditators improved their PVT reaction times immediately following periods of meditation, and all but one got worse immediately following naps. Sleep deprivation produced a slower baseline reaction time (RT) on the PVT that still improved significantly following a period of meditation. In experiments with long-term experienced meditators, sleep duration was measured using both sleep journals and actigraphy. Sleep duration in these subjects was lower than control non-meditators and general population norms, with no apparent decrements in PVT scores

  15. Post discharge issues identified by a call-back program: identifying improvement opportunities.

    PubMed

    Ojeda, Patricia I; Kara, Areeba

    2017-12-01

    The period following discharge from the hospital is one of heightened vulnerability. Discharge instructions serve as a guide during this transition. Yet, clinicians receive little feedback on the quality of this document that ties into the patients' experience. We reviewed the issues voiced by discharged patients via a call-back program and compared them to the discharge instructions they had received. At our institution, patients receive an automated call forty-eight hours following discharge inquiring about progress. If indicated by the response to the call, they are directed to a nurse who assists with problem solving. We reviewed the nursing documentation of these encounters for a period of nine months. The issues voiced were grouped into five categories: communication, medications, durable medical equipment/therapies, follow up and new or ongoing symptoms. The discharge instructions given to each patient were reviewed. We retrieved data on the number of discharges from each specialty from the hospital over the same period. A total of 592 patients voiced 685 issues. The numbers of patients discharged from medical or surgical services identified as having issues via the call-back line paralleled the proportions discharged from medical and surgical services from the hospital during the same period. Nearly a quarter of the issues discussed had been addressed in the discharge instructions. The most common category of issues was related to communication deficits including missing or incomplete information which made it difficult for the patient to enact or understand the plan of care. Medication prescription related issues were the next most common. Resource barriers and questions surrounding medications were often unaddressed. Post discharge issues affect patients discharged from all services equally. Data from call back programs may provide actionable targets for improvement, identify the inpatient team's 'blind spots' and be used to provide feedback to clinicians.

  16. Health and household air pollution from solid fuel use: the need for improved exposure assessment.

    PubMed

    Clark, Maggie L; Peel, Jennifer L; Balakrishnan, Kalpana; Breysse, Patrick N; Chillrud, Steven N; Naeher, Luke P; Rodes, Charles E; Vette, Alan F; Balbus, John M

    2013-10-01

    Nearly 3 billion people worldwide rely on solid fuel combustion to meet basic household energy needs. The resulting exposure to air pollution causes an estimated 4.5% of the global burden of disease. Large variability and a lack of resources for research and development have resulted in highly uncertain exposure estimates. We sought to identify research priorities for exposure assessment that will more accurately and precisely define exposure-response relationships of household air pollution necessary to inform future cleaner-burning cookstove dissemination programs. As part of an international workshop in May 2011, an expert group characterized the state of the science and developed recommendations for exposure assessment of household air pollution. The following priority research areas were identified to explain variability and reduce uncertainty of household air pollution exposure measurements: improved characterization of spatial and temporal variability for studies examining both short- and long-term health effects; development and validation of measurement technology and approaches to conduct complex exposure assessments in resource-limited settings with a large range of pollutant concentrations; and development and validation of biomarkers for estimating dose. Addressing these priority research areas, which will inherently require an increased allocation of resources for cookstove research, will lead to better characterization of exposure-response relationships. Although the type and extent of exposure assessment will necessarily depend on the goal and design of the cookstove study, without improved understanding of exposure-response relationships, the level of air pollution reduction necessary to meet the health targets of cookstove interventions will remain uncertain.

  17. Eco-Efficient Process Improvement at the Early Development Stage: Identifying Environmental and Economic Process Hotspots for Synergetic Improvement Potential.

    PubMed

    Piccinno, Fabiano; Hischier, Roland; Seeger, Stefan; Som, Claudia

    2018-05-15

    We present here a new eco-efficiency process-improvement method to highlight combined environmental and costs hotspots of the production process of new material at a very early development stage. Production-specific and scaled-up results for life cycle assessment (LCA) and production costs are combined in a new analysis to identify synergetic improvement potentials and trade-offs, setting goals for the eco-design of new processes. The identified hotspots and bottlenecks will help users to focus on the relevant steps for improvements from an eco-efficiency perspective and potentially reduce their associated environmental impacts and production costs. Our method is illustrated with a case study of nanocellulose. The results indicate that the production route should start with carrot pomace, use heat and solvent recovery, and deactivate the enzymes with bleach instead of heat. To further improve the process, the results show that focus should be laid on the carrier polymer, sodium alginate, and the production of the GripX coating. Overall, the method shows that the underlying LCA scale-up framework is valuable for purposes beyond conventional LCA studies and is applicable at a very early stage to provide researchers with a better understanding of their production process.

  18. Using patients’ experiences to identify priorities for quality improvement in breast cancer care: patient narratives, surveys or both?

    PubMed Central

    2012-01-01

    Background Patients’ experiences have become central to assessing the performance of healthcare systems worldwide and are increasingly being used to inform quality improvement processes. This paper explores the relative value of surveys and detailed patient narratives in identifying priorities for improving breast cancer services as part of a quality improvement process. Methods One dataset was collected using a narrative interview approach, (n = 13) and the other using a postal survey (n = 82). Datasets were analyzed separately and then compared to determine whether similar priorities for improving patient experiences were identified. Results There were both similarities and differences in the improvement priorities arising from each approach. Day surgery was specifically identified as a priority in the narrative dataset but included in the survey recommendations only as part of a broader priority around improving inpatient experience. Both datasets identified appointment systems, patients spending enough time with staff, information about treatment and side effects and more information at the end of treatment as priorities. The specific priorities identified by the narrative interviews commonly related to ‘relational’ aspects of patient experience. Those identified by the survey typically related to more ‘functional’ aspects and were not always sufficiently detailed to identify specific improvement actions. Conclusions Our analysis suggests that whilst local survey data may act as a screening tool to identify potential problems within the breast cancer service, they do not always provide sufficient detail of what to do to improve that service. These findings may have wider applicability in other services. We recommend using an initial preliminary survey, with better use of survey open comments, followed by an in-depth qualitative analysis to help deliver improvements to relational and functional aspects of patient experience. PMID:22913525

  19. The association of sociodemographic factors and needs of hemodialysis patients according to Maslow's hierarchy of needs.

    PubMed

    Shih, Chiung-Yu; Huang, Chiu-Ya; Huang, Mei-Lun; Chen, Chyong-Mei; Tang, Fu-In

    2018-05-18

    To explore the association between the sociodemographic factors and the needs of patients undergoing hemodialysis in Taiwan. Concomitant discomfort, including physical and mental aspects, affects the patients' quality of life and their willingness to undergo hemodialysis. Maslow's hierarchy of needs is a well-known tool to assess different levels of human needs. We conducted a small-scale cross-sectional observational study using a structured needs assessment questionnaire on 159 patients from the Taipei Veterans General Hospital hemodialysis unit. The overall mean scores of physical, mental, spiritual, other needs, and needs in relation to medical staff care were 4.0±0.8, 3.2±0.8, 2.7±1.0, 3.1±0.9, and 4.1±0.7, respectively. The results showed that the patients' highest need was in relation to medical staff care, followed by physical needs. Further analysis showed that patients who are still employed during the treatment process have higher mental, spiritual, and other needs. Patient who are financially supported by their family have higher physical needs. Patients taken cared of by paid caregivers have lower spiritual needs and other needs. This is also the same with patients who are religious as opposed to those who are non-religious. Patients who have attained tertiary education have higher other needs compared to patients who have only achieved up to primary or secondary education. The study is the first in Taiwan to identify and quantify the needs of patients undergoing hemodialysis. When the needs of the patients are identified in relation to their sociodemographic factors, the medical staff can give the appropriate treatment in order to meet the needs and improve the patients' well-being. Healthcare providers should not only focus on the patients' physiological needs, but should determine and address their other needs in various aspects in order to improve the quality and efficacy of the dialysis care process. This article is protected by copyright

  20. Chemical and Biological Defense: Designated Entity Needed to Identify, Align, and Manage DOD’s Infrastructure

    DTIC Science & Technology

    2015-06-01

    Designated Leader, GAO-10-645 (Washington, D.C.: June 30, 2010). 35See GAO, Biological Defense: DOD Has Strengthened Coordination on Medical... on track to be designated a Leadership in Energy and Environmental Design facility. metabolic poisons, and pulmonary toxicants; nerve agent...CHEMICAL AND BIOLOGICAL DEFENSE Designated Entity Needed to Identify, Align, and Manage DOD’s Infrastructure

  1. Identifying major hemorrhage with automated data: results of the Veterans Affairs study to improve anticoagulation (VARIA).

    PubMed

    Jasuja, Guneet K; Reisman, Joel I; Miller, Donald R; Berlowitz, Dan R; Hylek, Elaine M; Ash, Arlene S; Ozonoff, Al; Zhao, Shibei; Rose, Adam J

    2013-01-01

    Identifying major bleeding is fundamental to assessing the outcomes of anticoagulation therapy. This drives the need for a credible implementation in automated data for the International Society of Thrombosis and Haemostasis (ISTH) definition of major bleeding. We studied 102,395 patients who received 158,511 person-years of warfarin treatment from the Veterans Health Administration (VA) between 10/1/06-9/30/08. We constructed a list of ICD-9-CM codes of "candidate" bleeding events. Each candidate event was identified as a major hemorrhage if it fulfilled one of four criteria: 1) associated with death within 30days; 2) bleeding in a critical anatomic site; 3) associated with a transfusion; or 4) was coded as the event that precipitated or was responsible for the majority of an inpatient hospitalization. This definition classified 11,240 (15.8%) of 71, 338 candidate events as major hemorrhage. Typically, events more likely to be severe were retained at higher rates than those less likely to be severe. For example, Diverticula of Colon with Hemorrhage (562.12) and Hematuria (599.7) were retained 46% and 4% of the time, respectively. Major, intracranial, and fatal hemorrhage were identified at rates comparable to those found in randomized clinical trials however, higher than those reported in observational studies: 4.73, 1.29, and 0.41 per 100 patient years, respectively. We describe here a workable definition for identifying major hemorrhagic events from large automated datasets. This method of identifying major bleeding may have applications for quality measurement, quality improvement, and comparative effectiveness research. Copyright © 2012 Elsevier Ltd. All rights reserved.

  2. Identifying Decision Support Tools to Bridge Climate and Agricultural Needs in the Midwest

    NASA Astrophysics Data System (ADS)

    Hall, B. L.; Kluck, D. R.; Hatfield, J.; Black, C.; Kellner, O.; Woloszyn, M.; Timlin, M. S.

    2015-12-01

    Climate monitoring tools designed to help stakeholders reduce climate impacts have been developed for the primary Midwest field crops of corn and soybean. However, the region also produces vital livestock and specialty crops that currently lack similar climate monitoring and projection tools. In autumn 2015, the National Oceanic and Atmospheric Administration's (NOAA's) National Integrated Drought Information System (NIDIS) and Midwestern Regional Climate Center (MRCC) partnered with the US Department of Agriculture's Midwest Climate Hub to convene agriculture stakeholders, climate scientists, and climate service specialists to discuss climate impacts and needs for these two, often under-represented, sectors. The goals of this workshop were to (1) identify climate impacts that specialty crops and livestock producers face within the Midwest, (2) develop an understanding of the types of climate and weather information and tools currently available in the Midwest that could be applied to decision making, and (3) discover the types of climate and weather information and tools needed to address concerns of specialty crop and livestock commodities across the Midwest. This presentation will discuss the workshop and provide highlights of the outcomes that developed into strategic plans for the future to better serve these sectors of agriculture in the Midwest.

  3. Screening tools to identify patients with complex health needs at risk of high use of health care services: A scoping review.

    PubMed

    Marcoux, Valérie; Chouinard, Maud-Christine; Diadiou, Fatoumata; Dufour, Isabelle; Hudon, Catherine

    2017-01-01

    Many people with chronic conditions have complex health needs often due to multiple chronic conditions, psychiatric comorbidities, psychosocial issues, or a combination of these factors. They are at high risk of frequent use of healthcare services. To offer these patients interventions adapted to their needs, it is crucial to be able to identify them early. The aim of this study was to find all existing screening tools that identify patients with complex health needs at risk of frequent use of healthcare services, and to highlight their principal characteristics. Our purpose was to find a short, valid screening tool to identify adult patients of all ages. A scoping review was performed on articles published between 1985 and July 2016, retrieved through a comprehensive search of the Scopus and CINAHL databases, following the methodological framework developed by Arksey and O'Malley (2005), and completed by Levac et al. (2010). Of the 3,818 articles identified, 30 were included, presenting 14 different screening tools. Seven tools were self-reported. Five targeted adult patients, and nine geriatric patients. Two tools were designed for specific populations. Four can be completed in 15 minutes or less. Most screening tools target elderly persons. The INTERMED self-assessment (IM-SA) targets adults of all ages and can be completed in less than 15 minutes. Future research could evaluate its usefulness as a screening tool for identifying patients with complex needs at risk of becoming high users of healthcare services.

  4. Microfluidic screening and whole-genome sequencing identifies mutations associated with improved protein secretion by yeast.

    PubMed

    Huang, Mingtao; Bai, Yunpeng; Sjostrom, Staffan L; Hallström, Björn M; Liu, Zihe; Petranovic, Dina; Uhlén, Mathias; Joensson, Haakan N; Andersson-Svahn, Helene; Nielsen, Jens

    2015-08-25

    There is an increasing demand for biotech-based production of recombinant proteins for use as pharmaceuticals in the food and feed industry and in industrial applications. Yeast Saccharomyces cerevisiae is among preferred cell factories for recombinant protein production, and there is increasing interest in improving its protein secretion capacity. Due to the complexity of the secretory machinery in eukaryotic cells, it is difficult to apply rational engineering for construction of improved strains. Here we used high-throughput microfluidics for the screening of yeast libraries, generated by UV mutagenesis. Several screening and sorting rounds resulted in the selection of eight yeast clones with significantly improved secretion of recombinant α-amylase. Efficient secretion was genetically stable in the selected clones. We performed whole-genome sequencing of the eight clones and identified 330 mutations in total. Gene ontology analysis of mutated genes revealed many biological processes, including some that have not been identified before in the context of protein secretion. Mutated genes identified in this study can be potentially used for reverse metabolic engineering, with the objective to construct efficient cell factories for protein secretion. The combined use of microfluidics screening and whole-genome sequencing to map the mutations associated with the improved phenotype can easily be adapted for other products and cell types to identify novel engineering targets, and this approach could broadly facilitate design of novel cell factories.

  5. Identifying the Types of Support Needed by Interprofessional Teams Providing Pediatric End-of-Life Care: A Thematic Analysis.

    PubMed

    Riotte, Clare O; Kukora, Stephanie K; Keefer, Patricia M; Firn, Janice I

    2018-04-01

    Despite the number of interprofessional team members caring for children at the end of life, little evidence exists on how institutions can support their staff in providing care in these situations. We sought to evaluate which aspects of the hospital work environment were most helpful for multidisciplinary team members who care for patients at the end of life and identify areas for improvement to better address staff needs. Qualitative thematic analysis was completed of free-text comments from a survey distributed to interprofessional staff members involved in the care of a recently deceased pediatric patient. A total of 2701 surveys were sent; 890 completed. Free-text responses were provided by 306 interprofessional team members. Interprofessional team members involved in the care of a child who died at a 348 bed academic children's hospital in the Midwestern United States. Realist thematic analysis of free-text responses was completed in Dedoose using a deductive and inductive approach with line-by-line coding. Descriptive statistics of demographic information was completed using Excel. Thematic analysis of the 306 free-text responses identified three main support-related themes. Interprofessional team members desire to have (1) support through educational efforts such as workshops, (2) support from colleagues, and (3) support through institutional practices. Providers who participate in end-of-life work benefit from ongoing support through education, interpersonal relationships, and institutional practices. Addressing these areas from an interprofessional perspective enables staff to provide the optimal care for patients, patients' families, and themselves.

  6. Identifying professionals' needs in integrating electronic pain monitoring in community palliative care services: An interview study.

    PubMed

    Taylor, Sally; Allsop, Matthew J; Bekker, Hilary L; Bennett, Michael I; Bewick, Bridgette M

    2017-07-01

    Poor pain assessment is a barrier to effective pain control. There is growing interest internationally in the development and implementation of remote monitoring technologies to enhance assessment in cancer and chronic disease contexts. Findings describe the development and testing of pain monitoring systems, but research identifying the needs of health professionals to implement routine monitoring systems within clinical practice is limited. To inform the development and implementation strategy of an electronic pain monitoring system, PainCheck, by understanding palliative care professionals' needs when integrating PainCheck into routine clinical practice. Qualitative study using face-to-face interviews. Data were analysed using framework analysis Setting/participants: Purposive sample of health professionals managing the palliative care of patients living in the community Results: A total of 15 interviews with health professionals took place. Three meta-themes emerged from the data: (1) uncertainties about integration of PainCheck and changes to current practice, (2) appraisal of current practice and (3) pain management is everybody's responsibility Conclusion: Even the most sceptical of health professionals could see the potential benefits of implementing an electronic patient-reported pain monitoring system. Health professionals have reservations about how PainCheck would work in practice. For optimal use, PainCheck needs embedding within existing electronic health records. Electronic pain monitoring systems have the potential to enable professionals to support patients' pain management more effectively but only when barriers to implementation are appropriately identified and addressed.

  7. Identifying unmet informational needs in the inpatient setting to increase patient and caregiver engagement in the context of pediatric hematopoietic stem cell transplantation.

    PubMed

    Kaziunas, Elizabeth; Hanauer, David A; Ackerman, Mark S; Choi, Sung Won

    2016-01-01

    Patient-centered care has been shown to improve patient outcomes, satisfaction, and engagement. However, there is a paucity of research on patient-centered care in the inpatient setting, including an understanding of unmet informational needs that may be limiting patient engagement. Pediatric hematopoietic stem cell transplantation (HSCT) represents an ideal patient population for elucidating unmet informational needs, due to the procedure's complexity and its requirement for caregiver involvement. We conducted field observations and semi-structured interviews of pediatric HSCT caregivers and patients to identify informational challenges in the inpatient hospital setting. Data were analyzed using a thematic grounded theory approach. Three stages of the caregiving experience that could potentially be supported by a health information technology system, with the goal of enhancing patient/caregiver engagement, were identified: (1) navigating the health system and learning to communicate effectively with the healthcare team, (2) managing daily challenges of caregiving, and (3) transitioning from inpatient care to long-term outpatient management. We provide four practical recommendations to meet the informational needs of pediatric HSCT patients and caregivers: (1) provide patients/caregivers with real-time access to electronic health record data, (2) provide information about the clinical trials in which the patient is enrolled, (3) provide information about the patient's care team, and (4) properly prepare patients and caregivers for hospital discharge. Pediatric HSCT caregivers and patients have multiple informational needs that could be met with a health information technology system that integrates data from several sources, including electronic health records. Meeting these needs could reduce patients' and caregivers' anxiety surrounding the care process; reduce information asymmetry between caregivers/patients and providers; empower patients/caregivers to

  8. Integrating unmet needs into dementia health-related quality of life research and care: Introduction of the Hierarchy Model of Needs in Dementia.

    PubMed

    Scholzel-Dorenbos, Carla J M; Meeuwsen, Els J; Olde Rikkert, Marcel G M

    2010-01-01

    To make an inventory of needs assessment instruments in dementia, to explore the interaction between unmet needs and health-related quality of life (HRQoL) and to relate these to the conceptual model of Maslow's Hierarchy of needs in order to design a dementia-specific model. Narrative review of literature on (measures of) needs of patients and caregivers and HRQoL determinants important in dementia. Relating these needs to individual goal setting instruments and Maslow's Hierarchy of needs model. The Camberwell Assessment of Needs for the Elderly (CANE) turns out to be a valid tool to assess needs of dementia patients, suitable for research and clinical use. The Carers' Needs Assessment for Dementia (CNA-D) is a valid instrument to assess needs of caregivers. Patients identified significantly fewer needs than (in)formal caregivers. The most important needs, that also determine large part of HRQoL, are need for information; support with regard to symptoms of dementia; social contact and company; and for health monitoring and safety. Goal attainment scaling in dementia is an important but not yet valid outcome measure, with only few data on feasibility in dementia patients. There are several instruments to assess needs of dementia patients and caregivers. Domains of unmet needs and HRQoL overlap. The Hierarchy Model of Needs in Dementia (HMND) offers a new theoretical framework to address the interplay between meeting of needs and improvement of HRQoL in dementia. By identifying unmet needs in dementia-research and focussing on unmet needs in dementia-care, much can be done to improve HRQoL.

  9. Changes in HIV needs identified by the National AIDS Hotline of Trinidad and Tobago.

    PubMed

    Reid, Sandra D; Nielsen, Anders L; Reddock, Rhoda

    2010-02-01

    To examine utilization of the National AIDS Hotline of Trinidad and Tobago (AIDSLINE), evaluate its validity as a reliable data source for monitoring national HIV-related needs, and identify changes in caller requests between two different time periods. A total of 7 046 anonymous hotline calls in 1998-2002 (T1) and 2 338 calls in 2007 (T2) were analyzed for associations between caller characteristics and call content. A subsample of the data was also analyzed qualitatively. T1 findings were compared with HIV-related data collected by national policy-makers during that period, to evaluate the hotline's validity as a data source, and findings from T2, to reveal changes in call content over time. In T1, the hotline was well utilized for information and counseling by both the general population and those living with HIV/AIDS. Call content from T2 indicated an increase versus T1 in 1) general awareness of HIV and other sexually transmitted diseases; 2) HIV testing; and 3) knowledge of HIV symptoms and transmission. HIV-related mental health needs, and the relationship between HIV and both child sexual abuse (CSA) and intimate partner violence (IPV), were identified as emerging issues. AIDSLINE is a well-utilized tool for providing information and counseling on national HIV-related issues, and a valid, cost-effective, easily accessed information source for planners and policy-makers involved in HIV management. Over the two study periods, there was an increase in HIV awareness and testing and in requests related to mental health, CSA, and IPV, but no change in sexual behaviors.

  10. Improving cell mixture deconvolution by identifying optimal DNA methylation libraries (IDOL).

    PubMed

    Koestler, Devin C; Jones, Meaghan J; Usset, Joseph; Christensen, Brock C; Butler, Rondi A; Kobor, Michael S; Wiencke, John K; Kelsey, Karl T

    2016-03-08

    Confounding due to cellular heterogeneity represents one of the foremost challenges currently facing Epigenome-Wide Association Studies (EWAS). Statistical methods leveraging the tissue-specificity of DNA methylation for deconvoluting the cellular mixture of heterogenous biospecimens offer a promising solution, however the performance of such methods depends entirely on the library of methylation markers being used for deconvolution. Here, we introduce a novel algorithm for Identifying Optimal Libraries (IDOL) that dynamically scans a candidate set of cell-specific methylation markers to find libraries that optimize the accuracy of cell fraction estimates obtained from cell mixture deconvolution. Application of IDOL to training set consisting of samples with both whole-blood DNA methylation data (Illumina HumanMethylation450 BeadArray (HM450)) and flow cytometry measurements of cell composition revealed an optimized library comprised of 300 CpG sites. When compared existing libraries, the library identified by IDOL demonstrated significantly better overall discrimination of the entire immune cell landscape (p = 0.038), and resulted in improved discrimination of 14 out of the 15 pairs of leukocyte subtypes. Estimates of cell composition across the samples in the training set using the IDOL library were highly correlated with their respective flow cytometry measurements, with all cell-specific R (2)>0.99 and root mean square errors (RMSEs) ranging from [0.97 % to 1.33 %] across leukocyte subtypes. Independent validation of the optimized IDOL library using two additional HM450 data sets showed similarly strong prediction performance, with all cell-specific R (2)>0.90 and R M S E<4.00 %. In simulation studies, adjustments for cell composition using the IDOL library resulted in uniformly lower false positive rates compared to competing libraries, while also demonstrating an improved capacity to explain epigenome-wide variation in DNA methylation within two large

  11. Follow-up Care Education and Information: Identifying Cancer Survivors in Need of More Guidance.

    PubMed

    O'Malley, Denalee M; Hudson, Shawna V; Ohman-Strickland, Pamela A; Bator, Alicja; Lee, Heather S; Gundersen, Daniel A; Miller, Suzanne M

    2016-03-01

    Cancer survivors engage in cancer screenings and protective health behaviors at suboptimal rates despite their increased risk for future illness. Survivorship care plans and other educational strategies to prepare cancer survivors to adopt engaged roles in managing long-term follow-up care and health risks are needed. In a sample of cancer survivors, we identified patient characteristics and psychosocial predictors associated with increased follow-up care informational needs. Cross-sectional surveys were administered to early-stage breast and prostate survivors (N = 278; 68 % breast) at least 2 years post treatment from four community hospital programs in New Jersey between May 2012 and July 2013. Patient demographics, medical history, psychosocial characteristics (i.e., worries about the future, fear of disease recurrence, and patient activation), and perceptions of oncology and primary care were assessed. African-American survivors (AOR = 2.69, 95 % confidence interval [CI] 1.27-5.68) and survivors with higher comorbidity (AOR =1.16, CI 1.01-1.33) were more likely to want additional information to guide follow-up care. Adjusting for race and comorbidities, survivors who wanted more information to guide their follow-up care reported greater worries about the future (p < 0.05) and fears about disease recurrence (p < 0.05) compared to those who did not want additional information. Results emphasize the need to develop cancer survivorship educational strategies that are both responsive to the needs of specific populations (e.g., African-American survivors and patients with multiple comorbidities) and the psychosocial profiles that motivate requests for more extensive follow-up guidance.

  12. Follow-up Care Education and Information: Identifying Cancer Survivors in Need of More Guidance

    PubMed Central

    O’Malley, Denalee M.; Hudson, Shawna V.; Ohman-Strickland, Pamela A; Bator, Alicja; Lee, Heather S.; Gundersen, Daniel A.; Miller, Suzanne M.

    2015-01-01

    Background Cancer survivors engage in cancer screenings and protective health behaviors at suboptimal rates despite their increased risk for future illness. Survivorship care plans and other educational strategies to prepare cancer survivors to adopt engaged roles in managing long-term follow-up care and health risks are needed. In a sample of cancer survivors, we identified patient characteristics and psychosocial predictors associated with increased follow-up care informational needs. Methods Cross-sectional surveys were administered to early stage breast and prostate survivors (N=278; 68% breast) at least two years post-treatment from four community hospital programs in New Jersey between May 2012-July 2013. Patient demographics, medical history, psychosocial characteristics (i.e., worries about the future, fear of disease recurrence, and patient activation) and perceptions of oncology and primary care were assessed. Results African American survivors (AOR =2.69, 95% confidence interval [CI] 1.27–5.68) and survivors with higher comorbidity (AOR=1.16, CI 1.01–1.33) were more likely to want additional information to guide follow-up care. Adjusting for race and comorbidities, survivors who wanted more information to guide their follow-up care reported greater worries about the future (p<0.05) and fears about disease recurrence (p<0.05) compared to those who did not want additional information. Conclusions Results emphasize the need to develop cancer survivorship educational strategies that are both responsive to the needs of specific populations (e.g., African American survivors and patients with multiple comorbidities) and the psychosocial profiles that motivate requests for more extensive follow-up guidance. PMID:25524391

  13. Can hospital audit teams identify case management problems, analyse their causes, identify and implement improvements? A cross-sectional process evaluation of obstetric near-miss case reviews in Benin.

    PubMed

    Borchert, Matthias; Goufodji, Sourou; Alihonou, Eusèbe; Delvaux, Thérèse; Saizonou, Jacques; Kanhonou, Lydie; Filippi, Véronique

    2012-10-11

    Obstetric near-miss case reviews are being promoted as a quality assurance intervention suitable for hospitals in low income countries. We introduced such reviews in five district, regional and national hospitals in Benin, West Africa. In a cross-sectional study we analysed the extent to which the hospital audit teams were able to identify case management problems (CMPs), analyse their causes, agree on solutions and put these solutions into practice. We analysed case summaries, women's interview transcripts and audit minutes produced by the audit teams for 67 meetings concerning one woman with near-miss complications each. We compared the proportion of CMPs identified by an external assessment team to the number found by the audit teams. For the latter, we described the CMP causes identified, solutions proposed and implemented by the audit teams. Audit meetings were conducted regularly and were well attended. Audit teams identified half of the 714 CMPs; they were more likely to find managerial ones (71%) than the ones relating to treatment (30%). Most identified CMPs were valid. Almost all causes of CMPs were plausible, but often too superficial to be of great value for directing remedial action. Audit teams suggested solutions, most of them promising ones, for 38% of the CMPs they had identified, but recorded their implementation only for a minority (8.5%). The importance of following-up and documenting the implementation of solutions should be stressed in future audit interventions. Tools facilitating the follow-up should be made available. Near-miss case reviews hold promise, but their effectiveness to improve the quality of care sustainably and on a large scale still needs to be established.

  14. Can hospital audit teams identify case management problems, analyse their causes, identify and implement improvements? A cross-sectional process evaluation of obstetric near-miss case reviews in Benin

    PubMed Central

    2012-01-01

    Background Obstetric near-miss case reviews are being promoted as a quality assurance intervention suitable for hospitals in low income countries. We introduced such reviews in five district, regional and national hospitals in Benin, West Africa. In a cross-sectional study we analysed the extent to which the hospital audit teams were able to identify case management problems (CMPs), analyse their causes, agree on solutions and put these solutions into practice. Methods We analysed case summaries, women’s interview transcripts and audit minutes produced by the audit teams for 67 meetings concerning one woman with near-miss complications each. We compared the proportion of CMPs identified by an external assessment team to the number found by the audit teams. For the latter, we described the CMP causes identified, solutions proposed and implemented by the audit teams. Results Audit meetings were conducted regularly and were well attended. Audit teams identified half of the 714 CMPs; they were more likely to find managerial ones (71%) than the ones relating to treatment (30%). Most identified CMPs were valid. Almost all causes of CMPs were plausible, but often too superficial to be of great value for directing remedial action. Audit teams suggested solutions, most of them promising ones, for 38% of the CMPs they had identified, but recorded their implementation only for a minority (8.5%). Conclusions The importance of following-up and documenting the implementation of solutions should be stressed in future audit interventions. Tools facilitating the follow-up should be made available. Near-miss case reviews hold promise, but their effectiveness to improve the quality of care sustainably and on a large scale still needs to be established. PMID:23057707

  15. Identifying profiles of service users in housing services and exploring their quality of life and care needs.

    PubMed

    Bitter, Neis A; Roeg, Diana P K; van Nieuwenhuizen, Chijs; van Weeghel, Jaap

    2016-11-23

    Housing services aim to support people with mental illness in their daily life and recovery. As the level of recovery differs between service users, the quality of life and care needs also might vary. However, the type and amount of care and support that service users receive do not always match their recovery. In order to improve the quality of care, this study aims to explore whether subgroups of service users exist based on three dimensions of recovery and to examine and compare the quality of life and care needs of the persons in these subgroups. Latent class analysis was performed with data from 263 service users of housing services in the Netherlands. Classes were based on three variables: personal recovery (Mental Health Recovery Measure), social recovery (Social Functioning Scale), and clinical recovery (Brief Symptom Inventory). Subsequently, the quality of life (MANSA) and care needs (CANSAS) of the different classes were analysed by the use of descriptive and inferential statistics. Three classes could be distinguished. Class 1 (45%) comprised of people who score the highest of the three classes in terms of personal and social recovery and who experience the least number of symptoms. People in class 2 (44%) and class 3 (11%) score significantly lower on personal and social recovery, and they experience significantly more symptoms compared to class 1. The distinction between class 2 and 3 can be made on the significantly higher number of symptoms in class 3. All three classes differ significantly on quality of life and unmet needs. The quality of life of service users of housing services needs improvement, as even persons in the best-recovered subgroup have a lower quality of life than the average population. Workers of housing services need to be aware of the recovery of a client and what his or her individual needs and goals are. Furthermore, better care (allocation) concerning mental and physical health and rehabilitation is needed. Care should be

  16. Identifying Employer Needs from Accounting Information Systems Programs

    ERIC Educational Resources Information Center

    Dillon, Thomas W.; Kruck, S. E.

    2008-01-01

    As the need for new hires with accounting and information technology knowledge increases, a new major in accounting information systems (AIS) has emerged. This new AIS degree is a hybrid of accounting concepts and common business subjects combined with key information technology issues. Employers were presented with 56 core content areas found in…

  17. Screening tools to identify patients with complex health needs at risk of high use of health care services: A scoping review

    PubMed Central

    Chouinard, Maud-Christine; Diadiou, Fatoumata; Dufour, Isabelle

    2017-01-01

    Background Many people with chronic conditions have complex health needs often due to multiple chronic conditions, psychiatric comorbidities, psychosocial issues, or a combination of these factors. They are at high risk of frequent use of healthcare services. To offer these patients interventions adapted to their needs, it is crucial to be able to identify them early. Objective The aim of this study was to find all existing screening tools that identify patients with complex health needs at risk of frequent use of healthcare services, and to highlight their principal characteristics. Our purpose was to find a short, valid screening tool to identify adult patients of all ages. Methods A scoping review was performed on articles published between 1985 and July 2016, retrieved through a comprehensive search of the Scopus and CINAHL databases, following the methodological framework developed by Arksey and O’Malley (2005), and completed by Levac et al. (2010). Results Of the 3,818 articles identified, 30 were included, presenting 14 different screening tools. Seven tools were self-reported. Five targeted adult patients, and nine geriatric patients. Two tools were designed for specific populations. Four can be completed in 15 minutes or less. Most screening tools target elderly persons. The INTERMED self-assessment (IM-SA) targets adults of all ages and can be completed in less than 15 minutes. Conclusion Future research could evaluate its usefulness as a screening tool for identifying patients with complex needs at risk of becoming high users of healthcare services. PMID:29190658

  18. Use of rapid needs assessment as a tool to identify vaccination delays in Guatemala and Peru.

    PubMed

    D'Ardenne, Katie K; Darrow, Juliana; Furniss, Anna; Chavez, Catia; Hernandez, Herminio; Berman, Stephen; Asturias, Edwin J

    2016-03-29

    To explore the use of rapid needs assessment (RNA) surveys to determine the prevalence and factors contributing to delays in vaccination of children in two low middle-income countries (LMIC). Data from two RNA surveys performed as part of program improvement evaluations in Guatemala and Peru were used for this analysis. The primary endpoint was the timeliness of immunization with delay defined as administration of vaccines beyond 28 days from recommended age for DTwP-HepB-Hib (Penta) and measles-mumps-rubella (MMR) vaccines, as well as past age-restrictions for rotavirus vaccine. Independent risk factors analyzed included child's gender, birth year, number of children in household, maternal age, maternal education, and food insecurity. Vaccine information was available from 811 children from 838 households surveyed. High rate of immunization delays was observed, with 75.6% of children in Guatemala and 57.8% of children in Peru being delayed for the third dose of Penta primary series. Factors associated with delayed vaccination in Guatemala included advanced maternal age and increased number of children in household. In Peru, significant associations were birth year before 2009, lower maternal education level, and increased number of children in household. RNA is a fast and effective method to identify timely vaccine coverage and derive a hypothesis of factors possibly associated with vaccination delay. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Identifying User Needs and the Participative Design Process

    NASA Astrophysics Data System (ADS)

    Meiland, Franka; Dröes, Rose-Marie; Sävenstedt, Stefan; Bergvall-Kåreborn, Birgitta; Andersson, Anna-Lena

    As the number of persons with dementia increases and also the demands on care and support at home, additional solutions to support persons with dementia are needed. The COGKNOW project aims to develop an integrated, user-driven cognitive prosthetic device to help persons with dementia. The project focuses on support in the areas of memory, social contact, daily living activities and feelings of safety. The design process is user-participatory and consists of iterative cycles at three test sites across Europe. In the first cycle persons with dementia and their carers (n = 17) actively participated in the developmental process. Based on their priorities of needs and solutions, on their disabilities and after discussion between the team, a top four list of Information and Communication Technology (ICT) solutions was made and now serves as the basis for development: in the area of remembering - day and time orientation support, find mobile service and reminding service, in the area of social contact - telephone support by picture dialling, in the area of daily activities - media control support through a music playback and radio function, and finally, in the area of safety - a warning service to indicate when the front door is open and an emergency contact service to enhance feelings of safety. The results of this first project phase show that, in general, the people with mild dementia as well as their carers were able to express and prioritize their (unmet) needs, and the kind of technological assistance they preferred in the selected areas. In next phases it will be tested if the user-participatory design and multidisciplinary approach employed in the COGKNOW project result in a user-friendly, useful device that positively impacts the autonomy and quality of life of persons with dementia and their carers.

  20. Research needs for an improved primary care response to chronic non-communicable diseases in Africa.

    PubMed

    Maher, D; Sekajugo, J; Harries, A D; Grosskurth, H

    2010-02-01

    With non-communicable diseases (NCDs) projected to become leading causes of morbidity and mortality in developing countries, research is needed to improve the primary care response, especially in sub-Saharan Africa. This region has a particularly high double burden of communicable diseases and NCDs and the least resources for an effective response. There is a lack of good quality epidemiological data from diverse settings on chronic NCD burden in sub-Saharan Africa, and the approach to primary care of people with chronic NCDs is currently often unstructured. The main primary care research needs are therefore firstly, epidemiological research to document the burden of chronic NCDs, and secondly, health system research to deliver the structured, programmatic, public health approach that has been proposed for the primary care of people with chronic NCDs. Documentation of the burden and trends of chronic NCDs and associated risk factors in different settings and different population groups is needed to enable health system planning for an improved primary care response. Key research issues in implementing the programmatic framework for an improved primary care response are how to (i) integrate screening and prevention within health delivery; (ii) validate the use of standard diagnostic protocols for NCD case-finding among patients presenting to the local health facilities; (iii) improve the procurement and provision of standardised treatment and (iv) develop and implement a data collection system for standardised monitoring and evaluation of patient outcomes. Important research considerations include the following: selection of research sites and the particular NCDs targeted; research methodology; local research capacity; research collaborations; ethical issues; translating research findings into policy and practice and funding. Meeting the research needs for an improved health system response is crucial to deliver effective, affordable and equitable care for the

  1. Forward genetics screen coupled with whole-genome resequencing identifies novel gene targets for improving heterologous enzyme production in Aspergillus niger

    DOE PAGES

    Reilly, Morgann C.; Kim, Joonhoon; Lynn, Jed; ...

    2018-01-06

    Plant biomass, once reduced to its composite sugars, can be converted to fuel substitutes. One means of overcoming the recalcitrance of lignocellulose is pretreatment followed by enzymatic hydrolysis. However, currently available commercial enzyme cocktails are inhibited in the presence of residual pretreatment chemicals. Recent studies have identified a number of cellulolytic enzymes from bacteria that are tolerant to pretreatment chemicals such as ionic liquids. The challenge now is generation of these enzymes in copious amounts, an arena where fungal organisms such as Aspergillus niger have proven efficient. Fungal host strains still need to be engineered to increase production titers ofmore » heterologous protein over native enzymes, which has been a difficult task. Here, we developed a forward genetics screen coupled with whole-genome resequencing to identify specific lesions responsible for a protein hyper-production phenotype in A. niger. As a result, this strategy successfully identified novel targets, including a low-affinity glucose transporter, MstC, whose deletion significantly improved secretion of recombinant proteins driven by a glucoamylase promoter.« less

  2. Forward genetics screen coupled with whole-genome resequencing identifies novel gene targets for improving heterologous enzyme production in Aspergillus niger

    DOE PAGES

    Reilly, Morgann C.; Kim, Joonhoon; Lynn, Jed; ...

    2018-01-06

    Plant biomass, once reduced to its composite sugars, can be converted to fuel substitutes. One means of overcoming the recalcitrance of lignocellulose is pretreatment followed by enzymatic hydrolysis. However, currently available commercial enzyme cocktails are inhibited in the presence of residual pretreatment chemicals. Recent studies have identified a number of cellulolytic enzymes from bacteria that are tolerant to pretreatment chemicals such as ionic liquids. The challenge now is generation of these enzymes in copious amounts, an arena where fungal organisms such as Aspergillus niger have proven efficient. Fungal host strains still need to be engineered to increase production titers ofmore » heterologous protein over native enzymes, which has been a difficult task. Here, we developed a forward genetics screen coupled with whole-genome resequencing to identify specific lesions responsible for a protein hyper-production phenotype in A. niger. This strategy successfully identified novel targets, including a low-affinity glucose transporter, MstC, whose deletion significantly improved secretion of recombinant proteins driven by a glucoamylase promoter.« less

  3. Forward genetics screen coupled with whole-genome resequencing identifies novel gene targets for improving heterologous enzyme production in Aspergillus niger

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

    Reilly, Morgann C.; Kim, Joonhoon; Lynn, Jed

    Plant biomass, once reduced to its composite sugars, can be converted to fuel substitutes. One means of overcoming the recalcitrance of lignocellulose is pretreatment followed by enzymatic hydrolysis. However, currently available commercial enzyme cocktails are inhibited in the presence of residual pretreatment chemicals. Recent studies have identified a number of cellulolytic enzymes from bacteria that are tolerant to pretreatment chemicals such as ionic liquids. The challenge now is generation of these enzymes in copious amounts, an arena where fungal organisms such as Aspergillus niger have proven efficient. Fungal host strains still need to be engineered to increase production titers ofmore » heterologous protein over native enzymes, which has been a difficult task. Here, we developed a forward genetics screen coupled with whole-genome resequencing to identify specific lesions responsible for a protein hyper-production phenotype in A. niger. This strategy successfully identified novel targets, including a low-affinity glucose transporter, MstC, whose deletion significantly improved secretion of recombinant proteins driven by a glucoamylase promoter.« less

  4. Forward genetics screen coupled with whole-genome resequencing identifies novel gene targets for improving heterologous enzyme production in Aspergillus niger

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

    Reilly, Morgann C.; Kim, Joonhoon; Lynn, Jed

    Plant biomass, once reduced to its composite sugars, can be converted to fuel substitutes. One means of overcoming the recalcitrance of lignocellulose is pretreatment followed by enzymatic hydrolysis. However, currently available commercial enzyme cocktails are inhibited in the presence of residual pretreatment chemicals. Recent studies have identified a number of cellulolytic enzymes from bacteria that are tolerant to pretreatment chemicals such as ionic liquids. The challenge now is generation of these enzymes in copious amounts, an arena where fungal organisms such as Aspergillus niger have proven efficient. Fungal host strains still need to be engineered to increase production titers ofmore » heterologous protein over native enzymes, which has been a difficult task. Here, we developed a forward genetics screen coupled with whole-genome resequencing to identify specific lesions responsible for a protein hyper-production phenotype in A. niger. As a result, this strategy successfully identified novel targets, including a low-affinity glucose transporter, MstC, whose deletion significantly improved secretion of recombinant proteins driven by a glucoamylase promoter.« less

  5. Trophic transfer of microplastics in aquatic ecosystems: Identifying critical research needs.

    PubMed

    Au, Sarah Y; Lee, Cindy M; Weinstein, John E; van den Hurk, Peter; Klaine, Stephen J

    2017-05-01

    To evaluate the process of trophic transfer of microplastics, it is important to consider various abiotic and biotic factors involved in their ingestion, egestion, bioaccumulation, and biomagnification. Toward this end, a review of the literature on microplastics has been conducted to identify factors influencing their uptake and absorption; their residence times in organisms and bioaccumulation; the physical effects of their aggregation in gastrointestinal tracts; and their potential to act as vectors for the transfer of other contaminants. Limited field evidence from higher trophic level organisms in a variety of habitats suggests that trophic transfer of microplastics may be a common phenomenon and occurs concurrently with direct ingestion. Critical research needs include standardizing methods of field characterization of microplastics, quantifying uptake and depuration rates in organisms at different trophic levels, quantifying the influence that microplastics have on the uptake and/or depuration of environmental contaminants among different trophic levels, and investigating the potential for biomagnification of microplastic-associated chemicals. More integrated approaches involving computational modeling are required to fully assess trophic transfer of microplastics. Integr Environ Assess Manag 2017;13:505-509. © 2017 SETAC. © 2017 SETAC.

