Does implementing a development plan for user participation in a mental hospital change patients' experience? A non-randomized controlled study.

PubMed

Rise, Marit B; Steinsbekk, Aslak

2015-10-01

Governments in several countries attempt to strengthen user participation through instructing health-care organizations to implement user participation initiatives. There is, however, little knowledge on the effect on patients' experience from comprehensive plans for enhancing user participation in whole health service organizations. To investigate whether implementing a development plan intending to enhance user participation in a mental hospital had any effect on the patients' experience of user participation. A non-randomized controlled study including patients in three mental hospitals in Central Norway, one intervention hospital and two control hospitals. A development plan intended to enhance user participation was implemented in the intervention hospital as a part of a larger reorganizational process. The plan included establishment of a patient education centre and a user office, purchase of user expertise, appointment of contact professionals for next of kin and improvement of the centre's information and the professional culture. Perceptions of Care, Inpatient Treatment Alliance Scale and questions made for this study. A total of 1651 patients participated. Implementing a development plan in a mental hospital intending to enhance user participation had no significant effect on the patients' experience of user participation. The lack of effect can be due to inappropriate initiatives or challenges in implementation processes. Further research should ensure that initiatives and implementation processes are appropriate to impact the patients' experience. © 2013 John Wiley & Sons Ltd.

Hands4U: the effects of a multifaceted implementation strategy on hand eczema prevalence in a healthcare setting. Results of a randomized controlled trial.

PubMed

van der Meer, Esther W C; Boot, Cécile R L; van der Gulden, Joost W J; Knol, Dirk L; Jungbauer, Frank H W; Coenraads, Pieter Jan; Anema, Johannes R

2015-05-01

Healthcare workers have an increased risk of developing hand eczema. A multifaceted implementation strategy was developed to implement a guideline to prevent hand eczema among healthcare workers. To investigate the effects of the implementation strategy on self-reported hand eczema and preventive behaviour. A randomized controlled trial was performed. A total of 48 departments (n = 1649) were randomly allocated to the multifaceted implementation strategy or the control group. The strategy consisted of education, participatory working groups, and role models. Outcome measures were self-reported hand eczema and preventive behaviour. Data were collected at baseline, and 3, 6, 9 and 12 months of follow-up. Participants in the intervention group were significantly more likely to report hand eczema [odds ratio (OR) 1.45; 95% confidence interval (CI) 1.03-2.04], and they reported significantly less hand washing (B, - 0.38; 95%CI: - 0.48 to - 0.27), reported significantly more frequent use of a moisturizer (B, 0.30; 95%CI: 0.22-0.39) and were more likely to report wearing cotton undergloves (OR 6.33; 95%CI: 3.23-12.41) than participants in the control group 12 months after baseline. The strategy implemented can be used in practice, as it showed positive effects on preventive behaviour. More research is needed to investigate the unexpected effects on hand eczema. © 2014 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.

Sea-level evaluation of digitally implemented turbojet engine control functions

NASA Technical Reports Server (NTRS)

Arpasi, D. J.; Cwynar, D. S.; Wallhagen, R. E.

1972-01-01

The standard hydromechanical control system of a turbojet engine was replaced with a digital control system that implemented the same control laws. A detailed discussion of the digital control system in use with the engine is presented. The engine was operated in a sea-level test stand. The effects of control update interval are defined, and a method for extending this interval by using digital compensation is discussed.

Effect of systematic ergonomic hazard identification and control implementation on musculoskeletal disorder and injury risk.

PubMed

Cantley, Linda F; Taiwo, Oyebode A; Galusha, Deron; Barbour, Russell; Slade, Martin D; Tessier-Sherman, Baylah; Cullen, Mark R

2014-01-01

This study aimed to examine the effect of an ergonomic hazard control (HC) initiative, undertaken as part of a company ergonomics standard, on worker injury risk. Using the company's ergonomic hazards database to identify jobs with and without ergonomic HC implementation and linking to individual job and injury histories, injury risk among person-jobs with HC implementation (the HC group) was compared to those without HC (NoHC group) using random coefficient models. Further analysis of the HC group was conducted to determine the effect of additional ergonomic hazards controlled on injury risk. Among 123 jobs at 17 plant locations, 347 ergonomic hazards were quantitatively identified during the study period. HC were implemented for 204 quantified ergonomic hazards in 84 jobs, impacting 10 385 persons (12 967 person-jobs). No HC were implemented for quantified ergonomic hazards in the remaining 39 jobs affecting 4155 persons (5046 person-jobs). Adjusting for age, sex, plant origin, and year to control for any temporal trend in injury risk, the relative risk (RR) for musculoskeletal disorder (MSD) was 0.85 and the RR for any injury or MSD was 0.92 in the HC compared to NoHC group. Among the HC group, each ergonomic hazard controlled was associated with risk reduction for MSD and acute injury outcomes (RR 0.93). Systematic ergonomic HC through participatory ergonomics, as part of a mandatory company ergonomics standard, is associated with MSD and injury risk reduction among workers in jobs with HC implemented.

Effectiveness of guideline dissemination and implementation strategies on health care professionals' behaviour and patient outcomes in the cancer care context: a systematic review protocol.

PubMed

Tomasone, Jennifer R; Chaudhary, Rushil; Brouwers, Melissa C

2015-08-25

Health care professionals (HCPs) are able to make effective decisions regarding patient care through the use of systematically developed clinical practice guidelines (CPGs). These recommendations are especially important in a cancer health care context as patients are exposed to a multitude of interdisciplinary HCPs offering high-quality care throughout diagnosis, treatment, survivorship and palliative care. Although a large number of CPGs targeted towards cancer are widely disseminated, it is unknown whether implementation strategies targeting the use of these guidelines are effective in effecting HCP behaviour and patient outcomes in the cancer care context. The purpose of this systematic review will be to determine the effectiveness of different CPG dissemination and implementation interventions on HCPs' behaviour and patient outcomes in the cancer health care context. Five electronic databases (CINAHL, the Cochrane Controlled Trials Register, MEDLINE via Ovid, EMBASE via Ovid and PsycINFO via Ovid) will be searched to include all studies examining the dissemination and/or implementation of CPGs in a cancer care setting targeting all HCPs. CPG implementation strategies will be included if the CPGs were systematically developed (e.g. literature review/evidence-informed, expert panel, evidence appraisal). The studies will be limited to randomized controlled trials, controlled clinical trials and quasi-experimental (interrupted time series, controlled before-and-after designs) studies. Two independent reviewers will assess articles for eligibility, data extraction and quality appraisal. The aim of this review is to inform cancer care health care professionals and policymakers about evidence-based implementation strategies that will allow for effective use of CPGs. PROSPERO CRD42015019331.

Effectiveness and implementation of an obesity prevention intervention: the HeLP-her Rural cluster randomised controlled trial.

PubMed

Lombard, Catherine B; Harrison, Cheryce L; Kozica, Samantha L; Zoungas, Sophia; Keating, Catherine; Teede, Helena J

2014-06-16

To impact on the obesity epidemic, interventions that prevent weight gain across populations are urgently needed. However, even the most efficacious interventions will have little impact on obesity prevention unless they are successfully implemented in diverse populations and settings. Implementation research takes isolated efficacy studies into practice and policy and is particularly important in obesity prevention where there is an urgent need to accelerate the evidence to practice cycle. Despite the recognised need, few obesity prevention interventions have been implemented in real life settings and to our knowledge rarely target rural communities. Here we describe the rationale, design and implementation of a Healthy Lifestyle Program for women living in small rural communities (HeLP-her Rural). The primary goal of HeLP-her Rural is to prevent weight gain using a low intensity, self-management intervention. Six hundred women from 42 small rural communities in Australia will be randomised as clusters (n-21 control towns and n = 21 intervention towns). A pragmatic randomised controlled trial methodology will test efficacy and a comprehensive mixed methods community evaluation and cost analysis will inform effectiveness and implementation of this novel prevention program. Implementing population interventions to prevent obesity is complex, costly and challenging. To address these barriers, evidence based interventions need to move beyond isolated efficacy trials and report outcomes related to effectiveness and implementation. Large pragmatic trials provide an opportunity to inform both effectiveness and implementation leading to potential for greater impact at the population level. Pragmatic trials should incorporate both effectiveness and implementation outcomes and a multidimensional methodology to inform scale-up to population level. The learnings from this trial will impact on the design and implementation of population obesity prevention strategies nationally and internationally. ANZ clinical trial registry ACTRN12612000115831. Date of registration 24/01/2012.

Three axis electronic flight motion simulator real time control system design and implementation

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

Gao, Zhiyuan; Miao, Zhonghua, E-mail: zhonghua-miao@163.com; Wang, Xiaohua

2014-12-15

A three axis electronic flight motion simulator is reported in this paper including the modelling, the controller design as well as the hardware implementation. This flight motion simulator could be used for inertial navigation test and high precision inertial navigation system with good dynamic and static performances. A real time control system is designed, several control system implementation problems were solved including time unification with parallel port interrupt, high speed finding-zero method of rotary inductosyn, zero-crossing management with continuous rotary, etc. Tests were carried out to show the effectiveness of the proposed real time control system.

Three axis electronic flight motion simulator real time control system design and implementation.

PubMed

Gao, Zhiyuan; Miao, Zhonghua; Wang, Xuyong; Wang, Xiaohua

2014-12-01

A three axis electronic flight motion simulator is reported in this paper including the modelling, the controller design as well as the hardware implementation. This flight motion simulator could be used for inertial navigation test and high precision inertial navigation system with good dynamic and static performances. A real time control system is designed, several control system implementation problems were solved including time unification with parallel port interrupt, high speed finding-zero method of rotary inductosyn, zero-crossing management with continuous rotary, etc. Tests were carried out to show the effectiveness of the proposed real time control system.

Comparison of Intervention Fidelity between COPE TEEN and an Attention-Control Program in a Randomized Controlled Trial

ERIC Educational Resources Information Center

Kelly, Stephanie A.; Oswalt, Krista; Melnyk, Bernadette Mazurek; Jacobson, Diana

2015-01-01

Fidelity in implementing an intervention is critical to accurately determine and interpret the effects of an intervention. It is important to monitor the manner in which the behavioral intervention is implemented (e.g. adaptations, delivery as intended and dose). Few interventions are implemented with 100% fidelity. In this study, high school…

An Implementation Method of the Fractional-Order PID Control System Considering the Memory Constraint and its Application to the Temperature Control of Heat Plate

NASA Astrophysics Data System (ADS)

Sasano, Koji; Okajima, Hiroshi; Matsunaga, Nobutomo

Recently, the fractional order PID (FO-PID) control, which is the extension of the PID control, has been focused on. Even though the FO-PID requires the high-order filter, it is difficult to realize the high-order filter due to the memory limitation of digital computer. For implementation of FO-PID, approximation of the fractional integrator and differentiator are required. Short memory principle (SMP) is one of the effective approximation methods. However, there is a disadvantage that the approximated filter with SMP cannot eliminate the steady-state error. For this problem, we introduce the distributed implementation of the integrator and the dynamic quantizer to make the efficient use of permissible memory. The objective of this study is to clarify how to implement the accurate FO-PID with limited memories. In this paper, we propose the implementation method of FO-PID with memory constraint using dynamic quantizer. And the trade off between approximation of fractional elements and quantized data size are examined so as to close to the ideal FO-PID responses. The effectiveness of proposed method is evaluated by numerical example and experiment in the temperature control of heat plate.

Readiness to Change Over Time: Change Commitment and Change Efficacy in a Workplace Health-Promotion Trial.

PubMed

Helfrich, Christian D; Kohn, Marlana J; Stapleton, Austin; Allen, Claire L; Hammerback, Kristen Elizabeth; Chan, K C Gary; Parrish, Amanda T; Ryan, Daron E; Weiner, Bryan J; Harris, Jeffrey R; Hannon, Peggy A

2018-01-01

Organizational readiness to change may be a key determinant of implementation success and a mediator of the effectiveness of implementation interventions. If organizational readiness can be reliably and validly assessed at the outset of a change initiative, it could be used to assess the effectiveness of implementation-support activities by measuring changes in readiness factors over time. We analyzed two waves of readiness-to-change survey data collected as part of a three-arm, randomized controlled trial to implement evidence-based health promotion practices in small worksites in low-wage industries. We measured five readiness factors: context (favorable broader conditions); change valence (valuing health promotion); information assessment (demands and resources to implement health promotion); change commitment (an intention to implement health promotion); and change efficacy (a belief in shared ability to implement health promotion). We expected commitment and efficacy to increase at intervention sites along with their self-reported effort to implement health promotion practices, termed wellness-program effort. We compared means between baseline and 15 months, and between intervention and control sites. We used linear regression to test whether intervention and control sites differed in their change-readiness scores over time. Only context and change commitment met reliability thresholds. Change commitment declined significantly for both control (-0.39) and interventions sites (-0.29) from baseline to 15 months, while context did not change for either. Only wellness program effort at 15 months, but not at baseline, differed significantly between control and intervention sites (1.20 controls, 2.02 intervention). Regression analyses resulted in two significant differences between intervention and control sites in changes from baseline to 15 months: (1) intervention sites exhibited significantly smaller change in context scores relative to control sites over time and (2) intervention sites exhibited significantly higher changes in wellness program effort relative to control sites. Contrary to our hypothesis, change commitment declined significantly at both Healthlinks and control sites, even as wellness-program effort increased significantly at HealthLinks sites. Regression to the mean may explain the decline in change commitment. Future research needs to assess whether baseline commitment is an independent predictor of wellness-program effort or an effect modifier of the HealthLinks intervention.

Fast and robust control of nanopositioning systems: Performance limits enabled by field programmable analog arrays.

PubMed

Baranwal, Mayank; Gorugantu, Ram S; Salapaka, Srinivasa M

2015-08-01

This paper aims at control design and its implementation for robust high-bandwidth precision (nanoscale) positioning systems. Even though modern model-based control theoretic designs for robust broadband high-resolution positioning have enabled orders of magnitude improvement in performance over existing model independent designs, their scope is severely limited by the inefficacies of digital implementation of the control designs. High-order control laws that result from model-based designs typically have to be approximated with reduced-order systems to facilitate digital implementation. Digital systems, even those that have very high sampling frequencies, provide low effective control bandwidth when implementing high-order systems. In this context, field programmable analog arrays (FPAAs) provide a good alternative to the use of digital-logic based processors since they enable very high implementation speeds, moreover with cheaper resources. The superior flexibility of digital systems in terms of the implementable mathematical and logical functions does not give significant edge over FPAAs when implementing linear dynamic control laws. In this paper, we pose the control design objectives for positioning systems in different configurations as optimal control problems and demonstrate significant improvements in performance when the resulting control laws are applied using FPAAs as opposed to their digital counterparts. An improvement of over 200% in positioning bandwidth is achieved over an earlier digital signal processor (DSP) based implementation for the same system and same control design, even when for the DSP-based system, the sampling frequency is about 100 times the desired positioning bandwidth.

Effectiveness of an HIV/STD risk-reduction intervention for adolescents when implemented by community-based organizations: a cluster-randomized controlled trial.

PubMed

Jemmott, John B; Jemmott, Loretta S; Fong, Geoffrey T; Morales, Knashawn H

2010-04-01

We evaluated the effectiveness of an HIV/STD risk-reduction intervention when implemented by community-based organizations (CBOs). In a cluster-randomized controlled trial, 86 CBOs that served African American adolescents aged 13 to 18 years were randomized to implement either an HIV/STD risk-reduction intervention whose efficacy has been demonstrated or a health-promotion control intervention. CBOs agreed to implement 6 intervention groups, a random half of which completed 3-, 6-, and 12-month follow-up assessments. The primary outcome was consistent condom use in the 3 months prior to each follow-up assessment, averaged over the follow-up assessments. Participants were 1707 adolescents, 863 in HIV/STD-intervention CBOs and 844 in control-intervention CBOs. HIV/STD-intervention participants were more likely to report consistent condom use (odds ratio [OR] = 1.39; 95% confidence interval [CI] = 1.06, 1.84) than were control-intervention participants. HIV/STD-intervention participants also reported a greater proportion of condom-protected intercourse (beta = 0.06; 95% CI = 0.00, 0.12) than did the control group. This is the first large, randomized intervention trial to demonstrate that CBOs can successfully implement an HIV/STD risk-reduction intervention whose efficacy has been established.

Effectiveness of an HIV/STD Risk-Reduction Intervention for Adolescents When Implemented by Community-Based Organizations: A Cluster-Randomized Controlled Trial

PubMed Central

Jemmott, Loretta S.; Fong, Geoffrey T.; Morales, Knashawn H.

2010-01-01

Objectives. We evaluated the effectiveness of an HIV/STD risk-reduction intervention when implemented by community-based organizations (CBOs). Methods. In a cluster-randomized controlled trial, 86 CBOs that served African American adolescents aged 13 to 18 years were randomized to implement either an HIV/STD risk-reduction intervention whose efficacy has been demonstrated or a health-promotion control intervention. CBOs agreed to implement 6 intervention groups, a random half of which completed 3-, 6-, and 12-month follow-up assessments. The primary outcome was consistent condom use in the 3 months prior to each follow-up assessment, averaged over the follow-up assessments. Results. Participants were 1707 adolescents, 863 in HIV/STD-intervention CBOs and 844 in control-intervention CBOs. HIV/STD-intervention participants were more likely to report consistent condom use (odds ratio [OR] = 1.39; 95% confidence interval [CI] = 1.06, 1.84) than were control-intervention participants. HIV/STD-intervention participants also reported a greater proportion of condom-protected intercourse (β = 0.06; 95% CI = 0.00, 0.12) than did the control group. Conclusions. This is the first large, randomized intervention trial to demonstrate that CBOs can successfully implement an HIV/STD risk-reduction intervention whose efficacy has been established. PMID:20167903

Noise Control in Space Shuttle Orbiter

NASA Technical Reports Server (NTRS)

Goodman, Jerry R.

2009-01-01

Acoustic limits in habitable space enclosures are required to ensure crew safety, comfort, and habitability. Noise control is implemented to ensure compliance with the acoustic requirements. The purpose of this paper is to describe problems with establishing acoustic requirements and noise control efforts, and present examples of noise control treatments and design applications used in the Space Shuttle Orbiter. Included is the need to implement the design discipline of acoustics early in the design process, and noise control throughout a program to ensure that limits are met. The use of dedicated personnel to provide expertise and oversight of acoustic requirements and noise control implementation has shown to be of value in the Space Shuttle Orbiter program. It is concluded that to achieve acceptable and safe noise levels in the crew habitable space, early resolution of acoustic requirements and implementation of effective noise control efforts are needed. Management support of established acoustic requirements and noise control efforts is essential.

Implementing Mother Tongue Instruction in the Real World: Results from a Medium-Scale Randomized Controlled Trial in Kenya

ERIC Educational Resources Information Center

Piper, Benjamin; Zuilkowski, Stephanie S.; Ong'ele, Salome

2016-01-01

Research in sub-Saharan Africa investigating the effect of mother tongue (MT) literacy instruction at medium scale is limited. A randomized controlled trial of MT literacy instruction was implemented in 2013 and 2014 as part of the Primary Math and Reading (PRIMR) Initiative in Kenya. We compare the effect of two treatment groups--the base PRIMR…

The Effect of Professional Learning Activities on Implementation of California's Quality Professional Learning Standards in Alignment with the Local Control Funding Formula Priority 2

ERIC Educational Resources Information Center

Pinotti, Sadie

2017-01-01

The purpose of this Delphi study was to identify the professional learning activities that experts perceive are necessary for local education agencies (LEAs) to effectively implement California's Quality Professional Learning Standards (QPLS) in alignment with the Local Control Funding Formula (LCFF) Priority 2. The study also examined the degree…

The effects of dementia care mapping on nursing home residents' quality of life and staff attitudes: design of the quasi-experimental study Leben-QD II.

PubMed

Halek, Margareta; Dichter, Martin Nikolaus; Quasdorf, Tina; Riesner, Christine; Bartholomeyczik, Sabine

2013-06-01

The main objective of care for people with dementia is the maintenance and promotion of quality of life (Qol). Most of the residents in nursing homes have challenging behaviors that strongly affect their Qol. Person-centered care (PCC) is an approach that aims to achieve the best possible Qol and to reduce challenging behaviors. Dementia Care Mapping (DCM) is a method of implementing PCC that has been used in Germany for several years. However, there are no data on the effectiveness of DCM or the challenges of implementation of DCM in German nursing homes. In this quasi-experimental non-randomized cluster-controlled study, the effects of DCM will be compared to 2 comparison groups. 9 nursing homes will take part: 3 will implement DCM, 3 will implement a comparison intervention using an alternative Qol assessment, and 3 have already implemented DCM. The main effect outcomes are Qol, challenging behaviors, staff attitudes toward dementia, job satisfaction and burnout of caregivers. These outcomes will be measured on 3 data points. Different quantitative and qualitative data sources will be collected through the course of the study to investigate the degree of implementation as well as facilitators of and barriers to the implementation process. This study will provide new information about the effectiveness of DCM and the implementation process of DCM in German nursing homes. The study results will provide important information to guide the national discussion about the improvement of dementia-specific Qol, quality of care in nursing homes and allocation of resources. In addition, the study results will provide information for decision-making and implementation of complex psychosocial interventions such as DCM. The findings will also be important for the design of a subsequent randomized controlled trial (e.g. appropriateness of outcomes and measurements, inclusion criteria for participating nursing homes) and the development of a successful implementation strategy. Current Controlled Trials ISRCTN43916381.

Implementation of a guideline for low back pain management in primary care: a cost-effectiveness analysis.

PubMed

Becker, Annette; Held, Heiko; Redaelli, Marcus; Chenot, Jean F; Leonhardt, Corinna; Keller, Stefan; Baum, Erika; Pfingsten, Michael; Hildebrandt, Jan; Basler, Heinz-Dieter; Kochen, Michael M; Donner-Banzhoff, Norbert; Strauch, Konstantin

2012-04-15

Cost-effectiveness analysis alongside a cluster randomized controlled trial. To study the cost-effectiveness of 2 low back pain guideline implementation (GI) strategies. Several evidence-based guidelines on management of low back pain have been published. However, there is still no consensus on the effective implementation strategy. Especially studies on the economic impact of different implementation strategies are lacking. This analysis was performed alongside a cluster randomized controlled trial on the effectiveness of 2 GI strategies (physician education alone [GI] or physician education in combination with motivational counseling [MC] by practice nurses)--both compared with the postal dissemination of the guideline (control group, C). Sociodemographic data, pain characteristics, and cost data were collected by interview at baseline and after 6 and 12 months. low back pain-related health care costs were valued for 2004 from the societal perspective. For the cost analysis, 1322 patients from 126 general practices were included. Both interventions showed lower direct and indirect costs as well as better patient outcomes during follow-up compared with controls. In addition, both intervention arms showed superiority of cost-effectiveness to C. The effects attenuated when adjusting for differences of health care utilization prior to patient recruitment and for clustering of data. Trends in cost-effectiveness are visible but need to be confirmed in future studies. Researchers performing cost-evaluation studies should test for baseline imbalances of health care utilization data instead of judging on the randomization success by reviewing non-cost parameters like clinical data alone.

Effect of systematic ergonomic hazard identification and control implementation on musculoskeletal disorder and injury risk

PubMed Central

Cantley, Linda F; Taiwo, Oyebode A; Galusha, Deron; Barbour, Russell; Slade, Martin D; Tessier-Sherman, Baylah; Cullen, Mark R

2014-01-01

Objectives This study aimed to examine the effect of an ergonomic hazard control (HC) initiative, undertaken as part of a company ergonomics standard, on worker injury risk. Methods Using the company's ergonomic hazards database to identify jobs with and without ergonomic HC implementation and linking to individual job and injury histories, injury risk among person-jobs with HC implementation (the HC group) was compared to those without HC (NoHC group) using random coefficient models. Further analysis of the HC group was conducted to determine the effect of additional ergonomic hazards controlled on injury risk. Results Among 123jobs at 17 plant locations, 347 ergonomic hazards were quantitatively identified during the study period. HC were implemented for 204 quantified ergonomic hazards in 84 jobs, impacting 10 385 persons (12 967 person-jobs). No HC were implemented for quantified ergonomic hazards in the remaining 39 jobs affecting 4155 persons (5046 person-jobs). Adjusting for age, sex, plant origin, and year to control for any temporal trend in injury risk, the relative risk (RR) for musculoskeletal disorder (MSD) was 0.85 and the RR for any injury or MSD was 0.92 in the HC compared to NoHC group. Among the HC group, each ergonomic hazard controlled was associated with risk reduction for MSD and acute injury outcomes (RR 0.93). Conclusion Systematic ergonomic HC through participatory ergonomics, as part of a mandatory company ergonomics standard, is associated with MSD and injury risk reduction among workers in jobs with HC implemented. PMID:24142048

An Integrated WRF-CAMx Modeling Approach for Impact Analysis of Implementing the Emergency PM2.5 Control Measures during Red Alerts in Beijing in December 2015

NASA Astrophysics Data System (ADS)

Jia, J.; Cheng, S.; Lei, L.; Lang, J.

2017-12-01

In December 2015, the Beijing-Tianjin-Hebei (BTH) region experienced several episodes of heavy air pollution. Beijing municipal government therefore issued 2 red alerts on December 7 and 19, respectively, and also implemented emergency control measures to alleviate the negative effects of pollution. It is estimated that the heavy pollutions in 2 red alert periods in Beijing were due mainly to the accumulation of air pollutants from local emission sources and the transboundary transport of pollutants from surrounding areas. The collected meteorological and PM2.5 data indicate that the severity of air pollutions were enlarged by the poor meteorological conditions along with lower mixing layer height. In this study, the WRF-CAMx modeling system was utilized not only for analyzing the contributions of PM2.5 from different sources, but also for quantitatively assessing the effects of implementing various emergency control measures on PM2.5 pollution control during the red alert periods. The modeling results show that local emissions were the most dominant contributors (64.8%-83.5%) among all emission sources, while the main external contributions came from the city of Baoding (3.4%-9.3%). In addition, among 5 different emission source categories, coal and traffic were the two dominant contributors to PM2.5 concentration in urban area of Beijing. Then four pollution control scenarios were designed particularly to investigate the effectiveness of the emergency control measures, and the results show that, generally these emergency control measures have positive effects on air pollution reduction. In particular, restrictive measures of traffic volume control and industrial activity shutdown/suspension have been found as the most effective measures in comparison to other emergency control measures. It is recommended that such effective measures should be considered to implement when next time similar heavy air pollutions occur in the city of Beijing.

Implementing guidelines in nursing homes: a systematic review.

PubMed

Diehl, Heinz; Graverholt, Birgitte; Espehaug, Birgitte; Lund, Hans

2016-07-25

Research on guideline implementation strategies has mostly been conducted in settings which differ significantly from a nursing home setting and its transferability to the nursing home setting is therefore limited. The objective of this study was to systematically review the effects of interventions to improve the implementation of guidelines in nursing homes. A systematic literature search was conducted in the Cochrane Library, CINAHL, Embase, MEDLINE, DARE, HTA, CENTRAL, SveMed + and ISI Web of Science from their inception until August 2015. Reference screening and a citation search were performed. Studies were eligible if they evaluated any type of guideline implementation strategy in a nursing home setting. Eligible study designs were systematic reviews, randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted-time-series studies. The EPOC risk of bias tool was used to evaluate the risk of bias in the included studies. The overall quality of the evidence was rated using GRADE. Five cluster-randomised controlled trials met the inclusion criteria, evaluating a total of six different multifaceted implementation strategies. One study reported a small statistically significant effect on professional practice, and two studies demonstrated small to moderate statistically significant effects on patient outcome. The overall quality of the evidence for all comparisons was low or very low using GRADE. Little is known about how to improve the implementation of guidelines in nursing homes, and the evidence to support or discourage particular interventions is inconclusive. More implementation research is needed to ensure high quality of care in nursing homes. PROSPERO 2014: CRD42014007664.

77 FR 55217 - Health Information Technology Implementation

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-07

... Information Technology Implementation AGENCY: Health Resources and Services Administration (HRSA), Department... Technology Implementation for Health Center Controlled Networks (HCCN) funds originally awarded to Southwest... effective use of Health Information Technology (HIT). SUPPLEMENTARY INFORMATION: Former Grantee of Record...

Addressing the Social Determinants of Health to Reduce Tobacco-Related Disparities

PubMed Central

Garrett, Bridgette E.; Dube, Shanta R.; Babb, Stephen; McAfee, Tim

2016-01-01

Introduction Comprehensive tobacco prevention and control efforts that include implementing smoke-free air laws, increasing tobacco prices, conducting hard-hitting mass media campaigns, and making evidence-based cessation treatments available are effective in reducing tobacco use in the general population. However, if these interventions are not implemented in an equitable manner, certain population groups may be left out causing or exacerbating disparities in tobacco use. Disparities in tobacco use have, in part, stemmed from inequities in the way tobacco control policies and programs have been adopted and implemented to reach and impact the most vulnerable segments of the population that have the highest rates of smokings (e.g., those with lower education and incomes). Methods Education and income are the 2 main social determinants of health that negatively impact health. However, there are other social determinants of health that must be considered for tobacco control policies to be effective in reducing tobacco-related disparities. This article will provide an overview of how tobacco control policies and programs can address key social determinants of health in order to achieve equity and eliminate disparities in tobacco prevention and control. Results Tobacco control policy interventions can be effective in addressing the social determinants of health in tobacco prevention and control to achieve equity and eliminate tobacco-related disparities when they are implemented consistently and equitably across all population groups. Conclusions Taking a social determinants of health approach in tobacco prevention and control will be necessary to achieve equity and eliminate tobacco-related disparities. PMID:25516538

Theory-Based Interventions Combining Mental Simulation and Planning Techniques to Improve Physical Activity: Null Results from Two Randomized Controlled Trials.

PubMed

Meslot, Carine; Gauchet, Aurélie; Allenet, Benoît; François, Olivier; Hagger, Martin S

2016-01-01

Interventions to assist individuals in initiating and maintaining regular participation in physical activity are not always effective. Psychological and behavioral theories advocate the importance of both motivation and volition in interventions to change health behavior. Interventions adopting self-regulation strategies that foster motivational and volitional components may, therefore, have utility in promoting regular physical activity participation. We tested the efficacy of an intervention adopting motivational (mental simulation) and volitional (implementation intentions) components to promote a regular physical activity in two studies. Study 1 adopted a cluster randomized design in which participants ( n = 92) were allocated to one of three conditions: mental simulation plus implementation intention, implementation intention only, or control. Study 2 adopted a 2 (mental simulation vs. no mental simulation) × 2 (implementation intention vs. no implementation intention) randomized controlled design in which fitness center attendees ( n = 184) were randomly allocated one of four conditions: mental simulation only, implementation intention only, combined, or control. Physical activity behavior was measured by self-report (Study 1) or fitness center attendance (Study 2) at 4- (Studies 1 and 2) and 19- (Study 2 only) week follow-up periods. Findings revealed no statistically significant main or interactive effects of the mental simulation and implementation intention conditions on physical activity outcomes in either study. Findings are in contrast to previous research which has found pervasive effects for both intervention strategies. Findings are discussed in light of study limitations including the relatively small sample sizes, particularly for Study 1, deviations in the operationalization of the intervention components from previous research and the lack of a prompt for a goal intention. Future research should focus on ensuring uniformity in the format of the intervention components, test the effects of each component alone and in combination using standardized measures across multiple samples, and systematically explore effects of candidate moderators.

Theory-Based Interventions Combining Mental Simulation and Planning Techniques to Improve Physical Activity: Null Results from Two Randomized Controlled Trials

PubMed Central

Meslot, Carine; Gauchet, Aurélie; Allenet, Benoît; François, Olivier; Hagger, Martin S.

2016-01-01

Interventions to assist individuals in initiating and maintaining regular participation in physical activity are not always effective. Psychological and behavioral theories advocate the importance of both motivation and volition in interventions to change health behavior. Interventions adopting self-regulation strategies that foster motivational and volitional components may, therefore, have utility in promoting regular physical activity participation. We tested the efficacy of an intervention adopting motivational (mental simulation) and volitional (implementation intentions) components to promote a regular physical activity in two studies. Study 1 adopted a cluster randomized design in which participants (n = 92) were allocated to one of three conditions: mental simulation plus implementation intention, implementation intention only, or control. Study 2 adopted a 2 (mental simulation vs. no mental simulation) × 2 (implementation intention vs. no implementation intention) randomized controlled design in which fitness center attendees (n = 184) were randomly allocated one of four conditions: mental simulation only, implementation intention only, combined, or control. Physical activity behavior was measured by self-report (Study 1) or fitness center attendance (Study 2) at 4- (Studies 1 and 2) and 19- (Study 2 only) week follow-up periods. Findings revealed no statistically significant main or interactive effects of the mental simulation and implementation intention conditions on physical activity outcomes in either study. Findings are in contrast to previous research which has found pervasive effects for both intervention strategies. Findings are discussed in light of study limitations including the relatively small sample sizes, particularly for Study 1, deviations in the operationalization of the intervention components from previous research and the lack of a prompt for a goal intention. Future research should focus on ensuring uniformity in the format of the intervention components, test the effects of each component alone and in combination using standardized measures across multiple samples, and systematically explore effects of candidate moderators. PMID:27899904

Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial.

PubMed

Jabbour, Mona; Curran, Janet; Scott, Shannon D; Guttman, Astrid; Rotter, Thomas; Ducharme, Francine M; Lougheed, M Diane; McNaughton-Filion, M Louise; Newton, Amanda; Shafir, Mark; Paprica, Alison; Klassen, Terry; Taljaard, Monica; Grimshaw, Jeremy; Johnson, David W

2013-05-22

The clinical pathway is a tool that operationalizes best evidence recommendations and clinical practice guidelines in an accessible format for 'point of care' management by multidisciplinary health teams in hospital settings. While high-quality, expert-developed clinical pathways have many potential benefits, their impact has been limited by variable implementation strategies and suboptimal research designs. Best strategies for implementing pathways into hospital settings remain unknown. This study will seek to develop and comprehensively evaluate best strategies for effective local implementation of externally developed expert clinical pathways. We will develop a theory-based and knowledge user-informed intervention strategy to implement two pediatric clinical pathways: asthma and gastroenteritis. Using a balanced incomplete block design, we will randomize 16 community emergency departments to receive the intervention for one clinical pathway and serve as control for the alternate clinical pathway, thus conducting two cluster randomized controlled trials to evaluate this implementation intervention. A minimization procedure will be used to randomize sites. Intervention sites will receive a tailored strategy to support full clinical pathway implementation. We will evaluate implementation strategy effectiveness through measurement of relevant process and clinical outcomes. The primary process outcome will be the presence of an appropriately completed clinical pathway on the chart for relevant patients. Primary clinical outcomes for each clinical pathway include the following: Asthma--the proportion of asthmatic patients treated appropriately with corticosteroids in the emergency department and at discharge; and Gastroenteritis--the proportion of relevant patients appropriately treated with oral rehydration therapy. Data sources include chart audits, administrative databases, environmental scans, and qualitative interviews. We will also conduct an overall process evaluation to assess the implementation strategy and an economic analysis to evaluate implementation costs and benefits. This study will contribute to the body of evidence supporting effective strategies for clinical pathway implementation, and ultimately reducing the research to practice gaps by operationalizing best evidence care recommendations through effective use of clinical pathways. ClinicalTrials.gov: NCT01815710.

Making Self-Help More Helpful: A Randomized Controlled Trial of the Impact of Augmenting Self-Help Materials with Implementation Intentions on Promoting the Effective Self-Management of Anxiety Symptoms

ERIC Educational Resources Information Center

Varley, Rachel; Webb, Thomas L.; Sheeran, Paschal

2011-01-01

Objective: The effectiveness of self-help materials may be constrained by failures to undertake recommended exercises or to deploy the techniques that one has learned at the critical moment. The present randomized controlled trial investigated whether augmenting self-help materials with if-then plans (or implementation intentions) could overcome…

Toward optimal implementation of cancer prevention and control programs in public health: a study protocol on mis-implementation.

PubMed

Padek, Margaret; Allen, Peg; Erwin, Paul C; Franco, Melissa; Hammond, Ross A; Heuberger, Benjamin; Kasman, Matt; Luke, Doug A; Mazzucca, Stephanie; Moreland-Russell, Sarah; Brownson, Ross C

2018-03-23

Much of the cancer burden in the USA is preventable, through application of existing knowledge. State-level funders and public health practitioners are in ideal positions to affect programs and policies related to cancer control. Mis-implementation refers to ending effective programs and policies prematurely or continuing ineffective ones. Greater attention to mis-implementation should lead to use of effective interventions and more efficient expenditure of resources, which in the long term, will lead to more positive cancer outcomes. This is a three-phase study that takes a comprehensive approach, leading to the elucidation of tactics for addressing mis-implementation. Phase 1: We assess the extent to which mis-implementation is occurring among state cancer control programs in public health. This initial phase will involve a survey of 800 practitioners representing all states. The programs represented will span the full continuum of cancer control, from primary prevention to survivorship. Phase 2: Using data from phase 1 to identify organizations in which mis-implementation is particularly high or low, the team will conduct eight comparative case studies to get a richer understanding of mis-implementation and to understand contextual differences. These case studies will highlight lessons learned about mis-implementation and identify hypothesized drivers. Phase 3: Agent-based modeling will be used to identify dynamic interactions between individual capacity, organizational capacity, use of evidence, funding, and external factors driving mis-implementation. The team will then translate and disseminate findings from phases 1 to 3 to practitioners and practice-related stakeholders to support the reduction of mis-implementation. This study is innovative and significant because it will (1) be the first to refine and further develop reliable and valid measures of mis-implementation of public health programs; (2) bring together a strong, transdisciplinary team with significant expertise in practice-based research; (3) use agent-based modeling to address cancer control implementation; and (4) use a participatory, evidence-based, stakeholder-driven approach that will identify key leverage points for addressing mis-implementation among state public health programs. This research is expected to provide replicable computational simulation models that can identify leverage points and public health system dynamics to reduce mis-implementation in cancer control and may be of interest to other health areas.

Cost-effectiveness of interventions to control Campylobacter in the New Zealand poultry meat food supply.

PubMed

Lake, Robin J; Horn, Beverley J; Dunn, Alex H; Parris, Ruth; Green, F Terri; McNickle, Don C

2013-07-01

An analysis of the cost-effectiveness of interventions to control Campylobacter in the New Zealand poultry supply examined a series of interventions. Effectiveness was evaluated in terms of reduced health burden measured by disability-adjusted life years (DALYs). Costs of implementation were estimated from the value of cost elements, determined by discussions with industry. Benefits were estimated by changing the inputs to a poultry food chain quantitative risk model. Proportional reductions in the number of predicted Campylobacter infections were converted into reductions in the burden of disease measured in DALYs. Cost-effectiveness ratios were calculated for each intervention, as cost per DALY reduction and the ratios compared. The results suggest that the most cost-effective interventions (lowest ratios) are at the primary processing stage. Potential phage-based controls in broiler houses were also highly cost-effective. This study is limited by the ability to quantify costs of implementation and assumptions required to estimate health benefits, but it supports the implementation of interventions at the primary processing stage as providing the greatest quantum of benefit and lowest cost-effectiveness ratios.

Building capacity for implementation of the framework convention for tobacco control in Vietnam: lessons for developing countries

PubMed Central

Stillman, Frances A.; David, Annette M.; Kibria, Naseeb; Phan, Hai Thi

2014-01-01

Effective implementation of the WHO international Framework Convention on Tobacco Control (FCTC) is the key to controlling the tobacco epidemic. Within countries, strong national tobacco control capacity is the primary determinant for successful implementation of the FCTC. This case study of tobacco control policy describes the experience of building national tobacco control capacity in Vietnam under the Reduce Smoking in Vietnam Partnership project within a national capacity-building framework. In the Vietnam experience, four components of tobacco control capacity emerged as especially important to achieve ‘quality’ outputs and measurable outcomes at the implementation level: (i) organizational structure/infrastructure; (ii) leadership and expertise; (iii) partnerships and networks and (iv) data and evidence from research. The experience gained in this project helps in adapting our tobacco control capacity-building model, and the lessons that emerged from this country case study can provide guidance to global funders, tobacco control technical assistance providers and nations as governments endeavor to meet their commitment to the FCTC. PMID:23411160

Study protocol Implementation of the Veder contact method (VCM) in daily nursing home care for people with dementia: an evaluation based on the RE-AIM framework.

PubMed

Boersma, Petra; Van Weert, Julia C M; van Meijel, Berno; van de Ven, Peter M; Dröes, Rose-Marie

2017-07-01

People with dementia in nursing homes benefit from person-centred care methods. Studies examining the effect of these methods often fail to report about the implementation of these methods. The present study aims to describe the implementation of the Veder contact method (VCM) in daily nursing home care. A process analysis will be conducted based on qualitative data from focus groups with caregivers and interviews with key figures. To investigate whether the implementation of VCM is reflected in the attitude and behaviour of caregivers and in the behaviour and quality of life of people with dementia, a controlled observational cohort study will be conducted. Six nursing home wards implementing VCM will be compared with six control wards providing Care As Usual. Quantitative data from caregivers and residents will be collected before (T0), and 9-12 months after the implementation (T1). Qualitative analysis and multilevel analyses will be carried out on the collected data and structured based on the constructs of the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). By using the RE-AIM framework this study introduces a structured and comprehensive way of investigating the implementation process and implementation effectiveness of person-centred care methods in daily dementia care.

The effectiveness of state-level tobacco control interventions: a review of program implementation and behavioral outcomes.

PubMed

Siegel, Michael

2002-01-01

In 2001, nearly one billion dollars will be spent on statewide tobacco control programs, including those in California, Massachusetts, Arizona, and Oregon, funded by cigarette tax revenues, and the program in Florida, funded by the state's settlement with the tobacco industry. With such large expenditures, it is imperative to find out whether these programs are working. This paper reviews the effectiveness of the statewide tobacco control programs in California, Massachusetts, Arizona, Oregon, and Florida. It focuses on two aspects of process evaluation--the funding and implementation of the programs and the tobacco industry's response, and four elements of outcome evaluation--the programs' effects on cigarette consumption, adult and youth smoking prevalence, and protection of the public from secondhand smoke. The paper formulates general lessons learned from these existing programs and generates recommendations to improve and inform the development and implementation of these and future programs.

Economic evaluation of public-private mix for tuberculosis care and control, India. Part II. Cost and cost-effectiveness.

PubMed

Pantoja, A; Lönnroth, K; Lal, S S; Chauhan, L S; Uplekar, M; Padma, M R; Unnikrishnan, K P; Rajesh, J; Kumar, P; Sahu, S; Wares, F; Floyd, K

2009-06-01

Bangalore City, India. To assess the cost and cost-effectiveness of public-private mix (PPM) for tuberculosis (TB) care and control when implemented on a large scale. DOTS implementation under the Revised National TB Control Programme (RNTCP) began in 1999, PPM was introduced in mid-2001 and a second phase of intensified PPM began in 2003. Data on the costs and effects of TB treatment from 1999 to 2005 were collected and used to compare the two distinct phases of PPM with a scenario of no PPM. Costs were assessed in 2005 $US for public and private providers, patients and patient attendants. Sources of data included expenditure records, medical records, interviews with staff and patient surveys. Effectiveness was measured as the number of cases successfully treated. When PPM was implemented, total provider costs increased in proportion to the number of successfully treated TB cases. The average cost per patient treated from the provider perspective when PPM was implemented was stable, at US$69, in the intensified phase compared with US$71 pre-PPM. PPM resulted in the shift of an estimated 7200 patients from non-DOTS to DOTS treatment over 5 years. PPM implementation substantially reduced costs to patients, such that the average societal cost per patient successfully treated fell from US$154 to US$132 in the 4 years following the initiation of PPM. Implementation of PPM on a large scale in an urban setting can be cost-effective, and considerably reduces the financial burden of TB for patients.

Targeting impulsive processes of eating behavior via the internet. Effects on body weight.

PubMed

Veling, Harm; van Koningsbruggen, Guido M; Aarts, Henk; Stroebe, Wolfgang

2014-07-01

Because eating behavior can take on an impulsive nature many people experience difficulty with dieting to lose weight. Therefore, an experiment was conducted to test the effectiveness of two interventions targeting impulsive processes of eating behavior to facilitate weight loss: Implementation intentions to remind people about dieting versus a go/no-go task to change impulses toward palatable foods. Dieters performed an online training program (four times in 4 weeks) in which they were randomly assigned to a 2 (implementation intention condition: dieting versus control) × 2 (go/no-go task condition: food versus control) design. They formed either dieting implementation intentions (e.g., If I open the fridge I will think of dieting!) or control implementation intentions. Furthermore, they received either a go/no-go task in which behavioral stop signals were presented upon presentation of palatable foods (food go/no-go task), or upon control stimuli. Participants' weight was measured in the laboratory before and after the intervention. Strength of participants' dieting goal and their Body Mass Index (BMI; as a proxy for impulsiveness toward food) were examined as moderators. Results showed that both dieting implementation intentions and the food go/no-go task facilitated weight loss. Moreover, dieting implementation intentions facilitated weight loss particularly among people with a strong current dieting goal, whereas the food go/no-go task facilitated weight loss independent of this factor. Instead, the food go/no-go task, but not formation of dieting implementation intentions, was primarily effective among dieters with a relatively high BMI. These results provide the first preliminary evidence that interventions aimed at targeting impulsive eating-related processes via the internet can facilitate weight loss. Copyright © 2014 Elsevier Ltd. All rights reserved.

Development of Chemical Process Design and Control for ...

EPA Pesticide Factsheets

This contribution describes a novel process systems engineering framework that couples advanced control with sustainability evaluation and decision making for the optimization of process operations to minimize environmental impacts associated with products, materials, and energy. The implemented control strategy combines a biologically inspired method with optimal control concepts for finding more sustainable operating trajectories. The sustainability assessment of process operating points is carried out by using the U.S. E.P.A.’s Gauging Reaction Effectiveness for the ENvironmental Sustainability of Chemistries with a multi-Objective Process Evaluator (GREENSCOPE) tool that provides scores for the selected indicators in the economic, material efficiency, environmental and energy areas. The indicator scores describe process performance on a sustainability measurement scale, effectively determining which operating point is more sustainable if there are more than several steady states for one specific product manufacturing. Through comparisons between a representative benchmark and the optimal steady-states obtained through implementation of the proposed controller, a systematic decision can be made in terms of whether the implementation of the controller is moving the process towards a more sustainable operation. The effectiveness of the proposed framework is illustrated through a case study of a continuous fermentation process for fuel production, whose materi

Effectiveness of an Attendance Control Policy in Reducing Chronic Absenteeism

ERIC Educational Resources Information Center

Baum, John F.

1978-01-01

An attendance control policy based on the Katz and Kahn (1966) motivational pattern of legal compliance was implemented in one department of a large manufacturing organization with two comparable departments serving as controls. Results supported the effectiveness of the attendance control policy among chronically absent workers, but not with…

Comparison of intervention fidelity between COPE TEEN and an attention-control program in a randomized controlled trial

PubMed Central

Kelly, Stephanie A.; Oswalt, Krista; Melnyk, Bernadette Mazurek; Jacobson, Diana

2015-01-01

Fidelity in implementing an intervention is critical to accurately determine and interpret the effects of an intervention. It is important to monitor the manner in which the behavioral intervention is implemented (e.g. adaptations, delivery as intended and dose). Few interventions are implemented with 100% fidelity. In this study, high school health teachers implemented the intervention. To attribute study findings to the intervention, it was vital to know to what degree the intervention was implemented. Therefore, the purposes of this study were to evaluate intervention fidelity and to compare implementation fidelity between the creating opportunities for personal empowerment (COPE) Healthy Lifestyles TEEN (thinking, emotions, exercise, and nutrition) program, the experimental intervention and Healthy Teens, an attention-control intervention, in a randomized controlled trial with 779 adolescents from 11 high schools in the southwest region of the United States. Thirty teachers participated in this study. Findings indicated that the attention-control teachers implemented their intervention with greater fidelity than COPE TEEN teachers. It is possible due to the novel intervention and the teachers’ unfamiliarity with cognitive-behavioral skills building, COPE TEEN teachers had less fidelity. It is important to assess novel skill development prior to the commencement of experimental interventions and to provide corrective feedback during the course of implementation. PMID:25355179

Effects of a strategy to improve offender assessment practices: Staff perceptions of implementation outcomes.

PubMed

Welsh, Wayne N; Lin, Hsiu-Ju; Peters, Roger H; Stahler, Gerald J; Lehman, Wayne E K; Stein, Lynda A R; Monico, Laura; Eggers, Michele; Abdel-Salam, Sami; Pierce, Joshua C; Hunt, Elizabeth; Gallagher, Colleen; Frisman, Linda K

2015-07-01

This implementation study examined the impact of an organizational process improvement intervention (OPII) on a continuum of evidence based practices related to assessment and community reentry of drug-involved offenders: Measurement/Instrumentation, Case Plan Integration, Conveyance/Utility, and Service Activation/Delivery. To assess implementation outcomes (staff perceptions of evidence-based assessment practices), a survey was administered to correctional and treatment staff (n=1509) at 21 sites randomly assigned to an Early- or Delayed-Start condition. Hierarchical linear models with repeated measures were used to examine changes in evidence-based assessment practices over time, and organizational characteristics were examined as covariates to control for differences across the 21 research sites. Results demonstrated significant intervention and sustainability effects for three of the four assessment domains examined, although stronger effects were obtained for intra- than inter-agency outcomes. No significant effects were found for Conveyance/Utility. Implementation interventions such as the OPII represent an important tool to enhance the use of evidence-based assessment practices in large and diverse correctional systems. Intra-agency assessment activities that were more directly under the control of correctional agencies were implemented most effectively. Activities in domains that required cross-systems collaboration were not as successfully implemented, although longer follow-up periods might afford detection of stronger effects. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A RCT of three training and support strategies to encourage implementation of screening and brief alcohol intervention by general practitioners.

PubMed

Kaner, E F; Lock, C A; McAvoy, B R; Heather, N; Gilvarry, E

1999-09-01

Providing doctors with new research findings or clinical guidelines is rarely sufficient to promote changes in clinical practice. An implementation strategy is required to provide clinicians with the skills and encouragement needed to alter established routines. To evaluate the effectiveness and cost-effectiveness of different training and support strategies in promoting implementation of screening and brief alcohol intervention (SBI) by general practitioners (GPs). Subjects were 128 GPs, one per practice, from the former Northern and Yorkshire Regional Health Authority, who agreed to use the 'Drink-Less' SBI programme in an earlier dissemination trial. GPs were stratified by previous marketing conditions and randomly allocated to three intensities of training and support: controls (n = 43) received the programme with written guidelines only, trained GPs (n = 43) received the programme plus practice-based training in programme usage, trained and supported GPs (n = 42) received the programme plus practice-based training and a support telephone call every two weeks. GPs were requested to use the programme for three months. Outcome measures included proportions of GPs implementing the programme and numbers of patients screened and intervened with. Seventy-three (57%) GPs implemented the programme and screened 11,007 patients for risk drinking. Trained and supported GPs were significantly more likely to implement the programme (71%) than controls (44%) or trained GPs (56%); they also screened, and intervened with, significantly more patients. Costs per patient screened were: trained and supported GPs, 1.05 Pounds; trained GPs, 1.08 Pounds; and controls, 1.47 Pounds. Costs per patient intervened with were: trained and supported GPs, 5.43 Pounds; trained GPs, 6.02 Pounds; and controls, 8.19 Pounds. Practice-based training plus support telephone calls was the most effective and cost-effective strategy to encourage implementation of SBI by GPs.

Implements and cultivation frequency to improve in-row weed control in organic peanut production

USDA-ARS?s Scientific Manuscript database

Weed control in organic peanut production is difficult and costly, which limits expansion of the production system. Sweep cultivation in the row middles is effective, but weeds remain in the crop row causing yield loss. Research trials were conducted in Tifton, GA to evaluate implements and freque...

Views of implementation approaches by top managers in health service organizations.

PubMed

Nutt, P C

1996-01-01

This study examined how top managers view the prospects of success and resistance when using four implementation approaches in participative and control cultures that foster climates more or less conducive to change. An accommodation approach was viewed as having the best prospect of success and of lowering resistance in a participative culture. Bargaining and incentive approaches were thought to have successful and low resistance outcomes, which were just below those of accommodation, in a control type of culture. A persuasion approach was thought to be the least effective implementation approach in a control-oriented culture. These preferences differ from prescriptions found in the implementation literature. Assuming that preferences influence behavior, implementation success could be improved if managers selected an implementation approach according to the demands of the situation. More research is needed to appreciate fully the rationale that lies behind the preferences uncovered in this research.

How has the economic downturn affected communities and implementation of science-based prevention in the randomized trial of communities that care?

PubMed

Kuklinski, Margaret R; Hawkins, J David; Plotnick, Robert D; Abbott, Robert D; Reid, Carolina K

2013-06-01

This study examined implications of the economic downturn that began in December 2007 for the Community Youth Development Study (CYDS), a longitudinal randomized controlled trial of the Communities That Care (CTC) prevention system. The downturn had the potential to affect the internal validity of the CYDS research design and implementation of science-based prevention in study communities. We used archival economic indicators and community key leader reports of economic conditions to assess the extent of the economic downturn in CYDS communities and potential internal validity threats. We also examined whether stronger economic downturn effects were associated with a decline in science-based prevention implementation. Economic indicators suggested the downturn affected CYDS communities to different degrees. We found no evidence of systematic differences in downturn effects in CTC compared to control communities that would threaten internal validity of the randomized trial. The Community Economic Problems scale was a reliable measure of community economic conditions, and it showed criterion validity in relation to several objective economic indicators. CTC coalitions continued to implement science-based prevention to a significantly greater degree than control coalitions 2 years after the downturn began. However, CTC implementation levels declined to some extent as unemployment, the percentage of students qualifying for free lunch, and community economic problems worsened. Control coalition implementation levels were not related to economic conditions before or after the downturn, but mean implementation levels of science-based prevention were also relatively low in both periods.

How Has the Economic Downturn Affected Communities and Implementation of Science-Based Prevention in the Randomized Trial of Communities That Care?

PubMed Central

Kuklinski, Margaret R.; Hawkins, J. David; Plotnick, Robert D.; Abbott, Robert D.; Reid, Carolina K.

2013-01-01

This study examined implications of the economic downturn that began in December 2007 for the Community Youth Development Study (CYDS), a longitudinal randomized controlled trial of the Communities That Care (CTC) prevention system. The downturn had the potential to affect the internal validity of the CYDS research design and implementation of science-based prevention in study communities. We used archival economic indicators and community key leader reports of economic conditions to assess the extent of the economic downturn in CYDS communities and potential internal validity threats. We also examined whether stronger economic downturn effects were associated with a decline in science-based prevention implementation. Economic indicators suggested the downturn affected CYDS communities to different degrees. We found no evidence of systematic differences in downturn effects in CTC compared to control communities that would threaten internal validity of the randomized trial. The Community Economic Problems scale was a reliable measure of community economic conditions, and it showed criterion validity in relation to several objective economic indicators. CTC coalitions continued to implement science-based prevention to a significantly greater degree than control coalitions 2 years after the downturn began. However, CTC implementation levels declined to some extent as unemployment, the percentage of students qualifying for free lunch, and community economic problems worsened. Control coalition implementation levels were not related to economic conditions before or after the downturn, but mean implementation levels of science-based prevention were also relatively low in both periods. PMID:23054169

Development of Real Time Implementation of 5/5 Rule based Fuzzy Logic Controller Shunt Active Power Filter for Power Quality Improvement

NASA Astrophysics Data System (ADS)

Puhan, Pratap Sekhar; Ray, Pravat Kumar; Panda, Gayadhar

2016-12-01

This paper presents the effectiveness of 5/5 Fuzzy rule implementation in Fuzzy Logic Controller conjunction with indirect control technique to enhance the power quality in single phase system, An indirect current controller in conjunction with Fuzzy Logic Controller is applied to the proposed shunt active power filter to estimate the peak reference current and capacitor voltage. Current Controller based pulse width modulation (CCPWM) is used to generate the switching signals of voltage source inverter. Various simulation results are presented to verify the good behaviour of the Shunt active Power Filter (SAPF) with proposed two levels Hysteresis Current Controller (HCC). For verification of Shunt Active Power Filter in real time, the proposed control algorithm has been implemented in laboratory developed setup in dSPACE platform.

Consolidating tactical planning and implementation frameworks for integrated vector management in Uganda.

PubMed

Okia, Michael; Okui, Peter; Lugemwa, Myers; Govere, John M; Katamba, Vincent; Rwakimari, John B; Mpeka, Betty; Chanda, Emmanuel

2016-04-14

Integrated vector management (IVM) is the recommended approach for controlling some vector-borne diseases (VBD). In the face of current challenges to disease vector control, IVM is vital to achieve national targets set for VBD control. Though global efforts, especially for combating malaria, now focus on elimination and eradication, IVM remains useful for Uganda which is principally still in the control phase of the malaria continuum. This paper outlines the processes undertaken to consolidate tactical planning and implementation frameworks for IVM in Uganda. The Uganda National Malaria Control Programme with its efforts to implement an IVM approach to vector control was the 'case' for this study. Integrated management of malaria vectors in Uganda remained an underdeveloped component of malaria control policy. In 2012, knowledge and perceptions of malaria vector control policy and IVM were assessed, and recommendations for a specific IVM policy were made. In 2014, a thorough vector control needs assessment (VCNA) was conducted according to WHO recommendations. The findings of the VCNA informed the development of the national IVM strategic guidelines. Information sources for this study included all available data and accessible archived documentary records on VBD control in Uganda. The literature was reviewed and adapted to the local context and translated into the consolidated tactical framework. WHO recommends implementation of IVM as the main strategy to vector control and has encouraged member states to adopt the approach. However, many VBD-endemic countries lack IVM policy frameworks to guide implementation of the approach. In Uganda most VBD coexists and could be managed more effectively if done in tandem. In order to successfully control malaria and other VBD and move towards their elimination, the country needs to scale up proven and effective vector control interventions and also learn from the experience of other countries. The IVM strategy is important in consolidating inter-sectoral collaboration and coordination and providing the tactical direction for effective deployment of vector control interventions along the five key elements of the approach and to align them with contemporary epidemiology of VBD in the country. Uganda has successfully established an evidence-based IVM approach and consolidated strategic planning and operational frameworks for VBD control. However, operating implementation arrangements as outlined in the national strategic guidelines for IVM and managing insecticide resistance, as well as improving vector surveillance, are imperative. In addition, strengthened information, education and communication/behaviour change and communication, collaboration and coordination will be crucial in scaling up and using vector control interventions.