  6. Active Learning for Creating Innovators: Employability Skills beyond Industrial Needs

    ERIC Educational Resources Information Center

    Ito, Hiroshi; Kawazoe, Nobuo

    2015-01-01

    In 2012, Japan's Ministry of Education, Culture, Sports, Science, and Technology initiated a project entitled "Improving Higher Education for Industrial Needs" in which 147 universities have participated. One of the main purposes of this project is to identify what industrial needs and help develop university students' employability…

  7. Overlooked and Underserved: “Action Signs” for Identifying Children With Unmet Mental Health Needs

    PubMed Central

    Goldman, Eliot; Offord, David; Costello, Elizabeth J.; Friedman, Robert; Huff, Barbara; Crowe, Maura; Amsel, Lawrence; Bennett, Kathryn; Bird, Hector; Conger, Rand; Fisher, Prudence; Hoagwood, Kimberly; Kessler, Ronald C.; Roberts, Robert

    2011-01-01

    OBJECTIVE: The US Surgeon General has called for new approaches to close the mental health services gap for the large proportion of US children with significant mental health needs who have not received evaluation or services within the previous 6 to 12 months. In response, investigators sought to develop brief, easily understood, scientifically derived “warning signs” to help parents, teachers, and the lay public to more easily recognize children with unmet mental health needs and bring these children to health care providers' attention for evaluation and possible services. METHOD: Analyses of epidemiologic data sets from >6000 children and parents were conducted to (1) determine the frequency of common but severely impairing symptom profiles, (2) examine symptom profile frequencies according to age and gender, (3) evaluate positive predictive values of symptom profiles relative to Diagnostic and Statistical Manual of Mental Disorders diagnoses, and (4) examine whether children with 1 or more symptom profiles receive mental health services. RESULTS: Symptom-profile frequencies ranged from 0.5% to 2.0%, and 8% of the children had 1 or more symptom profile. Profiles generated moderate-to-high positive predictive values (52.7%–75.4%) for impairing psychiatric diagnoses, but fewer than 25% of children with 1 or more profiles had received services in the previous 6 months. CONCLUSIONS: Scientifically robust symptom profiles that reflect severe but largely untreated mental health problems were identified. Used as “action signs,” these profiles might help increase public awareness about children's mental health needs, facilitate communication and referral for specific children in need of evaluation, and narrow the child mental health services gap. PMID:22025589

  8. A Need for Better Studies to Identify Those Populations at Greatest Risk of a Pollutant-Related Health Effect

    EPA Science Inventory

    This invited editorial on a paper accepted for publication in the Journal of Pediatrics details scientific advances needed to improve the identification of those populations at greatest risk of a pollutant-related health effect with a primary focus on air pollution.

  9. Pacific Region: A Report Identifying and Addressing the Educational Needs

    ERIC Educational Resources Information Center

    US Department of Education, 2011

    2011-01-01

    This report represents the deliberations of the Pacific Regional Advisory Committee (RAC), one of 10 RACs established under the Educational Technical Assistance Act of 2002 to assess the educational needs of the region. The committee's report outlines educational needs across the state, districts, and territories of Hawai'i, the Commonwealth of…

  10. Usability Evaluation at the Point-of-Care: A Method to Identify User Information Needs in CPOE Applications

    PubMed Central

    Washburn, Jeff; Fiol, Guilherme Del; Rocha, Roberto A.

    2006-01-01

    Point of care usability evaluation may help identify information needs that occur during the process of providing care. We describe the process of using usability-specific recording software to record Computerized Physician Order Entry (CPOE) ordering sessions on admitted adult and pediatric patients at two urban tertiary hospitals in the Intermountain Healthcare system of hospitals. PMID:17238756

  11. Support group programme for siblings of children with special needs: predictors of improved emotional and behavioural functioning.

    PubMed

    Roberts, Rachel M; Ejova, Anastasia; Giallo, Rebecca; Strohm, Kate; Lillie, Meredith E

    2016-10-01

    A pilot study to identify the predictors of improvement in emotional and behavioural functioning of siblings of children with special needs following participation in SibworkS, a six-week manual-based, cognitive-behavioural group programme. Data from 36 participants from a recent evaluation of the SibworkS programme was used. Measures were administered pre-intervention, immediately post-intervention and three months post-intervention. Treatment effects were measured using change scores for siblings on the Strengths and Difficulties Questionnaire - Parent Version (SDQ). Seven predictors were analysed: symptom severity of the child with special needs, participant age and gender, sibling birth order, family socio-economic status, participant baseline SDQ score and participant use of additional support services. The overall model significantly predicted change in SDQ scores at post-intervention and follow-up (adjusted R(2) = 0.41 and 0.40). At both evaluation points, SDQ change scores were significantly predicted by baseline SDQ score. Furthermore, symptom severity of the child with special needs was a significant predictor at three months post-intervention. Poorer emotional and behavioural functioning among participants and symptom severity of the child with special needs were associated with greater intervention effects. These results indicate that SibworkS is likely to be beneficial for siblings who have difficulties adjusting, and siblings of children with more severe special needs. Implications for Rehabilitation Siblings of children with disability are at increased risk of emotional and behavioural difficulties. Sibworks is a manualised group-based intervention for the siblings of children with a disability. Poorer emotional and behavioural functioning among participants and symptom severity of the child with special needs were associated with greater intervention effects. SibworkS is likely to be beneficial for siblings who have difficulties adjusting and

  12. The RISE Framework: Using Learning Analytics to Automatically Identify Open Educational Resources for Continuous Improvement

    ERIC Educational Resources Information Center

    Bodily, Robert; Nyland, Rob; Wiley, David

    2017-01-01

    The RISE (Resource Inspection, Selection, and Enhancement) Framework is a framework supporting the continuous improvement of open educational resources (OER). The framework is an automated process that identifies learning resources that should be evaluated and either eliminated or improved. This is particularly useful in OER contexts where the…

  13. Appalachian Region: A Report Identifying and Addressing the Educational Needs

    ERIC Educational Resources Information Center

    US Department of Education, 2011

    2011-01-01

    This report presents the deliberations of the Appalachia Regional Advisory Committee (Appalachia RAC), one of 10 RACs established under the Educational Technical Assistance Act of 2002 (20 U.S.C. sections 9601 et. seq.) to assess the educational needs of the region. The Committee's report outlines the educational needs across the four states of…

  14. Central Region: A Report Identifying and Addressing the Educational Needs

    ERIC Educational Resources Information Center

    US Department of Education, 2011

    2011-01-01

    This report presents the deliberations of the Central Regional Advisory Committee (RAC), one of 10 RACs established under the Educational Technical Assistance Act of 2002 (20 U.S.C. sections 9601 et. seq.) to assess the educational needs of the region. The committee's report outlines the educational needs across the states of Colorado, Kansas,…

  15. Midwest Region: A Report Identifying and Addressing the Educational Needs

    ERIC Educational Resources Information Center

    US Department of Education, 2011

    2011-01-01

    This report presents the deliberations of the Midwest Regional Advisory Committee (MW RAC), one of 10 RACs established under the Educational Technical Assistance Act of 2002 (20 U.S.C. sections 9601 et. seq.) to assess the educational needs of the region. The committee's report outlines the educational needs across the seven states of Illinois,…

  16. Using Geographic Information Systems (GIS) to understand a community's primary care needs.

    PubMed

    Dulin, Michael F; Ludden, Thomas M; Tapp, Hazel; Blackwell, Joshua; de Hernandez, Brisa Urquieta; Smith, Heather A; Furuseth, Owen J

    2010-01-01

    A key element for reducing health care costs and improving community health is increased access to primary care and preventative health services. Geographic information systems (GIS) have the potential to assess patterns of health care utilization and community-level attributes to identify geographic regions most in need of primary care access. GIS, analytical hierarchy process, and multiattribute assessment and evaluation techniques were used to examine attributes describing primary care need and identify areas that would benefit from increased access to primary care services. Attributes were identified by a collaborative partnership working within a practice-based research network using tenets of community-based participatory research. Maps were created based on socioeconomic status, population density, insurance status, and emergency department and primary care safety-net utilization. Individual and composite maps identified areas in our community with the greatest need for increased access to primary care services. Applying GIS to commonly available community- and patient-level data can rapidly identify areas most in need of increased access to primary care services. We have termed this a Multiple Attribute Primary Care Targeting Strategy. This model can be used to plan health services delivery as well as to target and evaluate interventions designed to improve health care access.

  17. On a European collaboration to identify organizational models, potential shortcomings and improvement options in out-of-hours primary health care.

    PubMed

    Leutgeb, Ruediger; Walker, Nicola; Remmen, Roy; Klemenc-Ketis, Zalika; Szecsenyi, Joachim; Laux, Gunter

    2014-09-01

    Abstract Background: Out-of-hours care (OOHC) provision is an increasingly challenging aspect in the delivery of primary health care services. Although many European countries have implemented organizational models for out-of-hours primary care, which has been traditionally delivered by general practitioners, health care providers throughout Europe are still looking to resolve current challenges in OOHC. It is within this context that the European Research Network for Out-of-Hours Primary Health Care (EurOOHnet) was established in 2010 to investigate the provision of out-of-hours care across European countries, which have diverse political and health care systems. In this paper, we report on the EurOOHnet work related to OOHC organizational models, potential shortcomings and improvement options in out-of-hours primary health care. Needs assessment: The EurOOHnet expert working party proposed that models for OOHC should be reviewed to evaluate the availability and accessibility of OOHC for patients while also seeking ways to make the delivery of care more satisfying for service providers. To move towards resolution of OOHC challenges in primary care, as the first stage, the EurOOHnet expert working party identified the following key needs: clear and uniform definitions of the different OOHC models between different countries; adequate-ideally transnational-definitions of urgency levels and corresponding data; and educational programmes for nurses and doctors (e.g. in the use of a standardized triage system for OOHC). Finally, the need for a modern system of data transfer between different health care providers in regular care and providers in OOHC to prevent information loss was identified.

  18. UMI-tools: modeling sequencing errors in Unique Molecular Identifiers to improve quantification accuracy

    PubMed Central

    2017-01-01

    Unique Molecular Identifiers (UMIs) are random oligonucleotide barcodes that are increasingly used in high-throughput sequencing experiments. Through a UMI, identical copies arising from distinct molecules can be distinguished from those arising through PCR amplification of the same molecule. However, bioinformatic methods to leverage the information from UMIs have yet to be formalized. In particular, sequencing errors in the UMI sequence are often ignored or else resolved in an ad hoc manner. We show that errors in the UMI sequence are common and introduce network-based methods to account for these errors when identifying PCR duplicates. Using these methods, we demonstrate improved quantification accuracy both under simulated conditions and real iCLIP and single-cell RNA-seq data sets. Reproducibility between iCLIP replicates and single-cell RNA-seq clustering are both improved using our proposed network-based method, demonstrating the value of properly accounting for errors in UMIs. These methods are implemented in the open source UMI-tools software package. PMID:28100584

  19. Illinois Higher Education in the 21st Century. Identifying and Responding to the Educational Needs in Lake County: A Committee Report.

    ERIC Educational Resources Information Center

    Illinois State Board of Higher Education, Springfield.

    This report presents the findings of a pilot study conducted in Lake County (Illinois) that was designed to identify higher educational needs and to develop recommendations to respond to those needs. Several methodologies were employed: public hearings; market research; analyses of census, labor, economic, and educational data; consultations with…

  20. Using a service sector segmented approach to identify community stakeholders who can improve access to suicide prevention services for veterans.

    PubMed

    Matthieu, Monica M; Gardiner, Giovanina; Ziegemeier, Ellen; Buxton, Miranda

    2014-04-01

    Veterans in need of social services may access many different community agencies within the public and private sectors. Each of these settings has the potential to be a pipeline for attaining needed health, mental health, and benefits services; however, many service providers lack information on how to conceptualize where Veterans go for services within their local community. This article describes a conceptual framework for outreach that uses a service sector segmented approach. This framework was developed to aid recruitment of a provider-based sample of stakeholders (N = 70) for a study on improving access to the Department of Veterans Affairs and community-based suicide prevention services. Results indicate that although there are statistically significant differences in the percent of Veterans served by the different service sectors (F(9, 55) = 2.71, p = 0.04), exposure to suicidal Veterans and providers' referral behavior is consistent across the sectors. Challenges to using this framework include isolating the appropriate sectors for targeted outreach efforts. The service sector segmented approach holds promise for identifying and referring at-risk Veterans in need of services. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

  1. Identifying traffic safety needs - a systematic approach : [technical summary].

    DOT National Transportation Integrated Search

    2011-01-01

    The Indiana Department of Transportation (INDOT) manages road safety in Indiana through safety emphasis areas, identification of safety needs within these areas, and development and implementation of transportation interventions that address the safe...

  2. Contradictions as Drivers for Improving Inclusion in Teaching Pupils with Special Educational Needs

    ERIC Educational Resources Information Center

    Paju, Birgit; Kajamaa, Anu; Pirttimaa, Raija; Kontu, Elina

    2018-01-01

    The aim of this paper is to enhance understanding of the contradictions that arise in the drive to improve teaching practices among pupils with special educational needs (SENs). A questionnaire was administrated to 167 classroom teachers, subject teachers, special education teachers and teaching assistants in Finland. The analysis, based on…

  3. Transformation in Higher Education: A Learner-Needs Segmentation Leads to Improved Learner Satisfaction

    ERIC Educational Resources Information Center

    Rogers, Gayla; Finley, Donna S.; Patterson, Margaret

    2006-01-01

    Segmentation is a marketing concept that can be applied in a post-secondary context. This article delineates the outcome of applying a learner-needs segmentation that resulted in significantly improved learner satisfaction scores in a professional faculty at a large public university. Our original work described the purpose and value of…

  4. The Clinical Validation of the Athlete Sleep Screening Questionnaire: an Instrument to Identify Athletes that Need Further Sleep Assessment.

    PubMed

    Bender, Amy M; Lawson, Doug; Werthner, Penny; Samuels, Charles H

    2018-06-04

    Previous research has established that general sleep screening questionnaires are not valid and reliable in an athlete population. The Athlete Sleep Screening Questionnaire (ASSQ) was developed to address this need. While the initial validation of the ASSQ has been established, the clinical validity of the ASSQ has yet to be determined. The main objective of the current study was to evaluate the clinical validity of the ASSQ. Canadian National Team athletes (N = 199; mean age 24.0 ± 4.2 years, 62% females; from 23 sports) completed the ASSQ. A subset of athletes (N = 46) were randomized to the clinical validation sub-study which required subjects to complete an ASSQ at times 2 and 3 and to have a clinical sleep interview by a sleep medicine physician (SMP) who rated each subjects' category of clinical sleep problem and provided recommendations to improve sleep. To assess clinical validity, the SMP category of clinical sleep problem was compared to the ASSQ. The internal consistency (Cronbach's alpha = 0.74) and test-retest reliability (r = 0.86) of the ASSQ were acceptable. The ASSQ demonstrated good agreement with the SMP (Cohen's kappa = 0.84) which yielded a diagnostic sensitivity of 81%, specificity of 93%, positive predictive value of 87%, and negative predictive value of 90%. There were 25.1% of athletes identified to have clinically relevant sleep disturbances that required further clinical sleep assessment. Sleep improved from time 1 at baseline to after the recommendations at time 3. Sleep screening athletes with the ASSQ provides a method of accurately determining which athletes would benefit from preventative measures and which athletes suffer from clinically significant sleep problems. The process of sleep screening athletes and providing recommendations improves sleep and offers a clinical intervention output that is simple and efficient for teams and athletes to implement.

  5. Improving state Medicaid contracts and plan practices for children with special needs.

    PubMed

    Fox, H B; McManus, M A

    1998-01-01

    The rapid transition of state Medicaid beneficiaries into fully capitated managed care plans requires a special focus on children with chronic or disabling conditions, who often depend on numerous pediatric physicians and other specialty services for health care and related services. Because managed care arrangements for this population are growing in popularity nationwide, it is important that states craft managed care contracts to address the unique needs of children with complex physical, developmental, and mental health problems. Based on the research reported in this article, in-depth interviews with state Medicaid agency staff, interviews with medical directors and administrators of managed care plans serving Medicaid recipients, and input from experts in pediatrics and managed care, a set of recommendations is made for tailoring managed care contracts to meet the needs of this vulnerable group of children. Six contracting elements that should be adopted by state Medicaid agencies include (1) clarifying the specificity of pediatric benefits, (2) defining appropriate pediatric provider capacity requirements, (3) developing a medical necessity standard specific to children, (4) identifying pediatric quality-of-care measures, (5) setting appropriate pediatric capitation rates, and (6) creating incentives for high-quality pediatric care. Nine approaches that should be adopted by managed care practices interested in providing high-quality care for children with special needs also are identified. These include (1) ensuring that assigned primary care providers have appropriate training and experience, (2) offering support systems for primary care practices, (3) providing specialty consultation for primary care providers, (4) establishing arrangements for the comanagement of primary and specialty pediatric services, (5) arranging for comprehensive care coordination, (6) establishing flexible service authorization policies, (7) implementing provider profiling systems

  6. How Can Health Information Technologies Contribute to Improve Health Care Services for High-Need Patients?

    PubMed

    Nøhr, Christian; Botin, Lars; Zhu, Xinxin

    2017-01-01

    This paper discusses how health information technologies like tele-care, tele-health and tele-medicine can improve the condition for high-need patients, specifically in relation to access. The paper addresses specifically the values of timeliness and equity and how tele technological solutions can support and enhance these values. The paper introduces to the concept of scaffolding, which constitutes the framework for dynamic, appropriate, caring and embracing approaches for engaging and involving high-need patients that are vulnerable and exposed. A number of specific considerations for designing tele-technologies for high-need patients are derived, and the paper concludes that ethical and epistemological criterions for design are needed in order to meet the needs and requirements of the weak and exposed.

  7. Psychosocial issues in post-treatment cancer survivors: Desire for support and challenges in identifying individuals in need.

    PubMed

    Philip, Errol J; Merluzzi, Thomas V

    2016-01-01

    The ongoing and late effects of cancer treatment can interfere with quality of life and adoption of healthy behaviors, thus potentially impairing recovery and survival. Developing effective methods to identify individuals in need of support is crucial in providing comprehensive, ongoing care and ensuring optimal use of limited resources. The current study provides an examination of long-term survivors' reports of psychosocial issues, their desire for follow-up, and the role of widely used distress-screening measures for identifying survivors who desire help. 317 cancer survivors (M age = 62.98 years, female = 70%, Md years since treatment = 7.5 years, mixed diagnoses) completed measures of psychosocial adjustment and quality of life as well as a checklist of psychosocial issues on which they indicated whether they would like to speak with a health professional regarding each issue. Participants reported an average of 1.7 psychosocial issues. Only a minority desired to speak to a health professional; however, those desiring follow-up reported significant impairments in adjustment and quality of life. Though far from adequate as a stand-alone measure, area under the curve and regression analysis suggested a combination of the distress thermometer and number of psychosocial issues may be the best assessment of those desiring follow-up assistance. These results indicate that there is a need for a more sophisticated system of assisting survivors that takes into account issues, symptoms, and motivation for help. The present study is important in guiding the development of effective survivorship care and contributing to the growing literature describing the adjustment and care needs of survivors.

  8. Identifying fruitful connections between and among researchers and practitioners

    NASA Technical Reports Server (NTRS)

    Feather, Martin S.; Menzies, Tim; Connelly, Judith R.

    2003-01-01

    Many organizations look to research to yield new and improved products and practices. Connecting practitioners who have the need for research results to the researchers producing those results is important to guiding research and utilizing its results. Likewise, connecting researchers working on related topics to one another, and connecting practitioners with related needs to one another, is important to establishing communities of shared interests. We present an approach that helps identify fruitful such connections.

  9. Computer Security Incident Response Team Effectiveness: A Needs Assessment

    PubMed Central

    Van der Kleij, Rick; Kleinhuis, Geert; Young, Heather

    2017-01-01

    Computer security incident response teams (CSIRTs) respond to a computer security incident when the need arises. Failure of these teams can have far-reaching effects for the economy and national security. CSIRTs often have to work on an ad hoc basis, in close cooperation with other teams, and in time constrained environments. It could be argued that under these working conditions CSIRTs would be likely to encounter problems. A needs assessment was done to see to which extent this argument holds true. We constructed an incident response needs model to assist in identifying areas that require improvement. We envisioned a model consisting of four assessment categories: Organization, Team, Individual and Instrumental. Central to this is the idea that both problems and needs can have an organizational, team, individual, or technical origin or a combination of these levels. To gather data we conducted a literature review. This resulted in a comprehensive list of challenges and needs that could hinder or improve, respectively, the performance of CSIRTs. Then, semi-structured in depth interviews were held with team coordinators and team members of five public and private sector Dutch CSIRTs to ground these findings in practice and to identify gaps between current and desired incident handling practices. This paper presents the findings of our needs assessment and ends with a discussion of potential solutions to problems with performance in incident response. PMID:29312051

  10. Computer Security Incident Response Team Effectiveness: A Needs Assessment.

    PubMed

    Van der Kleij, Rick; Kleinhuis, Geert; Young, Heather

    2017-01-01

    Computer security incident response teams (CSIRTs) respond to a computer security incident when the need arises. Failure of these teams can have far-reaching effects for the economy and national security. CSIRTs often have to work on an ad hoc basis, in close cooperation with other teams, and in time constrained environments. It could be argued that under these working conditions CSIRTs would be likely to encounter problems. A needs assessment was done to see to which extent this argument holds true. We constructed an incident response needs model to assist in identifying areas that require improvement. We envisioned a model consisting of four assessment categories: Organization, Team, Individual and Instrumental. Central to this is the idea that both problems and needs can have an organizational, team, individual, or technical origin or a combination of these levels. To gather data we conducted a literature review. This resulted in a comprehensive list of challenges and needs that could hinder or improve, respectively, the performance of CSIRTs. Then, semi-structured in depth interviews were held with team coordinators and team members of five public and private sector Dutch CSIRTs to ground these findings in practice and to identify gaps between current and desired incident handling practices. This paper presents the findings of our needs assessment and ends with a discussion of potential solutions to problems with performance in incident response.

  11. Identifying and Funding the Greatest Needs in School Facilities

    ERIC Educational Resources Information Center

    Gorrell, Bob; Salamone, Frank

    2012-01-01

    How should public school facilities programs allocate limited resources to school facilities needs fairly, cost-effectively, and efficiently while taking into account facility condition, educational adequacy, and other priorities? New Mexico has developed a solution that overcomes key challenges that are common to school facilities programs across…

  12. Physics and biophysics experiments needed for improved risk assessment in space

    NASA Astrophysics Data System (ADS)

    Sihver, L.

    To improve the risk assessment of radiation carcinogenesis, late degenerative tissue effects, acute syndromes, synergistic effects of radiation and microgravity or other spacecraft factors, and hereditary effects, on future LEO and interplanetary space missions, the radiobiological effects of cosmic radiation before and after shielding must be well understood. However, cosmic radiation is very complex and includes low and high LET components of many different neutral and charged particles. The understanding of the radiobiology of the heavy ions, from GCRs and SPEs, is still a subject of great concern due to the complicated dependence of their biological effects on the type of ion and energy, and its interaction with various targets both outside and within the spacecraft and the human body. In order to estimate the biological effects of cosmic radiation, accurate knowledge of the physics of the interactions of both charged and non-charged high-LET particles is necessary. Since it is practically impossible to measure all primary and secondary particles from all projectile-target-energy combinations needed for a correct risk assessment in space, accurate particle and heavy ion transport codes might be a helpful instrument to overcome those difficulties. These codes have to be carefully validated to make sure they fulfill preset accuracy criteria, e.g. to be able to predict particle fluence and energy distributions within a certain accuracy. When validating the accuracy of the transport codes, both space and ground-based accelerator experiments are needed. In this paper current and future physics and biophysics experiments needed for improved risk assessment in space will be discussed. The cyclotron HIRFL (heavy ion research facility in Lanzhou) and the new synchrotron CSR (cooling storage ring), which can be used to provide ion beams for space related experiments at the Institute of Modern Physics, Chinese Academy of Sciences (IMP-CAS), will be presented together with

  13. Identifying Needs: a Qualitative Study of women's Experiences Regarding Rapid Genetic Testing for Hereditary Breast and Ovarian Cancer in the DNA BONus Study.

    PubMed

    Augestad, Mirjam Tonheim; Høberg-Vetti, Hildegunn; Bjorvatn, Cathrine; Sekse, Ragnhild Johanne Tveit

    2017-02-01

    Genetic testing for hereditary breast and ovarian cancer is increasingly being offered in newly diagnosed breast and ovarian cancer patients. This genetic information may influence treatment decisions. However, there are some concerns that genetic testing offered in an already vulnerable situation might be an extra burden to these women. The aim of this study was to explore the experiences of women who had been offered and accepted genetic testing when newly diagnosed with breast or ovarian cancer. Four semi-structured focus-group interviews were conducted with 17 women recruited from a Norwegian multicenter study. The material was condensed, and conventional qualitative analysis was used to identify patterns in the participants' descriptions. Three core themes were identified: 1) being "beside oneself" 2) altruism and ethical dilemmas 3) the need for support and counselling to assist the decision process. The present study indicates that women who are offered genetic testing when newly diagnosed with breast or ovarian cancer want a consultation with a health professional. Personalized support and counselling might empower women to improve their ability to manage and comprehend this overwhelming situation, and find meaning in this experience.

  14. Vulnerable Youth: Identifying Their Need for Alternative Educational Settings.

    ERIC Educational Resources Information Center

    Zweig, Janine M.

    This paper examines the extent to which alternative education can meet the needs of disconnected youth who are at risk of economic and social hardship. It summarizes characteristics of disconnected youth, risk factors associated with disconnection, and characteristics of students in selected alternative education settings. The most common factors…

  15. Report: EPA Needs to Improve Physical Security at Its Offices in Las Vegas, Nevada

    EPA Pesticide Factsheets

    Report #10-P-0059, February 3, 2010. EPA needs to improve physical security at its Las Vegas facilities. The Las Vegas Finance Center’s (LVFC’s) server room and other key areas are susceptible to unauthorized access by personnel not a part of LVFC.

  16. Improving outcomes for people with progressive cancer: interrupted time series trial of a needs assessment intervention.

    PubMed

    Waller, Amy; Girgis, Afaf; Johnson, Claire; Lecathelinais, Christophe; Sibbritt, David; Forstner, Dion; Liauw, Winston; Currow, David C

    2012-03-01

    Improving the effectiveness of cancer care delivery has become a major focus of research. This study assessed the uptake and impact of the Palliative Care Needs Assessment Guidelines and Needs Assessment Tool: Progressive Disease--Cancer (NAT: PD-C) on the outcomes of people with advanced cancer. Given widely varying survival in people with advanced cancer, an interrupted time series design was used, with data on unmet needs, depression, anxiety, and quality of life collected from 195 patients using telephone interviews every two months, for up to 18 months. Patients completed at least two baseline interviews before health professionals were academically detailed in the use of the Palliative Care Needs Assessment Guidelines and NAT: PD-C. Health professionals completed the NAT: PD-C with patients approximately monthly for the remainder of the study. Changes in patients' outcomes were compared prior to and following the introduction of the NAT: PD-C using general estimating equations. Moderate to high needs across all domains were frequently seen in the preintervention phase. The use of the NAT: PD-C was associated with a significant reduction in health system and information and patient care and support needs. These resources have the potential as an efficient and acceptable strategy for supporting needs-based cancer care. Further work is required to determine their unique contribution to improvements in patient outcomes. Copyright © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  17. Stakeholder Engagement to Identify Priorities for Improving the Quality and Value of Critical Care.

    PubMed

    Stelfox, Henry T; Niven, Daniel J; Clement, Fiona M; Bagshaw, Sean M; Cook, Deborah J; McKenzie, Emily; Potestio, Melissa L; Doig, Christopher J; O'Neill, Barbara; Zygun, David

    2015-01-01

    Large amounts of scientific evidence are generated, but not implemented into patient care (the 'knowledge-to-care' gap). We identified and prioritized knowledge-to-care gaps in critical care as opportunities to improve the quality and value of healthcare. We used a multi-method community-based participatory research approach to engage a Network of all adult (n = 14) and pediatric (n = 2) medical-surgical intensive care units (ICUs) in a fully integrated geographically defined healthcare system serving 4 million residents. Participants included Network oversight committee members (n = 38) and frontline providers (n = 1,790). Network committee members used a modified RAND/University of California Appropriateness Methodology, to serially propose, rate (validated 9 point scale) and revise potential knowledge-to-care gaps as priorities for improvement. The priorities were sent to frontline providers for evaluation. Results were relayed back to all frontline providers for feedback. Initially, 68 knowledge-to-care gaps were proposed, rated and revised by the committee (n = 32 participants) over 3 rounds of review and resulted in 13 proposed priorities for improvement. Then, 1,103 providers (62% response rate) evaluated the priorities, and rated 9 as 'necessary' (median score 7-9). Several factors were associated with rating priorities as necessary in multivariable logistic regression, related to the provider (experience, teaching status of ICU) and topic (strength of supporting evidence, potential to benefit the patient, potential to improve patient/family experience, potential to decrease costs). A community-based participatory research approach engaged a diverse group of stakeholders to identify 9 priorities for improving the quality and value of critical care. The approach was time and cost efficient and could serve as a model to prioritize areas for research quality improvement across other settings.

  18. The need for improved brain lesion segmentation techniques for children with cerebral palsy: A review.

    PubMed

    Pagnozzi, Alex M; Gal, Yaniv; Boyd, Roslyn N; Fiori, Simona; Fripp, Jurgen; Rose, Stephen; Dowson, Nicholas

    2015-12-01

    Cerebral palsy (CP) describes a group of permanent disorders of posture and movement caused by disturbances in the developing brain. Accurate diagnosis and prognosis, in terms of motor type and severity, is difficult to obtain due to the heterogeneous appearance of brain injury and large anatomical distortions commonly observed in children with CP. There is a need to optimise treatment strategies for individual patients in order to lead to lifelong improvements in function and capabilities. Magnetic resonance imaging (MRI) is critical to non-invasively visualizing brain lesions, and is currently used to assist the diagnosis and qualitative classification in CP patients. Although such qualitative approaches under-utilise available data, the quantification of MRIs is not automated and therefore not widely performed in clinical assessment. Automated brain lesion segmentation techniques are necessary to provide valid and reproducible quantifications of injury. Such techniques have been used to study other neurological disorders, however the technical challenges unique to CP mean that existing algorithms require modification to be sufficiently reliable, and therefore have not been widely applied to MRIs of children with CP. In this paper, we present a review of a subset of available brain injury segmentation approaches that could be applied to CP, including the detection of cortical malformations, white and grey matter lesions and ventricular enlargement. Following a discussion of strengths and weaknesses, we suggest areas of future research in applying segmentation techniques to the MRI of children with CP. Specifically, we identify atlas-based priors to be ineffective in regions of substantial malformations, instead propose relying on adaptive, spatially consistent algorithms, with fast initialisation mechanisms to provide additional robustness to injury. We also identify several cortical shape parameters that could be used to identify cortical injury, and shape

  19. Report: EPA Needs to Improve Management Practices to Ensure a Successful Customer Technology Solutions Project

    EPA Pesticide Factsheets

    Report #10-P-0194, August 23, 2010. Although EPA indicated it could avoid spending more than $115.4 million over 8.5 years by consolidating the desktop computing environment, improved management practices are needed.

  20. Suicide Risk Protocols: Addressing the Needs of High Risk Youths Identified through Suicide Prevention Efforts and in Clinical Settings

    ERIC Educational Resources Information Center

    Heilbron, Nicole; Goldston, David; Walrath, Christine; Rodi, Michael; McKeon, Richard

    2013-01-01

    Several agencies have emphasized the importance of establishing clear protocols or procedures to address the needs of youths who are identified as suicidal through suicide prevention programs or in emergency department settings. What constitutes optimal guidelines for developing and implementing such protocols, however, is unclear. At the request…

  1. Needs Assessment: Who Needs It?

    ERIC Educational Resources Information Center

    Hays, Donald G.; Linn, Joan K.

    This monograph addresses the issue of needs assessment in the educational process and how it applies to the school counselor's role. The authors provide information on the process of needs assessment, from the initial step of obtaining commitment to the final outcome of improved program planning and development. Using an example common to many…

  2. Report: Office of Research and Development Needs to Improve Its Method of Measuring Administrative Savings

    EPA Pesticide Factsheets

    Report #11-P-0333, July 14, 2011. ORD’s efforts to reduce its administrative costs are noteworthy, but ORD needs to improve its measurement mechanism for assessing the effectiveness of its initiatives to reduce administrative costs.

  3. Non-adherence in children with asthma reviewed: The need for improvement of asthma care and medical education.

    PubMed

    Klok, Ted; Kaptein, Adrian A; Brand, Paul L P

    2015-05-01

    Adherence to daily inhaled corticosteroid therapy is a key determinant of asthma control. Therefore, improving adherence to inhaled corticosteroids is the most effective method through which healthcare providers can help children with uncontrolled asthma. However, identifying non-adherent patients is difficult, and electronic monitoring is the only reliable method to assess adherence. (Non-)adherence is a complex behavioural process influenced by many interacting factors. Intentional barriers to adherence are common; driven by illness perceptions and medication beliefs, patients and parents deliberately choose not to follow the doctor's recommendations. Common non-intentional barriers are related to family routines, child-raising issues, and to social issues such as poverty. Effective interventions improving adherence are complex, because they take intentional and non-intentional barriers to adherence into account. There is evidence that comprehensive, guideline-based asthma self-management programmes can be successful, with excellent adherence and good asthma control. Patient-centred care focused on healthcare provider-patient/parent collaboration is the key factor determining the success of guided self-management programmes. Such care should focus on shared decision-making as this has been shown to improve adherence and healthcare outcomes. Current asthma care falls short because many physicians fail to adhere to asthma guidelines in their diagnostic approach and therapeutic prescriptions, and because of the lack of application of patient-centred health care. Increased awareness of the importance of patient-centred communication and increased training in patient-centred communication skills of undergraduates and experienced attending physicians are needed to improve adherence to daily controller therapy and asthma control in children with asthma. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. What are the motivational needs behind volunteer work?

    PubMed

    Danoff, A; Kopel, S

    1994-01-01

    Identification of an individual's motivational need and desired volunteer work enables volunteer administrators to capitalize on the motivation a person brings to the organization as well as to make effective use of the role by being cognizant of the levels of participation behind the differing volunteer assignments. The Motivation by Maslow Questionnaire was used to identify motivational needs of 35 helpline (crisis) volunteers, and three categories of volunteer work were used to classify their levels of participation. Implications for improving volunteer commitment to the formal voluntary organization and recruitment and retention strategies relative to volunteer motivational needs are discussed.

  5. 25 CFR 170.501 - What happens when the review process identifies areas for improvement?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false What happens when the review process identifies areas for improvement? 170.501 Section 170.501 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER INDIAN RESERVATION ROADS PROGRAM Planning, Design, and Construction of Indian Reservation Roads...

  6. Identifying Social Determinants of Health and Legal Needs for Children With Special Health Care Needs.

    PubMed

    DeJong, Neal A; Wood, Charles T; Morreale, Madlyn C; Ellis, Cameron; Davis, Darragh; Fernandez, Jorge; Steiner, Michael J

    2016-03-01

    Children with special health care needs (CSHCN) require comprehensive care with high levels of community and government assistance. Medical-legal partnerships may be particularly suited to address needs for this population. To explore this, we conducted in-depth telephone interviews of families of CSHCN cared for in the primary care practice of our tertiary care children's hospital. The majority of the sample (N = 46) had been late on housing payments and 17% of homeowners had been threatened with foreclosure. Families frequently reported denial of public benefits. Approximately 10% had executed advance planning documents such as guardianship plans for the children or wills for the parents. A minority of families had sought help from community agencies or lawyers. Less than one third had ever discussed any of the issues with health care providers, but two thirds were likely or very likely to in the future. CSHCN may especially benefit from the social support of a medical-legal partnership. © The Author(s) 2015.

  7. Mid-Atlantic Region: A Report Identifying and Addressing the Educational Needs

    ERIC Educational Resources Information Center

    US Department of Education, 2011

    2011-01-01

    This report presents the deliberations of the Mid-Atlantic Regional Advisory Committee (RAC), one of 10 RACs established under the Educational Technical Assistance Act of 2002 (20 U.S.C. sections 9601 et. seq.) to assess the educational needs of the region. The committee's report outlines the educational needs across the District of Columbia and…

  8. Learning from the public: citizens describe the need to improve end-of-life care access, provision and recognition across Europe

    PubMed Central

    Daveson, Barbara A.; Alonso, Juan P.; Calanzani, Natalia; Ramsenthaler, Christina; Gysels, Marjolein; Antunes, Barbara; Moens, Katrien; Groeneveld, Esther I.; Albers, Gwenda; Finetti, Silvia; Pettenati, Francesca; Bausewein, Claudia; Higginson, Irene J.; Harding, Richard; Deliens, Luc; Toscani, Franco; Ferreira, Pedro L.; Ceulemans, Lucas; Gomes, Barbara

    2014-01-01

    Background: Despite ageing populations and increasing cancer deaths, many European countries lack national policies regarding palliative and end-of-life care. The aim of our research was to determine public views regarding end-of-life care in the face of serious illness. Methods: Implementation of a pan-European population-based survey with adults in England, Belgium (Flanders), Germany, Italy, the Netherlands, Portugal and Spain. Three stages of analysis were completed on open-ended question data: (i) inductive analysis to determine a category-code framework; (ii) country-level manifest deductive content analysis; and (iii) thematic analysis to identify cross-country prominent themes. Results: Of the 9344 respondents, 1543 (17%) answered the open-ended question. Two prominent themes were revealed: (i) a need for improved quality of end-of-life and palliative care, and access to this care for patients and families and (ii) the recognition of the importance of death and dying, the cessation of treatments to extend life unnecessarily and the need for holistic care to include comfort and support. Conclusions: Within Europe, the public recognizes the importance of death and dying; they are concerned about the prioritization of quantity of life over quality of life; and they call for improved quality of end-of-life and palliative care for patients, especially for elderly patients, and families. To fulfil the urgent need for a policy response and to advance research and care, we suggest four solutions for European palliative and end-of-life care: institute government-led national strategies; protect regional research funding; consider within- and between-country variance; establish standards for training, education and service delivery. PMID:23487548

  9. Need for Improved Methods to Collect and Present Spatial Epidemiologic Data for Vectorborne Diseases

    PubMed Central

    Eisen, Rebecca J.

    2007-01-01

    Improved methods for collection and presentation of spatial epidemiologic data are needed for vectorborne diseases in the United States. Lack of reliable data for probable pathogen exposure site has emerged as a major obstacle to the development of predictive spatial risk models. Although plague case investigations can serve as a model for how to ideally generate needed information, this comprehensive approach is cost-prohibitive for more common and less severe diseases. New methods are urgently needed to determine probable pathogen exposure sites that will yield reliable results while taking into account economic and time constraints of the public health system and attending physicians. Recent data demonstrate the need for a change from use of the county spatial unit for presentation of incidence of vectorborne diseases to more precise ZIP code or census tract scales. Such fine-scale spatial risk patterns can be communicated to the public and medical community through Web-mapping approaches. PMID:18258029

  10. Need for improved methods to collect and present spatial epidemiologic data for vectorborne diseases.

    PubMed

    Eisen, Lars; Eisen, Rebecca J

    2007-12-01

    Improved methods for collection and presentation of spatial epidemiologic data are needed for vectorborne diseases in the United States. Lack of reliable data for probable pathogen exposure site has emerged as a major obstacle to the development of predictive spatial risk models. Although plague case investigations can serve as a model for how to ideally generate needed information, this comprehensive approach is cost-prohibitive for more common and less severe diseases. New methods are urgently needed to determine probable pathogen exposure sites that will yield reliable results while taking into account economic and time constraints of the public health system and attending physicians. Recent data demonstrate the need for a change from use of the county spatial unit for presentation of incidence of vectorborne diseases to more precise ZIP code or census tract scales. Such fine-scale spatial risk patterns can be communicated to the public and medical community through Web-mapping approaches.

  11. Physician Educational Needs in Osteoporosis: An Approach to Needs Assessment.

    ERIC Educational Resources Information Center

    Lockyer, Jocelyn; Hanley, David; Fidler, Herta; Toews, John; Lysholm-Andrews, Elaine

    1998-01-01

    A literature review, focus groups (n=200), and questionnaire responses from 324 family physicians identified their learning needs related to osteoporosis. The three methods identified different learning issues, suggesting the importance of triangulation to ensure currency and relevance in continuing-education needs-assessment. (SK)

  12. Applying GRA and QFD to Improve Library Service Quality

    ERIC Educational Resources Information Center

    Chen, Yen-Ting; Chou, Tsung-Yu

    2011-01-01

    This paper applied Grey Relational Analysis (GRA) to Quality Function Deployment (QFD) to identify service improvement techniques for an academic library. First, reader needs and their importance, and satisfaction degrees were examined via questionnaires. Second, the service improvement techniques for satisfying the reader needs were developed by…

  13. Improving medication information transfer between hospitals, skilled-nursing facilities, and long-term-care pharmacies for hospital discharge transitions of care: A targeted needs assessment using the Intervention Mapping framework.

    PubMed

    Kerstenetzky, Luiza; Birschbach, Matthew J; Beach, Katherine F; Hager, David R; Kennelty, Korey A

    2018-02-01

    Patients transitioning from the hospital to a skilled nursing home (SNF) are susceptible to medication-related errors resulting from fragmented communication between facilities. Through continuous process improvement efforts at the hospital, a targeted needs assessment was performed to understand the extent of medication-related issues when patients transition from the hospital into a SNF, and the gaps between the hospital's discharge process, and the needs of the SNF and long-term care (LTC) pharmacy. We report on the development of a logic model that will be used to explore methods for minimizing patient care medication delays and errors while further improving handoff communication to SNF and LTC pharmacy staff. Applying the Intervention Mapping (IM) framework, a targeted needs assessment was performed using quantitative and qualitative methods. Using the hospital discharge medication list as reference, medication discrepancies in the SNF and LTC pharmacy lists were identified. SNF and LTC pharmacy staffs were also interviewed regarding the continuity of medication information post-discharge from the hospital. At least one medication discrepancy was discovered in 77.6% (n = 45/58) of SNF and 76.0% (n = 19/25) of LTC pharmacy medication lists. A total of 191 medication discrepancies were identified across all SNF and LTC pharmacy records. Of the 69 SNF staff interviewed, 20.3% (n = 14) reported patient care delays due to omitted documents during the hospital-to-SNF transition. During interviews, communication between the SNF/LTC pharmacy and the discharging hospital was described by facility staff as unidirectional with little opportunity for feedback on patient care concerns. The targeted needs assessment guided by the IM framework has lent to several planned process improvements initiatives to help reduce medication discrepancies during the hospital-to-SNF transition as well as improve communication between healthcare entities. Opening lines of

  14. Dissemination and Implementation Science Training Needs: Insights From Practitioners and Researchers.

    PubMed

    Tabak, Rachel G; Padek, Margaret M; Kerner, Jon F; Stange, Kurt C; Proctor, Enola K; Dobbins, Maureen J; Colditz, Graham A; Chambers, David A; Brownson, Ross C

    2017-03-01

    Dissemination and implementation research training has great potential to improve the impact and reach of health-related research; however, research training needs from the end user perspective are unknown. This paper identifies and prioritizes dissemination and implementation research training needs. A diverse sample of researchers, practitioners, and policymakers was invited to participate in Concept Mapping in 2014-2015. Phase 1 (Brainstorming) gathered participants' responses to the prompt: To improve the impact of research evidence in practice and policy settings, a skill in which researchers need more training is… The resulting statement list was edited and included subsequent phases. Phase 2 (Sorting) asked participants to sort each statement into conceptual piles. In Phase 3 (Rating), participants rated the difficulty and importance of incorporating each statement into a training curriculum. A multidisciplinary team synthesized and interpreted the results in 2015-2016. During Brainstorming, 60 researchers and 60 practitioners/policymakers contributed 274 unique statements. Twenty-nine researchers and 16 practitioners completed sorting and rating. Nine concept clusters were identified: Communicating Research Findings, Improve Practice Partnerships, Make Research More Relevant, Strengthen Communication Skills, Develop Research Methods and Measures, Consider and Enhance Fit, Build Capacity for Research, and Understand Multilevel Context. Though researchers and practitioners had high agreement about importance (r =0.93) and difficulty (r =0.80), ratings differed for several clusters (e.g., Build Capacity for Research). Including researcher and practitioner perspectives in competency development for dissemination and implementation research identifies skills and capacities needed to conduct and communicate contextualized, meaningful, and relevant research. Copyright © 2016 American Journal of Preventive Medicine. All rights reserved.

  15. Integrating themes, evidence gaps, and research needs identified by workshop on iron screening and supplementation in iron-replete pregnant women and young children.

    PubMed

    Brannon, Patsy M; Stover, Patrick J; Taylor, Christine L

    2017-12-01

    This report addresses the evidence and the uncertainties, knowledge gaps, and research needs identified by participants at the NIH workshop related to iron screening and routine iron supplementation of largely iron-replete pregnant women and young children (6-24 mo) in developed countries. The workshop presentations and panel discussions focused on current understanding and knowledge gaps related to iron homeostasis, measurement of and evidence for iron status, and emerging concerns about supplementing iron-replete members of these vulnerable populations. Four integrating themes emerged across workshop presentations and discussion and centered on 1 ) physiologic or developmental adaptations of iron homeostasis to pregnancy and early infancy, respectively, and their implications, 2 ) improvement of the assessment of iron status across the full continuum from iron deficiency anemia to iron deficiency to iron replete to iron excess, 3 ) the linkage of iron status with health outcomes beyond hematologic outcomes, and 4 ) the balance of benefit and harm of iron supplementation of iron-replete pregnant women and young children. Research that addresses these themes in the context of the full continuum of iron status is needed to inform approaches to the balancing of benefits and harms of screening and routine supplementation. © 2017 American Society for Nutrition.

  16. Confirming, Classifying, and Prioritizing Needed Over-the-Bed Table Improvements via Methodological Triangulation.

    PubMed

    Manganelli, Joe; Threatt, Anthony; Brooks, Johnell O; Healy, Stan; Merino, Jessica; Yanik, Paul; Walker, Ian; Green, Keith

    2014-01-01

    This article presents the results of a qualitative study that confirmed, classified, and prioritized user needs for the design of a more useful, usable, and actively assistive over-the-bed table. Manganelli et al. (2014) generated a list of 74 needs for use in developing an actively assistive over-the-bed table. This present study assesses the value and importance of those needs. Fourteen healthcare subject matter experts and eight research and design subject matter experts engaged in a participatory and iterative research and design process. A mixed methods qualitative approach used methodological triangulation to confirm the value of the findings and ratings to establish importance. Open and closed card sorts and a Delphi study were used. Data analysis methods included frequency analysis, content analysis, and a modified Kano analysis. A table demonstrating the needs that are of high importance to both groups of subject matter experts and classification of the design challenges each represents was produced. Through this process, the list of 74 needs was refined to the 37 most important need statements for both groups. Designing a more useful, usable, and actively assistive over-the-bed table is primarily about the ability to position it optimally with respect to the user for any task, as well as improving ease of use and usability. It is also important to make explicit and discuss the differences in priorities and perspectives demonstrated between research and design teams and their clients. © 2014 Vendome Group, LLC.

  17. Identifying key components for an effective case report poster: an observational study.

    PubMed

    Willett, Lisa L; Paranjape, Anuradha; Estrada, Carlos

    2009-03-01

    Residents demonstrate scholarly activity by presenting posters at academic meetings. Although recommendations from national organizations are available, evidence identifying which components are most important is not. To develop and test an evaluation tool to measure the quality of case report posters and identify the specific components most in need of improvement. Faculty evaluators reviewed case report posters and provided on-site feedback to presenters at poster sessions of four annual academic general internal medicine meetings. A newly developed ten-item evaluation form measured poster quality for specific components of content, discussion, and format (5-point Likert scale, 1 = lowest, 5 = highest). Evaluation tool performance, including Cronbach alpha and inter-rater reliability, overall poster scores, differences across meetings and evaluators and specific components of the posters most in need of improvement. Forty-five evaluators from 20 medical institutions reviewed 347 posters. Cronbach's alpha of the evaluation form was 0.84 and inter-rater reliability, Spearman's rho 0.49 (p < 0.001). The median score was 4.1 (Q1 -Q3, 3.7-4.6)(Q1 = 25th, Q3 = 75th percentile). The national meeting median score was higher than the regional meetings (4.4 vs, 4.0, P < 0.001). We found no difference in faculty scores. The following areas were identified as most needing improvement: clearly state learning objectives, tie conclusions to learning objectives, and use appropriate amount of words. Our evaluation tool provides empirical data to guide trainees as they prepare posters for presentation which may improve poster quality and enhance their scholarly productivity.

  18. Improving institutional fairness to live kidney donors: donor needs must be addressed by safeguarding donation risks and compensating donation costs.

    PubMed

    Schulz-Baldes, Annette; Delmonico, Francis L

    2007-11-01

    The number of kidney transplants from live donors is increasing worldwide, yet donor needs have not been satisfactorily addressed in either developed or developing countries. This paper argues that unmet donor needs are unfair to live kidney donors in two ways. First, when safeguards against the risks of donation are insufficient, live donation can impair the donor's health and thus his or her fair opportunities to access jobs and offices and to function as a free and equal citizen more generally. Secondly, when the financial costs of donation are not fully compensated, operational fairness (associated with the nephrectomy event) is compromised for the donor. The donor assumes the risks of a nontherapeutic intervention--for the good of the recipient and society--and should not have to incur costs for donating. Based on a systematic analysis of unmet donor needs in developed and developing countries, context-relative measures to improve institutional fairness to live kidney donors are delineated in this paper. The identified ways of safeguarding donation risks and compensating donation costs are not merely means to removing disincentives for donation and increasing donation rates. They are essential for preserving institutional fairness in the health care of the live kidney donor.

  19. Research needs in family planning program promotion.

    PubMed

    Cernada, G P

    1984-09-01

    Areas of family planning promotion which need to be further researched are identified. The effectiveness of diverse information, education, and communication approaches needs to be evaluated, feasible ways to increase contraceptive continuation rates must be identified, the relative merits of providing fieldworkers with salaries or incentives should be assessed, different styles of interactions between providers and clients should be identified and evaluated and research directed toward improving training programs, field supervision, and supply logistics should be undertaken. A number of more detailed research suggestions with special reference to Taiwan and other Asian and Pacific countries are also provided. Little is known, for example, about provider and user interaction patterns in Asia, and the impact of these patterns on contraceptive acceptance and continuance. These patterns could be analyzed using diverse research techniques ranging from observation to experimental manipulation. Despite the fact that approximately 50% of all acceptors discontinue use within 2 years, researchers tend to focus on identifying acceptor characteristics while ignoring the discontinuation process. Researcher should 1) identify the best time for providing postacceptance followup services, 2) identify training strategies which provide fieldworkers with the highest level of confidence in specific contraceptive methods, 3) experiment with the use of newspaper columns and telephone advisory services to provide users with information about side effects, 4) assess the merits of involving both partners in the contraceptive counseling process, 5) develop and evaluate postacceptance educational materials, and 6) assess the impact of various supply systems on contraceptive continuance. Another neglected area of research is the public's attitude toward different contraceptive knowledge sources. For example, receptivity to family planning messages may vary depending on wether the message is

  20. Identifying Continuous Quality Improvement Priorities in Maternal, Infant, and Early Childhood Home Visiting.

    PubMed

    Preskitt, Julie; Fifolt, Matthew; Ginter, Peter M; Rucks, Andrew; Wingate, Martha S

    2016-01-01

    The purpose of this article was to describe a methodology to identify continuous quality improvement (CQI) priorities for one state's Maternal, Infant, and Early Childhood Home Visiting program from among the 40 required constructs associated with 6 program benchmarks. The authors discuss how the methodology provided consensus on system CQI quality measure priorities and describe variation among the 3 service delivery models used within the state. Q-sort methodology was used by home visiting (HV) service delivery providers (home visitors) to prioritize HV quality measures for the overall state HV system as well as their service delivery model. There was general consensus overall and among the service delivery models on CQI quality measure priorities, although some variation was observed. Measures associated with Maternal, Infant, and Early Childhood Home Visiting benchmark 1, Improved Maternal and Newborn Health, and benchmark 3, Improvement in School Readiness and Achievement, were the highest ranked. The Q-sort exercise allowed home visitors an opportunity to examine priorities within their service delivery model as well as for the overall First Teacher HV system. Participants engaged in meaningful discussions regarding how and why they selected specific quality measures and developed a greater awareness and understanding of a systems approach to HV within the state. The Q-sort methodology presented in this article can easily be replicated by other states to identify CQI priorities at the local and state levels and can be used effectively in states that use a single HV service delivery model or those that implement multiple evidence-based models for HV service delivery.

  1. The urgent need for quality improvement in Russia.

    PubMed

    Ruevekamp, D

    1994-01-01

    Induced abortion became accepted as a legal method of family planning after the October Revolution of 1917 from which terminations were performed in state hospitals free of charge upon a woman's request. The procedure was made legal in response to then newly voiced egalitarian ideals and the increasing involvement of women in the labor market, as well as because of the rapidly deteriorating situation and post-Revolution period of famine. Administrators fully expected to reduce the incidence of abortion once living conditions improved. Little was done at the time to develop contraceptives. Stalin, however, in the 1920s and 1930s, lamented a falling birth rate in the face of manpower needed for labor and the military; abortion and contraceptives were banned, leading to post-abortion complications without really stimulating the birth rate. Abortion was relegalized in 1956, but the right to contraception was never fully restored. Seven million induced abortions were officially registered to have taken place in each of the last ten years in the former Soviet Union. A woman typically undergoes one abortion per year, or approximately twenty abortions during the childbearing period of her life. Lacking knowledge about contraception, contraceptives, and what many Western countries regard to be women's reproductive health rights, most Russian women, however, freely tolerate frequent repeated abortion as a normal method of fertility regulation. Lack of access to contraceptives along with the lack of domestic contraceptive method production facilities and lack of hard currency to secure quality supplies from abroad are contributing factors to this ongoing trend. Gynecologists also receive lucrative fees for illegal abortions and are unlikely to promote change. Plans to open twelve family planning centers in Moscow have been hampered by the inertia of bureaucracy, the lack of financial means, the lack of trained personnel, and people's suspicion of government bodies. Much needs

  2. Foreign Affairs: Specific Action Plan Needed to Improve Response to Parental Child Abductions

    DTIC Science & Technology

    2000-03-01

    the child or prejudice to interested parties; (3) secure the voluntary return of the child or to bring about an amicable resolution of the issues, and...FOREIGN AFFAIRS Specific Action Plan Needed to Improve Response to Parental Child Abductions DISTRIBUTION STATEMENT A Approved for Public Release...International Parental Child Abduction 17 Page 1 GAO/NSIAD-00-10 Parental Child Abduction Page 2 GAO/NSIAD-00-10 Parental Child Abduction GAP

  3. Homeland Defense: Continued Actions Needed to Improve Management of Air Sovereignty Alert Operations

    DTIC Science & Technology

    2012-01-01

    Better Outcomes, GAO-10-374T (Washington, D.C.: May 20, 2009); Aviation Security : DHS and TSA Have Researched, Developed and Begun Deploying Passenger... Security : TSA Has Made Progress, but Additional Efforts Are Needed to Improve Security. GAO-11-938T. Washington, D.C.: September 16, 2011. Aviation ...Washington, D.C.: October 23, 2009. Related GAO Products Homeland Defense DOD Tactical Aircraft Aviation Security Risk Management Related GAO

  4. Strengthening Nursing Education To Improve End-of-life Care.

    ERIC Educational Resources Information Center

    Ferrell, Betty R.; Virani, Rose; Grant, Marcia

    1999-01-01

    As the members of the health care team who spend the most time with patients who are facing death, nurses are aware of the need for improved end-of-life (EOL) care and have identified resources to achieve that goal by improving education. A survey of 725 nursing faculty and state boards indicates an awareness of the need for improved EOL care and…

  5. Issues in Biomedical Research Data Management and Analysis: Needs and Barriers

    PubMed Central

    Anderson, Nicholas R.; Lee, E. Sally; Brockenbrough, J. Scott; Minie, Mark E.; Fuller, Sherrilynne; Brinkley, James; Tarczy-Hornoch, Peter

    2007-01-01

    Objectives A. Identify the current state of data management needs of academic biomedical researchers. B. Explore their anticipated data management and analysis needs. C. Identify barriers to addressing those needs. Design A multimodal needs analysis was conducted using a combination of an online survey and in-depth one-on-one semi-structured interviews. Subjects were recruited via an e-mail list representing a wide range of academic biomedical researchers in the Pacific Northwest. Measurements The results from 286 survey respondents were used to provide triangulation of the qualitative analysis of data gathered from 15 semi-structured in-depth interviews. Results Three major themes were identified: 1) there continues to be widespread use of basic general-purpose applications for core data management; 2) there is broad perceived need for additional support in managing and analyzing large datasets; and 3) the barriers to acquiring currently available tools are most commonly related to financial burdens on small labs and unmet expectations of institutional support. Conclusion Themes identified in this study suggest that at least some common data management needs will best be served by improving access to basic level tools such that researchers can solve their own problems. Additionally, institutions and informaticians should focus on three components: 1) facilitate and encourage the use of modern data exchange models and standards, enabling researchers to leverage a common layer of interoperability and analysis; 2) improve the ability of researchers to maintain provenance of data and models as they evolve over time though tools and the leveraging of standards; and 3) develop and support information management service cores that could assist in these previous components while providing researchers with unique data analysis and information design support within a spectrum of informatics capabilities. PMID:17460139

  6. Identifying Priorities for Post-Secondary Education in Qatar. Research Brief

    ERIC Educational Resources Information Center

    Stasz, Cathleen; Eide, Eric R.; Martorell, Francisco; Salem, Hanine; Constant, Louay; Goldman, Charles A.; Moini, Joy S.; Nadareishvili, Vazha

    2007-01-01

    Although Qatar has improved its post-secondary educational opportunities, the country's efforts have not undergone a broad strategic review. This study analyzed the extent to which the current offerings can meet the country's future needs and identified priorities for developing further educational options. Researchers found that Qataris' current…

  7. Getting right to the point: identifying Australian outpatients' priorities and preferences for patient-centred quality improvement in chronic disease care.

    PubMed

    Fradgley, Elizabeth A; Paul, Christine L; Bryant, Jamie; Oldmeadow, Christopher

    2016-09-01

    To identify specific actions for patient-centred quality improvement in chronic disease outpatient settings, this study identified patients' general and specific preferences among a comprehensive suite of initiatives for change. A cross-sectional survey was conducted in three hospital-based clinics specializing in oncology, neurology and cardiology care located in New South Wales, Australia. Adult English-speaking outpatients completed the touch-screen Consumer Preferences Survey in waiting rooms or treatment areas. Participants selected up to 23 general initiatives that would improve their experience. Using adaptive branching, participants could select an additional 110 detailed initiatives and complete a relative prioritization exercise. A total of 541 individuals completed the survey (71.1% consent, 73.1% completion). Commonly selected general initiatives, presented in order of decreasing priority (along with sample proportion), included: improved parking (60.3%), up-to-date information provision (15.0%), ease of clinic contact (12.9%), access to information at home (12.8%), convenient appointment scheduling (14.2%), reduced wait-times (19.8%) and information on medical emergencies (11.1%). To address these general initiatives, 40 detailed initiatives were selected by respondents. Initiatives targeting service accessibility and information provision, such as parking and up-to-date information on patient prognoses and progress, were commonly selected and perceived to be of relatively greater priority. Specific preferences included the need for clinics to provide patient-designated parking in close proximity to the clinic, information on treatment progress and test results (potentially in the form of designated brief appointments or via telehealth) and comprehensive and trustworthy lists of information sources to access at home. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All

  8. Skills Needs Assessment Process To Support Economic Development. HRD & ALL Research Series. Paper 90-01.

    ERIC Educational Resources Information Center

    Geroy, Gary D.; Kaman, Vickie

    The purpose of skills-training needs-assessment is to identify what type of skills and knowledge are needed to support economic strategies and, as a result, improve organizational decisionmaking related to training investments and general work force development. This paper presents findings of 11 skills-retraining, needs-assessment,…

  9. Improving the Service with the Servqual Method

    NASA Astrophysics Data System (ADS)

    Midor, Katarzyna; Kučera, Marian

    2018-03-01

    At the time when economy is growing, there is strong competition in the market, and customers have increasingly higher expectations as regards quality of service and products. Under such conditions, organizations need to improve. One of the areas of improvement for an organization is to research the level of customer satisfaction. The article presents results of customer satisfaction surveys conducted by the Servqual method in a pharmaceutical service company. Use of this method allowed to improve the services provided by that pharmaceutical wholesaler, identify areas that need to be improved as soon as possible in order to improve the level of service provided.

  10. Benefits for employees with children with special needs: findings from the collaborative employee benefit study.

    PubMed

    Perrin, James M; Fluet, Christina F; Honberg, Lynda; Anderson, Betsy; Wells, Nora; Epstein, Susan; Allen, Deborah; Tobias, Carol; Kuhlthau, Karen A

    2007-01-01

    Approximately 13-15 percent of U.S. children have special health care needs. The demands of their caregiving can affect their parents' health and workplace performance. We interviewed forty-one U.S. employers and conducted focus groups with working parents in four U.S. cities to determine the extent to which employers understand the needs of these families and to identify opportunities for improving workplace benefits for these employees beyond health insurance. Employers saw value in improving workforce performance and employee retention through expanded benefits and indicated promising opportunities to improve their response to the needs of employees with children with chronic conditions.

  11. Identifying Online Preferences and Needs of Early Childhood Professionals

    ERIC Educational Resources Information Center

    Weigel, Daniel J.; Weiser, Dana A.; Bales, Diane W.; Moyses, Kendra J.

    2012-01-01

    A growing number of early childhood professionals use the Internet to improve their skills, knowledge, and practice. The Internet may be a practical alternative for providing high-quality, research-based training, information, and resources to these professionals. When designing online materials and Web sites, however, it is important to first…

  12. Rural Information Needs.

    ERIC Educational Resources Information Center

    Fowler, Dave

    1989-01-01

    Examines the information needs of rural populations by identifying eight national issues and interpreting these as requests made to rural county agents. Four groups of rural information users are identified, and information needs specific to each group and that cross over all groups are discussed. (CLB)

  13. Good practice or positive action? Using Q methodology to identify competing views on improving gender equality in academic medicine

    PubMed Central

    Burkinshaw, Paula; West, Robert M; Ward, Vicky

    2017-01-01

    Objectives The number of women entering medicine has increased significantly, yet women are still under-represented at senior levels in academic medicine. To support the gender equality action plan at one School of Medicine, this study sought to (1) identify the range of viewpoints held by staff on how to address gender inequality and (2) identify attitudinal barriers to change. Design Q methodology. 50 potential interventions representing good practice or positive action, and addressing cultural, organisational and individual barriers to gender equality, were ranked by participants according to their perception of priority. Setting The School of Medicine at the University of Leeds, UK. Participants Fifty-five staff members were purposively sampled to represent gender and academic pay grade. Results Principal components analysis identified six competing viewpoints on how to address gender inequality. Four viewpoints favoured positive action interventions: (1) support careers of women with childcare commitments, (2) support progression of women into leadership roles rather than focus on women with children, (3) support careers of all women rather than just those aiming for leadership, and (4) drive change via high-level financial and strategic initiatives. Two viewpoints favoured good practice with no specific focus on women by (5) recognising merit irrespective of gender and (6) improving existing career development practice. No viewpoint was strongly associated with gender, pay grade or role; however, latent class analysis identified that female staff were more likely than male to prioritise the setting of equality targets. Attitudinal barriers to the setting of targets and other positive action initiatives were identified, and it was clear that not all staff supported positive action approaches. Conclusions The findings and the approach have utility for those involved in gender equality work in other medical and academic institutions. However, the impact of such

  14. Assessing needs of family members of inpatients with advanced cancer.

    PubMed

    Bužgová, R; Špatenková, N; Fukasová-Hajnová, E; Feltl, D

    2016-07-01

    To provide high-quality and effective cancer care, problems and unmet needs of family members during their relatives' hospitalisation have to be identified as well. The aims were to determine how needs of family members of patients with terminal cancer are met and to analyse factors that influence them. The needs were assessed with the Family Inventory of Needs. Each item (n = 20) represents one need of family members, for which the importance and satisfaction are rated. The study comprised 270 family members of hospitalised advanced cancer patients staying in the University Hospital Ostrava who were receiving palliative care. The family members preferred sufficient basic information and patient comfort. The unmet needs were support of hope (73%) and provision of information (65%). The unmet needs were more frequently identified by women, individuals with lower education, younger persons, unemployed, patients' children and family members of patients with generally unfavourable health status (P < 0.05). There was a correlation between lower quality of life and higher numbers of unmet needs. Targeted interventions aimed at meeting important needs of the family members may improve their quality of life. © 2016 John Wiley & Sons Ltd.

  15. What new mothers need to know: perspectives from women and providers in Georgia.

    PubMed

    Gazmararian, Julie A; Dalmida, Safiya George; Merino, Yesenia; Blake, Sarah; Thompson, Winifred; Gaydos, Laura

    2014-05-01

    Identifying the educational and resource needs of new mothers is of paramount importance in developing programs to improve maternal and child health outcomes. The primary purpose of this study was to explore the educational needs of new mothers and identify opportunities to enhance healthcare providers' current educational efforts. A two-part methodology was utilized to qualitatively explore the topic of parenting information needs for new mothers in Georgia. Data collection included information from 11 focus groups with 92 first-time, new mothers and 20 interviews with healthcare providers who serve new mothers. Discussions with both new mothers and providers clearly indicated that new mothers face a significant informational deficit, especially regarding very basic, daily infant care information and health literacy challenges. Educational materials already exist; however, mothers report difficulty accessing and understanding this information. For this reason, both the mothers and the providers stressed a focus on developing programs or interventions that allow in-person education and/or alternative modalities to access information, as opposed to development of new written materials solely. Information from the focus group and interviews provided important insight regarding what improvements need to be made to help new mothers and their families during the early stages of parenthood. By improving the education of new mothers and their families, it is proposed that maternal and infant health status could be improved.

  16. Identifying Key Components for an Effective Case Report Poster: An Observational Study

    PubMed Central

    Paranjape, Anuradha; Estrada, Carlos

    2008-01-01

    BACKGROUND Residents demonstrate scholarly activity by presenting posters at academic meetings. Although recommendations from national organizations are available, evidence identifying which components are most important is not. OBJECTIVE To develop and test an evaluation tool to measure the quality of case report posters and identify the specific components most in need of improvement. DESIGN Faculty evaluators reviewed case report posters and provided on-site feedback to presenters at poster sessions of four annual academic general internal medicine meetings. A newly developed ten-item evaluation form measured poster quality for specific components of content, discussion, and format (5-point Likert scale, 1 = lowest, 5 = highest). Main outcome measure(s): Evaluation tool performance, including Cronbach alpha and inter-rater reliability, overall poster scores, differences across meetings and evaluators and specific components of the posters most in need of improvement. RESULTS Forty-five evaluators from 20 medical institutions reviewed 347 posters. Cronbach’s alpha of the evaluation form was 0.84 and inter-rater reliability, Spearman’s rho 0.49 ( < 0.001). The median score was 4.1 (Q1 -Q3, 3.7-4.6)(Q1 = 25th, Q3 = 75th percentile). The national meeting median score was higher than the regional meetings (4.4 vs, 4.0,  < 0.001). We found no difference in faculty scores. The following areas were identified as most needing improvement: clearly state learning objectives, tie conclusions to learning objectives, and use appropriate amount of words. CONCLUSIONS Our evaluation tool provides empirical data to guide trainees as they prepare posters for presentation which may improve poster quality and enhance their scholarly productivity. PMID:19089510

  17. An Assessment Instrument for Identifying Counseling Needs of Elementary-Aged Students: The Multimodal Sentence Completion Form for Children (MSCF-C).

    ERIC Educational Resources Information Center

    Gamble, Charles W.; Hamblin, Arthur G.

    1986-01-01

    Discusses the use of a sentence completion instrument predicated on Lazarus' multimodal system. The instrument, entitled The Multimodal Sentence Completion Form for Children (MSCF-C), is designed to systematically assess client needs and assist in identifying intervention strategies. Presents a case study of a 12-year-old, sixth-grade student.…

  18. Engineering Improved Balance Confidence in Older Adults With Complex Health Care Needs: Learning From the Muscling Up Against Disability Study.

    PubMed

    Hetherington, Sharon; Henwood, Tim; Swinton, Paul; Keogh, Justin; Gardiner, Paul; Tuckett, Anthony; Rouse, Kevin

    2018-04-05

    To investigate the associations of balance confidence with physical and cognitive markers of well-being in older adults receiving government-funded aged care services and whether progressive resistance plus balance training could positively influence change. Intervention study. Community-based older adult-specific exercise clinic. Older adults (N=245) with complex care needs who were receiving government-funded aged care support. Twenty-four weeks of twice weekly progressive resistance plus balance training carried out under the supervision of accredited exercise physiologists. The primary measure was the Activity-specific Balance Confidence Scale. Secondary measures included the Short Physical Performance Battery; fall history gathered as part of the health history questionnaire; hierarchical timed balance tests; Geriatric Anxiety Index; Geriatric Depression Scale; Fatigue, Resistance, Ambulation, Illness, Loss of Weight scale; and EuroQoL-5 dimension 3 level. At baseline, better physical performance (r=.54; P<.01) and quality of life (r=.52; P<.01) predicted better balance confidence. In contrast, at baseline, higher levels of frailty predicted worse balance confidence (r=-.55; P<.01). Change in balance confidence after the exercise intervention was accompanied by improved physical performance (+12%) and reduced frailty (-11%). Baseline balance confidence was identified as the most consistent negative predictor of change scores across the intervention. This study shows that reduced physical performance and quality of life and increased frailty are predictive of worse balance confidence in older adults with aged care needs. However, when a targeted intervention of resistance and balance exercise is implemented that reduces frailty and improves physical performance, balance confidence will also improve. Given the influence of balance confidence on a raft of well-being determinants, including the capacity for positive physical and cognitive change, this study offers

  19. National Labor Relations Board: Action Needed to Improve Case-Processing Time at Headquarters

    DTIC Science & Technology

    1991-01-01

    Board more than 2 years. The Board agreed with the report regarding (1) the disruptive impact of Board-member turnover and vacancies, (2) Board...establish) and the impact of lead case delays were signifi- cant factors that warrant the extent of discussion in the report. ’’A Staff Report on the...of course, too early to evaluate the final impact of the Draft Report’s recommendations on action needed to improve case-processing time at the five

  20. Characteristics and quality of reporting of cluster randomized trials in children: reporting needs improvement.

    PubMed

    Walleser, Silke; Hill, Suzanne R; Bero, Lisa A

    2011-12-01

    To describe the characteristics and quality of reporting of cluster randomized trials (CRTs) in children published from 2004 to 2010. Four databases were searched for reports of CRTs in children (0-18 years). Characteristics of the studies were summarized and the quality of reporting assessed using consolidated standards of reporting trial-CRT (CONSORT-CRT). Of 1,949 identified references, 106 were included. The number of published CRTs in children increased since 2004. The greatest proportion of CRTs was undertaken in Europe (29%), whereas 40% was conducted in low- and middle-income countries. Most studies were of complex rather than simple interventions (83%); were preventive rather than treatment interventions (76%); and most frequently addressed infectious disease (21%), diet/physical activity interventions (19%), health-risk behaviors (15%), and undernutrition (13%). The majority used schools as units of randomization (72%) and enrolled 1,000-10,000 children per study (51%). Reporting was generally poor, with 34% of CRTs inadequately reporting on more than half of the CONSORT-CRT criteria. Although 85% of CRTs reported that they had ethics approval for the study, consent or assent was not obtained from children in most studies. Children-specific elements of reporting are needed to improve the quality of reporting of CRTs and consequently their planning and implementation. Copyright © 2011 Elsevier Inc. All rights reserved.

  1. Educational Needs for Improving Self-care in Heart Failure Patients with Diabetes

    PubMed Central

    Cha, Eun Seok; Clark, Patricia C.; Reilly, Carolyn Miller; Higgins, Melinda; Lobb, Maureen; Smith, Andrew L.; Dunbar, Sandra B.

    2013-01-01

    Purpose To explore the need for self-monitoring and self-care education in heart failure patients with diabetes (HF-DM patients) by describing cognitive and affective factors to provide guidance in developing effective self- management education. Method A cross-sectional correlation design was employed using baseline patient data from a study testing a 12 week patient and family dyad intervention to improve dietary and medication-taking self-management behaviors in HF patients. Data from 116 participants recruited from metropolitan Atlanta area were used. Demographic and co-morbidities, physical function, psychological distress, relationship with health care provider, self-efficacy (medication taking and low sodium diet), and behavioral outcomes (medications, dietary habits) were assessed. Descriptive statistics and a series of chi-square tests, t-tests or Mann Whitney tests were performed to compare HF patients with and without DM. Results HF-DM patients were older, heavier, had more co- morbidities, and took more daily medications than HF patients. High self-efficacy on medication and low sodium diet was reported in both groups with no significant difference. Although HF-DM patients took more daily medications than HF, both groups exhibited high HF medication taking behaviors. The HF-DM patients consumed significantly lower total sugar than HF patients, but clinically higher levels of sodium. Conclusions Diabetes educators need to be aware of potential conflicts of treatment regimens to manage two chronic diseases. Special and integrated diabetes self-management education programs which incorporate principles of HF self-management should be developed to improve self-management behavior in HF-DM patients. PMID:22722611

  2. Educational needs for improving self-care in heart failure patients with diabetes.

    PubMed

    Cha, EunSeok; Clark, Patricia C; Reilly, Carolyn Miller; Higgins, Melinda; Lobb, Maureen; Smith, Andrew L; Dunbar, Sandra B

    2012-01-01

    To explore the need for self-monitoring and self-care education in heart failure patients with diabetes (HF- DM patients) by describing cognitive and affective factors to provide guidance in developing effective self-management education. A cross-sectional correlation design was employed using baseline patient data from a study testing a 12-week patient and family dyad intervention to improve dietary and medication-taking self-management behaviors in HF patients. Data from 116 participants recruited from metropolitan Atlanta area were used. Demographic and comorbidities, physical function, psychological distress, relationship with health care provider, self-efficacy (medication taking and low sodium diet), and behavioral outcomes (medications, dietary habits) were assessed. Descriptive statistics and a series of chi-square tests, t tests, or Mann-Whitney tests were performed to compare HF patients with and without DM. HF-DM patients were older and heavier, had more comorbidities, and took more daily medications than HF patients. High self-efficacy on medication and low-sodium diet was reported in both groups with no significant difference. Although HF-DM patients took more daily medications than HF, both groups exhibited high HF medication-taking behaviors. The HF-DM patients consumed significantly lower total sugar than HF patients but clinically higher levels of sodium. Diabetes educators need to be aware of potential conflicts of treatment regimens to manage 2 chronic diseases. Special and integrated diabetes self-management education programs that incorporate principles of HF self-management should be developed to improve self-management behavior in HF-DM patients.

  3. Health and Social Needs of Young Mothers.

    PubMed

    Dumas, S Amanda; Terrell, Ivy W; Gustafson, Maggie

    Teen parenting rates are disproportionately high among minority youth in the Southern United States. We explored barriers and unmet needs relating to medical and social support as perceived by these teen mothers, and elicited suggestions for improving their healthcare through the medical home. We conducted four focus groups of 18- to 24-year-old mothers in New Orleans with questions designed to prompt discussions on young motherhood and healthcare. All 18 participants identified as African American, became mothers when <20, and their children were <5 at the time of the study. Two researchers independently analyzed focus group transcripts and coded them thematically, revealing various unmet social and health needs. Seven main themes emerged, which revealed a concerning lack of mental healthcare, few with consistent medical homes, inadequate contraceptive knowledge and access, and a desire for parenting education and support groups. Suggestions for improving care largely centered around logistical and material support, such as extended clinic hours, transportation, and baby supplies. Findings suggest a need for improved medical knowledge, healthcare access, and social support for teen mothers. This may be provided through a multidisciplinary medical home model, such as a Teen-Tot clinic, where the unique challenges of adolescent parenting are continuously considered.

  4. Critical differences between elective and emergency surgery: identifying domains for quality improvement in emergency general surgery.

    PubMed

    Columbus, Alexandra B; Morris, Megan A; Lilley, Elizabeth J; Harlow, Alyssa F; Haider, Adil H; Salim, Ali; Havens, Joaquim M

    2018-04-01

    The objective of our study was to characterize providers' impressions of factors contributing to disproportionate rates of morbidity and mortality in emergency general surgery to identify targets for care quality improvement. Emergency general surgery is characterized by a high-cost burden and disproportionate morbidity and mortality. Factors contributing to these observed disparities are not comprehensively understood and targets for quality improvement have not been formally developed. Using a grounded theory approach, emergency general surgery providers were recruited through purposive-criterion-based sampling to participate in semi-structured interviews and focus groups. Participants were asked to identify contributors to emergency general surgery outcomes, to define effective care for EGS patients, and to describe operating room team structure. Interviews were performed to thematic saturation. Transcripts were iteratively coded and analyzed within and across cases to identify emergent themes. Member checking was performed to establish credibility of the findings. A total of 40 participants from 5 academic hospitals participated in either individual interviews (n = 25 [9 anesthesia, 12 surgery, 4 nursing]) or focus groups (n = 2 [15 nursing]). Emergency general surgery was characterized by an exceptionally high level of variability, which can be subcategorized as patient-variability (acute physiology and comorbidities) and system-variability (operating room resources and workforce). Multidisciplinary communication is identified as a modifier to variability in emergency general surgery; however, nursing is often left out of early communication exchanges. Critical variability in emergency general surgery may impact outcomes. Patient-variability and system-variability, with focus on multidisciplinary communication, represent potential domains for quality improvement in this field. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Family Life Education for Young Inner-City Teens: Identifying Needs.

    ERIC Educational Resources Information Center

    Herz, Elicia J.; Reis, Janet S.

    1987-01-01

    Sexual decision making, perceptions of responsibility for birth control and pregnancy, and knowledge of contraception and the consequences of teenage pregnancy were assessed among 251 high-risk seventh- and eighth-grade Black, inner-city adolescents to determine these young peoples' need for information. (Author/LMO)

  6. VA Health Care: Improvements Needed in Monitoring Antidepressant Use for Major Depressive Disorder and in Increasing Accuracy of Suicide Data

    DTIC Science & Technology

    2014-11-01

    VA HEALTH CARE Improvements Needed in Monitoring Antidepressant Use for Major Depressive Disorder and in Increasing...00-2014 4. TITLE AND SUBTITLE VA Health Care: Improvements Needed in Monitoring Antidepressant Use for Major Depressive Disorder and in Increasing...Use for Major Depressive Disorder and in Increasing Accuracy of Suicide Data Why GAO Did This Study In 2013, VA estimated that about 1.5 million

  7. A Study Identifying and Validating Competencies Needed for Mid-Managers That Work in Housing and Residence Life at Colleges and Universities in the United States of America

    ERIC Educational Resources Information Center

    Morrison, Hassel Andre

    2016-01-01

    The researcher identified a gap in the knowledge of competencies needed for midmanagers that work in housing and residence life at the southeast colleges and universities in the United States. The purpose of this study was to identify and develop a consensus on competencies needed by mid-managers. The review of the literature describes and…

  8. Head Start: An Effective Program But the Fund Distribution Formula Needs Revision and Management Controls Need Improvement. Report to the Congress of the United States by the Comptroller General.

    ERIC Educational Resources Information Center

    Comptroller General of the U.S., Washington, DC.

    This report from the Comptroller General to the United States Congress finds Head Start to be an effective program whose fund distribution formula needs revision and whose management controls need improvement. Head Start's funding for enrollment and operating costs increased significantly between 1977-81. However, these funding increases were not…

  9. Basic Research Needs for Geosciences: Facilitating 21st Century Energy Systems

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

    DePaolo, D. J.; Orr, F. M.; Benson, S. M.

    2007-06-01

    To identify research areas in geosciences, such as behavior of multiphase fluid-solid systems on a variety of scales, chemical migration processes in geologic media, characterization of geologic systems, and modeling and simulation of geologic systems, needed for improved energy systems.

  10. Identifying effective pathways in a successful continuous quality improvement programme: the GEDAPS study.

    PubMed

    Bodicoat, Danielle H; Mundet, Xavier; Gray, Laura J; Cos, Xavier; Davies, Melanie J; Khunti, Kamlesh; Cano, Juan-Franciso

    2014-12-01

    Continuous quality improvement programmes often target several aspects of care, some of which may be more effective meaning that resources could be focussed on these. The objective was to identify the effective and ineffective aspects of a successful continuous quality improvement programme for individuals with type 2 diabetes in primary care. Data were from a series of cross-sectional studies (GEDAPS) in primary care, Catalonia, Spain, in 55 centres (2239 participants) in 1993, and 92 centres (5819 participants) in 2002. A structural equation modelling approach was used. The intervention was associated with improved microvascular outcomes through microalbuminuria and funduscopy screening, which had a direct effect on microvascular outcomes, and through attending 2-4 nurse visits and having ≥1 blood pressure measurement, which acted through reducing systolic blood pressure. The intervention was associated with improved macrovascular outcomes through blood pressure measurement and attending 2-4 nurse visits (through systolic blood pressure) and having ≥3 education topics, ≥1 HbA1c measurement and adequate medication (through HbA1c). Cholesterol measurement, weight measurement and foot examination did not contribute towards the effectiveness of the intervention. The pathways through which a continuous quality improvement programme appeared to act to reduce microvascular and macrovascular complications were driven by reductions in systolic blood pressure and HbA1c, which were attained through changes in nurse and education visits, measurement and medication. This suggests that these factors are potential areas on which future quality improvement programmes should focus. © 2014 John Wiley & Sons, Ltd.

  11. The Progress of US Hospitals in Addressing Community Health Needs.

    PubMed

    Cramer, Geri Rosen; Singh, Simone R; Flaherty, Stephen; Young, Gary J

    2017-02-01

    To identify how US tax-exempt hospitals are progressing in regard to community health needs assessment (CHNA) implementation following the Patient Protection and Affordable Care Act. We analyzed data on more than 1500 tax-exempt hospitals in 2013 to assess patterns in CHNA implementation and to determine whether a hospital's institutional and community characteristics are associated with greater progress. Our findings show wide variation among hospitals in CHNA implementation. Hospitals operating as part of a health system as well as hospitals participating in a Medicare accountable care organization showed greater progress in CHNA implementation whereas hospitals serving a greater proportion of uninsured showed less progress. We also found that hospitals reporting the highest level of CHNA implementation progress spent more on community health improvement. Hospitals widely embraced the regulations to perform a CHNA. Less is known about how hospitals are moving forward to improve population health through the implementation of programs to meet identified community needs.

  12. Identifying priorities for quality improvement at an emergency Department in Ghana.

    PubMed

    DeWulf, Annelies; Otchi, Elom H; Soghoian, Sari

    2017-08-30

    Healthcare quality improvement (QI) is a global priority, and understanding the perspectives of frontline healthcare workers can help guide sustainable and meaningful change. We report a qualitative investigation of emergency department (ED) staff priorities for QI at a tertiary care hospital in Ghana. The aims of the study were to educate staff about the World Health Organization's (WHO) definition of quality in healthcare, and to identify an initial focus for building a departmental QI program. Semi-structured interviews were conducted with ED staff using open-ended questions to probe their understanding and valuation of the six dimensions of quality defined by the WHO. Participants were then asked to rank the dimensions in order of importance for QI. Qualitative responses were thematically analyzed, and ordinal rank-order was determined for quantitative data regarding QI priorities. Twenty (20) members of staff of different cadres participated, including ED physicians, nurses, orderlies, a security officer, and an accountant. A majority of participants (61%) ranked access to emergency healthcare as high priority for QI. Two recurrent themes - financial accessibility and hospital bed availability - accounted for the majority of discussions, each linked to all the dimensions of healthcare quality. ED staff related all of the WHO quality dimensions to their work, and prioritized access to emergency care as the most important area for improvement. Participants expressed a high degree of motivation to improve healthcare quality, and the study helped with the development of a departmental QI program focused on the broad topic of access to ED services.

  13. Hospital to Post-Acute Care Facility Transfers: Identifying Targets for Information Exchange Quality Improvement.

    PubMed

    Jones, Christine D; Cumbler, Ethan; Honigman, Benjamin; Burke, Robert E; Boxer, Rebecca S; Levy, Cari; Coleman, Eric A; Wald, Heidi L

    2017-01-01

    Information exchange is critical to high-quality care transitions from hospitals to post-acute care (PAC) facilities. We conducted a survey to evaluate the completeness and timeliness of information transfer and communication between a tertiary-care academic hospital and its related PAC facilities. This was a cross-sectional Web-based 36-question survey of 110 PAC clinicians and staff representing 31 PAC facilities conducted between October and December 2013. We received responses from 71 of 110 individuals representing 29 of 31 facilities (65% and 94% response rates). We collapsed 4-point Likert responses into dichotomous variables to reflect completeness (sufficient vs insufficient) and timeliness (timely vs not timely) for information transfer and communication. Among respondents, 32% reported insufficient information about discharge medical conditions and management plan, and 83% reported at least occasionally encountering problems directly related to inadequate information from the hospital. Hospital clinician contact information was the most common insufficient domain. With respect to timeliness, 86% of respondents desired receipt of a discharge summary on or before the day of discharge, but only 58% reported receiving the summary within this time frame. Through free-text responses, several participants expressed the need for paper prescriptions for controlled pain medications to be sent with patients at the time of transfer. Staff and clinicians at PAC facilities perceive substantial deficits in content and timeliness of information exchange between the hospital and facilities. Such deficits are particularly relevant in the context of the increasing prevalence of bundled payments for care across settings as well as forthcoming readmissions penalties for PAC facilities. Targets identified for quality improvement include structuring discharge summary information to include information identified as deficient by respondents, completion of discharge summaries

  14. Cerritos Community College: Improvements Needed in Aspects of Operating the District and Its Auxiliary Organization.

    ERIC Educational Resources Information Center

    California State Office of the Auditor General, Sacramento.