Safety margins in the implementation of planetary quarantine requirements

NASA Technical Reports Server (NTRS)

Schalkowsky, S.; Jacoby, I.

1972-01-01

The formulation of planetary quarantine requirements, and their implementation as determined by a risk allocation model, is discussed. The model defines control safety margins with particular emphasis on utility in achieving the desired minimization of excessive margins, and their effect on implementation procedures.

Hands4U: the effectiveness of a multifaceted implementation strategy on behaviour related to the prevention of hand eczema-a randomised controlled trial among healthcare workers.

PubMed

van der Meer, Esther W C; Boot, Cécile R L; Twisk, Jos W R; Coenraads, Pieter Jan; Jungbauer, Frank H W; van der Gulden, Joost W J; Anema, Johannes R

2014-07-01

To investigate the effects of a multifaceted implementation strategy on behaviour, behavioural determinants, knowledge and awareness of healthcare workers regarding the use of recommendations to prevent hand eczema. The Hands4U study is a randomised controlled trial. A total of 48 departments (n=1649 workers) were randomly allocated to the multifaceted implementation strategy or the control group (minimal implementation strategy). Within the departments designated to the multifaceted implementation strategy, participatory working groups were set up to enhance the implementation of the recommendations for hand eczema. In addition, working group members were trained to become role models, and an education session was given within the department. Outcome measures were awareness, knowledge, receiving information, behaviour and behavioural determinants. Data were collected at baseline, with a 3- and 6-month follow-up. Statistically significant effects were found after 6 months for awareness (OR 6.30; 95% CI 3.41 to 11.63), knowledge (B 0.74; 95% CI 0.54 to 0.95), receiving information (OR 9.81; 95% CI 5.60 to 17.18), washing hands (B -0.40; 95% -0.51 to -0.29), use of moisturiser (B 0.29; 95% CI 0.20 to 0.38), cotton under gloves (OR 3.94; 95% CI 2.04 to 7.60) and the overall compliance measure (B 0.14; 95% CI 0.02 to 0.26), as a result of the multifaceted implementation strategy. No effects were found for behavioural determinants. The multifaceted implementation strategy can be used in healthcare settings to enhance the implementation of recommendations for the prevention of hand eczema. NTR2812. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Effect and Process Evaluation of a Cluster Randomized Control Trial on Water Intake and Beverage Consumption in Preschoolers from Six European Countries: The ToyBox-Study

PubMed Central

Pinket, An-Sofie; Van Lippevelde, Wendy; De Bourdeaudhuij, Ilse; Deforche, Benedicte; Cardon, Greet; Androutsos, Odysseas; Koletzko, Berthold; Moreno, Luis A.; Socha, Piotr; Iotova, Violeta; Manios, Yannis; De Craemer, Marieke

2016-01-01

Background Within the ToyBox-study, a kindergarten-based, family-involved intervention was developed to prevent overweight and obesity in European preschoolers, targeting four key behaviours related to early childhood obesity, including water consumption. The present study aimed to examine the effect of the ToyBox-intervention (cluster randomized controlled trial) on water intake and beverage consumption in European preschoolers and to investigate if the intervention effects differed by implementation score of kindergartens and parents/caregivers. Method A sample of 4964 preschoolers (4.7±0.4 years; 51.5% boys) from six European countries (Belgium, Bulgaria, Germany, Greece, Poland, Spain) was included in the data analyses. A standardized protocol was used and parents/caregivers filled in socio-demographic data and a food-frequency questionnaire. To assess intervention effects, multilevel repeated measures analyses were conducted for the total sample and for the six country-specific samples. Based on the process evaluation questionnaire of teachers and parents/caregivers, an implementation score was constructed. To assess differences in water intake and beverage consumption by implementation score in the total sample, multilevel repeated measures analyses were performed. Results Limited intervention effects on water intake from beverages and overall beverage consumption were found. However, important results were found on prepacked fruit juice consumption, with a larger decrease in the intervention group compared to the control group. However, also a decline in plain milk consumption was found. Implementation scores were rather low in both kindergartens and parents/caregivers. Nevertheless, more favorable effects on beverage choices were found in preschoolers whose parents/caregivers and kindergarten teachers had higher implementation scores compared to those with lower implementation scores. Conclusion The ToyBox-intervention can provide the basis for the development of more tailor-made interventions. However, new strategies to improve implementation of interventions should be created. PMID:27064274

Making It Harder to Smoke and Easier to Quit: The Effect of 10 Years of Tobacco Control in New York City

PubMed Central

Kilgore, Elizabeth A.; Mandel-Ricci, Jenna; Johns, Michael; Coady, Micaela H.; Perl, Sarah B.; Goodman, Andrew

2014-01-01

In 2002, New York City implemented a comprehensive tobacco control plan that discouraged smoking through excise taxes and smoke-free air laws and facilitated quitting through population-wide cessation services and hard-hitting media campaigns. Following the implementation of these activities through a well-funded and politically supported program, the adult smoking rate declined by 28% from 2002 to 2012, and the youth smoking rate declined by 52% from 2001 to 2011. These improvements indicate that local jurisdictions can have a significant positive effect on tobacco control. PMID:24825232

Effectiveness of a standardized back school program for patients with chronic low back pain after implementation in routine rehabilitation care.

PubMed

Meng, Karin; Peters, Stefan; Faller, Hermann

2017-06-01

To evaluate the effectiveness of a standardized, patient-oriented, biopsychosocial back school after implementation in inpatient orthopedic rehabilitation. A multi-center, quasi-experimental controlled study of patients with low back pain (n=535) was conducted. Patients in the control group received the traditional back school before implementation of the new program (usual care); patients in the intervention group received the new standardized back school after implementation into routine care. Patients' illness knowledge and conduct of back exercises (primary outcomes) and secondary self-management outcomes and treatment satisfaction were obtained at admission, discharge, and 6 and 12 months after rehabilitation. We found a significant small between-group intervention effect on patients' illness knowledge in medium- to long term (6 months: η 2 =0.015; 12 months: η 2 =0.013). There were trends for effects on conduct of back exercises among men (6 and 12 months: η 2 =0.008 both). Furthermore, significant small effects were observed for treatment satisfaction at discharge and physical activity after 6 months. The standardized back school seems to be more effective in certain outcomes than a usual care program despite heterogeneous program implementation. Further dissemination within orthopedic rehabilitation may be encouraged to foster self-management outcomes. Copyright © 2017 Elsevier B.V. All rights reserved.

The intention of North-Western Ethiopian dairy farmers to control mastitis

PubMed Central

Koop, Gerrit; Lam, Theo J. G. M.; Hogeveen, Henk

2017-01-01

Understanding the intentions of dairy farmers towards mastitis control is important to design effective udder health control programs. We used the Theory of Planned Behavior (TPB) to explore the intentions of North-Western Ethiopian dairy farmers towards implementing non-specified mastitis control measures (nsMCMs) and towards implementing 4 specific MCMs. Face to face interviews were held with 134 dairy farmers to study associations between their intentions and any of three factors (attitude, subjective norm and perceived behavioral control) that, according to the TPB, determine intentions. The majority of the farmers (93%) had a positive intention to implement nsMCMs, whereas a smaller majority of farmers had the intention to implement the specific MCMs to improve udder cleaning (87%), to improve stall hygiene (78%), to improve feeding of cows (76%), and to perform foremilk stripping (74%). Farmers had a more positive attitude, but lower subjective norm and lower perceived behavioural control towards implementing nsMCMs compared with implementing most specific MCMs, although the subjective norms for stall hygiene and perceived behavioural control for improving feeding of cows were also low. Attitude was positively associated with intentions to implement nsMCMs, to improve cleaning of the udders, to improve stall hygiene and to implement foremilk stripping. Both the intention to improve udder cleaning and to implement foremilk stripping, were positively associated to subjective norms towards these MCMs. Our data can help tailor intervention programs aiming to increase the intention of Ethiopian dairy farmers to implement MCMs and thus to improve udder health in this country. We show that such programs should primarily focus on changing attitude and secondarily on improving the farmers’ subjective norms. PMID:28787018

The intention of North-Western Ethiopian dairy farmers to control mastitis.

PubMed

Mekonnen, Sefinew Alemu; Koop, Gerrit; Lam, Theo J G M; Hogeveen, Henk

2017-01-01

Understanding the intentions of dairy farmers towards mastitis control is important to design effective udder health control programs. We used the Theory of Planned Behavior (TPB) to explore the intentions of North-Western Ethiopian dairy farmers towards implementing non-specified mastitis control measures (nsMCMs) and towards implementing 4 specific MCMs. Face to face interviews were held with 134 dairy farmers to study associations between their intentions and any of three factors (attitude, subjective norm and perceived behavioral control) that, according to the TPB, determine intentions. The majority of the farmers (93%) had a positive intention to implement nsMCMs, whereas a smaller majority of farmers had the intention to implement the specific MCMs to improve udder cleaning (87%), to improve stall hygiene (78%), to improve feeding of cows (76%), and to perform foremilk stripping (74%). Farmers had a more positive attitude, but lower subjective norm and lower perceived behavioural control towards implementing nsMCMs compared with implementing most specific MCMs, although the subjective norms for stall hygiene and perceived behavioural control for improving feeding of cows were also low. Attitude was positively associated with intentions to implement nsMCMs, to improve cleaning of the udders, to improve stall hygiene and to implement foremilk stripping. Both the intention to improve udder cleaning and to implement foremilk stripping, were positively associated to subjective norms towards these MCMs. Our data can help tailor intervention programs aiming to increase the intention of Ethiopian dairy farmers to implement MCMs and thus to improve udder health in this country. We show that such programs should primarily focus on changing attitude and secondarily on improving the farmers' subjective norms.

[WHO Framework Convention on Tobacco Control (FCTC) Article 11: packaging and labelling of tobacco products].

PubMed

Bekki, Kanae; Inaba, Yohei; Kunugita, Naoki

2015-01-01

The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) requires member countries to implement measures aimed at reducing the demand for tobacco products. FCTC article 11 describes the important forms of health communication and packaging regulations. And this article recommends on large pictorial health warnings and encourages more effective forms of disclosure on constituents and emissions. Furthermore, article 11 recognizes the importance of the package as a promotional vehicle for tobacco companies and requires the removal of potentially misleading packaging information, including the terms "light" and "mild." The Conference of the Parties (COP) adopted guidelines for implementation of article 11 on "Packaging and labelling of Tobacco Products". Some countries, such as Canada, the U.S.A., Australia, EU countries etc. positively promoted tobacco control by implementing countermeasures such as the graphic health warning labels and plain packages. These countermeasures showed the significant effects of decreasing smoking rate and preventing smoking initiation in young people. Furthermore, these warning labels were effective for the literally challenged. However, the Japanese government has not implemented these countermeasures, and only limited texts are shown on Japanese tobacco packaging. Therefore, Japan should emulate approaches taken by other countries, and promote the tobacco control policy in accordance with FCTC.

Building capacity for implementation of the framework convention for tobacco control in Vietnam: lessons for developing countries.

PubMed

Stillman, Frances A; David, Annette M; Kibria, Naseeb; Phan, Hai Thi

2014-09-01

Effective implementation of the WHO international Framework Convention on Tobacco Control (FCTC) is the key to controlling the tobacco epidemic. Within countries, strong national tobacco control capacity is the primary determinant for successful implementation of the FCTC. This case study of tobacco control policy describes the experience of building national tobacco control capacity in Vietnam under the Reduce Smoking in Vietnam Partnership project within a national capacity-building framework. In the Vietnam experience, four components of tobacco control capacity emerged as especially important to achieve 'quality' outputs and measurable outcomes at the implementation level: (i) organizational structure/infrastructure; (ii) leadership and expertise; (iii) partnerships and networks and (iv) data and evidence from research. The experience gained in this project helps in adapting our tobacco control capacity-building model, and the lessons that emerged from this country case study can provide guidance to global funders, tobacco control technical assistance providers and nations as governments endeavor to meet their commitment to the FCTC. © The Author (2013). Published by Oxford University Press.

Strategies for enhancing the implementation of school-based policies or practices targeting risk factors for chronic disease.

PubMed

Wolfenden, Luke; Nathan, Nicole K; Sutherland, Rachel; Yoong, Sze Lin; Hodder, Rebecca K; Wyse, Rebecca J; Delaney, Tessa; Grady, Alice; Fielding, Alison; Tzelepis, Flora; Clinton-McHarg, Tara; Parmenter, Benjamin; Butler, Peter; Wiggers, John; Bauman, Adrian; Milat, Andrew; Booth, Debbie; Williams, Christopher M

2017-11-29

A number of school-based policies or practices have been found to be effective in improving child diet and physical activity, and preventing excessive weight gain, tobacco or harmful alcohol use. Schools, however, frequently fail to implement such evidence-based interventions. The primary aims of the review are to examine the effectiveness of strategies aiming to improve the implementation of school-based policies, programs or practices to address child diet, physical activity, obesity, tobacco or alcohol use.Secondary objectives of the review are to: Examine the effectiveness of implementation strategies on health behaviour (e.g. fruit and vegetable consumption) and anthropometric outcomes (e.g. BMI, weight); describe the impact of such strategies on the knowledge, skills or attitudes of school staff involved in implementing health-promoting policies, programs or practices; describe the cost or cost-effectiveness of such strategies; and describe any unintended adverse effects of strategies on schools, school staff or children. All electronic databases were searched on 16 July 2017 for studies published up to 31 August 2016. We searched the following electronic databases: Cochrane Library including the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; MEDLINE In-Process & Other Non-Indexed Citations; Embase Classic and Embase; PsycINFO; Education Resource Information Center (ERIC); Cumulative Index to Nursing and Allied Health Literature (CINAHL); Dissertations and Theses; and SCOPUS. We screened reference lists of all included trials for citations of other potentially relevant trials. We handsearched all publications between 2011 and 2016 in two specialty journals (Implementation Science and Journal of Translational Behavioral Medicine) and conducted searches of the WHO International Clinical Trials Registry Platform (ICTRP) (http://apps.who.int/trialsearch/) as well as the US National Institutes of Health registry (https://clinicaltrials.gov). We consulted with experts in the field to identify other relevant research. 'Implementation' was defined as the use of strategies to adopt and integrate evidence-based health interventions and to change practice patterns within specific settings. We included any trial (randomised or non-randomised) conducted at any scale, with a parallel control group that compared a strategy to implement policies or practices to address diet, physical activity, overweight or obesity, tobacco or alcohol use by school staff to 'no intervention', 'usual' practice or a different implementation strategy. Citation screening, data extraction and assessment of risk of bias was performed by review authors in pairs. Disagreements between review authors were resolved via consensus, or if required, by a third author. Considerable trial heterogeneity precluded meta-analysis. We narratively synthesised trial findings by describing the effect size of the primary outcome measure for policy or practice implementation (or the median of such measures where a single primary outcome was not stated). We included 27 trials, 18 of which were conducted in the USA. Nineteen studies employed randomised controlled trial (RCT) designs. Fifteen trials tested strategies to implement healthy eating policies, practice or programs; six trials tested strategies targeting physical activity policies or practices; and three trials targeted tobacco policies or practices. Three trials targeted a combination of risk factors. None of the included trials sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials examined multi-strategic implementation strategies and no two trials examined the same combinations of implementation strategies. The most common implementation strategies included educational materials, educational outreach and educational meetings. For all outcomes, the overall quality of evidence was very low and the risk of bias was high for the majority of trials for detection and performance bias.Among 13 trials reporting dichotomous implementation outcomes-the proportion of schools or school staff (e.g. classes) implementing a targeted policy or practice-the median unadjusted (improvement) effect sizes ranged from 8.5% to 66.6%. Of seven trials reporting the percentage of a practice, program or policy that had been implemented, the median unadjusted effect (improvement), relative to the control ranged from -8% to 43%. The effect, relative to control, reported in two trials assessing the impact of implementation strategies on the time per week teachers spent delivering targeted policies or practices ranged from 26.6 to 54.9 minutes per week. Among trials reporting other continuous implementation outcomes, findings were mixed. Four trials were conducted of strategies that sought to achieve implementation 'at scale', that is, across samples of at least 50 schools, of which improvements in implementation were reported in three trials.The impact of interventions on student health behaviour or weight status were mixed. Three of the eight trials with physical activity outcomes reported no significant improvements. Two trials reported reductions in tobacco use among intervention relative to control. Seven of nine trials reported no between-group differences on student overweight, obesity or adiposity. Positive improvements in child dietary intake were generally reported among trials reporting these outcomes. Three trials assessed the impact of implementation strategies on the attitudes of school staff and found mixed effects. Two trials specified in the study methods an assessment of potential unintended adverse effects, of which, they reported none. One trial reported implementation support did not significantly increase school revenue or expenses and another, conducted a formal economic evaluation, reporting the intervention to be cost-effective. Trial heterogeneity, and the lack of consistent terminology describing implementation strategies, were important limitations of the review. Given the very low quality of the available evidence, it is uncertain whether the strategies tested improve implementation of the targeted school-based policies or practices, student health behaviours, or the knowledge or attitudes of school staff. It is also uncertain if strategies to improve implementation are cost-effective or if they result in unintended adverse consequences. Further research is required to guide efforts to facilitate the translation of evidence into practice in this setting.

Bringing automatic stereotyping under control: implementation intentions as efficient means of thought control.

PubMed

Stewart, Brandon D; Payne, B Keith

2008-10-01

The evidence for whether intentional control strategies can reduce automatic stereotyping is mixed. Therefore, the authors tested the utility of implementation intentions--specific plans linking a behavioral opportunity to a specific response--in reducing automatic bias. In three experiments, automatic stereotyping was reduced when participants made an intention to think specific counterstereotypical thoughts whenever they encountered a Black individual. The authors used two implicit tasks and process dissociation analysis, which allowed them to separate contributions of automatic and controlled thinking to task performance. Of importance, the reduction in stereotyping was driven by a change in automatic stereotyping and not controlled thinking. This benefit was acquired with little practice and generalized to novel faces. Thus, implementation intentions may be an effective and efficient means for controlling automatic aspects of thought.

Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial

PubMed Central

2013-01-01

Background The clinical pathway is a tool that operationalizes best evidence recommendations and clinical practice guidelines in an accessible format for ‘point of care’ management by multidisciplinary health teams in hospital settings. While high-quality, expert-developed clinical pathways have many potential benefits, their impact has been limited by variable implementation strategies and suboptimal research designs. Best strategies for implementing pathways into hospital settings remain unknown. This study will seek to develop and comprehensively evaluate best strategies for effective local implementation of externally developed expert clinical pathways. Design/methods We will develop a theory-based and knowledge user-informed intervention strategy to implement two pediatric clinical pathways: asthma and gastroenteritis. Using a balanced incomplete block design, we will randomize 16 community emergency departments to receive the intervention for one clinical pathway and serve as control for the alternate clinical pathway, thus conducting two cluster randomized controlled trials to evaluate this implementation intervention. A minimization procedure will be used to randomize sites. Intervention sites will receive a tailored strategy to support full clinical pathway implementation. We will evaluate implementation strategy effectiveness through measurement of relevant process and clinical outcomes. The primary process outcome will be the presence of an appropriately completed clinical pathway on the chart for relevant patients. Primary clinical outcomes for each clinical pathway include the following: Asthma—the proportion of asthmatic patients treated appropriately with corticosteroids in the emergency department and at discharge; and Gastroenteritis—the proportion of relevant patients appropriately treated with oral rehydration therapy. Data sources include chart audits, administrative databases, environmental scans, and qualitative interviews. We will also conduct an overall process evaluation to assess the implementation strategy and an economic analysis to evaluate implementation costs and benefits. Discussion This study will contribute to the body of evidence supporting effective strategies for clinical pathway implementation, and ultimately reducing the research to practice gaps by operationalizing best evidence care recommendations through effective use of clinical pathways. Trial registration ClinicalTrials.gov: NCT01815710 PMID:23692634

Constant voltage and constant current control implementation for electric vehicles (evs) wireless charger

NASA Astrophysics Data System (ADS)

Tampubolon, Marojahan; Pamungkas, Laskar; Hsieh, Yao Ching; Chiu, Huang Jen

2018-04-01

This paper presents the implementation of Constant Voltage (CV) and Constant Current (CC) control for a wireless charger system. A battery charging system needs these control modes to ensure the safety of the battery and the effectiveness of the charging system. Here, the wireless charger system does not employ any post-regulator stage to control the output voltage and output current of the charger. But, it uses a variable frequency control incorporated with a conventional PI control. As a result, the size and the weight of the system are reduced. This paper discusses the brief review of the SS-WPT, control strategy and implementation of the CV and CC control. Experimental hardware with 2kW output power has been performed and tested. The results show that the proposed CV and CC control method works well with the system.

Patient-experienced effect of an active implementation of a disease management programme for COPD – a randomised trial

PubMed Central

2013-01-01

Background People living with chronic disease currently account for the majority of the total healthcare costs. The Central Denmark Region implemented a disease management programme (DMP) for chronic obstructive pulmonary disease (COPD) in 2008. This presented an opportunity to examine the effect of an evidence-based, planned and proactive implementation of a DMP compared to the usual implementation strategy. Methods We performed a block- and cluster-randomised controlled trial with two groups and an extra external control group. The primary outcome was patients’ assessment of their care after using an active implementation model for a DMP for COPD measured with the Patient-Assessment-of-Chronic-Illness-Care (PACIC) instrument. At baseline, questionnaires were sent to 2,895 patients identified by an algorithm based on health registry data on lung-related contacts to the healthcare system. Patients were asked to confirm or refute their diagnosis of COPD. Of those who responded, 1,445 (72.8%) confirmed their diagnosis. PACIC data were collected at baseline and at a 12-month follow-up for 744 (51.1%) patients. Results Comparing the three groups after the implementation of the DMP, we found a statistically significantly higher change in the PACIC score in the intervention group than in the control groups. No statistically significant differences were found between the control and the external control groups in any of the dimensions. Conclusions Reinforcing the role of general practice as coordinator for care-and self-management-support with an active implementation of a DMP for COPD made patients score higher on the PACIC instrument, which indicates a better experience of the received healthcare. Trial registration NCT01228708. PMID:24088417

Patient-experienced effect of an active implementation of a disease management programme for COPD - a randomised trial.

PubMed

Smidth, Margrethe; Olesen, Frede; Fenger-Grøn, Morten; Vedsted, Peter

2013-10-03

People living with chronic disease currently account for the majority of the total healthcare costs. The Central Denmark Region implemented a disease management programme (DMP) for chronic obstructive pulmonary disease (COPD) in 2008. This presented an opportunity to examine the effect of an evidence-based, planned and proactive implementation of a DMP compared to the usual implementation strategy. We performed a block- and cluster-randomised controlled trial with two groups and an extra external control group. The primary outcome was patients' assessment of their care after using an active implementation model for a DMP for COPD measured with the Patient-Assessment-of-Chronic-Illness-Care (PACIC) instrument. At baseline, questionnaires were sent to 2,895 patients identified by an algorithm based on health registry data on lung-related contacts to the healthcare system. Patients were asked to confirm or refute their diagnosis of COPD. Of those who responded, 1,445 (72.8%) confirmed their diagnosis. PACIC data were collected at baseline and at a 12-month follow-up for 744 (51.1%) patients. Comparing the three groups after the implementation of the DMP, we found a statistically significantly higher change in the PACIC score in the intervention group than in the control groups. No statistically significant differences were found between the control and the external control groups in any of the dimensions. Reinforcing the role of general practice as coordinator for care-and self-management-support with an active implementation of a DMP for COPD made patients score higher on the PACIC instrument, which indicates a better experience of the received healthcare. NCT01228708.

Implementation Science in Cancer Prevention and Control: A framework for research and programs in low and middle-income countries

PubMed Central

Sanchez, Michael A.; Rimer, Barbara K.; Samet, Jonathan M.; Glasgow, Russell E.

2014-01-01

Implementation Science is a set of tools, principles and methodologies that can be used to bring scientific evidence into action, improve health care quality and delivery and improve public health. As the burden of cancer increases in low- and middle-income countries, it is important to plan cancer control programs that are both evidence-based and delivered in ways that are feasible, cost-effective, contextually appropriate and sustainable. This review presents a framework for using implementation science for cancer control planning and implementation and discusses potential areas of focus for research and programs in low and middle-income countries interested in integrating research into practice and policy. PMID:25178984

Teachers or Psychologists: Who Should Facilitate Depression Prevention Programs in Schools?

PubMed Central

Wahl, Melanie S.; Adelson, Jill L.; Patak, Margarete A.; Pössel, Patrick; Hautzinger, Martin

2014-01-01

The current study evaluates a depression prevention program for adolescents led by psychologists vs. teachers in comparison to a control. The universal school-based prevention program has shown its efficacy in several studies when implemented by psychologists. The current study compares the effects of the program as implemented by teachers versus that implemented by psychologists under real-life conditions. A total of 646 vocational track 8th grade students from Germany participated either in a universal prevention program, led by teachers (n = 207) or psychologists (n = 213), or a teaching-as-usual control condition (n = 226). The design includes baseline, post-intervention, and follow-up (at 6 and 12 months post-intervention). The cognitive-behavioral program includes 10 sessions held in a regular school setting in same-gender groups and is based on the social information-processing model of social competence. Positive intervention effects were found on the change in girls’ depressive symptoms up to 12 months after program delivery when the program was implemented by psychologists. No such effects were found on boys or when program was delivered by teachers. The prevention program can successfully be implemented for girls by psychologists. Further research is needed for explanations of these effects. PMID:24837667

The development of effects-based air quality management regimes

NASA Astrophysics Data System (ADS)

Longhurst, J. W. S.; Irwin, J. G.; Chatterton, T. J.; Hayes, E. T.; Leksmono, N. S.; Symons, J. K.

This paper considers the evolution of attempts to control and manage air pollution, principally but not exclusively focussing upon the challenge of managing air pollution in urban environments. The development and implementation of a range of air pollution control measures are considered. Initially the measures implemented primarily addressed point sources, a small number of fuel types and a limited number of pollutants. The adequacy of such a source-control approach is assessed within the context of a changing and challenging air pollution climate. An assessment of air quality management in the United Kingdom over a 50-year timeframe exemplifies the range of issues and challenges in contemporary air quality management. The need for new approaches is explored and the development and implementation of an effects-based, risk management system for air quality regulation is evaluated.

Importance of implementation level when evaluating the effect of the Hi Five Intervention on infectious illness and illness-related absenteeism.

PubMed

Denbæk, Anne Maj; Andersen, Anette; Bast, Lotus Sofie; Bonnesen, Camilla Thørring; Ersbøll, Annette Kjær; Due, Pernille; Johansen, Anette

2018-05-01

There is limited research on the importance of implementation when evaluating the effect of hand hygiene interventions in school settings in developed countries. The aim of this study was to examine the association between an implementation index and the effect of the intervention. The Hi Five Intervention was evaluated in a 3-armed cluster randomized controlled trial involving 43 randomly selected Danish schools. Analyses investigating the association between implementation of the Hi Five Intervention and infectious illness days, infectious illness episodes, illness-related absenteeism, and hand hygiene were carried out in a multilevel model (school, class, and child). The level of implementation was associated with hand hygiene and potentially associated with number of infectious illness days and infectious illness episodes among children. This association was not found for illness-related absenteeism. Classes that succeeded in achieving a high level of implementation of the Hi Five Intervention had a lower number of infectious illness days and infectious illness episodes, suggesting that the Hi Five Intervention, if implemented adequately, may be relevant as a tool to decrease infectious illness in a Danish school setting. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2009-10-01

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

Translation of tobacco control programs in schools: findings from a rapid review of systematic reviews of implementation and dissemination interventions.

PubMed

Wolfenden, L; Carruthers, J; Wyse, R; Yoong, S

2014-08-01

School-based programs targeting the prevention of tobacco use are a key strategy for reducing the overall tobacco-related mortality and morbidity in the community. While substantial research investment has resulted in the identification of various effective tobacco prevention interventions in schools, this research investment will not result in public health benefits, unless effectively disseminated and implemented. This rapid review aimed to identify effective implementation or dissemination interventions, targeting the adoption of school-based tobacco prevention programs. A systematic search was conducted to identify published systematic reviews that examined the effectiveness of implementation and dissemination strategies for facilitating the adoption of tobacco policies or programs in schools from 1992 to 2012. The search yielded 1028 results, with one relevant systematic review being identified. The review included two controlled studies examining the implementation and dissemination of tobacco prevention programs and guidelines. The two randomised trials examined the delivery of active face-to-face training to implement a school-based curriculum compared with video-delivered or mail-based training. Improvements in the implementation of the programs were reported for the face-to-face training arm in both trials. Little rigorous evidence exists to guide the implementation and dissemination of tobacco prevention programs in schools. SO WHAT? Few systematic reviews exist to inform the implementation of evidence-based tobacco prevention programs in schools. In the absence of a strong evidence base, health care policymakers and practitioners may need to draw on setting-based frameworks or parallel evidence from other settings to design strategies to facilitate the adoption of tobacco prevention initiatives.

The Industrial User Permitting Guidance Manual

EPA Pesticide Factsheets

Provides guidance for control authorities to effectively develop and issue control mechanisms to IUs discharging to the POTW and covers developing and implementing control mechanisms for both SIUs and non-SIUs.

Addressing the Social Determinants of Health to Reduce Tobacco-Related Disparities.

PubMed

Garrett, Bridgette E; Dube, Shanta R; Babb, Stephen; McAfee, Tim

2015-08-01

Comprehensive tobacco prevention and control efforts that include implementing smoke-free air laws, increasing tobacco prices, conducting hard-hitting mass media campaigns, and making evidence-based cessation treatments available are effective in reducing tobacco use in the general population. However, if these interventions are not implemented in an equitable manner, certain population groups may be left out causing or exacerbating disparities in tobacco use. Disparities in tobacco use have, in part, stemmed from inequities in the way tobacco control policies and programs have been adopted and implemented to reach and impact the most vulnerable segments of the population that have the highest rates of smokings (e.g., those with lower education and incomes). Education and income are the 2 main social determinants of health that negatively impact health. However, there are other social determinants of health that must be considered for tobacco control policies to be effective in reducing tobacco-related disparities. This article will provide an overview of how tobacco control policies and programs can address key social determinants of health in order to achieve equity and eliminate disparities in tobacco prevention and control. Tobacco control policy interventions can be effective in addressing the social determinants of health in tobacco prevention and control to achieve equity and eliminate tobacco-related disparities when they are implemented consistently and equitably across all population groups. Taking a social determinants of health approach in tobacco prevention and control will be necessary to achieve equity and eliminate tobacco-related disparities. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Effects of physical exercise programme on happiness among older people.

PubMed

Khazaee-Pool, M; Sadeghi, R; Majlessi, F; Rahimi Foroushani, A

2015-02-01

This randomized-controlled trial investigated the effect of physical exercise programme (PEP) on happiness among older adults in Nowshahr, Iran. Results of this study on 120 male and female volunteers showed that an 8-week group physical exercise programme was significantly effective in older adults' happiness. Findings showed that physical exercise programme is so beneficial for increasing older adults' happiness. Physical activity is associated with well-being and happiness. The purpose of this study was to determine the effects of an 8-week long physical exercise programme (PEP) on happiness among older adults in Nowshahr, Iran. This was a randomized control trial study. The participants consisted of a group of 120 male and female volunteers (mean ± SD age: 71 ± 5.86 years) in a convenience sampling among older adults in public parks in Nowshahr, Iran. We randomly allocated them into experimental (n = 60) and control (n = 60) groups. A validated instrument was used to measure well-being and happiness [Oxford Happiness Inventory (OHI)]. Respondents were asked to complete the OHI before and 2 months after implementing PEP. The 8-week PEP was implemented with the intervention group. The statistical analysis of the data was conducted using paired t-test, Fisher's exact test and χ(2). Before the intervention, there was no significant difference in the happiness mean score between the case and control groups; however, after implementing PEP, happiness significantly improved among the experimental group (P = 0.001) and did not improve within the control group (P = 0.79). It can be concluded that PEP had positive effects on happiness among older adults. Planning and implementing of physical activity is so important for older happiness. © 2014 John Wiley & Sons Ltd.

77 FR 66945 - Approval and Promulgation of Air Quality Implementation Plans; New Hampshire; Reasonably...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-08

... and Promulgation of Air Quality Implementation Plans; New Hampshire; Reasonably Available Control... Implementation Plan (SIP) revision submitted by the State of New Hampshire. The revision establishes Reasonably... intended effect of this action is to approve these requirements into the New Hampshire SIP. This action is...

Development of Algorithms for Control of Humidity in Plant Growth Chambers

NASA Technical Reports Server (NTRS)

Costello, Thomas A.

2003-01-01

Algorithms were developed to control humidity in plant growth chambers used for research on bioregenerative life support at Kennedy Space Center. The algorithms used the computed water vapor pressure (based on measured air temperature and relative humidity) as the process variable, with time-proportioned outputs to operate the humidifier and de-humidifier. Algorithms were based upon proportional-integral-differential (PID) and Fuzzy Logic schemes and were implemented using I/O Control software (OPTO-22) to define and download the control logic to an autonomous programmable logic controller (PLC, ultimate ethernet brain and assorted input-output modules, OPTO-22), which performed the monitoring and control logic processing, as well the physical control of the devices that effected the targeted environment in the chamber. During limited testing, the PLC's successfully implemented the intended control schemes and attained a control resolution for humidity of less than 1%. The algorithms have potential to be used not only with autonomous PLC's but could also be implemented within network-based supervisory control programs. This report documents unique control features that were implemented within the OPTO-22 framework and makes recommendations regarding future uses of the hardware and software for biological research by NASA.

Introduction of a breast cancer care programme including ultra short hospital stay in 4 early adopter centres: framework for an implementation study.

PubMed

de Kok, Mascha; Frotscher, Caroline N A; van der Weijden, Trudy; Kessels, Alfons G H; Dirksen, Carmen D; van de Velde, Cornelis J H; Roukema, Jan A; Bell, Antoine V R J; van der Ent, Fred W; von Meyenfeldt, Maarten F

2007-07-02

Whereas ultra-short stay (day care or 24 hour hospitalisation) following breast cancer surgery was introduced in the US and Canada in the 1990s, it is not yet common practice in Europe. This paper describes the design of the MaDO study, which involves the implementation of ultra short stay admission for patients after breast cancer surgery, and evaluates whether the targets of the implementation strategy are reached. The ultra short stay programme and the applied implementation strategy will be evaluated from the economic perspective. The MaDO study is a pre-post-controlled multi-centre study, that is performed in four hospitals in the Netherlands. It includes a pre and post measuring period of six months each with six months of implementation in between in at least 40 patients per hospital per measurement period. Primary outcome measure is the percentage of patients treated in ultra short stay. Secondary endpoints are the percentage of patients treated according to protocol, degree of involvement of home care nursing, quality of care from the patient's perspective, cost-effectiveness of the ultra short stay programme and cost-effectiveness of the implementation strategy. Quality of care will be measured by the QUOTE-breast cancer instrument, cost-effectiveness of the ultra short stay programme will be measured by means of the EuroQol (administered at four time-points) and a cost book for patients. Cost-effectiveness analysis will be performed from a societal perspective. Cost-effectiveness of the implementation strategy will be measured by determination of the costs of implementation activities. This study will reveal barriers and facilitators for implementation of the ultra short stay programme. Moreover, the results of the study will provide information about the cost-effectiveness of the ultra short stay programme and the implementation strategy. Current Controlled Trials ISRCTN77253391.

Age and educational inequalities in smoking cessation due to three population-level tobacco control interventions: findings from the International Tobacco Control (ITC) Netherlands Survey.

PubMed

Nagelhout, Gera E; Crone, Matty R; van den Putte, Bas; Willemsen, Marc C; Fong, Geoffrey T; de Vries, Hein

2013-02-01

This study aimed to examine age and educational inequalities in smoking cessation due to the implementation of a tobacco tax increase, smoke-free legislation and a cessation campaign. Longitudinal data from 962 smokers aged 15 years and older were used from three survey waves of the International Tobacco Control (ITC) Netherlands Survey. The 2008 survey was performed before the implementation of the interventions and the 2009 and 2010 surveys were performed after the implementation. No significant age and educational differences in successful smoking cessation were found after the implementation of the three tobacco control interventions, although smokers aged 15-39 years were more likely to attempt to quit. Of the three population-level tobacco control interventions that were implemented simultaneously in the Netherlands, only the smoke-free legislation seemed to have increased quit attempts. The price increase of cigarettes may have been only effective in stimulating smoking cessation among younger smokers. Larger tax increases, stronger smoke-free legislation and media campaigns about the dangers of (second-hand) smoking are needed in the Netherlands.

Assessing the impact of public health interventions on the transmission of pandemic H1N1 influenza a virus aboard a Peruvian navy ship

PubMed Central

Vera, Delphis M; Hora, Ricardo A; Murillo, Anarina; Wong, Juan F; Torre, Armando J; Wang, David; Boulay, Darbi; Hancock, Kathy; Katz, Jacqueline M; Ramos, Mariana; Loayza, Luis; Quispe, Jose; Reaves, Erik J; Bausch, Daniel G; Chowell, Gerardo; Montgomery, Joel M

2014-01-01

Background Limited data exist on transmission dynamics and effectiveness of control measures for influenza in confined settings. Objectives To investigate the transmission dynamics of a 2009 pandemic H1N1 influenza A outbreak aboard a Peruvian Navy ship and quantify the effectiveness of the implemented control measures. Methods We used surveillance data and a simple stochastic epidemic model to characterize and evaluate the effectiveness of control interventions implemented during an outbreak of 2009 pandemic H1N1 influenza A aboard a Peruvian Navy ship. Results The serological attack rate for the outbreak was 49·1%, with younger cadets and low-ranking officers at greater risk of infection than older, higher-ranking officers. Our transmission model yielded a good fit to the daily time series of new influenza cases by date of symptom onset. We estimated a reduction of 54·4% in the reproduction number during the period of intense control interventions. Conclusion Our results indicate that the patient isolation strategy and other control measures put in place during the outbreak reduced the infectiousness of isolated individuals by 86·7%. Our findings support that early implementation of control interventions can limit the spread of influenza epidemics in confined settings. PMID:24506160

Impact on cardiovascular disease events of the implementation of Argentina's national tobacco control law.

PubMed

Konfino, Jonatan; Ferrante, Daniel; Mejia, Raul; Coxson, Pamela; Moran, Andrew; Goldman, Lee; Pérez-Stable, Eliseo J

2014-03-01

Argentina's congress passed a tobacco control law that would enforce 100% smoke-free environments for the entire country, strong and pictorial health warnings on tobacco products and a comprehensive advertising ban. However, the Executive Branch continues to review the law and it has not been fully implemented. Our objective was to project the potential impact of full implementation of this tobacco control legislation on cardiovascular disease. The Coronary Heart Disease (CHD) Policy Model was used to project future cardiovascular events. Data sources for the model included vital statistics, morbidity and mortality data, and tobacco use estimates from the National Risk Factor Survey. Estimated effectiveness of interventions was based on a literature review. Results were expressed as life-years, myocardial infarctions and strokes saved in an 8-year-period between 2012 and 2020. In addition we projected the incremental effectiveness on the same outcomes of a tobacco price increase not included in the law. In the period 2012-2020, 7500 CHD deaths, 16 900 myocardial infarctions and 4300 strokes could be avoided with the full implementation and enforcement of this law. Annual per cent reduction would be 3% for CHD deaths, 3% for myocardial infarctions and 1% for stroke. If a tobacco price increase is implemented the projected avoided CHD deaths, myocardial infarctions and strokes would be 15 500, 34 600 and 11 900, respectively. Implementation of the tobacco control law would produce significant public health benefits in Argentina. Strong advocacy is needed at national and international levels to get this law implemented throughout Argentina.

78 FR 77557 - Releasing Information; General Provisions; Accounting and Reporting Requirements; Reports of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-24

..., including controls for maintaining the confidentiality of borrower information. The system of internal... develop and implement an effective system of internal controls over the central data repository to ensure..., and maintain an effective system of internal controls over the data included in the report of accounts...

Global systematic review of Indigenous community-led legal interventions to control alcohol

PubMed Central

Muhunthan, Janani; Angell, Blake; Hackett, Maree L; Wilson, Andrew; Latimer, Jane; Eades, Anne-Marie; Jan, Stephen

2017-01-01

Objectives The national and subnational governments of most developed nations have adopted cost-effective regulatory and legislative controls over alcohol supply and consumption with great success. However, there has been a lack of scrutiny of the effectiveness and appropriateness of these laws in shaping the health-related behaviours of Indigenous communities, who disproportionately experience alcohol-related harm. Further, such controls imposed unilaterally without Indigenous consultation have often been discriminatory and harmful in practice. Setting, participants and outcome measures In this systematic review of quantitative evaluations of Indigenous-led alcohol controls, we aim to investigate how regulatory responses have been developed and implemented by Indigenous communities worldwide, and evaluate their effectiveness in improving health and social outcomes. We included articles from electronic databases MEDLINE, EMBASE, CINAHL, PsycINFO and Web of Science from inception to December 2015. Results Our search yielded 1489 articles from which 18 met the inclusion criteria. Controls were implemented in rural and remote populations of high-income nations. Communities employed a range of regulatory options including alcohol rationing, prohibition of sale, importation or possession, restrictions on liquor sold, times of sale or mode of sale, Indigenous-controlled liquor licensing, sin tax and traditional forms of control. 11 studies reported interventions that were effective in reducing crime, injury deaths, injury, hospitalisations or lowering per capita consumption. In six studies interventions were found to be ineffective or harmful. The results were inconclusive in one. Conclusions Indigenous-led policies that are developed or implemented by communities can be effective in improving health and social outcomes. PMID:28348189

The Use of Interactive Computer Animations Based on POE as a Presentation Tool in Primary Science Teaching

NASA Astrophysics Data System (ADS)

Akpınar, Ercan

2014-08-01

This study investigates the effects of using interactive computer animations based on predict-observe-explain (POE) as a presentation tool on primary school students' understanding of the static electricity concepts. A quasi-experimental pre-test/post-test control group design was utilized in this study. The experiment group consisted of 30 students, and the control group of 27 students. The control group received normal instruction in which the teacher provided instruction by means of lecture, discussion and homework. Whereas in the experiment group, dynamic and interactive animations based on POE were used as a presentation tool. Data collection tools used in the study were static electricity concept test and open-ended questions. The static electricity concept test was used as pre-test before the implementation, as post-test at the end of the implementation and as delay test approximately 6 weeks after the implementation. Open-ended questions were used at the end of the implementation and approximately 6 weeks after the implementation. Results indicated that the interactive animations used as presentation tools were more effective on the students' understanding of static electricity concepts compared to normal instruction.

Control of Taenia solium taeniasis/cysticercosis: from research towards implementation.

PubMed

Pawlowski, Zbigniew; Allan, James; Sarti, Elsa

2005-10-01

Theoretically, considering the biology of its transmission and reservoirs, global eradication of Taenia solium taeniasis and cysticercosis is feasible. Recently much progress has been made in research on diagnosis, treatment and prevention of human taeniasis and porcine cysticercosis, although more operational research is still needed. In spite of this, global eradication of T. solium infection is still unlikely in the near future. Major obstacles to practical implementation of control measures include low levels of sanitation and health education amongst endemic populations, ineffective health services infrastructure and inadequate socioeconomic development in these areas. The continued public health impact of neurocysticercosis, especially fatalities and epilepsy, force us to identify improved options for control. In order to implement control measures in highly endemic areas the active involvement of medical services in controlling T. solium infection and more effective collaboration between medical and veterinary services is necessary. A switch is suggested from total reliance on meat inspection to active diagnosis and treatment of human taeniasis, protection of pigs against infection, promotion of health education and improved surveillance preparing chemotherapeutic and/or sanitary interventions. This could be implemented in areas where active transmission causes substantial morbidity and mortality provided there is the political will, social support, better financing and an effective organizational framework.

Beyond Binary: Using Propensity Scores to Account for Varying Levels of Program Participation in Randomized Controlled Trials

ERIC Educational Resources Information Center

Stuart, Elizabeth A.; Warkentien, Siri; Jo, Booil

2011-01-01

The purpose of the current project is to explore the use of propensity scores to estimate the effects of interventions within randomized control trials, accounting for varying levels of implementation or fidelity. This work extends that of Jo and Stuart (2009) to settings with multiple or continuous measures of implementation. Rather than focus…

Hybrid Implementation Model of Community-Partnered Early Intervention for Toddlers with Autism: A Randomized Trial

ERIC Educational Resources Information Center

Shire, Stephanie Y.; Chang, Ya-Chih; Shih, Wendy; Bracaglia, Suzanne; Kodjoe, Maria; Kasari, Connie

2017-01-01

Background: Interventions found to be effective in research settings are often not as effective when implemented in community settings. Considering children with autism, studies have rarely examined the efficacy of laboratory-tested interventions on child outcomes in community settings using randomized controlled designs. Methods: One hundred and…

Evidence Based Bullying Prevention in Turkey: Implementation of the ViSC Social Competence Program

ERIC Educational Resources Information Center

Dogan, Aysun; Keser, Eda; Sen, Zeynep; Yanagida, Takuya; Gradinger, Petra; Strohmeier, Dagmar

2017-01-01

The ViSC program is the first evidence based anti-bullying program implemented in Turkey. A quasi-experimental longitudinal control group design comprising six schools and 26 classes was realized to examine the program effectiveness regarding different forms of perpetration and victimization. The effectiveness of two dosages of…

Managing Air Quality - Program Implementation

EPA Pesticide Factsheets

Describes elements for the set of activities to ensure that control strategies are put into effect and that air quality goals and standards are fulfilled, permitting programs, and additional resources related to implementation under the Clean Air Act.

Long-term effectiveness of the integrated schistosomiasis control strategy with emphasis on infectious source control in China: a 10-year evaluation from 2005 to 2014.

PubMed

Wang, Xiaoli; Wang, Wei; Wang, Peng

2017-02-01

Schistosomiasis is a neglected tropical parasitic disease of great public health significance worldwide. Currently, mass drug administration with praziquantel remains the major strategy for global schistosomiasis control programs. Since 2005, an integrated strategy with emphasis on infectious source control was implemented for the control of schistosomiasis japonica, a major public health concern in China, and pilot studies have demonstrated that such a strategy is effective to reduce the prevalence of Schistosoma japonicum infection in both humans and bovines. However, there is little knowledge on the long-term effectiveness of this integrated strategy for controlling schistosomiasis japonica. The aim of this study was to evaluate the long-term effectiveness of the integrated strategy for schistosomiasis control following the 10-year implementation, based on the data from the national schistosomiasis control program released by the Ministry of Health, People's Republic of China. In 2014, there were 5 counties in which the transmission of schistosomiasis japonica had not been interrupted, which reduced by 95.2% as compared to that in 2005 (105 counties). The number of schistosomiasis patients and acute cases reduced by 85.5 and 99.7% in 2014 (115,614 cases and 2 cases) as compared to that in 2005 (798,762 cases and 564 cases), and the number of bovines and S. japonicum-infected bovines reduced by 47.9 and 98% in 2014 (919,579 bovines and 666 infected bovines) as compared to that in 2005 (1,764,472 bovines and 33,736 infected bovines), respectively. During the 10-year implementation of the integrated strategy, however, there was a minor fluctuation in the area of Oncomelania hupensis snail habitats, and there was only a 5.6% reduction in the area of snail habitats in 2014 relative to in 2005. The results of the current study demonstrate that the 10-year implementation of the integrated strategy with emphasis on infectious source has greatly reduced schistosomiasis-related morbidity in humans and bovines. It is concluded that the new integrated strategy has remarkable long-term effectiveness on the transmission of schistosomiasis japonica in China, which facilitates the shift of the national schistosomiasis control program from transmission control to transmission interruption and elimination. However, such a strategy seems to have little effect on the shrinking of areas of snail habitats.

The Effects of an Orientation Program on Quality of Life of Patients with Thalassemia: a Quasi-Experimental Study.

PubMed

Rafii, Zahra; Ahmadi, Fazlollah; Nourbakhsh, Sayed Mohamad Kazem; Hajizadeh, Ebrahim

2016-09-01

Introduction: Medical advances have improved life expectancy and survival of patients with thalassemia. However, as getting older, patients with thalassemia experience different complications which impair their quality of life. The aim of this study was to examine the effects of a nurse-implemented orientation program on quality of life in patients with thalassemia. Methods: A convenience sample of 55 patients with thalassemia were recruited in this quasi-experimental study. Patients were randomly allocated to control or experimental groups. A demographic questionnaire, Thalassemia quality of life questionnaire, and 36-item short form health survey were used for data collection before and one month after the intervention. In the intervention group, 1.5-month orientation program including of the three steps of inauguration, implementation, and closure was implemented, while the control group received routine care. The Chi-square, independent t-test and paired-samples t-test were used for data analysis by using SPSS ver.13 software. Results: The intervention and control group did not differ significantly from each other regarding demographic characteristics. Moreover, no significant difference was observed between the two groups regarding the quality of life scores after the implementation of orientation program. Conclusion: Implementing a short-term orientation program was not effective in enhancing the quality of life in patients with thalassemia; hence, developing long-term multimodal strategies may result in better improvement.

Self-regulation Interventions for the Reduction of Sugar-Sweetened Beverages in Adolescents

PubMed Central

Ames, Susan L.; Wurpts, Ingrid C.; Pike, James; MacKinnon, David P.; Reynolds, Kim R.; Stacy, Alan W.

2017-01-01

This study evaluated the efficacy of self-regulation interventions through the use of drink-specific implementation intentions and drink-specific Go/No-Go training tasks as compensatory strategies to modify inhibitory control to reduce intake of sugar-sweetened beverages (SSB). In a between-subjects randomized manipulation of implementation intentions and Go/No-Go training to learn to inhibit sugary drink consumption, 168 adolescents reporting inhibitory control problems over sugary drinks and foods were recruited from high schools in southern California to participate. Analysis of covariance overall test of effects revealed no significant differences between the groups regarding calories consumed, calories from SSBs, grams of sugar consumed from drinks, or the number of unhealthy drinks chosen. However, subsequent contrasts revealed SSB implementation intentions significantly reduced SSB consumption following intervention while controlling for inhibitory control failure and general SSB consumption during observation in a lab setting that provided SSBs and healthy drinks, as well as healthy and unhealthy snacks. Specifically, during post-intervention observation, participants in the sugar-sweetened beverage implementation intentions (SSB-II) conditions consumed significantly fewer calories overall, fewer calories from drinks, and fewer grams of sugar. No effects were found for the drink-specific Go/No-Go training on SSB or calorie consumption. However, participants in SSB-II with an added SSB Go/No-Go training made fewer unhealthy drink choices than those in the other conditions. Implementation intentions may aid individuals with inhibitory (executive control) difficulties by intervening on pre-potent behavioral tendencies, like SSB consumption. PMID:27374899

FPGA implementation of bit controller in double-tick architecture

NASA Astrophysics Data System (ADS)

Kobylecki, Michał; Kania, Dariusz

2017-11-01

This paper presents a comparison of the two original architectures of programmable bit controllers built on FPGAs. Programmable Logic Controllers (which include, among other things programmable bit controllers) built on FPGAs provide a efficient alternative to the controllers based on microprocessors which are expensive and often too slow. The presented and compared methods allow for the efficient implementation of any bit control algorithm written in Ladder Diagram language into the programmable logic system in accordance with IEC61131-3. In both cases, we have compared the effect of the applied architecture on the performance of executing the same bit control program in relation to its own size.

Research on cost control and management in high voltage transmission line construction

NASA Astrophysics Data System (ADS)

Xu, Xiaobin

2017-05-01

Enterprises. The cost control is of vital importance to the construction enterprises. It is the key to the profitability of the transmission line project, which is related to the survival and development of the electric power construction enterprises. Due to the long construction line, complex and changeable construction terrain as well as large construction costs of transmission line, it is difficult for us to take accurate and effective cost control on the project implementation of entire transmission line. Therefore, the cost control of transmission line project is a complicated and arduous task. It is of great theoretical and practical significance to study the cost control scheme of transmission line project by a more scientific and efficient way. Based on the characteristics of the construction project of the transmission line project, this paper analyzes the construction cost structure of the transmission line project and the current cost control problem of the transmission line project, and demonstrates the necessity and feasibility of studying the cost control scheme of the transmission line project more accurately. In this way, the dynamic cycle cost control process including plan, implementation, feedback, correction, modification and re-implement is achieved to realize the accurate and effective cost control of entire electric power transmission line project.

Promoting the translation of intentions into action by implementation intentions: behavioral effects and physiological correlates

PubMed Central

Wieber, Frank; Thürmer, J. Lukas; Gollwitzer, Peter M.

2015-01-01

The present review addresses the physiological correlates of planning effects on behavior. Although intentions to act qualify as predictors of behavior, accumulated evidence indicates that there is a substantial gap between even strong intentions and subsequent action. One effective strategy to reduce this intention–behavior gap is the formation of implementation intentions that specify when, where, and how to act on a given goal in an if-then format (“If I encounter situation Y, then I will initiate action Z!”). It has been proposed that implementation intentions render the mental representation of the situation highly accessible and establish a strong associative link between the mental representations of the situation and the action. These process assumptions have been examined in behavioral research, and in physiological research, a field that has begun to investigate the temporal dynamics of and brain areas involved in implementation intention effects. In the present review, we first summarize studies on the cognitive processes that are central to the strategic automation of action control by implementation intentions. We then examine studies involving critical samples with impaired self-regulation. Lastly, we review studies that have applied physiological measures such as heart rate, cortisol level, and eye movement, as well as electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) studies on the neural correlates of implementation intention effects. In support of the assumed processes, implementation intentions increased goal attainment in studies on cognitive processes and in critical samples, modulated brain waves related to perceptual and decision processes, and generated less activity in brain areas associated with effortful action control. In our discussion, we reflect on the status quo of physiological research on implementation intentions, methodological and conceptual issues, related research, and propose future directions. PMID:26236214

A tailored implementation strategy to reduce the duration of intravenous antibiotic treatment in community-acquired pneumonia: a controlled before-and-after study.

PubMed

Engel, M F; Bruns, A H W; Hulscher, M E J L; Gaillard, C A J M; Sankatsing, S U C; Teding van Berkhout, F; Emmelot-Vonk, M H; Kuck, E M; Steeghs, M H M; den Breeijen, J H; Stellato, R K; Hoepelman, A I M; Oosterheert, J J

2014-11-01

We previously showed that 40 % of clinically stable patients hospitalised for community-acquired pneumonia (CAP) are not switched to oral therapy in a timely fashion because of physicians' barriers. We aimed to decrease this proportion by implementing a novel protocol. In a multi-centre controlled before-and-after study, we evaluated the effect of an implementation strategy tailored to previously identified barriers to an early switch. In three Dutch hospitals, a protocol dictating a timely switch strategy was implemented using educational sessions, pocket reminders and active involvement of nursing staff. Primary outcomes were the proportion of patients switched timely and the duration of intravenous antibiotic therapy. Length of hospital stay (LOS), patient outcome, education effects 6 months after implementation and implementation costs were secondary outcomes. Statistical analysis was performed using mixed-effects models. Prior to implementation, 146 patients were included and, after implementation, 213 patients were included. The case mix was comparable. The implementation did not change the proportion of patients switched on time (66 %). The median duration of intravenous antibiotic administration decreased from 4 days [interquartile range (IQR) 2-5] to 3 days (IQR 2-4), a decrease of 21 % [95 % confidence interval (CI) 11 %; 30 %) in the multi-variable analysis. LOS and patient outcome were comparable before and after implementation. Forty-three percent (56/129) of physicians attended the educational sessions. After 6 months, 24 % (10/42) of the interviewed attendees remembered the protocol's main message. Cumulative implementation costs were 5,798 (20/reduced intravenous treatment day). An implementation strategy tailored to previously identified barriers reduced the duration of intravenous antibiotic administration in hospitalised CAP patients by 1 day, at minimal cost.

Information system equality for food security--implementation of the food safety control system in Taiwan.

PubMed

Chen, Shaun C; Hsu, Guoo-Shyng Wang; Chiu, Chihwei P

2009-01-01

Food security plays a central role in governing agricultural policies in Taiwan. In addition to overuse or the illegal use of pesticide, meat leanness promoters, animal drugs and melamine in the food supply; as well as foodborne illness draws the greatest public concern due to incidents that occur every year in Taiwan. The present report demonstrates the implementation of a food safety control system in Taiwan. In order to control foodborne outbreaks effectively, the central government of the Department of Health of Taiwan launched the food safety control system which includes both the good hygienic practice (GHP) and the HACCP plan, in the last decade. From 1998 to the present, 302 food affiliations that implemented the system have been validated and accredited by a well-established audit system. The implementation of a food safety control system in compliance with international standards is of crucial importance to ensure complete safety and the high quality of foods, not only for domestic markets, but also for international trade.

Spatially-Distributed Cost–Effectiveness Analysis Framework to Control Phosphorus from Agricultural Diffuse Pollution

PubMed Central

Geng, Runzhe; Wang, Xiaoyan; Sharpley, Andrew N.; Meng, Fande

2015-01-01

Best management practices (BMPs) for agricultural diffuse pollution control are implemented at the field or small-watershed scale. However, the benefits of BMP implementation on receiving water quality at multiple spatial is an ongoing challenge. In this paper, we introduce an integrated approach that combines risk assessment (i.e., Phosphorus (P) index), model simulation techniques (Hydrological Simulation Program–FORTRAN), and a BMP placement tool at various scales to identify the optimal location for implementing multiple BMPs and estimate BMP effectiveness after implementation. A statistically significant decrease in nutrient discharge from watersheds is proposed to evaluate the effectiveness of BMPs, strategically targeted within watersheds. Specifically, we estimate two types of cost-effectiveness curves (total pollution reduction and proportion of watersheds improved) for four allocation approaches. Selection of a ‘‘best approach” depends on the relative importance of the two types of effectiveness, which involves a value judgment based on the random/aggregated degree of BMP distribution among and within sub-watersheds. A statistical optimization framework is developed and evaluated in Chaohe River Watershed located in the northern mountain area of Beijing. Results show that BMP implementation significantly (p >0.001) decrease P loss from the watershed. Remedial strategies where BMPs were targeted to areas of high risk of P loss, deceased P loads compared with strategies where BMPs were randomly located across watersheds. Sensitivity analysis indicated that aggregated BMP placement in particular watershed is the most cost-effective scenario to decrease P loss. The optimization approach outlined in this paper is a spatially hierarchical method for targeting nonpoint source controls across a range of scales from field to farm, to watersheds, to regions. Further, model estimates showed targeting at multiple scales is necessary to optimize program efficiency. The integrated model approach described that selects and places BMPs at varying levels of implementation, provides a new theoretical basis and technical guidance for diffuse pollution management in agricultural watersheds. PMID:26313561

Spatially-Distributed Cost-Effectiveness Analysis Framework to Control Phosphorus from Agricultural Diffuse Pollution.