    This audit report discusses the operation of the Enterprise Fund by Cerritos Community College District in California. In addition, the Cerritos College Foundation's conflict of interest policies, its relationship with the district, and its award of contracts for services was reviewed. It was found that the district needed improvement in its…

  15. Water-resources programs and hydrologic-information needs, Marion County, Indiana, 1987

    USGS Publications Warehouse

    Duwelius, R.F.

    1990-01-01

    Water resources are abundant in Marion County, Indiana, and have been developed for public and industrial supply, energy generation, irrigation, and recreation. The largest water withdrawals are from surface water, and the two largest water uses are public supply and cooling water for electrical-generating plants. Water-resources programs in the county are carried out by Federal, State and local agencies to address issues of surface and groundwater availability and quality. The programs of each agency are related to the functions and goals of the agency. Although each agency has specific information needs to fulfill its functions, sometimes these needs overlap, and there are times when the same hydrologic information benefits all. Overlapping information needs and activities create opportunities for interagency coordination and cooperation. Such cooperation could lead to a savings of dollars spent on water-resources programs and could assure an improved understanding of the water resources of the county. Representatives from four agencies-- the Indiana Department of Environmental Management, the Indiana Department of Natural Resources, the Indianapolis Department of Public Works, and the U.S. Geological Survey--met four times in 1987 to describe their own water-resources programs, to identify hydrologic-information needs, and to contact other agencies with related programs. This report presents the interagency findings and is intended to further communication among water resource agencies by identifying current programs and common needs for hydrologic information. Hydrologic information needs identified by the agency representatives include more precise methods for determining the volume of water withdrawals and for determining the volume of industrial and municipal discharges to surface water. Maps of flood-prone areas need to be updated as more of the county is developed. Improved aquifer maps of the inter-till aquifers are needed, and additional observation

  16. Transferring information to an out-of-hours primary care service for patients with palliative care needs: an action research study to improve the use of handover forms.

    PubMed

    Asprey, Anthea; Richards, Suzanne H; Wright, Christine; Seamark, Clare; Seamark, David; Moxon, Jane

    2013-01-01

    To work with service users and providers to optimise the design and implementation of handover forms to support the transfer of information between daytime and out-of-hours primary care services for patients with palliative care needs. There is a need for improved informational continuity between daytime and out-of-hours primary care services for patients with palliative care needs. Research suggests that while handover forms are vital to ensure continuity of care, they remain underused for such patients. Audit work in an out-of-hours primary care service in South West England identified that their current system of handover forms was underused. An action research study consisting of two phases was undertaken. In phase one, the views of general practitioners and nurses working in the out-of-hours and daytime primary care services (29 health professionals) in Devon (population c.1.4 million) and patients with palliative care needs and their carers (8 participants) were investigated using qualitative interviews and focus group methods. Participants' views on the content and use of handover forms, and of the systems supporting their generation were sought. In phase two, additional feedback from the health professional stakeholder groups was collected and collaborative work undertaken with the out-of-hours service to implement recommendations emerging from the qualitative research. Findings Respondents identified variable use of handover forms and inconsistent practice in terms of: who was responsible for generating and updating forms; when and where they were discussed in primary care; the criteria used to define which patient needed a form; and the information forms should contain. There was uncertainty about how handover forms were used by the out-of-hours service and concerns about incomplete access to forms for certain groups of staff. An action plan to improve the existing system was developed. This included distribution of educational materials (desktop guide

  17. Identifying the conditions needed for integrated knowledge translation (IKT) in health care organizations: qualitative interviews with researchers and research users.

    PubMed

    Gagliardi, Anna R; Dobrow, Mark J

    2016-07-12

    Collaboration among researchers and research users, or integrated knowledge translation (IKT), enhances the relevance and uptake of evidence into policy and practice. However, it is not widely practiced and, even when well-resourced, desired impacts may not be achieved. Given that large-scale investment is not the norm, further research is needed to identify how IKT can be optimized. Interviews were conducted with researchers and research users (clinicians, managers) in a health care delivery (HCDO) and health care monitoring (HCMO) organization that differed in size and infrastructure, and were IKT-naïve. Basic qualitative description was used. Participants were asked about IKT activities and challenges, and recommendations for optimizing IKT. Data were analysed inductively using constant comparative technique. Forty-three interviews were conducted (28 HCDO, 15 HCMO) with 13 researchers, 8 clinicians, and 22 managers. Little to no IKT took place. Participants articulated similar challenges and recommendations revealing that a considerable number of changes were needed at the organizational, professional and individual levels. Given the IKT-absent state of participating organizations, this research identified a core set of conditions which must be addressed to prepare an environment conducive to IKT. These conditions were compiled into a framework by which organizations can plan for, or evaluate their capacity for IKT. The IKT capacity framework is relevant for organizations in which there is no current IKT activity. Use of the IKT framework may result in more organizations that are ready to initiate and establish IKT, perhaps ultimately leading to more, and higher-quality collaboration for health system innovation. Further research is needed to confirm these findings in other organizations not yet resourced for, or undertaking IKT, and to explore the resource implications and mechanisms for establishing the conditions identified here as essential to preparing for

  18. Comprehensive assessment of critical care needs in a community hospital*.

    PubMed

    Sarti, Aimee J; Sutherland, Stephanie; Landriault, Angèle; Fothergill-Bourbonnais, Frances; Bouali, Redouane; Willett, Timothy; Hamstra, Stanley J; Cardinal, Pierre

    2014-04-01

    To design and implement a needs assessment process that identifies gaps in caring for critically ill patients in a community hospital. This mixed-method study was conducted between June 2011 and February 2012. A conceptual framework, centered on the critically ill patient, guided the design and selection of the data collection instruments. Different perspectives sampled included regional leaders, healthcare professionals at the community hospital and its referral hospital, as well as family members of patients who had received care at the community ICU. Data sources included interviews (n = 22), walk-throughs (n = 5), focus groups (n = 31), database searches, context questionnaires (n = 8), family surveys (n = 16), and simulations (n = 13). None. Nine needs were identified. At the community hospital, needs identified included lack of access to human resources, gaps in expertise, poor patient flow and ICU bed use, communication, lack of educational opportunities, and gaps in end-of-life care and interprofessional teamwork. Needs were also identified in the interhospital interaction between the community and referral hospitals, which included an inadequate hospital network and gaps in transfer and repatriation of patients. The methodology uncovered the causes and widespread impact of each need and how they interacted with one another. Proposed solutions by the participants are presented including both organizational and educational/clinical solutions. This study captured needs in a complex, interprofessional, interhospital context, which can be targeted with tailored interventions to improve patient outcomes in a community hospital. Furthermore, this study provides a preliminary framework and rigorous methodology to performing a needs assessment in this setting.

  19. Identifying Invasive Species Educational Needs in Florida: Opportunities for Extension

    ERIC Educational Resources Information Center

    Huang, Pei-wen; Lamm, Alexa J.

    2016-01-01

    Florida's ecology has been adversely affected by invasive species. In Florida, a study was conducted to explore opportunities for Extension educators to contribute to combating the issue of invasive species. Florida residents' responses were captured through the use of an online public opinion survey. The findings revealed a need for invasive…

  20. Does the Army Need a Homeland Security Skill Identifier?

    DTIC Science & Technology

    2011-06-10

    MOS is represented in the fourth character of the warrant officer MOSC . The use of a skill qualification identifier (SQI) in the fifth character of...the MOSC creates another MOS that carries the title of the SQI. (Department of the Army 2009a, 50) Multiple Skill Position (officers). A position...training. The SQI is represented in the fifth character of the warrant officer MOSC and may be used to represent functional career tracks with an

  1. Improving accuracy for identifying related PubMed queries by an integrated approach.

    PubMed

    Lu, Zhiyong; Wilbur, W John

    2009-10-01

    PubMed is the most widely used tool for searching biomedical literature online. As with many other online search tools, a user often types a series of multiple related queries before retrieving satisfactory results to fulfill a single information need. Meanwhile, it is also a common phenomenon to see a user type queries on unrelated topics in a single session. In order to study PubMed users' search strategies, it is necessary to be able to automatically separate unrelated queries and group together related queries. Here, we report a novel approach combining both lexical and contextual analyses for segmenting PubMed query sessions and identifying related queries and compare its performance with the previous approach based solely on concept mapping. We experimented with our integrated approach on sample data consisting of 1539 pairs of consecutive user queries in 351 user sessions. The prediction results of 1396 pairs agreed with the gold-standard annotations, achieving an overall accuracy of 90.7%. This demonstrates that our approach is significantly better than the previously published method. By applying this approach to a one day query log of PubMed, we found that a significant proportion of information needs involved more than one PubMed query, and that most of the consecutive queries for the same information need are lexically related. Finally, the proposed PubMed distance is shown to be an accurate and meaningful measure for determining the contextual similarity between biological terms. The integrated approach can play a critical role in handling real-world PubMed query log data as is demonstrated in our experiments.

  2. Needs and barriers to improve the collaboration in oral anticoagulant therapy: a qualitative study

    PubMed Central

    2011-01-01

    Background Oral anticoagulant therapy (OAT) involves many health care disciplines. Even though collaboration between care professionals is assumed to improve the quality of OAT, very little research has been done into the practice of OAT management to arrange and manage the collaboration. This study aims to identify the problems in collaboration experienced by the care professionals involved, the solutions they proposed to improve collaboration, and the barriers they encountered to the implementation of these solutions. Methods In the Netherlands, intensive follow-up of OAT is provided by specialized anticoagulant clinics (ACs). Sixty-eight semi-structured face-to-face interviews were conducted with 103 professionals working at an AC. These semi-structured interviews were transcribed verbatim and analysed inductively. Wagner's chronic care model (CCM) and Cabana's framework for improvement were used to categorize the results. Results AC professionals experienced three main bottlenecks in collaboration: lack of knowledge (mostly of other professionals), lack of consensus on OAT, and limited information exchange between professionals. They mentioned several solutions to improve collaboration, especially solutions of CCM's decision support component (i.e. education, regular meetings, and agreements and protocols). Education is considered a prerequisite for the successful implementation of other proposed solutions such as developing a multidisciplinary protocol and changing the allocation of tasks. The potential of the health care organization to improve collaboration seemed to be underestimated by professionals. They experienced several barriers to the successful implementation of the proposed solutions. Most important barriers were the lack motivation of non-AC professionals and lack of time to establish collaboration. Conclusions This study revealed that the collaboration in OAT is limited by a lack of knowledge, a lack of consensus, and a limited information

  3. Improving Community Health While Satisfying a Critical Community Need: A Case Study for Nonprofit Hospitals

    PubMed Central

    Kephart, Donna K.; Dillon, Judith F.; McCullough, Jody R.; Blatt, Barbara J.; Kraschnewski, Jennifer L.

    2015-01-01

    Background School-based student health screenings identify issues that may affect physical and intellectual development and are an important way to maintain student health. Nonprofit hospitals can provide a unique resource to school districts by assisting in the timely completion of school-based screenings and meet requirements of the Affordable Care Act. This case study describes the collaboration between an academic medical center and a local school district to conduct school-based health screenings. Community Context Penn State Milton S. Hershey Medical Center and Penn State Hershey PRO Wellness Center collaborated with Lebanon School District to facilitate student health screenings, a need identified in part by a community health needs assessment. Methods From June 2012 through February 2013, district-wide student health screenings were planned and implemented by teams of hospital nursing leadership, school district leadership, and school nurses. In fall 2013, students were screened through standardized procedures for height, weight, scoliosis, vision, and hearing. Outcomes In 2 days, 3,105 students (67% of all students in the district) were screened. Letters explaining screening results were mailed to parents of all students screened. Debriefing meetings and follow-up surveys for the participating nurses provided feedback for future screenings. Interpretation The 2-day collaborative screening event decreased the amount of time spent by school nurses in screening students throughout the year and allowed them more time in their role as school wellness champion. Additionally, parents found out early in the school year whether their child needed physician follow-up. Partnerships between school districts and hospitals to conduct student health screenings are a practical option for increasing outreach while satisfying community needs. PMID:26513441

  4. Leaving No American Indian/Alaska Native Behind: Identifying Reading Strengths and Needs

    ERIC Educational Resources Information Center

    Buly, Marsha Riddle

    2005-01-01

    American Indian/Alaska Native (AI/AN) students are often labeled as struggling readers based on the results of large-scale standardized tests yet little empirical data about specific strengths and needs exists. In the present study we looked beyond high-stakes assessment to highlight reading strengths and needs for a group of fourth grade American…

  5. The Functions and Preparational Needs of Directors of Hospital Education.

    ERIC Educational Resources Information Center

    Hole, Floyd Marvin

    This study sought mainly to determine the important functions and the preparational needs of directors of hospital education, to identify the most pertinent problems encountered by these directors in recent years, to propose educational recommendations, and to provide a pattern for improving existing preparational programs or developing new ones.…

  6. Career Development Needs of Low Socio-Economic Status University Students

    ERIC Educational Resources Information Center

    Doyle, Erin

    2011-01-01

    With increased funding from the Australian federal government to improve the enrolments of students with low socio-economic status into university, identifying the career needs of this student cohort is of utmost importance, if indeed they are different from other university students. This will ensure career services offer comprehensive and…

  7. Climate Change and Water Working Group - User Needs to Manage Hydrclimatic Risk from Days to Decades

    NASA Astrophysics Data System (ADS)

    Raff, D. A.; Brekke, L. D.; Werner, K.; Wood, A.; White, K. D.

    2012-12-01

    The Federal Climate Change Water Working Group (CCAWWG) provides engineering and scientific collaborations in support of water management. CCAWWG objectives include building working relationships across federal science and water management agencies, provide a forum to share expertise and leverage resources, develop education and training forums, to work with water managers to understand scientific needs and to foster collaborative efforts across the Federal and non-Federal water management and science communities to address those needs. Identifying and addressing water management needs has been categorized across two major time scales: days to a decade and multi-decadal, respectively. These two time periods are termed "Short-Term" and "Long-Term" in terms of the types of water management decisions they support where Short-Term roughly correlates to water management operations and Long-Term roughly correlates to planning activities. This presentation will focus on portraying the identified water management user needs across these two time periods. User Needs for Long-Term planning were identified in the 2011 Reclamation and USACE "Addressing Climate Change in Long-Term Water Resources Planning and Management: User Needs for Improving Tools and Information." User needs for Long-Term planning are identified across eight major categories: Summarize Relevant Literature, Obtain Climate Change Information, Make Decisions About How to Use the Climate Change Information, Assess Natural Systems Response, Assess Socioeconomic and Institutional Response, Assess System Risks and Evaluate Alternatives, Assess and Characterize Uncertainties, and Communicating Results and Uncertainties to Decisionmakers. User Needs for Short-Term operations are focused on needs relative to available or desired monitoring and forecast products from the hydroclimatic community. These needs are presenting in the 2012 USACE, Reclamation, and NOAA - NWS "Short-Term Water Management Decisions: User

  8. Pharmacist Computer Skills and Needs Assessment Survey

    PubMed Central

    Jewesson, Peter J

    2004-01-01

    , respondents rated their ability to manipulate files, use software help features, and install software as low, but rated their ability to access and navigate the Internet as high. Respondents were generally aware of what online resources were available to them and Clinical Pharmacology was the most commonly employed reference. In terms of anticipated needs, most pharmacists believed they needed to upgrade their computer skills. Medical database and Internet searching skills were identified as those in greatest need of improvement. Conclusions Most pharmacists believed they needed to upgrade their computer skills. Medical database and Internet searching skills were identified as those in greatest need of improvement for the purposes of improving practice effectiveness. PMID:15111277

  9. Working in disadvantaged communities: What additional competencies do we need?

    PubMed Central

    Harris, Elizabeth; Harris, Mark F; Madden, Lynne; Wise, Marilyn; Sainsbury, Peter; MacDonald, John; Gill, Betty

    2009-01-01

    Background Residents of socioeconomically disadvantaged locations are more likely to have poor health than residents of socioeconomically advantaged locations and this has been comprehensively mapped in Australian cities. These inequalities present a challenge for the public health workers based in or responsible for improving the health of people living in disadvantaged localities. The purpose of this study was to develop a generic workforce needs assessment tool and to use it to identify the competencies needed by the public health workforce to work effectively in disadvantaged communities. Methods A two-step mixed method process was used to identify the workforce needs. In step 1 a generic workforce needs assessment tool was developed and applied in three NSW Area Health Services using focus groups, key stakeholder interviews and a staff survey. In step 2 the findings of this needs assessment process were mapped against the existing National Health Training Package (HLT07) competencies, gaps were identified, additional competencies described and modules of training developed to fill identified gaps. Results There was a high level of agreement among the AHS staff on the nature of the problems to be addressed but less confidence indentifying the work to be done. Processes for needs assessments, community consultations and adapting mainstream programs to local needs were frequently mentioned as points of intervention. Recruiting and retaining experienced staff to work in these communities and ensuring their safety were major concerns. Workforce skill development needs were seen in two ways: higher order planning/epidemiological skills and more effective working relationships with communities and other sectors. Organisational barriers to effective practice were high levels of annual compulsory training, balancing state and national priorities with local needs and giving equal attention to the population groups that are easy to reach and to those that are difficult

  10. Western Region: A Report Identifying and Addressing the Educational Needs

    ERIC Educational Resources Information Center

    US Department of Education, 2011

    2011-01-01

    During a four-week period (May 23, 2011-June 21, 2011), the Western Regional Advisory Committee (RAC) held a series of public meetings to solicit input and deliberate on key educational needs facing the four states in the region--Arizona, California, Nevada, and Utah. A two-day, face-to-face, public meeting was held May 23-24, 2011 in Arlington,…

  11. Hepatitis C virus testing in adults living with HIV: a need for improved screening efforts.

    PubMed

    Yehia, Baligh R; Herati, Ramin S; Fleishman, John A; Gallant, Joel E; Agwu, Allison L; Berry, Stephen A; Korthuis, P Todd; Moore, Richard D; Metlay, Joshua P; Gebo, Kelly A

    2014-01-01

    Guidelines recommend hepatitis C virus (HCV) screening for all people living with HIV (PLWH). Understanding HCV testing practices may improve compliance with guidelines and can help identify areas for future intervention. We evaluated HCV screening and unnecessary repeat HCV testing in 8,590 PLWH initiating care at 12 U.S. HIV clinics between 2006 and 2010, with follow-up through 2011. Multivariable logistic regression examined the association between patient factors and the outcomes: HCV screening (≥1 HCV antibody tests during the study period) and unnecessary repeat HCV testing (≥1 HCV antibody tests in patients with a prior positive test result). Overall, 82% of patients were screened for HCV, 18% of those screened were HCV antibody-positive, and 40% of HCV antibody-positive patients had unnecessary repeat HCV testing. The likelihood of being screened for HCV increased as the number of outpatient visits rose (adjusted odds ratio 1.02, 95% confidence interval 1.01-1.03). Compared to men who have sex with men (MSM), patients with injection drug use (IDU) were less likely to be screened for HCV (0.63, 0.52-0.78); while individuals with Medicaid were more likely to be screened than those with private insurance (1.30, 1.04-1.62). Patients with heterosexual (1.78, 1.20-2.65) and IDU (1.58, 1.06-2.34) risk compared to MSM, and those with higher numbers of outpatient (1.03, 1.01-1.04) and inpatient (1.09, 1.01-1.19) visits were at greatest risk of unnecessary HCV testing. Additional efforts to improve compliance with HCV testing guidelines are needed. Leveraging health information technology may increase HCV screening and reduce unnecessary testing.

  12. Review of ICT-Based Services for Identified Unmet Needs in People with Dementia

    NASA Astrophysics Data System (ADS)

    Lauriks, Steve; Reinersmann, Annika; van der Roest, Henriëtte Geralde; Meiland, Franka; Davies, Richard; Moelaert, Ferial; Mulvenna, Maurice D.; Nugent, Chris D.; Dröes, Rose-Marie

    Some of the needs that people with dementia and their informal carers currently perceive as insufficiently met by regular care and support services might be alleviated, or even be met, using modern Information and Communication Technology (ICT). The study described in this chapter was designed to provide an insight into the state of the art in ICT solutions that could contribute to meet the most frequently mentioned unmet needs by people with dementia and their informal carers. These needs can be summarized as (1) the need for general and personalized information; (2) the need for support with regard to symptoms of dementia; (3) the need for social contact and company; and (4) the need for health monitoring and perceived safety. Databases that were searched include PubMed, Cinahl, Psychinfo, Google (Scholar), INSPEC and IEEE. In total 22 websites and 46 publications were included that satisfied the following criteria: the article reports on people with dementia and/or their informal carers and discusses an ICT device that has been tested within the target group and has proven to be helpful. Within the first need area 18 relevant websites and three studies were included; within the second need area 4 websites and 20 publications were included. Within the third and fourth need area 11 and 12 publications were included, respectively. Most articles reported on uncontrolled studies. It is concluded that the informational websites offer helpful information for carers but seem less attuned to the person with dementia and do not offer personalized information. ICT solutions aimed at compensating for disabilities, such as memory problems and daily activities, demonstrate that people with mild to moderate dementia are capable of handling simple electronic equipment and can benefit from it in terms of more confidence and enhanced positive affect. Instrumental ICT support for coping with behavioural and psychological changes in dementia is relatively disregarded as yet, while

  13. Improving accuracy for identifying related PubMed queries by an integrated approach

    PubMed Central

    Lu, Zhiyong; Wilbur, W. John

    2009-01-01

    PubMed is the most widely used tool for searching biomedical literature online. As with many other online search tools, a user often types a series of multiple related queries before retrieving satisfactory results to fulfill a single information need. Meanwhile, it is also a common phenomenon to see a user type queries on unrelated topics in a single session. In order to study PubMed users’ search strategies, it is necessary to be able to automatically separate unrelated queries and group together related queries. Here, we report a novel approach combining both lexical and contextual analyses for segmenting PubMed query sessions and identifying related queries and compare its performance with the previous approach based solely on concept mapping. We experimented with our integrated approach on sample data consisting of 1,539 pairs of consecutive user queries in 351 user sessions. The prediction results of 1,396 pairs agreed with the gold-standard annotations, achieving an overall accuracy of 90.7%. This demonstrates that our approach is significantly better than the previously published method. By applying this approach to a one day query log of PubMed, we found that a significant proportion of information needs involved more than one PubMed query, and that most of the consecutive queries for the same information need are lexically related. Finally, the proposed PubMed distance is shown to be an accurate and meaningful measure for determining the contextual similarity between biological terms. The integrated approach can play a critical role in handling real-world PubMed query log data as is demonstrated in our experiments. PMID:19162232

  14. Identifying the needs of elderly, hearing-impaired persons: the importance and utility of hearing aid attributes.

    PubMed

    Meister, Hartmut; Lausberg, Isabel; Kiessling, Juergen; von Wedel, Hasso; Walger, Martin

    2002-11-01

    Older patients represent the majority of hearing-aid users. The needs of elderly, hearing-impaired subjects are not entirely identified. The present study aims to determine the importance of fundamental hearing-aid attributes and to elicit the utility of associated hypothetical hearing aids for older patients. This was achieved using a questionnaire-based conjoint analysis--a decompositional approach to preference measurement offering a realistic study design. A random sample of 200 experienced hearing-aid users participated in the study. Though three out of the six examined attributes revealed age-related dependencies, the only significant effect was found for the attribute "handling", which was considerably more important for older than younger hearing-aid users. A trend of decreasing importance of speech intelligibility in noise and increasing significance of speech in quiet was observed for subjects older than 70 years. In general, the utility of various hypothetical hearing aids was similar for older and younger subjects. Apart from the attribute "handling", older and younger subjects have comparable needs regarding hearing-aid features. On the basis of the examined attributes, there is no requirement for hearing aids designed specifically for elderly hearing-aid users, provided that ergonomic features are considered and the benefits of modern technology are made fully available for older patients.

  15. Handbook for Conducting School Climate Improvement Projects.

    ERIC Educational Resources Information Center

    Howard, Eugene; And Others

    This book discusses practical ways to improve a school's climate by increasing both productivity and satisfaction concurrently. Chapter 1, "Defining School Climate," identifies the overarching goals of school climate improvement, the basic human needs that school climate must address, the factors that make up a school's climate and…

  16. Identifying and understanding the health and social care needs of older adults with multiple chronic conditions and their caregivers: a protocol for a scoping review

    PubMed Central

    Commisso, Elana; McGilton, Katherine S; Ayala, Ana Patricia; Andrew, Melissa, K; Bergman, Howard; Beaudet, Line; Dubé, Veronique; Gray, Mikaela; Hale, Lori; Keatings, Margaret; Marshall, Emily Gard; McElhaney, Janet; Morgan, Debra; Parrott, Edna; Ploeg, Jenny; Sampalli, Tara; Stephens, Douglas; Vedel, Isabelle; Walker, Jennifer; Puts, Martine T E

    2017-01-01

    Introduction People are living longer; however, they are not necessarily experiencing good health and well-being as they age. Many older adults live with multiple chronic conditions (MCC), and complex health issues, which adversely affect their day-to-day functioning and overall quality of life. As a result, they frequently rely on the support of friend and/or family caregivers. Caregivers of older adults with MCC often face challenges to their own well-being and also require support. Currently, not enough is known about the health and social care needs of older adults with MCC and the needs of their caregivers or how best to identify and meet these needs. This study will examine and synthesise the literature on the needs of older adults with MCC and those of their caregivers, and identify gaps in evidence and directions for further research. Methods and analysis We will conduct a scoping review of the peer-reviewed and grey literature using the updated Arksey and O’Malley framework. The literature will be identified using a multidatabase and grey literature search strategy developed by a health sciences librarian. Papers, reports and other materials addressing the health and social care needs of older adults and their friend/family caregivers will be included. Search results will be screened, independently, by two reviewers, and data will be abstracted from included literature and charted in duplicate. Ethics and dissemination This scoping review does not require ethics approval. We anticipate that study findings will inform novel strategies for identifying and ascertaining the health and social care needs of older adults living with MCC and those of their caregivers. Working with knowledge-user members of our team, we will prepare materials and presentations to disseminate findings to relevant stakeholder and end-user groups at local, national and international levels. We will also publish our findings in a peer-reviewed journal. PMID:29288180

  17. Integrating emotional and psychological support into the end-stage renal disease pathway: a protocol for mixed methods research to identify patients' lower-level support needs and how these can most effectively be addressed.

    PubMed

    Taylor, Francesca; Taylor, Celia; Baharani, Jyoti; Nicholas, Johann; Combes, Gill

    2016-08-02

    As a result of difficulties related to their illness, diagnosis and treatment, patients with end-stage renal disease experience significant emotional and psychological problems, which untreated can have considerable negative impact on their health and wellbeing. Despite evidence that patients desire improved support, management of their psychosocial problems, particularly at the lower-level, remains sub-optimal. There is limited understanding of the specific support that patients need and want, from whom, and when, and also a lack of data on what helps and hinders renal staff in identifying and responding to their patients' support needs, and how barriers to doing so might be overcome. Through this research we therefore seek to determine what, when, and how, support for patients with lower-level emotional and psychological problems should be integrated into the end-stage renal disease pathway. The research will involve two linked, multicentre studies, designed to identify and consider the perspectives of patients at five different stages of the end-stage renal disease pathway (Study 1), and renal staff working with them (Study 2). A convergent, parallel mixed methods design will be employed for both studies, with quantitative and qualitative data collected separately. For each study, the data sets will be analysed separately and the results then compared or combined using interpretive analysis. A further stage of synthesis will employ data-driven thematic analysis to identify: triangulation and frequency of themes across pathway stages; patterns and plausible explanations of effects. There is an important need for this research given the high frequency of lower-level distress experienced by end-stage renal disease patients and lack of progress to date in integrating support for their lower-level psychosocial needs into the care pathway. Use of a mixed methods design across the two studies will generate a holistic patient and healthcare professional perspective that

  18. Good practice or positive action? Using Q methodology to identify competing views on improving gender equality in academic medicine.

    PubMed

    Bryant, Louise D; Burkinshaw, Paula; House, Allan O; West, Robert M; Ward, Vicky

    2017-08-22

    The number of women entering medicine has increased significantly, yet women are still under-represented at senior levels in academic medicine. To support the gender equality action plan at one School of Medicine, this study sought to (1) identify the range of viewpoints held by staff on how to address gender inequality and (2) identify attitudinal barriers to change. Q methodology. 50 potential interventions representing good practice or positive action, and addressing cultural, organisational and individual barriers to gender equality, were ranked by participants according to their perception of priority. The School of Medicine at the University of Leeds, UK. Fifty-five staff members were purposively sampled to represent gender and academic pay grade. Principal components analysis identified six competing viewpoints on how to address gender inequality. Four viewpoints favoured positive action interventions: (1) support careers of women with childcare commitments, (2) support progression of women into leadership roles rather than focus on women with children, (3) support careers of all women rather than just those aiming for leadership, and (4) drive change via high-level financial and strategic initiatives. Two viewpoints favoured good practice with no specific focus on women by (5) recognising merit irrespective of gender and (6) improving existing career development practice. No viewpoint was strongly associated with gender, pay grade or role; however, latent class analysis identified that female staff were more likely than male to prioritise the setting of equality targets. Attitudinal barriers to the setting of targets and other positive action initiatives were identified, and it was clear that not all staff supported positive action approaches. The findings and the approach have utility for those involved in gender equality work in other medical and academic institutions. However, the impact of such initiatives needs to be evaluated in the longer term.

  19. Corporate-physician relationships: a need for education.

    PubMed

    Shah, Udayan K; Smith, Gina M; Devaiah, Anand; Setzen, Gavin; Roth, Maurice; Reilly, James S

    2009-03-01

    Knowledge is lacking among Otolaryngologist-Head and Neck Surgeons (ORL-HNS) regarding basic ethical situations in corporate-provider relationships. A pilot educational program demonstrates the need and potential for improvement by structured intervention. "At risk" areas specifically identified regard acceptable gifts, and payments for meetings and travel. Recommendations are made to educate otolaryngologists in standards for compliant behavior in corporate-physician relationships. Further work to formalize and tailor education to the needs of ORL-HNS is warranted, including continued education through the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF). A checklist is provided here as a first step in enabling more compliant behavior as surgeons engage in corporate relationships.

  20. Surgical education to improve the quality of patient care: the role of practice-based learning and improvement.

    PubMed

    Sachdeva, Ajit K

    2007-11-01

    Health care is going through immense change, and concerns regarding the quality of patient care and patient safety continue to be expressed in many national forums. A variety of stakeholders are demanding greater accountability from the health care profession. Education is key to supporting surgeons' efforts to provide high-quality patient care during these challenging times. Educational programs for surgeons should be founded on principles of continuous professional development (CPD) and practice-based learning and improvement (PBLI). CPD focuses on the specific needs of individual surgeons and involves lifelong learning throughout a surgeon's career. It needs to form the basis of PBLI efforts. PBLI involves a cycle of four steps--identifying areas for improvement, engaging in learning, applying new knowledge and skills to practice, and checking for improvement. Ongoing involvement in PBLI activities to address specific learning needs should positively impact a surgeon's practice and improve outcomes of surgical care.

  1. A Research on Identifying the Need for Distance Education for National Athletes Who Study in School of Physical Education and Sport

    ERIC Educational Resources Information Center

    Bozkus, Taner

    2014-01-01

    The purpose of this study was to identify the problems which national athletes, who study in School of Physical Education and Sport in universities, encounter in formal education and to determine their need for distance learning. Qualitative research, which is one the techniques of researching the method of the study, forms a structured…

  2. Using an International Clinical Registry of Regional Anesthesia to Identify Targets for Quality Improvement

    PubMed Central

    Sites, Brian D.; Barrington, Michael J.; Davis, Matthew

    2014-01-01

    Background Despite the widespread use of regional anesthesia, limited information on clinical performance exists. Institutions, therefore, have little knowledge of how they are performing in regards to both safety and effectiveness. In this study, we demonstrate how a medical institution (or physician/physician group) may use data from a multi-center clinical registry of regional anesthesia to inform quality improvement strategies. Methods We analyzed data from the International Registry of Regional Anesthesia that includes prospective data on peripheral regional anesthesia procedures from 19 centers located around the world. Using data from the clinical registry, we present summary statistics of the overall safety and effectiveness of regional anesthesia. Furthermore, we demonstrate, using a variety of performance measures, how these data can be used by hospitals to identify areas for quality improvement. To do so, we compare the performance of one member institution (a United States medical center in New Hampshire) to that of the other 18 member institutions of the clinical registry. Results The clinical registry contained information on 23,271 blocks that were performed between June 1, 2011, and May 1, 2014, on 16,725 patients. The overall success rate was 96.7%, immediate complication rate was 2.2%, and the all-cause 60-day rate of neurological sequelae was 8.3 (95% CI, 7.2–9.7) per 10,000. Registry wide major hospital events included 7 wrong site blocks, 3 seizures, 1 complete heart block, 1 retroperitoneal hematoma, and 3 pneumothoraces. For our reference medical center, we identified areas meriting quality improvement. Specifically, after accounting for differences in the age, sex, and health status of patient populations, the reference medical center appeared to rely more heavily on opioids for post procedure management, had higher patient pain scores, and experienced delayed discharge when compared with other member institutions. Conclusions To our

  3. Assessing the capacity of social determinants of health data to augment predictive models identifying patients in need of wraparound social services.

    PubMed

    Kasthurirathne, Suranga N; Vest, Joshua R; Menachemi, Nir; Halverson, Paul K; Grannis, Shaun J

    2018-01-01

    A growing variety of diverse data sources is emerging to better inform health care delivery and health outcomes. We sought to evaluate the capacity for clinical, socioeconomic, and public health data sources to predict the need for various social service referrals among patients at a safety-net hospital. We integrated patient clinical data and community-level data representing patients' social determinants of health (SDH) obtained from multiple sources to build random forest decision models to predict the need for any, mental health, dietitian, social work, or other SDH service referrals. To assess the impact of SDH on improving performance, we built separate decision models using clinical and SDH determinants and clinical data only. Decision models predicting the need for any, mental health, and dietitian referrals yielded sensitivity, specificity, and accuracy measures ranging between 60% and 75%. Specificity and accuracy scores for social work and other SDH services ranged between 67% and 77%, while sensitivity scores were between 50% and 63%. Area under the receiver operating characteristic curve values for the decision models ranged between 70% and 78%. Models for predicting the need for any services reported positive predictive values between 65% and 73%. Positive predictive values for predicting individual outcomes were below 40%. The need for various social service referrals can be predicted with considerable accuracy using a wide range of readily available clinical and community data that measure socioeconomic and public health conditions. While the use of SDH did not result in significant performance improvements, our approach represents a novel and important application of risk predictive modeling. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  4. Farmer innovation driven by needs and understanding: building the capacities of farmer groups for improved cooking stove construction and continued adaptation

    NASA Astrophysics Data System (ADS)

    Uckert, G.; Hafner, J.; Graef, F.; Hoffmann, H.; Kimaro, A.; Sererya, O.; Sieber, S.

    2017-12-01

    Enhancing food security is one of the main goals of subsistence farmers in Sub-Saharan Africa. This study investigates the implementation of improved loam-made cooking stoves and its contribution to coping and livelihood strategies. Controlled combustion, air as well as smoke flue, and heat insulation facilitate the more efficient fuel consumption of improved cooking stoves compared to traditional stoves—namely three stone fires. Although the majority of small-scale farmers in Sub-Saharan Africa rely on the free public good of firewood, the increasing time needed for collecting firewood implies high opportunity costs for productive members of the family. The primary outcomes for users of improved stoves are reduced fuel consumption, greater safety, saved time, and reduced smoke in the kitchen. The paper illustrates part of the output, outcome, and impact of a participatory action research approach for implementing improved cooking stoves. Special emphasis was put on enabling the villagers to construct their stoves without external support, hence having locally manufactured stoves made of mud, bricks, and dried grass. The impact pathway of improved cooking stoves followed the training-of-trainers concept, where members of the initially established farmer groups were trained to construct stoves on their own. Special focus was given to knowledge exchange and knowledge transfer in order to increase firewood efficiency and overall satisfaction of users of improved cook stoves. Encouraging the members to further adapt the stoves enabled them to scale-up the construction of improved cooked stoves into a business model and increase dissemination while creating income. Although many important benefits, like time and knowledge gain, were identified by the farmers after adoption of the new technology, we found adoption rates differed significantly between regions.

  5. Assessing the methods needed for improved dengue mapping: a SWOT analysis.

    PubMed

    Attaway, David Frost; Jacobsen, Kathryn H; Falconer, Allan; Manca, Germana; Waters, Nigel M

    2014-01-01

    Dengue fever, a mosquito-borne viral infection, is a growing threat to human health in tropical and subtropical areas worldwide. There is a demand from public officials for maps that capture the current distribution of dengue and maps that analyze risk factors to predict the future burden of disease. To identify relevant articles, we searched Google Scholar, PubMed, BioMed Central, and WHOLIS (World Health Organization Library Database) for published articles with a specific set of dengue criteria between January 2002 and July 2013. After evaluating the currently available dengue models, we identified four key barriers to the creation of high-quality dengue maps: (1) data limitations related to the expense of diagnosing and reporting dengue cases in places where health information systems are underdeveloped; (2) issues related to the use of socioeconomic proxies in places with limited dengue incidence data; (3) mosquito ranges which may be changing as a result of climate changes; and (4) the challenges of mapping dengue events at a variety of scales. An ideal dengue map will present endemic and epidemic dengue information from both rural and urban areas. Overcoming the current barriers requires expanded collaboration and data sharing by geographers, epidemiologists, and entomologists. Enhanced mapping techniques would allow for improved visualizations of dengue rates and risks.

  6. Needs for Robotic Assessments of Nuclear Disasters

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

    Victor Walker; Derek Wadsworth

    Following the nuclear disaster at the Fukushima nuclear reactor plant in Japan, the need for systems which can assist in dynamic high-radiation environments such as nuclear incidents has become more apparent. The INL participated in delivering robotic technologies to Japan and has identified key components which are needed for success and obstacles to their deployment. In addition, we are proposing new work and methods to improve assessments and reactions to such events in the future. Robotics needs in disaster situations include phases such as: Assessment, Remediation, and Recovery Our particular interest is in the initial assessment activities. In assessment wemore » need collection of environmental parameters, determination of conditions, and physical sample collection. Each phase would require key tools and efforts to develop. This includes study of necessary sensors and their deployment methods, the effects of radiation on sensors and deployment, and the development of training and execution systems.« less

  7. 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.

  8. Identifying key areas of ecosystem services potential to improve ecological management in Chongqing City, southwest China.

    PubMed

    Xiao, Yang; Xiao, Qiang

    2018-03-29

    Because natural ecosystems and ecosystem services (ES) are both critical to the well-being of humankind, it is important to understand their relationships and congruence for conservation planning. Spatial conservation planning is required to set focused preservation priorities and to assess future ecological implications. This study uses the combined measures of ES models and ES potential to estimate and analyze all four groups of ecosystem services to generate opportunities to maximize ecosystem services. Subsequently, we identify the key areas of conservation priorities as future forestation and conservation hotspot zones to improve the ecological management in Chongqing City, located in the upper reaches of the Three Gorges Reservoir Area, China. Results show that ecosystem services potential is extremely obvious. Compared to ecosystem services from 2000, we determined that soil conservation could be increased by 59.11%, carbon sequestration by 129.51%, water flow regulation by 83.42%, and water purification by 84.42%. According to our prioritization results, approximately 48% of area converted to forests exhibited high improvements in all ecosystem services (categorized as hotspot-1, hotspot-2, and hotspot-3). The hotspots identified in this study can be used as an excellent surrogate for evaluation ecological engineering benefits and can be effectively applied in improving ecological management planning.

  9. The Magnitude of a Community's Health Needs and Nonprofit Hospitals' Progress in Meeting Those Needs: Are We Faced With a Paradox?

    PubMed

    Singh, Simone R; Cramer, Geri R; Young, Gary J

    Although most nonprofit hospitals are required to conduct periodic community health needs assessments (CHNAs), such assessments arguably are most critical for communities with substantial health needs. The objective of this study was to describe differences in progress in conducting CHNAs between hospitals located in communities with the greatest compared with the fewest health needs. We used data on CHNA activity from the 2013 tax filings of 1331 US hospitals combined with data on community health needs from the County Health Rankings. We used bivariate and multivariate analyses to examine differences in hospitals' progress in implementing comprehensive CHNAs using 4 activities: (1) strategies to address identified needs, (2) participation in developing community-wide plans, (3) including CHNA into a hospital's operational plan, and (4) developing a budget to address identified needs. We compared progress in communities with the greatest and the fewest health needs using a comprehensive indicator comprising a community's socioeconomic factors, health behaviors, access to medical care, and physical environment. In 2013, nonprofit hospitals serving communities with the greatest health needs conducted an average of 2.5 of the 4 CHNA activities, whereas hospitals serving communities with the fewest health needs conducted an average of 2.7 activities. Multivariate analysis, however, showed a negative but not significant relationship between the magnitude of a community's health needs and a hospital's progress in implementing comprehensive CHNAs. Hospitals serving communities with the greatest health needs face high demand for free and reduced-cost care, which may limit their ability to invest more of their community benefit dollars in initiatives aimed at improving the health of the community.

  10. Physician Information Needs in Managing Delirium

    PubMed Central

    Taft, Teresa; Nelsen, Scott D; Slager, Stacey; Weir, Charlene

    2017-01-01

    Delirium has the highest occurrence rate of any complication in hospitalized adults over the age of 65. The study objective was to determine physician information needs for use in the development of electronic clinical decision support for physicians managing the care of patients with delirium. Critical incident interviews were conducted with 8 experienced internal medicine physicians and 1 cardiologist. Thematic analysis revealed the following 6 themes: 1) Clinician’s experience an impoverished information field for mental status, 2) Uncertainty is pervasive, 3) Extensive information foraging effort is required for cohesive story building, 4) Goal Conflict leads to missed diagnosis and early closure, 5) Diffusion of Responsibility for treating delirium is common, and 6) Use of structured delirium resources is minimal. Elicited information needs were identified and physician recommendations for improving access to information needed in managing the care of patient’s with delirium are reported. Information elicited in this study is useful for designing delirium clinical decision support that supports physician cognition.

  11. Identifying climate risk perceptions, information needs, and barriers to information exchange among public land managers.

    PubMed

    Peters, Casey B; Schwartz, Mark W; Lubell, Mark N

    2018-03-01

    Meeting ecosystem management challenges posed by climate change requires building effective communication channels among researchers, planners and practitioners to focus research on management issues requiring new knowledge. We surveyed resource managers within two regions of the western United States regions to better understand perceived risks and vulnerabilities associated with climate change and barriers to obtaining and using relevant climate science information in making ecosystem management decisions. We sought to understand what types of climate science information resource managers find most valuable, and the formats in which they prefer to receive climate science information. We found broad concern among natural resource managers in federal agencies that climate change will make it more difficult for them to achieve their management goals. Primary barriers to incorporating climate science into planning are distributed among challenges identifying, receiving, and interpreting appropriate science and a lack of direction provided by agency leadership needed to meaningfully use this emerging science in resource planning. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Identifying Pathways for Improving Household Food Self-Sufficiency Outcomes in the Hills of Nepal

    PubMed Central

    Karki, Tika B.; Sah, Shrawan K.; Thapa, Resam B.; McDonald, Andrew J.; Davis, Adam S.