PubMed

Geng, Runzhe; Wang, Xiaoyan; Sharpley, Andrew N; Meng, Fande

2015-01-01

Best management practices (BMPs) for agricultural diffuse pollution control are implemented at the field or small-watershed scale. However, the benefits of BMP implementation on receiving water quality at multiple spatial is an ongoing challenge. In this paper, we introduce an integrated approach that combines risk assessment (i.e., Phosphorus (P) index), model simulation techniques (Hydrological Simulation Program-FORTRAN), and a BMP placement tool at various scales to identify the optimal location for implementing multiple BMPs and estimate BMP effectiveness after implementation. A statistically significant decrease in nutrient discharge from watersheds is proposed to evaluate the effectiveness of BMPs, strategically targeted within watersheds. Specifically, we estimate two types of cost-effectiveness curves (total pollution reduction and proportion of watersheds improved) for four allocation approaches. Selection of a ''best approach" depends on the relative importance of the two types of effectiveness, which involves a value judgment based on the random/aggregated degree of BMP distribution among and within sub-watersheds. A statistical optimization framework is developed and evaluated in Chaohe River Watershed located in the northern mountain area of Beijing. Results show that BMP implementation significantly (p >0.001) decrease P loss from the watershed. Remedial strategies where BMPs were targeted to areas of high risk of P loss, deceased P loads compared with strategies where BMPs were randomly located across watersheds. Sensitivity analysis indicated that aggregated BMP placement in particular watershed is the most cost-effective scenario to decrease P loss. The optimization approach outlined in this paper is a spatially hierarchical method for targeting nonpoint source controls across a range of scales from field to farm, to watersheds, to regions. Further, model estimates showed targeting at multiple scales is necessary to optimize program efficiency. The integrated model approach described that selects and places BMPs at varying levels of implementation, provides a new theoretical basis and technical guidance for diffuse pollution management in agricultural watersheds.

Aeroelastic simulation of higher harmonic control

NASA Technical Reports Server (NTRS)

Robinson, Lawson H.; Friedmann, Peretz P.

1994-01-01

This report describes the development of an aeroelastic analysis of a helicopter rotor and its application to the simulation of helicopter vibration reduction through higher harmonic control (HHC). An improved finite-state, time-domain model of unsteady aerodynamics is developed to capture high frequency aerodynamic effects. An improved trim procedure is implemented which accounts for flap, lead-lag, and torsional deformations of the blade. The effect of unsteady aerodynamics is studied and it is found that its impact on blade aeroelastic stability and low frequency response is small, but it has a significant influence on rotor hub vibrations. Several different HHC algorithms are implemented on a hingeless rotor and their effectiveness in reducing hub vibratory shears is compared. All the controllers are found to be quite effective, but very differing HHC inputs are required depending on the aerodynamic model used. Effects of HHC on rotor stability and power requirements are found to be quite small. Simulations of roughly equivalent articulated and hingeless rotors are carried out, and it is found that hingeless rotors can require considerably larger HHC inputs to reduce vibratory shears. This implies that the practical implementation of HHC on hingeless rotors might be considerably more difficult than on articulated rotors.

An implementation science perspective on psychological science and cancer: what is known and opportunities for research, policy, and practice.

PubMed

Rabin, Borsika; Glasgow, Russell E

2015-01-01

We discuss the role of implementation science in cancer and summarize the need for this perspective. Following a summary of key implementation science principles and lessons learned, we review the literature on implementation of cancer prevention and control activities across the continuum from prevention to palliative care. We identified 10 unique relevant reviews, four of which were specific to cancer. Multicomponent implementation strategies were found to be superior to single-component interventions, but it was not possible to draw conclusions about specific strategies or the range of conditions across which strategies were effective. Particular gaps identified include the need for more studies of health policies and reports of cost, cost-effectiveness, and resources required. Following this review, we summarize the types of evidence needed to make research findings more actionable and discuss emerging implementation science opportunities for psychological research on cancer prevention and control. These include innovative study designs (i.e., rapid learning designs, simulation modeling, comparative effectiveness, pragmatic studies, mixed-methods research) and measurement science (i.e., development of context-relevant measures; practical, longitudinal measures to gauge improvement; cost-effectiveness data; and harmonized patient report data). We conclude by identifying a few grand challenges for psychologists that if successfully addressed would accelerate integration of evidence into cancer practice and policy more consistently and rapidly. PsycINFO Database Record (c) 2015 APA, all rights reserved.

INTERIM ANALYSIS OF THE CONTRIBUTION OF HIGH-LEVEL EVIDENCE FOR DENGUE VECTOR CONTROL.

PubMed

Horstick, Olaf; Ranzinger, Silvia Runge

2015-01-01

This interim analysis reviews the available systematic literature for dengue vector control on three levels: 1) single and combined vector control methods, with existing work on peridomestic space spraying and on Bacillus thuringiensis israelensis; further work is available soon on the use of Temephos, Copepods and larvivorous fish; 2) or for a specific purpose, like outbreak control, and 3) on a strategic level, as for example decentralization vs centralization, with a systematic review on vector control organization. Clear best practice guidelines for methodology of entomological studies are needed. There is a need to include measuring dengue transmission data. The following recommendations emerge: Although vector control can be effective, implementation remains an issue; Single interventions are probably not useful; Combinations of interventions have mixed results; Careful implementation of vector control measures may be most important; Outbreak interventions are often applied with questionable effectiveness.

Distinguishing the roles of meteorology, emission control measures, regional transport, and co-benefits of reduced aerosol feedbacks in ;APEC Blue;

NASA Astrophysics Data System (ADS)

Gao, Meng; Liu, Zirui; Wang, Yuesi; Lu, Xiao; Ji, Dongsheng; Wang, Lili; Li, Meng; Wang, Zifa; Zhang, Qiang; Carmichael, Gregory R.

2017-10-01

Air quality are strongly influenced by both emissions and meteorological conditions. During the Asia Pacific Economic Cooperation (APEC) week (November 5-11, 2014), the Chinese government implemented unprecedented strict emission control measures in Beijing and surrounding provinces, and then a phenomenon referred to as ;APEC Blue; (rare blue sky) occurred. It is challenging to quantify the effectiveness of the implemented strict control measures solely based on observations. In this study, we use the WRF-Chem model to distinguish the roles of meteorology, emission control measures, regional transport, and co-benefits of reduced aerosol feedbacks during APEC week. In general, meteorological variables, PM2.5 concentrations and PM2.5 chemical compositions are well reproduced in Beijing. Positive weather conditions (lower temperature, lower relative humidity, higher wind speeds and enhanced boundary layer heights) play important roles in ;APEC Blue;. Applying strict emission control measures in Beijing and five surrounding provinces can only explain an average decrease of 17.7 μg/m3 (-21.8%) decreases in PM2.5 concentrations, roughly more than half of which is caused by emission controls that implemented in the five surrounding provinces (12.5 μg/m3). During the APEC week, non-local emissions contributed to 41.3% to PM2.5 concentrations in Beijing, and the effectiveness of implementing emission control measures hinges on dominant pathways and transport speeds. Besides, we also quantified the contribution of reduced aerosol feedbacks due to strict emission control measures in this study. During daytime, co-benefits of reduced aerosol feedbacks account for about 10.9% of the total decreases in PM2.5 concentrations in urban Beijing. The separation of contributions from aerosol absorption and scattering restates the importance of controlling BC to accelerate the effectiveness of aerosol pollution control.

Implementing healthy lifestyle promotion in primary care: a quasi-experimental cross-sectional study evaluating a team initiative.

PubMed

Thomas, Kristin; Krevers, Barbro; Bendtsen, Preben

2015-01-22

Non-communicable diseases are a leading cause of death and can largely be prevented by healthy lifestyles. Health care organizations are encouraged to integrate healthy lifestyle promotion in routine care. This study evaluates the impact of a team initiative on healthy lifestyle promotion in primary care. A quasi-experimental, cross-sectional design compared three intervention centres that had implemented lifestyle teams with three control centres that used a traditional model of care. Outcomes were defined using the RE-AIM framework: reach, the proportion of patients receiving lifestyle promotion; effectiveness, self-reported attitudes and competency among staff; adoption, proportion of staff reporting regular practice of lifestyle promotion; implementation, fidelity to the original lifestyle team protocol. Data collection methods included a patient questionnaire (n = 888), a staff questionnaire (n = 120) and structured interviews with all practice managers and, where applicable, team managers (n = 8). The chi square test and problem-driven content analysis was used to analyse the questionnaire and interview data, respectively. Reach: patients at control centres (48%, n = 211) received lifestyle promotion significantly more often compared with patients at intervention centres (41%, n = 169). Effectiveness: intervention staff was significantly more positive towards the effectiveness of lifestyle promotion, shared competency and how lifestyle promotion was prioritized at their centre. Adoption: 47% of staff at intervention centres and 58% at control centres reported that they asked patients about their lifestyle on a daily basis. all intervention centres had implemented multi-professional teams and team managers and held regular meetings but struggled to implement in-house referral structures for lifestyle promotion, which was used consistently among staff. Intervention centres did not show higher rates than control centres on reach of patients or adoption among staff at this stage. All intervention centres struggled to implement working referral structures for lifestyle promotion. Intervention centres were more positive on effectiveness outcomes, attitudes and competency among staff, however. Thus, lifestyle teams may facilitate lifestyle promotion practice in terms of increased responsiveness among staff, illustrated by positive attitudes and perceptions of shared competency. More research is needed on lifestyle promotion referral structures in primary care regarding their configuration and implementation.

Study protocol of an economic evaluation of an extended implementation strategy for the treatment of low back pain in general practice: a cluster randomised controlled trial.

PubMed

Jensen, Cathrine Elgaard; Riis, Allan; Pedersen, Kjeld Møller; Jensen, Martin Bach; Petersen, Karin Dam

2014-10-08

In Denmark, guidelines on low back pain management are currently being implemented; in association with this, a clinical trial is conducted. A health economic evaluation is carried out alongside the clinical trial to assess the cost-effectiveness of an extended implementation strategy to increase the general practitioners' adherence to the guidelines. In addition to usual dissemination, the extended implementation strategy is composed of visits from a guideline facilitator, stratification tools, and feedback on guideline adherence. The aim of this paper is to provide the considerations on the design of the health economic evaluation. The economic evaluation is carried out alongside a cluster randomised controlled trial consisting of 60 general practices in the North Denmark Region. An expected 1,200 patients between the age of 18 and 65 years with a low back pain diagnosis will be enrolled. The economic evaluation comprises both a cost-effectiveness analyses and a cost-utility analysis. Effectiveness measures include referral to secondary care, health-related quality of life measured by EQ-5D-5L, and disability measured by the Roland Morris disability questionnaire. Cost measures include all relevant additional costs of the extended implementation strategy compared to usual implementation. The economic evaluation will be performed from both a societal perspective and a health sector perspective with a 12-month time horizon. It is expected that the extended implementation strategy will reduce the number of patients referred to secondary care. It is hypothesised that the additional upfront cost of extended implementation will be counterbalanced by improvements in clinical practice and patient-related outcomes, thereby rendering the extended implementation strategy cost-effective. ClinicalTrials.gov: NCT01699256.

A Stitch in Time: Strategic Self-Control in High School and College Students.

PubMed

Duckworth, Angela L; White, Rachel E; Matteucci, Alyssa J; Shearer, Annie; Gross, James J

2016-04-01

A growing body of research indicates that self-control is critical to academic success. Surprisingly little is known, however, about the diverse strategies students use to implement self-control or how well these strategies work. To address these issues, we conducted a naturalistic investigation of self-control strategies (Study 1) and two field experiments (Studies 2 and 3). In Study 1, high school students described the strategies they use to manage interpersonal conflicts, get academic work done, eat healthfully, and manage other everyday self-control challenges. The majority of strategies in these self-nominated incidents as well as in three hypothetical academic scenarios (e.g., studying instead of texting friends) were reliably classified using the process model of self-control. As predicted by the process model, students rated strategies deployed early in the impulse-generation process (situation selection, situation modification) as being dramatically more effective than strategies deployed later (attentional deployment, cognitive change, response modulation). In Study 2, high school students randomly assigned to implement situation modification were more likely to meet their academic goals during the following week than students assigned either to implement response modulation or no strategy at all. In Study 3, college students randomly assigned to implement situation modification were also more successful in meeting their academic goals, and this effect was partially mediated by decreased feelings of temptation throughout the week. Collectively, these findings suggest that students might benefit from learning to initiate self-control when their impulses are still nascent.

A Stitch in Time: Strategic Self-Control in High School and College Students

PubMed Central

Duckworth, Angela L.; White, Rachel E.; Matteucci, Alyssa J.; Shearer, Annie; Gross, James J.

2015-01-01

A growing body of research indicates that self-control is critical to academic success. Surprisingly little is known, however, about the diverse strategies students use to implement self-control or how well these strategies work. To address these issues, we conducted a naturalistic investigation of self-control strategies (Study 1) and two field experiments (Studies 2 and 3). In Study 1, high school students described the strategies they use to manage interpersonal conflicts, get academic work done, eat healthfully, and manage other everyday self-control challenges. The majority of strategies in these self-nominated incidents as well as in three hypothetical academic scenarios (e.g., studying instead of texting friends) were reliably classified using the process model of self-control. As predicted by the process model, students rated strategies deployed early in the impulse-generation process (situation selection, situation modification) as being dramatically more effective than strategies deployed later (attentional deployment, cognitive change, response modulation). In Study 2, high school students randomly assigned to implement situation modification were more likely to meet their academic goals during the following week than students assigned either to implement response modulation or no strategy at all. In Study 3, college students randomly assigned to implement situation modification were also more successful in meeting their academic goals, and this effect was partially mediated by decreased feelings of temptation throughout the week. Collectively, these findings suggest that students might benefit from learning to initiate self-control when their impulses are still nascent. PMID:27158155

Multi-Stakeholder Taskforces in Bangladesh — A Distinctive Approach to Build Sustainable Tobacco Control Implementation

PubMed Central

Jackson-Morris, Angela M.; Chowdhury, Ishrat; Warner, Valerie; Bleymann, Kayleigh

2015-01-01

The MPOWER policy package enables countries to implement effective, evidence-based strategies to address the threat posed to their population by tobacco. All countries have challenges to overcome when implementing tobacco control policy. Some are generic such as tobacco industry efforts to undermine and circumvent legislation; others are specific to national or local context. Various factors influence how successfully challenges are addressed, including the legal-political framework for enforcement, public and administrative attitudes towards the law, and whether policy implementation measures are undertaken. This paper examines District Tobacco Control Taskforces, a flexible policy mechanism developed in Bangladesh to support the implementation of the Smoking and Tobacco Products Usage (Control) Act 2005 and its 2013 Amendment. At the time of this study published research and/or data was not available and understanding about these structures, their role, contribution, limitations and potential, was limited. We consider Taskforce characteristics and suggest that the “package” comprises a distinctive tobacco control implementation model. Qualitative data is presented from interviews with key informants in ten districts with activated taskforces (n = 70) to provide insight from the perspectives of taskforce members and non-members. In all ten districts taskforces were seen as a crucial tool for tobacco control implementation. Where taskforces were perceived to be functioning well, current positive impacts were perceived, including reduced smoking in public places and tobacco advertising, and increased public awareness and political profile. In districts with less well established taskforces, interviewees believed in their taskforce’s ‘potential’ to deliver similar benefits once their functioning was improved. Recommendations to improve functioning and enhance impact were made. The distinctive taskforce concept and lessons from their development may provide other countries with a flexible local implementation model for tobacco control. PMID:25575369

Multi-stakeholder taskforces in Bangladesh--a distinctive approach to build sustainable tobacco control implementation.

PubMed

Jackson-Morris, Angela M; Chowdhury, Ishrat; Warner, Valerie; Bleymann, Kayleigh

2015-01-07

The MPOWER policy package enables countries to implement effective, evidence-based strategies to address the threat posed to their population by tobacco. All countries have challenges to overcome when implementing tobacco control policy. Some are generic such as tobacco industry efforts to undermine and circumvent legislation; others are specific to national or local context. Various factors influence how successfully challenges are addressed, including the legal-political framework for enforcement, public and administrative attitudes towards the law, and whether policy implementation measures are undertaken. This paper examines District Tobacco Control Taskforces, a flexible policy mechanism developed in Bangladesh to support the implementation of the Smoking and Tobacco Products Usage (Control) Act 2005 and its 2013 Amendment. At the time of this study published research and/or data was not available and understanding about these structures, their role, contribution, limitations and potential, was limited. We consider Taskforce characteristics and suggest that the "package" comprises a distinctive tobacco control implementation model. Qualitative data is presented from interviews with key informants in ten districts with activated taskforces (n = 70) to provide insight from the perspectives of taskforce members and non-members. In all ten districts taskforces were seen as a crucial tool for tobacco control implementation. Where taskforces were perceived to be functioning well, current positive impacts were perceived, including reduced smoking in public places and tobacco advertising, and increased public awareness and political profile. In districts with less well established taskforces, interviewees believed in their taskforce's 'potential' to deliver similar benefits once their functioning was improved. Recommendations to improve functioning and enhance impact were made. The distinctive taskforce concept and lessons from their development may provide other countries with a flexible local implementation model for tobacco control.

The effect of an active implementation of a disease management programme for chronic obstructive pulmonary disease on healthcare utilization - a cluster-randomised controlled trial

PubMed Central

2013-01-01

Background The growing population living with chronic conditions calls for efficient healthcare-planning and effective care. Implementing disease-management-programmes is one option for responding to this demand. Knowledge is scarce about the effect of implementation processes and their effect on patients; only few studies have reported the effectiveness of disease-management-programmes targeting patients with chronic obstructive pulmonary disease (COPD). The objective of this paper was to determine the effect on healthcare-utilization of an active implementation model for a disease-management-programme for patients with one of the major multimorbidity diseases, COPD. Methods The standard implementation of a new disease-management-programme for COPD was ongoing during the study-period from November 2008 to November 2010 in the Central Denmark Region. We wanted to test a strategy using Breakthrough Series, academic detailing and lists of patients with COPD. It targeted GPs and three hospitals serving approx. 60,000 inhabitants aged 35 or older and included interventions directed at professionals, organisations and patients. The study was a non-blinded block- and cluster-randomised controlled trial with GP-practices as the unit of randomisation. In Ringkoebing-Skjern Municipality, Denmark, 16 GP-practices involving 38 GPs were randomised to either the intervention-group or the control-group. A comparable neighbouring municipality acted as an external-control-group which included nine GP-practices with 25 GPs. An algorithm based on health-registry-data on lung-related contacts to the healthcare-system identified 2,736 patients who were alive at the end of the study-period. The population included in this study counted 1,372 (69.2%) patients who responded to the baseline questionnaire and confirmed their COPD diagnosis; 458 (33.4%) patients were from the intervention-group, 376 (27.4%) from the control-group and 538(39.2%) from the external-control-group. The primary outcome was adherence to the disease-management-programme measured at patient-level by use of specific services from general practice. Secondary outcomes were use of out-of-hours-services, outpatient-clinic, and emergency-department and hospital-admissions. Results The intervention practices provided more planned preventive consultations, additional preventive consultations and spirometries than non-intervention practices. A comparison of the development in the intervention practices with the development in the control-practices showed that the intervention resulted in more planned preventive-consultations, fewer conventional consultations and fewer patients admitted without a lung-related-diagnosis. Conclusions Use of the active implementation model for the disease-management-programme for COPD changed the healthcare utilization in accordance with the programme. Trial registration Clinicaltrials.gov identifier: NCT01228708. PMID:24090189

The effect of an active implementation of a disease management programme for chronic obstructive pulmonary disease on healthcare utilization--a cluster-randomised controlled trial.

PubMed

Smidth, Margrethe; Christensen, Morten Bondo; Fenger-Grøn, Morten; Olesen, Frede; Vedsted, Peter

2013-10-03

The growing population living with chronic conditions calls for efficient healthcare-planning and effective care. Implementing disease-management-programmes is one option for responding to this demand. Knowledge is scarce about the effect of implementation processes and their effect on patients; only few studies have reported the effectiveness of disease-management-programmes targeting patients with chronic obstructive pulmonary disease (COPD). The objective of this paper was to determine the effect on healthcare-utilization of an active implementation model for a disease-management-programme for patients with one of the major multimorbidity diseases, COPD. The standard implementation of a new disease-management-programme for COPD was ongoing during the study-period from November 2008 to November 2010 in the Central Denmark Region. We wanted to test a strategy using Breakthrough Series, academic detailing and lists of patients with COPD. It targeted GPs and three hospitals serving approx. 60,000 inhabitants aged 35 or older and included interventions directed at professionals, organisations and patients. The study was a non-blinded block- and cluster-randomised controlled trial with GP-practices as the unit of randomisation. In Ringkoebing-Skjern Municipality, Denmark, 16 GP-practices involving 38 GPs were randomised to either the intervention-group or the control-group. A comparable neighbouring municipality acted as an external-control-group which included nine GP-practices with 25 GPs. An algorithm based on health-registry-data on lung-related contacts to the healthcare-system identified 2,736 patients who were alive at the end of the study-period. The population included in this study counted 1,372 (69.2%) patients who responded to the baseline questionnaire and confirmed their COPD diagnosis; 458 (33.4%) patients were from the intervention-group, 376 (27.4%) from the control-group and 538(39.2%) from the external-control-group. The primary outcome was adherence to the disease-management-programme measured at patient-level by use of specific services from general practice. Secondary outcomes were use of out-of-hours-services, outpatient-clinic, and emergency-department and hospital-admissions. The intervention practices provided more planned preventive consultations, additional preventive consultations and spirometries than non-intervention practices. A comparison of the development in the intervention practices with the development in the control-practices showed that the intervention resulted in more planned preventive-consultations, fewer conventional consultations and fewer patients admitted without a lung-related-diagnosis. Use of the active implementation model for the disease-management-programme for COPD changed the healthcare utilization in accordance with the programme. Clinicaltrials.gov identifier: NCT01228708.

Implementation intentions for physical activity behavior in older adult women: an examination of executive function as a moderator of treatment effects.

PubMed

Hall, Peter A; Zehr, Christopher; Paulitzki, Jeffrey; Rhodes, Ryan

2014-08-01

Implementation intentions are effective for enhancing physical activity, but it is unknown how well these effects extend to older adults and/or are modified by cognitive variables. Our objective is to examine (1) the efficacy of an implementation intentions intervention for physical activity in older adult women and (2) to examine the moderating effects of executive function. Participants (N = 75, M age = 73.72) completed measures of executive function and were randomly assigned to weekly implementation intentions for physical activity (experimental condition), implementation intentions for an unrelated behavior (control condition), or no treatment. Baseline activity was measured by accelerometer and self-report; follow-up activity was measured by weekly self-report. Findings indicated a significant treatment effect for the experimental condition and a treatment by executive function interaction. Specifically, participants with relatively stronger executive function benefited most from the experimental intervention. Implementation intentions are effective for enhancing physical activity among older adult women, and the effects may be especially pronounced for those with relatively stronger executive function.

Field Evaluation of Fracture Control in Tunnel Blasting

DOT National Transportation Integrated Search

1979-12-01

The objective of this research was to implement fracture control procedures in a tunnel project and to assess the practicality, advantages, disadvantages, performance and cost effectiveness of fracture control methods against smooth blasting procedur...

[Effect analysis on the two total load control methods for poisonous heavy metals].

PubMed

Fu, Guo-Wei

2012-12-01

Firstly it should be made clear that implementation of source total load control for the first type of pollutants is necessary for environmental pollution control legislation and economic structure regulation. This kind of surveillance method has been more practical to be implemented since the Manual of the Industry Discharge Coefficient of First National Pollution Sources Investigation was published. The source total load control and water environment total load control are independent of each other and none of them is redundant, on the other side they can be complementary to each other. In the present, some local planning managers are blurring and confusing the contents and styles of the two surveillance methods. They just use the water total load control to manage all the pollutants, and source total load control is discarded, which results in the loss of control for the first type of pollutants especially for the drinking water source surveillance. There is a big difference between the water quality standards and the water environmental background concentration values for the first type of pollutants in the Environmental quality standard for surface water (GB 3838-88), which means that there are problems such as "relaxing the pollutant discharge permit" and "risk induced by valence state change". Taking an enterprise with 10t electrolytic lead production capacity as an example, there is a big difference between the allowable lead discharged loads by the two total load surveillance methods. In summary, it will bring a lot of harmful effects if the water total load control is implemented for the two types of pollutants, so the source total load control and water environmental total load control should be implemented strictly at the same time.

Effectiveness of multifaceted implementation strategies for the implementation of back and neck pain guidelines in health care: a systematic review.

PubMed

Suman, Arnela; Dikkers, Marije F; Schaafsma, Frederieke G; van Tulder, Maurits W; Anema, Johannes R

2016-09-20

For the optimal use of clinical guidelines in daily practice, mere distribution of guidelines and materials is not enough, and active implementation is needed. This review investigated the effectiveness of multifaceted implementation strategies compared to minimal, single, or no implementation strategy for the implementation of non-specific low back and/or neck pain guidelines in health care. The following electronic databases were searched from inception to June 1, 2015: MEDLINE, Embase, PsycInfo, the Cochrane Library, and CINAHL. The search strategy was restricted to low back pain, neck pain, and implementation research. Studies were included if their design was a randomized controlled trial, reporting on patients (age ≥18 years) with non-specific low back pain or neck pain (with or without radiating pain). Trials were eligible if they reported patient outcomes, measures of healthcare professional behaviour, and/or outcomes on healthcare level. The primary outcome was professional behaviour. Guidelines that were evaluated in the studies had to be implemented in a healthcare setting. No language restrictions were applied, and studies had to be published full-text in peer-reviewed journals, thus excluding abstract only publications, conference abstracts, and dissertation articles. Two researchers independently screened titles and abstract, extracted data from included studies, and performed risk of bias assessments. After removal of duplicates, the search resulted in 4750 abstracts to be screened. Of 43 full-text articles assessed for eligibility, 12 were included in this review, reporting on 9 individual studies, and separate cost-effectiveness analyses of 3 included studies. Implementation strategies varied between studies. Meta-analyses did not reveal any differences in effect between multifaceted strategies and controls. This review showed that multifaceted strategies for the implementation of neck and/or back pain guidelines in health care do not significantly improve professional behaviour outcomes. No effects on patient outcomes or cost of care could be found. More research is necessary to determine whether multifaceted implementation strategies are conducted as planned and whether these strategies are effective in changing professional behaviour and thereby clinical practice.

CHERISH (collaboration for hospitalised elders reducing the impact of stays in hospital): protocol for a multi-site improvement program to reduce geriatric syndromes in older inpatients.

PubMed

Mudge, Alison M; Banks, Merrilyn D; Barnett, Adrian G; Blackberry, Irene; Graves, Nicholas; Green, Theresa; Harvey, Gillian; Hubbard, Ruth E; Inouye, Sharon K; Kurrle, Sue; Lim, Kwang; McRae, Prue; Peel, Nancye M; Suna, Jessica; Young, Adrienne M

2017-01-09

Older inpatients are at risk of hospital-associated geriatric syndromes including delirium, functional decline, incontinence, falls and pressure injuries. These contribute to longer hospital stays, loss of independence, and death. Effective interventions to reduce geriatric syndromes remain poorly implemented due to their complexity, and require an organised approach to change care practices and systems. Eat Walk Engage is a complex multi-component intervention with structured implementation, which has shown reduced geriatric syndromes and length of stay in pilot studies at one hospital. This study will test effectiveness of implementing Eat Walk Engage using a multi-site cluster randomised trial to inform transferability of this intervention. A hybrid study design will evaluate the effectiveness and implementation strategy of Eat Walk Engage in a real-world setting. A multisite cluster randomised study will be conducted in 8 medical and surgical wards in 4 hospitals, with one ward in each site randomised to implement Eat Walk Engage (intervention) and one to continue usual care (control). Intervention wards will be supported to develop and implement locally tailored strategies to enhance early mobility, nutrition, and meaningful activities. Resources will include a trained, mentored facilitator, audit support, a trained healthcare assistant, and support by an expert facilitator team using the i-PARIHS implementation framework. Patient outcomes and process measures before and after intervention will be compared between intervention and control wards. Primary outcomes are any hospital-associated geriatric syndrome (delirium, functional decline, falls, pressure injuries, new incontinence) and length of stay. Secondary outcomes include discharge destination; 30-day mortality, function and quality of life; 6 month readmissions; and cost-effectiveness. Process measures including patient interviews, activity mapping and mealtime audits will inform interventions in each site and measure improvement progress. Factors influencing the trajectory of implementation success will be monitored on implementation wards. Using a hybrid design and guided by an explicit implementation framework, the CHERISH study will establish the effectiveness, cost-effectiveness and transferability of a successful pilot program for improving care of older inpatients, and identify features that support successful implementation. ACTRN12615000879561 registered prospectively 21/8/2015.

Implementation and comparative study of control strategies for an isolated DFIG based WECS

NASA Astrophysics Data System (ADS)

Bouchiba, Nouha; Barkia, Asma; Sallem, Souhir; Chrifi-Alaoui, Larbi; Drid, Saïd; Kammoun, M. B. A.

2017-10-01

Nowadays, a global interest for renewable energy sources has been growing intensely. In particular, a wind energy has become the most popular. In case of autonomous systems, wind energy conversion system (WECS) based on a double fed induction generator (DFIG) is widely used. In this paper, in order to control the stand-alone system outputs under wind speed and load variations, three kinds of nonlinear control strategies have been proposed, applied and compared, such as: Classical PI controller, Back-Stepping and Sliding Mode controllers. A series of experiments have been conducted to evaluate and to compare the developed controllers' dynamic performances under load demand and speed variations. The design and the implementation of different control strategies to a 1.5kW doubly fed induction machine is carried out using a dSpace DS1104 card based on MATLAB/Simulink environment. Experimental results are presented to show the validity of the implemented controllers and demonstrate the effectiveness of each controller compared with others.

[Cost-effectiveness and cost-benefit analysis on the integrated schistosomiasis control strategies with emphasis on infection source in Poyang Lake region].

PubMed

Lin, Dan-Dan; Zeng, Xiao-Jun; Chen, Hong-Gen; Hong, Xian-Lin; Tao, Bo; Li, Yi-Feng; Xiong, Ji-Jie; Zhou, Xiao-Nong

2009-08-01

To evaluate the cost-effectiveness and cost-benefit on the integrated schistosomiasis control strategies with emphasis on infection source, and provide scientific basis for the improvement of schistosomiasis control strategy. Aiguo and Xinhe villages in Jinxian County were selected as intervention group where the new comprehensive strategy was implemented, while Ximiao and Zuxi villages in Xinzi County served as control where routine control program was implemented. New strategy of interventions included removing cattle from snail-infested grasslands and providing farmers with farm machinery, improving sanitation by supplying tap water and building lavatories and methane gas tanks, and implementing an intensive health education program. Routine interventions were carried out in the control villages including diagnosis and treatment for human and cattle, health education, and focal mollusciciding. Data were collected from retrospective investigation and field survey for the analysis and comparison of cost-effectiveness and cost-benefit between intervention and control groups. The control effect of the intervention group was better than that of the control. The cost for 1% decrease of infection rate per 100 people, 100 cattle, and 100 snails in intervention group was 480.01, 6 851.24, and 683.63 Yuan, respectively, which were about 2.70, 4.37 and 20.25 times as those in the control respectively. The total cost/benefit ratio (BCR) was lower than 1 (0.94 in intervention group and 0.08 in the control). But the total benefit of intervention group was higher than that of the control from 2005 to 2008. The forecasting analysis indicated that the total BCR in intervention group would be 1.13 at the 4th year and all cost could be recalled. Sensitivity analysis revealed that the BCR in intervention group changed in the range around 1.0 and that of the control ranged blow 0.5. The cost-benefit of intervention group was evidently higher than that of the control. The integrated control strategy focusing on infection source control brings about triplex benefits in schistosomiasis control, social development (and ecological protection) and economic efficacy, and shows better effects and benefits than the conventional control strategy.

Implementation and control of a 3 degree-of-freedom, force-reflecting manual controller

NASA Astrophysics Data System (ADS)

Kim, Whee-Kuk; Bevill, Pat; Tesar, Delbert

1991-02-01

Most available manual controllers which are used in bilateral or force-reflecting teleoperator systems can be characterized by their bulky size heavy weight high cost low magnitude of reflecting-force lack of smoothness insufficient transparency and simplified architectures. A compact smooth lightweight portable universal manual controller could provide a markedly improved level of transparency and be able to drive a broad spectrum of slave manipulators. This implies that a single stand-off position could be used for a diverse population of remote systems and that a standard environment for training of operators would result in reduced costs and higher reliability. In the implementation presented in this paper a parallel 3 degree-of-freedom (DOF) spherical structure (for compactness and reduced weight) is combined with high gear-ratio reducers using a force control algorithm to produce a " power steering" effect for enhanced smoothness and transparency. The force control algorithm has the further benefit of minimizing the effect of the system friction and non-linear inertia forces. The fundamental analytical description for the spherical force-reflecting manual controller such as forward position analysis reflecting-force transformation and applied force control algorithm are presented. Also a brief description of the system integration its actual implementation and preliminary test results are presented in the paper.

Implementing Nonlinear Feedback Controllers Using DNA Strand Displacement Reactions.

PubMed

Sawlekar, Rucha; Montefusco, Francesco; Kulkarni, Vishwesh V; Bates, Declan G

2016-07-01

We show how an important class of nonlinear feedback controllers can be designed using idealized abstract chemical reactions and implemented via DNA strand displacement (DSD) reactions. Exploiting chemical reaction networks (CRNs) as a programming language for the design of complex circuits and networks, we show how a set of unimolecular and bimolecular reactions can be used to realize input-output dynamics that produce a nonlinear quasi sliding mode (QSM) feedback controller. The kinetics of the required chemical reactions can then be implemented as enzyme-free, enthalpy/entropy driven DNA reactions using a toehold mediated strand displacement mechanism via Watson-Crick base pairing and branch migration. We demonstrate that the closed loop response of the nonlinear QSM controller outperforms a traditional linear controller by facilitating much faster tracking response dynamics without introducing overshoots in the transient response. The resulting controller is highly modular and is less affected by retroactivity effects than standard linear designs.

On an LAS-integrated soft PLC system based on WorldFIP fieldbus.

PubMed

Liang, Geng; Li, Zhijun; Li, Wen; Bai, Yan

2012-01-01

Communication efficiency is lowered and real-time performance is not good enough in discrete control based on traditional WorldFIP field intelligent nodes in case that the scale of control in field is large. A soft PLC system based on WorldFIP fieldbus was designed and implemented. Link Activity Scheduler (LAS) was integrated into the system and field intelligent I/O modules acted as networked basic nodes. Discrete control logic was implemented with the LAS-integrated soft PLC system. The proposed system was composed of configuration and supervisory sub-systems and running sub-systems. The configuration and supervisory sub-system was implemented with a personal computer or an industrial personal computer; running subsystems were designed and implemented based on embedded hardware and software systems. Communication and schedule in the running subsystem was implemented with an embedded sub-module; discrete control and system self-diagnosis were implemented with another embedded sub-module. Structure of the proposed system was presented. Methodology for the design of the sub-systems was expounded. Experiments were carried out to evaluate the performance of the proposed system both in discrete and process control by investigating the effect of network data transmission delay induced by the soft PLC in WorldFIP network and CPU workload on resulting control performances. The experimental observations indicated that the proposed system is practically applicable. Copyright © 2011 ISA. Published by Elsevier Ltd. All rights reserved.

Active feedforward noise control and signal tracking of headsets: Electroacoustic analysis and system implementation.

PubMed

Bai, Mingsian R; Pan, Weichi; Chen, Hungyu

2018-03-01

Active noise control (ANC) of headsets is revisited in this paper. An in-depth electroacoustic analysis of the combined loudspeaker-cavity headset system is conducted on the basis of electro-mechano-acoustical analogous circuits. Model matching of the primary path and the secondary path leads to a feedforward control architecture. The ideal controller sheds some light on the key parameters that affect the noise reduction performance. Filtered-X least-mean-squares algorithm is employed to implement the feedforward controller on a digital signal processor. Since the relative delay of the primary path and the secondary path is crucial to the noise reduction performance, multirate signal processing with polyphase implementation is utilized to minimize the effective analog-digital conversion delay in the secondary path. Ad hoc decimation and interpolation filters are designed in order not to introduce excessive phase delays at the cutoff. Real-time experiments are undertaken to validate the implemented ANC system. Listening tests are also conducted to compare the fixed controller and the adaptive controller in terms of noise reduction and signal tracking performance for three noise types. The results have demonstrated that the fixed feedforward controller achieved satisfactory noise reduction performance and signal tracking quality.

Force and Moment Approach for Achievable Dynamics Using Nonlinear Dynamic Inversion

NASA Technical Reports Server (NTRS)

Ostroff, Aaron J.; Bacon, Barton J.

1999-01-01

This paper describes a general form of nonlinear dynamic inversion control for use in a generic nonlinear simulation to evaluate candidate augmented aircraft dynamics. The implementation is specifically tailored to the task of quickly assessing an aircraft's control power requirements and defining the achievable dynamic set. The achievable set is evaluated while undergoing complex mission maneuvers, and perfect tracking will be accomplished when the desired dynamics are achievable. Variables are extracted directly from the simulation model each iteration, so robustness is not an issue. Included in this paper is a description of the implementation of the forces and moments from simulation variables, the calculation of control effectiveness coefficients, methods for implementing different types of aerodynamic and thrust vectoring controls, adjustments for control effector failures, and the allocation approach used. A few examples illustrate the perfect tracking results obtained.

A stepped strategy that aims at the nationwide implementation of the Enhanced Recovery After Surgery programme in major gynaecological surgery: study protocol of a cluster randomised controlled trial.

PubMed

de Groot, Jeanny Ja; Maessen, José Mc; Slangen, Brigitte Fm; Winkens, Bjorn; Dirksen, Carmen D; van der Weijden, Trudy

2015-07-30

Enhanced Recovery After Surgery (ERAS) programmes aim at an early recovery after surgical trauma and consequently at a reduced length of hospitalisation. This paper presents the protocol for a study that focuses on large-scale implementation of the ERAS programme in major gynaecological surgery in the Netherlands. The trial will evaluate effectiveness and costs of a stepped implementation approach that is characterised by tailoring the intensity of implementation activities to the needs of organisations and local barriers for change, in comparison with the generic breakthrough strategy that is usually applied in large-scale improvement projects in the Netherlands. All Dutch hospitals authorised to perform major abdominal surgery in gynaecological oncology patients are eligible for inclusion in this cluster randomised controlled trial. The hospitals that already fully implemented the ERAS programme in their local perioperative management or those who predominantly admit gynaecological surgery patients to an external hospital replacement care facility will be excluded. Cluster randomisation will be applied at the hospital level and will be stratified based on tertiary status. Hospitals will be randomly assigned to the stepped implementation strategy or the breakthrough strategy. The control group will receive the traditional breakthrough strategy with three educational sessions and the use of plan-do-study-act cycles for planning and executing local improvement activities. The intervention group will receive an innovative stepped strategy comprising four levels of intensity of support. Implementation starts with generic low-cost activities and may build up to the highest level of tailored and labour-intensive activities. The decision for a stepwise increase in intensive support will be based on the success of implementation so far. Both implementation strategies will be completed within 1 year and evaluated on effect, process, and cost-effectiveness. The primary outcome is length of postoperative hospital stay. Additional outcome measures are length of recovery, guideline adherence, and mean implementation costs per patient. This study takes up the challenge to evaluate an efficient strategy for large-scale implementation. Comparing effectiveness and costs of two different approaches, this study will help to define a preferred strategy for nationwide dissemination of best practices. Dutch Trial Register NTR4058.

What is actually measured in process evaluations for worksite health promotion programs: a systematic review

PubMed Central

2013-01-01

Background Numerous worksite health promotion program (WHPPs) have been implemented the past years to improve employees’ health and lifestyle (i.e., physical activity, nutrition, smoking, alcohol use and relaxation). Research primarily focused on the effectiveness of these WHPPs. Whereas process evaluations provide essential information necessary to improve large scale implementation across other settings. Therefore, this review aims to: (1) further our understanding of the quality of process evaluations alongside effect evaluations for WHPPs, (2) identify barriers/facilitators affecting implementation, and (3) explore the relationship between effectiveness and the implementation process. Methods Pubmed, EMBASE, PsycINFO, and Cochrane (controlled trials) were searched from 2000 to July 2012 for peer-reviewed (randomized) controlled trials published in English reporting on both the effectiveness and the implementation process of a WHPP focusing on physical activity, smoking cessation, alcohol use, healthy diet and/or relaxation at work, targeting employees aged 18-65 years. Results Of the 307 effect evaluations identified, twenty-two (7.2%) published an additional process evaluation and were included in this review. The results showed that eight of those studies based their process evaluation on a theoretical framework. The methodological quality of nine process evaluations was good. The most frequently reported process components were dose delivered and dose received. Over 50 different implementation barriers/facilitators were identified. The most frequently reported facilitator was strong management support. Lack of resources was the most frequently reported barrier. Seven studies examined the link between implementation and effectiveness. In general a positive association was found between fidelity, dose and the primary outcome of the program. Conclusions Process evaluations are not systematically performed alongside effectiveness studies for WHPPs. The quality of the process evaluations is mostly poor to average, resulting in a lack of systematically measured barriers/facilitators. The narrow focus on implementation makes it difficult to explore the relationship between effectiveness and implementation. Furthermore, the operationalisation of process components varied between studies, indicating a need for consensus about defining and operationalising process components. PMID:24341605

Strategies to improve the implementation of healthy eating, physical activity and obesity prevention policies, practices or programmes within childcare services.

PubMed

Wolfenden, Luke; Jones, Jannah; Williams, Christopher M; Finch, Meghan; Wyse, Rebecca J; Kingsland, Melanie; Tzelepis, Flora; Wiggers, John; Williams, Amanda J; Seward, Kirsty; Small, Tameka; Welch, Vivian; Booth, Debbie; Yoong, Sze Lin

2016-10-04

Despite the existence of effective interventions and best-practice guideline recommendations for childcare services to implement policies, practices and programmes to promote child healthy eating, physical activity and prevent unhealthy weight gain, many services fail to do so. The primary aim of the review was to examine the effectiveness of strategies aimed at improving the implementation of policies, practices or programmes by childcare services that promote child healthy eating, physical activity and/or obesity prevention. The secondary aims of the review were to:1. describe the impact of such strategies on childcare service staff knowledge, skills or attitudes;2. describe the cost or cost-effectiveness of such strategies;3. describe any adverse effects of such strategies on childcare services, service staff or children;4. examine the effect of such strategies on child diet, physical activity or weight status. We searched the following electronic databases on 3 August 2015: the Cochrane Central Register of Controlled trials (CENTRAL), MEDLINE, MEDLINE In Process, EMBASE, PsycINFO, ERIC, CINAHL and SCOPUS. We also searched reference lists of included trials, handsearched two international implementation science journals and searched the World Health Organization International Clinical Trials Registry Platform (www.who.int/ictrp/) and ClinicalTrials.gov (www.clinicaltrials.gov). We included any study (randomised or non-randomised) with a parallel control group that compared any strategy to improve the implementation of a healthy eating, physical activity or obesity prevention policy, practice or programme by staff of centre-based childcare services to no intervention, 'usual' practice or an alternative strategy. The review authors independently screened abstracts and titles, extracted trial data and assessed risk of bias in pairs; we resolved discrepancies via consensus. Heterogeneity across studies precluded pooling of data and undertaking quantitative assessment via meta-analysis. However, we narratively synthesised the trial findings by describing the effect size of the primary outcome measure for policy or practice implementation (or the median of such measures where a single primary outcome was not stated). We identified 10 trials as eligible and included them in the review. The trials sought to improve the implementation of policies and practices targeting healthy eating (two trials), physical activity (two trials) or both healthy eating and physical activity (six trials). Collectively the implementation strategies tested in the 10 trials included educational materials, educational meetings, audit and feedback, opinion leaders, small incentives or grants, educational outreach visits or academic detailing. A total of 1053 childcare services participated across all trials. Of the 10 trials, eight examined implementation strategies versus a usual practice control and two compared alternative implementation strategies. There was considerable study heterogeneity. We judged all studies as having high risk of bias for at least one domain.It is uncertain whether the strategies tested improved the implementation of policies, practices or programmes that promote child healthy eating, physical activity and/or obesity prevention. No intervention improved the implementation of all policies and practices targeted by the implementation strategies relative to a comparison group. Of the eight trials that compared an implementation strategy to usual practice or a no intervention control, however, seven reported improvements in the implementation of at least one of the targeted policies or practices relative to control. For these trials the effect on the primary implementation outcome was as follows: among the three trials that reported score-based measures of implementation the scores ranged from 1 to 5.1; across four trials reporting the proportion of staff or services implementing a specific policy or practice this ranged from 0% to 9.5%; and in three trials reporting the time (per day or week) staff or services spent implementing a policy or practice this ranged from 4.3 minutes to 7.7 minutes. The review findings also indicate that is it uncertain whether such interventions improve childcare service staff knowledge or attitudes (two trials), child physical activity (two trials), child weight status (two trials) or child diet (one trial). None of the included trials reported on the cost or cost-effectiveness of the intervention. One trial assessed the adverse effects of a physical activity intervention and found no difference in rates of child injury between groups. For all review outcomes, we rated the quality of the evidence as very low. The primary limitation of the review was the lack of conventional terminology in implementation science, which may have resulted in potentially relevant studies failing to be identified based on the search terms used in this review. Current research provides weak and inconsistent evidence of the effectiveness of such strategies in improving the implementation of policies and practices, childcare service staff knowledge or attitudes, or child diet, physical activity or weight status. Further research in the field is required.

Global systematic review of Indigenous community-led legal interventions to control alcohol.

PubMed

Muhunthan, Janani; Angell, Blake; Hackett, Maree L; Wilson, Andrew; Latimer, Jane; Eades, Anne-Marie; Jan, Stephen

2017-03-27

The national and subnational governments of most developed nations have adopted cost-effective regulatory and legislative controls over alcohol supply and consumption with great success. However, there has been a lack of scrutiny of the effectiveness and appropriateness of these laws in shaping the health-related behaviours of Indigenous communities, who disproportionately experience alcohol-related harm. Further, such controls imposed unilaterally without Indigenous consultation have often been discriminatory and harmful in practice. In this systematic review of quantitative evaluations of Indigenous-led alcohol controls, we aim to investigate how regulatory responses have been developed and implemented by Indigenous communities worldwide, and evaluate their effectiveness in improving health and social outcomes. We included articles from electronic databases MEDLINE, EMBASE, CINAHL, PsycINFO and Web of Science from inception to December 2015. Our search yielded 1489 articles from which 18 met the inclusion criteria. Controls were implemented in rural and remote populations of high-income nations. Communities employed a range of regulatory options including alcohol rationing, prohibition of sale, importation or possession, restrictions on liquor sold, times of sale or mode of sale, Indigenous-controlled liquor licensing, sin tax and traditional forms of control. 11 studies reported interventions that were effective in reducing crime, injury deaths, injury, hospitalisations or lowering per capita consumption. In six studies interventions were found to be ineffective or harmful. The results were inconclusive in one. Indigenous-led policies that are developed or implemented by communities can be effective in improving health and social outcomes. 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/.

Lean management in health care: definition, concepts, methodology and effects reported (systematic review protocol).

PubMed

Lawal, Adegboyega K; Rotter, Thomas; Kinsman, Leigh; Sari, Nazmi; Harrison, Liz; Jeffery, Cathy; Kutz, Mareike; Khan, Mohammad F; Flynn, Rachel

2014-09-19

Lean is a set of operating philosophies and methods that help create a maximum value for patients by reducing waste and waits. It emphasizes the consideration of the customer's needs, employee involvement and continuous improvement. Research on the application and implementation of lean principles in health care has been limited. This is a protocol for a systematic review, following the Cochrane Effective Practice and Organisation of Care (EPOC) methodology. The review aims to document, catalogue and synthesize the existing literature on the effects of lean implementation in health care settings especially the potential effects on professional practice and health care outcomes. We have developed a Medline keyword search strategy, and this focused strategy will be translated into other databases. All search strategies will be provided in the review. The method proposed by the Cochrane EPOC group regarding randomized study designs, non-randomised controlled trials controlled before and after studies and interrupted time series will be followed. In addition, we will also include cohort, case-control studies, and relevant non-comparative publications such as case reports. We will categorize and analyse the review findings according to the study design employed, the study quality (low- versus high-quality studies) and the reported types of implementation in the primary studies. We will present the results of studies in a tabular form. Overall, the systematic review aims to identify, assess and synthesize the evidence to underpin the implementation of lean activities in health care settings as defined in this protocol. As a result, the review will provide an evidence base for the effectiveness of lean and implementation methodologies reported in health care. PROSPERO CRD42014008853.

Lean management in health care: definition, concepts, methodology and effects reported (systematic review protocol)

PubMed Central

2014-01-01

Background Lean is a set of operating philosophies and methods that help create a maximum value for patients by reducing waste and waits. It emphasizes the consideration of the customer’s needs, employee involvement and continuous improvement. Research on the application and implementation of lean principles in health care has been limited. Methods This is a protocol for a systematic review, following the Cochrane Effective Practice and Organisation of Care (EPOC) methodology. The review aims to document, catalogue and synthesize the existing literature on the effects of lean implementation in health care settings especially the potential effects on professional practice and health care outcomes. We have developed a Medline keyword search strategy, and this focused strategy will be translated into other databases. All search strategies will be provided in the review. The method proposed by the Cochrane EPOC group regarding randomized study designs, non-randomised controlled trials controlled before and after studies and interrupted time series will be followed. In addition, we will also include cohort, case–control studies, and relevant non-comparative publications such as case reports. We will categorize and analyse the review findings according to the study design employed, the study quality (low- versus high-quality studies) and the reported types of implementation in the primary studies. We will present the results of studies in a tabular form. Discussion Overall, the systematic review aims to identify, assess and synthesize the evidence to underpin the implementation of lean activities in health care settings as defined in this protocol. As a result, the review will provide an evidence base for the effectiveness of lean and implementation methodologies reported in health care. Systematic review registration PROSPERO CRD42014008853 PMID:25238974

Effects of Implementation Intentions on the Self-Reported Frequency of Drivers' Compliance with Speed Limits

ERIC Educational Resources Information Center

Elliott, Mark A.; Armitage, Christopher J.

2006-01-01

This study tested the efficacy of implementation intentions in the context of drivers' speeding behavior. Participants (N = 300) completed self-report measures of goal intention and behavior, and they were randomly assigned to an experimental condition, which required them to specify an implementation intention, or a control condition. One month…

The Effects of Team-Based Learning on Social Studies Knowledge Acquisition in High School

ERIC Educational Resources Information Center

Wanzek, Jeanne; Vaughn, Sharon; Kent, Shawn C.; Swanson, Elizabeth A.; Roberts, Greg; Haynes, Martha; Fall, Anna-Mária; Stillman-Spisak, Stephanie J.; Solis, Michael

2014-01-01

This randomized control trial examined the efficacy of team-based learning implemented within 11th-grade social studies classes. A randomized blocked design was implemented with 26 classes randomly assigned to treatment or comparison. In the treatment classes teachers implemented team-based learning practices to support students in engaging in…

40 CFR 450.21 - Effluent limitations reflecting the best practicable technology currently available (BPT).

Code of Federal Regulations, 2010 CFR

2010-07-01

... control technology currently available (BPT). (a) Erosion and sediment controls. Design, install and... minimum, such controls must be designed, installed and maintained to: (1) Control stormwater volume and... appropriate controls. (d) Pollution prevention measures. Design, install, implement, and maintain effective...

40 CFR 450.21 - Effluent limitations reflecting the best practicable technology currently available (BPT).

Code of Federal Regulations, 2011 CFR

2011-07-01

... control technology currently available (BPT). (a) Erosion and sediment controls. Design, install and... minimum, such controls must be designed, installed and maintained to: (1) Control stormwater volume and... appropriate controls. (d) Pollution prevention measures. Design, install, implement, and maintain effective...

Implementing a Complex Intervention to Support Personal Recovery: A Qualitative Study Nested within a Cluster Randomised Controlled Trial

PubMed Central

Leamy, Mary; Clarke, Eleanor; Le Boutillier, Clair; Bird, Victoria; Janosik, Monika; Sabas, Kai; Riley, Genevieve; Williams, Julie; Slade, Mike

2014-01-01

Objective To investigate staff and trainer perspectives on the barriers and facilitators to implementing a complex intervention to help staff support the recovery of service users with a primary diagnosis of psychosis in community mental health teams. Design Process evaluation nested within a cluster randomised controlled trial (RCT). Participants 28 interviews with mental health care staff, 3 interviews with trainers, 4 focus groups with intervention teams and 28 written trainer reports. Setting 14 community-based mental health teams in two UK sites (one urban, one semi-rural) who received the intervention. Results The factors influencing the implementation of the intervention can be organised under two over-arching themes: Organisational readiness for change and Training effectiveness. Organisational readiness for change comprised three sub-themes: NHS Trust readiness; Team readiness; and Practitioner readiness. Training effectiveness comprised three sub-themes: Engagement strategies; Delivery style and Modelling recovery principles. Conclusions Three findings can inform future implementation and evaluation of complex interventions. First, the underlying intervention model predicted that three areas would be important for changing practice: staff skill development; intention to implement; and actual implementation behaviour. This study highlighted the importance of targeting the transition from practitioners' intent to implement to actual implementation behaviour, using experiential learning and target setting. Second, practitioners make inferences about organisational commitment by observing the allocation of resources, Knowledge Performance Indicators and service evaluation outcome measures. These need to be aligned with recovery values, principles and practice. Finally, we recommend the use of organisational readiness tools as an inclusion criteria for selecting both organisations and teams in cluster RCTs. We believe this would maximise the likelihood of adequate implementation and hence reduce waste in research expenditure. Trial Registration Controlled-Trials.com ISRCTN02507940 PMID:24875748

Implementing a complex intervention to support personal recovery: a qualitative study nested within a cluster randomised controlled trial.

PubMed

Leamy, Mary; Clarke, Eleanor; Le Boutillier, Clair; Bird, Victoria; Janosik, Monika; Sabas, Kai; Riley, Genevieve; Williams, Julie; Slade, Mike

2014-01-01

To investigate staff and trainer perspectives on the barriers and facilitators to implementing a complex intervention to help staff support the recovery of service users with a primary diagnosis of psychosis in community mental health teams. Process evaluation nested within a cluster randomised controlled trial (RCT). 28 interviews with mental health care staff, 3 interviews with trainers, 4 focus groups with intervention teams and 28 written trainer reports. 14 community-based mental health teams in two UK sites (one urban, one semi-rural) who received the intervention. The factors influencing the implementation of the intervention can be organised under two over-arching themes: Organisational readiness for change and Training effectiveness. Organisational readiness for change comprised three sub-themes: NHS Trust readiness; Team readiness; and Practitioner readiness. Training effectiveness comprised three sub-themes: Engagement strategies; Delivery style and Modelling recovery principles. Three findings can inform future implementation and evaluation of complex interventions. First, the underlying intervention model predicted that three areas would be important for changing practice: staff skill development; intention to implement; and actual implementation behaviour. This study highlighted the importance of targeting the transition from practitioners' intent to implement to actual implementation behaviour, using experiential learning and target setting. Second, practitioners make inferences about organisational commitment by observing the allocation of resources, Knowledge Performance Indicators and service evaluation outcome measures. These need to be aligned with recovery values, principles and practice. Finally, we recommend the use of organisational readiness tools as an inclusion criteria for selecting both organisations and teams in cluster RCTs. We believe this would maximise the likelihood of adequate implementation and hence reduce waste in research expenditure. Controlled-Trials.com ISRCTN02507940.

A generic approach for examining the effectiveness of traffic control devices in school zones.

PubMed

Zhao, Xiaohua; Li, Jiahui; Ding, Han; Zhang, Guohui; Rong, Jian

2015-09-01

The effectiveness and performance of traffic control devices in school zones have been impacted significantly by many factors, such as driver behavioral attributes, roadway geometric features, environmental characteristics, weather and visibility conditions, region-wide traffic regulations and policies, control modes, etc. When deploying traffic control devices in school zones, efforts are needed to clarify: (1) whether traffic control device installation is warranted; and (2) whether other device effectively complements this traffic control device and strengthens its effectiveness. In this study, a generic approach is developed to examine and evaluate the effectiveness of various traffic control devices deployed in school zones through driving simulator-based experiments. A Traffic Control Device Selection Model (TCDSM) is developed and two representative school zones are selected as the testbed in Beijing for driving simulation implementation to enhance its applicability. Statistical analyses are conducted to extract the knowledge from test data recorded by a driving simulator. Multiple measures of effectiveness (MOEs) are developed and adopted including average speed, relative speed difference, and standard deviation of acceleration for traffic control device performance quantification. The experimental tests and analysis results reveal that the appropriateness of the installation of certain traffic control devices can be statistically verified by TCDSM. The proposed approach provides a generic framework to assess traffic control device performance in school zones including experiment design, statistical formulation, data analysis, simulation model implementation, data interpretation, and recommendation development. Copyright © 2015 Elsevier Ltd. All rights reserved.

A Systematic Review of Strategies for Implementing Empirically Supported Mental Health Interventions

PubMed Central

Powell, Byron J.; Proctor, Enola K.; Glass, Joseph E.

2013-01-01

Objective This systematic review examines experimental studies that test the effectiveness of strategies intended to integrate empirically supported mental health interventions into routine care settings. Our goal was to characterize the state of the literature and to provide direction for future implementation studies. Methods A literature search was conducted using electronic databases and a manual search. Results Eleven studies were identified that tested implementation strategies with a randomized (n = 10) or controlled clinical trial design (n = 1). The wide range of clinical interventions, implementation strategies, and outcomes evaluated precluded meta-analysis. However, the majority of studies (n = 7; 64%) found a statistically significant effect in the hypothesized direction for at least one implementation or clinical outcome. Conclusions There is a clear need for more rigorous research on the effectiveness of implementation strategies, and we provide several suggestions that could improve this research area. PMID:24791131

Navigating institutional complexity in the health sector: lessons from tobacco control in Kenya

PubMed Central

Lencucha, Raphael; Magati, Peter; Drope, Jeffrey

2016-01-01

Introduction This research examines the institutional dynamics of tobacco control following the establishment of Kenya’s 2007 landmark tobacco control legislation. Our analysis focuses specifically on coordination challenges within the health sector. Methods We conducted semi-structured interviews with key informants (n = 17) involved in tobacco regulation and control in Kenya. We recruited participants from different offices and sectors of government and non-governmental organizations. Results We find that the main challenges toward successful implementation of tobacco control are a lack of coordination and clarity of mandate of the principal institutions involved in tobacco control efforts. In a related development, the passage of a new constitution in 2010 created structural changes that have affected the successful implementation of the country’s tobacco control legislation. Discussion We discuss how proponents of tobacco control navigated these two overarching institutional challenges. These findings point to the institutional factors that influence policy implementation extending beyond the traditional focus on the dynamic between government and the tobacco industry. These findings specifically point to the intragovernmental challenges that bear on policy implementation. The findings suggest that for effective implementation of tobacco control legislation and regulation, there is need for increased cooperation among institutions charged with tobacco control, particularly within or involving the Ministry of Health. Decisive leadership was also widely presented as a component of successful institutional reform. Conclusion This study points to the importance of coordinating policy development and implementation across levels of government and the need for leadership and clear mandates to guide cooperation within the health sector. The Kenyan experience offers useful lessons in the pitfalls of institutional incoherence, but more importantly, the value of investing in and then promoting well-functioning institutions. PMID:27418654

Self-regulation interventions to reduce consumption of sugar-sweetened beverages in adolescents.