    2015-01-01

    Maintaining and improving household food self-sufficiency (FSS) in mountain regions is an ongoing challenge. There are many facets to the issue, including comparatively high levels of land fragmentation, challenging terrain and transportation bottlenecks, declining labor availability due to out-migration, and low technical knowledge, among others. Using a nonparametric multivariate approach, we quantified primary associations underlying current levels of FSS in the mid-hills of Nepal. A needs assessment survey was administered to 77 households in Lungaun (Baglung District), Pang (Parbat District), and Pathlekhet (Myagdi District), with a total of 80 variables covering five performance areas; resulting data were analyzed using Classification and Regression Trees. The most parsimonious statistical model for household FSS highlighted associations with agronomic management, including yields of maize and fingermillet within a relay cropping system and adoption of improved crop cultivars. Secondary analyses of the variables retained in the first model again focused primarily on crop and livestock management. It thus appears that continued emphasis on technical agricultural improvements is warranted, independent of factors such as land holding size that, in any case, are very difficult to change through development interventions. Initiatives to increase household FSS in the mid-hills of Nepal will benefit from placing a primary focus on methods of agricultural intensification to improve crop yields and effective technology transfer to increase adoption of these methods. PMID:26047508

  13. Making a Good Match: How Schools and External Service Providers Negotiate Needs and Services in Support of School Improvement

    ERIC Educational Resources Information Center

    Vixie Sandy, Mary

    2013-01-01

    This study investigated a problem facing policy makers, education leaders, and external providers of service that support or facilitate school-based change designed to improve teaching and learning: How to match school needs with providers' services in ways that maximize school improvement. A growing number of organizations provide service to…

  14. Measuring newborn foot length to identify small babies in need of extra care: a cross sectional hospital based study with community follow-up in Tanzania.

    PubMed

    Marchant, Tanya; Jaribu, Jennie; Penfold, Suzanne; Tanner, Marcel; Armstrong Schellenberg, Joanna

    2010-10-19

    Neonatal mortality because of low birth weight or prematurity remains high in many developing country settings. This research aimed to estimate the sensitivity and specificity, and the positive and negative predictive values of newborn foot length to identify babies who are low birth weight or premature and in need of extra care in a rural African setting. A cross-sectional study of newborn babies in hospital, with community follow-up on the fifth day of life, was carried out between 13 July and 16 October 2009 in southern Tanzania. Foot length, birth weight and gestational age were estimated on the first day and foot length remeasured on the fifth day of life. In hospital 529 babies were recruited and measured within 24 hours of birth, 183 of whom were also followed-up at home on the fifth day. Day one foot length <7 cm at birth was 75% sensitive (95%CI 36-100) and 99% specific (95%CI 97-99) to identify very small babies (birth weight <1500 grams); foot length <8 cm had sensitivity and specificity of 87% (95%CI 79-94) and 60% (95%CI 55-64) to identify those with low birth weight (<2500 grams), and 93% (95%CI 82-99) and 58% (95%CI 53-62) to identify those born premature (<37 weeks). Mean foot length on the first day was 7.8 cm (standard deviation 0.47); the mean difference between first and fifth day foot lengths was 0.1 cm (standard deviation 0.3): foot length measured on or before the fifth day of life identified more than three-quarters of babies who were born low birth weight. Measurement of newborn foot length for home births in resource poor settings has the potential to be used by birth attendants, community volunteers or parents as a screening tool to identify low birth weight or premature newborns in order that they can receive targeted interventions for improved survival.

  15. Understanding the Health Needs and Barriers to Seeking Health Care of Veteran Students in the Community.

    PubMed

    Misra-Hebert, Anita D; Santurri, Laura; DeChant, Richard; Watts, Brook; Rothberg, Michael; Sehgal, Ashwini R; Aron, David C

    2015-08-01

    Access to care at Veterans Affairs facilities may be limited by long wait times; however, additional barriers may prevent US military veterans from seeking help at all. We sought to understand the health needs of veterans in the community to identify possible barriers to health-seeking behavior. Focus groups were conducted with veteran students at a community college until thematic saturation was reached. Qualitative data analysis involved both an inductive content analysis approach and deductive elements. A total of 17 veteran students participated in 6 separate focus groups. Health needs affecting health-seeking behavior were identified. Themes included lack of motivation to improve health, concern about social exclusion and stigma, social interactions and behavior, limited access to affordable and convenient health care, unmet basic needs for self and family, and academics competing with health needs. Veterans face a range of personal, societal, and logistical barriers to accessing care. In addition to decreasing wait times for appointments, efforts to improve the transition to civilian life; reduce stigma; and offer assistance related to work, housing, and convenient access to health care may improve health in veteran students.

  16. Understanding the Health Needs and Barriers to Seeking Health Care of Veteran Students in the Community

    PubMed Central

    Misra-Hebert, Anita D.; Santurri, Laura; DeChant, Richard; Watts, Brook; Rothberg, Michael; Sehgal, Ashwini R.; Aron, David C.

    2015-01-01

    Objectives Access to care at Veterans Affairs facilities may be limited by long wait times; however, additional barriers may prevent US military veterans from seeking help at all. We sought to understand the health needs of veterans in the community to identify possible barriers to health-seeking behavior. Methods Focus groups were conducted with veteran students at a community college until thematic saturation was reached. Qualitative data analysis involved both an inductive content analysis approach and deductive elements. Results A total of 17 veteran students participated in 6 separate focus groups. Health needs affecting health-seeking behavior were identified. Themes included lack of motivation to improve health, concern about social exclusion and stigma, social interactions and behavior, limited access to affordable and convenient health care, unmet basic needs for self and family, and academics competing with health needs. Conclusions Veterans face a range of personal, societal, and logistical barriers to accessing care. In addition to decreasing wait times for appointments, efforts to improve the transition to civilian life, reduce stigma, and offer assistance related to work, housing, and convenient access to health care may improve health in veteran students. PMID:26280777

  17. Identifying a need for more focused treatment of chlamydia and gonorrhoea in the emergency department.

    PubMed

    Wilson, Sean P; Knych, McKenna; Iordanova, Rossitza; Mahan, Meredith; Vohra, Taher

    2016-10-01

    The indolent nature of chlamydia and gonorrhoea, along with the time delay associated with current diagnostic testing, makes definitive diagnosis while in the emergency department impossible. We therefore sought to determine the proportion of patients who receive accurate, presumptive antimicrobial treatment for these infections. A retrospective chart review was performed on all patient encounters that underwent chlamydia and gonorrhoea testing at an urban emergency department during a single month in 2012. Each encounter was reviewed for nucleic acid amplification test results and whether presumptive antibiotics were given during the initial visit. A total of 639 patient encounters were reviewed; 87.2% were female and the mean age was 26.7 years. Chlamydia was present in 11.1%, with women and men having similar infection rates: 10.6% vs. 14.6% (p = 0.277). Gonorrhoea was present in 5.0%, with a lower prevalence among women than men: 3.2% vs. 17.1% (p < 0.001). Women received presumptive treatment less often than men: 37.7% vs. 82.9% (p < 0.001). Presumptive treatment was less accurate in women than men: 7.9% vs. 25.6% (p < 0.001). After combining genders, 10.2% received accurate presumptive treatment; 33.3% were overtreated and 4.4% missed treatment. Presumptive treatment for chlamydia and gonorrhoea was more frequent and more accurate in men than in women. Overall, one-third of patients received unnecessary antibiotics, yet nearly 5% missed treatment. Better methods are needed for identifying patients who need treatment. © The Author(s) 2016.

  18. Does influenza vaccination improve pregnancy outcome? Methodological issues and research needs.

    PubMed

    Savitz, David A; Fell, Deshayne B; Ortiz, Justin R; Bhat, Niranjan

    2015-11-25

    Evidence that influenza vaccination during pregnancy is safe and effective at preventing influenza disease in women and their children through the first months of life is increasing. Several reports of reduced risk of adverse outcomes associated with influenza vaccination have generated interest in its potential for improving pregnancy outcome. Gavi, the Vaccine Alliance, estimates maternal influenza immunization programs in low-income countries would have a relatively modest impact on mortality compared to other new or under-utilized vaccines, however the impact would be substantially greater if reported vaccine effects on improved pregnancy outcomes were accurate. Here, we examine the available evidence and methodological issues bearing on the relationship between influenza vaccination and pregnancy outcome, particularly preterm birth and fetal growth restriction, and summarize research needs. Evidence for absence of harm associated with vaccination at a point in time is not symmetric with evidence of benefit, given the scenario in which vaccination reduces risk of influenza disease and, in turn, risk of adverse pregnancy outcome. The empirical evidence for vaccination preventing influenza in pregnant women is strong, but the evidence that influenza itself causes adverse pregnancy outcomes is inconsistent and limited in quality. Studies of vaccination and pregnancy outcome have produced mixed evidence of potential benefit but are limited in terms of influenza disease assessment and control of confounding, and their analytic methods often fail to fully address the longitudinal nature of pregnancy and influenza prevalence. We recommend making full use of results of randomized trials, re-analysis of existing observational studies to account for confounding and time-related factors, and quantitative assessment of the potential benefits of vaccination in improving pregnancy outcome, all of which should be informed by the collective engagement of experts in influenza

  19. Identifying Students for Secondary and Tertiary Prevention Efforts: How Do We Determine Which Students Have Tier 2 and Tier 3 Needs?

    ERIC Educational Resources Information Center

    Lane, Kathleen Lynne; Oakes, Wendy Peia; Ennis, Robin Parks; Hirsch, Shanna Eisner

    2014-01-01

    In comprehensive, integrated, three-tiered models, it is essential to have a systematic method for identifying students who need supports at Tier 2 or Tier 3. This article provides explicit information on how to use multiple sources of data to determine which students might benefit from these supports. First, the authors provide an overview of how…

  20. Improvements in the Protein Identifier Cross-Reference service.

    PubMed

    Wein, Samuel P; Côté, Richard G; Dumousseau, Marine; Reisinger, Florian; Hermjakob, Henning; Vizcaíno, Juan A

    2012-07-01

    The Protein Identifier Cross-Reference (PICR) service is a tool that allows users to map protein identifiers, protein sequences and gene identifiers across over 100 different source databases. PICR takes input through an interactive website as well as Representational State Transfer (REST) and Simple Object Access Protocol (SOAP) services. It returns the results as HTML pages, XLS and CSV files. It has been in production since 2007 and has been recently enhanced to add new functionality and increase the number of databases it covers. Protein subsequences can be Basic Local Alignment Search Tool (BLAST) against the UniProt Knowledgebase (UniProtKB) to provide an entry point to the standard PICR mapping algorithm. In addition, gene identifiers from UniProtKB and Ensembl can now be submitted as input or mapped to as output from PICR. We have also implemented a 'best-guess' mapping algorithm for UniProt. In this article, we describe the usefulness of PICR, how these changes have been implemented, and the corresponding additions to the web services. Finally, we explain that the number of source databases covered by PICR has increased from the initial 73 to the current 102. New resources include several new species-specific Ensembl databases as well as the Ensembl Genome ones. PICR can be accessed at http://www.ebi.ac.uk/Tools/picr/.

  1. Identifying treatment responders and predictors of improvement after cognitive-behavioral therapy for juvenile fibromyalgia.

    PubMed

    Sil, Soumitri; Arnold, Lesley M; Lynch-Jordan, Anne; Ting, Tracy V; Peugh, James; Cunningham, Natoshia; Powers, Scott W; Lovell, Daniel J; Hashkes, Philip J; Passo, Murray; Schikler, Kenneth N; Kashikar-Zuck, Susmita

    2014-07-01

    The primary objective of this study was to estimate a clinically significant and quantifiable change in functional disability to identify treatment responders in a clinical trial of cognitive-behavioral therapy (CBT) for youth with juvenile fibromyalgia (JFM). The second objective was to examine whether baseline functional disability (Functional Disability Inventory), pain intensity, depressive symptoms (Children's Depression Inventory), coping self-efficacy (Pain Coping Questionnaire), and parental pain history predicted treatment response in disability at 6-month follow-up. Participants were 100 adolescents (11-18 years of age) with JFM enrolled in a recently published clinical trial comparing CBT to a fibromyalgia education (FE) intervention. Patients were identified as achieving a clinically significant change in disability (i.e., were considered treatment responders) if they achieved both a reliable magnitude of change (estimated as a > or = 7.8-point reduction on the FDI) using the Reliable Change Index, and a reduction in FDI disability grade based on established clinical reference points. Using this rigorous standard, 40% of patients who received CBT (20 of 50) were identified as treatment responders, compared to 28% who received FE (14 of 50). For CBT, patients with greater initial disability and higher coping efficacy were significantly more likely to achieve a clinically significant improvement in functioning. Pain intensity, depressive symptoms, and parent pain history did not significantly predict treatment response. Estimating clinically significant change for outcome measures in behavioral trials sets a high bar but is a potentially valuable approach to improve the quality of clinical trials, to enhance interpretability of treatment effects, and to challenge researchers to develop more potent and tailored interventions. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  2. Elementary School Teacher Training Based on Needs and Interests of Teachers and The Effectiveness of The Improvement of Students Competence

    NASA Astrophysics Data System (ADS)

    Suyitno, A.; Sugiharti, E.; Pujiastuti, E.

    2017-04-01

    Teachers need always to improve their competence because of the growth of science very rapidly as well as elementary school teachers. However, the provision of training will not produce an increase in the competence effectively if it is implemented without considering the needs and interests of teachers. The novelty factor which is highlighted through this research results, want to answer a problem, namely: how to conduct an effective training based on the needs and interests of teachers so that the effects of training can improve the competence of teachers? After going through research for two years with a qualitative approach which was preceded by a visit to the school and a series of interviews, treatment of training model, FGD, and triangulation then have been produced a way to implement of training based on the needs and interests of teachers. The training model includes face to face training which structured and scheduled according to the needs of elementary school teachers, followed by workshops, simulations, then the coach holds guidance in the classroom, and ends with reflections.

  3. Rehabilitation Needs Assessment for Vocational Rehabilitation Agencies. Volume II. Needs Assessment Topics Identified in the Rehabilitation Act: Issues and Resources.

    ERIC Educational Resources Information Center

    Wisconsin Univ.-Stout, Menomonie. Stout Vocational Rehabilitation Inst.

    This guide was developed to help Wisconsin agency assessment, evaluation, and planning personnel to develop a perspective on how needs assessment fits into their state's vocational rehabilitation program planning. Volume II provides state agency personnel with tools for conducting rehabilitation needs assessment. The first three chapters consider…

  4. HIV prevention among diverse young MSM: Research needs, priorities, and opportunities

    PubMed Central

    Rhodes, Scott D.; Wong, Frank Y.

    2016-01-01

    There remains a profound need for innovative and effective interventions designed for young men who have sex with men (YMSM) generally; and racial and ethnic minority YMSM, YMSM living in rural communities, and low-income YMSM, particularly, to prevent HIV and improve health outcomes in the United States. This introduction to this theme issue identifies some of the research needs, priorities, and opportunities that emerged during a seminal NIMHD-sponsored workshop on HIV prevention behavioral interventions for diverse YMSM. It provides researchers, practitioners, and federal partners guidance in next steps to reduce the impact of the HIV epidemic among YMSMS. The needs, priorities, and opportunities identified serve as a foundation to push both the science and the practice of HIV prevention forward. We recognize that considerably more research is needed, and this issue highlights intervention research – where we have been and where we should go. With the disparities faced by YMSM, we must act rapidly to do the work it will take to meet their prevention needs, reduce infections, and save lives. PMID:27244188

  5. Intensive care unit nurses' information needs and recommendations for integrated displays to improve nurses' situation awareness.

    PubMed

    Koch, Sven H; Weir, Charlene; Haar, Maral; Staggers, Nancy; Agutter, Jim; Görges, Matthias; Westenskow, Dwayne

    2012-01-01

    Fatal errors can occur in intensive care units (ICUs). Researchers claim that information integration at the bedside may improve nurses' situation awareness (SA) of patients and decrease errors. However, it is unclear which information should be integrated and in what form. Our research uses the theory of SA to analyze the type of tasks, and their associated information gaps. We aimed to provide recommendations for integrated, consolidated information displays to improve nurses' SA. Systematic observations methods were used to follow 19 ICU nurses for 38 hours in 3 clinical practice settings. Storyboard methods and concept mapping helped to categorize the observed tasks, the associated information needs, and the information gaps of the most frequent tasks by SA level. Consensus and discussion of the research team was used to propose recommendations to improve information displays at the bedside based on information deficits. Nurses performed 46 different tasks at a rate of 23.4 tasks per hour. The information needed to perform the most common tasks was often inaccessible, difficult to see at a distance or located on multiple monitoring devices. Current devices at the ICU bedside do not adequately support a nurse's information-gathering activities. Medication management was the most frequent category of tasks. Information gaps were present at all levels of SA and across most of the tasks. Using a theoretical model to understand information gaps can aid in designing functional requirements. Integrated information that enhances nurses' Situation Awareness may decrease errors and improve patient safety in the future.

  6. Intensive care unit nurses' information needs and recommendations for integrated displays to improve nurses' situation awareness

    PubMed Central

    Weir, Charlene; Haar, Maral; Staggers, Nancy; Agutter, Jim; Görges, Matthias; Westenskow, Dwayne

    2012-01-01

    Objective Fatal errors can occur in intensive care units (ICUs). Researchers claim that information integration at the bedside may improve nurses' situation awareness (SA) of patients and decrease errors. However, it is unclear which information should be integrated and in what form. Our research uses the theory of SA to analyze the type of tasks, and their associated information gaps. We aimed to provide recommendations for integrated, consolidated information displays to improve nurses' SA. Materials and Methods Systematic observations methods were used to follow 19 ICU nurses for 38 hours in 3 clinical practice settings. Storyboard methods and concept mapping helped to categorize the observed tasks, the associated information needs, and the information gaps of the most frequent tasks by SA level. Consensus and discussion of the research team was used to propose recommendations to improve information displays at the bedside based on information deficits. Results Nurses performed 46 different tasks at a rate of 23.4 tasks per hour. The information needed to perform the most common tasks was often inaccessible, difficult to see at a distance or located on multiple monitoring devices. Current devices at the ICU bedside do not adequately support a nurse's information-gathering activities. Medication management was the most frequent category of tasks. Discussion Information gaps were present at all levels of SA and across most of the tasks. Using a theoretical model to understand information gaps can aid in designing functional requirements. Conclusion Integrated information that enhances nurses' Situation Awareness may decrease errors and improve patient safety in the future. PMID:22437074

  7. A needs assessment study of undergraduate surgical education.

    PubMed

    Kaur, Navneet; Gupta, Ankit; Saini, Pradeep

    2011-01-01

    A needs assessment is the process of identifying performance requirements or 'gaps' between what is required and what exists at present. To identify these gaps, the inputs of all stakeholders are needed. In medical education, graduating medical students are important stakeholders who can provide valuable feedback on deficiencies in their training. To know the students' perceptions about effectiveness of their surgical training, an anonymous questionnaire seeking their opinion on the duration, content, methods of teaching and assessment was administered. Their responses were analysed using descriptive statistics. The students were largely in favour of active methods of learning and there was very little preference for didactic lectures. For clinical teaching, involvement in ward rounds and patient care activities, in addition to case discussions, was considered to facilitate learning. A clerkship model of clinical training was favoured. Any teaching-learning activity in small groups of 8-10 students were preferred. As regards their evaluation, besides internal assessment, the students felt the need for direct constructive feedback from teachers on how to improve their performance. A large number (73.5%) were opposed to attendance being considered a qualifying criterion for taking the examination. Students' feedback about their 'perceived needs' should be considered when revising training programmes.

  8. Unmet needs of children with special health care needs in a specialized day school setting.

    PubMed

    Aruda, Mary M; Kelly, Mary; Newinsky, Karina

    2011-06-01

    Children with Special Health Care Needs (CSHCN) represent a significant component of the pediatric population. They often present to schools with multiple and increasingly complex health issues, including medical technology dependency. Their daily variation in health status requires close monitoring and communication among caregivers. Limited research exists regarding parental concerns and communication between health providers, schools, and families. This study identifies the concerns of parents with CSHCN families, including satisfaction with communication between medical providers and schools. Parents completed a survey adapted from the American Academy of Pediatrics (AAP). Analysis of data indicated a high utilization of primary care services but highlighted persistent difficulty accessing services. This study demonstrates families have basic unmet needs in attaining services, including respite and palliative care; indicated an interest in improved communication and coordination of health information between schools and their primary health care providers; and expressed interest in augmenting school health services.

  9. A Spatial Index for Identifying Opportunity Zones for Woody Cellulosic Conversion Facilities

    Treesearch

    Xia Huang; James H. Perdue; Timothy M. Young

    2012-01-01

    A challenge in the development of renewable energy is the ability to spatially assess the risk of feedstock supply to conversion facilities. Policy makers and investors need improved methods to identify the interactions associated with landscape features, socioeconomic conditions, and ownership patterns, and the influence these variables have on the geographic location...

  10. Using Medicare Data to Identify Individuals Who Are Electricity Dependent to Improve Disaster Preparedness and Response

    PubMed Central

    DeSalvo, Karen; Finne, Kristen; Worrall, Chris; Bogdanov, Alina; Dinkler, Ayame; Babcock, Sarah; Kelman, Jeffrey

    2014-01-01

    During a disaster or prolonged power outage, individuals who use electricity-dependent medical equipment are often unable to operate it and seek care in acute care settings or local shelters. Public health officials often report that they do not have proactive and systematic ways to rapidly identify and assist these individuals. In June 2013, we piloted a first-in-the-nation emergency preparedness drill in which we used Medicare claims data to identify individuals with electricity-dependent durable medical equipment during a disaster and securely disclosed it to a local health department. We found that Medicare claims data were 93% accurate in identifying individuals using a home oxygen concentrator or ventilator. The drill findings suggest that claims data can be useful in improving preparedness and response for electricity-dependent populations. PMID:24832404

  11. Using Medicare data to identify individuals who are electricity dependent to improve disaster preparedness and response.

    PubMed

    DeSalvo, Karen; Lurie, Nicole; Finne, Kristen; Worrall, Chris; Bogdanov, Alina; Dinkler, Ayame; Babcock, Sarah; Kelman, Jeffrey

    2014-07-01

    During a disaster or prolonged power outage, individuals who use electricity-dependent medical equipment are often unable to operate it and seek care in acute care settings or local shelters. Public health officials often report that they do not have proactive and systematic ways to rapidly identify and assist these individuals. In June 2013, we piloted a first-in-the-nation emergency preparedness drill in which we used Medicare claims data to identify individuals with electricity-dependent durable medical equipment during a disaster and securely disclosed it to a local health department. We found that Medicare claims data were 93% accurate in identifying individuals using a home oxygen concentrator or ventilator. The drill findings suggest that claims data can be useful in improving preparedness and response for electricity-dependent populations.

  12. Central intake to improve access to physiotherapy for children with complex needs: a mixed methods case report.

    PubMed

    Wittmeier, Kristy D M; Restall, Gayle; Mulder, Kathy; Dufault, Brenden; Paterson, Marie; Thiessen, Matthew; Lix, Lisa M

    2016-08-31

    Children with complex needs can face barriers to system access and navigation related to their need for multiple services and healthcare providers. Central intake for pediatric rehabilitation was developed and implemented in 2008 in Winnipeg Manitoba Canada as a means to enhance service coordination and access for children and their families. This study evaluates the process and impact of implementing a central intake system, using pediatric physiotherapy as a case example. A mixed methods instrumental case study design was used. Interviews were completed with 9 individuals. Data was transcribed and analyzed for themes. Quantitative data (wait times, referral volume and caregiver satisfaction) was collected for children referred to physiotherapy with complex needs (n = 1399), and a comparison group of children referred for orthopedic concerns (n = 3901). Wait times were analyzed using the Kruskal-Wallis test, caregiver satisfaction was analyzed using Fisher exact test and change point modeling was applied to examine referral volume over the study period. Interview participants described central intake implementation as creating more streamlined processes. Factors that facilitated successful implementation included 1) agreement among stakeholders, 2) hiring of a central intake coordinator, 3) a financial commitment from the government and 4) leadership at the individual and organization level. Mean (sd) wait times improved for children with complex needs (12.3(13.1) to 8.0(6.9) days from referral to contact with family, p < 0.0001; 29.8(17.9) to 24.3(17.0) days from referral to appointment, p < 0.0001) while referral volumes remained consistent. A small but significant increase in wait times was observed for the comparison group (9.6(8.6) to 10.1(6.6) days from referral to contact with family, p < 0.001; 20.4(14.3) to 22.1(13.1) days from referral to appointment, p < 0.0001), accompanied by an increasing referral volume for this group

  13. A critical assessment of research needs identified by the dietary guidelines committees from 1980 to 2010.

    PubMed

    Myers, Esther F; Khoo, Chor-San; Murphy, William; Steiber, Alison; Agarwal, Sanjiv

    2013-07-01

    The Dietary Goals for the United States were introduced in 1977 and have been followed by the Dietary Guidelines for Americans (DGA) every 5 years from 1980 to 2010. The DGA provide science-based advice to promote health and reduce risk for major chronic diseases through diet and physical activity. The Dietary Guidelines Advisory Committees are charged to provide updates of the DGA topics using the best available science. The Dietary Guidelines Advisory Committees' reports also identified 169 research gaps. To date, these gaps have not been compiled and assessed. We evaluated trends in number, topics, and specificity of research gaps by year by placing them in the following topic categories: general, chronic diseases/conditions, diet/diet pattern, food/ingredient, and nutrient-specific research gaps. Some research topics (eg, sodium and hypertension and appropriate uses of DGA) have been identified consistently across the years, some emerged in later years (eg, increasingly specific research gaps between dietary fatty acids and cardiovascular disease), and others appeared intermittently (eg, relationships between dietary components and cancer). These results are a call to action for all DGA stakeholders to have an immediate dialogue about how the research enterprise can best address critical research needs in a timely way to support public policy. Copyright © 2013 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  14. Assessing the methods needed for improved dengue mapping: a SWOT analysis

    PubMed Central

    Attaway, David Frost; Jacobsen, Kathryn H; Falconer, Allan; Manca, Germana; Waters, Nigel M

    2014-01-01

    Introduction Dengue fever, a mosquito-borne viral infection, is a growing threat to human health in tropical and subtropical areas worldwide. There is a demand from public officials for maps that capture the current distribution of dengue and maps that analyze risk factors to predict the future burden of disease. Methods To identify relevant articles, we searched Google Scholar, PubMed, BioMed Central, and WHOLIS (World Health Organization Library Database) for published articles with a specific set of dengue criteria between January 2002 and July 2013. Results After evaluating the currently available dengue models, we identified four key barriers to the creation of high-quality dengue maps: (1) data limitations related to the expense of diagnosing and reporting dengue cases in places where health information systems are underdeveloped; (2) issues related to the use of socioeconomic proxies in places with limited dengue incidence data; (3) mosquito ranges which may be changing as a result of climate changes; and (4) the challenges of mapping dengue events at a variety of scales. Conclusion An ideal dengue map will present endemic and epidemic dengue information from both rural and urban areas. Overcoming the current barriers requires expanded collaboration and data sharing by geographers, epidemiologists, and entomologists. Enhanced mapping techniques would allow for improved visualizations of dengue rates and risks. PMID:25328585

  15. Identifying Eating Occasion-Based Opportunities to Improve the Overall Diets of Australian Adolescents

    PubMed Central

    Fayet-Moore, Flavia; McConnell, Andrew; Kim, Jean; Mathias, Kevin C.

    2017-01-01

    Adolescents in Australia have a poor dietary intake, leading to large numbers of them being at risk for inadequate intake of micronutrients, and excessive intake of less healthful dietary components. This study examined dietary intakes at multiple eating occasions to identify opportunities for more targeted recommendations and strategies to improve dietary intakes among adolescents. Data from the first 24-h recall of 14–18 years old in the 2011–2012 National Nutrition and Physical Activity Survey were analysed (n = 772). Participant-defined eating occasions were classified as breakfast, lunch, dinner or other eating occasions combined. The mean percent contribution to the total day intake of top shortfall nutrients (calcium, magnesium, vitamin A, iron), discretionary calories, saturated fat, free sugars and sodium, as well as nutrient density, the foods consumed and the percent of consumers at each eating occasion, were calculated. Breakfast had the lowest prevalence of consumers (81%), contributed the least to total daily energy (14.6%) and almost a quarter of daily calcium and iron. Other eating occasions combined contributed 47.5% of free sugars and were top contributors of daily calcium (34.6%) and magnesium (31.7%). Discretionary foods contributed 32.4% of the energy at lunch, and the sodium content at lunch was 415 mg/1000 kJ. Key opportunities identified for adolescents were to increase breakfast consumption, given the high nutrient densities of breakfasts consumed; improve overall lunch quality, particularly the sodium content; promote the intake of milk, fruit and a variety of vegetables at both lunch and dinner; maintain healthful choices at in-between meal eating occasions while focusing on decreasing the intake of discretionary foods. PMID:28613261

  16. The Work Ability Index as a screening tool to identify the need for rehabilitation: longitudinal findings from the Second German Sociomedical Panel of Employees.

    PubMed

    Bethge, Matthias; Radoschewski, Friedrich Michael; Gutenbrunner, Christoph

    2012-11-01

    To evaluate the predictive value of the Work Ability Index (WAI) for different indicators of the need for rehabilitation at 1-year follow-up. Cohort study. Data were obtained from the Second German Sociomedical Panel of Employees, a large-scale cohort study with postal surveys in 2009 and 2010. A total of 457 women and 579 men were included. Confirmatory factor analysis confirmed the one-dimensionality of the WAI. Regression analyses showed that poor and moderate baseline WAI scores were associated with lower health-related quality of life and more frequent use of primary healthcare 1 year later. Subjects with poor baseline work ability had 4.6 times higher odds of unemployment and 12.2 times higher odds of prolonged sick leave than the reference group with good or excellent baseline work ability. Moreover, the odds of subjectively perceived need for rehabilitation, intention to request rehabilitation and actual use of rehabilitation services were 9.7, 5.7 and 3 times higher in the poor baseline WAI group and 5.5, 4 and 1.8 times higher in the moderate baseline WAI group, respectively. A WAI score ≤ 37 was identified as the optimal cut-off to predict the need for rehabilitation. The WAI is a valid screening tool for identifying the need for rehabilitation.

  17. Improving Work Processes by Making the Invisible Visible

    ERIC Educational Resources Information Center

    Bakker, Arthur; Hoyles, Celia; Kent, Phillip; Noss, Richard

    2006-01-01

    Increasingly, companies are taking part in process improvement programmes, which brings about a growing need for employees to interpret and act on data representations. We have carried out case studies in a range of companies to identify the existence and need of what we call "techno-mathematical literacies" (TmL): functional mathematical…

  18. Improving Test Preparation for Students with Special Needs: Web-Based Tutorial, Student Charting, and a Text Reader

    ERIC Educational Resources Information Center

    Menard, Lauren A.

    2011-01-01

    Obstacles to the classroom implementation of the fourth grade Math component of Louisiana's web-based testing tutorial were addressed in this informal pilot. Technology integration improved standardized test preparation for students with special needs. Supplemental test preparation sessions give the benefits of (a) increased familiarity with…

  19. Characteristics of Teacher-Identified Students with Special Educational Needs in Dutch Mainstream Primary Education

    ERIC Educational Resources Information Center

    Bruggink, M.; Goei, S. L.; Koot, H. M.

    2013-01-01

    Background: Traditionally, special educational needs (SEN) were often defined in terms of child deficits. Recently, there has been a tendency to define SEN in terms of (additional) support needed in the classroom. However, little is known about how teachers define students with special educational needs. To close this gap, characteristics of…

  20. Occupational injuries and fatalities in a tanzanite mine: Need to improve workers safety in Tanzania

    PubMed Central

    Boniface, Respicious; Museru, Lawrence; Munthali, Victoria; Lett, Ronald

    2013-01-01

    Introduction Work related injuries are common, and the mining industry accounts for a significant proportion of these injuries. Tanzania is among the countries with high rates of mining injuries, nevertheless pre-hospital care is almost non existant and health care service deliveries are poor. This study sought to identify factors associated with injuries and fatalities among miners in Mererani, Tanzania. Methods A Cross - Sectional study of miners who sustained injuries and seen at Mererani health centre between January 2009 and May 2012. Results In the selected period 248 injury patients were seen. All were males, and 54% were between 18 - 30 years age-group. Almost all (98.7%) didn’t use protective gears at work, and worked for more than 12 hours daily. Falling rocks were the leading cause of injury (18.2%), and majority sustained multiple injuries (33%). Of the patients seen, 41.3% died. The following were more likely to die than others; Primary education (p = 0.04), Less than 5 years work experience (p = 0.000), unintentional injuries (p = 0.000), fall injuries (p = 0.000) and sustaining multiple injuries (p = 0.000). Conclusion The burden of injuries and fatalities demonstrated in this study, point to the need for implementation and monitoring of the use of safety equipment and operating procedures of the mines by government and other regulatory authorities. Initiation of pre hospital care at the mines and improved emergency medical service delivery at health centers in Tanzania. PMID:24778757

  1. Patient-identified information and communication needs in the context of major trauma.

    PubMed

    Braaf, Sandra; Ameratunga, Shanthi; Nunn, Andrew; Christie, Nicola; Teague, Warwick; Judson, Rodney; Gabbe, Belinda J

    2018-03-07

    Navigating complex health care systems during the multiple phases of recovery following major trauma entails many challenges for injured patients. Patients' experiences communicating with health professionals are of particular importance in this context. The aim of this study was to explore seriously injured patients' perceptions of communication with and information provided by health professionals in their first 3-years following injury. A qualitative study designed was used, nested within a population-based longitudinal cohort study. Semi-structured telephone interviews were undertaken with 65 major trauma patients, aged 17 years and older at the time of injury, identified through purposive sampling from the Victorian State Trauma Registry. A detailed thematic analysis was undertaken using a framework approach. Many seriously injured patients faced barriers to communication with health professionals in the hospital, rehabilitation and in the community settings. Key themes related to limited contact with health professionals, insufficient information provision, and challenges with information coordination. Communication difficulties were particularly apparent when many health professionals were involved in patient care, or when patients transitioned from hospital to rehabilitation or to the community. Difficulties in patient-health professional engagement compromised communication and exchange of information particularly at transitions of care, e.g., discharge from hospital. Conversely, positive attributes displayed by health professionals such as active discussion, clear language, listening and an empathetic manner, all facilitated effective communication. Most patients preferred communication consistent with patient-centred approaches, and the use of multiple modes to communicate information. The communication and information needs of seriously injured patients were inconsistently met over the course of their recovery continuum. To assist patients along their

  2. Needs assessment final report

    NASA Technical Reports Server (NTRS)

    Sepulveda, Jose A.

    1992-01-01

    The stated purposes of the Management Science Faculty Fellowship Project were to: (1) provide a comprehensive analysis of KSC management training for engineers and other management professionals from project/program lead through executive levels; and (2) development of evaluation methodologies which can be used to perform ongoing program-wide course-to-course assessments. This report will focus primarily in the first stated purpose for the project. Ideally, the analysis of KSC management training will build in the current system and efficiently propose improvements to achieve existing goals and objectives while helping to identify new visions and new outcomes for the Center's Management Training Mission. Section 2 describes the objectives, approach, and specific tasks used to analyze KSC's Management training System. Section 3 discusses the main conclusions derived from an analysis of the available training data. Section 4 discusses the characteristics and benefits envisioned for a Management Training System. Section 5 proposes a Training System as identified by the results of a Needs Assessment exercise conducted at KSC this summer. Section 6 presents a number of recommendations for future work.

  3. Innovating for quality and value: Utilizing national quality improvement programs to identify opportunities for responsible surgical innovation.

    PubMed

    Woo, Russell K; Skarsgard, Erik D

    2015-06-01

    Innovation in surgical techniques, technology, and care processes are essential for improving the care and outcomes of surgical patients, including children. The time and cost associated with surgical innovation can be significant, and unless it leads to improvements in outcome at equivalent or lower costs, it adds little or no value from the perspective of the patients, and decreases the overall resources available to our already financially constrained healthcare system. The emergence of a safety and quality mandate in surgery, and the development of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) allow needs-based surgical care innovation which leads to value-based improvement in care. In addition to general and procedure-specific clinical outcomes, surgeons should consider the measurement of quality from the patients' perspective. To this end, the integration of validated Patient Reported Outcome Measures (PROMs) into actionable, benchmarked institutional outcomes reporting has the potential to facilitate quality improvement in process, treatment and technology that optimizes value for our patients and health system. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Partners in Flight research needs assessment summary

    USGS Publications Warehouse

    Ruth, Janet M.; Rosenberg, Kenneth V.

    2009-01-01

    An important component of the PIF International Conference in McAllen, TX in February 2008 was the incorporation of a Needs Assessment Process in all of the conference sessions. Throughout the McAllen sessions, a number of critical information gaps were identified, pointing to future research that will be needed to establish bird conservation objectives and accomplish bird conservation goals. This document is a summary of the research needs topics identified in the McAllen sessions, placed in the larger context of PIF research needs information. This summary is not intended to be a comprehensive evaluation of landbird research needs, nor a literature review or synthesis of such research needs and research topics. This report was developed by compiling and organizing the research needs identified in McAllen (Rich et al. 2008) and then placing the needs within the context of other PIF-related documents that have identified research needs.

  5. Toward sustainable environmental quality: Identifying priority research questions for Latin America.

    PubMed

    Furley, Tatiana Heid; Brodeur, Julie; Silva de Assis, Helena C; Carriquiriborde, Pedro; Chagas, Katia R; Corrales, Jone; Denadai, Marina; Fuchs, Julio; Mascarenhas, Renata; Miglioranza, Karina Sb; Miguez Caramés, Diana Margarita; Navas, José Maria; Nugegoda, Dayanthi; Planes, Estela; Rodriguez-Jorquera, Ignacio Alejandro; Orozco-Medina, Martha; Boxall, Alistair Ba; Rudd, Murray A; Brooks, Bryan W

    2018-05-01

    The Global Horizon Scanning Project (GHSP) is an innovative initiative that aims to identify important global environmental quality research needs. Here we report 20 key research questions from Latin America (LA). Members of the Society of Environmental Toxicology and Chemistry (SETAC) LA and other scientists from LA were asked to submit research questions that would represent priority needs to address in the region. One hundred questions were received, then partitioned among categories, examined, and some rearranged during a workshop in Buenos Aires, Argentina. Twenty priority research questions were subsequently identified. These research questions included developing, improving, and harmonizing across LA countries methods for 1) identifying contaminants and degradation products in complex matrices (including biota); 2) advancing prediction of contaminant risks and effects in ecosystems, addressing lab-to-field extrapolation challenges, and understanding complexities of multiple stressors (including chemicals and climate change); and 3) improving management and regulatory tools toward achieving sustainable development. Whereas environmental contaminants frequently identified in these key questions were pesticides, pharmaceuticals, endocrine disruptors or modulators, plastics, and nanomaterials, commonly identified environmental challenges were related to agriculture, urban effluents, solid wastes, pulp and paper mills, and natural extraction activities. Several interesting research topics included assessing and preventing pollution impacts on conservation protected areas, integrating environment and health assessments, and developing strategies for identification, substitution, and design of less hazardous chemicals (e.g., green chemistry). Finally, a recurrent research need included developing an understanding of differential sensitivity of regional species and ecosystems to environmental contaminants and other stressors. Addressing these critical questions will

  6. Toward sustainable environmental quality: Identifying priority research questions for Latin America

    PubMed Central

    Furley, Tatiana Heid; Brodeur, Julie; Silva de Assis, Helena C; Carriquiriborde, Pedro; Chagas, Katia R; Corrales, Jone; Denadai, Marina; Fuchs, Julio; Mascarenhas, Renata; Miglioranza, Karina SB; Miguez Caramés, Diana Margarita; Navas, José Maria; Nugegoda, Dayanthi; Planes, Estela; Rodriguez‐Jorquera, Ignacio Alejandro; Orozco‐Medina, Martha; Boxall, Alistair BA; Rudd, Murray A

    2018-01-01

    ABSTRACT The Global Horizon Scanning Project (GHSP) is an innovative initiative that aims to identify important global environmental quality research needs. Here we report 20 key research questions from Latin America (LA). Members of the Society of Environmental Toxicology and Chemistry (SETAC) LA and other scientists from LA were asked to submit research questions that would represent priority needs to address in the region. One hundred questions were received, then partitioned among categories, examined, and some rearranged during a workshop in Buenos Aires, Argentina. Twenty priority research questions were subsequently identified. These research questions included developing, improving, and harmonizing across LA countries methods for 1) identifying contaminants and degradation products in complex matrices (including biota); 2) advancing prediction of contaminant risks and effects in ecosystems, addressing lab‐to‐field extrapolation challenges, and understanding complexities of multiple stressors (including chemicals and climate change); and 3) improving management and regulatory tools toward achieving sustainable development. Whereas environmental contaminants frequently identified in these key questions were pesticides, pharmaceuticals, endocrine disruptors or modulators, plastics, and nanomaterials, commonly identified environmental challenges were related to agriculture, urban effluents, solid wastes, pulp and paper mills, and natural extraction activities. Several interesting research topics included assessing and preventing pollution impacts on conservation protected areas, integrating environment and health assessments, and developing strategies for identification, substitution, and design of less hazardous chemicals (e.g., green chemistry). Finally, a recurrent research need included developing an understanding of differential sensitivity of regional species and ecosystems to environmental contaminants and other stressors. Addressing these critical

  7. Understanding the needs of department chairs in academic medicine.

    PubMed

    Lieff, Susan; Banack, Jeannine Girard-Pearlman; Baker, Lindsay; Martimianakis, Maria Athina; Verma, Sarita; Whiteside, Catharine; Reeves, Scott

    2013-07-01

    The challenges for senior academic leadership in medicine are significant and becoming increasingly complex. Adapting to the rapidly changing environment of health care and medical education requires strong leadership and management skills. This article provides empirical evidence about the intricate needs of department chairs to provide insight into the design of support and development opportunities. In an exploratory case study, 21 of 25 (84%) department chairs within a faculty of medicine at a large Canadian university participated in semistructured interviews from December 2009 to February 2010. The authors conducted an inductive thematic analysis and identified a coding structure through an iterative process of relating and grouping of emerging themes. These participants were initially often insufficiently prepared for the demands of their roles. They identified a specific set of needs. They required cultural and structural awareness to navigate their hospital and university landscapes. A comprehensive network of support was necessary for eliciting advice and exchanging information, strategy, and emotional support. They identified a critical need for infrastructure growth and development. Finally, they stressed that they needed improvement in both effective interpersonal and influence skills in order to meet their mandate. Given the complexities and emotional burden of their role, it is necessary for chairs to have a range of supports and capabilities to succeed in their roles. Their leadership effectiveness can be enhanced by providing transitional processes and supports, development, and mentoring as well as facilitating the development of communities of peers.