PubMed

Ames, Susan L; Wurpts, Ingrid C; Pike, James R; MacKinnon, David P; Reynolds, Kim R; Stacy, Alan W

2016-10-01

This study evaluated the efficacy of self-regulation interventions through the use of drink-specific implementation intentions and drink-specific Go/No-Go training tasks as compensatory strategies to modify inhibitory control to reduce intake of sugar-sweetened beverages (SSB). In a between-subjects randomized manipulation of implementation intentions and Go/No-Go training to learn to inhibit sugary drink consumption, 168 adolescents reporting inhibitory control problems over sugary drinks and foods were recruited from high schools in southern California to participate. Analysis of covariance overall test of effects revealed no significant differences between the groups regarding calories consumed, calories from SSBs, grams of sugar consumed from drinks, or the number of unhealthy drinks chosen. However, subsequent contrasts revealed SSB implementation intentions significantly reduced SSB consumption following intervention while controlling for inhibitory control failure and general SSB consumption during observation in a lab setting that provided SSBs and healthy drinks, as well as healthy and unhealthy snacks. Specifically, during post-intervention observation, participants in the sugar-sweetened beverage implementation intentions (SSB-II) conditions consumed significantly fewer calories overall, fewer calories from drinks, and fewer grams of sugar. No effects were found for the drink-specific Go/No-Go training on SSB or calorie consumption. However, participants in SSB-II with an added SSB Go/No-Go training made fewer unhealthy drink choices than those in the other conditions. Implementation intentions may aid individuals with inhibitory (executive control) difficulties by intervening on pre-potent behavioral tendencies, like SSB consumption. Copyright © 2016. Published by Elsevier Ltd.

A mixed methods multiple case study of implementation as usual in children’s social service organizations: study protocol

PubMed Central

2013-01-01

Background Improving quality in children’s mental health and social service settings will require implementation strategies capable of moving effective treatments and other innovations (e.g., assessment tools) into routine care. It is likely that efforts to identify, develop, and refine implementation strategies will be more successful if they are informed by relevant stakeholders and are responsive to the strengths and limitations of the contexts and implementation processes identified in usual care settings. This study will describe: the types of implementation strategies used; how organizational leaders make decisions about what to implement and how to approach the implementation process; organizational stakeholders’ perceptions of different implementation strategies; and the potential influence of organizational culture and climate on implementation strategy selection, implementation decision-making, and stakeholders’ perceptions of implementation strategies. Methods/design This study is a mixed methods multiple case study of seven children’s social service organizations in one Midwestern city in the United States that compose the control group of a larger randomized controlled trial. Qualitative data will include semi-structured interviews with organizational leaders (e.g., CEOs/directors, clinical directors, program managers) and a review of documents (e.g., implementation and quality improvement plans, program manuals, etc.) that will shed light on implementation decision-making and specific implementation strategies that are used to implement new programs and practices. Additionally, focus groups with clinicians will explore their perceptions of a range of implementation strategies. This qualitative work will inform the development of a Web-based survey that will assess the perceived effectiveness, relative importance, acceptability, feasibility, and appropriateness of implementation strategies from the perspective of both clinicians and organizational leaders. Finally, the Organizational Social Context measure will be used to assess organizational culture and climate. Qualitative, quantitative, and mixed methods data will be analyzed and interpreted at the case level as well as across cases in order to highlight meaningful similarities, differences, and site-specific experiences. Discussion This study is designed to inform efforts to develop more effective implementation strategies by fully describing the implementation experiences of a sample of community-based organizations that provide mental health services to youth in one Midwestern city. PMID:23961701

Update on infection control challenges in special pediatric populations.

PubMed

Balkhy, Hanan H; Zingg, Walter

2014-08-01

Compared with adults, neonatal and pediatric populations are especially vulnerable patients who have specific diagnostic and therapeutic differences; therefore, the standard infection control practices designed for adults are sometimes not effective or need modifications to work. This review focuses on the recent literature addressing the challenges and successes in preventing healthcare-associated infections (HAIs) in children. Improving the implementation of pediatric versions of preventive bundles focusing on proper catheter insertion and maintenance, mainly as a part of a larger multimodal strategy, is effective in reducing the central-line-associated bloodstream infections in neonatal and pediatric populations including oncology patients. Appropriate feeding, antimicrobial stewardship, and infection control measures should be combined in reducing necrotizing enterocolitis in preterm neonates. Implementing a multimodal bundle strategy adapted for pediatric population is successful in preventing ventilator-associated pneumonia. Appropriate use of antimicrobial prophylaxis remains the cornerstone for preventing surgical-site infections irrespective of age, with few additional effective adjuvant preventive practices in specific pediatric patients. Several evidence-based practices are effective in reducing the incidence and the impact of HAIs in children; however, proper implementation remains a challenge. Additionally, several adult preventive practices are still unestablished in children and need further thorough examination.

The effectiveness of research-based physics learning module with predict-observe-explain strategies to improve the student’s competence

NASA Astrophysics Data System (ADS)

Usmeldi

2018-05-01

The preliminary study shows that many students are difficult to master the concept of physics. There are still many students who have not mastery learning physics. Teachers and students still use textbooks. Students rarely do experiments in the laboratory. One model of learning that can improve students’ competence is a research-based learning with Predict- Observe-Explain (POE) strategies. To implement this learning, research-based physics learning modules with POE strategy are used. The research aims to find out the effectiveness of implementation of research-based physics learning modules with POE strategy to improving the students’ competence. The research used a quasi-experimental with pretest-posttest group control design. Data were collected using observation sheets, achievement test, skill assessment sheets, questionnaire of attitude and student responses to learning implementation. The results of research showed that research-based physics learning modules with POE strategy was effective to improve the students’ competence, in the case of (1) mastery learning of physics has been achieved by majority of students, (2) improving the students competency of experimental class including high category, (3) there is a significant difference between the average score of students’ competence of experimental class and the control class, (4) the average score of the students competency of experimental class is higher than the control class, (5) the average score of the students’ responses to the learning implementation is very good category, this means that most students can implement research-based learning with POE strategies.

How to Invest in Getting Cost-effective Technologies into Practice? A Framework for Value of Implementation Analysis Applied to Novel Oral Anticoagulants.

PubMed

Faria, Rita; Walker, Simon; Whyte, Sophie; Dixon, Simon; Palmer, Stephen; Sculpher, Mark

2017-02-01

Cost-effective interventions are often implemented slowly and suboptimally in clinical practice. In such situations, a range of implementation activities may be considered to increase uptake. A framework is proposed to use cost-effectiveness analysis to inform decisions on how best to invest in implementation activities. This framework addresses 2 key issues: 1) how to account for changes in utilization in the future in the absence of implementation activities; and 2) how to prioritize implementation efforts between subgroups. A case study demonstrates the framework's application: novel oral anticoagulants (NOACs) for the prevention of stroke in the National Health Service in England and Wales. The results suggest that there is value in additional implementation activities to improve uptake of NOACs, particularly in targeting patients with average or poor warfarin control. At a cost-effectiveness threshold of £20,000 per quality-adjusted life-year (QALY) gained, additional investment in an educational activity that increases the utilization of NOACs by 5% in all patients currently taking warfarin generates an additional 254 QALYs, compared with 973 QALYs in the subgroup with average to poor warfarin control. However, greater value could be achieved with higher uptake of anticoagulation more generally: switching 5% of patients who are potentially eligible for anticoagulation but are currently receiving no treatment or are using aspirin would generate an additional 4990 QALYs. This work can help health services make decisions on investment at different points of the care pathway or across disease areas in a manner consistent with the value assessment of new interventions.

Cost-Effectiveness Analysis of an Automated Medication System Implemented in a Danish Hospital Setting.

PubMed

Risør, Bettina Wulff; Lisby, Marianne; Sørensen, Jan

To evaluate the cost-effectiveness of an automated medication system (AMS) implemented in a Danish hospital setting. An economic evaluation was performed alongside a controlled before-and-after effectiveness study with one control ward and one intervention ward. The primary outcome measure was the number of errors in the medication administration process observed prospectively before and after implementation. To determine the difference in proportion of errors after implementation of the AMS, logistic regression was applied with the presence of error(s) as the dependent variable. Time, group, and interaction between time and group were the independent variables. The cost analysis used the hospital perspective with a short-term incremental costing approach. The total 6-month costs with and without the AMS were calculated as well as the incremental costs. The number of avoided administration errors was related to the incremental costs to obtain the cost-effectiveness ratio expressed as the cost per avoided administration error. The AMS resulted in a statistically significant reduction in the proportion of errors in the intervention ward compared with the control ward. The cost analysis showed that the AMS increased the ward's 6-month cost by €16,843. The cost-effectiveness ratio was estimated at €2.01 per avoided administration error, €2.91 per avoided procedural error, and €19.38 per avoided clinical error. The AMS was effective in reducing errors in the medication administration process at a higher overall cost. The cost-effectiveness analysis showed that the AMS was associated with affordable cost-effectiveness rates. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Conference on alternatives for pollution control from coal-fired low emission sources, Plzen, Czech Republic. Plzen Proceedings

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

Not Available

1994-07-01

The Conference on Alternatives for Pollution Control from Coal-Fired Emission Sources presented cost-effective approaches for pollution control of low emission sources (LES). It also identified policies and strategies for implementation of pollution control measures at the local level. Plzen, Czech Republic, was chosen as the conference site to show participants first hand the LES problems facing Eastern Europe today. Collectively, these Proceedings contain clear reports on: (a) methods for evaluating the cost effectiveness of alternative approaches to control pollution from small coal-fired boilers and furnaces; (b) cost-effective technologies for controlling pollution from coal-fired boilers and furnaces; (c) case studies ofmore » assessment of cost effective pollution control measures for selected cities in eastern Europe; and (d) approaches for actually implementing pollution control measures in cities in Eastern Europe. It is intended that the eastern/central European reader will find in these Proceedings useful measures that can be applied to control emissions and clean the air in his city or region. The conference was sponsored by the United States Agency for International Development (AID), the United States Department of Energy (DOE), and the Czech Ministry of Industry and Trade. Selected papers have been indexed separately for inclusion in the Energy Science and Technology Database.« less

A randomised controlled trial of an intervention to facilitate the implementation of healthy eating and physical activity policies and practices in childcare services

PubMed Central

Jones, Jannah; Wolfenden, Luke; Wyse, Rebecca; Finch, Meghan; Yoong, Sze Lin; Dodds, Pennie; Pond, Nicole; Gillham, Karen; Freund, Megan; McElduff, Patrick; Wye, Paula; Wiggers, John

2014-01-01

Introduction Childhood overweight and obesity tracks into adulthood, increasing the risk of developing future chronic disease. Implementing initiatives promoting healthy eating and physical activity in childcare settings has been identified as a priority to prevent excessive child weight gain. Despite this, few trials have been conducted to assess the effectiveness of interventions to support population-wide implementation of such initiatives. The aim of this study is to assess the effectiveness of a multicomponent intervention in increasing the implementation of healthy eating and physical activity policies and practices by centre-based childcare services. Methods and analysis The study will employ a parallel group randomised controlled trial design. A sample of 128 childcare services in the Hunter region of New South Wales, Australia, will be recruited to participate in the trial. 64 services will be randomly allocated to a 12-month implementation intervention. The remaining 64 services will be allocated to a usual care control group. The intervention will consist of a number of strategies to facilitate childcare service implementation of healthy eating and physical activity policies and practices. Intervention strategies will include implementation support staff, securing executive support, consensus processes, staff training, academic detailing visits, performance monitoring and feedback, tools and resources, and a communications strategy. The primary outcome of the trial will be the prevalence of services implementing all healthy eating and physical activity policies and practices targeted by the intervention. To assess the effectiveness of the intervention, telephone surveys with nominated supervisors and room leaders of childcare services will be conducted at baseline and immediately postintervention. Ethics and dissemination The study was approved by the Hunter New England Human Research Ethics Committee and the University of Newcastle Human Research Ethics Committee. Study findings will be disseminated widely through peer-reviewed publications and conference presentations. Trial registration number Australian Clinical Trials Registry ACTRN12612000927820. PMID:24742978

Effect of Implementing a Birth Plan on Womens' Childbirth Experiences and Maternal & Neonatal Outcomes

ERIC Educational Resources Information Center

Farahat, Amal Hussain; Mohamed, Hanan El Sayed; Elkader, Shadia Abd; El-Nemer, Amina

2015-01-01

Childbirth satisfaction represents a sense of feeling good about one's birth. It is thought to result from having a sense of control, having expectations met, feeling empowered, confident and supported. The aim of this study was to implement a birth plan and evaluate its effect on women's childbirth experiences and maternal, neonatal outcomes. A…

Training Professionals to Implement a Group Model for Alleviating Loneliness among Older People--10-Year Follow-Up Study

ERIC Educational Resources Information Center

Jansson, Anu H.; Savikko, Niina M.; Pitkälä, Kaisu H.

2018-01-01

Background and objectives: Although randomized controlled trials (RCTs) have been performed to alleviate loneliness among older people, little is known about how they have been implemented, or whether they are effective in real life. Our RCT-based model, "Circle of Friends" (CoF) proved to be effective in improving the wellbeing, health…

Man-rated flight software for the F-8 DFBW program

NASA Technical Reports Server (NTRS)

Bairnsfather, R. R.

1976-01-01

The design, implementation, and verification of the flight control software used in the F-8 DFBW program are discussed. Since the DFBW utilizes an Apollo computer and hardware, the procedures, controls, and basic management techniques employed are based on those developed for the Apollo software system. Program assembly control, simulator configuration control, erasable-memory load generation, change procedures and anomaly reporting are discussed. The primary verification tools are described, as well as the program test plans and their implementation on the various simulators. Failure effects analysis and the creation of special failure generating software for testing purposes are described.

Implementation of Maximum Power Point Tracking (MPPT) Solar Charge Controller using Arduino

NASA Astrophysics Data System (ADS)

Abdelilah, B.; Mouna, A.; KouiderM’Sirdi, N.; El Hossain, A.

2018-05-01

the platform Arduino with a number of sensors standard can be used as components of an electronic system for acquiring measures and controls. This paper presents the design of a low-cost and effective solar charge controller. This system includes several elements such as the solar panel converter DC/DC, battery, circuit MPPT using Microcontroller, sensors, and the MPPT algorithm. The MPPT (Maximum Power Point Tracker) algorithm has been implemented using an Arduino Nano with the preferred program. The voltage and current of the Panel are taken where the program implemented will work and using this algorithm that MPP will be reached. This paper provides details on the solar charge control device at the maximum power point. The results include the change of the duty cycle with the change in load and thus mean the variation of the buck converter output voltage and current controlled by the MPPT algorithm.

Evaluating the Flipped Classroom: A Randomized Controlled Trial

ERIC Educational Resources Information Center

Wozny, Nathan; Balser, Cary; Ives, Drew

2018-01-01

Despite recent interest in flipped classrooms, rigorous research evaluating their effectiveness is sparse. In this study, the authors implement a randomized controlled trial to evaluate the effect of a flipped classroom technique relative to a traditional lecture in an introductory undergraduate econometrics course. Random assignment enables the…

Changing panorama for surveillance of device-associated healthcare infections: Challenges faced in implementation of current guidelines.

PubMed

Gupta, Renu; Sharma, Sangeeta; Saxena, Sonal

2018-01-01

Healthcare-associated infections (HAI) are preventable in up to 30% of patients with evidence-based infection prevention and control (IPC) activities. IPC activities require effective surveillance to generate data for the HAI rates, defining priority areas, identifying processes amenable for improvement and institute interventions to improve patient's safety. However, uniform, accurate and standardised surveillance methodology using objective definitions can only generate meaningful data for effective execution of IPC activities. The highly exhaustive, complex and ever-evolving infection surveillance methodology pose a challenge for effective data capture, analysis and interpretation by ground level personnel. The present review addresses the gaps in knowledge and day-to-day challenges in surveillance faced by infection control team for effective implementation of IPC activities.

Effective organizational solutions for implementation of DBMS software packages

NASA Technical Reports Server (NTRS)

Jones, D.

1984-01-01

The space telescope management information system development effort is a guideline for discussing effective organizational solutions used in implementing DBMS software. Focus is on the importance of strategic planning. The value of constructing an information system architecture to conform to the organization's managerial needs, the need for a senior decision maker, dealing with shifting user requirements, and the establishment of a reliable working relationship with the DBMS vendor are examined. Requirements for a schedule to demonstrate progress against a defined timeline and the importance of continued monitoring for production software control, production data control, and software enhancements are also discussed.

Effect of an Intervention on Observed Sun Protection by Vacationers in a Randomized Controlled Trial at North American Resorts

PubMed Central

Buller, David B.; Andersen, Peter A.; Walkosz, Barbara J.; Scott, Michael D.; Beck, Larry; Cutter, Gary R.

2017-01-01

During vacations, many individuals receive high-risk sun exposure that is associated with skin cancer. Vacationers in outdoor recreation venues (pretest n=4,347; posttest n=3,986) at warm-weather destination resorts in North America (n=41) were enrolled in a pair-matched, group-randomized pretest-posttest controlled quasi-experimental design in 2012-14. Print, audiovisual, and online messages based on Transportation Theory and Diffusion of Innovation Theory and promoting advanced sun protection (e.g., use of clothing, hats, shade and pre-application/reapplication of sunscreen and reliable cues to high UV) were delivered through resort channels. Vacationers' sun protection practices observed by trained research staff (i.e., body coverage and shade use analyzed individually and in combined scores) did not differ by experimental condition (p>0.05) or intervention implementation (p>0.05). However, recreation venue moderated intervention impact. The intervention improved sun protection at waterside recreation venues (z-score composite: intervention pre=-22.74, post=-15.77; control pre=-27.24, post=-23.24) but not non-waterside venues (z-score composite: intervention pre=20.43, post=20.53; control pre=22.94, post=18.03, p<0.01). An additional analysis showed that resorts with greater program implementation showed more improvements in sun protection by vacationers at waterside (z=score composite: high implementation pre=-25.45, post=-14.05; low implementation pre=-24.70, post=-21.40) compared to non-waterside (z-score composite: high implementation pre=14.51, post=19.98; low implementation pre=24.03, post=18.98, p<0.01) recreation venues. The intervention appeared effective with the vacationers in recreation venues with the highest-risk for sun exposure, waterside venues. However, it was not effective throughout all the resort venues, possibly because of the sun-seeking desires of vacationers, information overload at the resorts, and constraints on clothing styles and sun protection by recreation activity. PMID:28189810

Effect of an intervention on observed sun protection by vacationers in a randomized controlled trial at North American resorts.

PubMed

Buller, David B; Andersen, Peter A; Walkosz, Barbara J; Scott, Michael D; Beck, Larry; Cutter, Gary R

2017-06-01

During vacations, many individuals receive high-risk sun exposure that is associated with skin cancer. Vacationers in outdoor recreation venues (pretest n=4347; posttest n=3986) at warm-weather destination resorts in North America (n=41) were enrolled in a pair-matched, group-randomized pretest-posttest controlled quasi-experimental design in 2012-14. Print, audiovisual, and online messages based on Transportation Theory and Diffusion of Innovation Theory and promoting advanced sun protection (e.g., use of clothing, hats, shade and pre-application/reapplication of sunscreen and reliable cues to high UV) were delivered through resort channels. Vacationers' sun protection practices observed by trained research staff (i.e., body coverage and shade use analyzed individually and in combined scores) did not differ by experimental condition (p>0.05) or intervention implementation (p>0.05). However, recreation venue moderated intervention impact. The intervention improved sun protection at waterside recreation venues (z-score composite: intervention pre=-22.74, post=-15.77; control pre=-27.24, post=-23.24) but not non-waterside venues (z-score composite: intervention pre=20.43, post=20.53; control pre=22.94, post=18.03, p<0.01). An additional analysis showed that resorts with greater program implementation showed more improvements in sun protection by vacationers at waterside (z=score composite: high implementation pre=-25.45, post=-14.05; low implementation pre=-24.70, post=-21.40) compared to non-waterside (z-score composite: high implementation pre=14.51, post=19.98; low implementation pre=24.03, post=18.98, p<0.01) recreation venues. The intervention appeared effective with the vacationers in recreation venues with the highest-risk for sun exposure, waterside venues. However, it was not effective throughout all the resort venues, possibly because of the sun-seeking desires of vacationers, information overload at the resorts, and constraints on clothing styles and sun protection by recreation activity. Copyright © 2017 Elsevier Inc. All rights reserved.

Effect of occupational safety measures on micronucleus frequency in semiconductor workers.

PubMed

Winker, Robert; Roos, Gerhard; Pilger, Alexander; Rüdiger, Hugo W

2008-02-01

To examine whether semiconductor workers exposed to complex mixtures of chemical waste show an increase in genotoxic effects, and, if so, whether occupational safety measures protect these workers. To assess chemical exposure in the workplace, air monitoring of boron trifluoride and boron trichloride was performed and urinary concentrations of fluoride were measured. The cytokinesis-block micronucleus test on isolated lymphocytes was used for the detection of genotoxic effects. Two series of monitoring have been performed in order to assess the effect of implemented protection measures. We found a significantly higher mean frequency of micronuclei in exposed workers than in controls, whereas air monitoring and measurement of urinary fluoride failed to detect chemical exposure of these workers. Twelve years after implementation of protective measures, the mean level of micronuclei in exposed individuals was found to be as low as those from controls. These findings indicate that exposed workers in the semiconductor industry may have an increased risk of genotoxic effects from complex mixtures of chemical waste products. The decline of the mean level of micronuclei in exposed workers down to the base level of controls after implementation of protective measures points to the significance of adequate safety standards to protect against chromosomal damage in semiconductor personnel.

Structural and process factors affecting the implementation of antimicrobial resistance prevention and control strategies in U.S. hospitals.

PubMed

Chou, Ann F; Yano, Elizabeth M; McCoy, Kimberly D; Willis, Deanna R; Doebbeling, Bradley N

2008-01-01

To address increases in the incidence of infection with antimicrobial-resistant pathogens, the National Foundation for Infectious Diseases and Centers for Disease Control and Prevention proposed two sets of strategies to (a) optimize antibiotic use and (b) prevent the spread of antimicrobial resistance and control transmission. However, little is known about the implementation of these strategies. Our objective is to explore organizational structural and process factors that facilitate the implementation of National Foundation for Infectious Diseases/Centers for Disease Control and Prevention strategies in U.S. hospitals. We surveyed 448 infection control professionals from a national sample of hospitals. Clinically anchored in the Donabedian model that defines quality in terms of structural and process factors, with the structural domain further informed by a contingency approach, we modeled the degree to which National Foundation for Infectious Diseases and Centers for Disease Control and Prevention strategies were implemented as a function of formalization and standardization of protocols, centralization of decision-making hierarchy, information technology capabilities, culture, communication mechanisms, and interdepartmental coordination, controlling for hospital characteristics. Formalization, standardization, centralization, institutional culture, provider-management communication, and information technology use were associated with optimal antibiotic use and enhanced implementation of strategies that prevent and control antimicrobial resistance spread (all p < .001). However, interdepartmental coordination for patient care was inversely related with antibiotic use in contrast to antimicrobial resistance spread prevention and control (p < .0001). Formalization and standardization may eliminate staff role conflict, whereas centralized authority may minimize ambiguity. Culture and communication likely promote internal trust, whereas information technology use helps integrate and support these organizational processes. These findings suggest concrete strategies for evaluating current capabilities to implement effective practices and foster and sustain a culture of patient safety.

The Project Towards No Drug Abuse (TND) Dissemination Trial: Implementation Fidelity and Immediate Outcomes

PubMed Central

Gunning, Melissa; Sun, Ping; Sussman, Steve

2009-01-01

One of the important research issues in the emerging area of research on dissemination of prevention programs relates to the type and extent of training needed by program providers to prepare them to implement effective programs with fidelity. The present paper describes the immediate outcomes of a dissemination and implementation trial of Project Toward No Drug Abuse, an evidence-based prevention program for high school students. A total of 65 high schools in 14 school districts across the USA were recruited and randomly assigned to one of three experimental conditions: comprehensive implementation support for teachers, regular workshop training only, or standard care control. The comprehensive intervention was comprised of on-site coaching, web-based support, and technical assistance, in addition to the regular workshop. Students (n=2,983) completed self-report surveys before and immediately after program implementation. Fidelity of implementation was assessed with a classroom observation procedure that focused on program process. Results indicated that relative to the controls, both intervention conditions produced effects on hypothesized program mediators, including greater gains in program-related knowledge; greater reductions in cigarette, marijuana and hard drug use intentions; and more positive changes in drug-related beliefs. There were stronger effects on implementation fidelity in the comprehensive, relative to the regular, training condition. However, seven of the ten immediate student outcome measures showed no significant differences between the two training conditions. The implications of these findings for dissemination research and practice are discussed. PMID:19757052

The Project Towards No Drug Abuse (TND) dissemination trial: implementation fidelity and immediate outcomes.

PubMed

Rohrbach, Louise Ann; Gunning, Melissa; Sun, Ping; Sussman, Steve

2010-03-01

One of the important research issues in the emerging area of research on dissemination of prevention programs relates to the type and extent of training needed by program providers to prepare them to implement effective programs with fidelity. The present paper describes the immediate outcomes of a dissemination and implementation trial of Project Toward No Drug Abuse, an evidence-based prevention program for high school students. A total of 65 high schools in 14 school districts across the USA were recruited and randomly assigned to one of three experimental conditions: comprehensive implementation support for teachers, regular workshop training only, or standard care control. The comprehensive intervention was comprised of on-site coaching, web-based support, and technical assistance, in addition to the regular workshop. Students (n = 2,983) completed self-report surveys before and immediately after program implementation. Fidelity of implementation was assessed with a classroom observation procedure that focused on program process. Results indicated that relative to the controls, both intervention conditions produced effects on hypothesized program mediators, including greater gains in program-related knowledge; greater reductions in cigarette, marijuana and hard drug use intentions; and more positive changes in drug-related beliefs. There were stronger effects on implementation fidelity in the comprehensive, relative to the regular, training condition. However, seven of the ten immediate student outcome measures showed no significant differences between the two training conditions. The implications of these findings for dissemination research and practice are discussed.

Linking implementation process to intervention outcomes in a middle school obesity prevention curriculum, ‘Choice, Control and Change’

PubMed Central

Gray, Heewon Lee; Contento, Isobel R.; Koch, Pamela A.

2015-01-01

This study investigates the link between process evaluation components and the outcomes of a school-based nutrition curriculum intervention, ‘Choice, Control and Change’. Ten New York City public middle schools were recruited and randomly assigned into intervention or control condition. The curriculum was to improve sixth to seventh grade students’ energy balance related behaviors, based on social cognitive and self-determination theories, and implemented during the 2006–2007 school year (n = 1136). Behaviors and psychosocial variables were measured by self-reported questionnaires. Process components were evaluated with classroom observations, teacher interviews, and a student questionnaire. Using ‘Teacher Implementation’ (dose delivered) and ‘Student Reception’ (dose received) process data; intervention group was further categorized into medium- and high-implementation groups. Analysis of covariance revealed that, compared with control group, only high-implementation group showed significant improvement in students’ behavior and psychosocial outcomes. Hierarchical linear models showed that ‘Teacher Implementation’ and ‘Student Reception’ significantly predicted students’ sweetened beverage outcomes (P < 0.05). ‘Student Satisfaction’ was also greater when these implementation components were higher, and significantly associated with behavior and psychosocial outcomes (P < 0.05). Implementation process influenced the effectiveness of the ‘Choice, Control and Change’ intervention study. It is important to take into account the process components when interpreting the results of such research. PMID:25700557

APC implementation in Chandra Asri - ethylene plant

NASA Astrophysics Data System (ADS)

Sidiq, Mochamad; Mustofa, Ali

2017-05-01

Nowadays, the modern process plants are continuously improved for maximizing production, Optimization of the energy and raw material and reducing the risk. Due to many disturbances appearance between the process units, hence, the failure of one unit might have a bad effect on the overall productivity. Ethylene Plant have significant opportunities for using Advanced Process Control (APC) technologies to improve operation stability, push closer to quality or equipment limit, and improve the capability of process units to handle disturbances. APC implementation had considered a best answer for solving multivariable control problem. PT. Chandra Asri Petrochemical, Tbk (CAP) operates a large naphtha cracker complex at Cilegon, Indonesia. To optimize the plant operation and to enhance the benefit, Chandra Asri has been decided to implement Advance Process Control (APC) for ethylene plant. The APC implementation technology scopes at CAP are as follows: 1. Hot Section : Furnaces, Quench Tower 2. Cold Section : Demethanizer, Deethanizer, Acetylene Converter, Ethylene Fractionator, Depropanizer, Propylene Fractionator, Debutanizer

Assessment of long-term and large-scale even-odd license plate controlled plan effects on urban air quality and its implication

NASA Astrophysics Data System (ADS)

Zhao, Suping; Yu, Ye; Qin, Dahe; Yin, Daiying; He, Jianjun

2017-12-01

To solve traffic congestion and to improve urban air quality, long-lasting and large-scale even-odd license plate controlled plan was implemented by local government during 20 November to 26 December 2016 in urban Lanzhou, a semi-arid valley city of northwest China. The traffic control measures provided an invaluable opportunity to evaluate its effects on urban air quality in less developed cities of northwest China. Based on measured simultaneously air pollutants and meteorological parameters, the abatement of traffic-related pollutants induced by the implemented control measures such as CO, PM2.5 and PM10 (the particulate matter with diameter less than 2.5 μm and 10 μm) concentrations were firstly quantified by comparing the air quality data in urban areas with those in rural areas (uncontrolled zones). The concentrations of CO, NO2 from motor vehicles and fine particulate matter (PM2.5) were shown to have significant decreases of 15%-23% during traffic control period from those measured before control period with hourly maximum CO, PM2.5, and NO2/SO2 reduction of 43%, 35% and 141.4%, respectively. The influence of the control measures on AQI (air quality index) and ozone was less as compared to its effect on other air pollutants. Therefore, to alleviate serious winter haze pollution in China and to protect human health, the stringent long-term and large-scale even-odd license plate controlled plan should be implemented aperiodically in urban areas, especially for the periods with poor diffusion conditions.

The effect of financial and educational incentives on rational prescribing. A state-space approach.

PubMed

Pechlivanoglou, Petros; Wieringa, Jaap E; de Jager, Tim; Postma, Maarten J

2015-04-01

In 2005, a Dutch health insurer introduced a financial incentive directed to general practitioners to promote rational prescribing of statins and proton pump inhibitors (PPIs). Concomitantly, a regional institution that develops pharmacotherapeutic guidelines implemented two educational interventions also aiming at promoting rational statin and PPI prescribing. Utilizing a prescription database, we estimated the effect of the interventions on drug utilization and cost of statins and PPIs over time. We measured the effect of the interventions within an implementation and a control region. The implementation region included prescriptions from the province of Groningen where the educational intervention was implemented and where the health insurer is most active. The control region comprised all other provinces covered by the database. We modelled the effect of the intervention using a state-space approach. Significant differences in prescribing and cost patterns between regions were observed for statins and PPIs. These differences however were mostly related to the concurrent interventions of Proeftuin Farmacie Groningen. We found no evidence indicating a significant effect of the rational prescribing intervention on the prescription patterns of statins and PPIs. Our estimates on the economic impact of the Proeftuin Farmacie Groningen interventions indicate that educational activities as such can achieve significant cost savings. Copyright © 2014 John Wiley & Sons, Ltd.

Techniques for Combined Arms for Air Defense

DTIC Science & Technology

2016-07-29

loss remain in effect until communications are regained. Changes to ROE and supplemental fire control measures scheduled to go into effect after...communications are lost will be implemented as scheduled . Fire Control Orders Fire control orders are commands used to control engagements on a case...or a sleep matt over windshields (Figure 3-2). Camouflage is one of the basic weapons of war. The importance, the principles, and the techniques of

Barriers to and facilitators of implementing complex workplace dietary interventions: process evaluation results of a cluster controlled trial.

PubMed

Fitzgerald, Sarah; Geaney, Fiona; Kelly, Clare; McHugh, Sheena; Perry, Ivan J

2016-04-21

Ambiguity exists regarding the effectiveness of workplace dietary interventions. Rigorous process evaluation is vital to understand this uncertainty. This study was conducted as part of the Food Choice at Work trial which assessed the comparative effectiveness of a workplace environmental dietary modification intervention and an educational intervention both alone and in combination versus a control workplace. Effectiveness was assessed in terms of employees' dietary intakes, nutrition knowledge and health status in four large manufacturing workplaces. The study aimed to examine barriers to and facilitators of implementing complex workplace interventions, from the perspectives of key workplace stakeholders and researchers involved in implementation. A detailed process evaluation monitored and evaluated intervention implementation. Interviews were conducted at baseline (27 interviews) and at 7-9 month follow-up (27 interviews) with a purposive sample of workplace stakeholders (managers and participating employees). Topic guides explored factors which facilitated or impeded implementation. Researchers involved in recruitment and data collection participated in focus groups at baseline and at 7-9 month follow-up to explore their perceptions of intervention implementation. Data were imported into NVivo software and analysed using a thematic framework approach. Four major themes emerged; perceived benefits of participation, negotiation and flexibility of the implementation team, viability and intensity of interventions and workplace structures and cultures. The latter three themes either positively or negatively affected implementation, depending on context. The implementation team included managers involved in coordinating and delivering the interventions and the researchers who collected data and delivered intervention elements. Stakeholders' perceptions of the benefits of participating, which facilitated implementation, included managers' desire to improve company image and employees seeking health improvements. Other facilitators included stakeholder buy-in, organisational support and stakeholder cohesiveness with regards to the level of support provided to the intervention. Anticipation of employee resistance towards menu changes, workplace restructuring and target-driven workplace cultures impeded intervention implementation. Contextual factors such as workplace structures and cultures need to be considered in the implementation of future workplace dietary interventions. Negotiation and flexibility of key workplace stakeholders plays an integral role in overcoming the barriers of workplace cultures, structures and resistance to change. Current Controlled Trials: ISRCTN35108237. Date of registration: 02/07/2013.

[Implementation and (cost-)effectiveness of case management for people with dementia and their informal caregivers: results of the COMPAS study].

PubMed

van Mierlo, Lisa D; MacNeil-Vroomen, Janet; Meiland, Franka J M; Joling, Karlijn J; Bosmans, Judith E; Dröes, Rose Marie; Moll van Charante, Eric P; de Rooij, Sophia E J A; van Hout, Hein P J

2016-12-01

Different forms of case management for dementia have emerged over the past few years. In the COMPAS study (Collaborative dementia care for patients and caregivers study), two prominent Dutch case management forms were studied: the linkage and the integrated care form. Evaluation of the (cost)effectiveness of two dementia case management forms compared to usual care as well as factors that facilitated or impeded their implementation. A mixed methods design with a) a prospective, observational controlled cohort study with 2 years follow-up among 521 dyads of people with dementia and their primary informal caregiver with and without case management; b) interviews with 22 stakeholders on facilitating and impeding factors of the implementation and continuity of the two case management models. Outcome measures were severity and frequency of behavioural problems (NPI) for the person with dementia and mental health complaints (GHQ-12) for the informal caregiver, total met and unmet care needs (CANE) and quality adjusted life years (QALYs). Outcomes showed a better quality of life of informal caregivers in the integrated model compared to the linkage model. Caregivers in the control group reported more care needs than those in both case management groups. The independence of the case management provider in the integrated model facilitated the implementation, while the rivalry between multiple providers in the linkage model impeded the implementation. The costs of care were lower in the linkage model (minus 22 %) and integrated care model (minus 33 %) compared to the control group. The integrated care form was (very) cost-effective in comparison with the linkage form or no case management. The integrated care form is easy to implement.

A fast implementation of MPC-based motion cueing algorithms for mid-size road vehicle motion simulators

NASA Astrophysics Data System (ADS)

Bruschetta, M.; Maran, F.; Beghi, A.

2017-06-01

The use of dynamic driving simulators is constantly increasing in the automotive community, with applications ranging from vehicle development to rehab and driver training. The effectiveness of such devices is related to their capabilities of well reproducing the driving sensations, hence it is crucial that the motion control strategies generate both realistic and feasible inputs to the platform. Such strategies are called motion cueing algorithms (MCAs). In recent years several MCAs based on model predictive control (MPC) techniques have been proposed. The main drawback associated with the use of MPC is its computational burden, that may limit their application to high performance dynamic simulators. In the paper, a fast, real-time implementation of an MPC-based MCA for 9 DOF, high performance platform is proposed. Effectiveness of the approach in managing the available working area is illustrated by presenting experimental results from an implementation on a real device with a 200 Hz control frequency.

The Effect of STEM Learning through the Project of Designing Boat Model toward Student STEM Literacy

NASA Astrophysics Data System (ADS)

Tati, T.; Firman, H.; Riandi, R.

2017-09-01

STEM Learning focusses on development of STEM-literate society, the research about implementation of STEM learning to develope students’ STEM literacy is still limited. This study is aimed to examine the effect of implementation STEM learning through the project of designing boat model on students STEM literacy in energy topic. The method of this study was a quasi-experiment with non-randomized pretest-posttest control group design. There were two classes involved, the experiment class used Project Based Learning with STEM approach and control class used Project-Based Learning without STEM approach. A STEM Literacy test instrument was developed to measure students STEM literacy which consists of science literacy, mathematics literacy, and technology-engineering literacy. The analysis showed that there were significant differences on improvement science literacy, mathematics technology-engineering between experiment class and control class with effect size more than 0.8 (large effect). The difference of improvement of STEM literacy between experiment class and control class is caused by the existence of design engineering activity which required students to apply the knowledge from every field of STEM. The challenge that was faced in STEM learning through design engineering activity was how to give the students practice to integrate STEM field in solving the problems. In additional, most of the students gave positive response toward implementation of STEM learning through design boat model project.

Impact and cost-effectiveness of a comprehensive Schistosomiasis japonica control program in the Poyang Lake region of China.

PubMed

Yu, Qing; Zhao, Geng-Ming; Hong, Xian-Lin; Lutz, Eric A; Guo, Jia-Gang

2013-11-28

Schistosomiasis japonica remains a significant public-health problem in China. This study evaluated cost-effectiveness of a comprehensive schistosomiasis control program (2003-2006). The comprehensive control program was implemented in Zhangjia and Jianwu (cases); while standard interventions continued in Koutou and Xiajia (controls). Incurred costs were documented and the schistosomiasis comprehensive impact index (SCI) and cost-effectiveness ratio (Comprehensive Control Program Cost/SCI) were applied. In 2003, prevalence of Schistosoma japonicum infection was 11.3% (Zhangjia), 6.7% (Jianwu), 6.5% (Koutou), and 8.0% (Xiajia). In 2006, the comprehensive control program in Zhangjia and Jianwu reduced infection to 1.6% and 0.6%, respectively; while Koutou and Xiajia had a schistosomiasis prevalence of 3.2% and 13.0%, respectively. The year-by-year SCIs in Zhangjia were 0.28, 105.25, and 47.58, with an overall increase in cost-effectiveness ratio of 374.9%-544.8%. The SCIs in Jianwu were 16.21, 52.95, and 149.58, with increase in cost-effectiveness of 226.7%-1,149.4%. Investment in Koutou and Xiajia remained static (US$10,000 unit cost). The comprehensive control program implemented in the two case villages reduced median prevalence of schistosomiasis 8.5-fold. Further, the cost effectiveness ratio demonstrated that the comprehensive control program was 170% (Zhangjia) and 922.7% (Jianwu) more cost-effective. This work clearly shows the improvements in both cost and disease prevention effectiveness that a comprehensive control program-approach has on schistosomiasis infection prevalence.

Impact and Cost-Effectiveness of a Comprehensive Schistosomiasis japonica Control Program in the Poyang Lake Region of China

PubMed Central

Yu, Qing; Zhao, Geng-Ming; Hong, Xian-Lin; Lutz, Eric A.; Guo, Jia-Gang

2013-01-01

Schistosomiasis japonica remains a significant public-health problem in China. This study evaluated cost-effectiveness of a comprehensive schistosomiasis control program (2003–2006). The comprehensive control program was implemented in Zhangjia and Jianwu (cases); while standard interventions continued in Koutou and Xiajia (controls). Incurred costs were documented and the schistosomiasis comprehensive impact index (SCI) and cost-effectiveness ratio (Comprehensive Control Program Cost/SCI) were applied. In 2003, prevalence of Schistosoma japonicum infection was 11.3% (Zhangjia), 6.7% (Jianwu), 6.5% (Koutou), and 8.0% (Xiajia). In 2006, the comprehensive control program in Zhangjia and Jianwu reduced infection to 1.6% and 0.6%, respectively; while Koutou and Xiajia had a schistosomiasis prevalence of 3.2% and 13.0%, respectively. The year-by-year SCIs in Zhangjia were 0.28, 105.25, and 47.58, with an overall increase in cost-effectiveness ratio of 374.9%–544.8%. The SCIs in Jianwu were 16.21, 52.95, and 149.58, with increase in cost-effectiveness of 226.7%–1,149.4%. Investment in Koutou and Xiajia remained static (US$10,000 unit cost). The comprehensive control program implemented in the two case villages reduced median prevalence of schistosomiasis 8.5-fold. Further, the cost effectiveness ratio demonstrated that the comprehensive control program was 170% (Zhangjia) and 922.7% (Jianwu) more cost-effective. This work clearly shows the improvements in both cost and disease prevention effectiveness that a comprehensive control program-approach has on schistosomiasis infection prevalence. PMID:24287861

OZONE AMBIENT AIR QUALITY STANDARD HAS BENEFICIAL EFFECT ON PONDEROSA PINE IN CALIFORNIA

EPA Science Inventory

Ambient air quality standards and control strategies are implemented to protect humans and vegetation from adverse effects. However, to date there has not been a simple and objective method to determine if the standards and resultant control strategies have reduced O3 impacts on ...

Implementation of quantum logic gates via Stark-tuned Förster resonance in Rydberg atoms

NASA Astrophysics Data System (ADS)

Huang, Xi-Rong; Hu, Chang-Sheng; Shen, Li-Tuo; Yang, Zhen-Biao; Wu, Huai-Zhi

2018-02-01

We present a scheme for implementation of controlled-Z and controlled-NOT gates via rapid adiabatic passage and Stark-tuned Förster resonance. By sweeping the Förster resonance once without passing through it and adiabatically tuning the angle-dependent Rydberg-Rydberg interaction of the dipolar nature, the system can be effectively described by a two-level system with the adiabatic theorem. The single adiabatic passage leads to a gate fidelity as high as 0.999 and a greatly reduced gate operation time. We investigate the scheme by considering an actual atomic level configuration with rubidium atoms, where the fidelity of the controlled-Z gate is still higher than 0.99 under the influence of the Zeeman effect.

Early rigorous control interventions can largely reduce dengue outbreak magnitude: experience from Chaozhou, China.

PubMed

Liu, Tao; Zhu, Guanghu; He, Jianfeng; Song, Tie; Zhang, Meng; Lin, Hualiang; Xiao, Jianpeng; Zeng, Weilin; Li, Xing; Li, Zhihao; Xie, Runsheng; Zhong, Haojie; Wu, Xiaocheng; Hu, Wenbiao; Zhang, Yonghui; Ma, Wenjun

2017-08-02

Dengue fever is a severe public heath challenge in south China. A dengue outbreak was reported in Chaozhou city, China in 2015. Intensified interventions were implemented by the government to control the epidemic. However, it is still unknown the degree to which intensified control measures reduced the size of the epidemics, and when should such measures be initiated to reduce the risk of large dengue outbreaks developing? We selected Xiangqiao district as study setting because the majority of the indigenous cases (90.6%) in Chaozhou city were from this district. The numbers of daily indigenous dengue cases in 2015 were collected through the national infectious diseases and vectors surveillance system, and daily Breteau Index (BI) data were reported by local public health department. We used a compartmental dynamic SEIR (Susceptible, Exposed, Infected and Removed) model to assess the effectiveness of control interventions, and evaluate the control effect of intervention timing on dengue epidemic. A total of 1250 indigenous dengue cases was reported from Xiangqiao district. The results of SEIR modeling using BI as an indicator of actual control interventions showed a total of 1255 dengue cases, which is close to the reported number (n = 1250). The size and duration of the outbreak were highly sensitive to the intensity and timing of interventions. The more rigorous and earlier the control interventions implemented, the more effective it yielded. Even if the interventions were initiated several weeks after the onset of the dengue outbreak, the interventions were shown to greatly impact the prevalence and duration of dengue outbreak. This study suggests that early implementation of rigorous dengue interventions can effectively reduce the epidemic size and shorten the epidemic duration.

Integrated cable vibration control system using wireless sensors

NASA Astrophysics Data System (ADS)

Jeong, Seunghoo; Cho, Soojin; Sim, Sung-Han

2017-04-01

As the number of long-span bridges is increasing worldwide, maintaining their structural integrity and safety become an important issue. Because the stay cable is a critical member in most long-span bridges and vulnerable to wind-induced vibrations, vibration mitigation has been of interest both in academia and practice. While active and semi-active control schemes are known to be quite effective in vibration reduction compared to the passive control, requirements for equipment including data acquisition, control devices, and power supply prevent a widespread adoption in real-world applications. This study develops an integrated system for vibration control of stay-cables using wireless sensors implementing a semi-active control. Arduino, a low-cost single board system, is employed with a MEMS digital accelerometer and a Zigbee wireless communication module to build the wireless sensor. The magneto-rheological (MR) damper is selected as a damping device, controlled by an optimal control algorithm implemented on the Arduino sensing system. The developed integrated system is tested in a laboratory environment using a cable to demonstrate the effectiveness of the proposed system on vibration reduction. The proposed system is shown to reduce the vibration of stay-cables with low operating power effectively.

[Evaluation on cost-effectiveness of snail control project by environmental modification in hilly regions].

PubMed

Li, Shui-Ming; Chen, Shi-Jun; Wu, Xiao-Jun; Chen, Xi-Qing; Zhang, Rong-Ping; Zhang, Jian-Rong

2011-02-01

To evaluate the cost-effectiveness of the snail control project by environmental modification in order to provide the evidence for quickly interrupting the transmission of schistosomiasis in hilly regions. Field investigations were carried out. The changes of the snail habitat areas were compared before and after the snail control project. The direct costs of the snail control were calculated. The reduction rates of snail area and snail density were regarded as the evaluation indexes of the effectiveness. The costs for reduction of 1% of snail area and 1% of snail density were used as the unit for cost-effectiveness analysis. After the 15 projects were implemented, there were no snails in 12 areas. The reduction rates of snail areas were 72.22% to 100%. The reduction rates of the snail area and density were both 100% in the areas with digging new ditches to fill up the old ones and building reservoirs. The total cost of 15 projects was 1 450 800 Yuan. The average cost per unit was 0.56 Yuan/m2. After the snail control project by digging new ditches to fill up the old ones was implemented, the costs of snail area and density decreased by one unit were 300 -700 Yuan, by building reservoirs, the costs were 600 -2 600 Yuan, by building fishpond, the costs were 1 200 - 1 500 Yuan, by watershed comprehensive measures, the costs were 900 - 2 700 Yuan. The cost of digging new ditches to fill up the old ones was significantly lower than that of building reservoirs or watershed comprehensive measures, but there was no significant difference between building reservoirs and watershed comprehensive measures. In hilly regions, the implementation of snail control project by environmental modification combined with construction of water conservancy is effective, and the cost-effectiveness of the snail control with digging new ditches to fill up the old ones is excellent.

Planning, Implementing, and Maintaining an Effective In-School Suspension Program.

ERIC Educational Resources Information Center

Sullivan, Judy S.

1989-01-01

Notes that many in-school suspension (ISS) programs are used as a temporary controlling technique, rather than a truly rehabilitative measure. Presents 12 steps in planning and implementing, and 10 steps in maintaining, an ISS program that is a positive disciplinary strategy. (NH)

Implementation and evaluation of PM2.5 source contribution analysis in a photochemical model

EPA Science Inventory

Source culpability assessments are useful for developing effective emissions control programs. The Integrated Source Apportionment Method (ISAM) has been implemented in the Community Multiscale Air Quality (CMAQ) model to track contributions from source groups and regions to ambi...

American College of Cardiology/American Heart Association preoperative assessment guidelines reduce resource utilization before aortic surgery.

PubMed

Froehlich, James B; Karavite, Dean; Russman, Pamela L; Erdem, Nurum; Wise, Chris; Zelenock, Gerald; Wakefield, Thomas; Stanley, James; Eagle, Kim A

2002-10-01

Methods used for evaluation of cardiac risk before noncardiac surgery vary widely. We evaluated the effect over time on practice and resource utilization of implementing the American College of Cardiology/American Heart Association Guidelines on Preoperative Risk Assessment. We compared 102 historical control patients who underwent elective abdominal aortic surgery (from January 1993 to December 1994) with 94 consecutive patients after guideline implementation (from July 1995 to December 1996) and 104 patients in a late after guideline implementation (from July 1, 1997, to September 30, 1998). Resource use (testing, revascularization, and costs) and outcomes (perioperative death and myocardial infarction) were examined. Patients with and without clinical markers of risk for perioperative cardiac complications were compared. The use of preoperative stress testing (88% to 47%; P <.00001), cardiac catheterization (24% to 11%; P <.05), and coronary revascularization (25% to 2%; P <.00001) decreased between control and postguideline groups, respectively. These changes persisted in the late postguideline group. Mean preoperative evaluation costs also fell ($1087 versus $171; P <.0001). Outcomes of death (4% versus 3% versus 2%) and myocardial infarction (7% versus 3% versus 5%) were not significantly different between control, postguideline, and late postguideline groups, respectively. Stress test rates were similar for patients at low risk versus high risk in the historical control group (84% versus 91%; P =.29) but lower for patients at low risk after guideline implementation (31% versus 61%; P =.003). Implementation of the American College of Cardiology/American Heart Association cardiac risk assessment guidelines appropriately reduced resource use and costs in patients who underwent elective aortic surgery without affecting outcomes. This effect was sustained 2 years after guideline implementation.

A clustered controlled trial of the implementation and effectiveness of a medical home to improve health care of people with serious mental illness: study protocol.

PubMed

Young, Alexander S; Cohen, Amy N; Chang, Evelyn T; Flynn, Anthony W P; Hamilton, Alison B; Oberman, Rebecca; Vinzon, Merlyn

2018-06-07

People with serious mental illness (SMI) die many years prematurely, with rates of premature mortality two to three times greater than the general population. Most premature deaths are due to "natural causes," especially cardiovascular disease and cancer. Often, people with SMI are not well engaged in primary care treatment and do not receive high-value preventative and medical services. There have been numerous efforts to improve this care, and few controlled trials, with inconsistent results. While people with SMI often do poorly with usual primary care arrangements, research suggests that integrated care and medical care management may improve treatment and outcomes, and reduce treatment costs. This hybrid implementation-effectiveness study is a prospective, cluster controlled trial of a medical home, the SMI Patient-Aligned Care Team (SMI PACT), to improve the healthcare of patients with SMI enrolled with the Veterans Health Administration. The SMI PACT team includes proactive medical nurse care management, and integrated mental health treatment through regular psychiatry consultation and a collaborative care model. Patients are recruited to receive primary care through SMI PACT based on having a serious mental illness that is manageable with treatment, and elevated risk for hospitalization or death. In a site-level prospective controlled trial, this project studies the effect, relative to usual care, of SMI PACT on provision of appropriate preventive and medical treatments, health-related quality of life, satisfaction with care, and medical and mental health treatment utilization and costs. Research includes mixed-methods formative evaluation of usual care and SMI PACT implementation to strengthen the intervention and assess barriers and facilitators. Investigators examine relationships among organizational context, intervention factors, and patient and clinician outcomes, and identify patient factors related to successful patient outcomes. This will be one of the first controlled trials of the implementation and effectiveness of a patient centered medical home for people with serious mental illness. It will provide information regarding the value of this strategy, and processes and tools for implementing this model in community healthcare settings. ClinicalTrials.gov, NCT01668355 . Registered August 20, 2012.

Long-term benthic macroinvertebrate community monitoring to assess pollution abatement effectiveness.

PubMed

Smith, John G; Brandt, Craig C; Christensen, Sigurd W

2011-06-01

The benthic macroinvertebrate community of East Fork Poplar Creek (EFPC) in East Tennessee was monitored for 18 years to evaluate the effectiveness of a water pollution control program implemented at a major United States (U.S.) Department of Energy facility. Several actions were implemented to reduce and control releases of pollutants into the headwaters of the stream. Four of the most significant actions were implemented during different time periods, which allowed assessment of each action. Macroinvertebrate samples were collected annually in April from three locations in EFPC (EFK24, EFK23, and EFK14) and two nearby reference streams from 1986 through 2003. Significant improvements occurred in the macroinvertebrate community at the headwater sites (EFK24 and EFK23) after implementation of each action, while changes detected 9 km further downstream (EFK14) could not be clearly attributed to any of the actions. Because the stream was impacted at its origin, invertebrate recolonization was primarily limited to aerial immigration, thus, recovery has been slow. As recovery progressed, abundances of small pollution-tolerant taxa (e.g., Orthocladiinae chironomids) decreased and longer lived taxa colonized (e.g., hydropsychid caddisflies, riffle beetles, Baetis). While assessments lasting three to four years may be long enough to detect a response to new pollution controls at highly impacted locations, more time may be needed to understand the full effects. Studies on the effectiveness of pollution controls can be improved if impacted and reference sites are selected to maximize spatial and temporal trending, and if a multidisciplinary approach is used to broadly assess environmental responses (e.g., water quality trends, invertebrate and fish community assessments, toxicity testing, etc.).

Long-Term Benthic Macroinvertebrate Community Monitoring to Assess Pollution Abatement Effectiveness

NASA Astrophysics Data System (ADS)

Smith, John G.; Brandt, Craig C.; Christensen, Sigurd W.

2011-06-01

The benthic macroinvertebrate community of East Fork Poplar Creek (EFPC) in East Tennessee was monitored for 18 years to evaluate the effectiveness of a water pollution control program implemented at a major United States (U.S.) Department of Energy facility. Several actions were implemented to reduce and control releases of pollutants into the headwaters of the stream. Four of the most significant actions were implemented during different time periods, which allowed assessment of each action. Macroinvertebrate samples were collected annually in April from three locations in EFPC (EFK24, EFK23, and EFK14) and two nearby reference streams from 1986 through 2003. Significant improvements occurred in the macroinvertebrate community at the headwater sites (EFK24 and EFK23) after implementation of each action, while changes detected 9 km further downstream (EFK14) could not be clearly attributed to any of the actions. Because the stream was impacted at its origin, invertebrate recolonization was primarily limited to aerial immigration, thus, recovery has been slow. As recovery progressed, abundances of small pollution-tolerant taxa (e.g., Orthocladiinae chironomids) decreased and longer lived taxa colonized (e.g., hydropsychid caddisflies, riffle beetles, Baetis). While assessments lasting three to four years may be long enough to detect a response to new pollution controls at highly impacted locations, more time may be needed to understand the full effects. Studies on the effectiveness of pollution controls can be improved if impacted and reference sites are selected to maximize spatial and temporal trending, and if a multidisciplinary approach is used to broadly assess environmental responses (e.g., water quality trends, invertebrate and fish community assessments, toxicity testing, etc.).

Long-Term Benthic Macroinvertebrate Community Monitoring to Assess Pollution Abatement Effectiveness

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

Smith, John G; Brandt, Craig C; Christensen, Sigurd W

2011-01-01

The benthic macroinvertebrate community of East Fork Poplar Creek (EFPC) in East Tennessee was monitored for 18 years to evaluate the effectiveness of a water pollution control program implemented at a major United States (U.S.) Department of Energy facility. Several actions were implemented to reduce and control releases of pollutants into the headwaters of the stream. Four of the most significant actions were implemented during different time periods, which allowed assessment of each action. Macroinvertebrate samples were collected annually in April from three locations in EFPC (EFK24, EFK23, and EFK14) and two nearby reference streams from 1986 through 2003. Significantmore » improvements occurred in the macroinvertebrate community at the headwater sites (EFK24 and EFK23) after implementation of each action, while changes detected 9 km further downstream (EFK14) could not be clearly attributed to any of the actions. Because the stream was impacted at its origin, invertebrate recolonization was primarily limited to aerial immigration, thus, recovery has been slow. As recovery progressed, abundances of small pollution-tolerant taxa (e.g., Orthocladiinae chironomids) decreased and longer lived taxa colonized (e.g., hydropsychid caddisflies, riffle beetles, Baetis). While assessments lasting three to four years may be long enough to detect a response to new pollution controls at highly impacted locations, more time may be needed to understand the full effects. Studies on the effectiveness of pollution controls can be improved if impacted and reference sites are selected to maximize spatial and temporal trending, and if a multidisciplinary approach is used to broadly assess environmental responses (e.g., water quality trends, invertebrate and fish community assessments, toxicity testing, etc.).« less

An exploratory randomised controlled trial of a premises-level intervention to reduce alcohol-related harm including violence in the United Kingdom

PubMed Central

2012-01-01

Background To assess the feasibility of a randomised controlled trial of a licensed premises intervention to reduce severe intoxication and disorder; to establish effect sizes and identify appropriate approaches to the development and maintenance of a rigorous research design and intervention implementation. Methods An exploratory two-armed parallel randomised controlled trial with a nested process evaluation. An audit of risk factors and a tailored action plan for high risk premises, with three month follow up audit and feedback. Thirty-two premises that had experienced at least one assault in the year prior to the intervention were recruited, match paired and randomly allocated to control or intervention group. Police violence data and data from a street survey of study premises’ customers, including measures of breath alcohol concentration and surveyor rated customer intoxication, were used to assess effect sizes for a future definitive trial. A nested process evaluation explored implementation barriers and the fidelity of the intervention with key stakeholders and senior staff in intervention premises using semi-structured interviews. Results The process evaluation indicated implementation barriers and low fidelity, with a reluctance to implement the intervention and to submit to a formal risk audit. Power calculations suggest the intervention effect on violence and subjective intoxication would be raised to significance with a study size of 517 premises. Conclusions It is methodologically feasible to conduct randomised controlled trials where licensed premises are the unit of allocation. However, lack of enthusiasm in senior premises staff indicates the need for intervention enforcement, rather than voluntary agreements, and on-going strategies to promote sustainability. Trial registration UKCRN 7090; ISRCTN: 80875696 PMID:22676069

Comparison of the effectiveness of two styles of case-based learning implemented in lectures for developing nursing students' critical thinking ability: A randomized controlled trial.

PubMed

Hong, Shaohua; Yu, Ping

2017-03-01

To explore and compare the effectiveness of two styles of case-based learning methods, unfolding nursing case and usual nursing case, implemented in lectures for developing nursing students' critical thinking ability. 122 undergraduate nursing students in four classes were taught the subject of medical nursing for one year. Two classes were randomly assigned as the experimental group and the other two the control group. The experimental group received the lectures presenting unfolding nursing cases and the control group was taught the usual cases. Nineteen case-based lectures were provided in 8 months in two semesters to each group. The two groups started with a similar level of critical thinking ability as tested by the instrument of Critical Thinking Disposition Inventory-Chinese version (CTDI-CV). After receiving 19 case-based learning lectures for 8 months, both groups of students significantly improved their critical thinking ability. The improvement in the experimental group was significantly higher than that in the control group (with the average total score of 303.77±15.24 vs. 288.34±13.94, p<0.05). The experimental group also had significantly better improvement in six out of seven dimensions whereas the control group showed improvement in only three out of seven dimensions of CTDI-CV. The study suggests the feasibility of implementing case-based learning in lectures. Unfolding nursing cases appear to be significantly more effective than the usual nursing cases in developing undergraduate nursing students' critical thinking ability in the subject of medical nursing. Further research can implement the unfolding nursing cases in other nursing subjects. Copyright © 2016 Elsevier Ltd. All rights reserved.

Enhancing implementation of tobacco use prevention and cessation counselling guideline among dental providers: a cluster randomised controlled trial.

PubMed

Amemori, Masamitsu; Korhonen, Tellervo; Kinnunen, Taru; Michie, Susan; Murtomaa, Heikki

2011-02-14

Tobacco use adversely affects oral health. Tobacco use prevention and cessation (TUPAC) counselling guidelines recommend that healthcare providers ask about each patient's tobacco use, assess the patient's readiness and willingness to stop, document tobacco use habits, advise the patient to stop, assist and help in quitting, and arrange monitoring of progress at follow-up appointments. Adherence to such guidelines, especially among dental providers, is poor. To improve guideline implementation, it is essential to understand factors influencing it and find effective ways to influence those factors. The aim of the present study protocol is to introduce a theory-based approach to diagnose implementation difficulties of TUPAC counselling guidelines among dental providers. Theories of behaviour change have been used to identify key theoretical domains relevant to the behaviours of healthcare providers involved in implementing clinical guidelines. These theoretical domains will inform the development of a questionnaire aimed at assessing the implementation of the TUPAC counselling guidelines among Finnish municipal dental providers. Specific items will be drawn from the guidelines and the literature on TUPAC studies. After identifying potential implementation difficulties, we will design two interventions using theories of behaviour change to link them with relevant behaviour change techniques aiming to improve guideline adherence. For assessing the implementation of TUPAC guidelines, the electronic dental record audit and self-reported questionnaires will be used. To improve guideline adherence, the theoretical-domains approach could provide a comprehensive basis for assessing implementation difficulties, as well as designing and evaluating interventions. After having identified implementation difficulties, we will design and test two interventions to enhance TUPAC guideline adherence. Using the cluster randomised controlled design, we aim to provide further evidence on intervention effects, as well as on the validity and feasibility of the theoretical-domain approach. The empirical data collected within this trial will be useful in testing whether this theoretical-domain approach can improve our understanding of the implementation of TUPAC guidelines among dental providers. Current Controlled Trials ISRCTN15427433.

An Implementation Study of Two Evidence-Based Exercise and Health Education Programmes for Older Adults with Osteoarthritis of the Knee and Hip

ERIC Educational Resources Information Center

de Jong, O. R. W.; Hopman-Rock, M.; Tak, E. C. M. P.; Klazinga, N. S.

2004-01-01

Implementation studies are recommended to assess the feasibility and effectiveness in real-life of programmes which have been tested in randomized controlled trials (RCTs). We report on an implementation study of two evidence-based exercise and health education programmes for older adults with osteoarthritis (OA) of the knee or hip. Three types of…

Teachers’ patterns of implementation of an evidence-based intervention and student outcomes: results from a nationwide dissemination over 24-months follow-up

PubMed Central

Stanton, Bonita; Wang, Bo; Deveaux, Lynette; Lunn, Sonja; Rolle, Glenda; Mortimer, Arvis; Li, Xiaoming; Marshall, Sharon; Poitier, Maxwell; Adderley, Richard

2015-01-01

More information is needed about factors influencing real-life implementation and program impact of interventions effective in controlled study conditions. Ongoing national implementation of an evidence-based HIV prevention program targeting grade 6 students in The Bahamas offers the opportunity to examine patterns of implementation and relate them to student outcomes. Data were collected from 208 grade 6 teachers, 75 grade 7 teachers and 4,411 grade 6 students followed over two years. Mixed-effects modeling analysis examined the association of teachers’ patterns of implementation with student outcomes. High quality program implementation in grade 6 (high implementation dosage and fidelity) was significantly related to student outcomes six and 18 months post-intervention. Quality of implementation of the booster session in grade 7 was also significantly related to student outcomes in grade 7. Quality of delivery of the brief booster session a year after initial implementation is important in maintaining or resetting the student outcome trajectory. PMID:26093781

On the comparison of stochastic model predictive control strategies applied to a hydrogen-based microgrid

NASA Astrophysics Data System (ADS)

Velarde, P.; Valverde, L.; Maestre, J. M.; Ocampo-Martinez, C.; Bordons, C.

2017-03-01

In this paper, a performance comparison among three well-known stochastic model predictive control approaches, namely, multi-scenario, tree-based, and chance-constrained model predictive control is presented. To this end, three predictive controllers have been designed and implemented in a real renewable-hydrogen-based microgrid. The experimental set-up includes a PEM electrolyzer, lead-acid batteries, and a PEM fuel cell as main equipment. The real experimental results show significant differences from the plant components, mainly in terms of use of energy, for each implemented technique. Effectiveness, performance, advantages, and disadvantages of these techniques are extensively discussed and analyzed to give some valid criteria when selecting an appropriate stochastic predictive controller.

Efficient community-based control strategies in adaptive networks

NASA Astrophysics Data System (ADS)

Yang, Hui; Tang, Ming; Zhang, Hai-Feng

2012-12-01

Most studies on adaptive networks concentrate on the properties of steady state, but neglect transient dynamics. In this study, we pay attention to the emergence of community structure in the transient process and the effects of community-based control strategies on epidemic spreading. First, by normalizing the modularity, we investigate the evolution of community structure during the transient process, and find that a strong community structure is induced by the rewiring mechanism in the early stage of epidemic dynamics, which, remarkably, delays the outbreak of disease. We then study the effects of control strategies started at different stages on the prevalence. Both immunization and quarantine strategies indicate that it is not ‘the earlier, the better’ for the implementation of control measures. And the optimal control effect is obtained if control measures can be efficiently implemented in the period of a strong community structure. For the immunization strategy, immunizing the susceptible nodes on susceptible-infected links and immunizing susceptible nodes randomly have similar control effects. However, for the quarantine strategy, quarantining the infected nodes on susceptible-infected links can yield a far better result than quarantining infected nodes randomly. More significantly, the community-based quarantine strategy performs better than the community-based immunization strategy. This study may shed new light on the forecast and the prevention of epidemics among humans.

Distributed cooperative control of AC microgrids

NASA Astrophysics Data System (ADS)

Bidram, Ali

In this dissertation, the comprehensive secondary control of electric power microgrids is of concern. Microgrid technical challenges are mainly realized through the hierarchical control structure, including primary, secondary, and tertiary control levels. Primary control level is locally implemented at each distributed generator (DG), while the secondary and tertiary control levels are conventionally implemented through a centralized control structure. The centralized structure requires a central controller which increases the reliability concerns by posing the single point of failure. In this dissertation, the distributed control structure using the distributed cooperative control of multi-agent systems is exploited to increase the secondary control reliability. The secondary control objectives are microgrid voltage and frequency, and distributed generators (DGs) active and reactive powers. Fully distributed control protocols are implemented through distributed communication networks. In the distributed control structure, each DG only requires its own information and the information of its neighbors on the communication network. The distributed structure obviates the requirements for a central controller and complex communication network which, in turn, improves the system reliability. Since the DG dynamics are nonlinear and non-identical, input-output feedback linearization is used to transform the nonlinear dynamics of DGs to linear dynamics. Proposed control frameworks cover the control of microgrids containing inverter-based DGs. Typical microgrid test systems are used to verify the effectiveness of the proposed control protocols.

Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: a non-randomized controlled trial.

PubMed

Bernhardsson, Susanne; Larsson, Maria E H; Eggertsen, Robert; Olsén, Monika Fagevik; Johansson, Kajsa; Nilsen, Per; Nordeman, Lena; van Tulder, Maurits; Öberg, Birgitta

2014-03-04

Clinical practice guidelines are important for transmitting research findings into practice and facilitating the application of evidence-based practice (EBP). There is a paucity of knowledge about the impact of guideline implementation strategies in primary care physical therapy. The aim of this study was to evaluate the effect of a guideline implementation intervention in primary care physical therapy in western Sweden. An implementation strategy based on theory and current evidence was developed. A tailored, multi-component implementation intervention, addressing earlier identified determinants, was carried out in three areas comprising 28 physical therapy practices including 277 physical therapists (PTs) (intervention group). In two adjacent areas, 171 PTs at 32 practices received no intervention (control group). The core component of the intervention was an implementation seminar with group discussions. Among other components were a website and email reminders. Data were collected at baseline and follow-up with a web-based questionnaire. Primary outcomes were the self-reported awareness of, knowledge of, access to, and use of guidelines. Secondary outcomes were self-reported attitudes toward EBP and guidelines. Analyses were performed using Pearson's χ2 test and approximative z-test. 168 PTs (60.6%) in the intervention group and 88 PTs (51.5%) in the control group responded to the follow-up questionnaire. 186/277 PTs (67.1%) participated in the implementation seminars, of which 97 (52.2%) responded. The proportions of PTs reporting awareness of (absolute difference in change 20.6%, p = 0.023), knowledge where to find (20.4%, p = 0.007), access to (21.7%, p < 0.001), and frequent use of (9.5%, NS) guidelines increased more in the intervention group than in the control group. The proportion of PTs reporting frequent guideline use after participation in the implementation seminar was 15.2% (p = 0.043) higher than the proportion in the control group. A higher proportion considered EBP helpful in decision making (p = 0.018). There were no other significant differences in secondary outcomes. A tailored, theory- and evidence-informed, multi-component intervention for the implementation of clinical practice guidelines had a modest, positive effect on awareness of, knowledge of, access to, and use of guidelines, among PTs in primary care in western Sweden. In general, attitudes to EBP and guidelines were not affected.

Implementation of single-photon quantum routing and decoupling using a nitrogen-vacancy center and a whispering-gallery-mode resonator-waveguide system.

PubMed

Cao, Cong; Duan, Yu-Wen; Chen, Xi; Zhang, Ru; Wang, Tie-Jun; Wang, Chuan

2017-07-24

Quantum router is a key element needed for the construction of future complex quantum networks. However, quantum routing with photons, and its inverse, quantum decoupling, are difficult to implement as photons do not interact, or interact very weakly in nonlinear media. In this paper, we investigate the possibility of implementing photonic quantum routing based on effects in cavity quantum electrodynamics, and present a scheme for single-photon quantum routing controlled by the other photon using a hybrid system consisting of a single nitrogen-vacancy (NV) center coupled with a whispering-gallery-mode resonator-waveguide structure. Different from the cases in which classical information is used to control the path of quantum signals, both the control and signal photons are quantum in our implementation. Compared with the probabilistic quantum routing protocols based on linear optics, our scheme is deterministic and also scalable to multiple photons. We also present a scheme for single-photon quantum decoupling from an initial state with polarization and spatial-mode encoding, which can implement an inverse operation to the quantum routing. We discuss the feasibility of our schemes by considering current or near-future techniques, and show that both the schemes can operate effectively in the bad-cavity regime. We believe that the schemes could be key building blocks for future complex quantum networks and large-scale quantum information processing.

77 FR 35866 - Approval and Promulgation of Implementation Plans; Revisions to the Georgia State Implementation...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-15

... (GA DNR), on November 16, 2010. This revision consists of transportation conformity criteria and procedures related to interagency consultation and enforceability of certain transportation-related control measures and mitigation measures. The intended effect is to update the transportation conformity criteria...

Effective standards and regulatory tools for respiratory gas monitors and pulse oximeters: the role of the engineer and clinician.

PubMed

Weininger, Sandy

2007-12-01

Developing safe and effective medical devices involves understanding the hazardous situations that can arise in clinical practice and implementing appropriate risk control measures. The hazardous situations may have their roots in the design or in the use of the device. Risk control measures may be engineering or clinically based. A multidisciplinary team of engineers and clinicians is needed to fully identify and assess the risks and implement and evaluate the effectiveness of the control measures. In this paper, I use three issues, calibration/accuracy, response time, and protective measures/alarms, to highlight the contributions of these groups. This important information is captured in standards and regulatory tools to control risk for respiratory gas monitors and pulse oximeters. This paper begins with a discussion of the framework of safety, explaining how voluntary standards and regulatory tools work. The discussion is followed by an examination of how engineering and clinical knowledge are used to support the assurance of safety.

Communications Handbook for Traffic Control Systems

DOT National Transportation Integrated Search

1993-04-01

The communications system generally proves the most critical and expensive element of a traffic control system/IVHS. Therefore the successful design, implementation, and operation of the communications system become key to the effectiveness of the ov...

Peak reduction for commercial buildings using energy storage

NASA Astrophysics Data System (ADS)

Chua, K. H.; Lim, Y. S.; Morris, S.

2017-11-01

Battery-based energy storage has emerged as a cost-effective solution for peak reduction due to the decrement of battery’s price. In this study, a battery-based energy storage system is developed and implemented to achieve an optimal peak reduction for commercial customers with the limited energy capacity of the energy storage. The energy storage system is formed by three bi-directional power converter rated at 5 kVA and a battery bank with capacity of 64 kWh. Three control algorithms, namely fixed-threshold, adaptive-threshold, and fuzzy-based control algorithms have been developed and implemented into the energy storage system in a campus building. The control algorithms are evaluated and compared under different load conditions. The overall experimental results show that the fuzzy-based controller is the most effective algorithm among the three controllers in peak reduction. The fuzzy-based control algorithm is capable of incorporating a priori qualitative knowledge and expertise about the load characteristic of the buildings as well as the useable energy without over-discharging the batteries.

Design and implementation of robust controllers for a gait trainer.

PubMed

Wang, F C; Yu, C H; Chou, T Y

2009-08-01

This paper applies robust algorithms to control an active gait trainer for children with walking disabilities. Compared with traditional rehabilitation procedures, in which two or three trainers are required to assist the patient, a motor-driven mechanism was constructed to improve the efficiency of the procedures. First, a six-bar mechanism was designed and constructed to mimic the trajectory of children's ankles in walking. Second, system identification techniques were applied to obtain system transfer functions at different operating points by experiments. Third, robust control algorithms were used to design Hinfinity robust controllers for the system. Finally, the designed controllers were implemented to verify experimentally the system performance. From the results, the proposed robust control strategies are shown to be effective.

Teacher training as a behavior change process: principles and results from a longitudinal study.

PubMed

Kealey, K A; Peterson, A V; Gaul, M A; Dinh, K T

2000-02-01

For students to realize the benefits of behavior change curricula for disease prevention, programs must be implemented effectively. However, implementation failure is a common problem documented in the literature. In this article, teacher training is conceptualized as a behavior change process with explicit teacher motivation components included to help effect the intended behavior (i.e., implementation). Using this method, the Hutchinson Smoking Prevention Project, a randomized controlled trial in school-based smoking prevention, conducted 65 in-service programs, training nearly 500 teachers (Grades 3-10) from 72 schools. Implementation was monitored by teacher self-report and classroom observations by project staff. The results were favorable. All eligible teachers received training, virtually all trained teachers implemented the research curriculum, and 89% of observed lessons worked as intended. It is concluded that teacher training conceptualized as a behavior change process and including explicit teacher motivation components can promote effective implementation of behavior change curricula in public school classrooms.

Using Lean Six Sigma Methodology to Improve Quality of the Anesthesia Supply Chain in a Pediatric Hospital.

PubMed

Roberts, Renée J; Wilson, Ashley E; Quezado, Zenaide

2017-03-01

Six Sigma and Lean methodologies are effective quality improvement tools in many health care settings. We applied the DMAIC methodology (define, measure, analyze, improve, control) to address deficiencies in our pediatric anesthesia supply chain. We defined supply chain problems by mapping existing processes and soliciting comments from those involved. We used daily distance walked by anesthesia technicians and number of callouts for missing supplies as measurements that we analyzed before and after implementing improvements (anesthesia cart redesign). We showed improvement in the metrics after those interventions were implemented, and those improvements were sustained and thus controlled 1 year after implementation.

Translating a Fall Prevention Intervention Into Practice: A Randomized Community Trial

PubMed Central

Peterson, Donna J.; Christiansen, Ann L.; Mahoney, Jane; Laud, Purushottam; Layde, Peter M.

2015-01-01

Objectives. We examined whether community translation of an effective evidence-based fall prevention program via standard monetary support can produce a community-wide reduction in fall injuries in older adults and evaluated whether an enhanced version with added technical support and capacity building amplified the fall reduction effect. Methods. We completed a randomized controlled community trial among adults aged 65 and older in (1) 10 control communities receiving no special resources or guidance on fall prevention, (2) 5 standard support communities receiving modest funding to implement Stepping On, and (3) 5 enhanced support communities receiving funding and technical support. The primary outcome was hospital inpatient and emergency department discharges for falls, examined with Poisson regression. Results. Compared with control communities, standard and enhanced support communities showed significantly higher community-wide reductions (9% and 8%, respectively) in fall injuries from baseline (2007–2008) to follow-up (2010–2011). No significant difference was found between enhanced and standard support communities. Conclusions. Population-based fall prevention interventions can be effective when implemented in community settings. More research is needed to identify the barriers and facilitators that influence the successful adoption and implementation of fall prevention interventions into broad community practice. PMID:25602891

Translating a Fall Prevention Intervention Into Practice: A Randomized Community Trial.

PubMed

Guse, Clare E; Peterson, Donna J; Christiansen, Ann L; Mahoney, Jane; Laud, Purushottam; Layde, Peter M

2015-07-01

We examined whether community translation of an effective evidence-based fall prevention program via standard monetary support can produce a community-wide reduction in fall injuries in older adults and evaluated whether an enhanced version with added technical support and capacity building amplified the fall reduction effect. We completed a randomized controlled community trial among adults aged 65 and older in (1) 10 control communities receiving no special resources or guidance on fall prevention, (2) 5 standard support communities receiving modest funding to implement Stepping On, and (3) 5 enhanced support communities receiving funding and technical support. The primary outcome was hospital inpatient and emergency department discharges for falls, examined with Poisson regression. Compared with control communities, standard and enhanced support communities showed significantly higher community-wide reductions (9% and 8%, respectively) in fall injuries from baseline (2007-2008) to follow-up (2010-2011). No significant difference was found between enhanced and standard support communities. Population-based fall prevention interventions can be effective when implemented in community settings. More research is needed to identify the barriers and facilitators that influence the successful adoption and implementation of fall prevention interventions into broad community practice.

Implementation and characterization of a controllable dephasing channel based on coupling polarization and spatial degrees of freedom of light.

PubMed

Urrego, Daniel F; Álvarez, Juan-Rafael; Calderón-Losada, Omar; Svozilík, Jiří; Nuñez, Mayerlin; Valencia, Alejandra

2018-04-30

We present the experimental implementation and theoretical model of a controllable dephasing quantum channel using photonic systems. The channel is implemented by coupling the polarization and the spatial distribution of light that play, in the perspective of open quantum systems, the role of quantum system and environment, respectively. The capability of controlling our channel allows us to visualize its effects in a quantum system. Different from standard dephasing channels, our channel presents an exotic behavior in the sense that the evolution of a state, from a pure to a mixed state, shows an oscillatory behavior if tracked in the Bloch sphere. Additionally, we report the evolution of the purity and perform a quantum process tomography to obtain the χ matrix associated to our channel.

Ozone changes in response to the heavy-duty diesel truck control in the Pearl River Delta

NASA Astrophysics Data System (ADS)

Yu, Xin; Yuan, Zibing; Fung, J. C. H.; Xue, Jian; Li, Ying; Zheng, Junyu; Lau, A. K. H.

2014-05-01

In recent years, restricting heavy-duty diesel trucks from driving within urban areas during the daytime is implemented in major PRD cities (e.g. Guangzhou and Shenzhen). Potential effects of this traffic control policy on spatial and temporal variations of O3 concentrations are examined by CMAQ model system. Temporal profiles of mobile source emissions are modified to reflect the emission characteristics after the control. Our results show that: (1) with the updated mobile emission profile, there is a notable improvement in O3 simulation performance for urban sites, with reductions in both the nighttime O3 overestimation (up to 25 ppb) and the daytime underestimation on O3 peak values (up to 20 ppb); (2) although the control policies are only applied in urban locations, their effects may extend to much larger downwind areas. The results from this study provide basic information that is useful in understanding the effects of mobile control policies on ambient O3 in highly developing regions of China where similar strategies have been widely implemented.

Effectiveness of prerequisites and the HACCP plan in the control of microbial contamination in ice cream and cheese companies.

PubMed

Domenech, Eva; Amorós, José Antonio; Escriche, Isabel

2013-03-01

In food safety, implementation of prerequisites and application of Hazard Analysis and Critical Control Points (HACCP) guarantee the control of processes, and microbiological criteria permit validation of their effectiveness. With these aims in mind, this article presents the results obtained by the official control carried out by the Valencian administration in ice cream and cheese companies, located in the Xativa/Ontinyente area (Valencian region, Spain) in the period between 2005 and 2010. The audits of Good Hygienic Practices (GHP) and HACCP show that "Structure & Design" followed by "Hygiene & Cleaning" and "Traceability" were the evaluated items with most nonconformities. Pathogenic microorganisms were not found in any of the final products analyzed. Microorganism indicators of unhygienic conditions were present in 100% of the analyses; however, 87.98% of them had low levels, which did not exceed the microbiological criteria. These results highlight the general good effectiveness of the safety management systems implemented and emphasize that companies and official control must continue working in order to guarantee the consumers' welfare.

Development and Operation of an Automatic Rotor Trim Control System for the UH-60 Individual Blade Control Wind Tunnel Test

NASA Technical Reports Server (NTRS)

Theodore, Colin R.; Tischler, Mark B.

2010-01-01

An automatic rotor trim control system was developed and successfully used during a wind tunnel test of a full-scale UH-60 rotor system with Individual Blade Control (IBC) actuators. The trim control system allowed rotor trim to be set more quickly, precisely and repeatably than in previous wind tunnel tests. This control system also allowed the rotor trim state to be maintained during transients and drift in wind tunnel flow, and through changes in IBC actuation. The ability to maintain a consistent rotor trim state was key to quickly and accurately evaluating the effect of IBC on rotor performance, vibration, noise and loads. This paper presents details of the design and implementation of the trim control system including the rotor system hardware, trim control requirements, and trim control hardware and software implementation. Results are presented showing the effect of IBC on rotor trim and dynamic response, a validation of the rotor dynamic simulation used to calculate the initial control gains and tuning of the control system, and the overall performance of the trim control system during the wind tunnel test.

Magnetic induction of hyperthermia by a modified self-learning fuzzy temperature controller

NASA Astrophysics Data System (ADS)

Wang, Wei-Cheng; Tai, Cheng-Chi

2017-07-01

The aim of this study involved developing a temperature controller for magnetic induction hyperthermia (MIH). A closed-loop controller was applied to track a reference model to guarantee a desired temperature response. The MIH system generated an alternating magnetic field to heat a high magnetic permeability material. This wireless induction heating had few side effects when it was extensively applied to cancer treatment. The effects of hyperthermia strongly depend on the precise control of temperature. However, during the treatment process, the control performance is degraded due to severe perturbations and parameter variations. In this study, a modified self-learning fuzzy logic controller (SLFLC) with a gain tuning mechanism was implemented to obtain high control performance in a wide range of treatment situations. This implementation was performed by appropriately altering the output scaling factor of a fuzzy inverse model to adjust the control rules. In this study, the proposed SLFLC was compared to the classical self-tuning fuzzy logic controller and fuzzy model reference learning control. Additionally, the proposed SLFLC was verified by conducting in vitro experiments with porcine liver. The experimental results indicated that the proposed controller showed greater robustness and excellent adaptability with respect to the temperature control of the MIH system.

Haptic control of a pneumatic muscle actuator to provide resistance for simulated isokinetic exercise; part II: control development and testing.

PubMed

Hall, Kara L; Phillips, Chandler A; Reynolds, David B; Mohler, Stanley R; Rogers, Dana B; Neidhard-Doll, Amy T

2015-01-01

Pneumatic muscle actuators (PMAs) have a high power to weight ratio and possess unique characteristics which make them ideal actuators for applications involving human interaction. PMAs are difficult to control due to nonlinear dynamics, presenting challenges in system implementation. Despite these challenges, PMAs have great potential as a source of resistance for strength training and rehabilitation. The objective of this work was to control a PMA for use in isokinetic exercise, potentially benefiting anyone in need of optimal strength training through a joint's range of motion. The controller, based on an inverse three-element phenomenological model and adaptive nonlinear control, allows the system to operate as a type of haptic device. A human quadriceps dynamic simulator was developed (as described in Part I of this work) so that control effectiveness and accommodation could be tested prior to human implementation. Tracking error results indicate that the control system is effective at producing PMA displacement and resistance necessary for a scaled, simulated neuromuscular actuator to maintain low-velocity isokinetic movement during simulated concentric and eccentric knee extension.

Fidelity of Implementation in Project Towards No Drug Abuse (TND): A Comparison of Classroom Teachers and Program Specialists

PubMed Central

Dent, Clyde W.; Skara, Silvana; Sun, Ping; Sussman, Steve

2011-01-01

This paper presents the results of an effectiveness trial of Project Towards No Drug Abuse [TND], in which we compared program delivery by regular classroom teachers and program specialists within the same high schools. Within 18 schools that were randomly assigned to the program or control conditions, health classrooms were assigned to program delivery by teachers or (outside) specialists. Classroom sessions were observed by pairs of observers to assess three domains of implementation fidelity: adherence, classroom process, and perceived student acceptance of the program. Pre- and immediate posttest survey data were collected from 2331 students. Of the four composite indexes of implementation fidelity that were examined, only one (quality of delivery) showed a difference between specialists and teachers, with marginally higher ratings of specialists (p < .10). Both teachers and program specialists achieved effects on three of the five immediate outcome measures, including program-specific knowledge, addiction concern, and social self-control. Students’ posttest ratings of the program overall and the quality of program delivery failed to reveal differences between the teacher- and specialist-led classrooms. These results suggest that motivated, trained classroom teachers can implement evidence-based prevention programs with fidelity and achieve immediate effects. PMID:17180722

Adherence and delivery: Implementation quality and program outcomes for the 7th grade keepin’ it REAL program

PubMed Central

Pettigrew, Jonathan; Graham, John W.; Miller-Day, Michelle; Hecht, Michael L.; Krieger, Janice L.; Shin, Young Ju

2014-01-01

Poor implementation quality (IQ) is known to reduce program effects making it important to consider IQ for evaluation and dissemination of prevention programs. However, less is known about the ways specific implementation variables relate to outcomes. In this study, two versions of the keepin’ it REAL, 7th grade drug prevention intervention were implemented in 78 classrooms in 25 schools in rural districts in Pennsylvania and Ohio. IQ was measured through observational coding of 276 videos. IQ variables included adherence to the curriculum, teacher engagement (attentiveness, enthusiasm, seriousness, clarity, positivity), student engagement (attention, participation), and a global rating of teacher delivery quality. Factor analysis showed that teacher engagement, student engagement, and delivery quality formed one factor, which was labeled delivery. A second factor was adherence to the curriculum. Self-report student surveys measured substance use, norms (beliefs about prevalence and acceptability of use), and efficacy (beliefs about one’s ability to refuse substance offers) at two waves (pretest, immediate posttest). Mixed model regression analysis which accounted for missing data and controlled for pretest levels examined implementation quality’s effects on individual level outcomes, statistically controlling for cluster level effects. Results show that when implemented well, students show positive outcomes compared to students receiving a poorly implemented program. Delivery significantly influenced substance use and norms, but not efficacy. Adherence marginally significantly predicted use and significantly predicted norms, but not efficacy. Findings underscore the importance of comprehensively measuring and accounting for IQ, particularly delivery, when evaluating prevention interventions. PMID:24442403

STRATEGIES TO REDUCE EXPOSURE TO TRAFFIC-RELATED AIR POLLUTION AT THE LOCAL LEVEL

EPA Science Inventory

As public health concerns for populations living, working and going to school near high-traffic roadways have increased, so have the need to identify and implement air pollution control strategies effective at the local level. While strategies implemented at the federal and stat...

Implementing Project Based Learning in Computer Classroom

ERIC Educational Resources Information Center

Asan, Askin; Haliloglu, Zeynep

2005-01-01

Project-based learning offers the opportunity to apply theoretical and practical knowledge, and to develop the student's group working, and collaboration skills. In this paper we presented a design of effective computer class that implements the well-known and highly accepted project-based learning paradigm. A pre-test/post-test control group…

Pointer Animation Implementation at Development of Multimedia Learning of Java Programming

ERIC Educational Resources Information Center

Rusli, Muhammad; Atmojo, Yohanes Priyo

2015-01-01

This research represents the development research using the references of previous research results related to the development of interactive multimedia learning (learner controlled), specially about the effectiveness and efficiency of multimedia learning of a content that developed by pointer animation implementation showing the content in…

Poor Implementation of Learner-Centered Practices: A Cautionary Tale

ERIC Educational Resources Information Center

Ikemoto, Gina Schuyler; Steele, Jennifer L.; Pane, John F.

2016-01-01

Many school systems are adopting new curricula in response to more rigorous standards that require higher-order thinking skills. This chapter presents implementation findings from a randomized, controlled trial of the Cognitive Tutor Geometry curriculum. We found a significant negative effect on student achievement despite the curriculum's focus…

78 FR 9828 - Approval and Promulgation of Implementation Plans; New Mexico; Albuquerque/Bernalillo County...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-12

... Promulgation of Implementation Plans; New Mexico; Albuquerque/Bernalillo County: Infrastructure and Interstate... State State citation Title/subject approval/ EPA approval date Explanation effective date New Mexico... Quality Control Board * * * * * * * Part 8 (20.11.8 NMAC) Ambient Air Quality 8/12/2009 September 19, 2012...

Validity as Process: A Construct Driven Measure of Fidelity of Implementation

ERIC Educational Resources Information Center

Jones, Ryan Seth

2013-01-01

Estimates of fidelity of implementation are essential to interpret the effects of educational interventions in randomized controlled trials (RCTs). While random assignment protects against many threats to validity, and therefore provides the best approximation to a true counterfactual condition, it does not ensure that the treatment condition…

Characterization of cotton gin particulate matter emissions – project plan

USDA-ARS?s Scientific Manuscript database

In 2006, EPA implemented a more stringent standard for particulate matter with an effective diameter less than 2.5 microns (PM2.5). The implementation timeline for this standard will vary by state/district regulatory agency. For example, the San Joaquin Valley Air Pollution Control District, has pro...

Characterization of cotton gin particulate matter emissions - project plan

USDA-ARS?s Scientific Manuscript database

In 2006, EPA implemented a more stringent standard for particulate matter with an effective diameter less than 2.5 microns (PM2.5). The implementation time line for this standard will vary by state/district regulatory agency. For example, the San Joaquin Valley Air Pollution Control District has pro...

Functional Based Adaptive and Fuzzy Sliding Controller for Non-Autonomous Active Suspension System

NASA Astrophysics Data System (ADS)

Huang, Shiuh-Jer; Chen, Hung-Yi

In this paper, an adaptive sliding controller is developed for controlling a vehicle active suspension system. The functional approximation technique is employed to substitute the unknown non-autonomous functions of the suspension system and release the model-based requirement of sliding mode control algorithm. In order to improve the control performance and reduce the implementation problem, a fuzzy strategy with online learning ability is added to compensate the functional approximation error. The update laws of the functional approximation coefficients and the fuzzy tuning parameters are derived from the Lyapunov theorem to guarantee the system stability. The proposed controller is implemented on a quarter-car hydraulic actuating active suspension system test-rig. The experimental results show that the proposed controller suppresses the oscillation amplitude of the suspension system effectively.

Community-based implementation and effectiveness in a randomized trial of a risk reduction intervention for HIV-serodiscordant couples: study protocol

PubMed Central

2014-01-01

Background The HIV/AIDS epidemic continues to disproportionately affect African American communities in the US, particularly those located in urban areas. Despite the fact that HIV is often transmitted from one sexual partner to another, most HIV prevention interventions have focused only on individuals, rather than couples. This five-year study investigates community-based implementation, effectiveness, and sustainability of ‘Eban II,’ an evidence-based risk reduction intervention for African-American heterosexual, serodiscordant couples. Methods/design This hybrid implementation/effectiveness implementation study is guided by organizational change theory as conceptualized in the Texas Christian University Program Change Model (PCM), a model of phased organizational change from exposure to adoption, implementation, and sustainability. The primary implementation aims are to assist 10 community-based organizations (CBOs) to implement and sustain Eban II; specifically, to partner with CBOs to expose providers to the intervention; facilitate its adoption, implementation and sustainment; and to evaluate processes and determinants of implementation, effectiveness, fidelity, and sustainment. The primary effectiveness aim is to evaluate the effect of Eban II on participant (n = 200 couples) outcomes, specifically incidents of protected sex and proportion of condom use. We will also determine the cost-effectiveness of implementation, as measured by implementation costs and potential cost savings. A mixed methods evaluation will examine implementation at the agency level; staff members from the CBOs will complete baseline measures of organizational context and climate, while key stakeholders will be interviewed periodically throughout implementation. Effectiveness of Eban II will be assessed using a randomized delayed enrollment (waitlist) control design to evaluate the impact of treatment on outcomes at posttest and three-month follow-up. Multi-level hierarchical modeling with a multi-level nested structure will be used to evaluate the effects of agency- and couples-level characteristics on couples-level outcomes (e.g., condom use). Discussion This study will produce important information regarding the value of the Eban II program and a theory-guided implementation process and tools designed for use in implementing Eban II and other evidence-based programs in demographically diverse, resource-constrained treatment settings. Trial registration NCT00644163 PMID:24950708

Community-based implementation and effectiveness in a randomized trial of a risk reduction intervention for HIV-serodiscordant couples: study protocol.

PubMed

Hamilton, Alison B; Mittman, Brian S; Williams, John K; Liu, Honghu H; Eccles, Alicia M; Hutchinson, Craig S; Wyatt, Gail E

2014-06-20

The HIV/AIDS epidemic continues to disproportionately affect African American communities in the US, particularly those located in urban areas. Despite the fact that HIV is often transmitted from one sexual partner to another, most HIV prevention interventions have focused only on individuals, rather than couples. This five-year study investigates community-based implementation, effectiveness, and sustainability of 'Eban II,' an evidence-based risk reduction intervention for African-American heterosexual, serodiscordant couples. This hybrid implementation/effectiveness implementation study is guided by organizational change theory as conceptualized in the Texas Christian University Program Change Model (PCM), a model of phased organizational change from exposure to adoption, implementation, and sustainability. The primary implementation aims are to assist 10 community-based organizations (CBOs) to implement and sustain Eban II; specifically, to partner with CBOs to expose providers to the intervention; facilitate its adoption, implementation and sustainment; and to evaluate processes and determinants of implementation, effectiveness, fidelity, and sustainment. The primary effectiveness aim is to evaluate the effect of Eban II on participant (n = 200 couples) outcomes, specifically incidents of protected sex and proportion of condom use. We will also determine the cost-effectiveness of implementation, as measured by implementation costs and potential cost savings. A mixed methods evaluation will examine implementation at the agency level; staff members from the CBOs will complete baseline measures of organizational context and climate, while key stakeholders will be interviewed periodically throughout implementation. Effectiveness of Eban II will be assessed using a randomized delayed enrollment (waitlist) control design to evaluate the impact of treatment on outcomes at posttest and three-month follow-up. Multi-level hierarchical modeling with a multi-level nested structure will be used to evaluate the effects of agency- and couples-level characteristics on couples-level outcomes (e.g., condom use). This study will produce important information regarding the value of the Eban II program and a theory-guided implementation process and tools designed for use in implementing Eban II and other evidence-based programs in demographically diverse, resource-constrained treatment settings. NCT00644163.

Information Management Utilizing Valued Information at the Right Time (VIRT) as Applied to a Joint Terminal Attack Controller (JTAC) Mission

DTIC Science & Technology

2008-03-01

technology in an effective way without taking a decade for implementation. 15. NUMBER OF PAGES 77 14. SUBJECT TERMS VIRT, Model Based... effective way without taking a decade for implementation. vi THIS PAGE INTENTIONALLY LEFT BLANK vii TABLE OF CONTENTS I. INTRODUCTION...To build the most effective force for 2020, we must be fully joint.”2 What does being fully joint mean and how does the DoD take advantage of

Navigating institutional complexity in the health sector: lessons from tobacco control in Kenya.

PubMed

Lencucha, Raphael; Magati, Peter; Drope, Jeffrey

2016-12-01

 This research examines the institutional dynamics of tobacco control following the establishment of Kenya's 2007 landmark tobacco control legislation. Our analysis focuses specifically on coordination challenges within the health sector.  We conducted semi-structured interviews with key informants (n = 17) involved in tobacco regulation and control in Kenya. We recruited participants from different offices and sectors of government and non-governmental organizations.  We find that the main challenges toward successful implementation of tobacco control are a lack of coordination and clarity of mandate of the principal institutions involved in tobacco control efforts. In a related development, the passage of a new constitution in 2010 created structural changes that have affected the successful implementation of the country's tobacco control legislation.  We discuss how proponents of tobacco control navigated these two overarching institutional challenges. These findings point to the institutional factors that influence policy implementation extending beyond the traditional focus on the dynamic between government and the tobacco industry. These findings specifically point to the intragovernmental challenges that bear on policy implementation. The findings suggest that for effective implementation of tobacco control legislation and regulation, there is need for increased cooperation among institutions charged with tobacco control, particularly within or involving the Ministry of Health. Decisive leadership was also widely presented as a component of successful institutional reform.  This study points to the importance of coordinating policy development and implementation across levels of government and the need for leadership and clear mandates to guide cooperation within the health sector. The Kenyan experience offers useful lessons in the pitfalls of institutional incoherence, but more importantly, the value of investing in and then promoting well-functioning institutions. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Considerations for the implementation and operation of stormwater control measure (SCM) performance monitoring systems

EPA Science Inventory

Green infrastructure (GI) studies are needed to make informed decisions about whether or not to select GI technologies over traditional urban drainage control methods and to assist in the timing of effective maintenance. Two permeable pavement infiltration stormwater control meas...

Risk watershed analysis: a new approach to manage torrent control structures

NASA Astrophysics Data System (ADS)

Quefféléan, Yann; Carladous, Simon; Deymier, Christian; Marco, Olivier

2017-04-01

Torrential check dams have been built in French public forests since the 19th century, applying the Restoration and conservation of Mountainous Areas (RTM) laws (1860, 1864, 1882). The RTM department of the National Forestry Office (ONF) helps the government to decide on protective actions to implement within these areas. While more than 100 000 structures were registered in 1964, more than 14 000 check dams are currently registered and maintained within approximatively 380 000 ha of RTM public forests. The RTM department officers thus have a long experience in using check dams for soil restoration, but also in implementing other kinds of torrential protective structures such as sediment traps, embankments, bank protection, and so forth. As a part of the ONF, they are also experienced in forestry engineering. Nevertheless, some limits in torrent control management have been highlighted: - as existing protective structures are ageing, their effectiveness to protect elements at risk must be assessed but it is a difficult task ; - as available budget for maintenance is continuously decreasing, priorities have to be made but decisions are difficult : what are the existing check dams functions? what is their expected effect on torrential hazard? is maintenance cost too important given this expected effect to protect elements at risk? Given these questions, a new policy has been engaged by the RTM department since 2012. A technical overview at the torrential watershed scale is now needed to help better maintenance decisions: it has been called a Risk Watershed Analysis (Etude de Bassin de Risque in French, EBR) and is funded by the government. Its objectives are to: - recall initial objectives of protective structures : therefore, a detailed archive analysis is made ; - describe current elements at risk to protect ; - describe natural hazards at the torrential watershed scale and their evolution since protective structures implementation ; - describe civil engineering and forestry works that have been implemented within the watershed, including their cost ; - decide on current protective works to implement (maintenance and new investment). For each EBR, a multidisciplinary team is involved with specialists in geomorphology, hydrology, hydraulics, geology, civil engineering and forestry. Approximatively 1 100 EBRs should be implemented at the national scale, including other natural phenomena such as snow avalanches and rock falls. Since 2012, approximatively 10 % have been realized in areas with the most significant elements at risk. From a practical point of view, these studies have helped a better understanding of torrential watershed conditions and of torrent control expected effect over years. An analysis of these studies will be performed soon to have a first overview of torrent control effect. We claim that these EBRs could be a significant source of information to help a comprehensive evaluation of long-term effectiveness of torrent control.

The importance of continued engagement during the implementation phase of tobacco control policies in a middle-income country: the case of Costa Rica

PubMed Central

Crosbie, Eric; Sosa, Patricia; Glantz, Stanton A

2016-01-01

Objective To analyse the process of implementing and enforcing smoke-free environments, tobacco advertising, tobacco taxes and health warning labels from Costa Rica's 2012 tobacco control law. Method Review of tobacco control legislation, newspaper articles and interviewing key informants. Results Despite overcoming decades of tobacco industry dominance to win enactment of a strong tobacco control law in March 2012 consistent with WHO's Framework Convention on Tobacco Control, the tobacco industry and their allies lobbied executive branch authorities for exemptions in smoke-free environments to create public confusion, and continued to report in the media that increasing cigarette taxes led to a rise in illicit trade. In response, tobacco control advocates, with technical support from international health groups, helped strengthen tobacco advertising regulations by prohibiting advertising at the point-of-sale (POS) and banning corporate social responsibility campaigns. The Health Ministry used increased tobacco taxes earmarked for tobacco control to help effectively promote and enforce the law, resulting in high compliance for smoke-free environments, advertising restrictions and health warning label (HWL) regulations. Despite this success, government trade concerns allowed, as of December 2015, POS tobacco advertising, and delayed the release of HWL regulations for 15 months. Conclusions The implementation phase continues to be a site of intensive tobacco industry political activity in low and middle-income countries. International support and earmarked tobacco taxes provide important technical and financial assistance to implement tobacco control policies, but more legal expertise is needed to overcome government trade concerns and avoid unnecessary delays in implementation. PMID:26856614

Exploring the implementation of the framework convention on tobacco control in four small island developing states of the Pacific: a qualitative study

PubMed Central

Martin, Erik; de Leeuw, Evelyne

2013-01-01

Objectives To determine what variables influence the implementation of the Framework Convention on Tobacco Control (FCTC) in small island developing states of the Pacific and how they affect its success or failure. To explore how barriers can be overcome and opportunities utilised to ensure an effective FCTC implementation in the Pacific Islands. Design A mixed methods, multiple case study consisting of primarily qualitative data in the form of semistructured interviews, document analysis and opportunistic observation. Setting Field visits were undertaken to collect data in the Cook Islands, Vanuatu, Palau and Nauru. The key informants were interviewed in the major cities or islands of each respective country: Rarotonga, Port Vila, Koror and Nauru. Participants Purposive sampling was used to select 39 informants, whose roles were associated with FCTC implementation. Most of the participants worked in health-oriented positions in the government and non-government organisations. Results Each country made a significant progress towards FCTC implementation. Overall, strong policy content, public support and limited pro-tobacco coalition activity were conducive to FCTC implementation, but the challenges were evident in the form of limited capacity, limited antitobacco coalition activity and limited political commitment outside the ministries of health in each country. Conclusions Further efforts are needed for full FCTC implementation, through building capacity and using resources effectively, growing commitment to FCTC beyond the health sector, fostering growth in antitobacco coalition activity, exploiting the limited pro-tobacco activity that may be present and garnering public support for tobacco control. These lessons may be particularly important for other small island developing states in the Pacific and developing countries elsewhere. PMID:24327364

Challenges and Opportunities for the implementation of interventions to prevent and control CVD in low resource settings in Argentina

PubMed Central

Rubinstein, Adolfo; Irazola, Vilma E.; Poggio, Rosana; Gulayin, Pablo; Nejamis, Analía; Beratarrechea, Andrea

2015-01-01

In Argentina, Cardiovascular diseases are estimated to cause about 100,000 deaths and more than 250,000 coronary heart disease and stroke events annually, at a cost of more than one billion international dollars. Despite progress in the implementation of several programs to combat non-communicable diseases in Argentina over the last years, most health resources are still dedicated to infectious disease and maternal and child health. The Institute for Clinical Effectiveness and Health Policy, an independent academic institution affiliated to the University of Buenos Aires medical school, runs CESCAS (South American Centre of Excellence in Cardiovascular Health), a center devoted to epidemiological, implementation and policy research. At CESCAS there are three ongoing randomized clinical trials focused on implementation science: 1) A Mobile health intervention to prevent progression of pre-hypertension in poor urban settings in Argentina, Guatemala and Peru; 2) A Comprehensive Approach for Hypertension Prevention and Control in low-resource settings in Argentina; and 3) An Educational Approach to Improve Physician Effectiveness in the Detection, Treatment and Control for patients with Hypercholesterolemia and high Cardiovascular Disease (CVD) risk in low-resource settings in Argentina. All these studies involve the design and implementation of complex interventions to change behaviors of providers and patients. The rationale of each of the three studies, the design of the interventions and the evaluation of processes and outcomes are described in this article together with the barriers and enabling factors associated with implementation research studies. There is a strong need in Argentina and the region at large to build the health research capacity and infrastructure necessary to undertake implementation studies to translate evidence from research findings into improvements in health policy and practice to address CVD and their risk factors. PMID:25754563

Effectiveness of implementing a best practice primary healthcare model for low back pain (BetterBack) compared with current routine care in the Swedish context: an internal pilot study informed protocol for an effectiveness-implementation hybrid type 2 trial

PubMed Central

Abbott, Allan; Schröder, Karin; Enthoven, Paul; Nilsen, Per; Öberg, Birgitta

2018-01-01

Introduction Low back pain (LBP) is a major health problem commonly requiring healthcare. In Sweden, there is a call from healthcare practitioners (HCPs) for the development, implementation and evaluation of a best practice primary healthcare model for LBP. Aims (1) To improve and understand the mechanisms underlying changes in HCP confidence, attitudes and beliefs for providing best practice coherent primary healthcare for patients with LBP; (2) to improve and understand the mechanisms underlying illness beliefs, self-care enablement, pain, disability and quality of life in patients with LBP; and (3) to evaluate a multifaceted and sustained implementation strategy and the cost-effectiveness of the BetterBack☺ model of care (MOC) for LBP from the perspective of the Swedish primary healthcare context. Methods This study is an effectiveness-implementation hybrid type 2 trial testing the hypothesised superiority of the BetterBack☺ MOC compared with current routine care. The trial involves simultaneous testing of MOC effects at the HCP, patient and implementation process levels. This involves a prospective cohort study investigating implementation at the HCP level and a patient-blinded, pragmatic, cluster, randomised controlled trial with longitudinal follow-up at 3, 6 and 12 months post baseline for effectiveness at the patient level. A parallel process and economic analysis from a healthcare sector perspective will also be performed. Patients will be allocated to routine care (control group) or the BetterBack☺ MOC (intervention group) according to a stepped cluster dogleg structure with two assessments in routine care. Experimental conditions will be compared and causal mediation analysis investigated. Qualitative HCP and patient experiences of the BetterBack☺ MOC will also be investigated. Dissemination The findings will be published in peer-reviewed journals and presented at national and international conferences. Further national dissemination and implementation in Sweden and associated national quality register data collection are potential future developments of the project. Date and version identifier 13 December 2017, protocol version 3. Trial registration number NCT03147300; Pre-results. PMID:29691246

Brief cognitive behavioral therapy in primary care: a hybrid type 2 patient-randomized effectiveness-implementation design.

PubMed

Cully, Jeffrey A; Armento, Maria E A; Mott, Juliette; Nadorff, Michael R; Naik, Aanand D; Stanley, Melinda A; Sorocco, Kristen H; Kunik, Mark E; Petersen, Nancy J; Kauth, Michael R

2012-07-11

Despite the availability of evidence-based psychotherapies for depression and anxiety, they are underused in non-mental health specialty settings such as primary care. Hybrid effectiveness-implementation designs have the potential to evaluate clinical and implementation outcomes of evidence-based psychotherapies to improve their translation into routine clinical care practices. This protocol article discusses the study methodology and implementation strategies employed in an ongoing, hybrid, type 2 randomized controlled trial with two primary aims: (1) to determine whether a brief, manualized cognitive behavioral therapy administered by Veterans Affairs Primary Care Mental Health Integration program clinicians is effective in treating depression and anxiety in a sample of medically ill (chronic cardiopulmonary diseases) primary care patients and (2) to examine the acceptability, feasibility, and preliminary outcomes of a focused implementation strategy on improving adoption and fidelity of brief cognitive behavioral therapy at two Primary Care-Mental Health Integration clinics. The study uses a hybrid type 2 effectiveness/implementation design to simultaneously test clinical effectiveness and to collect pilot data on a multifaceted implementation strategy that includes an online training program, audit and feedback of session content, and internal and external facilitation. Additionally, the study engages the participation of an advisory council consisting of stakeholders from Primary Care-Mental Health Integration, as well as regional and national mental health leaders within the Veterans Administration. It targets recruitment of 320 participants randomized to brief cognitive behavioral therapy (n = 200) or usual care (n = 120). Both effectiveness and implementation outcomes are being assessed using mixed methods, including quantitative evaluation (e.g., intent-to-treat analyses across multiple time points) and qualitative methods (e.g., focus interviews and surveys from patients and providers). Patient-effectiveness outcomes include measures of depression, anxiety, and physical health functioning using blinded independent evaluators. Implementation outcomes include patient engagement and adherence and clinician brief cognitive behavioral therapy adoption and fidelity. Hybrid designs are needed to advance clinical effectiveness and implementation knowledge to improve healthcare practices. The current article describes the rationale and challenges associated with the use of a hybrid design for the study of brief cognitive behavioral therapy in primary care. Although trade-offs exist between scientific control and external validity, hybrid designs are part of an emerging approach that has the potential to rapidly advance both science and practice. NCT01149772 at http://www.clinicaltrials.gov/ct2/show/NCT01149772.

Vaccination and treatment as control interventions in an infectious disease model with their cost optimization

NASA Astrophysics Data System (ADS)

Kumar, Anuj; Srivastava, Prashant K.

2017-03-01

In this work, an optimal control problem with vaccination and treatment as control policies is proposed and analysed for an SVIR model. We choose vaccination and treatment as control policies because both these interventions have their own practical advantage and ease in implementation. Also, they are widely applied to control or curtail a disease. The corresponding total cost incurred is considered as weighted combination of costs because of opportunity loss due to infected individuals and costs incurred in providing vaccination and treatment. The existence of optimal control paths for the problem is established and guaranteed. Further, these optimal paths are obtained analytically using Pontryagin's Maximum Principle. We analyse our results numerically to compare three important strategies of proposed controls, viz.: vaccination only; with both treatment and vaccination; and treatment only. We note that first strategy (vaccination only) is less effective as well as expensive. Though, for a highly effective vaccine, vaccination alone may also work well in comparison with treatment only strategy. Among all the strategies, we observe that implementation of both treatment and vaccination is most effective and less expensive. Moreover, in this case the infective population is found to be relatively very low. Thus, we conclude that the comprehensive effect of vaccination and treatment not only minimizes cost burden due to opportunity loss and applied control policies but also keeps a tab on infective population.

Noise-resilient quantum evolution steered by dynamical decoupling

PubMed Central

Liu, Gang-Qin; Po, Hoi Chun; Du, Jiangfeng; Liu, Ren-Bao; Pan, Xin-Yu

2013-01-01

Realistic quantum computing is subject to noise. Therefore, an important frontier in quantum computing is to implement noise-resilient quantum control over qubits. At the same time, dynamical decoupling can protect the coherence of qubits. Here we demonstrate non-trivial quantum evolution steered by dynamical decoupling control, which simultaneously suppresses noise effects. We design and implement a self-protected controlled-NOT gate on the electron spin of a nitrogen-vacancy centre and a nearby carbon-13 nuclear spin in diamond at room temperature, by employing an engineered dynamical decoupling control on the electron spin. Final state fidelity of 0.91(1) is observed in preparation of a Bell state using the gate. At the same time, the qubit coherence time is elongated at least 30 fold. The design scheme does not require the dynamical decoupling control to commute with the qubit interaction and therefore works for general qubit systems. This work marks a step towards implementing realistic quantum computing systems. PMID:23912335

Noise-resilient quantum evolution steered by dynamical decoupling.

PubMed

Liu, Gang-Qin; Po, Hoi Chun; Du, Jiangfeng; Liu, Ren-Bao; Pan, Xin-Yu

2013-01-01

Realistic quantum computing is subject to noise. Therefore, an important frontier in quantum computing is to implement noise-resilient quantum control over qubits. At the same time, dynamical decoupling can protect the coherence of qubits. Here we demonstrate non-trivial quantum evolution steered by dynamical decoupling control, which simultaneously suppresses noise effects. We design and implement a self-protected controlled-NOT gate on the electron spin of a nitrogen-vacancy centre and a nearby carbon-13 nuclear spin in diamond at room temperature, by employing an engineered dynamical decoupling control on the electron spin. Final state fidelity of 0.91(1) is observed in preparation of a Bell state using the gate. At the same time, the qubit coherence time is elongated at least 30 fold. The design scheme does not require the dynamical decoupling control to commute with the qubit interaction and therefore works for general qubit systems. This work marks a step towards implementing realistic quantum computing systems.

Successful hazard analysis critical control point implementation in the United Kingdom: understanding the barriers through the use of a behavioral adherence model.

PubMed

Gilling, S J; Taylor, E A; Kane, K; Taylor, J Z

2001-05-01

Hazard analysis critical control point (HACCP), a system of risk management designed to control food safety, has emerged over the last decade as the primary approach to securing the safety of the food supply. It is thus an important tool in combatting the worldwide escalation of foodborne disease. Yet despite wide dissemination and scientific support of its principles, successful HACCP implementation has been limited. This report takes a psychological approach to this problem by examining processes and factors that could impede adherence to the internationally accepted HACCP Guidelines and subsequent successful implementation of HACCP. Utilizing knowledge of medical clinical guideline adherence models and practical experience of HACCP implementation problems, the potential advantages of applying a behavioral model to food safety management are highlighted. The models' applicability was investigated using telephone interviews from over 200 businesses in the United Kingdom. Eleven key barriers to HACCP guideline adherence were identified. In-depth narrative interviews with food business proprietors then confirmed these findings and demonstrated the subsequent negative effect(s) on HACCP implementation. A resultant HACCP awareness to adherence model is proposed that demonstrates the complex range of potential knowledge, attitude, and behavior-related barriers involved in failures of HACCP guideline adherence. The model's specificity and detail provide a tool whereby problems can be identified and located and in this way facilitate tailored and constructive intervention. It is suggested that further investigation into the barriers involved and how to overcome them would be of substantial benefit to successful HACCP implementation and thereby contribute to an overall improvement in public health.

Building sandbars in Grand Canyon

USGS Publications Warehouse

2016-01-01

Now, by implementing a new strategy that calls for repeated releases of large volumes of water from the dam, the U.S. Department of the Interior seeks to increase the size and number of these sandbars. Three years into the “High Flow Experiment” protocol, the releases appear to be achieving the desired effect. Many sandbars have increased in size following each controlled flood and the cumulative results of the first three releases suggests that sandbar declines may be reversed if controlled floods can be implemented frequently enough.

Building sandbars in the Grand Canyon

USGS Publications Warehouse

Grams, Paul E.; Schmidt, John C.; Wright, Scott A.; Topping, David; Melis, Theodore S.; Rubin, David M.

2015-01-01

Now, by implementing a new strategy that calls for repeated releases of large volumes of water from the dam, the U.S. Department of the Interior (DOI) seeks to increase the size and number of these sandbars. Three years into the "high-flow experiment" (HFE) protocol, the releases appear to be achieving the desired effect. Many sandbars have increased in size following each controlled flood, and the cumulative results of the first three releases suggest that sandbar declines may be reversed if controlled floods can be implemented frequently enough.

Testing evidence routine practice: Using an implementation framework to embed a clinically proven asthma service in Australian community pharmacy.

PubMed

Fuller, Joanne M; Saini, Bandana; Bosnic-Anticevich, Sinthia; Garcia Cardenas, Victoria; Benrimoj, Shalom I; Armour, Carol

Community pharmacists are well placed and evidence clearly demonstrates that they can be suitably trained to deliver professional services that improve the management of asthma patients in clinical, economic and humanistic terms. However the gap between this evidence and practice reality remains wide. In this study we measure the implementation process as well as the service benefits of an asthma service model. Using an effectiveness-implementation hybrid design, a defined implementation process (progression from Exploration through Preparation and Testing to Operation stages) supporting an asthma service (promoting asthma control and inhaler technique) was tested in 17 community pharmacies across metropolitan Sydney. Seven pharmacies reached the Operation stage of implementation. Eight pharmacies reached the Testing stage of implementation and two pharmacies did not progress beyond the Preparation stage of implementation. A total of 128 patients were enrolled in the asthma service with 110 patients remaining enrolled at the close of the study. Asthma control showed a positive trend throughout the service with the overall proportion of patients with 'poor' asthma control at baseline decreasing from 72% to 57% at study close. There was a statistically significant increase in the proportion of patients with correct inhaler technique from 12% at Baseline (Visit 1) to 33% at Visit 2 and 57% at study close. Implementation of the asthma service varied across pharmacies. Different strategies specific to practice sites at different stages of the implementation model may result in greater uptake of professional services. The asthma service led to improved patient outcomes overall with a positive trend in asthma control and significant change in inhaler technique. Copyright © 2017 Elsevier Inc. All rights reserved.