  8. Improving operative flow during pediatric airway evaluation: a quality-improvement initiative.

    PubMed

    Prager, Jeremy D; Ruiz, Amanda G; Mooney, Kristin; Gao, Dexiang; Szolnoki, Judit; Shah, Rahul K

    2015-03-01

    Microlaryngoscopy and bronchoscopy procedures (MLBs) are short-duration, high-acuity procedures that carry risk. Poor case flow and communication exacerbate such potential risk. Efficient operative flow is critical for patient safety and resource expenditure. To identify areas for improvement and evaluate the effectiveness of a multidisciplinary quality-improvement (QI) initiative. A QI project using the "Plan-Do-Study-Act" (PDSA) cycle was implemented to assess MLBs performed on pediatric patients in a tertiary academic children's hospital. Forty MLBs were audited using a QI evaluation tool containing 144 fields. Each MLB was evaluated for flow, communication, and timing. Opportunities for improvement were identified. Subsequently, QI interventions were implemented in an iterative cycle, and 66 MLBs were audited after the intervention. Specific QI interventions addressed issues of personnel frequently exiting the operating room (OR) and poor preoperative preparation, identified during QI audit as areas for improvement. Interventions included (1) conducting "huddles" between surgeon and OR staff to discuss needed equipment; (2) implementing improvements to surgeon case ordering and preference cards review; (3) posting an OR door sign to limit traffic during airway procedures; and (4) discouraging personnel breaks during airway procedures. Operating room exiting behavior of OR personnel, preoperative preparation, and case timing were assessed and compared before and after the QI intervention. Personnel exiting the OR during the MLB was identified as a preintervention issue, with the surgical technologist, circulator, or surgeon exiting the room in 55% of cases (n = 22). The surgical technologist and circulator left the room to retrieve equipment in 40% of cases (n = 16), which indicated the need for increased preoperative preparation to improve case timing and operative flow. The QI interventions implemented to address these concerns included education

  9. IDENTIFYING PERFORMANCE ASSURANCE CHALLENGES FOR SMART MANUFACTURING.

    PubMed

    Helu, Moneer; Morris, Katherine; Jung, Kiwook; Lyons, Kevin; Leong, Swee

    2015-10-01

    Smart manufacturing has the potential to address many of the challenges faced by industry. However, the manufacturing community often needs assistance to leverage available technologies to improve their systems. To assure the performance of these technologies, this paper proposes a shared knowledge base that collects problem areas, solutions, and best practices for manufacturing technology. An Implementation Risk Assessment Framework (IRAF) is also described to identify the primary weaknesses of technologies in specific manufacturing contexts. Such approaches have the potential to stimulate new ideas and drive standardization activities critical to scale up and deploy smart manufacturing technologies successfully and quickly.

  10. IDENTIFYING PERFORMANCE ASSURANCE CHALLENGES FOR SMART MANUFACTURING

    PubMed Central

    Helu, Moneer; Morris, Katherine; Jung, Kiwook; Lyons, Kevin; Leong, Swee

    2015-01-01

    Smart manufacturing has the potential to address many of the challenges faced by industry. However, the manufacturing community often needs assistance to leverage available technologies to improve their systems. To assure the performance of these technologies, this paper proposes a shared knowledge base that collects problem areas, solutions, and best practices for manufacturing technology. An Implementation Risk Assessment Framework (IRAF) is also described to identify the primary weaknesses of technologies in specific manufacturing contexts. Such approaches have the potential to stimulate new ideas and drive standardization activities critical to scale up and deploy smart manufacturing technologies successfully and quickly. PMID:26783512

  11. The benefits of improved national elevation data

    USGS Publications Warehouse

    Snyder, Gregory I.

    2013-01-01

    This article describes how the National Enhanced Elevation Assessment (NEEA) has identified substantial benefits that could come about if improved elevation data were publicly available for current and emerging applications and business uses such as renewable energy, precision agriculture, and intelligent vehicle navigation and safety. In order to support these diverse needs, new national elevation data with higher resolution and accuracy are needed. The 3D Elevation Program (3DEP) initiative was developed to meet the majority of these needs and it is expected that 3DEP will result in new, unimagined information services that would result in job growth and the transformation of the geospatial community. Private-sector data collection companies are continuously evolving sensors and positioning technologies that are needed to collect improved elevation data. An initiative of this scope might also provide an opportunity for companies to improve their capabilities and produce even higher data quality and consistency at a pace that might not have otherwise occurred.

  12. The Rural Wings Project: Bridging the Digital Divide with Satellite-Provided Internet. Phase I--Identifying and Analysing the Learning Needs of 31 Communities in 10 Countries

    ERIC Educational Resources Information Center

    Hansson, Henrik; Mihailidis, Paul; Larsson, Ken; Sotiriou, Menelaos; Sotiriou, Sofoklis; Uzunoglu, Nikolaos; Gargalakos, Michail

    2007-01-01

    The digitally marginalised communities are in focus in the EU-funded Rural Wings project 2006-2008. The aim is to identify and analyse the user learning needs in non-connected communities and to meet these needs by providing satellite Internet broadband connections, education and tools. This article reports the findings of the user needs…

  13. Optimizing the User Experience: Identifying Opportunities to Improve Use of an Inpatient Portal.

    PubMed

    Walker, Daniel M; Menser, Terri; Yen, Po-Yin; McAlearney, Ann Scheck

    2018-01-01

    Patient portals specifically designed for the inpatient setting have significant potential to improve patient care. However, little is known about how the users of this technology, the patients, may interact with the inpatient portals. As a result, hospitals have limited ability to design approaches that support patient use of the portal. This study aims to evaluate the user experience associated with an inpatient portal. We used a Think-Aloud protocol to study user interactions with a commercially available inpatient portal-MyChart Bedside (MCB). Study participants included 19 English-speaking adults over the age of 18 years. In one-on-one sessions, participants narrated their experience using the MCB application and completing eight specific tasks. Recordings were transcribed and coded into three dimensions of the user experience: physical, cognitive, and sociobehavioral. Our analysis of the physical experience highlighted the navigational errors and technical challenges associated with the use of MCB. We also found that issues associated with the cognitive experience included comprehension problems that spurred anxiety and uncertainty. Analysis of the sociobehavioral experience suggested that users have different learning styles and preferences for learning including self-guided, handouts, and in-person training. Inpatient portals may be an effective tool to improve the patient experience in the hospital. Moreover, making this technology available to inpatients may help to foster ongoing use of technology across the care continuum. However, deriving the benefits from the technology requires appropriate support. We identified multiple opportunities for hospital management to intervene. In particular, teaching patients to use the application by making a variety of instructional materials available could help to reduce several identified barriers to use. Additionally, hospitals should be prepared to manage patient anxiety and increased questioning arising from the

  14. The Daily Readiness Huddle: a process to rapidly identify issues and foster improvement through problem-solving accountability.

    PubMed

    Donnelly, Lane F; Cherian, Shirley S; Chua, Kimberly B; Thankachan, Sam; Millecker, Laura A; Koroll, Alex G; Bisset, George S

    2017-01-01

    Because of the increasing complexities of providing imaging for pediatric health care services, a more reliable process to manage the daily delivery of care is necessary. Objective We describe our Daily Readiness Huddle and the effects of the process on problem identification and improvement. Our Daily Readiness Huddle has four elements: metrics review, clinical volume review, daily readiness assessment, and problem accountability. It is attended by radiologists, directors, managers, front-line staff with concerns, representatives from support services (information technology [IT] and biomedical engineering [biomed]), and representatives who join the meeting in a virtual format from off-site locations. Data are visually displayed on erasable whiteboards. The daily readiness assessment uses queues to determine whether anyone has concerns or outlier data in regard to S-MESA (Safety, Methods, Equipment, Supplies or Associates). Through this assessment, problems are identified and categorized as quick hits (will be resolved in 24-48 h, not requiring project management) and complex issues. Complex issues are assigned an owner, quality coach and report-back date. Additionally, projects are defined as improvements that are often strategic, are anticipated to take more than 60 days, and do not necessarily arise out of identified issues during the Daily Readiness Huddle. We tracked and calculated the mean, median and range of days to resolution and completion for complex issues and for projects during the first full year of implementing this process. During the first 12 months, 91 complex issues were identified and resolved, 11 projects were in progress and 33 completed, with 23 other projects active or in planning. Time to resolution of complex issues (in days) was mean 37.5, median 34.0, and range 1-105. For projects, time to completion (in days) was mean 86.0, median 84.0, and range 5-280. The Daily Readiness Huddle process has given us a framework to rapidly identify

  15. The Need for Comprehensive Health Care Quality Measures for Older Adults.

    PubMed

    MacLeod, Stephanie; Schwebke, Kay; Hawkins, Kevin; Ruiz, Joann; Hoo, Emma; Yeh, Charlotte S

    2017-10-24

    Research indicates that older adults receive only about half of their recommended care, with varying quality and limited attention to social issues impacting their health through the most commonly used quality measures. Additionally, many existing measures neglect to address nonclinical social determinants of health. Evidence of the need for more comprehensive measures for seniors is growing. The primary purpose of this article, which is supported by a limited review of literature, is to describe gaps among current quality measures in addressing certain nonclinical needs of older adults, including key social determinants of health. In doing so, the authors describe their position on the need for expanded measures to incorporate these factors to improve care and quality of life. The authors conducted a limited review of the literature to inform this article, focusing specifically on selected measures for older adults rather than a broader systematic review of all measures. Most research identified was related to clinical practice guidelines rather than quality measures of care as applied to older adults. Furthermore, the literature reviewed reflected limited evidence of efforts to tailor quality measures for the unique social needs of older adults, confirming a potential gap in this area. A growing need exists for improved quality measures specifically designed to help providers address the unique social needs of older adults. Filling this gap will improve overall understanding of seniors and help them to achieve optimal health and successful aging.

  16. Improving Care for Children With Complex Needs

    ClinicalTrials.gov

    2017-10-10

    Medically Complex Children; Care Coordination; Case Manager; Care Manager; Collaborative Care; Disease Management; Patient Care Team or Organization; Managed Care; Children With Chronic Conditions; Children With Special Health Care Needs; Shared Care Plan; Patient Care Plan; Health Care and Resource Utilization; Adherence to Care; Functional Status and Productivity; Health Related Quality of Life; Satisfaction With Care; Care Coordinator; Family Experience of Care; Quality Health Care

  17. Progress in Space Weather Modeling and Observations Needed to Improve the Operational NAIRAS Model Aircraft Radiation Exposure Predictions

    NASA Astrophysics Data System (ADS)

    Mertens, C. J.; Kress, B. T.; Wiltberger, M. J.; Tobiska, W.; Xu, X.

    2011-12-01

    The Nowcast of Atmospheric Ionizing Radiation for Aviation Safety (NAIRAS) is a prototype operational model for predicting commercial aircraft radiation exposure from galactic and solar cosmic rays. NAIRAS predictions are currently streaming live from the project's public website, and the exposure rate nowcast is also available on the SpaceWx smartphone app for iPhone, IPad, and Android. Cosmic rays are the primary source of human exposure to high linear energy transfer radiation at aircraft altitudes, which increases the risk of cancer and other adverse health effects. Thus, the NAIRAS model addresses an important national need with broad societal, public health and economic benefits. The processes responsible for the variability in the solar wind, interplanetary magnetic field, solar energetic particle spectrum, and the dynamical response of the magnetosphere to these space environment inputs, strongly influence the composition and energy distribution of the atmospheric ionizing radiation field. During the development of the NAIRAS model, new science questions were identified that must be addressed in order to obtain a more reliable and robust operational model of atmospheric radiation exposure. Addressing these science questions require improvements in both space weather modeling and observations. The focus of this talk is to present these science questions, the proposed methodologies for addressing these science questions, and the anticipated improvements to the operational predictions of atmospheric radiation exposure. The overarching goal of this work is to provide a decision support tool for the aviation industry that will enable an optimal balance to be achieved between minimizing health risks to passengers and aircrew while simultaneously minimizing costs to the airline companies.

  18. Web-Based Learning Environment Based on Students’ Needs

    NASA Astrophysics Data System (ADS)

    Hamzah, N.; Ariffin, A.; Hamid, H.

    2017-08-01

    Traditional learning needs to be improved since it does not involve active learning among students. Therefore, in the twenty-first century, the development of internet technology in the learning environment has become the main needs of each student. One of the learning environments to meet the needs of the teaching and learning process is a web-based learning environment. This study aims to identify the characteristics of a web-based learning environment that supports students’ learning needs. The study involved 542 students from fifteen faculties in a public higher education institution in Malaysia. A quantitative method was used to collect the data via a questionnaire survey by randomly. The findings indicate that the characteristics of a web-based learning environment that support students’ needs in the process of learning are online discussion forum, lecture notes, assignments, portfolio, and chat. In conclusion, the students overwhelmingly agreed that online discussion forum is the highest requirement because the tool can provide a space for students and teachers to share knowledge and experiences related to teaching and learning.

  19. Multiple Behavior Change Intervention to Improve Detection of Unmet Social Needs and Resulting Resource Referrals.

    PubMed

    Colvin, Jeffrey D; Bettenhausen, Jessica L; Anderson-Carpenter, Kaston D; Collie-Akers, Vicki; Plencner, Laura; Krager, Molly; Nelson, Brooke; Donnelly, Sara; Simmons, Julia; Higinio, Valeria; Chung, Paul J

    2016-03-01

    It is critical that pediatric residents learn to effectively screen families for active and addressable social needs (ie, negative social determinants of health). We sought to determine 1) whether a brief intervention teaching residents about IHELP, a social needs screening tool, could improve resident screening, and 2) how accurately IHELP could detect needs in the inpatient setting. During an 18-month period, interns rotating on 1 of 2 otherwise identical inpatient general pediatrics teams were trained in IHELP. Interns on the other team served as the comparison group. Every admission history and physical examination (H&P) was reviewed for IHELP screening. Social work evaluations were used to establish the sensitivity and specificity of IHELP and document resources provided to families with active needs. During a 21-month postintervention period, every third H&P was reviewed to determine median duration of continued IHELP use. A total of 619 admissions met inclusion criteria. Over 80% of intervention team H&Ps documented use of IHELP. The percentage of social work consults was nearly 3 times greater on the intervention team than on the comparison team (P < .001). Among H&Ps with documented use of IHELP, specificity was 0.96 (95% confidence interval 0.87-0.99) and sensitivity was 0.63 (95% confidence interval 0.50-0.73). Social work provided resources for 78% of positively screened families. The median duration of screening use by residents after the intervention was 8.1 months (interquartile range 1-10 months). A brief intervention increased resident screening and detection of social needs, leading to important referrals to address those needs. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  20. Multiple Behavior Change Intervention to Improve Detection of Unmet Social Needs and Resulting Resource Referrals

    PubMed Central

    Colvin, Jeffrey D.; Bettenhausen, Jessica L.; Anderson-Carpenter, Kaston D.; Collie-Akers, Vicki; Plencner, Laura; Krager, Molly; Nelson, Brooke; Donnelly, Sara; Simmons, Julia; Higinio, Valeria; Chung, Paul J.

    2015-01-01

    Objective It is critical that pediatric residents learn to effectively screen families for active and addressable social needs (i.e., negative social determinants of health.) We sought to determine 1) whether a brief intervention teaching residents about IHELP, a social needs screening tool, could improve resident screening, and 2) how accurately IHELP could detect needs in the inpatient setting. Methods During an 18-month period, interns rotating on one of two otherwise identical inpatient general pediatrics teams were trained in IHELP. Interns on the other team served as the comparison group. Every admission history and physical (H&P) was reviewed for IHELP screening. Social work evaluations were used to establish the sensitivity and specificity of IHELP and document resources provided to families with active needs. During a 21-month post-intervention period, every third H&P was reviewed to determine median duration of continued IHELP use. Results 619 admissions met inclusion criteria. Over 80% of intervention team H&Ps documented use of IHELP. The percentage of social work consults was nearly 3 times greater on the intervention team than on the comparison team (P<0.001). Among H&Ps with documented use of IHELP, specificity was 0.96 (95% CI 0.87–0.99) and sensitivity was 0.63 (95% CI 0.50–0.73). Social work provided resources for 78% of positively screened families. The median duration of screening use by residents after the intervention was 8.1 months (IQR 1–10 months) Conclusions A brief intervention increased resident screening and detection of social needs, leading to important referrals to address those needs. PMID:26183003

  1. HIV Prevention Among Diverse Young MSM: Research Needs, Priorities, and Opportunities.

    PubMed

    Rhodes, Scott D; Wong, Frank Y

    2016-06-01

    There remains a profound need for innovative and effective interventions designed for young men who have sex with men (YMSM) generally, and racial and ethnic minority YMSM, YMSM living in rural communities, and low-income YMSM, particularly, to prevent HIV and improve health outcomes in the United States. This introduction to this theme issue, "Behavioral HIV Prevention Interventions for Diverse YMSM," of AIDS Education and Prevention identifies some of the research needs, priorities, and opportunities that emerged during a seminal NIMHD-sponsored workshop on HIV prevention behavioral interventions for diverse YMSM. It provides researchers, practitioners, and federal partners guidance in next steps to reduce the impact of the HIV epidemic among YMSM. The needs, priorities, and opportunities identified serve as a foundation to push both the science and the practice of HIV prevention forward. We recognize that considerably more research is needed, and this issue highlights intervention research-where we have been and where we should go. With the disparities faced by YMSM, we must act rapidly to do the work it will take to meet their prevention needs, reduce infections, and save lives.

  2. Stakeholder-led science: engaging resource managers to identify science needs for long-term management of floodplain conservation lands

    USGS Publications Warehouse

    Bouska, Kristin L.; Lindner, Garth; Paukert, Craig P.; Jacobson, Robert B.

    2016-01-01

    Floodplains pose challenges to managers of conservation lands because of constantly changing interactions with their rivers. Although scientific knowledge and understanding of the dynamics and drivers of river-floodplain systems can provide guidance to floodplain managers, the scientific process often occurs in isolation from management. Further, communication barriers between scientists and managers can be obstacles to appropriate application of scientific knowledge. With the coproduction of science in mind, our objectives were the following: (1) to document management priorities of floodplain conservation lands, and (2) identify science needs required to better manage the identified management priorities under nonstationary conditions, i.e., climate change, through stakeholder queries and interactions. We conducted an online survey with 80 resource managers of floodplain conservation lands along the Upper and Middle Mississippi River and Lower Missouri River, USA, to evaluate management priority, management intensity, and available scientific information for management objectives and conservation targets. Management objectives with the least information available relative to priority included controlling invasive species, maintaining respectful relationships with neighbors, and managing native, nongame species. Conservation targets with the least information available to manage relative to management priority included pollinators, marsh birds, reptiles, and shore birds. A follow-up workshop and survey focused on clarifying science needs to achieve management objectives under nonstationary conditions. Managers agreed that metrics of inundation, including depth and extent of inundation, and frequency, duration, and timing of inundation would be the most useful metrics for management of floodplain conservation lands with multiple objectives. This assessment provides guidance for developing relevant and accessible science products to inform management of highly

  3. Identifying elements of job satisfaction to improve retention rates in healthcare.

    PubMed

    Lamberth, Becky; Comello, Robert J

    2005-01-01

    According to the American Hospital Association, by the year 2010, the United States will need 1,000,000 qualified nurses to care for patients, an additional 75,000 licensed radiologic technologists, and several other ancillary medical staff employees. A number of health professionals question why there is such a significant shortage--especially considering that many facilities; are implementing cost initiatives and insurance companies are decreasing the length of patient hospital stays. One specific factor may not be fully appreciated: Although the length of stay is decreasing,the acuity level of the patient is increasing. The number and types of available opportunities also contribute to the staffing shortage. Hospitals and healthcare facilities are now working diligently to address the crisis and answer that one very important question: How can they keep employees satisfied and willing commit long-term to the organization? This review focuses on identifying those key variables of job satisfaction that will lead to long-term retention of healthcare workers, including money, work environment, performance feedback, advancement opportunities, group cohesion, and relationships with management. It also discusses the effects of demographic characteristics such as age and gender on job satisfaction.

  4. Improving access to supportive cancer care through an eHealth application: a qualitative needs assessment among cancer survivors.

    PubMed

    Lubberding, Sanne; van Uden-Kraan, Cornelia F; Te Velde, Elisabeth A; Cuijpers, Pim; Leemans, C René; Verdonck-de Leeuw, Irma M

    2015-05-01

    To gain insight into cancer survivors' needs towards an eHealth application monitoring quality of life and targeting personalised access to supportive care. Supportive care in cancer addresses survivors' concerns and needs. However, many survivors are not taking advantage of supportive care provided. To enable cancer survivors to benefit, survivors' needs must be identified timely and effectively. An eHealth application could be a solution to meet patients' individual supportive care needs. A qualitative approach. Thirty cancer survivors (15 head and neck and 15 breast cancer survivors) participated. The majority were female (n = 20·67%). The mean age was 60 (SD 8·8) years. Mean time interval since treatment was 13·5 months (SD 10·5). All interviews were audio-recorded and transcribed verbatim. During the interviews, participants were asked about their unmet needs during follow-up care and a potential eHealth application. Data were analyzed independently by two coders and coded into key issues and themes. Cancer survivors commented that they felt unprepared for the post-treatment period and that their symptoms often remained unknown to care providers. Survivors also mentioned a suboptimal referral pattern to supportive care services. Mentioned advantages of an eHealth application were as follows: insight into the course of symptoms by monitoring, availability of information among follow-up appointments, receiving personalised advice and tailored supportive care. Cancer survivors identified several unmet needs during follow-up care. Most survivors were positive towards the proposed eHealth application and expressed that it could be a valuable addition to follow-up cancer care. Study results provide care providers with insight into barriers that impede survivors from obtaining optimal supportive care. This study also provides insight into the characteristics needed to design, build and implement an eHealth application targeting personalised access to supportive

  5. Identifying critical steps towards improved access to innovation in cancer care: a European CanCer Organisation position paper.

    PubMed

    Aapro, Matti; Astier, Alain; Audisio, Riccardo; Banks, Ian; Bedossa, Pierre; Brain, Etienne; Cameron, David; Casali, Paolo; Chiti, Arturo; De Mattos-Arruda, Leticia; Kelly, Daniel; Lacombe, Denis; Nilsson, Per J; Piccart, Martine; Poortmans, Philip; Riklund, Katrine; Saeter, Gunnar; Schrappe, Martin; Soffietti, Riccardo; Travado, Luzia; van Poppel, Hein; Wait, Suzanne; Naredi, Peter

    2017-09-01

    In recent decades cancer care has seen improvements in the speed and accuracy of diagnostic procedures; the effectiveness of surgery, radiation therapy and medical treatments; the power of information technology; and the development of multidisciplinary, specialist-led approaches to care. Such innovations are essential if we are to continue improving the lives of cancer patients across Europe despite financial pressures on our healthcare systems. Investment in innovation must be balanced with the need to ensure the sustainability of healthcare budgets, and all health professionals have a responsibility to help achieve this balance. It requires scrutiny of the way care is delivered; we must be ready to discontinue practices or interventions that are inefficient, and prioritise innovations that may deliver the best outcomes possible for patients within the limits of available resources. Decisions on innovations should take into account their long-term impact on patient outcomes and costs, not just their immediate costs. Adopting a culture of innovation requires a multidisciplinary team approach, with the patient at the centre and an integral part of the team. It must take a whole-system and whole-patient perspective on cancer care and be guided by high-quality real-world data, including outcomes relevant to the patient and actual costs of care; this accurately reflects the impact of any innovation in clinical practice. The European CanCer Organisation is committed to working with its member societies, patient organisations and the cancer community at large to find sustainable ways to identify and integrate the most meaningful innovations into all aspects of cancer care. Copyright © 2017. Published by Elsevier Ltd.

  6. Role of educational institutions in identifying and responding to emerging health human resources needs.

    PubMed

    Tzountzouris, John-Paul; Gilbert, John H V

    2009-01-01

    The healthcare system continues to evolve, requiring innovation to promote patient-centred, fiscally responsible healthcare delivery. This evolution includes changes to the skills and competencies required of the health human resources (HHR), both regulated and unregulated, who are central supports to healthcare delivery. This has become a priority agenda item at the international, national, provincial, regional and local levels. This paper describes the system factors that drive the emergence of HHR skill and competency needs, and explores the roles of various institutions in the identification of and response to HHR needs. Educational institutions play an important role in responding to emerging HHR needs. Their actual response to HHR skill and competency needs will ultimately depend on the risk posed to the organizations of either addressing, or not addressing, these needs. These decisions are complex and are balanced against strategic, operational and educational risks, benefits and realities within each given educational institution. Educational institutions - through their linkages with the workplace, industry, professional organizations and government - have a unique view and understanding of many facets of the complexity of HHR planning. This paper proposes that educational institutions play a pivotal role as levers in a more coordinated response to emerging HHR needs and, as such, should be intimately involved in comprehensive HHR planning.

  7. On Adopting Solutions to Improve Population Health: Do We Have the Political Will?

    ERIC Educational Resources Information Center

    Galea, Sandro

    2016-01-01

    In this column, Sandro Galea addresses what would be required to identify and implement solutions that can improve the health of populations. Galea suggests that two perspectives need to inform solutions that might prove successful. First, solutions that aim to improve the health of populations need to be grounded in clarity of purpose, aiming to…

  8. The quality improvement strategy.

    PubMed

    Burns, L R; Beach, L R

    1994-01-01

    To prepare for managed competition, many hospitals now focus on service quality as a means to improve their competitive position. To aid in decisions about where best to direct limited resources, managers need physician feedback about how the hospital's services compare with its competitors' services (competitive advantage) and about the degree to which the hospital's services fall short of, meet, or exceed physicians' expectations (customer satisfaction). This article describes a strategy for acquiring information about competitive advantage and customer satisfaction and for using the information to identify optimal service improvement opportunities. It then presents a step-by-step application of the Quality Improvement Strategy (QIS) for a large urban hospital.

  9. Family needs after brain injury: A cross cultural study.

    PubMed

    Norup, Anne; Perrin, Paul B; Cuberos-Urbano, Gustavo; Anke, Audny; Andelic, Nada; Doyle, Sarah T; Cristina Quijano, Maria; Caracuel, Alfonso; Mar, Dulce; Guadalupe Espinosa Jove, Irma; Carlos Arango-Lasprilla, Juan

    2015-01-01

    The objective of this study was to explore differences by country in the importance of family needs after traumatic brain injury (TBI), as well as differences in met/unmet needs. Two hundred and seventy-one family members of an individual with TBI in Mexico, Colombia, Spain, Denmark, and Norway completed the Family Needs Questionnaire. Eight of the ten needs rated as most important globally were from the Health Information subscale. Importance ratings on the Health Information, Professional Support, and Involvement With Care subscales were similar across countries, but Mexican family members rated Instrumental Support needs as less important than Colombian, Spanish, and Danish family members, and also rated their Community Support needs as less important than Danish and Spanish family members. Mexican family member's rated emotional support needs as less important than Colombian, Spanish, and Danish family members. Globally, the needs rated as most often met were from the Health Information subscale, and the most unmet needs were from the Emotional Support subscale. Despite some similarities across countries several differences were identified, and these can help professionals to provide more culturally appropriate rehabilitation services for family members in order to improve informal care for TBI.

  10. Identifying Unmet Treatment Needs for Patients With Osteoporotic Fracture: Feasibility Study for an Electronic Clinical Surveillance System

    PubMed Central

    Shang, Rung Ji; Hsiao, Fei-Yuan; Lin, Mei-Shu; Hung, Kuan-Yu; Wang, Jui; Lin, Zhen-Fang; Lai, Feipei; Shen, Li-Jiuan

    2018-01-01

    Background Traditional clinical surveillance relied on the results from clinical trials and observational studies of administrative databases. However, these studies not only required many valuable resources but also faced a very long time lag. Objective This study aimed to illustrate a practical application of the National Taiwan University Hospital Clinical Surveillance System (NCSS) in the identification of patients with an osteoporotic fracture and to provide a high reusability infrastructure for longitudinal clinical data. Methods The NCSS integrates electronic medical records in the National Taiwan University Hospital (NTUH) with a data warehouse and is equipped with a user-friendly interface. The NCSS was developed using professional insight from multidisciplinary experts, including clinical practitioners, epidemiologists, and biomedical engineers. The practical example identifying the unmet treatment needs for patients encountering major osteoporotic fractures described herein was mainly achieved by adopting the computerized workflow in the NCSS. Results We developed the infrastructure of the NCSS, including an integrated data warehouse and an automatic surveillance workflow. By applying the NCSS, we efficiently identified 2193 patients who were newly diagnosed with a hip or vertebral fracture between 2010 and 2014 at NTUH. By adopting the filter function, we identified 1808 (1808/2193, 82.44%) patients who continued their follow-up at NTUH, and 464 (464/2193, 21.16%) patients who were prescribed anti-osteoporosis medications, within 3 and 12 months post the index date of their fracture, respectively. Conclusions The NCSS systems can integrate the workflow of cohort identification to accelerate the survey process of clinically relevant problems and provide decision support in the daily practice of clinical physicians, thereby making the benefit of evidence-based medicine a reality. PMID:29691201

  11. Defense Logistics Agency Disposition Services Needs to Improve Demilitarization Program Self-Assessment Evaluations - Redacted

    DTIC Science & Technology

    2016-12-20

    Program Self -Assessment Evaluations I N T E G R I T Y  E F F I C I E N C Y  A C C O U N T A B I L I T Y  E X C E L L E N C E Mission Our mission...Project No. D2016-D000RD-0057.000) │ i Results in Brief Defense Logistics Agency Disposition Services Needs to Improve Demilitarization Program Self ...mutilation contractor3 in Holbrook, New York, the two sites we visited. However, for self -assessment evaluations4 at three DLA Centralized

  12. DOD Manufacturing Arsenals: Actions Needed to Identify and Sustain Critical Capabilities

    DTIC Science & Technology

    2015-11-01

    to each develop their own unique method. A senior OSD official described the resulting process as unsound . Each manufacturing arsenal declared what...Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing instructions...searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments

  13. Identifying specific beliefs to target to improve restaurant employees' intentions for performing three important food safety behaviors.

    PubMed

    Pilling, Valerie K; Brannon, Laura A; Shanklin, Carol W; Howells, Amber D; Roberts, Kevin R

    2008-06-01

    Current national food safety training programs appear ineffective at improving food safety practices in foodservice operations, given the substantial number of Americans affected by foodborne illnesses after eating in restaurants each year. The Theory of Planned Behavior (TpB) was used to identify important beliefs that may be targeted to improve foodservice employees' intentions for three food safety behaviors that have the most substantial affect on public health: hand washing, using thermometers, and proper handling of food contact surfaces. In a cross-sectional design, foodservice employees (n=190) across three midwestern states completed a survey assessing TpB components and knowledge for the three food safety behaviors. Multiple regression analyses were performed on the TpB components for each behavior. Independent-samples t tests identified TpB beliefs that discriminated between participants who absolutely intend to perform the behaviors and those with lower intention. Employees' attitudes were the one consistent predictor of intentions for performing all three behaviors. However, a unique combination of important predictors existed for each separate behavior. Interventions for improving employees' behavioral intentions for food safety should focus on TpB components that predict intentions for each behavior and should bring all employees' beliefs in line with those of the employees who already intend to perform the food safety behaviors. Registered dietitians; dietetic technicians, registered; and foodservice managers can use these results to enhance training sessions and motivational programs to improve employees' food safety behaviors. Results also assist these professionals in recognizing their responsibility for enforcing and providing adequate resources for proper food safety behaviors.

  14. The psychosocial needs of breast cancer survivors; a qualitative study of the shared and unique needs of younger versus older survivors.

    PubMed

    Thewes, B; Butow, P; Girgis, A; Pendlebury, S

    2004-03-01

    Due to improvements in medical treatment and survival following breast cancer, researchers have turned their attention to investigating the needs of breast cancer survivors. There is disagreement about the extent to which survivors continue to experience psychological morbidity after treatment ends. Whilst the majority of women adjust well to breast cancer, some may have continued psychosocial needs. Available research suggests that younger pre-menopausal women are at increased risk of psychological morbidity following breast cancer. The present study aimed to gather preliminary qualitative data on the psychosocial needs of breast cancer survivors and to identify the shared and unique needs of younger versus older survivors. A qualitative methodology was chosen as this was a relatively unexplored area of enquiry. Patients treated for early-stage breast cancer who had completed their hospital-based treatment 6-24 months prior to participation were recruited. Sampling was discontinued when informational redundancy was achieved. Eighteen telephone interviews were conducted. A wide variety of on-going psychosocial and information needs were reported by breast cancer survivors including support needs, psychological needs, practical needs, physical needs and information needs. Younger women reported more needs than their older counterparts. Several needs reported by younger women were directly related to being of younger age or pre-menopausal at the time of diagnosis. Clinical implications are discussed. Copyright 2003 John Wiley & Sons, Ltd.

  15. How Northwest Region States Are Supporting Schools in Need of Improvement. Issues & Answers. REL 2007-No. 009

    ERIC Educational Resources Information Center

    Davis, Deborah; Krasnoff, Basha; Moilanen, Carolyn; Sather, Susan; Kushman, James

    2007-01-01

    This study examines the systems of technical assistance and support that Northwest Region states implemented during 2005-2006 for schools in need of improvement. By highlighting key characteristics and differences among state systems, the intent is to stimulate an analysis of what states can do and what issues they might address to move schools…

  16. School Improvement Plans and Student Learning in Jamaica

    ERIC Educational Resources Information Center

    Lockheed, Marlaine; Harris, Abigail; Jayasundera, Tamara

    2010-01-01

    A school improvement program that provided support to poor-performing schools on the basis of needs identified in a school improvement plan was implemented in 72 government schools in Jamaica, from 1998 to 2005. In this independent evaluation of the program, we use propensity score matching to create, post hoc, a control group of schools that were…

  17. A Survey on Dementia Training Needs among Staff at Community-Based Outpatient Clinics

    ERIC Educational Resources Information Center

    Adler, Geri; Lawrence, Briana M.; Ounpraseuth, Songthip T.; Asghar-Ali, Ali Abbas

    2015-01-01

    Dementia is a major public health concern. Educating health-care providers about dementia warning signs, diagnosis, and management is paramount to fostering clinical competence and improving patient outcomes. The objective of this project was to describe and identify educational and training needs of staff at community-based outpatient clinics…

  18. Researching the Influence of Teaching Assistants on the Learning of Pupils Identified with Special Educational Needs in Mainstream Primary Schools: Exploring Social Inclusion

    ERIC Educational Resources Information Center

    Saddler, Helen

    2014-01-01

    As a result of their high contact time with children, particularly children identified with special educational needs, it is widely acknowledged that teaching assistants (TAs) have great influence on pupils' education (Balshaw). However, recent research into the impact of TAs on pupils' learning has questioned TAs' usefulness in…

  19. Decrease in unmet needs contributes to improved motivation for treatment in elderly patients with severe mental illness.

    PubMed

    Stobbe, Jolanda; Wierdsma, André I; Kok, Rob M; Kroon, Hans; Depla, Marja; Mulder, Cornelis L

    2015-01-01

    To investigate the pattern of associations between changes in unmet needs and treatment motivation in elderly patients with severe mental illness. Observational longitudinal study in 70 patients treated by an assertive community treatment team for the elderly. Unmet needs and motivation for treatment were measured using the Camberwell assessment of needs for the elderly and the stages-of-change (SoC) scale, respectively, at baseline, after 9 and 18 months. SoC scores were dichotomized into two categories: motivated and unmotivated. Multinomial logistic regression analyses were conducted to determine whether changes in motivation were parallel to or preceded changes in unmet needs. The number of patients who were not motivated for treatment decreased over time (at baseline 71.4 % was not motivated, at the second measurement 51.4 %, and at 18 months 31.4 % of the patients were not motivated for treatment). A decrease in unmet needs, both from 0-9 to 0-18 months was associated with remaining motivated or a change from unmotivated to becoming motivated during the same observational period (parallel associations). A decrease in unmet needs from 0 to 9 months was also associated with remaining motivated or a change from unmotivated to motivated during the 9-18 months follow-up (sequential associations). Our findings suggest that a decrease in unmet needs is associated with improvements in motivation for treatment.

  20. An LCA researcher's wish list--data and emission models needed to improve LCA studies of animal production.

    PubMed

    Cederberg, C; Henriksson, M; Berglund, M

    2013-06-01

    The last decade has seen an increase in environmental systems analysis of livestock production, resulting in a significant number of studies with a holistic approach often based on life-cycle assessment (LCA) methodology. The growing public interest in global warming has added to this development; guidelines for carbon footprint (CF) accounting have been developed, including for greenhouse gas (GHG) accounting of animal products. Here we give an overview of methods for estimating GHG emissions, with emphasis on nitrous oxide, methane and carbon from land use change, presently used in LCA/CF studies of animal products. We discuss where methods and data availability for GHGs and nitrogen (N) compounds most urgently need to be improved in order to produce more accurate environmental assessments of livestock production. We conclude that the top priority is to improve models for N fluxes and emissions from soils and to implement soil carbon change models in LCA/CF studies of animal products. We also point at the need for more farm data and studies measuring emissions from soils, manure and livestock in developing countries.

  1. Business continuity, emergency planning and special needs: How to protect the vulnerable.

    PubMed

    Reilly, Daniel

    2015-01-01

    Emergencies and disasters affect all segments of the population. Some segments are more at risk during the emergency response and recovery efforts owing to vulnerabilities that increase the risk of harm. These vulnerabilities are due to individuals' disabilities, which must be incorporated into emergency and business continuity planning. Some disabilities are obvious, such as impaired vision, hearing or mobility, while other are less evident, but equally disabling, such as cognitive disorders, geographical or language isolation, and numerous age-related factors. Taken together when creating emergency or business continuity plans, the issues identified as disabilities can be grouped by functionality and termed as special needs. This paper will detail the identification of special needs populations, explain how these persons are vulnerable during the emergency or disaster response and recovery process, and provide examples of how to partner with individuals within identified special needs populations to improve the planning process.

  2. A survey of nurses' perceived competence and educational needs in performing resuscitation.

    PubMed

    Roh, Young Sook; Issenberg, S Barry; Chung, Hyun Soo; Kim, So Sun; Lim, Tae Ho

    2013-05-01

    Effective training is needed for high-quality performance of staff nurses, who are often the first responders in initiating resuscitation. There is insufficient evidence to identify specific educational strategies that improve outcomes, including early recognition and rescue of the critical patient. This study was conducted to identify perceived competence and educational needs as well as to examine factors influencing perceived competence in resuscitation among staff nurses to build a resuscitation training curriculum. A convenience sample of 502 staff nurses was recruited from 11 hospitals in a single city. Staff nurses were asked to complete a self-administered questionnaire. On a five-point scale, chest compression was the lowest-rated technical skill (M = 3.33, SD = 0.80), whereas staying calm and focusing on required tasks was the lowest-rated non-technical skill (M = 3.30, SD = 0.80). Work duration, the usefulness of simulation, recent code experience, and recent simulation-based training were significant factors in perceived competence, F(4, 496) = 45.94, p < .001. Simulation-based resuscitation training was the most preferred training modality, and cardiac arrest was the most preferred training topic. Based on this needs assessment, a simulation-based resuscitation training curriculum with cardiac arrest scenarios is suggested to improve the resuscitation skills of staff nurses. Copyright 2013, SLACK Incorporated.

  3. Identifying traffic safety needs - a systematic approach : research report and user manual.

    DOT National Transportation Integrated Search

    2012-01-01

    The Indiana Department of Transportation (INDOT) manages road safety in Indiana through safety emphasis areas, identification of : safety needs within these areas, and development and implementation of transportation interventions that address the sa...

  4. Do we need to overcome barriers to learning in the workplace for foundation trainees rotating in neurosurgery in order to improve training satisfaction?

    PubMed

    Phan, Pho Nh; Patel, Keyur; Bhavsar, Amar; Acharya, Vikas

    2016-01-01

    Junior doctors go through a challenging transition upon qualification; this repeats every time they start a rotation in a new department. Foundation level doctors (first 2 years postqualification) in neurosurgery are often new to the specialty and face various challenges that may result in significant workplace dissatisfaction. The neurosurgical environment is a clinically demanding area with a high volume of unwell patients and frequent emergencies - this poses various barriers to learning in the workplace for junior doctors. We identify a number of key barriers and review ideas that can be trialed in the department to overcome them. Through an evaluation of current suggestions in the literature, we propose that learning opportunities need to be made explicit to junior doctors in order to encourage them to participate as a member of the team. We consider ideas for adjustments to the induction program and the postgraduate medical curriculum to shift the focus from medical knowledge to improving confidence and clinical skills in newly qualified doctors. Despite being a powerful window for opportunistic learning, the daily ward round is unfortunately not maximized and needs to be more learner focused while maintaining efficiency and time consumption. Finally, we put forward the idea of an open forum where trainees can talk about their learning experiences, identify subjective barriers, and suggest solutions to senior doctors. This would be achieved through departmental faculty development. These interventions are presented within the context of the neurosurgical ward; however, they are transferable and can be adapted in other specialties and departments.

  5. Oncology healthcare professionals' perspectives on the psychosocial support needs of cancer patients during oncology treatment.

    PubMed

    Aldaz, Bruno E; Treharne, Gareth J; Knight, Robert G; Conner, Tamlin S; Perez, David

    2017-09-01

    This study explored oncology healthcare professionals' perspectives on the psychosocial support needs of diverse cancer patients during oncology treatment. Six themes were identified using thematic analysis. Healthcare professionals highlighted the importance of their sensitivity, respect and emotional tact during appointments in order to effectively identify and meet the needs of oncology patients. Participants also emphasised the importance of building rapport that recognises patients as people. Patients' acceptance of treatment-related distress and uncertainty was described as required for uptake of available psychosocial supportive services. We offer some practical implications that may help improve cancer patients' experiences during oncology treatment.

  6. iCanCope with Pain™: User-centred design of a web- and mobile-based self-management program for youth with chronic pain based on identified health care needs

    PubMed Central

    Stinson, Jennifer N; Lalloo, Chitra; Harris, Lauren; Isaac, Lisa; Campbell, Fiona; Brown, Stephen; Ruskin, Danielle; Gordon, Allan; Galonski, Marilyn; Pink, Leah R; Buckley, Norman; Henry, James L; White, Meghan; Karim, Allia

    2014-01-01

    BACKGROUND: While there are emerging web-based self-management programs for children and adolescents with chronic pain, there is currently not an integrated web- and smartphone-based app that specifically addresses the needs of adolescents with chronic pain. OBJECTIVES: To conduct a needs assessment to inform the development of an online chronic pain self-management program for adolescents, called iCanCope with Pain™. METHODS: A purposive sample of adolescents (n=23; 14 to 18 years of age) was recruited from two pediatric chronic pain clinics in Ontario. Interdisciplinary health care providers were also recruited from these sites. Three focus groups were conducted with adolescents (n=16) and one with pediatric health care providers (n=7). Individual adolescent interviews were also conducted (n=7). RESULTS: Qualitative analysis uncovered four major themes: pain impact; barriers to care; pain management strategies; and transition to adult care. Pain impacted social, emotional, physical and role functioning, as well as future goals. Barriers to care were revealed at the health care system, patient and societal levels. Pain management strategies included support systems, and pharmacological, physical and psychological approaches. Transition subthemes were: disconnect between pediatric and adult systems; skills development; parental role; and fear/anxiety. Based on these identified needs, the iCanCope with Pain™ architecture will include the core theory-based functionalities of: symptom self-monitoring; personalized goal setting; pain coping skills training; peer-based social support; and chronic pain education. CONCLUSIONS: The proposed iCanCope with Pain™ program aims to address the self-management needs of adolescents with chronic pain by improving access to disease information, strategies to manage symptoms and social support. PMID:25000507

  7. Public health financial management needs: report of a national survey.

    PubMed

    Costich, Julia F; Honoré, Peggy A; Scutchfield, F Douglas

    2009-01-01

    The work reported here builds on the identification of public health financial management practice competencies by a national expert panel. The next logical step was to provide a validity check for the competencies and identify priority areas for educational programming. We developed a survey for local public health finance officers based on the public health finance competencies and field tested it with a convenience sample of officials. We asked respondents to indicate the importance of each competency area and the need for training to improve performance; we also requested information regarding respondent education, jurisdiction size, and additional comments. Our local agency survey sample drew on the respondent list from the National Association of County and City Health Officials 2005 local health department survey, stratified by agency size and limited to jurisdiction populations of 25,000 to 1,000,000. Identifying appropriate respondents was a major challenge. The survey was fielded electronically, yielding 112 responses from 30 states. The areas identified as most important and needing most additional training were knowledge of budget activities, financial data interpretation and communication, and ability to assess and correct the organization's financial status. The majority of respondents had some postbaccalaureate education. Many provided additional comments and recommendations. Health department finance officers demonstrated a high level of general agreement regarding the importance of finance competencies in public health and the need for training. The findings point to a critical need for additional training opportunities that are accessible, cost-effective, and targeted to individual needs.