A randomised controlled trial of an intervention to increase the implementation of a healthy canteen policy in Australian primary schools: study protocol.

PubMed

Wolfenden, Luke; Nathan, Nicole; Williams, Christopher M; Delaney, Tessa; Reilly, Kathryn L; Freund, Megan; Gillham, Karen; Sutherland, Rachel; Bell, Andrew C; Campbell, Libby; Yoong, Serene; Wyse, Rebecca; Janssen, Lisa M; Preece, Sarah; Asmar, Melanie; Wiggers, John

2014-10-11

The implementation of healthy school canteen policies has been recommended as a strategy to help prevent unhealthy eating and excessive weight gain. Internationally, research suggests that schools often fail to implement practices consistent with healthy school canteen policies. Without a population wide implementation, the potential benefits of these policies will not be realised. The aim of this trial is to assess the effectiveness of an implementation intervention in increasing school canteen practices consistent with a healthy canteen policy of the New South Wales (NSW), Australia, government known as the 'Fresh Tastes @ School NSW Healthy School Canteen Strategy'. The parallel randomised trial will be conducted in 70 primary schools located in the Hunter region of New South Wales, Australia. Schools will be eligible to participate if they are not currently meeting key components of the healthy canteen policy. Schools will be randomly allocated after baseline data collection in a 1:1 ratio to either an intervention or control group using a computerised random number function in Microsoft Excel. Thirty-five schools will be selected to receive a multi-component intervention including implementation support from research staff, staff training, resources, recognition and incentives, consensus and leadership strategies, follow-up support and implementation feedback. The 35 schools allocated to the control group will not receive any intervention support as part of the research trial. The primary outcome measures will be i) the proportion of schools with a canteen menu that does not contain foods or beverages restricted from regular sale ('red' and 'banned' items) and ii) the proportion of schools where healthy canteen items ('green' items) represent the majority (>50%) of products listed on the menu. Outcome data will be collected via a comprehensive menu audit, conducted by dietitians blind to group allocation. Intervention effectiveness will be assessed using logistic regression models adjusting for baseline values. The proposed trial will represent a novel contribution to the literature, being the first randomised trial internationally to examine the effectiveness of an intervention to facilitate implementation of a healthy canteen policy. Australian New Zealand Clinical Trials Registry ACTRN12613000311752.

The effect of an organizational level participatory intervention in secondary vocational education on work-related health outcomes: results of a controlled trial.

PubMed

Schelvis, Roosmarijn M C; Wiezer, Noortje M; van der Beek, Allard J; Twisk, Jos W R; Bohlmeijer, Ernst T; Oude Hengel, Karen M

2017-01-31

Work-related stress is highly prevalent in the educational sector. The aim of the current study was to evaluate the effectiveness of an organizational level, participatory intervention on need for recovery and vitality in educational workers. It was hypothesized that the intervention would decrease need for recovery and increase vitality. A quasi-experiment was conducted at two secondary Vocational Education and Training schools (N = 356) with 12- and 24-months follow-up measurements. The intervention consisted of 1) a needs assessment phase, wherein staff and teachers developed actions for happy and healthy working under supervision of a facilitator, and 2) an implementation phase, wherein these actions were implemented by the management teams. Mixed model analysis was applied in order to assess the differences between the intervention and control group on average over time. All analyses were corrected for baseline values and several covariates. No effects of the intervention were found on need for recovery, vitality and most of the secondary outcomes. Two small, statistically significant effects were in unfavorable direction: the intervention group scored on average over time significantly lower on absorption (i.e. a subscale of work engagement) and organizational efficacy than the control group. Since no beneficial effects of this intervention were found on the primary and most of the secondary outcomes, further implementation of the intervention in its current form is not eligible. We recommend that future organizational level interventions for occupational health 1) incorporate an elaborate implementation strategy, 2) are more specific in relating actions to stressors in the context, and 3) are integrated with secondary preventive, individual focused stress management interventions. Netherlands Trial Register NTR3284 (date registered: February 14 2012).

Feasibility, appropriateness, meaningfulness and effectiveness of patient participation at bedside shift reporting: mixed-method research protocol.

PubMed

Malfait, Simon; Eeckloo, Kristof; Lust, Elisa; Van Biesen, Wim; Van Hecke, Ann

2017-02-01

To evaluate the feasibility, appropriateness, meaningfulness and effectiveness of bedside shift reporting in a minimum of five interventions and five control wards. Hospitals continually improve their quality of care. Next to improvements in clinical performance, more patient participation is stimulated through different methods. Methods to enhance patient participation such as bedside shift reporting lack rigorously performed research to determine their feasibility, appropriateness, meaningfulness and effectiveness. Small-scale research and a previous pilot study indicate that bedside shift reporting improves patient participation, nurse-nurse communication and nurse-patient communication. The development, implementation and evaluation of bedside shift report are based on the Medical Research Council framework for complex interventions in health care. A matched, controlled, mixed-method, longitudinal study design will be used. The Feasibility-Appropriateness-Meaningfulness-Effectiveness framework will be applied for the quantitative and qualitative evaluation of bedside shift report. A tailored intervention and implementation process for bedside shift report will be developed using diagnostic interviews, co-design and acceptability testing. The intervention will be evaluated before implementation and three times after implementation. Individual and focus group interviews will be performed. Questionnaires, observations and analysis of the medical records and administrative databases will be completed. This study was funded in October 2015. Research Ethics Committee approval was granted in March 2016. There is a pressing need for rigorous research into the effects of interventions for improving patient participation. This study addresses the significance of bedside shift report as an intervention to improve quality of care, communication and patient participation within a large-scale, matched, controlled research design. © 2016 John Wiley & Sons Ltd.

Evidence that self-incentives increase fruit consumption: a randomized exploratory trial among high-risk romanian adolescents.

PubMed

Armitage, Christopher J

2014-04-01

High mortality rates associated with cancer and cardiovascular disease in Romania have been partly attributed to low fruit consumption. The aim of the present research was to test whether self-incentives delivered via implementation intentions could increase fruit consumption among 238 high-risk Romanian adolescents. Participants were randomly allocated to either: (1) a control condition (asked to plan to increase their fruit intake but given no further instruction), (2) a standard implementation intention condition (asked to form an implementation intention using standard open-ended instructions), or (3) a self-incentivizing implementation intention condition (asked to reward themselves at the end of the week if they had successfully consumed an extra portion of fruit each day). There were significant increases in fruit consumption in the self-incentivizing implementation intention condition, but not in the control condition or-contrary to predictions-in the standard implementation intention condition. The findings support the use of implementation intentions to deliver self-incentives and increase fruit consumption, and suggest that providing children with a structured prompt might enhance the effectiveness of implementation intention-based interventions compared with standard implementation intention instructions.

When planning is not enough: the self-regulatory effect of implementation intentions on changing snacking habits.

PubMed

Tam, Leona; Bagozzi, Richard P; Spanjol, Jelena

2010-05-01

This study examined whether matching implementation intentions to people's regulatory orientation affects the effectiveness of changing unhealthy snacking habits. Participants' regulatory orientation was either measured (as a chronic trait) or manipulated (as a situational state), and participants were randomly assigned to implementation intention conditions to eat more healthy snacks or avoid eating unhealthy ones. A self-reported online food diary of healthy and unhealthy snacks over a 2-day period. Participants with weak unhealthy snacking habits consumed more healthy snacks when forming any type of implementation intentions (regardless of match or mismatch with their regulatory orientation), while participants with strong unhealthy snacking habits consumed more healthy snacks only when forming implementation intentions that matched their regulatory orientations. RESULTS suggest that implementation intentions that match regulatory orientation heighten motivation intensity and put snacking under intentional control for people with strong unhealthy snacking habits. (c) 2010 APA, all rights reserved.

Modeling the Cost Effectiveness of Malaria Control Interventions in the Highlands of Western Kenya

PubMed Central

Stuckey, Erin M.; Stevenson, Jennifer; Galactionova, Katya; Baidjoe, Amrish Y.; Bousema, Teun; Odongo, Wycliffe; Kariuki, Simon; Drakeley, Chris; Smith, Thomas A.; Cox, Jonathan; Chitnis, Nakul

2014-01-01

Introduction Tools that allow for in silico optimization of available malaria control strategies can assist the decision-making process for prioritizing interventions. The OpenMalaria stochastic simulation modeling platform can be applied to simulate the impact of interventions singly and in combination as implemented in Rachuonyo South District, western Kenya, to support this goal. Methods Combinations of malaria interventions were simulated using a previously-published, validated model of malaria epidemiology and control in the study area. An economic model of the costs of case management and malaria control interventions in Kenya was applied to simulation results and cost-effectiveness of each intervention combination compared to the corresponding simulated outputs of a scenario without interventions. Uncertainty was evaluated by varying health system and intervention delivery parameters. Results The intervention strategy with the greatest simulated health impact employed long lasting insecticide treated net (LLIN) use by 80% of the population, 90% of households covered by indoor residual spraying (IRS) with deployment starting in April, and intermittent screen and treat (IST) of school children using Artemether lumefantrine (AL) with 80% coverage twice per term. However, the current malaria control strategy in the study area including LLIN use of 56% and IRS coverage of 70% was the most cost effective at reducing disability-adjusted life years (DALYs) over a five year period. Conclusions All the simulated intervention combinations can be considered cost effective in the context of available resources for health in Kenya. Increasing coverage of vector control interventions has a larger simulated impact compared to adding IST to the current implementation strategy, suggesting that transmission in the study area is not at a level to warrant replacing vector control to a school-based screen and treat program. These results have the potential to assist malaria control program managers in the study area in adding new or changing implementation of current interventions. PMID:25290939

Modeling the cost effectiveness of malaria control interventions in the highlands of western Kenya.

PubMed

Stuckey, Erin M; Stevenson, Jennifer; Galactionova, Katya; Baidjoe, Amrish Y; Bousema, Teun; Odongo, Wycliffe; Kariuki, Simon; Drakeley, Chris; Smith, Thomas A; Cox, Jonathan; Chitnis, Nakul

2014-01-01

Tools that allow for in silico optimization of available malaria control strategies can assist the decision-making process for prioritizing interventions. The OpenMalaria stochastic simulation modeling platform can be applied to simulate the impact of interventions singly and in combination as implemented in Rachuonyo South District, western Kenya, to support this goal. Combinations of malaria interventions were simulated using a previously-published, validated model of malaria epidemiology and control in the study area. An economic model of the costs of case management and malaria control interventions in Kenya was applied to simulation results and cost-effectiveness of each intervention combination compared to the corresponding simulated outputs of a scenario without interventions. Uncertainty was evaluated by varying health system and intervention delivery parameters. The intervention strategy with the greatest simulated health impact employed long lasting insecticide treated net (LLIN) use by 80% of the population, 90% of households covered by indoor residual spraying (IRS) with deployment starting in April, and intermittent screen and treat (IST) of school children using Artemether lumefantrine (AL) with 80% coverage twice per term. However, the current malaria control strategy in the study area including LLIN use of 56% and IRS coverage of 70% was the most cost effective at reducing disability-adjusted life years (DALYs) over a five year period. All the simulated intervention combinations can be considered cost effective in the context of available resources for health in Kenya. Increasing coverage of vector control interventions has a larger simulated impact compared to adding IST to the current implementation strategy, suggesting that transmission in the study area is not at a level to warrant replacing vector control to a school-based screen and treat program. These results have the potential to assist malaria control program managers in the study area in adding new or changing implementation of current interventions.

The Technology Security Program. A Report to the 99th Congress, Second Session

DTIC Science & Technology

1986-01-01

and implement effective and practical controls on advanced technologies. DoD has proposed and has collaborated with the Dept. of Commerce to establish...technology. The United States, the other NATO nations and Japan continue to revise the COCOM (coordinating Committee on Export Controls ) control list and

Controlled Assessments in 14-19 Diplomas: Implementation and Effects on Learning Experiences

ERIC Educational Resources Information Center

Crisp, Victoria; Green, Sylvia

2012-01-01

The Principal Learning components of 14-19 Diplomas (introduced in England in 2008) are assessed predominantly via "controlled assessments". These assessments are conducted within the learning context under specified conditions (or "controls") and require learners to apply their skills to work-related tasks. In this research,…

40 CFR 52.69 - Original identification of plan section.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Jefferson County Board of Health Air Pollution Control Rules and Regulations, which became effective June 14... Implementation Plan submitted on March 21, 1972, by the Alabama Air Pollution Control Commission. (2) Compliance schedules submitted on April 18, 1972, by the Alabama Air Pollution Control Commission. (3) Clarifying...

40 CFR 52.69 - Original identification of plan section.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Jefferson County Board of Health Air Pollution Control Rules and Regulations, which became effective June 14... Implementation Plan submitted on March 21, 1972, by the Alabama Air Pollution Control Commission. (2) Compliance schedules submitted on April 18, 1972, by the Alabama Air Pollution Control Commission. (3) Clarifying...

40 CFR 52.69 - Original identification of plan section.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Jefferson County Board of Health Air Pollution Control Rules and Regulations, which became effective June 14... Implementation Plan submitted on March 21, 1972, by the Alabama Air Pollution Control Commission. (2) Compliance schedules submitted on April 18, 1972, by the Alabama Air Pollution Control Commission. (3) Clarifying...

Composite synchronization of three eccentric rotors driven by induction motors in a vibrating system

NASA Astrophysics Data System (ADS)

Kong, Xiangxi; Chen, Changzheng; Wen, Bangchun

2018-03-01

This paper addresses the problem of composite synchronization of three eccentric rotors (ERs) driven by induction motors in a vibrating system. The composite synchronous motion of three ERs is composed of the controlled synchronous motion of two ERs and the self-synchronous motion of the third ER. Combining an adaptive sliding mode control (ASMC) algorithm with a modified master-slave control structure, the controllers are designed to implement controlled synchronous motion of two ERs with zero phase difference. Based on Lyapunov stability theorem and Barbalat's lemma, the stability of the designed controllers is verified. On basis of controlled synchronization of two ERs, self-synchronization of the third ER is introduced to implement composite synchronous motion of three ERs. The feasibility of the proposed composite synchronization method is analyzed by numerical method. The effects of motor and structure parameters on composite synchronous motion are discussed. Experiments on a vibrating test bench driven by three ERs are operated to validate the effectiveness of the proposed composite synchronization method, including a comparison with self-synchronization method.

Effects of controlled dog hunting on movements of female white-tailed deer

Treesearch

Gino D' angelo; John C. Kilgo; Christopher E. Comer; Cory D. Drennan; David A. Osborn; Karl V. Miller

2003-01-01

Understanding the responses of white-tailed deer (Odocoileus virginianus) to controlled dog hunting can aid in the effective implementation of canine-assisted population management strategies. We examined the 24-h diel movements of 13 radio-collared female deer exposed to dog hunting on the Savannah River Site (SRS) near Aiken, South Carolina, where...

Modelling and control of a nonlinear magnetostrictive actuator system

NASA Astrophysics Data System (ADS)

Ramli, M. H. M.; Majeed, A. P. P. Abdul; Anuar, M. A. M.; Mohamed, Z.

2018-04-01

This paper explores the implementation of a feedforward control method to a nonlinear control system, in particular, Magnetostrictive Actuators (MA) that has excellent properties of energy conversion between the mechanical and magnetic form through magnetostriction effects which could be used in actuating and sensing application. MA is known to exhibit hysteresis behaviour and it is rate dependent (the level of hysteresis depends closely on the rate of input excitation frequency). This is, nonetheless, an undesirable behaviour and has to be eliminated in realising high precision application. The MA is modelled by a phenomenological modelling approach via Prandtl-Ishlinskii (P-I) operator to characterise the hysteresis nonlinearities. A feedforward control strategy is designed and implemented to linearize and eliminate the hysteresis by model inversion. The results show that the P-I operator has the capability to model the hysteretic nonlinearity of MA with an acceptable accuracy. Furthermore, the proposed control scheme has demonstrated to be effective in providing superior trajectory tracking.

Implementation of a sliding-mode-based position sensorless drive for high-speed micro permanent-magnet synchronous motors.

PubMed

Chi, Wen-Chun; Cheng, Ming-Yang

2014-03-01

Due to issues such as limited space, it is difficult if it is not impossible to employ a position sensor in the drive control of high-speed micro PMSMs. In order to alleviate this problem, this paper analyzes and implements a simple and robust position sensorless field-oriented control method of high-speed micro PMSMs based on the sliding-mode observer. In particular, the angular position and velocity of the rotor of the high-speed micro PMSM are estimated using the sliding-mode observer. This observer is able to accurately estimate rotor position in the low speed region and guarantee fast convergence of the observer in the high speed region. The proposed position sensorless control method is suitable for electric dental handpiece motor drives where a wide speed range operation is essential. The proposed sensorless FOC method is implemented using a cost-effective 16-bit microcontroller and tested in a prototype electric dental handpiece motor. Several experiments are performed to verify the effectiveness of the proposed method. © 2013 ISA. Published by Elsevier Ltd. All rights reserved.

Public policy action and CCC implementation: benefits and hurdles

PubMed Central

Daniel, Kelley; Gurian, Gary L.; Petherick, J. T.; Stockmyer, Chris; David, Annette M.; Miller, Sara E.

2010-01-01

Policy change continues to be an increasingly effective means of advancing the agenda of comprehensive cancer control. Efforts have moved progressively from describing how public policy can enhance the comprehensive cancer control agenda to implementation of public policy best practices at both the state and federal levels. The current political and economic contexts bring additional challenges and opportunities to the efforts surrounding comprehensive cancer control and policy. The purpose of this paper is to highlight recent policy successes, to illustrate the importance of policy as a means of advancing the comprehensive cancer control agenda, and to discuss continued policy action as we move forward in a time of healthcare reform and continuing economic uncertainty. PMID:21086034

Real-time head movement system and embedded Linux implementation for the control of power wheelchairs.

PubMed

Nguyen, H T; King, L M; Knight, G

2004-01-01

Mobility has become very important for our quality of life. A loss of mobility due to an injury is usually accompanied by a loss of self-confidence. For many individuals, independent mobility is an important aspect of self-esteem. Head movement is a natural form of pointing and can be used to directly replace the joystick whilst still allowing for similar control. Through the use of embedded LINUX and artificial intelligence, a hands-free head movement wheelchair controller has been designed and implemented successfully. This system provides for severely disabled users an effective power wheelchair control method with improved posture, ease of use and attractiveness.

Optimum aerodynamic design via boundary control

NASA Technical Reports Server (NTRS)

Jameson, Antony

1994-01-01

These lectures describe the implementation of optimization techniques based on control theory for airfoil and wing design. In previous studies it was shown that control theory could be used to devise an effective optimization procedure for two-dimensional profiles in which the shape is determined by a conformal transformation from a unit circle, and the control is the mapping function. Recently the method has been implemented in an alternative formulation which does not depend on conformal mapping, so that it can more easily be extended to treat general configurations. The method has also been extended to treat the Euler equations, and results are presented for both two and three dimensional cases, including the optimization of a swept wing.

Public policy action and CCC implementation: benefits and hurdles.

PubMed

Steger, Carter; Daniel, Kelley; Gurian, Gary L; Petherick, J T; Stockmyer, Chris; David, Annette M; Miller, Sara E

2010-12-01

Policy change continues to be an increasingly effective means of advancing the agenda of comprehensive cancer control. Efforts have moved progressively from describing how public policy can enhance the comprehensive cancer control agenda to implementation of public policy best practices at both the state and federal levels. The current political and economic contexts bring additional challenges and opportunities to the efforts surrounding comprehensive cancer control and policy. The purpose of this paper is to highlight recent policy successes, to illustrate the importance of policy as a means of advancing the comprehensive cancer control agenda, and to discuss continued policy action as we move forward in a time of healthcare reform and continuing economic uncertainty.

Automated subsystems control development. [for life support systems of space station

NASA Technical Reports Server (NTRS)

Block, R. F.; Heppner, D. B.; Samonski, F. H., Jr.; Lance, N., Jr.

1985-01-01

NASA has the objective to launch a Space Station in the 1990s. It has been found that the success of the Space Station engineering development, the achievement of initial operational capability (IOC), and the operation of a productive Space Station will depend heavily on the implementation of an effective automation and control approach. For the development of technology needed to implement the required automation and control function, a contract entitled 'Automated Subsystems Control for Life Support Systems' (ASCLSS) was awarded to two American companies. The present paper provides a description of the ASCLSS program. Attention is given to an automation and control architecture study, a generic automation and control approach for hardware demonstration, a standard software approach, application of Air Revitalization Group (ARG) process simulators, and a generic man-machine interface.

Malaria vector control: from past to future.

PubMed

Raghavendra, Kamaraju; Barik, Tapan K; Reddy, B P Niranjan; Sharma, Poonam; Dash, Aditya P

2011-04-01

Malaria is one of the most common vector-borne diseases widespread in the tropical and subtropical regions. Despite considerable success of malaria control programs in the past, malaria still continues as a major public health problem in several countries. Vector control is an essential part for reducing malaria transmission and became less effective in recent years, due to many technical and administrative reasons, including poor or no adoption of alternative tools. Of the different strategies available for vector control, the most successful are indoor residual spraying and insecticide-treated nets (ITNs), including long-lasting ITNs and materials. Earlier DDT spray has shown spectacular success in decimating disease vectors but resulted in development of insecticide resistance, and to control the resistant mosquitoes, organophosphates, carbamates, and synthetic pyrethroids were introduced in indoor residual spraying with needed success but subsequently resulted in the development of widespread multiple insecticide resistance in vectors. Vector control in many countries still use insecticides in the absence of viable alternatives. Few developments for vector control, using ovitraps, space spray, biological control agents, etc., were encouraging when used in limited scale. Likewise, recent introduction of safer vector control agents, such as insect growth regulators, biocontrol agents, and natural plant products have yet to gain the needed scale of utility for vector control. Bacterial pesticides are promising and are effective in many countries. Environmental management has shown sufficient promise for vector control and disease management but still needs advocacy for inter-sectoral coordination and sometimes are very work-intensive. The more recent genetic manipulation and sterile insect techniques are under development and consideration for use in routine vector control and for these, standardized procedures and methods are available but need thorough understanding of biology, ethical considerations, and sufficiently trained manpower for implementation being technically intensive methods. All the methods mentioned in the review that are being implemented or proposed for implementation needs effective inter-sectoral coordination and community participation. The latest strategy is evolution-proof insecticides that include fungal biopesticides, Wolbachia, and Denso virus that essentially manipulate the life cycle of the mosquitoes were found effective but needs more research. However, for effective vector control, integrated vector management methods, involving use of combination of effective tools, is needed and is also suggested by Global Malaria Control Strategy. This review article raises issues associated with the present-day vector control strategies and state opportunities with a focus on ongoing research and recent advances to enable to sustain the gains achieved so far.

Real-time implementation of model predictive control on Maricopa-Stanfield irrigation and drainage district's WM canal

USDA-ARS?s Scientific Manuscript database

Water resources are limited in many agricultural areas. One method to improve the effective use of water is to improve delivery service from irrigation canals. This can be done by applying automatic control methods that control the gates in an irrigation canal. The model predictive control MPC is ...

Lean principles optimize on-time vascular surgery operating room starts and decrease resident work hours.

PubMed

Warner, Courtney J; Walsh, Daniel B; Horvath, Alexander J; Walsh, Teri R; Herrick, Daniel P; Prentiss, Steven J; Powell, Richard J

2013-11-01

Lean process improvement techniques are used in industry to improve efficiency and quality while controlling costs. These techniques are less commonly applied in health care. This study assessed the effectiveness of Lean principles on first case on-time operating room starts and quantified effects on resident work hours. Standard process improvement techniques (DMAIC methodology: define, measure, analyze, improve, control) were used to identify causes of delayed vascular surgery first case starts. Value stream maps and process flow diagrams were created. Process data were analyzed with Pareto and control charts. High-yield changes were identified and simulated in computer and live settings prior to implementation. The primary outcome measure was the proportion of on-time first case starts; secondary outcomes included hospital costs, resident rounding time, and work hours. Data were compared with existing benchmarks. Prior to implementation, 39% of first cases started on time. Process mapping identified late resident arrival in preoperative holding as a cause of delayed first case starts. Resident rounding process inefficiencies were identified and changed through the use of checklists, standardization, and elimination of nonvalue-added activity. Following implementation of process improvements, first case on-time starts improved to 71% at 6 weeks (P = .002). Improvement was sustained with an 86% on-time rate at 1 year (P < .001). Resident rounding time was reduced by 33% (from 70 to 47 minutes). At 9 weeks following implementation, these changes generated an opportunity cost potential of $12,582. Use of Lean principles allowed rapid identification and implementation of perioperative process changes that improved efficiency and resulted in significant cost savings. This improvement was sustained at 1 year. Downstream effects included improved resident efficiency with decreased work hours. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Teacher-Implemented Joint Attention Intervention: Pilot Randomized Controlled Study for Preschoolers with Autism

ERIC Educational Resources Information Center

Lawton, Kathy; Kasari, Connie

2012-01-01

Objective: The vast majority of children with an autism spectrum disorder (ASD) attend public preschools at some point in their childhood. Community preschool practices often are not evidence based, and almost none target the prelinguistic core deficits of ASD. This study investigated the effectiveness of public preschool teachers implementing a…

76 FR 72626 - Approval and Promulgation of Air Quality Implementation Plans; Delaware; Amendments to the...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-25

.... (See section 307(b)(2).) List of Subjects in 40 CFR part 52 Environmental protection, Air pollution... Promulgation of Air Quality Implementation Plans; Delaware; Amendments to the Control of Volatile Organic... accordance with the requirements of the Clean Air Act (CAA). DATES: Effective Date: This final rule is...

Implementing Internationalization Policy in Higher Education Explained by Regulatory Control in Neoliberal Times

ERIC Educational Resources Information Center

Chang, Dian-Fu

2015-01-01

This research investigated the internationalization policy and involved evaluating the effects of policy-driven reform on universities in the context of neoliberal theory. In this study, 293 professors from various universities were invited to express their opinions on the selected indicators reflected the implementation of internationalization in…

Seven Elements Important to Successful Implementation of Early Literacy Intervention

ERIC Educational Resources Information Center

Foorman, Barbara; Dombek, Jennifer; Smith, Kevin

2016-01-01

The objective of this article is to describe seven elements important to successful implementation of early literacy intervention. The seven elements are drawn from research as well as from the authors' recent randomized controlled trial of effective early literacy interventions in kindergarten through second grade in 55 schools across Florida.…

Controlling the Ecotourist in a Wild Dolphin Feeding Program: Is Education the Answer?

ERIC Educational Resources Information Center

Orams, Mark B.; Hill, Greg J. E.

1998-01-01

The effectiveness of an education program for tourists who hand-feed wild dolphins at Tangalooma, Moreton Island in eastern Australia was evaluated. Data were gathered on tourist behavior during feeding sessions before and after the education policy was implemented. After implementation of the education program, inappropriate behaviors such as…

Effectiveness of a multicomponent intervention to enhance implementation of a healthy canteen policy in Australian primary schools: a randomised controlled trial.

PubMed

Nathan, Nicole; Yoong, Sze Lin; Sutherland, Rachel; Reilly, Kathryn; Delaney, Tessa; Janssen, Lisa; Robertson, Katie; Reynolds, Renee; Chai, Li Kheng; Lecathelinais, Christophe; Wiggers, John; Wolfenden, Luke

2016-10-07

The implementation of school nutrition policies, which govern the provision of food in schools, is recommended as a public health strategy to support the development of healthy dietary behaviours in school-aged children. Despite this, research internationally and in Australia indicates that few schools implement such policies. This study aims to examine whether a theoretically designed, multi-strategy intervention was effective in increasing the implementation of a healthy canteen policy in Australian primary schools. A parallel group randomised controlled trial was conducted with all government and Catholic primary schools within one region in New South Wales, Australia who had an operational canteen that provided food to primary school aged children (5-12 years) and were not currently receiving an intervention to change their canteen practices. Schools randomised to the intervention arm received a 9-month multicomponent intervention including ongoing support, provision of resources, performance monitoring and feedback, executive support and recognition. The primary outcomes were the proportion of the schools with a canteen menu that: i) did not include 'red' or 'banned' items according to the healthy canteen policy; and ii) had more than 50 % 'green' items. The primary outcome was assessed via menu audit at baseline and follow up by dietitians blinded to group allocation. Fifty-three eligible schools were randomised to either the intervention or control group (28 intervention; 25 control). Analyses with 51 schools who returned school menus found that intervention schools were significantly more likely relative to control schools to have a menu without 'red' or 'banned' items (RR = 5.78 (1.45-23.05); p = 0.002) and have at least 50 % of menu items classified as green (RR = 2.03 (1.01-4.08); p = 0.03). This study found that a multi-component intervention was effective in improving primary schools' compliance with a healthy canteen policy. Given the lack of evidence regarding how best to support schools with implementing evidence-based policies to improve child diet, this trial for the first time provides high quality evidence to practitioners and policy makers seeking to improve nutrition policy implementation in schools. This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12614001148662 ) 30th October 2014.

Health Economic Evaluation of a Strict Glucose Control Guideline Implemented Using Point-of-Care Testing in Three Intensive Care Units in The Netherlands.

PubMed

van Hooijdonk, Roosmarijn T M; Steuten, Lotte M G; Kip, Michelle M A; Monteban, Helma; Mulder, Marianne R; van Braam Houckgeest, Floris; van der Sluijs, Johannes P; Abu-Hanna, Ameen; Spronk, Peter E; Schultz, Marcus J

2015-08-01

Point-of-care testing of blood glucose (BG-POCT) is essential for safe and effective insulin titrations in critically ill patients under glucose control with insulin. The costs associated with this practice are considered substantial, especially when more frequent blood glucose (BG) testing is needed, as with more strict glucose control (SGC) aiming for lower BG levels. The objective of this study was to estimate, from a hospital perspective, the incremental cost effectiveness of an SGC guideline, aiming for BG levels of 4.4-6.1 mmol/L, compared to the situation before implementation of that guideline (aiming for BG levels <8.3 mmol/L), both using BG-POCT. This is a secondary analysis of a guideline implementation project aiming for implementation of a guideline of SGC in three intensive care units in The Netherlands. A Markov model including the four health states 'target glucose', 'hyperglycaemia' (defined as BG levels >6.1 mmol/L), 'hypoglycaemia' (defined as BG levels <4.4 mmol/L) and 'in-hospital death' was developed to compare expected costs, number of patients within target and number of life-years saved before and after implementation of the SGC guideline. The effectiveness estimates are based on empirical data from 3195 patients 12 and 24 months before and after implementation of the guideline, respectively. All costs have been converted to price year 2013, and are estimated based on hospital data, the literature and available price lists. The number of BG-POCT increased from 4.8 [interquartile range (IQR) 2.6-6.7] to 8.0 [IQR 4.1-11.2] per patient per day, accruing 58% higher costs for BG-POCT (€13.56 vs. €8.57 per patient) in the SGC protocol versus the situation before implementation. When taking total hospital costs and clinical effects into account, implementation of the SGC guideline increased total hospital costs per patient by 1.8%, i.e., €355 (from €20,617 to €20,972) during the inpatient stay, while the number of patients in target glucose levels increased by 1.4% (i.e., from 881 to 895 per 1000 patients). This translates to an incremental cost-effectiveness ratio of €25 per additional patient within the target glucose level. The model outcomes are most sensitive to changes in ICU length of stay. The increase in the number of patients and time within target glucose levels is achieved with a small increase in total direct hospital costs.

A Framework for Engineering Stress Resilient Plants Using Genetic Feedback Control and Regulatory Network Rewiring.

PubMed

Foo, Mathias; Gherman, Iulia; Zhang, Peijun; Bates, Declan G; Denby, Katherine J

2018-05-23

Crop disease leads to significant waste worldwide, both pre- and postharvest, with subsequent economic and sustainability consequences. Disease outcome is determined both by the plants' response to the pathogen and by the ability of the pathogen to suppress defense responses and manipulate the plant to enhance colonization. The defense response of a plant is characterized by significant transcriptional reprogramming mediated by underlying gene regulatory networks, and components of these networks are often targeted by attacking pathogens. Here, using gene expression data from Botrytis cinerea-infected Arabidopsis plants, we develop a systematic approach for mitigating the effects of pathogen-induced network perturbations, using the tools of synthetic biology. We employ network inference and system identification techniques to build an accurate model of an Arabidopsis defense subnetwork that contains key genes determining susceptibility of the plant to the pathogen attack. Once validated against time-series data, we use this model to design and test perturbation mitigation strategies based on the use of genetic feedback control. We show how a synthetic feedback controller can be designed to attenuate the effect of external perturbations on the transcription factor CHE in our subnetwork. We investigate and compare two approaches for implementing such a controller biologically-direct implementation of the genetic feedback controller, and rewiring the regulatory regions of multiple genes-to achieve the network motif required to implement the controller. Our results highlight the potential of combining feedback control theory with synthetic biology for engineering plants with enhanced resilience to environmental stress.

Quantum phase gate based on electromagnetically induced transparency in optical cavities

NASA Astrophysics Data System (ADS)

Borges, Halyne S.; Villas-Bôas, Celso J.

2016-11-01

We theoretically investigate the implementation of a quantum controlled-phase gate in a system constituted by a single atom inside an optical cavity, based on the electromagnetically induced transparency effect. First we show that a probe pulse can experience a π phase shift due to the presence or absence of a classical control field. Considering the interplay of the cavity-EIT effect and the quantum memory process, we demonstrated a controlled-phase gate between two single photons. To this end, first one needs to store a (control) photon in the ground atomic states. In the following, a second (target) photon must impinge on the atom-cavity system. Depending on the atomic state, this second photon will be either transmitted or reflected, acquiring different phase shifts. This protocol can then be easily extended to multiphoton systems, i.e., keeping the control photon stored, it may induce phase shifts in several single photons, thus enabling the generation of multipartite entangled states. We explore the relevant parameter space in the atom-cavity system that allows the implementation of quantum controlled-phase gates using the recent technologies. In particular, we have found a lower bound for the cooperativity of the atom-cavity system which enables the implementation of phase shift on single photons. The induced shift on the phase of a photonic qubit and the controlled-phase gate between single photons, combined with optical devices, enable one to perform universal quantum computation.

Effects of Mobile Phone Usage in Supporting Leg Lymphedema Self-care

PubMed Central

Okutsu, Ayako; Koiyabashi, Kikuyo

2014-01-01

Objective: The aim of this study was to implement self-care support for leg lymphedema patients using mobile phones and to investigate the effects thereof. Patients and Methods: A total of 30 patients with lymphedema following female genital cancer surgery (stages I to II) who were referred from a nearby gynecologist were randomly divided into groups for routine self-care support (control group) and mobile telephone-assisted support (intervention group) and received the self-care support appropriate to their group. The (total) circumference of the leg with edema, FACT-G (cancer patient QOL), MHP (mental health status), and self-care self-assessment were comparatively investigated at three months after the initial interview. Results: No significant reduction in the (total) circumferences of legs with edema was confirmed in either the control or intervention group. The intervention group was significantly better than the control group in terms of the activity circumstances and FACT-G mental status at three months after the initial interview. The intervention group was also significantly better in psychological, social, and physical items in the MHP. The intervention group was significantly better than the control group in terms of circumstances of self-care implementation at three months after the initial interview. Additionally, comparison of the circumstances of implementation for different aspects of self-care content showed that the intervention group was significantly better at selecting shoes, observing edema, moisturizing, self-drainage, wearing compression garments, and implementing bandaging. Conclusion: Compared with routine self-care support, mobile telephone-assisted support is suggested to be effective for leg lymphedema patients’ QOL and mental health status as well as their self-care behaviors. PMID:25648778

TU-FG-201-12: Designing a Risk-Based Quality Assurance Program for a Newly Implemented Y-90 Microspheres Procedure

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

Vile, D; Zhang, L; Cuttino, L

2016-06-15

Purpose: To create a quality assurance program based upon a risk-based assessment of a newly implemented SirSpheres Y-90 procedure. Methods: A process map was created for a newly implemented SirSpheres procedure at a community hospital. The process map documented each step of this collaborative procedure, as well as the roles and responsibilities of each member. From the process map, different potential failure modes were determined as well as any current controls in place. From this list, a full failure mode and effects analysis (FMEA) was performed by grading each failure mode’s likelihood of occurrence, likelihood of detection, and potential severity.more » These numbers were then multiplied to compute the risk priority number (RPN) for each potential failure mode. Failure modes were then ranked based on their RPN. Additional controls were then added, with failure modes corresponding to the highest RPNs taking priority. Results: A process map was created that succinctly outlined each step in the SirSpheres procedure in its current implementation. From this, 72 potential failure modes were identified and ranked according to their associated RPN. Quality assurance controls and safety barriers were then added for failure modes associated with the highest risk being addressed first. Conclusion: A quality assurance program was created from a risk-based assessment of the SirSpheres process. Process mapping and FMEA were effective in identifying potential high-risk failure modes for this new procedure, which were prioritized for new quality assurance controls. TG 100 recommends the fault tree analysis methodology to design a comprehensive and effective QC/QM program, yet we found that by simply introducing additional safety barriers to address high RPN failure modes makes the whole process simpler and safer.« less

78 FR 37371 - Wassenaar Arrangement 2012 Plenary Agreements Implementation: Commerce Control List, Definitions...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-20

...The Bureau of Industry and Security (BIS) maintains, as part of its Export Administration Regulations (EAR), the Commerce Control List (CCL), which identifies certain of the items subject to Department of Commerce jurisdiction. This final rule revises the CCL to implement changes made to the Wassenaar Arrangement's List of Dual-Use Goods and Technologies (Wassenaar List) maintained and agreed to by governments participating in the Wassenaar Arrangement on Export Controls for Conventional Arms and Dual-Use Goods and Technologies (Wassenaar Arrangement, or WA) at the December 2012 WA Plenary Meeting (the Plenary). The Wassenaar Arrangement advocates implementation of effective export controls on strategic items with the objective of improving regional and international security and stability. This rule harmonizes the CCL with the changes made to the WA List at the Plenary by revising ECCNs controlled for national security reasons in each category of the CCL, except category 8, as well as amending the General Software Note, WA reporting requirements, and definitions section in the EAR. BIS is adding unilateral controls to the CCL for specific software and technology for aviation control systems, which the WA agreements removed from the WA List, i.e., EAR national security controls.

Costa Rica’s implementation of the Framework Convention on Tobacco Control: Overcoming decades of industry dominance

PubMed Central

Crosbie, Eric; Sosa, Patricia; Glantz, Stanton A

2016-01-01

Objective To analyze the passage of Costa Rica’s 2012 tobacco control law. Materials and methods Review of legislation, newspaper articles, and key informant interviews. Results Tobacco control advocates, in close collaboration with international health groups, recruited national, regional and international experts to testify in the Legislative Assembly, implemented grassroots advocacy campaigns, and generated media coverage to enact strong legislation in March 2012 consistent with the World Health Organization Framework Convention on Tobacco Control, despite tobacco industry lobbying efforts that for decades blocked effective tobacco control legislation. Conclusion Costa Rica’s experience illustrates how with resources, good strategic planning, aggressive tactics and perseverance tobacco control advocates can overcome tobacco industry opposition in the Legislative Assembly and Executive Branch. This determined approach has positioned Costa Rica to become a regional leader in tobacco control. PMID:26879509

GPs' role security and therapeutic commitment in managing alcohol problems: a randomised controlled trial of a tailored improvement programme.

PubMed

Keurhorst, Myrna; van Beurden, Ivonne; Anderson, Peter; Heinen, Maud; Akkermans, Reinier; Wensing, Michel; Laurant, Miranda

2014-04-17

General practitioners with more positive role security and therapeutic commitment towards patients with hazardous or harmful alcohol consumption are more involved and manage more alcohol-related problems than others. In this study we evaluated the effects of our tailored multi-faceted improvement implementation programme on GPs' role security and therapeutic commitment and, in addition, which professional related factors influenced the impact of the implementation programme. In a cluster randomised controlled trial, 124 GPs from 82 Dutch general practices were randomised to either the intervention or control group. The tailored, multi-faceted programme included combined physician, organisation, and patient directed alcohol-specific implementation strategies to increase role security and therapeutic commitment in GPs. The control group was mailed the national guideline and patients received feedback letters. Questionnaires were completed before and 12 months after start of the programme. We performed linear multilevel regression analysis to evaluate effects of the implementation programme. Participating GPs were predominantly male (63%) and had received very low levels of alcohol related education before start of the study (0.4 h). The programme increased therapeutic commitment (p = 0.005; 95%-CI 0.13 - 0.73) but not role security (p = 0.58; 95%-CI -0.31 - 0.54). How important GPs thought it was to improve their care for problematic alcohol consumption, and the GPs' reported proportion of patients asked about alcohol consumption at baseline, contributed to the effect of the programme on therapeutic commitment. A tailored, multi-faceted programme aimed at improving GP management of patients with hazardous and harmful alcohol consumption improved GPs' therapeutic commitment towards patients with alcohol-related problems, but failed to improve GPs' role security. How important GPs thought it was to improve their care for problematic alcohol consumption, and the GPs' reported proportion of patients asked about alcohol consumption at baseline, both increased the impact of the programme on therapeutic commitment. It might be worthwhile to monitor proceeding of role security and therapeutic commitment throughout the year after the implementation programme, to see whether the programme is effective on short term but faded out on the longer term. ClinicalTrials.gov Identifier: NCT00298220.

Pneumatic Variable Series Elastic Actuator.

PubMed

Zheng, Hao; Wu, Molei; Shen, Xiangrong

2016-08-01

Inspired by human motor control theory, stiffness control is highly effective in manipulation and human-interactive tasks. The implementation of stiffness control in robotic systems, however, has largely been limited to closed-loop control, and suffers from multiple issues such as limited frequency range, potential instability, and lack of contribution to energy efficiency. Variable-stiffness actuator represents a better solution, but the current designs are complex, heavy, and bulky. The approach in this paper seeks to address these issues by using pneumatic actuator as a variable series elastic actuator (VSEA), leveraging the compressibility of the working fluid. In this work, a pneumatic actuator is modeled as an elastic element with controllable stiffness and equilibrium point, both of which are functions of air masses in the two chambers. As such, for the implementation of stiffness control in a robotic system, the desired stiffness/equilibrium point can be converted to the desired chamber air masses, and a predictive pressure control approach is developed to control the timing of valve switching to obtain the desired air mass while minimizing control action. Experimental results showed that the new approach in this paper requires less expensive hardware (on-off valve instead of proportional valve), causes less control action in implementation, and provides good control performance by leveraging the inherent dynamics of the actuator.

Pneumatic Variable Series Elastic Actuator

PubMed Central

Zheng, Hao; Wu, Molei; Shen, Xiangrong

2016-01-01

Inspired by human motor control theory, stiffness control is highly effective in manipulation and human-interactive tasks. The implementation of stiffness control in robotic systems, however, has largely been limited to closed-loop control, and suffers from multiple issues such as limited frequency range, potential instability, and lack of contribution to energy efficiency. Variable-stiffness actuator represents a better solution, but the current designs are complex, heavy, and bulky. The approach in this paper seeks to address these issues by using pneumatic actuator as a variable series elastic actuator (VSEA), leveraging the compressibility of the working fluid. In this work, a pneumatic actuator is modeled as an elastic element with controllable stiffness and equilibrium point, both of which are functions of air masses in the two chambers. As such, for the implementation of stiffness control in a robotic system, the desired stiffness/equilibrium point can be converted to the desired chamber air masses, and a predictive pressure control approach is developed to control the timing of valve switching to obtain the desired air mass while minimizing control action. Experimental results showed that the new approach in this paper requires less expensive hardware (on–off valve instead of proportional valve), causes less control action in implementation, and provides good control performance by leveraging the inherent dynamics of the actuator. PMID:27354755

Stress Prevention@Work: a study protocol for the evaluation of a multifaceted integral stress prevention strategy to prevent employee stress in a healthcare organization: a cluster controlled trial.

PubMed

Hoek, Rianne J A; Havermans, Bo M; Houtman, Irene L D; Brouwers, Evelien P M; Heerkens, Yvonne F; Zijlstra-Vlasveld, Moniek C; Anema, Johannes R; van der Beek, Allard J; Boot, Cécile R L

2017-07-17

Adequate implementation of work-related stress management interventions can reduce or prevent work-related stress and sick leave in organizations. We developed a multifaceted integral stress-prevention strategy for organizations from several sectors that includes a digital platform and collaborative learning network. The digital platform contains a stepwise protocol to implement work-related stress-management interventions. It includes stress screeners, interventions and intervention providers to facilitate access to and the selection of matching work-related stress-management interventions. The collaborative learning network, including stakeholders from various organizations, plans meetings focussing on an exchange of experiences and good practices among organizations for the implementation of stress prevention measures. This paper describes the design of an integral stress-prevention strategy, Stress Prevention@Work, and the protocol for the evaluation of: 1) the effects of the strategy on perceived stress and work-related outcomes, and 2) the barriers and facilitators for implementation of the strategy. The effectiveness of Stress Prevention@Work will be evaluated in a cluster controlled trial, in a large healthcare organization in the Netherlands, at six and 12 months. An independent researcher will match teams on working conditions and size and allocate the teams to the intervention or control group. Teams in the intervention group will be offered Stress Prevention@Work. For each intervention team, one employee is responsible for applying the strategy within his/her team using the digital platform and visiting the collaborative learning network. Using a waiting list design, the control group will be given access to the strategy after 12 months. The primary outcome is the employees' perceived stress measured by the stress subscale of the Depression, Anxiety, and Stress Scale (DASS-21). Secondary outcome measures are job demands, job resources and the number of preventive stress measures implemented at the team level. Alongside the trial, a process evaluation, including barriers and facilitators of the implementation of Stress Prevention@Work, will be conducted in one healthcare organisation. If Stress Prevention@Work is found to be effective in one healthcare organisation, further implementation on a broader scale might lead to increased productivity and decreased stress and sick leave in other organizations. Results are expected in 2018. NTR5527 . Registered 7 Dec 2015.

The use of UNIX in a real-time environment

NASA Technical Reports Server (NTRS)

Luken, R. D.; Simons, P. C.

1986-01-01

This paper describes a project to evaluate the feasibility of using commercial off-the-shelf hardware and the UNIX operating system, to implement a real-time control and monitor system. A functional subset of the Checkout, Control and Monitor System was chosen as the test bed for the project. The project consists of three separate architecture implementations: a local area bus network, a star network, and a central host. The motivation for this project stemmed from the need to find a way to implement real-time systems, without the cost burden of developing and maintaining custom hardware and unique software. This has always been accepted as the only option because of the need to optimize the implementation for performance. However, with the cost/performance of today's hardware, the inefficiencies of high-level languages and portable operating systems can be effectively overcome.

Action to Support Practices Implement Research Evidence (ASPIRE): protocol for a cluster-randomised evaluation of adaptable implementation packages targeting 'high impact' clinical practice recommendations in general practice.

PubMed

Willis, Thomas A; Hartley, Suzanne; Glidewell, Liz; Farrin, Amanda J; Lawton, Rebecca; McEachan, Rosemary R C; Ingleson, Emma; Heudtlass, Peter; Collinson, Michelle; Clamp, Susan; Hunter, Cheryl; Ward, Vicky; Hulme, Claire; Meads, David; Bregantini, Daniele; Carder, Paul; Foy, Robbie

2016-02-29

There are recognised gaps between evidence and practice in general practice, a setting which provides particular challenges for implementation. We earlier screened clinical guideline recommendations to derive a set of 'high impact' indicators based upon criteria including potential for significant patient benefit, scope for improved practice and amenability to measurement using routinely collected data. We aim to evaluate the effectiveness and cost-effectiveness of a multifaceted, adaptable intervention package to implement four targeted, high impact recommendations in general practice. The research programme Action to Support Practice Implement Research Evidence (ASPIRE) includes a pair of pragmatic cluster-randomised trials which use a balanced incomplete block design. Clusters are general practices in West Yorkshire, United Kingdom (UK), recruited using an 'opt-out' recruitment process. The intervention package adapted to each recommendation includes combinations of audit and feedback, educational outreach visits and computerised prompts with embedded behaviour change techniques selected on the basis of identified needs and barriers to change. In trial 1, practices are randomised to adapted interventions targeting either diabetes control or risky prescribing and those in trial 2 to adapted interventions targeting either blood pressure control in patients at risk of cardiovascular events or anticoagulation in atrial fibrillation. The respective primary endpoints comprise achievement of all recommended target levels of haemoglobin A1c (HbA1c), blood pressure and cholesterol in patients with type 2 diabetes, a composite indicator of risky prescribing, achievement of recommended blood pressure targets for specific patient groups and anticoagulation prescribing in patients with atrial fibrillation. We are also randomising practices to a fifth, non-intervention control group to further assess Hawthorne effects. Outcomes will be assessed using routinely collected data extracted 1 year after randomisation. Economic modelling will estimate intervention cost-effectiveness. A process evaluation involving eight non-trial practices will examine intervention delivery, mechanisms of action and unintended consequences. ASPIRE will provide 'real-world' evidence about the effects, cost-effectiveness and delivery of adapted intervention packages targeting high impact recommendations. By implementing our adaptable intervention package across four distinct clinical topics, and using 'opt-out' recruitment, our findings will provide evidence of wider generalisability. ISRCTN91989345.

Farmers’ Intentions to Implement Foot and Mouth Disease Control Measures in Ethiopia

PubMed Central

Jemberu, Wudu T.; Mourits, M. C. M.; Hogeveen, H.

2015-01-01

The objectives of this study were to explore farmers’ intentions to implement foot and mouth disease (FMD) control in Ethiopia, and to identify perceptions about the disease and its control measures that influence these intentions using the Health Belief Model (HBM) framework. Data were collected using questionnaires from 293 farmers in three different production systems. The influence of perceptions on the intentions to implement control measures were analyzed using binary logistic regression. The effect of socio-demographic and husbandry variables on perceptions that were found to significantly influence the intentions were analyzed using ordinal logistic regression. Almost all farmers (99%) intended to implement FMD vaccination free of charge. The majority of farmers in the pastoral (94%) and market oriented (92%) systems also had the intention to implement vaccination with charge but only 42% of the crop-livestock mixed farmers had the intention to do so. Only 2% of pastoral and 18% of crop-livestock mixed farmers had the intention to implement herd isolation and animal movement restriction continuously. These proportions increased to 11% for pastoral and 50% for crop-livestock mixed farmers when the measure is applied only during an outbreak. The majority of farmers in the market oriented system (>80%) had the intention to implement herd isolation and animal movement restriction measure, both continuously and during an outbreak. Among the HBM perception constructs, perceived barrier was found to be the only significant predictor of the intention to implement vaccination. Perceived susceptibility, perceived benefit and perceived barrier were the significant predictors of the intention for herd isolation and animal movement restriction measure. In turn, the predicting perceived barrier on vaccination control varied significantly with the production system and the age of farmers. The significant HBM perception predictors on herd isolation and animal movement restriction control were significantly influenced only by the type of production system. The results of this study indicate that farmers’ intentions to apply FMD control measures are variable among production systems, an insight which is relevant in the development of future control programs. Promotion programs aimed at increasing farmers’ motivation to participate in FMD control by charged vaccination or animal movement restriction should give attention to the perceived barriers influencing the intentions to apply these measures. PMID:26375391

Farmers' Intentions to Implement Foot and Mouth Disease Control Measures in Ethiopia.

PubMed

Jemberu, Wudu T; Mourits, M C M; Hogeveen, H

2015-01-01

The objectives of this study were to explore farmers' intentions to implement foot and mouth disease (FMD) control in Ethiopia, and to identify perceptions about the disease and its control measures that influence these intentions using the Health Belief Model (HBM) framework. Data were collected using questionnaires from 293 farmers in three different production systems. The influence of perceptions on the intentions to implement control measures were analyzed using binary logistic regression. The effect of socio-demographic and husbandry variables on perceptions that were found to significantly influence the intentions were analyzed using ordinal logistic regression. Almost all farmers (99%) intended to implement FMD vaccination free of charge. The majority of farmers in the pastoral (94%) and market oriented (92%) systems also had the intention to implement vaccination with charge but only 42% of the crop-livestock mixed farmers had the intention to do so. Only 2% of pastoral and 18% of crop-livestock mixed farmers had the intention to implement herd isolation and animal movement restriction continuously. These proportions increased to 11% for pastoral and 50% for crop-livestock mixed farmers when the measure is applied only during an outbreak. The majority of farmers in the market oriented system (>80%) had the intention to implement herd isolation and animal movement restriction measure, both continuously and during an outbreak. Among the HBM perception constructs, perceived barrier was found to be the only significant predictor of the intention to implement vaccination. Perceived susceptibility, perceived benefit and perceived barrier were the significant predictors of the intention for herd isolation and animal movement restriction measure. In turn, the predicting perceived barrier on vaccination control varied significantly with the production system and the age of farmers. The significant HBM perception predictors on herd isolation and animal movement restriction control were significantly influenced only by the type of production system. The results of this study indicate that farmers' intentions to apply FMD control measures are variable among production systems, an insight which is relevant in the development of future control programs. Promotion programs aimed at increasing farmers' motivation to participate in FMD control by charged vaccination or animal movement restriction should give attention to the perceived barriers influencing the intentions to apply these measures.

The importance of continued engagement during the implementation phase of tobacco control policies in a middle-income country: the case of Costa Rica.

PubMed

Crosbie, Eric; Sosa, Patricia; Glantz, Stanton A

2017-01-01

To analyse the process of implementing and enforcing smoke-free environments, tobacco advertising, tobacco taxes and health warning labels from Costa Rica's 2012 tobacco control law. Review of tobacco control legislation, newspaper articles and interviewing key informants. Despite overcoming decades of tobacco industry dominance to win enactment of a strong tobacco control law in March 2012 consistent with WHO's Framework Convention on Tobacco Control, the tobacco industry and their allies lobbied executive branch authorities for exemptions in smoke-free environments to create public confusion, and continued to report in the media that increasing cigarette taxes led to a rise in illicit trade. In response, tobacco control advocates, with technical support from international health groups, helped strengthen tobacco advertising regulations by prohibiting advertising at the point-of-sale (POS) and banning corporate social responsibility campaigns. The Health Ministry used increased tobacco taxes earmarked for tobacco control to help effectively promote and enforce the law, resulting in high compliance for smoke-free environments, advertising restrictions and health warning label (HWL) regulations. Despite this success, government trade concerns allowed, as of December 2015, POS tobacco advertising, and delayed the release of HWL regulations for 15 months. The implementation phase continues to be a site of intensive tobacco industry political activity in low and middle-income countries. International support and earmarked tobacco taxes provide important technical and financial assistance to implement tobacco control policies, but more legal expertise is needed to overcome government trade concerns and avoid unnecessary delays in implementation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Implementing systems thinking for infection prevention: The cessation of repeated scabies outbreaks in a respiratory care ward.

PubMed

Chuang, Sheuwen; Howley, Peter P; Lin, Shih-Hua

2015-05-01

Root cause analysis (RCA) is often adopted to complement epidemiologic investigation for outbreaks and infection-related adverse events in hospitals; however, RCA has been argued to have limited effectiveness in preventing such events. We describe how an innovative systems analysis approach halted repeated scabies outbreaks, and highlight the importance of systems thinking for outbreaks analysis and sustaining effective infection prevention and control. Following RCA for a third successive outbreak of scabies over a 17-month period in a 60-bed respiratory care ward of a Taiwan hospital, a systems-oriented event analysis (SOEA) model was used to reanalyze the outbreak. Both approaches and the recommendations were compared. No nosocomial scabies have been reported for more than 1975 days since implementation of the SOEA. Previous intervals between seeming eradication and repeat outbreaks following RCA were 270 days and 180 days. Achieving a sustainable positive resolution relied on applying systems thinking and the holistic analysis of the system, not merely looking for root causes of events. To improve the effectiveness of outbreaks analysis and infection control, an emphasis on systems thinking is critical, along with a practical approach to ensure its effective implementation. The SOEA model provides the necessary framework and is a viable complementary approach, or alternative, to RCA. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Cascade generalized predictive control strategy for boiler drum level.

PubMed

Xu, Min; Li, Shaoyuan; Cai, Wenjian

2005-07-01

This paper proposes a cascade model predictive control scheme for boiler drum level control. By employing generalized predictive control structures for both inner and outer loops, measured and unmeasured disturbances can be effectively rejected, and drum level at constant load is maintained. In addition, nonminimum phase characteristic and system constraints in both loops can be handled effectively by generalized predictive control algorithms. Simulation results are provided to show that cascade generalized predictive control results in better performance than that of well tuned cascade proportional integral differential controllers. The algorithm has also been implemented to control a 75-MW boiler plant, and the results show an improvement over conventional control schemes.

Researching effective approaches to cleaning in hospitals: protocol of the REACH study, a multi-site stepped-wedge randomised trial.

PubMed

Hall, Lisa; Farrington, Alison; Mitchell, Brett G; Barnett, Adrian G; Halton, Kate; Allen, Michelle; Page, Katie; Gardner, Anne; Havers, Sally; Bailey, Emily; Dancer, Stephanie J; Riley, Thomas V; Gericke, Christian A; Paterson, David L; Graves, Nicholas

2016-03-24

The Researching Effective Approaches to Cleaning in Hospitals (REACH) study will generate evidence about the effectiveness and cost-effectiveness of a novel cleaning initiative that aims to improve the environmental cleanliness of hospitals. The initiative is an environmental cleaning bundle, with five interdependent, evidence-based components (training, technique, product, audit and communication) implemented with environmental services staff to enhance hospital cleaning practices. The REACH study will use a stepped-wedge randomised controlled design to test the study intervention, an environmental cleaning bundle, in 11 Australian hospitals. All trial hospitals will receive the intervention and act as their own control, with analysis undertaken of the change within each hospital based on data collected in the control and intervention periods. Each site will be randomised to one of the 11 intervention timings with staggered commencement dates in 2016 and an intervention period between 20 and 50 weeks. All sites complete the trial at the same time in 2017. The inclusion criteria allow for a purposive sample of both public and private hospitals that have higher-risk patient populations for healthcare-associated infections (HAIs). The primary outcome (objective one) is the monthly number of Staphylococcus aureus bacteraemias (SABs), Clostridium difficile infections (CDIs) and vancomycin resistant enterococci (VRE) infections, per 10,000 bed days. Secondary outcomes for objective one include the thoroughness of hospital cleaning assessed using fluorescent marker technology, the bio-burden of frequent touch surfaces post cleaning and changes in staff knowledge and attitudes about environmental cleaning. A cost-effectiveness analysis will determine the second key outcome (objective two): the incremental cost-effectiveness ratio from implementation of the cleaning bundle. The study uses the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework to support the tailored implementation of the environmental cleaning bundle in each hospital. Evidence from the REACH trial will contribute to future policy and practice guidelines about hospital environmental cleaning. It will be used by healthcare leaders and clinicians to inform decision-making and implementation of best-practice infection prevention strategies to reduce HAIs in hospitals. Australia New Zealand Clinical Trial Registry ACTRN12615000325505.

Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: a non-randomized controlled trial

PubMed Central

2014-01-01

Background Clinical practice guidelines are important for transmitting research findings into practice and facilitating the application of evidence-based practice (EBP). There is a paucity of knowledge about the impact of guideline implementation strategies in primary care physical therapy. The aim of this study was to evaluate the effect of a guideline implementation intervention in primary care physical therapy in western Sweden. Methods An implementation strategy based on theory and current evidence was developed. A tailored, multi-component implementation intervention, addressing earlier identified determinants, was carried out in three areas comprising 28 physical therapy practices including 277 physical therapists (PTs) (intervention group). In two adjacent areas, 171 PTs at 32 practices received no intervention (control group). The core component of the intervention was an implementation seminar with group discussions. Among other components were a website and email reminders. Data were collected at baseline and follow-up with a web-based questionnaire. Primary outcomes were the self-reported awareness of, knowledge of, access to, and use of guidelines. Secondary outcomes were self-reported attitudes toward EBP and guidelines. Analyses were performed using Pearson’s χ2 test and approximative z-test. Results 168 PTs (60.6%) in the intervention group and 88 PTs (51.5%) in the control group responded to the follow-up questionnaire. 186/277 PTs (67.1%) participated in the implementation seminars, of which 97 (52.2%) responded. The proportions of PTs reporting awareness of (absolute difference in change 20.6%, p = 0.023), knowledge where to find (20.4%, p = 0.007), access to (21.7%, p < 0.001), and frequent use of (9.5%, NS) guidelines increased more in the intervention group than in the control group. The proportion of PTs reporting frequent guideline use after participation in the implementation seminar was 15.2% (p = 0.043) higher than the proportion in the control group. A higher proportion considered EBP helpful in decision making (p = 0.018). There were no other significant differences in secondary outcomes. Conclusions A tailored, theory- and evidence-informed, multi-component intervention for the implementation of clinical practice guidelines had a modest, positive effect on awareness of, knowledge of, access to, and use of guidelines, among PTs in primary care in western Sweden. In general, attitudes to EBP and guidelines were not affected. PMID:24589291

Weight-loss intervention using implementation intentions and mental imagery: a randomised control trial study protocol.

PubMed

Hattar, Anne; Hagger, Martin S; Pal, Sebely

2015-02-27

Overweight and obesity are major health problems worldwide. This protocol describes the HEALTHI (Healthy Eating and Active LifesTyle Health Intervention) Program, a 12-week randomised-controlled weight-loss intervention that adopts two theory-based intervention techniques, mental imagery and implementation intentions, a behaviour-change technique based on planning that have been shown to be effective in promoting health-behaviour change in previous research. The effectiveness of goal-reminder text messages to augment intervention effects will also be tested. The trial will determine the effects of a brief, low cost, theory-based weight-loss intervention to improve dietary intake and physical activity behaviour and facilitate weight-loss in overweight and obese individuals. Overweight or obese participants will be randomly allocated to one of three conditions: (1) a psycho-education plus an implementation intentions and mental imagery condition; (2) a psycho-education plus an implementation intentions and mental imagery condition with text messages; or (3) a psycho-education control condition. The intervention will be delivered via video presentation to increase the intervention's applicability in multiple contexts and keep costs low. We hypothesise that the intervention conditions will lead to statistically-significant changes in the primary and secondary outcome variables measured at 6 and 12 weeks post-intervention relative to the psycho-education control condition after controlling for baseline values. The primary outcome variable will be body weight and secondary outcome variables will be biomedical (body mass, body fat percentage, muscle mass, waist-hip circumference ratio, systolic and diastolic blood pressure, low-density lipoprotein, high-density lipoprotein, total cholesterol, triglycerides, blood glucose and insulin levels), psychological (quality of life, motivation, risk perception, outcome expectancy, intention, action self-efficacy, maintenance self-efficacy, goal setting and planning), and behavioural (self-reported diet intake, and physical activity involvement) measures. We also expect the intervention condition augmented with text messages to lead to statistically significant differences in the primary and secondary outcome variables at the follow up periods after controlling for baseline values. The planned trial will test the effectiveness of the theory-based HEALTHI program intervention to reduce weight and salient psychological, biomedical, and behavioural outcomes in overweight and obese adults. The study has been designed to maximise applicability to real world settings and could be integrated into existing weight management practices. ACTRN: ACTRN12613001274763. Registration date 19/11/2013.

Enhancing implementation of tobacco use prevention and cessation counselling guideline among dental providers: a cluster randomised controlled trial

PubMed Central

2011-01-01

Background Tobacco use adversely affects oral health. Tobacco use prevention and cessation (TUPAC) counselling guidelines recommend that healthcare providers ask about each patient's tobacco use, assess the patient's readiness and willingness to stop, document tobacco use habits, advise the patient to stop, assist and help in quitting, and arrange monitoring of progress at follow-up appointments. Adherence to such guidelines, especially among dental providers, is poor. To improve guideline implementation, it is essential to understand factors influencing it and find effective ways to influence those factors. The aim of the present study protocol is to introduce a theory-based approach to diagnose implementation difficulties of TUPAC counselling guidelines among dental providers. Methods Theories of behaviour change have been used to identify key theoretical domains relevant to the behaviours of healthcare providers involved in implementing clinical guidelines. These theoretical domains will inform the development of a questionnaire aimed at assessing the implementation of the TUPAC counselling guidelines among Finnish municipal dental providers. Specific items will be drawn from the guidelines and the literature on TUPAC studies. After identifying potential implementation difficulties, we will design two interventions using theories of behaviour change to link them with relevant behaviour change techniques aiming to improve guideline adherence. For assessing the implementation of TUPAC guidelines, the electronic dental record audit and self-reported questionnaires will be used. Discussion To improve guideline adherence, the theoretical-domains approach could provide a comprehensive basis for assessing implementation difficulties, as well as designing and evaluating interventions. After having identified implementation difficulties, we will design and test two interventions to enhance TUPAC guideline adherence. Using the cluster randomised controlled design, we aim to provide further evidence on intervention effects, as well as on the validity and feasibility of the theoretical-domain approach. The empirical data collected within this trial will be useful in testing whether this theoretical-domain approach can improve our understanding of the implementation of TUPAC guidelines among dental providers. Trial registration Current Controlled Trials ISRCTN15427433 PMID:21320312

Health benefit modelling and optimization of vehicular pollution control strategies

NASA Astrophysics Data System (ADS)

Sonawane, Nayan V.; Patil, Rashmi S.; Sethi, Virendra

2012-12-01

This study asserts that the evaluation of pollution reduction strategies should be approached on the basis of health benefits. The framework presented could be used for decision making on the basis of cost effectiveness when the strategies are applied concurrently. Several vehicular pollution control strategies have been proposed in literature for effective management of urban air pollution. The effectiveness of these strategies has been mostly studied as a one at a time approach on the basis of change in pollution concentration. The adequacy and practicality of such an approach is studied in the present work. Also, the assessment of respective benefits of these strategies has been carried out when they are implemented simultaneously. An integrated model has been developed which can be used as a tool for optimal prioritization of various pollution management strategies. The model estimates health benefits associated with specific control strategies. ISC-AERMOD View has been used to provide the cause-effect relation between control options and change in ambient air quality. BenMAP, developed by U.S. EPA, has been applied for estimation of health and economic benefits associated with various management strategies. Valuation of health benefits has been done for impact indicators of premature mortality, hospital admissions and respiratory syndrome. An optimization model has been developed to maximize overall social benefits with determination of optimized percentage implementations for multiple strategies. The model has been applied for sub-urban region of Mumbai city for vehicular sector. Several control scenarios have been considered like revised emission standards, electric, CNG, LPG and hybrid vehicles. Reduction in concentration and resultant health benefits for the pollutants CO, NOx and particulate matter are estimated for different control scenarios. Finally, an optimization model has been applied to determine optimized percentage implementation of specific control strategies with maximization of social benefits, when these strategies are applied simultaneously.

Multilevel Mechanisms of Implementation Strategies in Mental Health: Integrating Theory, Research, and Practice

PubMed Central

2015-01-01

A step toward the development of optimally effective, efficient, and feasible implementation strategies that increase evidence-based treatment integration in mental health services involves identification of the multilevel mechanisms through which these strategies influence implementation outcomes. This article (a) provides an orientation to, and rationale for, consideration of multilevel mediating mechanisms in implementation trials, and (b) systematically reviews randomized controlled trials that examined mediators of implementation strategies in mental health. Nine trials were located. Mediation-related methodological deficiencies were prevalent and no trials supported a hypothesized mediator. The most common reason was failure to engage the mediation target. Discussion focuses on directions to accelerate implementation strategy development in mental health. PMID:26474761

Programmable logic controller implementation of an auto-tuned predictive control based on minimal plant information.

PubMed

Valencia-Palomo, G; Rossiter, J A

2011-01-01

This paper makes two key contributions. First, it tackles the issue of the availability of constrained predictive control for low-level control loops. Hence, it describes how the constrained control algorithm is embedded in an industrial programmable logic controller (PLC) using the IEC 61131-3 programming standard. Second, there is a definition and implementation of a novel auto-tuned predictive controller; the key novelty is that the modelling is based on relatively crude but pragmatic plant information. Laboratory experiment tests were carried out in two bench-scale laboratory systems to prove the effectiveness of the combined algorithm and hardware solution. For completeness, the results are compared with a commercial proportional-integral-derivative (PID) controller (also embedded in the PLC) using the most up to date auto-tuning rules. Copyright © 2010 ISA. Published by Elsevier Ltd. All rights reserved.

Discrete wavelet transform and energy eigen value for rotor bars fault detection in variable speed field-oriented control of induction motor drive.

PubMed

Ameid, Tarek; Menacer, Arezki; Talhaoui, Hicham; Azzoug, Youness

2018-05-03

This paper presents a methodology for the broken rotor bars fault detection is considered when the rotor speed varies continuously and the induction machine is controlled by Field-Oriented Control (FOC). The rotor fault detection is obtained by analyzing a several mechanical and electrical quantities (i.e., rotor speed, stator phase current and output signal of the speed regulator) by the Discrete Wavelet Transform (DWT) in variable speed drives. The severity of the fault is obtained by stored energy calculation for active power signal. Hence, it can be a useful solution as fault indicator. The FOC is implemented in order to preserve a good performance speed control; to compensate the broken rotor bars effect in the mechanical speed and to ensure the operation continuity and to investigate the fault effect in the variable speed. The effectiveness of the technique is evaluated in simulation and in a real-time implementation by using Matlab/Simulink with the real-time interface (RTI) based on dSpace 1104 board. Copyright © 2018. Published by Elsevier Ltd.

Evaluating the Measure of Effectiveness of Using a Deployed Command and Control System on Land Battlefield

DTIC Science & Technology

2015-09-01

SOA Service-Oriented Architecture SOTM Satellite Communications-on-the-Move SoS System of Systems SwCIs Software Criticality Indices TPM Technical...into the C2 system. To manage stakeholders’ expectations, there is a need to evaluate the effectiveness of the deployed C2 system having implemented ...the C2 system. However, there is a need to recognize the limitations and constraints on the land battlefield to implement these requirements. There

Treatment of Speech Anxiety by Cue-Controlled Relaxation and Desensitization with Professional and Paraprofessional Counselors

ERIC Educational Resources Information Center

Russell, Richard K.; Wise, Fred

1976-01-01

This investigation compared the relative effectiveness of group-administered cue-controlled relaxation and group systematic desensitization in the treatment of speech anxiety. Also examined was the role of professional versus paraprofessional counselors in implementing the treatment program. A description of the cue-controlled relaxation technique…

Adaptive automation of human-machine system information-processing functions.

PubMed

Kaber, David B; Wright, Melanie C; Prinzel, Lawrence J; Clamann, Michael P

2005-01-01

The goal of this research was to describe the ability of human operators to interact with adaptive automation (AA) applied to various stages of complex systems information processing, defined in a model of human-automation interaction. Forty participants operated a simulation of an air traffic control task. Automated assistance was adaptively applied to information acquisition, information analysis, decision making, and action implementation aspects of the task based on operator workload states, which were measured using a secondary task. The differential effects of the forms of automation were determined and compared with a manual control condition. Results of two 20-min trials of AA or manual control revealed a significant effect of the type of automation on performance, particularly during manual control periods as part of the adaptive conditions. Humans appear to better adapt to AA applied to sensory and psychomotor information-processing functions (action implementation) than to AA applied to cognitive functions (information analysis and decision making), and AA is superior to completely manual control. Potential applications of this research include the design of automation to support air traffic controller information processing.

Self-control with spiking and non-spiking neural networks playing games.

PubMed

Christodoulou, Chris; Banfield, Gaye; Cleanthous, Aristodemos

2010-01-01

Self-control can be defined as choosing a large delayed reward over a small immediate reward, while precommitment is the making of a choice with the specific aim of denying oneself future choices. Humans recognise that they have self-control problems and attempt to overcome them by applying precommitment. Problems in exercising self-control, suggest a conflict between cognition and motivation, which has been linked to competition between higher and lower brain functions (representing the frontal lobes and the limbic system respectively). This premise of an internal process conflict, lead to a behavioural model being proposed, based on which, we implemented a computational model for studying and explaining self-control through precommitment behaviour. Our model consists of two neural networks, initially non-spiking and then spiking ones, representing the higher and lower brain systems viewed as cooperating for the benefit of the organism. The non-spiking neural networks are of simple feed forward multilayer type with reinforcement learning, one with selective bootstrap weight update rule, which is seen as myopic, representing the lower brain and the other with the temporal difference weight update rule, which is seen as far-sighted, representing the higher brain. The spiking neural networks are implemented with leaky integrate-and-fire neurons with learning based on stochastic synaptic transmission. The differentiating element between the two brain centres in this implementation is based on the memory of past actions determined by an eligibility trace time constant. As the structure of the self-control problem can be likened to the Iterated Prisoner's Dilemma (IPD) game in that cooperation is to defection what self-control is to impulsiveness or what compromising is to insisting, we implemented the neural networks as two players, learning simultaneously but independently, competing in the IPD game. With a technique resembling the precommitment effect, whereby the payoffs for the dilemma cases in the IPD payoff matrix are differentially biased (increased or decreased), it is shown that increasing the precommitment effect (through increasing the differential bias) increases the probability of cooperating with oneself in the future, irrespective of whether the implementation is with spiking or non-spiking neural networks. Copyright (c) 2009 Elsevier Ltd. All rights reserved.

Economic evaluation of an implementation strategy for the management of low back pain in general practice.

PubMed

Jensen, Cathrine Elgaard; Riis, Allan; Petersen, Karin Dam; Jensen, Martin Bach; Pedersen, Kjeld Møller

2017-05-01

In connection with the publication of a clinical practice guideline on the management of low back pain (LBP) in general practice in Denmark, a cluster randomised controlled trial was conducted. In this trial, a multifaceted guideline implementation strategy to improve general practitioners' treatment of patients with LBP was compared with a usual implementation strategy. The aim was to determine whether the multifaceted strategy was cost effective, as compared with the usual implementation strategy. The economic evaluation was conducted as a cost-utility analysis where cost collected from a societal perspective and quality-adjusted life years were used as outcome measures. The analysis was conducted as a within-trial analysis with a 12-month time horizon consistent with the follow-up period of the clinical trial. To adjust for a priori selected covariates, generalised linear models with a gamma family were used to estimate incremental costs and quality-adjusted life years. Furthermore, both deterministic and probabilistic sensitivity analyses were conducted. Results showed that costs associated with primary health care were higher, whereas secondary health care costs were lower for the intervention group when compared with the control group. When adjusting for covariates, the intervention was less costly, and there was no significant difference in effect between the 2 groups. Sensitivity analyses showed that results were sensitive to uncertainty. In conclusion, the multifaceted implementation strategy was cost saving when compared with the usual strategy for implementing LBP clinical practice guidelines in general practice. Furthermore, there was no significant difference in effect, and the estimate was sensitive to uncertainty.

Evaluating an integrated approach to clinical quality improvement: clinical guidelines, quality measurement, and supportive system design.

PubMed

Cretin, S; Farley, D O; Dolter, K J; Nicholas, W

2001-08-01

Implementing clinical practice guidelines to change patient outcomes presents a challenge. Studies of single interventions focused on changing provider behavior demonstrate modest effects, suggesting that effective guideline implementation requires a multifaceted approach. Traditional biomedical research designs are not well suited to evaluating systems interventions. RAND and the Army Medical Department collaborated to develop and evaluate a system for implementing guidelines and documenting their effects on patient care. The evaluation design blended quality improvement, case study, and epidemiologic methods. A formative evaluation of implementation process and an outcome evaluation of patient impact were combined. Guidelines were implemented in 3 successive demonstrations targeting low back pain, asthma, and diabetes. This paper reports on the first wave of 4 facilities implementing a low back pain guideline. Organizational climate and culture, motivation, leadership commitment, and resources were assessed. Selected indicators of processes and outcomes of care were compared before, during, and after guideline implementation at the demonstration facilities and at comparison facilities. Logistic regression analysis was used to test for guideline effects on patient care. Process evaluation documented varied approaches to quality improvement across sites. Outcome evaluation revealed a significant downward trend in the percentage of acute low back pain patients referred to physical therapy or chiropractic care (10.7% to 7.2%) at demonstration sites and no such trend at control sites. Preliminary results suggest the power of this design to stimulate improvements in guideline implementation while retaining the power to evaluate rigorously effects on patient care.

Essential considerations in developing attention control groups in behavioral research.

PubMed

Aycock, Dawn M; Hayat, Matthew J; Helvig, Ashley; Dunbar, Sandra B; Clark, Patricia C

2018-06-01

Attention control groups strengthen randomized controlled trials of behavioral interventions, but researchers need to give careful consideration to the attention control activities. A comparative effectiveness research framework provides an ideal opportunity for an attention control group as a supplement to standard care, so participants potentially receive benefit regardless of group assignment. The anticipated benefit of the control condition must be independent of the study outcome. Resources needed for attention control activities need to be carefully considered and ethical considerations carefully weighed. In this paper we address nine considerations for the design and implementation of attention control groups: (1) ensure attention control activities are not associated with the outcome; (2) avoid contamination of the intervention or control group; (3) design comparable control and intervention activities; (4) ensure researcher training to adequately administer both treatment arms; (5) design control activities to be interesting and acceptable to participants; (6) evaluate attention control activities; (7) consider additional resources needed to implement attention control activities; (8) quantifying the effects of attention control and intervention groups; and (9) ethical considerations with attention control groups. Examples from the literature and ongoing research are presented. Careful planning for the attention control group is as important as for the intervention group. Researchers can use the considerations presented here to assist in planning for the best attention control group for their study. © 2018 Wiley Periodicals, Inc.

Contamination Control for Thermal Engineers

NASA Technical Reports Server (NTRS)

Rivera, Rachel B.

2015-01-01

The presentation will be given at the 26th Annual Thermal Fluids Analysis Workshop (TFAWS 2015) hosted by the Goddard Spaceflight Center (GSFC) Thermal Engineering Branch (Code 545). This course will cover the basics of Contamination Control, including contamination control related failures, the effects of contamination on Flight Hardware, what contamination requirements translate to, design methodology, and implementing contamination control into Integration, Testing and Launch.

Integrating tobacco control into health and development agendas.

PubMed

Reddy, K Srinath; Yadav, Amit; Arora, Monika; Nazar, Gaurang P

2012-03-01

Tobacco use is one of the major risk factors for non-communicable diseases, with a profound impact on resource-poor low-income and middle-income countries such as India, where tobacco use is high and where socioeconomic as well as health inequalities are rampant. Effective implementation of the Framework Convention on Tobacco Control requires multisectoral efforts that can fructify through integration of tobacco control into broader health and development agendas such as food and water security, environment, the right to education and human rights. The global tobacco control community will need to explore innovative partnerships beyond its traditional confines and build a global coalition that supports tobacco control by partnering with others having convergent concerns on common determinants. A firm political commitment and intersectoral coordination between government and non-government agencies is paramount in order to implement effective tobacco control programmes. Integration of tobacco control into other health and development agendas as described in this paper has the potential to contribute to the achievement of all the eight United Nations Millennium Development Goals. This paper explores why the whole of government should accord a high priority to tobacco control, and how this integration could be achieved.

Implementation and research priorities for FCTC Articles 13 and 16: tobacco advertising, promotion, and sponsorship and sales to and by minors.

PubMed

Nagler, Rebekah H; Viswanath, Kasisomayajula

2013-04-01

Article 13 of the Framework Convention on Tobacco Control (FCTC) calls for a comprehensive ban on tobacco advertising, promotion, and sponsorship (TAPS), and Article 16 calls for prohibition of tobacco sales to and by minors. Although these mandates are based on sound science, many countries have found provision implementation to be rife with challenges. This paper reviews the history of tobacco marketing and minor access restrictions in high-, middle-, and low-income countries, identifying past challenges and successes. We consider current challenges to FCTC implementation, how these barriers can be addressed, and what research is necessary to support such efforts. Specifically, we identify implementation and research priorities for FCTC Articles 13 and 16. Although a solid evidence base underpins the FCTC's call for TAPS bans and minor access restrictions, we know substantially less about how best to implement these restrictions. Drawing on the regulatory experiences of high-, middle-, and low-income countries, we discern several implementation and research priorities, which are organized into 4 categories: policy enactment and enforcement, human capital expertise, the effects of FCTC marketing and youth access policies, and knowledge exchange and transfer among signatories. Future research should provide detailed case studies on implementation successes and failures, as well as insights into how knowledge of successful restrictions can be translated into tobacco control policy and practice and shared among different stakeholders. Tobacco marketing surveillance, sales-to-minors compliance checks, enforcement and evaluation of restriction policies, and capacity building and knowledge transfer are likely to prove central to effective implementation.

URBAN WET-WEATHER FLOW POLLUTION MANAGEMENT AND CONTROL

EPA Science Inventory

One of the challenges in protecting urban watersheds lies in effectively controlling the contaminants in both overland runoff and sewerage system overflows during wet-weather events. Abatement of wet-weather flow (WWF) pollution can be implemented at the source by land managemen...

Integrated Schistosomiasis and Soil-Transmitted Helminthiasis Control over Five Years on Kome Island, Tanzania

PubMed Central

Kaatano, Godfrey M.; Siza, Julius E.; Mwanga, Joseph R.; Min, Duk-Yong; Yong, Tai-Soon; Chai, Jong-Yil; Ko, Yunsuk; Chang, Su Young; Kullaya, Cyril M.; Rim, Han-Jong; Changalucha, John M.; Eom, Keeseon S.

2015-01-01

Integrated control strategies are important for sustainable control of schistosomiasis and soil-transmitted helminthiasis, despite their challenges for their effective implementation. With the support of Good Neighbors International in collaboration with National Institute of Medical Research, Mwanza, Tanzania, integrated control applying mass drug administration (MDA), health education using PHAST, and improved safe water supply has been implemented on Kome Island over 5 years for controlling schistosomiasis and soil-transmitted helminths (STHs). Baseline surveys for schistosomiasis and STHs was conducted before implementation of any integrated control strategies, followed by 4 cross-sectional follow-up surveys on randomly selected samples of schoolchildren and adults in 10 primary schools and 8 villages, respectively, on Kome islands. Those follow-up surveys were conducted for impact evaluation after introduction of control strategies interventions in the study area. Five rounds of MDA have been implemented from 2009 along with PHAST and improved water supply with pumped wells as other control strategies for complementing MDA. A remarkable steady decline of schistosomiasis and STHs was observed from 2009 to 2012 with significant trends in their prevalence decline, and thereafter infection rate has remained at a low sustainable control. By the third follow-up survey in 2012, Schistosoma mansoni infection prevalence was reduced by 90.5% and hookworm by 93.3% among schoolchildren while in adults the corresponding reduction was 83.2% and 56.9%, respectively. Integrated control strategies have successfully reduced S. mansoni and STH infection status to a lower level. This study further suggests that monitoring and evaluation is a crucial component of any large-scale STH and schistosomiasis intervention. PMID:26537032

Integrated Schistosomiasis and Soil-Transmitted Helminthiasis Control over Five Years on Kome Island, Tanzania.

PubMed

Kaatano, Godfrey M; Siza, Julius E; Mwanga, Joseph R; Min, Duk-Yong; Yong, Tai-Soon; Chai, Jong-Yil; Ko, Yunsuk; Chang, Su Young; Kullaya, Cyril M; Rim, Han-Jong; Changalucha, John M; Eom, Keeseon S

2015-10-01

Integrated control strategies are important for sustainable control of schistosomiasis and soil-transmitted helminthiasis, despite their challenges for their effective implementation. With the support of Good Neighbors International in collaboration with National Institute of Medical Research, Mwanza, Tanzania, integrated control applying mass drug administration (MDA), health education using PHAST, and improved safe water supply has been implemented on Kome Island over 5 years for controlling schistosomiasis and soil-transmitted helminths (STHs). Baseline surveys for schistosomiasis and STHs was conducted before implementation of any integrated control strategies, followed by 4 cross-sectional follow-up surveys on randomly selected samples of schoolchildren and adults in 10 primary schools and 8 villages, respectively, on Kome islands. Those follow-up surveys were conducted for impact evaluation after introduction of control strategies interventions in the study area. Five rounds of MDA have been implemented from 2009 along with PHAST and improved water supply with pumped wells as other control strategies for complementing MDA. A remarkable steady decline of schistosomiasis and STHs was observed from 2009 to 2012 with significant trends in their prevalence decline, and thereafter infection rate has remained at a low sustainable control. By the third follow-up survey in 2012, Schistosoma mansoni infection prevalence was reduced by 90.5% and hookworm by 93.3% among schoolchildren while in adults the corresponding reduction was 83.2% and 56.9%, respectively. Integrated control strategies have successfully reduced S. mansoni and STH infection status to a lower level. This study further suggests that monitoring and evaluation is a crucial component of any large-scale STH and schistosomiasis intervention.

Improving prospective memory in persons with Parkinson disease: A randomized controlled trial

PubMed Central

Foster, Erin R.; McDaniel, Mark A.; Rendell, Peter G.

2017-01-01

Background Prospective memory is essential for productive and independent living and necessary for compliance with prescribed health behaviors. Parkinson disease (PD) can cause prospective memory deficits that are associated with activity limitations and reduced quality of life. Forming implementation intentions is an encoding strategy that may improve prospective memory in this population. Objective To determine the effect of implementation intentions on prospective memory performance in PD. Methods This was a laboratory-based randomized controlled trial. Participants with mild to moderate PD without dementia (N = 62) performed a computerized prospective memory test (Virtual Week) under standard instructions. One week later they were randomly allocated to perform it again while using either implementation intentions or a rehearsal encoding strategy. Results Prospective memory performance was better with the use of both strategies relative to standard instructions. This effect was larger for tasks with event-based compared to time-based cues. In addition, implementation intentions resulted in a larger effect than rehearsal for the non-repeated tasks. Conclusions Strategies that support full encoding of prospective memory cues and actions can improve prospective memory performance among people with PD, particularly for tasks with cues that are readily available in the environment. Implementation intentions may be more effective than rehearsal for non-repeated tasks, but this finding warrants verification. Future work should address transfer of strategy use from the laboratory to everyday life. Targeted strategies to manage prospective memory impairment could improve function and quality of life and significantly impact clinical care for people with PD. (NCT01469741) PMID:28176547

Applying sensory modulation to mental health inpatient care to reduce seclusion and restraint: a case control study.

PubMed

Andersen, Charlotte; Kolmos, Anne; Andersen, Kjeld; Sippel, Volkmar; Stenager, Elsebeth

2017-10-01

Clinical training in managing conflicts and preventing violence seldom contains sensory modulation (SM) as a method to de-escalate and prevent restraint and seclusion. Sensory-based interventions promote adaptive regulation of arousal and emotion. SM is a complementary approach that is associated with reduced rates of seclusion and restraint in mental healthcare, but there is need for more research in this area. Using SM to reduce restraint and seclusion in inpatient mental health care. The study included two similar psychiatric units where one unit implemented SM and one unit served as the control group. In the very beginning of the study, a staff-training program in the use of SM including assessment tools and intervention strategies was established. Data on restraint and forced medicine were sampled post the course of the year of implementation and compared with the control group. The use of belts decreased with 38% compared to the control group. The use of forced medication decreased with 46% compared to the control group. Altogether the use of physical restraint and forced medication decreased significantly with 42% (p < .05). Implementing a SM approach in mental healthcare facilities has a significant effect on the reduction of restraint and seclusion. As a part of the implementation, staff training and education in SM are crucial.

Improving maternity care using a personal health record: study protocol for a stepped-wedge, randomised, controlled trial.

PubMed

Groenen, Carola J M; Faber, Marjan J; Kremer, Jan A M; Vandenbussche, Frank P H A; van Duijnhoven, Noortje T L

2016-04-16

A personal health record (PHR) is an online application through which individuals can access, manage, and share their health information in a private, secure, and confidential environment. Personal health records empower patients, facilitate collaboration among healthcare professionals, and improve health outcomes. Given these anticipated positive effects, we want to implement a PHR, named MyPregn@ncy, in a Dutch maternity care setting and to evaluate its effects in routine care. This paper presents the study protocol. The effects of implementing a PHR in maternity care on patients and professionals will be identified in a stepped-wedge, cluster-randomised, controlled trial. The study will be performed in the region of Nijmegen, a Dutch area with an average of 4,500 births a year and more than 230 healthcare professionals involved in maternity care. Data analyses will describe the effects of MyPregn@ncy on health outcomes in maternity care, quality of care from the patients' perspectives, and collaboration among healthcare professionals. Additionally, a process evaluation of the implementation of MyPregn@ncy will be performed. Data will be collected using data from the Dutch perinatal registry, questionnaires, interviews, and log data. The study is expected to yield new information about the effects, strengths, possibilities, and challenges to the implementation and usage of a PHR in routine maternal care settings. Results may lead to new insights and improvements in the quality of maternal and perinatal care. Netherlands Trial Register: NTR4063.

The effect of hospital infection control policy on the prevalence of surgical site infection in a tertiary hospital in South-South Nigeria.

PubMed

Brisibe, Seiyefa Fun-Akpa; Ordinioha, Best; Gbeneolol, Precious K

2015-01-01

Surgical site infections (SSIs) are a significant cause of morbidity, emotional stress and financial cost to the affected patients and health care institutions; and infection control policy has been shown to reduce the burden of SSIs in several health care institutions. This study assessed the effects of the implementation of the policy on the prevalence of SSI in the University of Port Harcourt Teaching Hospital, Nigeria. A review of the records of all Caesarean sections carried out in the hospital, before and 2 years after the implementation of the infection control policy was conducted. Data collected include the number and characteristics of the patients that had Caesarean section in the hospital during the period and those that developed SSI while on admission. The proportion of patients with SSI decreased from 13.33% to 10.34%, 2 years after the implementation of the policy (P-value = 0.18). The implementation of the policy did not also result in any statistically significant change in the nature of the wound infection (P-value = 0.230), in the schedule of the operations (P-value = 0.93) and in the other predisposing factors of the infections (P-value = 0.72); except for the significant decrease in the infection rate among the un-booked patients (P-value = 0.032). The implementation of the policy led to a small decrease in SSI, due to the non-implementation of some important aspects of the WHO policy. The introduction of surveillance activities, continuous practice reinforcing communications and environmental sanitation are recommended to further decrease the prevalence of SSI in the hospital.

Modelling the ability of source control measures to reduce inundation risk in a community-scale urban drainage system

NASA Astrophysics Data System (ADS)

Mei, Chao; Liu, Jiahong; Wang, Hao; Shao, Weiwei; Xia, Lin; Xiang, Chenyao; Zhou, Jinjun

2018-06-01

Urban inundation is a serious challenge that increasingly confronts the residents of many cities, as well as policymakers, in the context of rapid urbanization and climate change worldwide. In recent years, source control measures (SCMs) such as green roofs, permeable pavements, rain gardens, and vegetative swales have been implemented to address flood inundation in urban settings, and proven to be cost-effective and sustainable. In order to investigate the ability of SCMs on reducing inundation in a community-scale urban drainage system, a dynamic rainfall-runoff model of a community-scale urban drainage system was developed based on SWMM. SCMs implementing scenarios were modelled under six design rainstorm events with return period ranging from 2 to 100 years, and inundation risks of the drainage system were evaluated before and after the proposed implementation of SCMs, with a risk-evaluation method based on SWMM and analytic hierarchy process (AHP). Results show that, SCMs implementation resulting in significantly reduction of hydrological indexes that related to inundation risks, range of reduction rates of average flow, peak flow, and total flooded volume of the drainage system were 28.1-72.1, 19.0-69.2, and 33.9-56.0 %, respectively, under six rainfall events with return periods ranging from 2 to 100 years. Corresponding, the inundation risks of the drainage system were significantly reduced after SCMs implementation, the risk values falling below 0.2 when the rainfall return period was less than 10 years. Simulation results confirm the effectiveness of SCMs on mitigating inundation, and quantified the potential of SCMs on reducing inundation risks in the urban drainage system, which provided scientific references for implementing SCMs for inundation control of the study area.

Out of sight, out of mind? Does terminating the physical presence of a geriatric consultant in the community clinic reduce the implementation rate for geriatric recommendations.

PubMed

Freud, Tamar; Punchik, Boris; Biderman, Aya; Peleg, Roni; Kagan, Ella; Barzak, Alex; Press, Yan

2016-01-01

To assess the effect of moving the geriatric consultation from the primary care clinic to another setting, on the rate of implementation of geriatric recommendations by family physicians. A retrospective review of the computerized medical records of elderly patients in four primary care clinics. The rate of implementation of geriatric recommendations was compared between clinics in which a geriatric consultant was physically present (control clinics) and a clinic where the consultation took place elsewhere (study clinic). In addition, the results of the present study were compared to a previous study in which the geriatric consultation was carried out in the study clinic and the family doctor was an active participant. 127 computerized files were reviewed in the study clinic and 133 in the control clinics. The mean age of the patients was 81.1±6.3 years and 63.1% were women. The overall implementation of geriatric recommendations by family doctors in the study clinic was 55.9%, a statistically significant decrease compared to the previous study where the rate was 73.9% (p<0.0001). In contrast, there was no change in the implementation rate in the control clinics at 65.0% in the present study and 59.9% in the previous one (p=0.205). Direct, person-to-person contact between the geriatric consultant and the family doctor has a beneficial effect on the implementation of geriatric recommendations. This should be considered by healthcare policy makers when planning geriatric services in the community. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

[Managing concerns about falls in older people: evaluation of the implementation of an evidence-based program].

PubMed

Zijlstra, G A R; Du Moulin, M F M T; van Haastregt, J C M; de Jonge, M; Kempen, G I J M; van der Poel, A

2013-12-01

A cognitive behavioral program reduced concerns about falling and related avoidance behavior among older community-dwelling adults in a randomized controlled trial. In the current study we examined the effects and acceptability of the program after nation-wide implementation into home care organizations in The Netherlands. In a one-group pretest-posttest study with data collection before the start of the program and at 2 and 4 months, the effects and acceptability of the program were assessed in 125 community-dwelling older people. The outcomes of the effect evaluation included concerns about falls, related avoidance behavior, falls, fall-related medical attention, feelings of anxiety, symptoms of depression, and loneliness. Pretest-posttest analyses with the Wilcoxon signed-rank test and the paired t-test showed significant improvements at 4 months for concerns about falls, activity avoidance, number of falls in the past 2 months, feelings of anxiety, and symptoms of depression. No significant differences were shown for the other outcomes. After implementation in home care organizations, the outcomes indicate positive program effects on concerns about falls, avoidance behavior, and falls in community-dwelling older people. Given the similarity in results, i.e. between those of the previously performed randomized controlled trial and those of the current pretest-posttest study, we conclude that the program can be successfully implemented in practice. This article is an adjusted, Dutch version of Zijlstra GA, van Haastregt JC, Du Moulin MF, de Jonge MC, van der Poel A, Kempen GI. Effects of the implementation of an evidenc-based program to manage concerns about falls in older adults. The Gerontologist 2013;53(5):839-849; doi: 10.1093/geront/gns142.

Design and implementation of multichannel global active structural acoustic control for a device casing

NASA Astrophysics Data System (ADS)

Mazur, Krzysztof; Wrona, Stanislaw; Pawelczyk, Marek

2018-01-01

The paper presents the idea and discussion on implementation of multichannel global active noise control systems. As a test plant an active casing is used. It has been developed by the authors to reduce device noise directly at the source by controlling vibration of its casing. To provide global acoustic effect in the whole environment, where the device operates, it requires a number of secondary sources and sensors for each casing wall, thus making the whole active control structure complicated, i.e. with a large number of interacting channels. The paper discloses all details concerning hardware setup and efficient implementation of control algorithms for the multichannel case. A new formulation is presented to introduce the distributed version of the Switched-error Filtered-reference Least Mean Squares (FXLMS) algorithm together with adaptation rate enhancement. The convergence rate of the proposed algorithm is compared with original Multiple-error FXLMS. A number of hints followed from many years of authors' experience on microprocessor control systems design and signal processing algorithms optimization are presented. They can be used for various active control and signal processing applications, both for academic research and commercialization.

A simple model-based control for Pichia pastoris allows a more efficient heterologous protein production bioprocess.

PubMed

Cos, Oriol; Ramon, Ramon; Montesinos, José Luis; Valero, Francisco

2006-09-05

A predictive control algorithm coupled with a PI feedback controller has been satisfactorily implemented in the heterologous Rhizopus oryzae lipase production by Pichia pastoris methanol utilization slow (Mut(s)) phenotype. This control algorithm has allowed the study of the effect of methanol concentration, ranging from 0.5 to 1.75 g/L, on heterologous protein production. The maximal lipolytic activity (490 UA/mL), specific yield (11,236 UA/g(biomass)), productivity (4,901 UA/L . h), and specific productivity (112 UA/g(biomass)h were reached for a methanol concentration of 1 g/L. These parameters are almost double than those obtained with a manual control at a similar methanol set-point. The study of the specific growth, consumption, and production rates showed different patterns for these rates depending on the methanol concentration set-point. Results obtained have shown the need of implementing a robust control scheme when reproducible quality and productivity are sought. It has been demonstrated that the model-based control proposed here is a very efficient, robust, and easy-to-implement strategy from an industrial application point of view. (c) 2006 Wiley Periodicals, Inc.

An Examination of Strategy Implementation During Abstract Nonlinguistic Category Learning in Aphasia.

PubMed

Vallila-Rohter, Sofia; Kiran, Swathi

2015-08-01

Our purpose was to study strategy use during nonlinguistic category learning in aphasia. Twelve control participants without aphasia and 53 participants with aphasia (PWA) completed a computerized feedback-based category learning task consisting of training and testing phases. Accuracy rates of categorization in testing phases were calculated. To evaluate strategy use, strategy analyses were conducted over training and testing phases. Participant data were compared with model data that simulated complex multi-cue, single feature, and random pattern strategies. Learning success and strategy use were evaluated within the context of standardized cognitive-linguistic assessments. Categorization accuracy was higher among control participants than among PWA. The majority of control participants implemented suboptimal or optimal multi-cue and single-feature strategies by testing phases of the experiment. In contrast, a large subgroup of PWA implemented random patterns, or no strategy, during both training and testing phases of the experiment. Person-to-person variability arises not only in category learning ability but also in the strategies implemented to complete category learning tasks. PWA less frequently developed effective strategies during category learning tasks than control participants. Certain PWA may have impairments of strategy development or feedback processing not captured by language and currently probed cognitive abilities.

An Integrative, Multilevel, and Transdisciplinary Research Approach to Challenges of Work, Family, and Health

PubMed Central

Bray, Jeremy W.; Kelly, Erin L.; Hammer, Leslie B.; Almeida, David M.; Dearing, James W.; King, Rosalind B.; Buxton, Orfeu M.

2013-01-01

Recognizing a need for rigorous, experimental research to support the efforts of workplaces and policymakers in improving the health and wellbeing of employees and their families, the National Institutes of Health and the Centers for Disease Control and Prevention formed the Work, Family & Health Network (WFHN). The WFHN is implementing an innovative multisite study with a rigorous experimental design (adaptive randomization, control groups), comprehensive multilevel measures, a novel and theoretically based intervention targeting the psychosocial work environment, and translational activities. This paper describes challenges and benefits of designing a multilevel and transdisciplinary research network that includes an effectiveness study to assess intervention effects on employees, families, and managers; a daily diary study to examine effects on family functioning and daily stress; a process study to understand intervention implementation; and translational research to understand and inform diffusion of innovation. Challenges were both conceptual and logistical, spanning all aspects of study design and implementation. In dealing with these challenges, however, the WFHN developed innovative, transdisciplinary, multi-method approaches to conducting workplace research that will benefit both the research and business communities. PMID:24618878

[The plain packaging of tobacco products: a new strategy for tobacco control].

PubMed

Rey-Pino, Juan Miguel; Nerín, Isabel; Lacave-García, Ma Blanca

There is evidence that global tobacco smoking control policies contribute to decrease the prevalence of smoking among populations, so there is a need to effectively implement different measures in a coordinated way. The plain packaging and labelling of tobacco products is one of the measures proposed by the World Health Organisation Framework Convention on Tobacco Control. At the moment, leading countries are implementing this tobacco control measure, which involves a plain packaging for all tobacco products, i.e., the absence of any promotional or communication tool in the packaging, except the name of the brand, appearing with a standardised font, size, colour and placing in the pack. Australia was the first country to implement this measure in 2012 and recently other countries are legislating and approving it. In Spain, tobacco legislation (2005 and 2010), was an important advance in tobacco control policies. The introduction of plain packaging in Spain would mean the next step in the development of a global strategy for fighting this significant health problem. The aim of this article is to synthesise in a structured manner the role that the packaging of tobacco products has within marketing and communication strategies, as well as to describe the potential effects that the plain packaging has on some aspects of smoking behaviour, according to current literature. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

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

PubMed Central

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

2014-01-01

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

Community-based youth tobacco control interventions: cost effectiveness of the Full Court Press project.

PubMed

Ross, Hana; Powell, Lisa M; Bauer, Joseph E; Levy, David T; Peck, Richard M; Lee, Hye-Ryeon

2006-01-01

We evaluated the impact of a community-based tobacco control project that was implemented in the city of Tucson, Arizona, USA, between 1996 and 2001. The project's goal was to reduce the prevalence of youth smoking through change in social norms at schools and in communities and workplaces. As is often the case, these community-based health promotion interventions were implemented in conjunction with other broader programmes, in this case implemented on the state level. Taking into account state level interventions as well as changes in sociodemographic and economic environment over the course of the project (e.g. increases in cigarette prices), we measure the net effect of the intervention in terms of the number of people who quit or did not initiate smoking and by the discounted life-years gained. To establish the value of investing into community-based intervention, we calculated the real discounted cost per quit and per life-year gained of 3789 US dollars and 3942 US dollars, respectively. These compare favourably with the real cost per quit of 4270 US dollars when implementing the 1996 US Clinical Practice Guideline for smoking cessation but exceed the real cost of 2923 US dollars per discounted life-year gained when following the guideline. A sensitivity analysis that assumed 5% programme persistence (i.e. 5% of the programme's impact would last forever in the absence of future funding for the programme), one-third would relapse and that one-third of those who quit may have quit smoking even without the programme, suggested a lower cost per discounted life-year saved of 3476 US dollars. The cost effectiveness of this project compares favourably with other tobacco control interventions. Despite its relatively small target group, this community-based intervention was cost effective.

Leadership, Control, Communication and Comprehension: Key Factors in Successful Implementation of SBDM.

ERIC Educational Resources Information Center

Etheridge, Carol Plata; And Others

This study examines the effects of principal leadership styles on the development of the working styles of seven local school councils in Memphis (Tennessee) during their first 15 months of operation. The successful implementation of a school-based decision making (SBDM) management model depends upon the ability of the local school council to…

76 FR 77178 - Approval and Promulgation of Implementation Plans; New York State Ozone Implementation Plan Revision

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-12

... Pavement and Asphalt Based Surface Coating.'' The intended effect of this action is to approve control..., ``Asphalt Pavement and Asphalt Based Surface Coating?'' A. Background B. What are the requirements of Part 241, ``Asphalt Pavement and Asphalt Based Surface Coating?'' C. What is EPA's evaluation? VI. What is...

Role of cytopathology in cancer control in low-resource settings: sub-Saharan Africa's perspective.

PubMed

Thomas, Jaiyeola

2011-03-01

Cancer is an emerging public health problem in Africa especially with increasing exposure to risky life styles, environmental carcinogens and emergence of AIDS-associated cancers. Of the WHO estimated 7.9 million cancer-related deaths in 2007 more than 72% occurred in the low- and middle-income countries and 80% presented in the late stages. To implement the WHO resolution on cancer control programs in these settings, feasible evidence-based interventions for prevention, early diagnosis and detection need to be widely introduced. Fundamental to appropriate cancer treatment and statistics is accurate diagnosis. In low-resource settings, the diagnostic techniques and procedures should be reliable, cost-effective, simple and acceptable to patients. In addition, the required equipment should be affordable, requiring minimal maintenance and with readily available consumables. Cytology, as a simple standardized low-technology procedure, fulfills these criteria and is most effective in addressing the major components of cancer control programs in these areas. The major obstacles to its widespread establishment are lack of awareness and inadequate numbers of trained personnel compounded by sociopolitical factors, poor national planning and implementation. Rather than investing in new technology or alternative screening methods, efforts should focus on the education and training of local personnel, as feasible options, to improve the chances of implementing meaningful cancer control programs.

US-Russian Cooperation in Upgrading MC&A System at Rosatom Facilities: Measurement of Nuclear Materials

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

Powell, Danny H; Jensen, Bruce A

2011-01-01

Improve protection of weapons-usable nuclear material from theft or diversion through the development and support of a nationwide sustainable and effective Material Control and Accountability (MC&A) program based on material measurement. The material protection, control, and accountability (MPC&A) cooperation has yielded significant results in implementing MC&A measurements at Russian nuclear facilities: (1) Establishment of MEM WG and MEMS SP; (2) Infrastructure for development, certification, and distribution of RMs; and (3) Coordination on development and implementation of MMs.

Floating-point scaling technique for sources separation automatic gain control

NASA Astrophysics Data System (ADS)

Fermas, A.; Belouchrani, A.; Ait-Mohamed, O.

2012-07-01

Based on the floating-point representation and taking advantage of scaling factor indetermination in blind source separation (BSS) processing, we propose a scaling technique applied to the separation matrix, to avoid the saturation or the weakness in the recovered source signals. This technique performs an automatic gain control in an on-line BSS environment. We demonstrate the effectiveness of this technique by using the implementation of a division-free BSS algorithm with two inputs, two outputs. The proposed technique is computationally cheaper and efficient for a hardware implementation compared to the Euclidean normalisation.

Tobacco Control Policies in Vietnam: Review on MPOWER Implementation Progress and Challenges.

PubMed

Minh, Hoang Van; Ngan, Tran Thu; Mai, Vu Quynh; My, Nguyen Thi Tuyet; Chung, Le Hong; Kien, Vu Duy; Anh, Tran Tuan; Ngoc, Nguyen Bao; Giap, Vu Van; Cuong, Nguyen Manh; Manh, Pham Duc; Giang, Kim Bao

2016-01-01

In Vietnam, the WHO Framework Convention on Tobacco Control (WHO FCTC) took effect in March 2005 while MPOWER has been implemented since 2008. This paper describes the progress and challenges of implementation of the MPOWER package in Vietnam. We can report that, in term of monitoring, Vietnam is very active in the Global Tobacco Surveillance System, completing two rounds of the Global Adult Tobacco Survey (GATS) and three rounds of the Global Youth Tobacco Survey (GYTS). To protect people from tobacco smoke, Vietnam has issued and enforced a law requiring comprehensive smoking bans at workplaces and public places since 2013. Tobacco advertising and promotion are also prohibited with the exception of points of sale displays of tobacco products. Violations come in the form of promotion girls, corporate social responsibility activities from tobacco manufacturers and packages displayed by retail vendors. Vietnam is one of the 77 countries that require pictorial health warnings to be printed on cigarette packages to warn about the danger of tobacco and the warnings have been implemented effectively. Cigarette tax is 70% of factory price which is equal to less than 45% of retail price and much lower than the recommendation of WHO. However, Vietnam is one of the very few countries that require manufacturers and importers to make "compulsory contributions" at 1-2% of the factory price of cigarettes sold in Vietnam for the establishment of a Tobacco Control Fund (TCF). The TCF is being operated well. In 2015, 67 units of 63 provinces/cities, 22 ministries and political-social organizations and 6 hospitals received funding from TCF to implement a wide range of tobacco control activities. Cessation services have been starting with a a toll-free quit-line but need to be further strengthened. In conclusion, Vietnam has constantly put efforts into the tobacco control field with high commitment from the government, scientists and activists. Though several remarkable achievements have been gained, many challenges remain. To overcome those challenges, implementation strategies that take into account the contextual factors and social determinants of tobacco use in Vietnam are needed.

Implementing an advance care planning program in German nursing homes: results of an inter-regionally controlled intervention trial.

PubMed

In der Schmitten, Jürgen; Lex, Katharina; Mellert, Christine; Rothärmel, Sonja; Wegscheider, Karl; Marckmann, Georg

2014-01-24

Advance Care Planning (ACP) is a systematic approach to ensure that effective advance directives (ADs) are developed and respected. We studied the effects of implementing a regional ACP program in Germany. In a prospective, inter-regionally controlled trial focusing on nursing homes (n/hs), we compared the number, relevance and validity of new ADs completed in the intervention region versus the control region. Intervention n/h residents and their families were offered professional facilitation including standardized documentation. Data from 136 residents of three intervention n/hs were compared with data from 439 residents of 10 control n/hs over a study period of 16.5 months. In the intervention region, 49 (36.0%) participating residents completed a new AD over the period of the study, compared to 18 (4.1%) in the control region; these ADs included 30 ADs by proxy in the intervention region versus 10 in the control region. Proxies were designated in 94.7% versus 50.0% of cases, the AD was signed by a physician in 93.9% versus 16.7%, and an emergency order was included in 98.0% versus 44.4%. Resuscitation status was addressed in 95.9% versus 38.9% of cases (p<0.01 for all of the differences mentioned above). In the intervention region, new ADs were preceded by an average of 2.5 facilitated conversations (range, 2–5) with a mean total duration of 100 minutes (range, 60–240 minutes). The implementation of an ACP program in German nursing homes led, much more frequently than previously reported, to the creation of advance directives with potential relevance to medical decision-making. Future research should assess the effect of such programs on clinical and structural outcomes.

[Effect of water storage and aquaculture on Oncomelania hupensis control in tidal flats wetlands of islet-beach type area of Dantu section of lower reaches of Yangtze River].

PubMed

Li, Ye-fang; Huang, Yi-xin; Wang, He-sheng; Hang, De-rong; Chen, Xiang-ping; Xie, Yi-feng; Zhang, Lian-heng

2015-12-01

To evaluate the effect and the benefits of the projects of water storage and aquaculture on Oncomelania hupensis snail control in the tidal flats wetlands of islet-beach type area of lower reaches of the Yangtze River. The projects of water storage and aquaculture on 0. hupensis snail control were implemented in the tidal flats wetlands of islet-beach type of lower reaches of the Yangtze River. The breed situation of the snails was investigated by the conventional method before and after the project implementation and the effect of control and elimination of the snails by the projects were evaluated. At the same time, the cost-benefit analysis of two projects among them was performed by the static benefit-cost ratio method. All of 0. hupensis snails were eliminated in the first year after the implementation of seven water storage and aquaculture projects. The costs of detection and control of snails saved by each project was 69.20 thousand yuan a year on average. The annual net benefits of the "Nanhao Group 10 beach" project and "Wutao Group 6-14 beach" project were 2 039.40 thousand yuan and 955.00 thousand yuan respectively, and the annual net benefit-cost ratios were 1.09: 1 and 1.07: 1 respectively. The O. hupensis snails could be rapidly eliminated by the water storage and aquaculture, and the economic benefit is obvious, but the wetland ecological protection and flood control safety should be considered in the tidal flats wetlands of islet-beach type area of lower reaches of the Yangtze River.

Revisiting sample size: are big trials the answer?

PubMed

Lurati Buse, Giovanna A L; Botto, Fernando; Devereaux, P J

2012-07-18

The superiority of the evidence generated in randomized controlled trials over observational data is not only conditional to randomization. Randomized controlled trials require proper design and implementation to provide a reliable effect estimate. Adequate random sequence generation, allocation implementation, analyses based on the intention-to-treat principle, and sufficient power are crucial to the quality of a randomized controlled trial. Power, or the probability of the trial to detect a difference when a real difference between treatments exists, strongly depends on sample size. The quality of orthopaedic randomized controlled trials is frequently threatened by a limited sample size. This paper reviews basic concepts and pitfalls in sample-size estimation and focuses on the importance of large trials in the generation of valid evidence.

A simple, inexpensive, and effective implementation of a vision-guided autonomous robot

NASA Astrophysics Data System (ADS)

Tippetts, Beau; Lillywhite, Kirt; Fowers, Spencer; Dennis, Aaron; Lee, Dah-Jye; Archibald, James

2006-10-01

This paper discusses a simple, inexpensive, and effective implementation of a vision-guided autonomous robot. This implementation is a second year entrance for Brigham Young University students to the Intelligent Ground Vehicle Competition. The objective of the robot was to navigate a course constructed of white boundary lines and orange obstacles for the autonomous competition. A used electric wheelchair was used as the robot base. The wheelchair was purchased from a local thrift store for $28. The base was modified to include Kegresse tracks using a friction drum system. This modification allowed the robot to perform better on a variety of terrains, resolving issues with last year's design. In order to control the wheelchair and retain the robust motor controls already on the wheelchair the wheelchair joystick was simply removed and replaced with a printed circuit board that emulated joystick operation and was capable of receiving commands through a serial port connection. Three different algorithms were implemented and compared: a purely reactive approach, a potential fields approach, and a machine learning approach. Each of the algorithms used color segmentation methods to interpret data from a digital camera in order to identify the features of the course. This paper will be useful to those interested in implementing an inexpensive vision-based autonomous robot.

Changes in perceptions and motivators that influence the implementation of on-farm Salmonella control measures by pig farmers in England.

PubMed

Marier, Elizabeth; Piers Smith, Richard; Ellis-Iversen, Johanne; Watson, Eamon; Armstrong, Derek; Hogeveen, Henk; Cook, Alasdair J C

2016-10-01

This study presents British farmers' perception of, and barriers to, implementing Salmonella control on pig farms. Four farms that had implemented interventions and their 33 close contacts (known to the intervention farmers) took part in interviews before (phase 1) and after (phase 2) intervention trials to assess the difference in perception over time. Their results were compared against those from nine randomly selected control farms. The hypothesis was that farms implementing interventions whether or not successful, would influence their close contacts' opinion over time. Based on a 'pathway to disease control' model, three intrinsic factors known to influence motivation - attitudes, social norms and self-efficacy - were evaluated. Farmers mentioned that successful interventions on a farm would attract their attention. The use of an appropriate communication strategy is therefore recommended to stimulate farmers' intent to implement control measures. Both before and after the intervention trials, all farmers had a positive attitude towards Salmonella control and felt that their peers and authorities were supportive of controlling Salmonella on farms. In phase 2, however, farmers were more likely to want to share the burden of control with other stakeholders along the food chain and their belief in self-efficacy had weakened. Whilst social norms were not associated with an intention to take action on control, a positive attitude towards Salmonella control and a belief in self-efficacy were more likely to result in an intent to control. In phase 2, farmers with an intent to implement an intervention appeared to have a greater, but not significant positive belief in self-efficacy (p=0.108). This study confirmed that farmers recognised their responsibility for controlling Salmonella in pork - even though their confidence in their ability to control Salmonella decreased over time - and believed that responsibility should be shared with the rest of the production chain. It showed that farmers trusted their veterinarian as a source of advice to guide them during the process of implementing change, though an increase in farms' Salmonella seroprevalence score (Zoonosis National Control Programme (ZNCP) score) especially for those with a low ZNCP score was also likely to influence their behaviour. Getting concrete feedback from customers or a tangible benefit from their action was a strong incentive especially for farms with a ZNCP score higher than 50%. The study also revealed a need to validate which measures are effective as farmers did not perceive that the current advised interventions were worth the additional effort. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

Research on Occupational Safety, Health Management and Risk Control Technology in Coal Mines.

PubMed

Zhou, Lu-Jie; Cao, Qing-Gui; Yu, Kai; Wang, Lin-Lin; Wang, Hai-Bin

2018-04-26

This paper studies the occupational safety and health management methods as well as risk control technology associated with the coal mining industry, including daily management of occupational safety and health, identification and assessment of risks, early warning and dynamic monitoring of risks, etc.; also, a B/S mode software (Geting Coal Mine, Jining, Shandong, China), i.e., Coal Mine Occupational Safety and Health Management and Risk Control System, is developed to attain the aforementioned objectives, namely promoting the coal mine occupational safety and health management based on early warning and dynamic monitoring of risks. Furthermore, the practical effectiveness and the associated pattern for applying this software package to coal mining is analyzed. The study indicates that the presently developed coal mine occupational safety and health management and risk control technology and the associated software can support the occupational safety and health management efforts in coal mines in a standardized and effective manner. It can also control the accident risks scientifically and effectively; its effective implementation can further improve the coal mine occupational safety and health management mechanism, and further enhance the risk management approaches. Besides, its implementation indicates that the occupational safety and health management and risk control technology has been established based on a benign cycle involving dynamic feedback and scientific development, which can provide a reliable assurance to the safe operation of coal mines.