  8. An urgent need to improve life conditions of seniors.

    PubMed

    Hebert, R

    2010-10-01

    In the fall of 2007, the Government of Quebec set up a Public Consultation on Living Conditions of Seniors. Fifty sessions were held in 26 cities across all 17 regions of the province. More than 4000 seniors attended the sessions and 275 briefs were received from scientists and associations. Three themes were identified in the report published in 2008: supporting seniors and their caregivers, reinforcing the place of seniors in society, and preventing problems associated with aging (suicide, abuse, addictions). The main actions that I recommended included: Increasing the Guaranteed Income Supplement to prevent poverty; Modifying pension plans and working conditions to allow for progressive retirement; Making a major investment in home care to provide access to services regardless of place of residence; Introducing an Autonomy Support Benefit and autonomy insurance program for financing services to support people with disabilities; Generalizing an Integrated Service Delivery Network providing services to frail older people; Better training for professionals in gerontology. I also recommended setting up a National Policy on Seniors to align all government departments and agencies, municipalities and the private sector around a vision, objectives and a set of actions for improving the integration of seniors in an aging society. This would contribute to a more equitable, interdependent and wiser society. Unfortunately, the Government did not support these recommendations. It is now time for scientists to get involved in leading policy on seniors and in the political arena.

  9. Identifying future research needs in landscape genetics: Where to from here?

    Treesearch

    Niko Balkenhol; Felix Gugerli; Sam A. Cushman; Lisette P. Waits; Aurelie Coulon; J. W. Arntzen; Rolf Holderegger; Helene H. Wagner

    2009-01-01

    Landscape genetics is an emerging interdisciplinary field that combines methods and concepts from population genetics, landscape ecology, and spatial statistics. The interest in landscape genetics is steadily increasing, and the field is evolving rapidly. We here outline four major challenges for future landscape genetic research that were identified during an...

  10. Determining Adult Agribusiness Training Needs. Final Report.

    ERIC Educational Resources Information Center

    Ahrens, Donald L.; And Others

    The prupose of the study was to: (1) identify the agribusiness firms within Wisconsin's Vocational-Technical and Adult Education (VTAE) District One, (2) identify the occupations of those employed in the industry, (3) identify present and future employment need for identified skills along with training needs for those currently employed in…

  11. Scoping the role and education needs of practice nurses in London.

    PubMed

    Procter, Susan; Griffiths, Lauren; Fanning, Agnes; Wallman, Lizzie; Loveday, Heather P

    2017-07-01

    Aims To identify education priorities for practice nursing across eight London Clinical Commissioning Groups (CCGs); to identify the education, training, development and support needs of practice nurses in undertaking current and future roles. The education needs of practice nurses have long been recognised but their employment status means that accessing education requires the support of their GP employer. This study scopes the educational requirements of the practice nurse workforce and working with educational providers and commissioners describes a coherent educational pathway for practice nurses. A survey of practice nurses to scope their educational attainment needs was undertaken. Focus groups were carried out which identified the education, training, development and support needs of practice nurses to fulfil current and future roles. Findings A total of 272 respondents completed the survey. Practice nurses took part in three focus groups (n=34) and one workshop (n=39). Findings from this research indicate a practice nurse workforce which lacked career progression, role autonomy or a coherent educational framework. Practice nurses recognised the strength of their role in building relationship-centred care with patients over an extended period of time. They valued this aspect of their role and would welcome opportunities to develop this to benefit patients. This paper demonstrates an appetite for more advanced education among practice nurses, a leadership role by the CCGs in working across the whole system to address the education needs of practice nurses, and a willingness on the part of National Health Service education commissioners to commission education which meets the education needs of the practice nurse workforce. Evidence is still required, however, to inform the scope of the practice nurse role within an integrated system of care and to identify the impact of practice nursing on improving health outcomes and care of local populations.

  12. Distance Learning for Students with Special Needs through 3D Virtual Learning

    ERIC Educational Resources Information Center

    Laffey, James M.; Stichter, Janine; Galyen, Krista

    2014-01-01

    iSocial is a 3D Virtual Learning Environment (3D VLE) to develop social competency for students who have been identified with High-Functioning Autism Spectrum Disorders. The motivation for developing a 3D VLE is to improve access to special needs curriculum for students who live in rural or small school districts. The paper first describes a…

  13. Determining the need for improvement of infant incubator design with quality function deployment

    NASA Astrophysics Data System (ADS)

    Tarigan, U.; Ginting, R.; Siregar, I.

    2018-02-01

    A Newborns need particular attention because it takes time to adapt to the outside world. In accordance with the standard post-neonatal procedures, newborns should be incorporated into the incubator within a specified period of time according to the infant’s health level. Infant incubator as a medical device used to care for newborns, often get complaints from doctors and child nurses. The complaint indicates consumer dissatisfaction with incubator products in the hospital. Broadly speaking, objection against infant incubators lie in inappropriate designs. To overcome these complaints the researchers apply the method of Quality Function Deployment to determine the characteristics of priority techniques in accordance with the wishes of consumers with it. The primary focus of QFD is to engage customers in the product development process as early as possible, which their needs and desires serve as the starting point of the QFD process. Therefore, QFD is called the voice of customer. The underlying philosophy is that customers are not always satisfied with a product even though the product has been perfectly produced. The results show that the category used as a priority improvement is the additional function of the oxygen cylinder and the size of the door hole. QFD phase one produces technical characteristics of Ergonomy, Features and Cost as critical part determinants.

  14. U.S. Army Engineering and Support Center, Huntsville, Price Reasonableness Determinations for Federal Supply Schedule Orders for Supplies Need Improvement

    DTIC Science & Technology

    2016-03-29

    Army Engineering and Support Center, Huntsville, Price Reasonableness Determinations for Federal Supply Schedule Orders for Supplies Need...0207.000) │ i Results in Brief U.S. Army Engineering and Support Center, Huntsville, Price Reasonableness Determinations for Federal Supply Schedule...Orders for Supplies Need Improvement Visit us at www.dodig.mil March 29, 2016 Objective We determined whether U.S. Army Corps of Engineers contracting

  15. Use of Focus Groups for Identifying Specialty Needs of Primary Care Physicians.

    ERIC Educational Resources Information Center

    Gelula, Mark H.; Sandlow, Leslie J.

    1998-01-01

    Focus groups with 42 primary care physicians revealed their interests and needs for continuing education. Similar interests were displayed among four specialties: family physicians, internists, pediatricians, and obstetricians/gynecologists, as well as significant overlap of opinions and ideas. (SK)

  16. Identifying emotional intelligence in professional nursing practice.

    PubMed

    Kooker, Barbara Molina; Shoultz, Jan; Codier, Estelle E

    2007-01-01

    The National Center for Health Workforce Analysis projects that the shortage of registered nurses in the United States will double by 2010 and will nearly quadruple to 20% by 2015 (Bureau of Health Professionals Health Resources and Services Administration. [2002]. Projected supply, demand, and shortages of registered nurses, 2000-2020 [On-line]. Available: http:bhpr.hrsa.gov/healthworkforce/reports/rnprojects/report.htm). The purpose of this study was to use the conceptual framework of emotional intelligence to analyze nurses' stories about their practice to identify factors that could be related to improved nurse retention and patient/client outcomes. The stories reflected evidence of the competencies and domains of emotional intelligence and were related to nurse retention and improved outcomes. Nurses recognized their own strengths and limitations, displayed empathy and recognized client needs, nurtured relationships, used personal influence, and acted as change agents. Nurses were frustrated when organizational barriers conflicted with their knowledge/intuition about nursing practice, their communications were disregarded, or their attempts to create a shared vision and teamwork were ignored. Elements of professional nursing practice, such as autonomy, nurse satisfaction, respect, and the professional practice environment, were identified in the excerpts of the stories. The shortage of practicing nurses continues to be a national issue. The use of emotional intelligence concepts may provide fresh insights into ways to keep nurses engaged in practice and to improve nurse retention and patient/client outcomes.

  17. Pulmonary specialty training to improve respiratory health in low- and middle-income countries. Needs and challenges.

    PubMed

    Chakaya, Jeremiah M; Carter, E Jane; Hopewell, Philip C

    2015-04-01

    It is estimated that 85% of the world's population lives in low- and middle-income countries (LMICs). Although economic conditions are improving in these countries, health expenditures have not kept pace with the overall economic growth, and health systems remain weak. These already inadequate systems are being further stressed by the epidemiologic transition that is taking place, characterized by a slow decrease in communicable diseases and an increase in noninfectious chronic diseases, resulting in a "double burden" of infectious and noninfectious diseases. Respiratory diseases comprise the largest category of illness within this combined burden of disease. Although there are chronic respiratory disease programs of proven effectiveness appropriate for LMICs, implementation has been greatly hampered by the lack of physicians who have special knowledge and skills in addressing the full spectrum of lung diseases. Thus, there is an urgent need to create training programs for specialists in respiratory diseases. Such programs should be developed and conducted by institutions in LMICs and tailored to fit the prevailing circumstances of the country. Existing curriculum blueprints may be used to guide training program development with appropriate modifications. Academic institutions and professional societies in high-income countries may be called upon to provide technical assistance in developing and implementing training programs. In order to better define the burden of respiratory diseases and identify effective interventions, research, moved forward by persons committed and specialized in this area of health, will be essential.

  18. Does the world need a scientific society for research on how to improve healthcare?

    PubMed

    Wensing, Michel; Grimshaw, Jeremy M; Eccles, Martin P

    2012-02-29

    In this editorial, we reflect on the arguments for starting a scientific society focused on research on how to improve healthcare. This society would take an inclusive approach to what constitutes healthcare. For instance, it should include mental health healthcare, treatment for substance abuse, the work of allied health professions, and preventive healthcare. The society would be open to researchers from all traditions. Thus, we take an inclusive approach to what constitutes scientific research, as long as it uses rigorous methods, is focused on improving healthcare, and aims at knowledge that can be transferred across settings. The society would primarily target scientific researchers but would invite others with an interest in this area of research, regardless of their discipline, position, field of application, or group affiliation (e.g., improvement science, behavioral medicine, knowledge translation). A society would need fruitful collaboration with related societies and organizations, which may include having combined meetings. Special links may be developed with one or more journals. A website to provide information on relevant resources, events, and training opportunities is another key activity. It would also provide a voice for the field at funding agencies, political arenas, and similar institutions. An organizational structure and financial resources are required to develop and run these activities. Our aim is to start an international debate, to discover if we can establish a shared vision across academics and stakeholders engaged with creating scientific knowledge on how to improve healthcare. We invite readers to express their views in the online questionnaire accessed by following the URL link provided at the end of the editorial.

  19. Future needs for biomedical transducers

    NASA Technical Reports Server (NTRS)

    Wooten, F. T.

    1971-01-01

    In summary there are three major classes of transducer improvements required: improvements in existing transducers, needs for unexploited physical science phenomena in transducer design, and needs for unutilized physiological phenomena in transducer design. During the next decade, increasing emphasis will be placed on noninvasive measurement in all of these areas. Patient safety, patient comfort, and the need for efficient utilization of the time of both patient and physician requires that noninvasive methods of monitoring be developed.

  20. The Role of Need for Contraception in the Evaluation of Interventions to Improve Access to Family-Planning Methods

    ERIC Educational Resources Information Center

    Leon, Federico R.; Lundgren, Rebecka; Sinai, Irit; Jennings, Victoria

    2011-01-01

    A nonrandomized experiment carried out in Jharkhand, India, shows how the effects of interventions designed to improve access to family-planning methods can be erroneously regarded as trivial when contraceptive use is utilized as dependent variable, ignoring women's need for contraception. Significant effects of the intervention were observed on…

  1. Information Needs Perceived as Important by Leaders in Advanced Technological Education: Alignment with Community College Program Improvement Initiatives

    ERIC Educational Resources Information Center

    Badway, Norena Norton; Somerville, Jerry

    2011-01-01

    The purpose of this study was to analyze what leaders of Advanced Technological Education (ATE) programs funded by the National Science Foundation believe are their most important needs for research information. Data was collected through a Delphi process, and results were analyzed through frameworks associated with program improvement initiatives…

  2. Parents served by assertive community treatment: parenting needs, services, and attitudes.

    PubMed

    White, Laura M; McGrew, John H; Salyers, Michelle P

    2013-03-01

    Assertive Community Treatment (ACT) is an evidence-based practice for individuals with severe mental illness. Although at least half of all people with severe mental illness are parents, little is known about their experiences as parents and as recipients of mental health interventions like ACT. The purpose of the current study was to examine the experiences of parent consumers served by ACT. Seventeen parents being served by ACT teams were interviewed about parenting, parenting needs, severe mental illness, satisfaction with ACT services, and suggestions for improved parent-focused treatment services. All parents identified at least one positive aspect of parenting and most parents (77%) also identified negative aspects of parenting. Loss of custody emerged as a significant parenting problem, with most parents (88%) experiencing custody loss at least once. Parents expressed interest in numerous parent-focused services, including family therapy, parenting skills, communication skills training, resources for children, and peer support groups. Most participants with adult children (88%) reported having no unmet parent-related needs and high satisfaction (4.63 of 5) with ACT services, whereas parents with young children (78%) reported having several unmet parenting needs and relatively lower satisfaction (3.78 out of 5) with ACT services. The ACT treatment model may not be adequately serving parents of young, dependent children. Findings suggest the need for more attention and focus on parent consumers, including identification of parental status and improved parent-related treatment services and support. PsycINFO Database Record (c) 2013 APA, all rights reserved

  3. High-throughput screening identifies microRNAs that target Nox2 and improve function after acute myocardial infarction.

    PubMed

    Yang, Junyu; Brown, Milton E; Zhang, Hanshuo; Martinez, Mario; Zhao, Zhihua; Bhutani, Srishti; Yin, Shenyi; Trac, David; Xi, Jianzhong Jeff; Davis, Michael E

    2017-05-01

    Myocardial infarction (MI) is the most common cause of heart failure. Excessive production of ROS plays a key role in the pathogenesis of cardiac remodeling after MI. NADPH with NADPH oxidase (Nox)2 as the catalytic subunit is a major source of superoxide production, and expression is significantly increased in the infarcted myocardium, especially by infiltrating macrophages. While microRNAs (miRNAs) are potent regulators of gene expression and play an important role in heart disease, there still lacks efficient ways to identify miRNAs that target important pathological genes for treating MI. Thus, the overall objective was to establish a miRNA screening and delivery system for improving heart function after MI using Nox2 as a critical target. With the use of the miRNA-target screening system composed of a self-assembled cell microarray (SAMcell), three miRNAs, miR-106b, miR-148b, and miR-204, were identified that could regulate Nox2 expression and its downstream products in both human and mouse macrophages. Each of these miRNAs were encapsulated into polyketal (PK3) nanoparticles that could effectively deliver miRNAs into macrophages. Both in vitro and in vivo studies in mice confirmed that PK3-miRNAs particles could inhibit Nox2 expression and activity and significantly improve infarct size and acute cardiac function after MI. In conclusion, our results show that miR-106b, miR-148b, and miR-204 were able to improve heart function after myocardial infarction in mice by targeting Nox2 and possibly altering inflammatory cytokine production. This screening system and delivery method could have broader implications for miRNA-mediated therapeutics for cardiovascular and other diseases. NEW & NOTEWORTHY NADPH oxidase (Nox)2 is a promising target for treating cardiovascular disease, but there are no specific inhibitors. Finding endogenous signals that can target Nox2 and other inflammatory molecules is of great interest. In this study, we used high-throughput screening

  4. A model for identifying and ranking need for trauma service in nonmetropolitan regions based on injury risk and access to services.

    PubMed

    Schuurman, Nadine; Bell, Nathaniel; Hameed, Morad S; Simons, Richard

    2008-07-01

    Timely access to definitive trauma care has been shown to improve survival rates after severe injury. Unfortunately, despite development of sophisticated trauma systems, prompt, definitive trauma care remains unavailable to over 50 million North Americans, particularly in rural areas. Measures to quantify social and geographic isolation may provide important insights for the development of health policy aimed at reducing the burden of injury and improving access to trauma care in presently under serviced populations. Indices of social deprivation based on census data, and spatial analyses of access to trauma centers based on street network files were combined into a single index, the Population Isolation Vulnerability Amplifier (PIVA) to characterize vulnerability to trauma in socioeconomically and geographically diverse rural and urban communities across British Columbia. Regions with a sufficient core population that are more than one hour travel time from existing services were ranked based on their level of socioeconomic vulnerability. Ten regions throughout the province were identified as most in need of trauma services based on population, isolation and vulnerability. Likewise, 10 communities were classified as some of the least isolated areas and were simultaneously classified as least vulnerable populations in province. The model was verified using trauma services utilization data from the British Columbia Trauma Registry. These data indicate that including vulnerability in the model provided superior results to running the model based only on population and road travel time. Using the PIVA model we have shown that across Census Urban Areas there are wide variations in population dependence on and distances to accredited tertiary/district trauma centers throughout British Columbia. Many of the factors that influence access to definitive trauma care can be combined into a single quantifiable model that researchers in the health sector can use to predict

  5. Spinal Cord Injury Clinical Registries: Improving Care across the SCI Care Continuum by Identifying Knowledge Gaps.

    PubMed

    Dvorak, Marcel F; Cheng, Christiana L; Fallah, Nader; Santos, Argelio; Atkins, Derek; Humphreys, Suzanne; Rivers, Carly S; White, Barry A B; Ho, Chester; Ahn, Henry; Kwon, Brian K; Christie, Sean; Noonan, Vanessa K

    2017-10-15

    Timely access and ongoing delivery of care and therapeutic interventions is needed to maximize recovery and function after traumatic spinal cord injury (tSCI). To ensure these decisions are evidence-based, access to consistent, reliable, and valid sources of clinical data is required. The Access to Care and Timing Model used data from the Rick Hansen SCI Registry (RHSCIR) to generate a simulation of healthcare delivery for persons after tSCI and to test scenarios aimed at improving outcomes and reducing the economic burden of SCI. Through model development, we identified knowledge gaps and challenges in the literature and current health outcomes data collection throughout the continuum of SCI care. The objectives of this article were to describe these gaps and to provide recommendations for bridging them. Accurate information on injury severity after tSCI was hindered by difficulties in conducting neurological assessments and classifications of SCI (e.g., timing), variations in reporting, and the lack of a validated SCI-specific measure of associated injuries. There was also limited availability of reliable data on patient factors such as multi-morbidity and patient-reported measures. Knowledge gaps related to structures (e.g., protocols) and processes (e.g., costs) at each phase of care have prevented comprehensive evaluation of system performance. Addressing these knowledge gaps will enhance comparative and cost-effectiveness evaluations to inform decision-making and standards of care. Recommendations to do so were: standardize data element collection and facilitate database linkages, validate and adopt more outcome measures for SCI, and increase opportunities for collaborations with stakeholders from diverse backgrounds.

  6. Spinal Cord Injury Clinical Registries: Improving Care across the SCI Care Continuum by Identifying Knowledge Gaps

    PubMed Central

    Cheng, Christiana L.; Fallah, Nader; Santos, Argelio; Atkins, Derek; Humphreys, Suzanne; Rivers, Carly S.; White, Barry A.B.; Ho, Chester; Ahn, Henry; Kwon, Brian K.; Christie, Sean; Noonan, Vanessa K.

    2017-01-01

    Abstract Timely access and ongoing delivery of care and therapeutic interventions is needed to maximize recovery and function after traumatic spinal cord injury (tSCI). To ensure these decisions are evidence-based, access to consistent, reliable, and valid sources of clinical data is required. The Access to Care and Timing Model used data from the Rick Hansen SCI Registry (RHSCIR) to generate a simulation of healthcare delivery for persons after tSCI and to test scenarios aimed at improving outcomes and reducing the economic burden of SCI. Through model development, we identified knowledge gaps and challenges in the literature and current health outcomes data collection throughout the continuum of SCI care. The objectives of this article were to describe these gaps and to provide recommendations for bridging them. Accurate information on injury severity after tSCI was hindered by difficulties in conducting neurological assessments and classifications of SCI (e.g., timing), variations in reporting, and the lack of a validated SCI-specific measure of associated injuries. There was also limited availability of reliable data on patient factors such as multi-morbidity and patient-reported measures. Knowledge gaps related to structures (e.g., protocols) and processes (e.g., costs) at each phase of care have prevented comprehensive evaluation of system performance. Addressing these knowledge gaps will enhance comparative and cost-effectiveness evaluations to inform decision-making and standards of care. Recommendations to do so were: standardize data element collection and facilitate database linkages, validate and adopt more outcome measures for SCI, and increase opportunities for collaborations with stakeholders from diverse backgrounds. PMID:28745934

  7. Participation needs of older adults having disabilities and receiving home care: met needs mainly concern daily activities, while unmet needs mostly involve social activities.

    PubMed

    Turcotte, Pier-Luc; Larivière, Nadine; Desrosiers, Johanne; Voyer, Philippe; Champoux, Nathalie; Carbonneau, Hélène; Carrier, Annie; Levasseur, Mélanie

    2015-08-01

    Participation is a key determinant of successful aging and enables older adults to stay in their homes and be integrated into the community. Assessing participation needs involves identifying restrictions in the accomplishment of daily and social activities. Although meeting participation needs involves older adults, their caregivers and healthcare providers, little is known about their respective viewpoints. This study thus explored the participation needs of older adults having disabilities as perceived by the older adults themselves, their caregivers and healthcare providers. A qualitative multiple case study consisted of conducting 33 semi-structured interviews in eleven triads, each composed of an older adult, his/her caregiver and a healthcare provider recruited in a Health and Social Services Centre (HSSC) in Québec, Canada. Interview transcripts and reviews of clinical records were analyzed using content analysis and descriptive statistics based on thematic saliency analysis methods. Aged 66 to 88 years, five older adults had physical disabilities, five had mild cognitive impairment and one had psychological problems, leading to moderate to severe functional decline. Caregivers and healthcare providers were mainly women, respectively retired spouses and various professionals with four to 32 years of clinical experience. Participation needs reported by each triad included all domains of participation. Needs related to daily activities, such as personal care, nutrition, and housing, were generally met. Regarding social activities, few needs were met by various resources in the community and were generally limited to personal responsibilities, including making decisions and managing budgets, and some community life activities, such as going shopping. Unmet needs were mainly related to social activities, involving leisure, other community life activities and interpersonal relationships, and some daily activities, including fitness and mobility. This study

  8. Using Concept Relations to Improve Ranking in Information Retrieval

    PubMed Central

    Price, Susan L.; Delcambre, Lois M.

    2005-01-01

    Despite improved search engine technology, most searches return numerous documents not directly related to the query. This problem is mitigated if relevant documents appear high on a ranked list of search results. We propose that some queries and the underlying information needs can be modeled as relationships between concepts (relations), and we match relations in queries to relations in documents to try to improve ranking of search results. We investigate four techniques to identify two relationships important in medicine, causes and treats, to improve the ranking of medical text documents relevant to clinical questions about causation and treatment. Preliminary results suggest that identifying relation instances can improve the ranking of search results. PMID:16779114

  9. Teacher Support Resources, Need Satisfaction and Well-Being.

    PubMed

    Doménech-Betoret, Fernando; Lloret-Segura, Susana; Gómez-Artiga, Amparo

    2015-03-03

    Based on Job Demands-Resources Model (JD-R), this study examines the relationships among teacher support resources, psychological need satisfaction, engagement and burnout in a sample of 282 Spanish secondary school teachers. Nine teacher psychological needs were identified based on the study of Bess and on the Self-Determination Theory (SDT). Self-report questionnaires were used to measure the constructs selected for this study and their interrelationships were examined by structural equation modeling. The results reveal a good model fit to the data (NNFI = .88; CFI = .90; GFI = .90; RMSEA = .061). The analyses indicate a positive and significant effect of latent variable Psychological Need Satisfaction on engagement (β = .74, p < .05), and a negative and significant effect on burnout (β = -.78, p ≤ .05). Furthermore, the results show the mediator role played by Psychological Need Satisfaction in the relationship between teacher support resources and both engagement and burnout (additional paths did not improve the model fit: Δχ2(2) = 2.428, p = .29). Finally, practical implications of these findings are discussed.

  10. Organizational diagnosis of computer and information learning needs: the process and product.

    PubMed

    Nelson, R; Anton, B

    1997-01-01

    Organizational diagnosis views the organization as a single entity with problems and challenges that are unique to the organization as a whole. This paper describes the process of establishing organizational diagnoses related to computer and information learning needs within a clinical or academic health care institution. The assessment of a college within a state-owned university in the U.S.A. is used to demonstrate the process of organizational diagnosis. The diagnoses identified include the need to improve information seeking skills and the information presentation skills of faculty.

  11. A continuous quality improvement approach to improving clinical practice in the areas of sedation, analgesia, and neuromuscular blockade.

    PubMed

    Arbour, Richard

    2003-01-01

    Practice concerns associated with the medical prescription and nurses' administration and monitoring of sedatives, analgesics, and neuromuscular blocking agents were identified by the clinical nurse specialist within a surgical intensive care unit of a large, tertiary-care referral center. These concerns were identified using a variety of needs assessment strategies. Results of the needs assessment were used to develop a program of care, including a teaching initiative, specific to these practice areas. The teaching initiative incorporated principles of andragogy, the theory of adult learning. Educational techniques included inservice education, bedside instruction using "teaching moments," competency-based education modules, and integration of instruction into critical care orientation. Content and approach were based on the background and level of experience of participants. Educational program outcomes included increased consistency in monitoring neuromuscular blockade by clinical assessment and peripheral nerve stimulation. A second outcome was more accurate patient assessment leading to the provision of drug therapy specific to the patients' clinical states, including anxiety or pain. The continuous quality improvement approach offers a model for improving patient care using individualized needs assessment, focused educational interventions, and program evaluation strategies.

  12. Healthcare needs of older Arab migrants: a systematic review.

    PubMed

    Al Abed, Naser A; Davidson, Patricia M; Hickman, Louise D

    2014-07-01

    To explore the healthcare needs of older Arab migrants, focussing on Arab-Australians and their socio-cultural characteristics. Disparities in accessing healthcare services and addressing healthcare needs are evident among ethnic minorities including Arab migrants, particularly, older people. Racial stereotyping can also affect their ability to use these services. Arabs are a populous and diverse group with a long history of global migration. Australia is one of the most multicultural societies in the world, and Arab-Australians constitute an important ethnic minority group. Systematic review. The electronic databases Academic Search Complete (EBSCO), MEDLINE (Ovid), Ageline, ProQuest, CINAHL, PubMed, PsychINFO and Google Scholar were searched from 1990-October 2012. Search terms included health care needs, aged care, ethnic, cultural, linguistics, social, ethnic groups, culturally and linguistically diverse, nonEnglish speaking, ageing, elderly, Arabs, Arabic-speaking and Australia. Eight articles reviewing the healthcare issues of Australians from Arabic-speaking background were identified using the search strategy. An additional eight articles were identified through hand searching. Racial stereotyping can alter health-seeking behaviours and healthcare treatment. Increasing the understanding of specific cultural attributes of Arab-Australians will contribute to improving health outcomes. Healthcare providers and policymakers need to adopt more effective ways of communication with Arab-Australians to provide more culturally competent care and achieve better health outcomes. © 2013 John Wiley & Sons Ltd.

  13. An Integrated Literature Review of the Knowledge Needs of Parents with Children with Special Health Care Needs and of Instruments to Assess These Needs

    ERIC Educational Resources Information Center

    Adler, Kristin; Salanterä, Sanna; Leino­-Kilpi, Helena; Grädel, Barbara

    2015-01-01

    The purpose of this integrative (including both quantitative and qualitative studies) literature review was to identify knowledge needs of parents of a child with special health care needs and to evaluate instruments to assess these needs. The content analysis of 48 publications revealed a vast amount of knowledge needs that were categorized into…

  14. Research needed for improving heavy-ion therapy

    NASA Astrophysics Data System (ADS)

    Kraft, G; Kraft, S D

    2009-02-01

    The large interest in heavy-ion therapy is stimulated from its excellent clinical results. The bases of this success are the radiobiological and physical advantages of heavy-ion beams and the active beam delivery used for an intensity-modulated particle radiotherapy (IMPT). Although heavy-ion therapy has reached a high degree of perfection for clinical use there is still large progress possible to improve this novel technique: in order to extend IMPT to more tumor entities and to tailor the planning more individually for each patient in an adaptive way, radiobiological work is required both experimentally and theoretically. It is also not clear whether the neighboring ions to carbon could have a clinical application as well. For this extension basic biological studies as well as physics experiments have to be performed. On the technical side, many improvements of the equipment used seem to be possible. Two major topics are the extension of IMPT to moving organs and the transition to more compact and therefore cheaper particle accelerators. In the present paper, these topics are treated to some extent in order to give an outline of the great future potential of ion-beam therapy.

  15. Action Research to Improve Phonological Recognition at Key Stage 1 with Reference to Pupils with Special Educational Needs

    ERIC Educational Resources Information Center

    Clark, Charlotte

    2017-01-01

    Given the focus on phonological attainment in the National Phonics Screening Check, small-scale school-based action research was undertaken to improve phonological recognition and assess the impact on progress and attainment in a sample drawn from Key Stage 1 which included pupils on the Special Educational Needs (SEN) Register. The research…

  16. Incorporation of unique molecular identifiers in TruSeq adapters improves the accuracy of quantitative sequencing.

    PubMed

    Hong, Jungeui; Gresham, David

    2017-11-01

    Quantitative analysis of next-generation sequencing (NGS) data requires discriminating duplicate reads generated by PCR from identical molecules that are of unique origin. Typically, PCR duplicates are identified as sequence reads that align to the same genomic coordinates using reference-based alignment. However, identical molecules can be independently generated during library preparation. Misidentification of these molecules as PCR duplicates can introduce unforeseen biases during analyses. Here, we developed a cost-effective sequencing adapter design by modifying Illumina TruSeq adapters to incorporate a unique molecular identifier (UMI) while maintaining the capacity to undertake multiplexed, single-index sequencing. Incorporation of UMIs into TruSeq adapters (TrUMIseq adapters) enables identification of bona fide PCR duplicates as identically mapped reads with identical UMIs. Using TrUMIseq adapters, we show that accurate removal of PCR duplicates results in improved accuracy of both allele frequency (AF) estimation in heterogeneous populations using DNA sequencing and gene expression quantification using RNA-Seq.

  17. A freshwater biodiversity hotspot under pressure - assessing threats and identifying conservation needs for ancient Lake Ohrid

    NASA Astrophysics Data System (ADS)

    Kostoski, G.; Albrecht, C.; Trajanovski, S.; Wilke, T.

    2010-07-01

    Freshwater habitats and species living in freshwater are generally more prone to extinction than terrestrial or marine ones. Immediate conservation measures for world-wide freshwater resources are thus of eminent importance. This is particularly true for so called ancient lakes. While these lakes are famous for being evolutionary theatres, often displaying an extraordinarily high degree of biodiversity and endemism, in many cases these biota are also experiencing extreme anthropogenic impact. Lake Ohrid, the European biodiversity hotspot, is a prime example for a lake with a magnitude of narrow range endemic taxa that are under increasing anthropogenic pressure. Unfortunately, evidence for a "creeping biodiversity crisis" has accumulated over the last decades, and major socio-political changes have gone along with human-mediated environmental changes. Based on field surveys, monitoring data, published records, and expert interviews, we aimed to (1) assess threats to Lake Ohrids' (endemic) biodiversity, (2) summarize existing conservation activities and strategies, and (3) outline future conservation needs for Lake Ohrid. We compiled threats to both specific taxa (and in cases to particular species) as well as to the lake ecosystems itself. Major conservation concerns identified for Lake Ohrid are: (1) watershed impacts, (2) agriculture and forestry, (3) tourism and population growth, (4) non-indigenous species, (5) habitat alteration or loss, (6) unsustainable exploitation of fisheries, and (7) global climate change. Of the 11 IUCN (International Union for Conservation of Nature and Natural Resources) threat classes scored, seven have moderate and three severe impacts. These latter threat classes are energy production and mining, biological resource use, and pollution. We review and discuss institutional responsibilities, environmental monitoring and ecosystem management, existing parks and reserves, biodiversity and species measures, international conservation

  18. A freshwater biodiversity hotspot under pressure - assessing threats and identifying conservation needs for ancient Lake Ohrid

    NASA Astrophysics Data System (ADS)

    Kostoski, G.; Albrecht, C.; Trajanovski, S.; Wilke, T.

    2010-12-01

    Immediate conservation measures for world-wide freshwater resources are of eminent importance. This is particularly true for so-called ancient lakes. While these lakes are famous for being evolutionary theatres, often displaying an extraordinarily high degree of biodiversity and endemism, in many cases these biota are also experiencing extreme anthropogenic impact. Lake Ohrid, a major European biodiversity hotspot situated in a trans-frontier setting on the Balkans, is a prime example for a lake with a magnitude of narrow range endemic taxa that are under increasing anthropogenic pressure. Unfortunately, evidence for a "creeping biodiversity crisis" has accumulated over the last decades, and major socio-political changes have gone along with human-mediated environmental changes. Based on field surveys, monitoring data, published records, and expert interviews, we aimed to (1) assess threats to Lake Ohrids' (endemic) biodiversity, (2) summarize existing conservation activities and strategies, and (3) outline future conservation needs for Lake Ohrid. We compiled threats to both specific taxa (and in cases to particular species) as well as to the lake ecosystems itself. Major conservation concerns identified for Lake Ohrid are: (1) watershed impacts, (2) agriculture and forestry, (3) tourism and population growth, (4) non-indigenous species, (5) habitat alteration or loss, (6) unsustainable exploitation of fisheries, and (7) global climate change. Among the major (well-known) threats with high impact are nutrient input (particularly of phosphorus), habitat conversion and silt load. Other threats are potentially of high impact but less well known. Such threats include pollution with hazardous substances (from sources such as mines, former industries, agriculture) or climate change. We review and discuss institutional responsibilities, environmental monitoring and ecosystem management, existing parks and reserves, biodiversity and species measures, international

  19. Identifying the Professional Development Needs of Adjunct Faculty Using an Online Delphi

    ERIC Educational Resources Information Center

    Cuddie, Stephani B.

    2016-01-01

    The purpose of this online Delphi was to explore the professional development needs and preferences of adjunct faculty, specifically those who teach online. The study involved adjunct faculty who were categorized by their self-selected type of adjunct faculty member: specialist, aspiring academic, professional/freelancer, and career-ender. Through…

  20. Building Relevant Leaders: Identifying the Development Needs of the Modern Construction Leader

    ERIC Educational Resources Information Center

    Shands, Mike

    2014-01-01

    "Do senior level construction leaders possess a common set of leadership development needs that can be addressed to better prepare them to lead and retain the Millennial workforce?" As older generations begin to retire in-mass, many organizations are reevaluating their approach to employee recruitment, performance, and retention. This…

  1. Using Participatory and Service Design to Identify Emerging Needs and Perceptions of Library Services among Science and Engineering Researchers Based at a Satellite Campus

    ERIC Educational Resources Information Center

    Johnson, Andrew; Kuglitsch, Rebecca; Bresnahan, Megan

    2015-01-01

    This study used participatory and service design methods to identify emerging research needs and existing perceptions of library services among science and engineering faculty, post-graduate, and graduate student researchers based at a satellite campus at the University of Colorado Boulder. These methods, and the results of the study, allowed us…

  2. Framework for Identifying Cybersecurity Risks in Manufacturing

    DOE PAGES

    Hutchins, Margot J.; Bhinge, Raunak; Micali, Maxwell K.; ...

    2015-10-21

    Increasing connectivity, use of digital computation, and off-site data storage provide potential for dramatic improvements in manufacturing productivity, quality, and cost. However, there are also risks associated with the increased volume and pervasiveness of data that are generated and potentially accessible to competitors or adversaries. Enterprises have experienced cyber attacks that exfiltrate confidential and/or proprietary data, alter information to cause an unexpected or unwanted effect, and destroy capital assets. Manufacturers need tools to incorporate these risks into their existing risk management processes. This article establishes a framework that considers the data flows within a manufacturing enterprise and throughout its supplymore » chain. The framework provides several mechanisms for identifying generic and manufacturing-specific vulnerabilities and is illustrated with details pertinent to an automotive manufacturer. Finally, in addition to providing manufacturers with insights into their potential data risks, this framework addresses an outcome identified by the NIST Cybersecurity Framework.« less

  3. Framework for Identifying Cybersecurity Risks in Manufacturing

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

    Hutchins, Margot J.; Bhinge, Raunak; Micali, Maxwell K.

    Increasing connectivity, use of digital computation, and off-site data storage provide potential for dramatic improvements in manufacturing productivity, quality, and cost. However, there are also risks associated with the increased volume and pervasiveness of data that are generated and potentially accessible to competitors or adversaries. Enterprises have experienced cyber attacks that exfiltrate confidential and/or proprietary data, alter information to cause an unexpected or unwanted effect, and destroy capital assets. Manufacturers need tools to incorporate these risks into their existing risk management processes. This article establishes a framework that considers the data flows within a manufacturing enterprise and throughout its supplymore » chain. The framework provides several mechanisms for identifying generic and manufacturing-specific vulnerabilities and is illustrated with details pertinent to an automotive manufacturer. Finally, in addition to providing manufacturers with insights into their potential data risks, this framework addresses an outcome identified by the NIST Cybersecurity Framework.« less

  4. Identifying health facilities outside the enterprise: challenges and strategies for supporting health reform and meaningful use.

    PubMed

    Dixon, Brian E; Colvard, Cyril; Tierney, William M

    2014-06-24

    Objective: To support collation of data for disability determination, we sought to accurately identify facilities where care was delivered across multiple, independent hospitals and clinics. Methods: Data from various institutions' electronic health records were merged and delivered as continuity of care documents to the United States Social Security Administration (SSA). Results: Electronic records for nearly 8000 disability claimants were exchanged with SSA. Due to the lack of standard nomenclature for identifying the facilities in which patients received the care documented in the electronic records, SSA could not match the information received with information provided by disability claimants. Facility identifiers were generated arbitrarily by health care systems and therefore could not be mapped to the existing international standards. Discussion: We propose strategies for improving facility identification in electronic health records to support improved tracking of a patient's care between providers to better serve clinical care delivery, disability determination, health reform and meaningful use. Conclusion: Accurately identifying the facilities where health care is delivered to patients is important to a number of major health reform and improvement efforts underway in many nations. A standardized nomenclature for identifying health care facilities is needed to improve tracking of care and linking of electronic health records.

  5. Research on Joint Sealant Materials to Improve Installation and Performance : Final Report

    DOT National Transportation Integrated Search

    2017-12-01

    The objectives of this project were to 1) identify failure modes and their mechanisms in joint seals in Texas, and to 2) identify what needs to be done to minimize the failures and improve joint seal performance. To achieve these objectives efficient...

  6. Does the world need a scientific society for research on how to improve healthcare?

    PubMed Central

    2012-01-01

    In this editorial, we reflect on the arguments for starting a scientific society focused on research on how to improve healthcare. This society would take an inclusive approach to what constitutes healthcare. For instance, it should include mental health healthcare, treatment for substance abuse, the work of allied health professions, and preventive healthcare. The society would be open to researchers from all traditions. Thus, we take an inclusive approach to what constitutes scientific research, as long as it uses rigorous methods, is focused on improving healthcare, and aims at knowledge that can be transferred across settings. The society would primarily target scientific researchers but would invite others with an interest in this area of research, regardless of their discipline, position, field of application, or group affiliation (e.g., improvement science, behavioral medicine, knowledge translation). A society would need fruitful collaboration with related societies and organizations, which may include having combined meetings. Special links may be developed with one or more journals. A website to provide information on relevant resources, events, and training opportunities is another key activity. It would also provide a voice for the field at funding agencies, political arenas, and similar institutions. An organizational structure and financial resources are required to develop and run these activities. Our aim is to start an international debate, to discover if we can establish a shared vision across academics and stakeholders engaged with creating scientific knowledge on how to improve healthcare. We invite readers to express their views in the online questionnaire accessed by following the URL link provided at the end of the editorial. PMID:22376988

  7. Analysis of the nutritional management practices in intensive care: Identification of needs for improvement.

    PubMed

    Lázaro-Martín, N I; Catalán-González, M; García-Fuentes, C; Terceros-Almanza, L; Montejo-González, J C

    2015-12-01

    To analyze the nutritional management practices in Intensive Care (ICU) to detect the need for improvement actions. Re-evaluate the process after implementation of improvement actions. Prospective observational study in 3 phases: 1) observation; 2) analysis, proposal development and dissemination; 3) analysis of the implementation. ICU of a hospital of high complexity. Adult ICU forecast more than 48h of artificial nutrition. Parenteral nutrition (PN), enteral nutrition (EN) (type, average effective volume, complications) and average nutritional ratio. A total of 229 patients (phase 1: 110, phase 3: 119). After analyzing the initial results, were proposed: increased use and precocity of EN, increased protein intake, nutritional monitoring effectiveness and increased supplementary indication NP. The measures were broadcast at specific meetings. During phase 3 more patients received EN (55.5 vs. 78.2%, P=.001), with no significant difference in the start time (1.66 vs. 2.33 days), duration (6.82 vs. 10,12 days) or complications (37,7 vs. 47,3%).Use of hyperproteic diets was higher in phase 3 (0 vs. 13.01%, P<.05). The use of NP was similar (48.2 vs. 48,7%) with a tendency to a later onset in phase 3 (1.25±1.25 vs. 2.45±3.22 days). There were no significant differences in the average nutritional ratio (0.56±0.28 vs. 0.61±0.27, P=.56). The use of EN and the protein intake increased, without appreciating effects on other improvement measures. Other methods appear to be necessary for the proper implementation of improvement measures. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  8. Northeast and Islands Region: A Report Identifying and Addressing the Educational Needs

    ERIC Educational Resources Information Center

    US Department of Education, 2011

    2011-01-01

    This report discusses the deliberations of the Northeast and Islands (NEI) Regional Advisory Committee (RAC), one of 10 RACs established by the U.S. Department of Education to solicit information about the educational needs of state and local educators, school officials, business leaders, state education agencies, parents, local communities, and…

  9. Workforce capacity to address obesity: a Western Australian cross-sectional study identifies the gap between health priority and human resources needed.

    PubMed

    Begley, Andrea; Pollard, Christina Mary

    2016-08-25

    The disease burden due to poor nutrition, physical inactivity and obesity is high and increasing. An adequately sized and skilled workforce is required to respond to this issue. This study describes the public health nutrition and physical activity (NAPA) practice priorities and explores health managers and practitioner's beliefs regarding workforce capacity to deliver on these priorities. A workforce audit was conducted including a telephone survey of all managers and a postal survey of practitioners working in the area of NAPA promotion in Western Australia in 2004. Managers gave their perspective on workforce priorities, current competencies and future needs, with a 70 % response rate. Practitioners reported on public health workforce priorities, qualifications and needs, with a 56 % response rate. The top practice priorities for managers were diabetes (35 %), alcohol and other drugs (33 %), and cardiovascular disease (27 %). Obesity (19 %), poor nutrition (15 %) and inadequate physical activity (10 %) were of lower priority. For nutrition, managers identified lack of staff (60.4 %), organisational and management factors (39.5 %) and insufficient financial resources (30.2 %) as the major barriers to adequate service delivery. For physical activity services, insufficient financial resources (41.7 %) and staffing (35.4 %) and a lack of specific physical activity service specifications (25.0 %) were the main barriers. Practitioners identified inadequate staffing as the main barrier to service delivery for nutrition (42.3 %) and physical activity (23.3 %). Ideally, managers said they required 152 % more specialist nutritionists in the workforce and 131 % specialists for physical activity services to meet health outcomes in addition to other generalist staff. Human and financial resources and organisational factors were the main barriers to meeting obesity, and public health nutrition and physical activity outcomes. Services were being delivered by

  10. Profile and predictors of service needs for families of children with autism spectrum disorders

    PubMed Central

    Zwaigenbaum, Lonnie; Nicholas, David

    2015-01-01

    Purpose: Increasing demand for autism services is straining service systems. Tailoring services to best meet families’ needs could improve their quality of life and decrease burden on the system. We explored overall, best, and worst met service needs, and predictors of those needs, for families of children with autism spectrum disorders. Methods: Parents of 143 children with autism spectrum disorders (2–18 years) completed a survey including demographic and descriptive information, the Family Needs Survey–Revised, and an open-ended question about service needs. Descriptive statistics characterize the sample and determine the degree to which items were identified and met as needs. Predictors of total and unmet needs were modeled with regression or generalized linear model. Qualitative responses were thematically analyzed. Results: The most frequently identified overall and unmet service needs were information on services, family support, and respite care. The funding and quality of professional support available were viewed positively. Decreased child’s age and income and being an older mother predicted more total needs. Having an older child or mother, lower income, and disruptive behaviors predicted more total unmet needs, yet only disruptive behaviors predicted proportional unmet need. Child’s language or intellectual abilities did not predict needs. Conclusion: Findings can help professionals, funders, and policy-makers tailor services to best meet families’ needs. PMID:25073749

  11. Epilepsy diagnostic and treatment needs identified with a collaborative database involving tertiary centers in France.

    PubMed

    Chipaux, Mathilde; Szurhaj, William; Vercueil, Laurent; Milh, Mathieu; Villeneuve, Nathalie; Cances, Claude; Auvin, Stéphane; Chassagnon, Serge; Napuri, Sylvia; Allaire, Catherine; Derambure, Philippe; Marchal, Cécile; Caubel, Isabelle; Ricard-Mousnier, Brigitte; N'Guyen The Tich, Sylvie; Pinard, Jean-Marc; Bahi-Buisson, Nadia; de Baracé, Claire; Kahane, Philippe; Gautier, Agnès; Hamelin, Sophie; Coste-Zeitoun, Delphine; Rosenberg, Sarah-Dominique; Clerson, Pierre; Nabbout, Rima; Kuchenbuch, Mathieu; Picot, Marie-Christine; Kaminska, Anna

    2016-05-01

    To obtain perspective on epilepsy in patients referred to tertiary centers in France, and describe etiology, epilepsy syndromes, and identify factors of drug resistance and comorbidities. We performed a cross-sectional analysis of the characteristics of 5,794 pediatric and adult patients with epilepsy included in a collaborative database in France between 2007 and 2013. Comparisons between groups used Student's t-test or Fisher's exact test for binary or categorical variables. Factors associated with drug resistance and intellectual disability were evaluated in multi-adjusted logistic regression models. Mean age at inclusion was 17.9 years; children accounted for 67%. Epilepsy was unclassified in 20% of patients, and etiology was unknown in 65%, including those with idiopathic epilepsies. Etiologies differed significantly in adult- when compared to pediatric-onset epilepsy; however, among focal structural epilepsies, mesial temporal lobe epilepsy with hippocampal sclerosis began as often in the pediatric as in adult age range. Drug resistance concerned 53% of 4,210 patients evaluable for seizure control and was highest in progressive myoclonic epilepsy (89%), metabolic diseases (84%), focal cortical dysplasia (70%), other cortical malformations (69%), and mesial temporal lobe epilepsy with hippocampal sclerosis (67%). Fifty-nine percent of patients with focal structural epilepsy and 69% with epileptic encephalopathies were drug resistant; however, 40-50% of patients with West syndrome and epileptic encephalopathy with continuous spike-and-waves during sleep were seizure-free. Ages at onset in infancy and in young adults shared the highest risk of drug resistance. Epilepsy onset in infancy comprised the highest risk of intellectual disability, whereas specific cognitive impairment affected 36% of children with idiopathic focal epilepsy. Our study provides a snapshot on epilepsy in patients referred to tertiary centers and discloses needs for diagnosis and treatment

  12. Improved method for roadside barrier length of need modeling using real-world trajectories.

    PubMed

    Johnson, Nicholas S; Thomson, Robert; Gabler, Hampton C

    2015-07-01

    The 2011 AASHTO Roadside Design Guide (RDG) contains perhaps the most widely used procedure for choosing an appropriate length of need (LON) for roadside barriers. However, this procedure has several limitations. The procedure uses a highly simplified model of vehicle departure, and the procedure does not allow designers to specify an explicit level of protection. A new procedure for choosing LON that addresses these limitations is presented in this paper. This new procedure is based on recent, real-world road departure trajectories and uses this departure data in a more realistic way. The new procedure also allows LON to be specified for a precisely known level of protection - a level which can be based on number of crashes, injury outcomes or even estimated crash cost - while still remaining straightforward and quick to use like the 2011 RDG procedure. In this analysis, the improved procedure was used to explore the effects of the RDG procedure's assumptions. LON recommendations given by the 2011 RDG procedure were compared with recommendations given by this improved procedure. For 55 mph roads, the 2011 RDG procedure appears to lead to a LON sufficient to intercept between 80% and 90% of right-side departures that would otherwise strike a hazard located 10 m from the roadway. For hazards closer than 10 m, the 2011 RDG procedure intercepts progressively higher percentages of real-world departures. This suggests the protection level provided by the 2011 RDG procedure varies with the hazard offset, becoming more conservative as the hazard moves closer to the roadway. The improved procedure, by comparison, gives a consistent protection level regardless of hazard location. Copyright © 2015. Published by Elsevier Ltd.

  13. A Hospital-Based Neuroscience Nursing Course Designed to Improve Competence and Confidence.

    PubMed

    Shields, Lisa B E; Perkins, Lewis; Clark, Lisa; Shields, Christopher B

    2018-06-01

    After experiencing growth in a neuroscience service line, nurse leaders identified a need for increased competencies among clinical staff. This hospital met the need by developing a unique multidisciplinary neuroscience nursing course to improve the clinical competence, confidence, and professional development of bedside nurses.

  14. Bearings: Technology and needs

    NASA Technical Reports Server (NTRS)

    Anderson, W. J.

    1982-01-01

    A brief status report on bearing technology and present and near-term future problems that warrant research support is presented. For rolling element bearings a material with improved fracture toughness, life data in the low Lambda region, a comprehensive failure theory verified by life data and incorporated into dynamic analyses, and an improved corrosion resistant alloy are perceived as important needs. For hydrodynamic bearings better definition of cavitation boundaries and pressure distributions for squeeze film dampers, and geometry optimization for minimum power loss in turbulent film bearings are needed. For gas film bearings, foil bearing geometries that form more nearly optimum film shapes for maximum load capacity, and more effective surface protective coatings for high temperature operation are needed.

  15. ["Gender-specific needs of nursing home residents" : Focus on personal hygiene].

    PubMed

    Heusinger, J; Dummert, S

    2016-12-01

    Residential nursing homes are specialized in dealing with people in need of care and are required to respect their dignity and right to self-determination. This includes the respectful handling of gender-specific needs and wishes of residents. Personal hygiene is one important area to which this applies. This study was carried out to investigate residents' gender-specific perception of life and care in nursing homes. This article focuses on unspecific and gender-specific needs in the area of personal hygiene, seeking to identify where changes are needed. Structured interviews were conducted in four nursing homes with a total of ten male and ten female residents without cognitive impairments. Content analysis and description of findings proceeded in two stages: interviewees' experiences of everyday life and care were first reconstructed before gender-specific aspects were analyzed. Both universal and gender-specific needs were identified in the area of personal hygiene. The gender-unspecific wish for respect for dignity and privacy was in some cases neglected. A need for meaningful communication and respectful relationships was also gender-unspecific. Gender-specific wishes related in particular to the gender of persons assisting with or conducting personal hygiene measures. In addition to improved perception and consideration of gender-specific needs, it is also necessary to adapt nursing in residential institutions more closely to the individual needs of residents. Further research is needed in relation to the perspectives of nursing staff and the development of participatory methods for involving residents in shaping everyday life in residential institutions.

  16. Towards a Healthy High Street: Identifying Skill Needs in Small Independent Retailers.

    ERIC Educational Resources Information Center

    Byrom, John; Parker, Cathy; Harris, John

    2002-01-01

    Secondary analysis of data from a study of skill needs in the British independent retail sector suggests there is justification for focusing on higher-level training in three areas: building and sustaining competitive advantage, e-commerce, and retail operations. These areas are the core modules in a distance learning initiative that resulted from…

  17. Hearing Screening Follow-Up: Completing the Process to Identify Hearing Health Needs

    ERIC Educational Resources Information Center

    Eiserman, William; Shisler, Lenore; Hoffman, Jeff

    2015-01-01

    Hearing is at the heart of language development and school readiness; increasing numbers of Early Head Start programs have come to rely on otoacoustic emissions (OAE) technology to screen all infants and toddlers for hearing loss. Successful identification of hearing health needs is dependent not only on an appropriate screening method, but also…

  18. What Is Improvement Science? Do We Need It in Education?

    ERIC Educational Resources Information Center

    Lewis, Catherine

    2015-01-01

    The theory and tools of "improvement science" have produced performance improvements in many organizational sectors. This essay describes improvement science and explores its potential and challenges within education. Potential contributions include attention to the knowledge-building and motivational systems within schools, strategies…

  19. Improving data collection, documentation, and workflow in a dementia screening study.

    PubMed

    Read, Kevin B; LaPolla, Fred Willie Zametkin; Tolea, Magdalena I; Galvin, James E; Surkis, Alisa

    2017-04-01

    A clinical study team performing three multicultural dementia screening studies identified the need to improve data management practices and facilitate data sharing. A collaboration was initiated with librarians as part of the National Library of Medicine (NLM) informationist supplement program. The librarians identified areas for improvement in the studies' data collection, entry, and processing workflows. The librarians' role in this project was to meet needs expressed by the study team around improving data collection and processing workflows to increase study efficiency and ensure data quality. The librarians addressed the data collection, entry, and processing weaknesses through standardizing and renaming variables, creating an electronic data capture system using REDCap, and developing well-documented, reproducible data processing workflows. NLM informationist supplements provide librarians with valuable experience in collaborating with study teams to address their data needs. For this project, the librarians gained skills in project management, REDCap, and understanding of the challenges and specifics of a clinical research study. However, the time and effort required to provide targeted and intensive support for one study team was not scalable to the library's broader user community.

  20. DEVELOPMENT AND IMPROVEMENT OF TEMPORAL ALLOCATION FACTOR FILES

    EPA Science Inventory

    The report gives results of a project to: (1) evaluate the quality and completeness of data and methods being used for temporal allocation of emissions data, (2) identify and prioritize needed improvements to current methods for developing temporal allocation factors (TAFs), and ...

  1. Improving Customer Satisfaction in an R and D Environment

    NASA Technical Reports Server (NTRS)

    Alexander, Anita; Liou, Y. H. Andrew

    1998-01-01

    Satisfying customer needs is critical to the sustained competitive advantage of service suppliers. It is therefore important to understand the types of customer needs which, if fulfilled or exceeded, add value and contribute to overall customer satisfaction. This study identifies the needs of various research and development (R&D) customers who contract for engineering and design support services. The Quality Function Deployment (QFD) process was used to organize and translate each customer need into performance measures that, if implemented, can improve customer satisfaction. This study also provides specific performance measures that will more accurately guide the efforts of the engineering supplier. These organizations can either implement the QFD methodology presented herein or extract a few performance measures that are specific to the quality dimensions in need of improvement. Listening to 'what' customers talk about is a good first start.

  2. Conceptualizing and assessing improvement capability: a review

    PubMed Central

    Boaden, Ruth; Walshe, Kieran

    2017-01-01

    Abstract Purpose The literature is reviewed to examine how ‘improvement capability’ is conceptualized and assessed and to identify future areas for research. Data sources An iterative and systematic search of the literature was carried out across all sectors including healthcare. The search was limited to literature written in English. Data extraction The study identifies and analyses 70 instruments and frameworks for assessing or measuring improvement capability. Information about the source of the instruments, the sectors in which they were developed or used, the measurement constructs or domains they employ, and how they were tested was extracted. Results of data synthesis The instruments and framework constructs are very heterogeneous, demonstrating the ambiguity of improvement capability as a concept, and the difficulties involved in its operationalisation. Two-thirds of the instruments and frameworks have been subject to tests of reliability and half to tests of validity. Many instruments have little apparent theoretical basis and do not seem to have been used widely. Conclusion The assessment and development of improvement capability needs clearer and more consistent conceptual and terminological definition, used consistently across disciplines and sectors. There is scope to learn from existing instruments and frameworks, and this study proposes a synthetic framework of eight dimensions of improvement capability. Future instruments need robust testing for reliability and validity. This study contributes to practice and research by presenting the first review of the literature on improvement capability across all sectors including healthcare. PMID:28992146

  3. Identifying psychological contract breaches to guide improvements in faculty recruitment, retention, and development.

    PubMed

    Peirce, Gretchen L; Desselle, Shane P; Draugalis, JoLaine R; Spies, Alan R; Davis, Tamra S; Bolino, Mark

    2012-08-10

    To identify pharmacy faculty members' perceptions of psychological contract breaches that can be used to guide improvements in faculty recruitment, retention, and development. A list of psychological contract breaches was developed using a Delphi procedure involving a panel of experts assembled through purposive sampling. The Delphi consisted of 4 rounds, the first of which elicited examples of psychological contract breaches in an open-ended format. The ensuing 3 rounds consisting of a survey and anonymous feedback on aggregated group responses. Usable responses were obtained from 11 of 12 faculty members who completed the Delphi procedure. The final list of psychological contract breaches included 27 items, after modifications based on participant feedback in subsequent rounds. The psychological contract breach items generated in this study provide guidance for colleges and schools of pharmacy regarding important aspects of faculty recruitment, retention, and development.

  4. Continuing Veterinary Medical Education Needs Assessment of Small Animal Practitioners in South Korea.

    PubMed

    Chun, Myung-Sun; Hwang, Cheol-Yong

    2015-01-01

    This first survey of small animal veterinarians in Korea explores demographic patterns, previous learning experiences, and program preferences for continuing veterinary medical education (CVME). Data were analyzed to identify and describe learning needs and preferences. Respondents' average CVME hours (38.4 hours/year) exceeded the mandatory 10 hours per year. Almost all respondents recognized the importance of CVME. Lack of time and travel distance were identified as significant barriers to CVME participation. CVME courses scheduled after 9 p.m. on weekdays with a registration fee of up to $50 US per hour were preferred. Respondents clearly defined the educational quality criteria of preferred CVME programs: delivery in a series of interventions in a small seminar format, with lectures on theory combined with practical skill-building wet labs taught by experienced veterinarians and board-certified specialists. Small animal veterinarians in Korea are enthusiastic life-long learners who are strongly motivated to select CVME learning activities based on self-identified needs. The changing environment of veterinary medicine in Korea demands an evolution of CVME quality criteria, such as clear program goals reflecting veterinarians' educational needs and desirable competencies, and specific measurable learning objectives. Moreover, the current accreditation system, which does not encourage hands-on skill development formats, needs urgent improvement.

  5. Making the most of learning needs assessments.

    PubMed

    Williams, M L

    1998-01-01

    Identifying learning needs of nurses is an important role of the staff development educator. However, few educators have specific training in the preparation and evaluation of a learning needs assessment. This article describes the assumptions, benefits, and potential barriers when planning a needs assessment survey. Specific strategies to maximize the benefits of the survey are shared. Competent nurses are the cornerstone of professional nursing care, and identifying and responding to learning needs through a needs assessment is a critical step in assuring competence.

  6. Development of an Interview Guide Identifying the Rehabilitation Needs of Women from the Middle East Living with Chronic Pain.

    PubMed

    Zander, Viktoria; Eriksson, Henrik; Christensson, Kyllike; Müllersdorf, Maria

    2015-09-25

    The purpose of this study was to develop an interview guide for use by primary healthcare professionals to support them in identifying the rehabilitation needs of forced resettled women from the Middle East living with chronic pain. Previous findings together with the existing literature were used as the basis for developing the interview guide in three steps: item generation, cognitive interviews, and a pilot study. The study resulted in a 16-item interview guide focusing on patients' concerns and expectations, with consideration of pre-migration, migration, and post-migration factors that might affect their health. With the help of the guide, patients were also invited to identify difficulties in their daily activities and to take part in setting goals and planning their rehabilitation. The current interview guide provides professional guidance to caretakers, taking a person-centered participative point of departure when meeting and planning care, for and together, with representatives from dispersed ethnic populations in Sweden. It can be used together with the patient by all staff members working in primary healthcare, with the aim of contributing to continuity of care and multi-professional collaboration.

  7. Development of an Interview Guide Identifying the Rehabilitation Needs of Women from the Middle East Living with Chronic Pain

    PubMed Central

    Zander, Viktoria; Eriksson, Henrik; Christensson, Kyllike; Müllersdorf, Maria

    2015-01-01

    The purpose of this study was to develop an interview guide for use by primary healthcare professionals to support them in identifying the rehabilitation needs of forced resettled women from the Middle East living with chronic pain. Previous findings together with the existing literature were used as the basis for developing the interview guide in three steps: item generation, cognitive interviews, and a pilot study. The study resulted in a 16-item interview guide focusing on patients’ concerns and expectations, with consideration of pre-migration, migration, and post-migration factors that might affect their health. With the help of the guide, patients were also invited to identify difficulties in their daily activities and to take part in setting goals and planning their rehabilitation. The current interview guide provides professional guidance to caretakers, taking a person-centered participative point of departure when meeting and planning care, for and together, with representatives from dispersed ethnic populations in Sweden. It can be used together with the patient by all staff members working in primary healthcare, with the aim of contributing to continuity of care and multi-professional collaboration. PMID:26404332

  8. Identifying areas of need relative to liver disease: geographic clustering within a health service district.

    PubMed

    El-Atem, Nathan; Irvine, Katharine M; Valery, Patricia C; Wojcik, Kyle; Horsfall, Leigh; Johnson, Tracey; Janda, Monika; McPhail, Steven M; Powell, Elizabeth E

    2017-08-01

    Background Many people with chronic liver disease (CLD) are not detected until they present to hospital with advanced disease, when opportunities for intervention are reduced and morbidity is high. In order to build capacity and liver expertise in the community, it is important to focus liver healthcare resources in high-prevalence disease areas and specific populations with an identified need. The aim of the present study was to examine the geographic location of people seen in a tertiary hospital hepatology clinic, as well as ethnic and sociodemographic characteristics of these geographic areas. Methods The geographic locations of hepatology out-patients were identified via the out-patient scheduling database and grouped into statistical area (SA) regions for demographic analysis using data compiled by the Australian Bureau of Statistics. Results During the 3-month study period, 943 individuals from 71 SA Level 3 regions attended clinic. Nine SA Level 3 regions accounted for 55% of the entire patient cohort. Geographic clustering was seen especially for people living with chronic hepatitis B virus. There was a wide spectrum of socioeconomic advantage and disadvantage in areas with high liver disease prevalence. Conclusions The geographic area from which people living with CLD travel to access liver health care is extensive. However, the greatest demand for tertiary liver disease speciality care is clustered within specific geographic areas. Outreach programs targeted to these areas may enhance liver disease-specific health service resourcing. What is known about the topic? The demand for tertiary hospital clinical services in CLD is rising. However, there is limited knowledge about the geographic areas from which people living with CLD travel to access liver services, or the ethnic, socioeconomic and education characteristics of these areas. What does this paper add? The present study demonstrates that a substantial proportion of people living with CLD and

  9. Top 10 Ways to Improve Science Achievement: Actions for School Principals, Assistant Principals, Department Chairs and School Improvement Consultants.

    ERIC Educational Resources Information Center

    Southern Regional Education Board (SREB), 2007

    2007-01-01

    High Schools That Work (HSTW) Assessment data show the need to improve science education in both the middle grades and high school. Science education increases students' critical thinking and problem-solving skills. This publication is designed to help principals, other school leaders and teachers identify rigorous instruction and successfully…

  10. Evaluability Assessment of an immunization improvement strategy in rural Burkina Faso: intervention theory versus reality, information need and evaluations.

    PubMed

    Sanou, Aboubakary; Kouyaté, Bocar; Bibeau, Gilles; Nguyen, Vinh-Kim

    2011-08-01

    An innovative immunization improvement strategy was proposed by the CRSN (Centre de Recherche en Santé de Nouna) to improve the low coverage rate for children aged 0-11 months in the health district of Nouna in Burkina Faso. This article reports on the Evaluability Assessment (EA) study that aimed to orient decisions for its evaluation in close relationship with the information needs of the stakeholders. Various methods were used, including document reviews, individual interviews, focus group discussions, meetings, literature reviews and site visits. A description of the intervention theory and philosophy is provided with its logic models and its reality documented. Lessons on the procedure include the importance of the position of the evaluability assessor, the value of replicating some steps of the assessment and the relationships between EA and process evaluation. The evaluability study concludes that the intervention had some evaluable components. To satisfy the stakeholders' needs, the initially planned community randomized controlled trial can be maintained and complemented with a process evaluation. There is a need to provide sufficient information on the cost of the intervention. This will inform decision makers on the possibility of replicating the intervention in other contexts. Copyright © 2010 Elsevier Ltd. All rights reserved.

  11. A national assessment of children with special health care needs: prevalence of special needs and use of health care services among children in the military health system.

    PubMed

    Williams, Thomas V; Schone, Eric M; Archibald, Nancy D; Thompson, Joseph W

    2004-08-01

    Children are frequently perceived to be healthy, low-risk individuals with a majority of clinical services devoted to health maintenance and preventive clinical services. However, a subset of children have unique needs that require specialized care to achieve optimal health outcomes. The purpose of this research was to use survey tools that have been developed to identify children with special health care needs (CSHCN) to measure prevalence and resource needs of these children in the military health system (MHS). The US Department of Defense manages the MHS, which is one of the largest integrated health care systems in the world and provides care to almost 2,000000 children. We incorporated the CSHCN survey screener and assessment questions into the annual health care survey of beneficiaries who are eligible for benefits within the MHS. In addition, we used claims information available from inpatient and outpatient services. We used parent reports from the survey to estimate the prevalence of CSHCN. Incorporating claims data and restricting our analyses to those who were enrolled continuously in a military health maintenance organization (TRICARE Prime), we described utilization of different types of health care resources and compared CSHCN with their healthy counterparts. Finally, we examined alternative types of special needs and performed regression analyses to identify the major determinants of health needs and resource utilization to guide system management and policy development. CSHCN compose 23% of the TRICARE Prime enrollees who are younger than 18 years and whose parents responded to the survey. The needs of a majority of these children consist of prescription medications and services targeting medical, mental health, and educational needs. CSHCN experience 5 times as many admissions and 10 times as many days in hospitals compared with children without special needs. CSHCN are responsible for nearly half of outpatient visits for enrolled children and more

  12. Scenario Planning to Identify Science Needs for the Management of Energy and Resource Development in the Arctic

    NASA Astrophysics Data System (ADS)

    Lassuy, D.

    2013-12-01

    Slope of Alaska and the adjacent Beaufort and Chukchi Seas. As currently designed, this NSSI scenario planning effort will encompass two broadly defined steps. We will engage local communities along with resource agencies, industry, non-governmental organizations, academia, and others with Arctic interests in exploring plausible future development activity (scenarios). Then we will undertake science- and traditional knowledge-informed explorations of the relevant research and monitoring that will be needed to detect, assess, and respond to the identified range of plausible development-driven changes on the North Slope and adjacent seas (strategies). The intent is for these strategies to then inform agency decisions about future investment in research and monitoring, and particularly to identify opportunities to collaborate in a manner that will benefit all involved parties. However, it is also important to note that the most important short- and long-term benefit of this scenario planning exercise may in fact be the strengthening of an involved and informed community of stakeholder participants, regardless of specific informational or strategic outcomes.

  13. Fulfilling Reform's Promise: The Need To Expand the Vision of Education in the South.

    ERIC Educational Resources Information Center

    BellSouth Foundation, Inc. Atlanta, GA.

    This study explored the role of philanthropy in educational reform. A survey of 22 educators with links to the southern United States was conducted to identify educational needs and to solicit ideas for educational improvement. Priorities redefined by the BellSouth Foundation in response to survey findings include supporting educators to meet…

  14. Improving Teacher Quality for Colorado Science Teachers in High Need Schools

    ERIC Educational Resources Information Center

    Stevenson, Mark; Stevenson, Cerissa; Cooner, Donna

    2015-01-01

    This article describes the evaluation of an online professional development program funded by the State of Colorado to address the need for highly qualified science teachers in high need and/or rural school districts. Recruitment and the retention of highly qualified educators in high need and/or rural school districts is a critical factor…

  15. Clinical leadership and prevention in practice: is a needs led preventive approach to the delivery of care to improve quality, outcomes and value in primary dental care practice a realistic concept?

    PubMed Central

    2015-01-01

    Background There is a need to improve access to, and the quality of, service delivery in NHS primary dental care. Building public health thinking and leadership capacity in clinicians from primary care teams was seen as an underpinning component to achieving this goal. Clinical teams contributed to service redesign concepts and were contractually supported to embrace a preventive approach. Methods Improvement in quality and preventive focus of dental practice care delivery was explored through determining the impact of several projects, to share how evidence, skill mix and clinical leadership could be utilised in design, implementation and measurement of care outcomes in general dental practice in order to champion and advocate change, during a period of substantial change within the NHS system. The projects were: 1. A needs-led, evidence informed preventive care pathway approach to primary dental care delivery with a focus on quality and outcomes. 2. Building clinical leadership to influence and advocate for improved quality of care; and spread of learning through local professional networks. This comprised two separate projects: improved access for very young children called “Baby Teeth DO Matter” and the production of a clinically led, evidence-based guidance for periodontyal treatment in primary care called “Healthy Gums DO Matter”. Results What worked and what hindered progress, is described. The projects developed understanding of how working with ‘local majorities’ of clinicians influenced, adoption and spread of learning, and the impact in prompting wider policy and contract reform in England. Conclusions The projects identified issues that required change to meet population need. Clinicians were allowed to innovate in an evironment working together with commissioners, patients and public health colleagues. Communication and the development of clinical leadership led to the development of an infrastructure to define care pathways and decision

  16. Clinical leadership and prevention in practice: is a needs led preventive approach to the delivery of care to improve quality, outcomes and value in primary dental care practice a realistic concept?

    PubMed

    Bridgman, Colette; McGrady, Michael G

    2015-01-01

    There is a need to improve access to, and the quality of, service delivery in NHS primary dental care. Building public health thinking and leadership capacity in clinicians from primary care teams was seen as an underpinning component to achieving this goal. Clinical teams contributed to service redesign concepts and were contractually supported to embrace a preventive approach. Improvement in quality and preventive focus of dental practice care delivery was explored through determining the impact of several projects, to share how evidence, skill mix and clinical leadership could be utilised in design, implementation and measurement of care outcomes in general dental practice in order to champion and advocate change, during a period of substantial change within the NHS system. The projects were: 1. A needs-led, evidence informed preventive care pathway approach to primary dental care delivery with a focus on quality and outcomes. 2. Building clinical leadership to influence and advocate for improved quality of care; and spread of learning through local professional networks. This comprised two separate projects: improved access for very young children called “Baby Teeth DO Matter” and the production of a clinically led, evidence-based guidance for periodontyal treatment in primary care called "Healthy Gums DO Matter". What worked and what hindered progress, is described. The projects developed understanding of how working with 'local majorities' of clinicians influenced, adoption and spread of learning, and the impact in prompting wider policy and contract reform in England. The projects identified issues that required change to meet population need. Clinicians were allowed to innovate in an environment working together with commissioners, patients and public health colleagues. Communication and the development of clinical leadership led to the development of an infrastructure to define care pathways and decision points in the patient's journey.

  17. Trauma patient discharge and care transition experiences: Identifying opportunities for quality improvement in trauma centres.

    PubMed

    Gotlib Conn, Lesley; Zwaiman, Ashley; DasGupta, Tracey; Hales, Brigette; Watamaniuk, Aaron; Nathens, Avery B

    2018-01-01

    Challenges delivering quality care are especially salient during hospital discharge and care transitions. Severely injured patients discharged from a trauma centre will go either home, to rehabilitation or another acute care hospital with complex management needs. This purpose of this study was to explore the experiences of trauma patients and families treated in a regional academic trauma centre to better understand and improve their discharge and care transition experiences. A qualitative study using inductive thematic analysis was conducted between March and October 2016. Telephone interviews were conducted with trauma patients and/or a family member after discharge from the trauma centre. Data collection and analysis were completed inductively and iteratively consistent with a qualitative approach. Twenty-four interviews included 19 patients and 7 family members. Participants' experiences drew attention to discharge and transfer processes that either (1) Fostered quality discharge or (2) Impeded quality discharge. Fostering quality discharge was ward staff preparation efforts; establishing effective care continuity; and, adequate emotional support. Impeding discharge quality was perceived pressure to leave the hospital; imposed transfer decisions; and, sub-optimal communication and coordination around discharge. Patient-provider communication was viewed to be driven by system, rather than patient need. Inter-facility information gaps raised concern about receiving facilities' ability to care for injured patients. The quality of trauma patient discharge and transition experiences is undermined by system- and ward-level processes that compete, rather than align, in producing high quality patient-centred discharge. Local improvement solutions focused on modifiable factors within the trauma centre include patient-oriented discharge education and patient navigation; however, these approaches alone may be insufficient to enhance patient experiences. Trauma patients

  18. Early detection monitoring for aquatic non-indigenous species: Optimizing surveillance, incorporating advanced technologies, and identifying research needs.

    PubMed

    Trebitz, Anett S; Hoffman, Joel C; Darling, John A; Pilgrim, Erik M; Kelly, John R; Brown, Emily A; Chadderton, W Lindsay; Egan, Scott P; Grey, Erin K; Hashsham, Syed A; Klymus, Katy E; Mahon, Andrew R; Ram, Jeffrey L; Schultz, Martin T; Stepien, Carol A; Schardt, James C

    2017-11-01

    Following decades of ecologic and economic impacts from a growing list of nonindigenous and invasive species, government and management entities are committing to systematic early- detection monitoring (EDM). This has reinvigorated investment in the science underpinning such monitoring, as well as the need to convey that science in practical terms to those tasked with EDM implementation. Using the context of nonindigenous species in the North American Great Lakes, this article summarizes the current scientific tools and knowledge - including limitations, research needs, and likely future developments - relevant to various aspects of planning and conducting comprehensive EDM. We begin with the scope of the effort, contrasting target-species with broad-spectrum monitoring, reviewing information to support prioritization based on species and locations, and exploring the challenge of moving beyond individual surveys towards a coordinated monitoring network. Next, we discuss survey design, including effort to expend and its allocation over space and time. A section on sample collection and analysis overviews the merits of collecting actual organisms versus shed DNA, reviews the capabilities and limitations of identification by morphology, DNA target markers, or DNA barcoding, and examines best practices for sample handling and data verification. We end with a section addressing the analysis of monitoring data, including methods to evaluate survey performance and characterize and communicate uncertainty. Although the body of science supporting EDM implementation is already substantial, research and information needs (many already actively being addressed) include: better data to support risk assessments that guide choice of taxa and locations to monitor; improved understanding of spatiotemporal scales for sample collection; further development of DNA target markers, reference barcodes, genomic workflows, and synergies between DNA-based and morphology-based taxonomy; and

  19. Lifestyle, attitudes and needs of uncured XDR-TB patients living in the communities of South Africa: a qualitative study.

    PubMed

    Senthilingam, Meera; Pietersen, Elize; McNerney, Ruth; Te Riele, Julian; Sedres, Pat; Wilson, Ruth; Dheda, Keertan

    2015-09-01

    Patient-level data are required to inform strategies interrupting transmission and default in patients with extensively drug-resistant TB (XDR-TB) to improve models of care and identify potential routes of transmission. We therefore explored the experiences, lifestyle, attitudes and needs of patients with uncured XDR-TB, who failed or interrupted therapy, living without treatment in the community. We conducted in-depth interviews with 12 community-based patients from South Africa. Family members were interviewed when patients were unavailable. Interviews were analysed using inductive thematic analysis. The thematic experiences identified from the interviews were as follows: (i) living with but not being cured of XDR-TB, (ii) altered lifestyle in the community, (iii) experiences with community health care, (iv) local community members, and (v) wants and needs. Patients identified mistrust in health care, futility of treatment regimens, a need for a purpose in life and subsistence as major concerns. Restriction of living in the community for patients whose treatment had failed resulted in self-imposed isolation. Defaulters focused more on the never-ending drug regimen and bad experiences with health care contributing to non-adherence. Family members emphasised an under-recognised experience of unforeseen burden, obligation, worry and discomfort. Lack of knowledge and lack of concern about transmission was evident. Current models of care are not adequately meeting the needs of patients with uncured XDR-TB and relatives. These data inform the need for community-based palliative care, vocational facilities to improve economic opportunities, home-based infection control and improved psychosocial support to increase patient adherence, reduce transmission, provide income and relieve the burden on family members. © 2015 John Wiley & Sons Ltd.

  20. Identifying Unmet Treatment Needs for Patients With Osteoporotic Fracture: Feasibility Study for an Electronic Clinical Surveillance System.

    PubMed

    Lin, Fong-Ci; Wang, Chen-Yu; Shang, Rung Ji; Hsiao, Fei-Yuan; Lin, Mei-Shu; Hung, Kuan-Yu; Wang, Jui; Lin, Zhen-Fang; Lai, Feipei; Shen, Li-Jiuan; Huang, Chih-Fen

    2018-04-24

    Traditional clinical surveillance relied on the results from clinical trials and observational studies of administrative databases. However, these studies not only required many valuable resources but also faced a very long time lag. This study aimed to illustrate a practical application of the National Taiwan University Hospital Clinical Surveillance System (NCSS) in the identification of patients with an osteoporotic fracture and to provide a high reusability infrastructure for longitudinal clinical data. The NCSS integrates electronic medical records in the National Taiwan University Hospital (NTUH) with a data warehouse and is equipped with a user-friendly interface. The NCSS was developed using professional insight from multidisciplinary experts, including clinical practitioners, epidemiologists, and biomedical engineers. The practical example identifying the unmet treatment needs for patients encountering major osteoporotic fractures described herein was mainly achieved by adopting the computerized workflow in the NCSS. We developed the infrastructure of the NCSS, including an integrated data warehouse and an automatic surveillance workflow. By applying the NCSS, we efficiently identified 2193 patients who were newly diagnosed with a hip or vertebral fracture between 2010 and 2014 at NTUH. By adopting the filter function, we identified 1808 (1808/2193, 82.44%) patients who continued their follow-up at NTUH, and 464 (464/2193, 21.16%) patients who were prescribed anti-osteoporosis medications, within 3 and 12 months post the index date of their fracture, respectively. The NCSS systems can integrate the workflow of cohort identification to accelerate the survey process of clinically relevant problems and provide decision support in the daily practice of clinical physicians, thereby making the benefit of evidence-based medicine a reality. ©Fong-Ci Lin, Chen-Yu Wang, Rung Ji Shang, Fei-Yuan Hsiao, Mei-Shu Lin, Kuan-Yu Hung, Jui Wang, Zhen-Fang Lin, Feipei Lai

  1. Rethinking Student Services: Assessing and Improving Service Quality.

    ERIC Educational Resources Information Center

    Zammuto, Raymond F.; And Others

    1996-01-01

    A study investigated the quality of services in four student enrollment services administrative sub-units (recruiting, admissions, records and registration, financial aid) at a public comprehensive university, using student and staff evaluations and program evaluations. Specific changes needed to improve service delivery are identified and…

  2. Identifying the needs of critical and acute cardiac care nurses within the first two years of practice in Egypt using a nominal group technique.

    PubMed

    Gorman, Linda L; McDowell, Joan R S

    2018-01-01

    Nursing in Egypt faces many challenges and working conditions in health care settings are generally poor. Little is known about the needs of new nurses transitioning in Egypt. The literature focuses on the first year of practice and only a small body of research has explored the transition needs within acute care speciality settings. This paper reports on the important professional needs of new graduate nurses working in an acute cardiac setting in Egypt during the first two years of practice and differences between their perceived most important needs. The total population participated and two group interviews were conducted (n = 5; n = 6) using the nominal group technique. Needs were identified and prioritised using both rankings and ratings to attain consensus. Content analysis was conducted to produce themes and enable cross-group comparison. Rating scores were standardised for comparison within and between groups. Both groups ranked and rated items as important: 1) education, training and continued professional development; 2) professional standards; 3) supportive clinical practice environment; 4) manageable work patterns, and 5) organisational structure. It is important that health care organisations are responsive to these needs to ensure support strategies reflect the priorities of new nurses transitioning in acute care hospitals within Egypt. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Improving the precision of lake ecosystem metabolism estimates by identifying predictors of model uncertainty

    USGS Publications Warehouse

    Rose, Kevin C.; Winslow, Luke A.; Read, Jordan S.; Read, Emily K.; Solomon, Christopher T.; Adrian, Rita; Hanson, Paul C.

    2014-01-01

    Diel changes in dissolved oxygen are often used to estimate gross primary production (GPP) and ecosystem respiration (ER) in aquatic ecosystems. Despite the widespread use of this approach to understand ecosystem metabolism, we are only beginning to understand the degree and underlying causes of uncertainty for metabolism model parameter estimates. Here, we present a novel approach to improve the precision and accuracy of ecosystem metabolism estimates by identifying physical metrics that indicate when metabolism estimates are highly uncertain. Using datasets from seventeen instrumented GLEON (Global Lake Ecological Observatory Network) lakes, we discovered that many physical characteristics correlated with uncertainty, including PAR (photosynthetically active radiation, 400-700 nm), daily variance in Schmidt stability, and wind speed. Low PAR was a consistent predictor of high variance in GPP model parameters, but also corresponded with low ER model parameter variance. We identified a threshold (30% of clear sky PAR) below which GPP parameter variance increased rapidly and was significantly greater in nearly all lakes compared with variance on days with PAR levels above this threshold. The relationship between daily variance in Schmidt stability and GPP model parameter variance depended on trophic status, whereas daily variance in Schmidt stability was consistently positively related to ER model parameter variance. Wind speeds in the range of ~0.8-3 m s–1 were consistent predictors of high variance for both GPP and ER model parameters, with greater uncertainty in eutrophic lakes. Our findings can be used to reduce ecosystem metabolism model parameter uncertainty and identify potential sources of that uncertainty.

  4. Pregnant adolescents living with HIV: what we know, what we need to know, where we need to go.

    PubMed

    Callahan, Tegan; Modi, Surbhi; Swanson, Jennifer; Ng'eno, Bernadette; Broyles, Laura N

    2017-08-04

    HIV-infected pregnant and breastfeeding adolescents are a particularly vulnerable group that require special attention and enhanced support to achieve optimal maternal and infant outcomes. The objective of this paper is to review published evidence about antenatal care (ANC) service delivery and outcomes for HIV-infected pregnant adolescents in low-income country settings, identify gaps in knowledge and programme services and highlight the way forward to improve clinical outcomes of this vulnerable group. Emerging data from programmes in sub-Saharan Africa highlight that HIV-infected pregnant adolescents have poorer prevention of mother-to-child HIV transmission (PMTCT) service outcomes, including lower PMTCT service uptake, compared to HIV-infected pregnant adults. In addition, the limited evidence available suggests that there may be higher rates of mother-to-child HIV transmission among infants of HIV-infected pregnant adolescents. While the reasons for the inferior outcomes among adolescents in ANC need to be further explored and addressed, there is sufficient evidence that immediate operational changes are needed to address the unique needs of this population. Such changes could include integration of adolescent-friendly services into PMTCT settings or targeting HIV-infected pregnant adolescents with enhanced retention and follow-up activities.

  5. Assessing School Wellness Policies and Identifying Priorities for Action: Results of a Bi-State Evaluation.

    PubMed

    Harvey, Susan P; Markenson, Deborah; Gibson, Cheryl A

    2018-05-01

    Obesity is a complex health problem affecting more than one-third of school-aged youth. The increasing obesity rates in Kansas and Missouri has been particularly concerning, with efforts being made to improve student health through the implementation of school wellness policies (SWPs). The primary purpose of this study was to conduct a rigorous assessment of SWPs in the bi-state region. SWPs were collected from 46 school districts. The Wellness School Assessment Tool (WellSAT) was used to assess comprehensiveness and strength. Additionally, focus group discussions and an online survey were conducted with school personnel to identify barriers and supports needed. Assessment of the SWPs indicated that most school districts failed to provide strong and specific language. Due to these deficiencies, districts reported lack of enforcement of policies. Several barriers to implementing the policies were reported by school personnel; supports needed for effective implementation were identified. To promote a healthful school environment, significant improvements are warranted in the strength and comprehensiveness of the SWPs. The focus group discussions provided insight as to where we need to bridge the gap between the current state of policies and the desired beneficial practices to support a healthy school environment. © 2018, American School Health Association.

  6. An integrated and sustainable EU health information system: national public health institutes' needs and possible benefits.

    PubMed

    Bogaert, Petronille; Van Oyen, Herman

    2017-01-01

    Although sound data and health information are at the basis of evidence-based policy-making and research, still no single, integrated and sustainable EU-wide public health monitoring system or health information system exists. BRIDGE Health is working towards an EU health information and data generation network covering major EU health policy areas. A stakeholder consultation with national public health institutes was organised to identify the needs to strengthen the current EU health information system and to identify its possible benefits. Five key issues for improvement were identified: (1) coherence, coordination and sustainability; (2) data harmonization, collection, processing and reporting; (3) comparison and benchmarking; (4) knowledge sharing and capacity building; and (5) transferability of health information into evidence-based policy making. The vision of an improved EU health information system was formulated and the possible benefits in relation to six target groups. Through this consultation, BRIDGE Health has identified the continuous need to strengthen the EU health information system. A better system is about sustainability, better coordination, governance and collaboration among national health information systems and stakeholders to jointly improve, harmonise, standardise and analyse health information. More and better sharing of this comparable health data allows for more and better comparative health research, international benchmarking, national and EU-wide public health monitoring. This should be developed with the view to provide the tools to fight both common and individual challenges faced by the Members States and their politicians.

  7. Identifying the Future Needs for Long-Term USDA Efforts in Agricultural Animal Genomics

    PubMed Central

    Green, R. D.; Qureshi, M. A.; Long, J. A.; Burfening, P.J.; Hamernik, D.L.

    2007-01-01

    Agricultural animal research has been immensely successful over the past century in developing technology and methodologies that have dramatically enhanced production efficiency of the beef, dairy, swine, poultry, sheep, and aquaculture industries. In the past two decades, molecular biology has changed the face of agricultural animal research, primarily in the arena of genomics and the relatively new offshoot areas of functional genomics, proteomics, transcriptomics, metabolomics and metagenomics. Publication of genetic and physical genome maps in the past 15 years has given rise to the possibility of being able finally to understand the molecular nature of the genetic component of phenotypic variation. While quantitative geneticists have been remarkably successful in improving production traits, genomic technology holds potential for being able to lead to more accurate and rapid animal improvement, especially for phenotypic traits that are difficult to measure. Recently, the agricultural research community has been able to capitalize on the infrastructure built by the human genome proj