Research on Occupational Safety, Health Management and Risk Control Technology in Coal Mines

PubMed Central

Zhou, Lu-jie; Cao, Qing-gui; Yu, Kai; Wang, Lin-lin; Wang, Hai-bin

2018-01-01

This paper studies the occupational safety and health management methods as well as risk control technology associated with the coal mining industry, including daily management of occupational safety and health, identification and assessment of risks, early warning and dynamic monitoring of risks, etc.; also, a B/S mode software (Geting Coal Mine, Jining, Shandong, China), i.e., Coal Mine Occupational Safety and Health Management and Risk Control System, is developed to attain the aforementioned objectives, namely promoting the coal mine occupational safety and health management based on early warning and dynamic monitoring of risks. Furthermore, the practical effectiveness and the associated pattern for applying this software package to coal mining is analyzed. The study indicates that the presently developed coal mine occupational safety and health management and risk control technology and the associated software can support the occupational safety and health management efforts in coal mines in a standardized and effective manner. It can also control the accident risks scientifically and effectively; its effective implementation can further improve the coal mine occupational safety and health management mechanism, and further enhance the risk management approaches. Besides, its implementation indicates that the occupational safety and health management and risk control technology has been established based on a benign cycle involving dynamic feedback and scientific development, which can provide a reliable assurance to the safe operation of coal mines. PMID:29701715

Best practices in tobacco control in the South-East Asia Region.

PubMed

Zolty, B C; Sinha, P K; Sinha, D N

2012-01-01

The tobacco epidemic is an increasing threat to public health with the tobacco burden particularly high in WHO's South-East Asia Region (SEAR). The Region has many obstacles to tobacco control, but despite these challenges, significant progress has been made in many countries. Although much work still needs to be done, SEAR countries have nevertheless implemented strong and often innovative tobacco control measures that can be classified as "best practices," with some setting global precedents. The best practice measures implemented in SEAR include bans on gutka, reducing tobacco imagery in movies, and warning about the dangers of tobacco. In a time of scarce resources, countries in SEAR and elsewhere must ensure that the most effective and cost-efficient measures are implemented. It is hoped that countries can learn from these examples and as appropriate, adapt these measures to their own specific cultural, social and political realities.

SU43. The Effect of Implementation Intention on Different Types of Prospective Memory Performance in Patients With Schizophrenia

PubMed Central

Wang, Ya; Liu, Lu-lu; Gan, Ming-yuan; Tan, Shu-ping; Shum, David; Chan, Raymond

2017-01-01

Abstract Background: Prospective memory (PM) refers to remembering to execute a planned intention in the future, which can been divided as event-based PM (focal, nonfocal) and time-based PM according to the nature of the cue. Focal event-based PM, where the ongoing task requires processing of the characteristics of PM cues, has been found to be benefited from implementation intention (II, ie, an encoding strategy in the format of “if I see X, then I will do Y”). However, to date, it is unclear whether implementation intention can produce a positive effect on nonfocal event-based PM (where the ongoing task is irrelevant with the PM cues) and time-based PM. Moreover, patients with schizophrenia (SCZ) were found to have impairments in these types of PM, and few studies have been conducted to examine the effect of II on these types of PM. This study investigated whether (and how) implementation intention can improve nonfocal event-based PM and time-based PM performance in patients with SCZ. Methods: Forty-two patients with SCZ and 42 healthy control participants were administered both computerized nonfocal event-based PM task and time-based PM task. Patients and healthy controls were further randomly allocated to implementation intention condition (N = 21) and typical instruction condition (N = 21). Results: Patients with SCZ in the implementation intention group showed higher PM accuracy than the typical instruction group in both nonfocal event-based PM task (0.51 ± 0.32 vs 0.19 ± 0.29, t(40) = 3.39, P = .002) and time-based PM task (0.72 ± 0.31 vs 0.39 ± 0.40, t(40) = 2.98, P = .005). Similarly, healthy controls in the II group also showed better PM performance than the typical instruction group in both tasks (all P’s < 0.05). Time check frequency of time-based PM task in the II group of all the participants was significantly higher than the typical instruction group. Conclusion: Implementation intention is an effective strategy for improving different types of PM performance in patients with schizophrenia and can be applied for clinical settings.

Patient-Centered Personal Health Record and Portal Implementation Toolkit for Ambulatory Clinics: A Feasibility Study.

PubMed

Nahm, Eun-Shim; Diblasi, Catherine; Gonzales, Eva; Silver, Kristi; Zhu, Shijun; Sagherian, Knar; Kongs, Katherine

2017-04-01

Personal health records and patient portals have been shown to be effective in managing chronic illnesses. Despite recent nationwide implementation efforts, the personal health record and patient portal adoption rates among patients are low, and the lack of support for patients using the programs remains a critical gap in most implementation processes. In this study, we implemented the Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit in a large diabetes/endocrinology center and assessed its preliminary impact on personal health record and patient portal knowledge, self-efficacy, patient-provider communication, and adherence to treatment plans. Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit is composed of Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit-General, clinic-level resources for clinicians, staff, and patients, and Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit Plus, an optional 4-week online resource program for patients ("MyHealthPortal"). First, Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit-General was implemented, and all clinicians and staff were educated about the center's personal health record and patient portal. Then general patient education was initiated, while a randomized controlled trial was conducted to test the preliminary effects of "MyHealthPortal" using a small sample (n = 74) with three observations (baseline and 4 and 12 weeks). The intervention group showed significantly greater improvement than the control group in patient-provider communication at 4 weeks (t56 = 3.00, P = .004). For other variables, the intervention group tended to show greater improvement; however, the differences were not significant. In this preliminary study, Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit showed potential for filling the gap in the current personal health record and patient portal implementation process. Further studies are needed using larger samples in other settings to ascertain if these results are generalizable to other populations.

Variation in community intervention programmes and consequences for children and families: the example of Sure Start Local Programmes.

PubMed

Melhuish, Edward; Belsky, Jay; Anning, Angela; Ball, Mog; Barnes, Jacqueline; Romaniuk, Helena; Leyland, Alastair

2007-06-01

An area-based initiative, Sure Start Local Programmes (SSLPs), was established by the UK government to reduce social exclusion through improving the well-being of children aged 0-3 years and their families in disadvantaged communities; a true community intervention in that all children under four and their families in specified areas served as targets of universal services. A national evaluation examined the links between variation in programme implementation and effectiveness. Data gathered from multiple sources produced measures of implementation in terms of proficiency, services and staffing. Measures of programme impact on child/parenting outcomes derived from multilevel models, controlling for child, family and area characteristics, were identified to demonstrate programme effectiveness. Some modest linkage between programme implementation (e.g., proficiency, empowerment of parents and staff, identification of users) and effectiveness for child and parenting outcomes. Overall proficiency and specific aspects of implementation may influence effectiveness, which should guide the design of other child, family and community services.

Implementation of fuzzy-sliding mode based control of a grid connected photovoltaic system.

PubMed

Menadi, Abdelkrim; Abdeddaim, Sabrina; Ghamri, Ahmed; Betka, Achour

2015-09-01

The present work describes an optimal operation of a small scale photovoltaic system connected to a micro-grid, based on both sliding mode and fuzzy logic control. Real time implementation is done through a dSPACE 1104 single board, controlling a boost chopper on the PV array side and a voltage source inverter (VSI) on the grid side. The sliding mode controller tracks permanently the maximum power of the PV array regardless of atmospheric condition variations, while The fuzzy logic controller (FLC) regulates the DC-link voltage, and ensures via current control of the VSI a quasi-total transit of the extracted PV power to the grid under a unity power factor operation. Simulation results, carried out via Matlab-Simulink package were approved through experiment, showing the effectiveness of the proposed control techniques. Copyright © 2015. Published by Elsevier Ltd.

Nonlinear integral sliding mode control design of photovoltaic pumping system: Real time implementation.

PubMed

Chihi, Asma; Ben Azza, Hechmi; Jemli, Mohamed; Sellami, Anis

2017-09-01

The aim of this paper is to provide high performance control of pumping system. The proposed method is designed by an indirect field oriented control based on Sliding Mode (SM) technique. The first contribution of this work is to design modified switching surfaces which presented by adding an integral action to the considered controlled variables. Then, in order to prevent the chattering phenomenon, modified nonlinear component is developed. The SM concept and a Lyapunov function are combined to compute the Sliding Mode Control (SMC) gains. Besides, the motor performance is validated by numeric simulations and real time implementation using a dSpace system with DS1104 controller board. Also, to show the effectiveness of the proposed approach, the obtained results are compared with other techniques such as conventional PI, Proportional Sliding Mode (PSM) and backstepping controls. Copyright © 2017 ISA. Published by Elsevier Ltd. All rights reserved.

Polychlorinated Biphenyls in suspended-sediment samples from outfalls to Meandering Road Creek at Air Force Plant 4, Fort Worth, Texas, 2003-08

USGS Publications Warehouse

Braun, Christopher L.; Wilson, Jennifer T.

2010-01-01

Meandering Road Creek is an intermittent stream and tributary to Lake Worth, a reservoir on the West Fork Trinity River on the western edge of Fort Worth, Texas. U.S. Air Force Plant 4 (AFP4) is on the eastern shore of Woods Inlet, an arm of Lake Worth. Meandering Road Creek gains inflow from several stormwater outfalls as it flows across AFP4. Several studies have characterized polychlorinated biphenyls (PCBs) in the water and sediments of Lake Worth and Meandering Road Creek; sources of PCBs are believed to originate primarily from AFP4. Two previous U.S. Geological Survey (USGS) reports documented elevated PCB concentrations in surficial sediment samples from Woods Inlet relative to concentrations in surficial sediment samples from other parts of Lake Worth. The second of these two previous reports also identified some of the sources of PCBs to Lake Worth. These reports were followed by a third USGS report that documented the extent of PCB contamination in Meandering Road Creek and Woods Inlet and identified runoff from outfalls 4 and 5 at AFP4 as prominent sources of these PCBs. This report describes the results of a fourth study by the USGS, in cooperation with the Lockheed Martin Corporation, to investigate PCBs in suspended-sediment samples in storm runoff from outfalls 4 and 5 at AFP4 following the implementation of engineering controls designed to potentially alleviate PCB contamination in the drainage areas of these outfalls. Suspended-sediment samples collected from outfalls 4 and 5 during storms on March 2 and November 10, 2008, were analyzed for selected PCBs. Sums of concentrations of 18 reported PCB congeners (Sigma PCBc) in suspended-sediment samples collected before and after implementation of engineering controls are compared. At both outfalls, the Sigma PCBc before engineering controls was higher than the Sigma PCBc after engineering controls. The Sigma PCBc in suspended-sediment samples collected at AFP4 before and after implementation of engineering controls also is compared to the threshold effect concentration (TEC), the concentration below which adverse effects to benthic biota rarely occur. Sigma PCBc exceeded the TEC for 75 percent of the samples collected at outfall 4 and 67 percent of the samples collected at outfall 5 before the implementation of engineering controls. Sigma PCBc did not exceed the TEC in samples collected at either outfall 4 or outfall 5 after the implementation of engineering controls. The relative prominence of 10 selected PCB congeners was evaluated by graphical analysis of ratios of individual concentrations of the 10 PCB congeners to the sum of these PCB congeners. An overall decrease in concentrations of PCB congeners at outfalls 4 and 5 after implementation of engineering controls, as well as a shift in prominence from lighter, less chlorinated congeners to a heavier, more chlorinated congener might have resulted from the implementation of engineering controls. Because of the small number of samples collected and lack of runoff and precipitation data to evaluate comparability of sampling conditions before and after implementation of engineering controls, all conclusions are preliminary.

[Strategy of comprehensive control for schistosomiasis and its effect in key areas of Jiangsu Province].

PubMed

Sun, Le-Ping; Tian, Zeng-Xi; Yang, Kun; Hong, Qing-Biao; Gao, Yang; Gao, Yuan; Zhang, Lian-Heng; Yang, Guo-Jing; Min, Jie; Ge, Jun; Wu, Hong-Hui; Huang, Yi-Xin; Liang, You-Sheng

2011-12-01

To evaluate the effect of comprehensive control for schistosomiasis in key areas of Jiangsu Province. The basic data and the data of implementation of comprehensive control measures were collected from the key areas of Jiangsu Province, including 30 townships, 87 marshlands and 78 anchor points. A field survey was carried out to investigate the Oncomelania snail status by using the systematic sampling method and schistosomiasis morbidity in humans and animals in the 12 key counties (districts). The changes of snail status and morbidity of humans and animals were statistically analyzed in key counties (districts) where comprehensive control measures was implemented, and the effects of schistosomiasis control before and after the implementation of the comprehensive control were compared. From 2008 to 2010, a total of 84 100 harmless latrines were constructed, 339 600 persons were examined, 2.6938 million people received health education, 112 000 protective creams and 798 000 publicity materials were allocated, 9 085 domestic animals were reared in pens, 11 800 domestic animals were examined, 130 high-risk cattle were eliminated in 30 key townships of 12 countries (districts), Jiangsu Province. A total of 19 640.78 hm2 were controlled with molluscicides, 798 warning tablets were placed, 116.07 hm2 of farmlands were ploughed up and planted, 306.80 hm2 were dug for fish culture, and 506.74 hm2 were planted with trees for snail control in 87 high-risk marshlands. A total of 118.83 million Yuan were invested into the water resources development projects, 39.82 km-long rivers were dredged, 70.04 km-long bank were concreted, 30 culvert gates were re-constructed, and 22 snail sedimentation tanks were built. In the 78 anchor points, 95 harmless public toilets were built, 3 192 stool container were allocated, 28 700 boatmen were examined, 71 600 protective creams and 53 200 publicity materials were allocated, and 46 600 persons received health education. Following the implementation of comprehensive control, the settings with infected snails, infected snail areas, infection rates of snails reduced from 75, 802.73 hm2 and 0.10% before the comprehensive control in 2007 to all 0 in 2010, with reduction rates of all 100%. The infection rates of schistosome in both humans and domestic animals appeared declining trends in 12 counties (districts) from 2005 to 2010, and the human infection rates were 0.16%, 0.04%, 0.02%, 0.02%, 0.01% and 0.01%, respectively, while being 0.11%, 0.05%, 0, 0, 0 and 0, respectively in domestic animals. During the period of comprehensive control, totally 45 transmission-controlled townships and 183 villages were newly added. In 2010, all of the 12 counties (districts) reached the criteria of schistosomiasis transmission control. The comprehensive control with emphasis on the key areas where infected snails are found, is an effective measure to further facilitate schistosomiasis control and rapidly control the transmission of schistosomiasis.

Implementation of Treat-to-Target in Rheumatoid Arthritis Through a Learning Collaborative: Results of a Randomized Controlled Trial.

PubMed

Solomon, Daniel H; Losina, Elena; Lu, Bing; Zak, Agnes; Corrigan, Cassandra; Lee, Sara B; Agosti, Jenifer; Bitton, Asaf; Harrold, Leslie R; Pincus, Theodore; Radner, Helga; Yu, Zhi; Smolen, Josef S; Fraenkel, Liana; Katz, Jeffrey N

2017-07-01

Treat-to-target (TTT) is an accepted paradigm for the management of rheumatoid arthritis (RA), but some evidence suggests poor adherence. The purpose of this study was to test the effects of a group-based multisite improvement learning collaborative on adherence to TTT. We conducted a cluster-randomized quality-improvement trial with waitlist control across 11 rheumatology sites in the US. The intervention entailed a 9-month group-based learning collaborative that incorporated rapid-cycle improvement methods. A composite TTT implementation score was calculated as the percentage of 4 required items documented in the visit notes for each patient at 2 time points, as evaluated by trained staff. The mean change in the implementation score for TTT across all patients for the intervention sites was compared with that for the control sites after accounting for intracluster correlation using linear mixed models. Five sites with a total of 23 participating rheumatology providers were randomized to intervention and 6 sites with 23 participating rheumatology providers were randomized to the waitlist control. The intervention included 320 patients, and the control included 321 patients. At baseline, the mean TTT implementation score was 11% in both arms; after the 9-month intervention, the mean TTT implementation score was 57% in the intervention group and 25% in the control group (change in score of 46% for intervention and 14% for control; P = 0.004). We did not observe excessive use of resources or excessive occurrence of adverse events in the intervention arm. A learning collaborative resulted in substantial improvements in adherence to TTT for the management of RA. This study supports the use of an educational collaborative to improve quality. © 2017, American College of Rheumatology.

Update and extension of the Brazil SimSmoke model to estimate the health impact of cigarette smoking by pregnant women in Brazil.

PubMed

Szklo, André Salem; Yuan, Zhe; Levy, David

2017-12-18

A previous application of the Brazil SimSmoke tobacco control policy simulation model was used to show the effect of policies implemented between 1989 and 2010 on smoking-attributable deaths (SADs). In this study, we updated and further validated the Brazil SimSmoke model to incorporate policies implemented since 2011 (e.g., a new tax structure with the purpose of increasing revenues/real prices). In addition, we extended the model to estimate smoking-attributable maternal and child health outcomes (MCHOs), such as placenta praevia, placental abruption, preterm birth, low birth weight, and sudden infant death syndrome, to show the role of tobacco control in achieving the Millennium Development Goals. Using data on population, births, smoking, policies, and prevalence of MCHOs, the model is used to assess the effect on both premature deaths and MCHOs of tobacco control policies implemented in Brazil in the last 25 years relative to a counterfactual of policies kept at 1989 levels. Smoking prevalence in Brazil has fallen by an additional 17% for males (16%-19%) and 19% for females (14%-24%) between 2011 and 2015. As a result of the policies implemented since 1989, 7.5 million (6.4-8.5) deaths among adults aged 18 years or older are projected to be averted by 2050. Current policies are also estimated to reduce a cumulative total of 0.9 million (0.4-2.4) adverse MCHOs by 2050. Our findings show the benefits of tobacco control in reducing both SADs and smoking-attributable MCHOs at population level. These benefits may be used to better inform policy makers in low and middle income countries about allocating resources towards tobacco control policies in this important area.

Design and implementation of a controlled clinical trial to evaluate the effectiveness and efficiency of routine opt-out rapid human immunodeficiency virus screening in the emergency department.

PubMed

Haukoos, Jason S; Hopkins, Emily; Byyny, Richard L; Conroy, Amy A; Silverman, Morgan; Eisert, Sheri; Thrun, Mark; Wilson, Michael; Boyett, Brian; Heffelfinger, James D

2009-08-01

In 2006, the Centers for Disease Control and Prevention (CDC) released revised recommendations for performing human immunodeficiency virus (HIV) testing in health care settings, including implementing routine rapid HIV screening, the use of an integrated opt-out consent, and limited prevention counseling. Emergency departments (EDs) have been a primary focus of these efforts. These revised CDC recommendations were primarily based on feasibility studies and have not been evaluated through the application of rigorous research methods. This article describes the design and implementation of a large prospective controlled clinical trial to evaluate the CDC's recommendations in an ED setting. From April 15, 2007, through April 15, 2009, a prospective quasi-experimental equivalent time-samples clinical trial was performed to compare the clinical effectiveness and efficiency of routine (nontargeted) opt-out rapid HIV screening (intervention) to physician-directed diagnostic rapid HIV testing (control) in a high-volume urban ED. In addition, three nested observational studies were performed to evaluate the cost-effectiveness and patient and staff acceptance of the two rapid HIV testing methods. This article describes the rationale, methodologies, and study design features of this program evaluation clinical trial. It also provides details regarding the integration of the principal clinical trial and its nested observational studies. Such ED-based trials are rare, but serve to provide valid comparisons between testing approaches. Investigators should consider similar methodology when performing future ED-based health services research.

49 CFR 192.631 - Control room management.

Code of Federal Regulations, 2010 CFR

2010-10-01

... to exceed 15 months; and (5) Establish and implement procedures for when a different controller..., but at intervals not exceeding 15 months, to determine the effectiveness of the plan; (5) Monitor the...) (regarding fatigue), (i) (regarding compliance validation), and (j) (regarding compliance and deviations) of...

The role of evidence-based media advocacy in the promotion of tobacco control policies.

PubMed

Lane, Ch'uyasonqo H; Carter, Marina I

2012-06-01

This article discusses the role of evidence-based media advocacy in the promotion of tobacco control policies. Evidence is a driving force for campaigns seeking to implement a tobacco control policy. An effective campaign is based in evidence that demonstrates why a policy should be implemented, and what the potential benefits are. Media advocacy is the process of disseminating information through the communications media where the aim is to effect action, such as a change of policy, or to alter the public's view of an issue. Discussion focuses on: 1) the importance of, and methods for, collecting and communicating evidence and information to make it clear and usable for legislators, the media, and the public; and 2) the role of earned and paid media in advancing tobacco control issues. The discussion is made within the context of a specific advocacy example; in this case the 2010 campaign to increase the tobacco tax in Mexico.

The limitations in implementing and operating a rapid response system.

PubMed

Subramaniam, A; Botha, J; Tiruvoipati, R

2016-10-01

Despite the widespread introduction of rapid response systems (RRS)/medical emergency teams (MET), there is still controversy regarding how effective they are. While there are some observational studies showing improved outcomes with RRS, there are no data from randomised controlled trials to support the effectiveness. Nevertheless, the MET system has become a standard of care in many healthcare organisations. In this review, we present an overview of the limitations in implementing and operating a RRS in modern healthcare. © 2016 Royal Australasian College of Physicians.

Translating infection control guidelines into practice: implementation process within a health care institution.

PubMed

Raveis, Victoria H; Conway, Laurie J; Uchida, Mayuko; Pogorzelska-Maziarz, Monika; Larson, Elaine L; Stone, Patricia W

2014-04-01

Health-care-associated infections (HAIs) remain a major patient safety problem even as policy and programmatic efforts designed to reduce HAIs have increased. Although information on implementing effective infection control (IC) efforts has steadily grown, knowledge gaps remain regarding the organizational elements that improve bedside practice and accommodate variations in clinical care settings. We conducted in-depth, semistructured interviews in 11 hospitals across the United States with a range of hospital personnel involved in IC (n = 116). We examined the collective nature of IC and the organizational elements that can enable disparate groups to work together to prevent HAIs. Our content analysis of participants' narratives yielded a rich description of the organizational process of implementing adherence to IC. Findings document the dynamic, fluid, interactional, and reactive nature of this process. Three themes emerged: implementing adherence efforts institution-wide, promoting an institutional culture to sustain adherence, and contending with opposition to the IC mandate.

Controlling cardiovascular diseases in low and middle income countries by placing proof in pragmatism

PubMed Central

Owolabi, Mayowa; Miranda, Jaime J; Yaria, Joseph; Ovbiagele, Bruce

2016-01-01

Low and middle income countries (LMICs) bear a huge, disproportionate and growing burden of cardiovascular disease (CVD) which constitutes a threat to development. Efforts to tackle the global burden of CVD must therefore emphasise effective control in LMICs by addressing the challenge of scarce resources and lack of pragmatic guidelines for CVD prevention, treatment and rehabilitation. To address these gaps, in this analysis article, we present an implementation cycle for developing, contextualising, communicating and evaluating CVD recommendations for LMICs. This includes a translatability scale to rank the potential ease of implementing recommendations, prescriptions for engaging stakeholders in implementing the recommendations (stakeholders such as providers and physicians, patients and the populace, policymakers and payers) and strategies for enhancing feedback. This approach can help LMICs combat CVD despite limited resources, and can stimulate new implementation science hypotheses, research, evidence and impact. PMID:27840737

[Assessment of laboratory diagnostic network in the implementation of the Program for Viral Hepatitis Prevention and Control in São Paulo State, Brazil, 1997-2012].

PubMed

Marques, Cristiano Corrêa de Azevedo; Carvalheiro, José da Rocha

2017-01-01

to assess the performance of the diagnostic network in the implementation process of the Program for Viral Hepatitis Prevention and Control in São Paulo State, Brazil, from 1997 to 2012. evaluation study based on documentary research and structured interviews, combined with a historical series analysis of indicators developed to assess the implementation process of the program, using data from the Department of the Brazilian National Health System. from 1997 to 2012, the serology, biopsy and molecular biology diagnostic networks showed an increase in the coefficients of coverage of 7.4, 7.3, and 62.0 times, respectively, with an increase in cases detection and treatment access. despite the effective implementation of the diagnostic network, there is a need to review the search strategy for new cases, and access to liver biopsy, still insufficient to the program demand.

Vector control for malaria and other mosquito-borne diseases. Report of a WHO study group.

PubMed

1995-01-01

Since the Ministerial Conference on Malaria in 1992, which acknowledged the urgent need for worldwide commitment to malaria control, efforts have been directed to implementation of a Global Malaria Control Strategy. Vector control, an essential component of malaria control, has become less effective in recent years, partly as a result of poor use of alternative control tools, inappropriate use of insecticides, lack of an epidemiological basis for interventions, inadequate resources and infrastructure, and weak management. Changing environmental conditions, the behavioural characteristics of certain vectors, and resistance to insecticides have added to the difficulties. This report of a WHO Study Group provides guidelines for the planning, implementation and evaluation of cost-effective and sustainable vector control in the context of the Global Malaria Control Strategy. It reviews the available methods - indoor residual spraying, personal protection, larval control and environmental management - stressing the need for selective and flexible use of interventions according to local conditions. Requirements for data collection and the appropriate use of entomological parameters and techniques are discussed and priorities identified for the development of local capacity for vector control and for operational research. Emphasis is placed both on the monitoring and evaluation of vector control to ensure cost-effectiveness and on the development of strong managerial structures, which can support community participation and intersectoral collaboration and accommodate the control of other vector-borne diseases. The report concludes with recommendations aimed at promoting the targeted and efficient use of vector control in preventing and controlling malaria, thereby reducing the threat to health and socioeconomic development in many tropical countries.

Community perceptions on the community-directed treatment and school-based approaches for the control of schistosomiasis and soil-transmitted helminthiasis among school-age children in Lushoto District, Tanzania.

PubMed

Massa, K; Magnussen, P; Sheshe, A; Ntakamulenga, R; Ndawi, B; Olsen, A

2009-01-01

The success of the Community-Directed Treatment (ComDT) approach in the control of onchocerciasis and filariasis has caught the attention of other disease control programmes. In this study the ComDT approach was implemented and compared with the school-based approach for control of schistosomiasis and soil-transmitted helminthiasis among school-age children in Lushoto District, Tanzania. This was a qualitative study, consisting of in-depth interviews with village leaders, community drug distributors (CDDs) and schoolteachers, as well as focus group discussions with separate groups of mothers and fathers to assess the perceptions and experiences of the villagers on the implementation of the two approaches. It was found that the villagers accepted the ComDT approach and took the responsibility of selecting the CDDs, organizing and implementing their own method of distributing drugs to the school-age children in their villages. The ComDT approach was well received and was successfully implemented in the villages. Although the villagers pointed out the limitation in reaching the non-enrolled children in the school-based approach, they also expressed satisfaction with this approach. This study suggests that the ComDT approach is well accepted and can be implemented effectively to ensure better coverage of especially non-enrolled school-age children.

Mindfulness-Based Stress Release Program for University Employees: A Pilot, Waitlist-Controlled Trial and Implementation Replication.

PubMed

Koncz, Rebecca; Wolfenden, Fiona; Hassed, Craig; Chambers, Richard; Cohen, Julia; Glozier, Nicholas

2016-10-01

The aim of this study was to evaluate the effectiveness of a 6-week mindfulness-based stress release program (SRP) on stress and work engagement in fulltime university employees. Perceived stress, workplace wellbeing, and engagement were measured at baseline and within 1 week of the SRP completion, and contemporaneously 6 weeks apart for a waitlist control group. A second program was implemented to examine reproducibility of results. Fifty participants undertook the SRPs, and 29 participants were waitlisted. A significant improvement in distress, workplace wellbeing, and vigor was observed within the first SRP group, when compared with the control group. The improvement in distress and wellbeing was reproduced in the second SRP group. This study adds to the growing body of research that mindfulness may be an effective method for reducing workplace stress, improving employee wellbeing, and enhancing work engagement.

The efficacy of focus group discussion in teaching ESP speaking skill for prospective vocational school teacher

NASA Astrophysics Data System (ADS)

Nurmasitah, Sita; Faridi, Abdurrachman; Utomo, Aryo Baskoro; Astuti, Pudji

2018-03-01

The aims of the study were to implement the focus group discussion in teaching English for Specific Purposes (ESP) speaking skill for prospective Vocational School teacher and also to find out its effectiveness in improving their English speaking skill in ESP course. Quasi-experimental design was employed in this research. Thirty students of Family Welfare Vocational Education Study Program who were taking ESP course, were divided into two classes; experimental and control class. The research data were collected through interview, observation and the students' speaking assessment. The result showed that the implementation of focus group discussion method in the experimental class effectively increased the students' speaking skill compared to the control class.

Implementing an Antibiotic Stewardship Information System to Improve Hospital Infection Control: A Co-Design Process.

PubMed

Maia, Mélanie R; Simões, Alexandra; Lapão, Luís V

2018-01-01

HAITooL information system design and implementation was based on Design Science Research Methodology, ensuring full participation, in close collaboration, of researchers and a multidisciplinary team of healthcare professionals. HAITooL enables effective monitoring of antibiotic resistance, antibiotic use and provides an antibiotic prescription decision-supporting system by clinicians, strengthening the patient safety procedures. The design, development and implementation process reveals benefits in organizational and behavior change with significant success. Leadership commitment multidisciplinary team and mainly informaticians engagement was crucial to the implementation process. Participants' motivation and the final product delivery and evolution depends on that.

The Feedback Intervention Trial (FIT) — Improving Hand-Hygiene Compliance in UK Healthcare Workers: A Stepped Wedge Cluster Randomised Controlled Trial

PubMed Central

Fuller, Christopher; Michie, Susan; Savage, Joanne; McAteer, John; Besser, Sarah; Charlett, Andre; Hayward, Andrew; Cookson, Barry D.; Cooper, Ben S.; Duckworth, Georgia; Jeanes, Annette; Roberts, Jenny; Teare, Louise; Stone, Sheldon

2012-01-01

Introduction Achieving a sustained improvement in hand-hygiene compliance is the WHO’s first global patient safety challenge. There is no RCT evidence showing how to do this. Systematic reviews suggest feedback is most effective and call for long term well designed RCTs, applying behavioural theory to intervention design to optimise effectiveness. Methods Three year stepped wedge cluster RCT of a feedback intervention testing hypothesis that the intervention was more effective than routine practice in 16 English/Welsh Hospitals (16 Intensive Therapy Units [ITU]; 44 Acute Care of the Elderly [ACE] wards) routinely implementing a national cleanyourhands campaign). Intervention-based on Goal & Control theories. Repeating 4 week cycle (20 mins/week) of observation, feedback and personalised action planning, recorded on forms. Computer-generated stepwise entry of all hospitals to intervention. Hospitals aware only of own allocation. Primary outcome: direct blinded hand hygiene compliance (%). Results All 16 trusts (60 wards) randomised, 33 wards implemented intervention (11 ITU, 22 ACE). Mixed effects regression analysis (all wards) accounting for confounders, temporal trends, ward type and fidelity to intervention (forms/month used). Intention to Treat Analysis Estimated odds ratio (OR) for hand hygiene compliance rose post randomisation (1.44; 95% CI 1.18, 1.76;p<0.001) in ITUs but not ACE wards, equivalent to 7–9% absolute increase in compliance. Per-Protocol Analysis for Implementing Wards OR for compliance rose for both ACE (1.67 [1.28–2.22]; p<0.001) & ITUs (2.09 [1.55–2.81];p<0.001) equating to absolute increases of 10–13% and 13–18% respectively. Fidelity to intervention closely related to compliance on ITUs (OR 1.12 [1.04, 1.20];p = 0.003 per completed form) but not ACE wards. Conclusion Despite difficulties in implementation, intention-to-treat, per-protocol and fidelity to intervention, analyses showed an intervention coupling feedback to personalised action planning produced moderate but significant sustained improvements in hand-hygiene compliance, in wards implementing a national hand-hygiene campaign. Further implementation studies are needed to maximise the intervention’s effect in different settings. Trial Registration Controlled-Trials.com ISRCTN65246961 PMID:23110040

Design and implementation of visual-haptic assistive control system for virtual rehabilitation exercise and teleoperation manipulation.

PubMed

Veras, Eduardo J; De Laurentis, Kathryn J; Dubey, Rajiv

2008-01-01

This paper describes the design and implementation of a control system that integrates visual and haptic information to give assistive force feedback through a haptic controller (Omni Phantom) to the user. A sensor-based assistive function and velocity scaling program provides force feedback that helps the user complete trajectory following exercises for rehabilitation purposes. This system also incorporates a PUMA robot for teleoperation, which implements a camera and a laser range finder, controlled in real time by a PC, were implemented into the system to help the user to define the intended path to the selected target. The real-time force feedback from the remote robot to the haptic controller is made possible by using effective multithreading programming strategies in the control system design and by novel sensor integration. The sensor-based assistant function concept applied to teleoperation as well as shared control enhances the motion range and manipulation capabilities of the users executing rehabilitation exercises such as trajectory following along a sensor-based defined path. The system is modularly designed to allow for integration of different master devices and sensors. Furthermore, because this real-time system is versatile the haptic component can be used separately from the telerobotic component; in other words, one can use the haptic device for rehabilitation purposes for cases in which assistance is needed to perform tasks (e.g., stroke rehab) and also for teleoperation with force feedback and sensor assistance in either supervisory or automatic modes.

[Ten years of the WHO Framework Convention on Tobacco Control: progress in the Americas].

PubMed

Blanco, Adriana; Sandoval, Rosa Carolina; Martínez-López, Leticia; Caixeta, Roberta de Betânia

2017-01-01

The objective of this article is to analyze the progress made in the Americas in the implementation of the World Health Organization Framework Convention on Tobacco Control (FCTC) after its tenth anniversary of entry into force. At the time of the analysis, 30 of the 35 countries of the Americas are Parties to the FCTC. While progress has been made in implementing the measures contained in the FCTC, the level of implementation has not been homogeneous either across mandates or across countries. Forty percent of Parties to the Convention in the Americas are yet to implement any of the measures at their highest level of implementation according to the WHO classification. It is crucial that the countries of the Americas continue to progress towards the full implementation of the FCTC progressively. In these efforts, it is important to take into account that FCTC measures such as those related to smoke-free environments and adoption of effective health warnings are basic public health measures, which are almost entirely within the competence of health authorities and therefore susceptible to be implemented in a prompt fashion in all countries of the region.

40 CFR 49.10711 - Federal Implementation Plan for the Astaris-Idaho LLC Facility (formerly owned by FMC Corporation...

Code of Federal Regulations, 2013 CFR

2013-07-01

... this section and associated air pollution control equipment, in a manner consistent with good air... practices. (iii) To the maximum extent practicable the air pollution control equipment or processes were..., considering the effect of any proposed air pollution control equipment; and (D) A description of any PM-10...

76 FR 26609 - Revisions to the California State Implementation Plan, San Joaquin Valley Unified Air Pollution...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-09

... that manufacturers would be forced to alter the design or emission control equipment on new nonroad... in practical effect force manufacturers to alter the design or emission control equipment on new... manufacturer or user of a nonroad engine or vehicle to change the emission control design of the engine or...

76 FR 10249 - Approval and Promulgation of Air Quality Implementation Plans; Texas; Revisions To Control...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-24

... Container rule as an ozone control strategy from the Texas SIP for the Control of Ozone Air Pollution. In the submittal, Texas demonstrates that Federal portable fuel container standards promulgated by EPA in... Portable Fuel Container Regulations IV. What is the effect of this action? V. Final Action VI. Statutory...

High reduction of ozone and particulate matter during the 2016 G-20 summit in Hangzhou by forced emission controls of industry and traffic

EPA Science Inventory

Many regions in China experience air pollution episodes because of the rapid urbanization and industrialization over the past decades. Here we analyzed the effect of emission controls implemented during the G-20 2016 Hangzhou summit on air quality. Emission controls included a fo...

Ride quality sensitivity to SAS control law and to handling quality variations

NASA Technical Reports Server (NTRS)

Roberts, P. A.; Schmidt, D. K.; Swaim, R. L.

1976-01-01

The RQ trends which large flexible aircraft exhibit under various parameterizations of control laws and handling qualities are discussed. A summary of the assumptions and solution technique, a control law parameterization review, a discussion of ride sensitivity to handling qualities, and the RQ effects generated by implementing relaxed static stability configurations are included.

Effect of implementation intentions to change behaviour: moderation by intention stability.

PubMed

Godin, Gaston; Bélanger-Gravel, Ariane; Amireault, Steve; Gallani, Maria-Cecilia B J; Vohl, Marie-Claude; Pérusse, Louis

2010-02-01

The aim of this study was to assess the effects of implementation intentions on leisure-time physical activity, taking into account the stability of intention. At baseline (T0), 349 participants completed a psychosocial questionnaire and were randomly assigned to implementation intention or control condition. Three months after baseline assessment (T1), participants in the experimental group were asked to plan where, when, and how they would exercise. Leisure-time physical activity was assessed 3 mo. later (i.e., at 6-mo. follow-up; T2). The intervention had no significant effect on physical activity at 6-mo. follow-up. However, a significant interaction of group and intention stability was observed, with the effect of the intervention on behaviour statistically significant only among those with unstable intention. Intention stability thus moderated the effect of the intervention, i.e., the intervention was more successful among individuals who needed support to change (unstable intenders).

Single event effects in pulse width modulation controllers

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

Penzin, S.H.; Crain, W.R.; Crawford, K.B.

1996-12-01

SEE testing was performed on pulse width modulation (PWM) controllers which are commonly used in switching mode power supply systems. The devices are designed using both Set-Reset (SR) flip-flops and Toggle (T) flip-flops which are vulnerable to single event upset (SEU) in a radiation environment. Depending on the implementation of the different devices the effect can be significant in spaceflight hardware.

Effectiveness of simple control measures on methicillin-resistant Staphylococcus aureus infection status and characteristics with susceptibility patterns in a teaching hospital in Peshawar.

PubMed

Rafiq, Muhammad Salman; Rafiq, Muhammad Imran; Khan, Taimur; Rafiq, Maria; Khan, Mah Muneer

2015-09-01

To determine the effectiveness of simple control measures on the infection status and characteristics of methicillin-resistant Staphylococcus aureus including susceptibility patterns among health professionals and patients in a teaching hospital. The cross-sectional study was conducted from September 2013 to January 2014, and comprised samples collected from healthcare personnel and patients in the various units of Khyber Teaching Hospital, Peshawar. The specimens were collected before and one month after the implementation of simple control measures for outbreak prevention of methicillin-resistant Staphylococcus aureus. These were tested for culture and antimicrobial susceptibility. Data about methicillin-sensitive and methicillin-resistant Staphylococcus aureus infection, wound characteristics and susceptibility patterns was collected and effectiveness of simple control measures was determined. SPSS 20 was used for statistical analysis. Of the total 390 isolates, 180(46.2%) were Staphylococcus aureus; 77(19.7%) from healthcare personnel and 103(26.4%) from patients. Of these, 164(42.1%) were methicillin-sensitive and 16(4.1%) were methicillin-resistant. Among the patients, 38(15.1%) methicillin-sensitive and 8(3.2%) methicillin-resistant isolates were recovered from wounds or skin and soft tissues. Pus with 33(13.1%) and 4(1.6%) cases respectively was the second most common source. Among methicillin-resistant isolates, resistance to Linezolid was 0%, all were resistant to Oxacillin, Cefoxitin, Amoxicillin, Cefotaxime and Cephradine, and resistance to both Co-Amoxiclav and Ciprofloxacin was 87.5%. After one month of implementation of simple control measures, the number of methicillin-resistant cases among healthcare professionals and patients dropped from 4(2.9%) and 7(10.8%) to 1(0.7%) and 5(2.7%), respectively. Methicillin-resistant and methicillin-sensitive Staphylococcus aureus differed in their anti-microbial susceptibility profiles. Selection of antibiotics based on susceptibility and culture is needed for prevention of resistance and effective treatment. A decrease was observed in methicillin-resistant cases with implementation of control measures.

Effects of an educational intervention based on the protection motivation theory and implementation intentions on first and second pap test practice in Iran.

PubMed

Dehdari, Tahereh; Hassani, Laleh; Hajizadeh, Ebrahim; Shojaeizadeh, Davoud; Nedjat, Saharnaz; Abedini, Mehrandokht

2014-01-01

Few Iranian women take the Papanicolaou test despite its important role in preventing cervical cancer. This study aimed to determine the effectiveness of an educational intervention based on the protection motivation theory (PMT) variables and implementation intentions in the first and second Pap test practice among Iranian women. In this quasi-randomized controlled trial, 200 women who were referred to 30 primary health care clinics in Tehran were randomly selected. PMT variables and Pap test practice were measured at baseline and again after 3 and 15 months. The 4-week educational intervention program was conducted for the intervention group. Following the intervention, the mean scores of self-efficacy, perceived vulnerability, and behavior intention variables were significantly higher in the intervention group when compared to the control group (p<0.05). No significant differences were found in the perceived severity, response efficacy, response cost, and fear between the two groups following the intervention. Higher percent of women in the intervention group had obtained first and second Pap test compared to the controls. The PMT and implementation intentions provide a suitable theory-based framework for developing educational interventions regarding Pap test practice in Iran.

Protocol for a statewide randomized controlled trial to compare three training models for implementing an evidence-based treatment.

PubMed

Herschell, Amy D; Kolko, David J; Scudder, Ashley T; Taber-Thomas, Sarah; Schaffner, Kristen F; Hiegel, Shelley A; Iyengar, Satish; Chaffin, Mark; Mrozowski, Stanley

2015-09-28

Evidence-based treatments (EBTs) are available for treating childhood behavioral health challenges. Despite EBTs' potential to help children and families, they have primarily remained in university settings. Little empirical evidence exists regarding how specific, commonly used training and quality control models are effective in changing practice, achieving full implementation, and supporting positive client outcomes. This study (NIMH RO1 MH095750; ClinicalTrials.gov Identifier: NCT02543359), which is currently in progress, will evaluate the effectiveness of three training models (Learning Collaborative (LC), Cascading Model (CM), and Distance Education (DE)) to implement a well-established EBT , Parent-Child Interaction Therapy, in real-world, community settings. The three models differ in their costs, skill training, quality control methods, and capacity to address broader implementation challenges. The project is guided by three specific aims: (1) to build knowledge about training outcomes, (2) to build knowledge about implementation outcomes, and (3) to test the differential impact of training clinicians using LC, CM, and DE models on key client outcomes. Fifty (50) licensed psychiatric clinics across Pennsylvania were randomized to one of the three training conditions: (1) LC, (2) CM, or (3) DE. The impact of training on practice skills (clinician level) and implementation/sustainment outcomes (clinic level) are being evaluated at four timepoints coinciding with the training schedule: baseline, 6 (mid), 12 (post), and 24 months (1 year follow-up). Immediately after training begins, parent-child dyads (client level) are recruited from the caseloads of participating clinicians. Client outcomes are being assessed at four timepoints (pre-treatment, 1, 6, and 12 months after the pre-treatment). This proposal builds on an ongoing initiative to implement an EBT statewide. A team of diverse stakeholders including state policy makers, payers, consumers, service providers, and academics from different, but complementary areas (e.g., public health, social work, psychiatry), has been assembled to guide the research plan by incorporating input from multidimensional perspective. ClinicalTrials.gov: NCT02543359.

Functional Basis for Efficient Physical Layer Classical Control in Quantum Processors

NASA Astrophysics Data System (ADS)

Ball, Harrison; Nguyen, Trung; Leong, Philip H. W.; Biercuk, Michael J.

2016-12-01

The rapid progress seen in the development of quantum-coherent devices for information processing has motivated serious consideration of quantum computer architecture and organization. One topic which remains open for investigation and optimization relates to the design of the classical-quantum interface, where control operations on individual qubits are applied according to higher-level algorithms; accommodating competing demands on performance and scalability remains a major outstanding challenge. In this work, we present a resource-efficient, scalable framework for the implementation of embedded physical layer classical controllers for quantum-information systems. Design drivers and key functionalities are introduced, leading to the selection of Walsh functions as an effective functional basis for both programing and controller hardware implementation. This approach leverages the simplicity of real-time Walsh-function generation in classical digital hardware, and the fact that a wide variety of physical layer controls, such as dynamic error suppression, are known to fall within the Walsh family. We experimentally implement a real-time field-programmable-gate-array-based Walsh controller producing Walsh timing signals and Walsh-synthesized analog waveforms appropriate for critical tasks in error-resistant quantum control and noise characterization. These demonstrations represent the first step towards a unified framework for the realization of physical layer controls compatible with large-scale quantum-information processing.

The effect of implementing an automated oxygen control on oxygen saturation in preterm infants.

PubMed

Van Zanten, H A; Kuypers, K L A M; Stenson, B J; Bachman, T E; Pauws, S C; Te Pas, A B

2017-09-01

To evaluate the effect of implementing automated oxygen control as routine care in maintaining oxygen saturation (SpO 2 ) within target range in preterm infants. Infants <30 weeks gestation in Leiden University Medical Centre before and after the implementation of automated oxygen control were compared. The percentage of time spent with SpO 2 within and outside the target range (90-95%) was calculated. SpO 2 values were collected every minute and included for analysis when infants received extra oxygen. In a period of 9 months, 42 preterm infants (21 manual, 21 automated) were studied. In the automated period, the median (IQR) time spent with SpO 2 within target range increased (manual vs automated: 48.4 (41.5-56.4)% vs 61.9 (48.5-72.3)%; p<0.01) and time SpO 2 >95% decreased (41.9 (30.6-49.4)% vs 19.3 (11.5-24.5)%; p<0.001). The time SpO 2 <90% increased (8.6 (7.2-11.7)% vs 15.1 (14.0-21.1)%; p<0.0001), while SpO 2 <80% was similar (1.1 (0.4-1.7)% vs 0.9 (0.5-2.1)%; ns). During oxygen therapy, preterm infants spent more time within the SpO 2 target range after implementation of automated oxygen control, with a significant reduction in hyperoxaemia, but not hypoxaemia. 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/.

An Orbit And Dispersion Correction Scheme for the PEP II

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

Cai, Y.; Donald, M.; Shoaee, H.

2011-09-01

To achieve optimum luminosity in a storage ring it is vital to control the residual vertical dispersion. In the original PEP storage ring, a scheme to control the residual dispersion function was implemented using the ring orbit as the controlling element. The 'best' orbit not necessarily giving the lowest vertical dispersion. A similar scheme has been implemented in both the on-line control code and in the simulation code LEGO. The method involves finding the response matrices (sensitivity of orbit/dispersion at each Beam-Position-Monitor (BPM) to each orbit corrector) and solving in a least squares sense for minimum orbit, dispersion function ormore » both. The optimum solution is usually a subset of the full least squares solution. A scheme of simultaneously correcting the orbits and dispersion has been implemented in the simulation code and on-line control system for PEP-II. The scheme is based on the eigenvector decomposition method. An important ingredient of the scheme is to choose the optimum eigenvectors that minimize the orbit, dispersion and corrector strength. Simulations indicate this to be a very effective way to control the vertical residual dispersion.« less

Technology Integration (Task 20) Aeroservoelastic Modeling and Design Studies. Part A; Evaluation of Aeroservoelastic Effects on Flutter and Dynamic Gust Response

NASA Technical Reports Server (NTRS)

Nagaraja, K. S.; Kraft, R. H.

1999-01-01

The HSCT Flight Controls Group has developed longitudinal control laws, utilizing PTC aeroelastic flexible models to minimize aeroservoelastic interaction effects, for a number of flight conditions. The control law design process resulted in a higher order controller and utilized a large number of sensors distributed along the body for minimizing the flexibility effects. Processes were developed to implement these higher order control laws for performing the dynamic gust loads and flutter analyses. The processes and its validation were documented in Reference 2, for selected flight condition. The analytical results for additional flight conditions are presented in this document for further validation.

Cost-effectiveness analysis of population-based tobacco control strategies in the prevention of cardiovascular diseases in Tanzania.

PubMed

Ngalesoni, Frida; Ruhago, George; Mayige, Mary; Oliveira, Tiago Cravo; Robberstad, Bjarne; Norheim, Ole Frithjof; Higashi, Hideki

2017-01-01

Tobacco consumption contributes significantly to the global burden of disease. The prevalence of smoking is estimated to be increasing in many low-income countries, including Tanzania, especially among women and youth. Even so, the implementation of tobacco control measures has been discouraging in the country. Efforts to foster investment in tobacco control are hindered by lack of evidence on what works and at what cost. We aim to estimate the cost and cost-effectiveness of population-based tobacco control strategies in the prevention of cardiovascular diseases (CVD) in Tanzania. A cost-effectiveness analysis was performed using an Excel-based Markov model, from a governmental perspective. We employed an ingredient approach and step-down methodologies in the costing exercise following a government perspective. Epidemiological data and efficacy inputs were derived from the literature. We used disability-adjusted life years (DALYs) averted as the outcome measure. A probabilistic sensitivity analysis was carried out with Ersatz to incorporate uncertainties in the model parameters. Our model results showed that all five tobacco control strategies were very cost-effective since they fell below the ceiling ratio of one GDP per capita suggested by the WHO. Increase in tobacco taxes was the most cost-effective strategy, while a workplace smoking ban was the least cost-effective option, with a cost-effectiveness ratio of US$5 and US$267, respectively. Even though all five interventions are deemed very cost-effective in the prevention of CVD in Tanzania, more research on budget impact analysis is required to further assess the government's ability to implement these interventions.

Food safety and nutritional quality for the prevention of non communicable diseases: the Nutrient, hazard Analysis and Critical Control Point process (NACCP).

PubMed

Di Renzo, Laura; Colica, Carmen; Carraro, Alberto; Cenci Goga, Beniamino; Marsella, Luigi Tonino; Botta, Roberto; Colombo, Maria Laura; Gratteri, Santo; Chang, Ting Fa Margherita; Droli, Maurizio; Sarlo, Francesca; De Lorenzo, Antonino

2015-04-23

The important role of food and nutrition in public health is being increasingly recognized as crucial for its potential impact on health-related quality of life and the economy, both at the societal and individual levels. The prevalence of non-communicable diseases calls for a reformulation of our view of food. The Hazard Analysis and Critical Control Point (HACCP) system, first implemented in the EU with the Directive 43/93/CEE, later replaced by Regulation CE 178/2002 and Regulation CE 852/2004, is the internationally agreed approach for food safety control. Our aim is to develop a new procedure for the assessment of the Nutrient, hazard Analysis and Critical Control Point (NACCP) process, for total quality management (TMQ), and optimize nutritional levels. NACCP was based on four general principles: i) guarantee of health maintenance; ii) evaluate and assure the nutritional quality of food and TMQ; iii) give correct information to the consumers; iv) ensure an ethical profit. There are three stages for the application of the NACCP process: 1) application of NACCP for quality principles; 2) application of NACCP for health principals; 3) implementation of the NACCP process. The actions are: 1) identification of nutritional markers, which must remain intact throughout the food supply chain; 2) identification of critical control points which must monitored in order to minimize the likelihood of a reduction in quality; 3) establishment of critical limits to maintain adequate levels of nutrient; 4) establishment, and implementation of effective monitoring procedures of critical control points; 5) establishment of corrective actions; 6) identification of metabolic biomarkers; 7) evaluation of the effects of food intake, through the application of specific clinical trials; 8) establishment of procedures for consumer information; 9) implementation of the Health claim Regulation EU 1924/2006; 10) starting a training program. We calculate the risk assessment as follows: Risk (R) = probability (P) × damage (D). The NACCP process considers the entire food supply chain "from farm to consumer"; in each point of the chain it is necessary implement a tight monitoring in order to guarantee optimal nutritional quality.

An application of high authority/low authority control and positivity

NASA Technical Reports Server (NTRS)

Seltzer, S. M.; Irwin, D.; Tollison, D.; Waites, H. B.

1988-01-01

Control Dynamics Company (CDy), in conjunction with NASA Marshall Space Flight Center (MSFC), has supported the U.S. Air Force Wright Aeronautical Laboratory (AFWAL) in conducting an investigation of the implementation of several DOD controls techniques. These techniques are to provide vibration suppression and precise attitude control for flexible space structures. AFWAL issued a contract to Control Dynamics to perform this work under the Active Control Technique Evaluation for Spacecraft (ACES) Program. The High Authority Control/Low Authority Control (HAC/LAC) and Positivity controls techniques, which were cultivated under the DARPA Active Control of Space Structures (ACOSS) Program, were applied to a structural model of the NASA/MSFC Ground Test Facility ACES configuration. The control systems design were accomplished and linear post-analyses of the closed-loop systems are provided. The control system designs take into account effects of sampling and delay in the control computer. Nonlinear simulation runs were used to verify the control system designs and implementations in the facility control computers. Finally, test results are given to verify operations of the control systems in the test facility.

Report: EPA Should Assess Needs and Implement Management Controls to Ensure Effective Incorporation of Chemical Safety Research Products

EPA Pesticide Factsheets

Report #17-P-0294, June 23, 2017. With management controls that ensure the collaborative development of research products and prioritize chemical safety research needs, the EPA would be better able to conduct faster chemical risk assessments.

Improving low-wage, midsized employers' health promotion practices: a randomized controlled trial.

PubMed

Hannon, Peggy A; Harris, Jeffrey R; Sopher, Carrie J; Kuniyuki, Alan; Ghosh, Donetta L; Henderson, Shelly; Martin, Diane P; Weaver, Marcia R; Williams, Barbara; Albano, Denise L; Meischke, Hendrika; Diehr, Paula; Lichiello, Patricia; Hammerback, Kristen E; Parks, Malcolm R; Forehand, Mark

2012-08-01

The Guide to Community Preventive Services (Community Guide) offers evidence-based intervention strategies to prevent chronic disease. The American Cancer Society (ACS) and the University of Washington Health Promotion Research Center co-developed ACS Workplace Solutions (WPS) to improve workplaces' implementation of Community Guide strategies. To test the effectiveness of WPS for midsized employers in low-wage industries. Two-arm RCT; workplaces were randomized to receive WPS during the study (intervention group) or at the end of the study (delayed control group). Forty-eight midsized employers (100-999 workers) in King County WA. WPS provides employers one-on-one consulting with an ACS interventionist via three meetings at the workplace. The interventionist recommends best practices to adopt based on the workplace's current practices, provides implementation toolkits for the best practices the employer chooses to adopt, conducts a follow-up visit at 6 months, and provides technical assistance. Employers' implementation of 16 best practices (in the categories of insurance benefits, health-related policies, programs, tracking, and health communications) at baseline (June 2007-June 2008) and 15-month follow-up (October 2008-December 2009). Data were analyzed in 2010-2011. Intervention employers demonstrated greater improvement from baseline than control employers in two of the five best-practice categories; implementing policies (baseline scores: 39% program, 43% control; follow-up scores: 49% program, 45% control; p=0.013) and communications (baseline scores: 42% program, 44% control; follow-up scores: 76% program, 55% control; p=0.007). Total best-practice implementation improvement did not differ between study groups (baseline scores: 32% intervention, 37% control; follow-up scores: 39% intervention, 42% control; p=0.328). WPS improved employers' health-related policies and communications but did not improve insurance benefits design, programs, or tracking. Many employers were unable to modify insurance benefits and reported that the time and costs of implementing best practices were major barriers. This study is registered at clinicaltrials.gov NCT00452816. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Altering school climate through school-wide Positive Behavioral Interventions and Supports: findings from a group-randomized effectiveness trial.

PubMed

Bradshaw, Catherine P; Koth, Christine W; Thornton, Leslie A; Leaf, Philip J

2009-06-01

Positive Behavioral Interventions and Supports (PBIS) is a universal, school-wide prevention strategy that is currently implemented in over 7,500 schools to reduce disruptive behavior problems. The present study examines the impact of PBIS on staff reports of school organizational health using data from a group-randomized controlled effectiveness trial of PBIS conducted in 37 elementary schools. Longitudinal multilevel analyses on data from 2,596 staff revealed a significant effect of PBIS on the schools' overall organizational health, resource influence, staff affiliation, and academic emphasis over the 5-year trial; the effects on collegial leadership and institutional integrity were significant when implementation fidelity was included in the model. Trained schools that adopted PBIS the fastest tended to have higher levels of organizational health at baseline, but the later-implementing schools tended to experience the greatest improvements in organizational health after implementing PBIS. This study indicated that changes in school organizational health are important consequences of the PBIS whole-school prevention model, and may in turn be a potential contextual mediator of the effect of PBIS on student performance.

Increasing Confidence and Ability in Implementing Kangaroo Mother Care Method Among Young Mothers.

PubMed

Kenanga Purbasary, Eleni; Rustina, Yeni; Budiarti, Tri

Mothers giving birth to low birth weight babies (LBWBs) have low confidence in caring for their babies because they are often still young and may lack the knowledge, experience, and ability to care for the baby. This research aims to determine the effect of education about kangaroo mother care (KMC) on the confidence and ability of young mothers to implement KMC. The research methodology used was a controlled-random experimental approach with pre- and post-test equivalent groups of 13 mothers and their LBWBs in the intervention group and 13 mothers and their LBWBs in the control group. Data were collected via an instrument measuring young mothers' confidence, the validity and reliability of which have been tested with a resulting r value of .941, and an observation sheet on KMC implementation. After conducting the education, the confidence score of young mothers and their ability to perform KMC increased meaningfully. The score of confidence of young mothers before education was 37 (p = .1555: and the ability score for KMC Implementation before education was 9 (p = .1555). The median score of confidence of young mothers after education in the intervention group was 87 and in the control group was 50 (p = .001, 95% CI 60.36-75.56), and ability median score for KMC implementation after education in the intervention group was 16 and in the control group was 12 (p = .001, 95% CI 1.50-1.88). KMC education should be conducted gradually, and it is necessary to involve the family, in order for KMC implementation to continue at home. A family visit can be done for LBWBs to evaluate the ability of the young mothers to implement KMC.

Vibration control of building structures using self-organizing and self-learning neural networks

NASA Astrophysics Data System (ADS)

Madan, Alok

2005-11-01

Past research in artificial intelligence establishes that artificial neural networks (ANN) are effective and efficient computational processors for performing a variety of tasks including pattern recognition, classification, associative recall, combinatorial problem solving, adaptive control, multi-sensor data fusion, noise filtering and data compression, modelling and forecasting. The paper presents a potentially feasible approach for training ANN in active control of earthquake-induced vibrations in building structures without the aid of teacher signals (i.e. target control forces). A counter-propagation neural network is trained to output the control forces that are required to reduce the structural vibrations in the absence of any feedback on the correctness of the output control forces (i.e. without any information on the errors in output activations of the network). The present study shows that, in principle, the counter-propagation network (CPN) can learn from the control environment to compute the required control forces without the supervision of a teacher (unsupervised learning). Simulated case studies are presented to demonstrate the feasibility of implementing the unsupervised learning approach in ANN for effective vibration control of structures under the influence of earthquake ground motions. The proposed learning methodology obviates the need for developing a mathematical model of structural dynamics or training a separate neural network to emulate the structural response for implementation in practice.

GestationaL Obesity Weight management: Implementation of National Guidelines (GLOWING): a pilot cluster randomised controlled trial of a guideline implementation intervention for the management of maternal obesity by midwives.

PubMed

Heslehurst, Nicola; Rankin, Judith; McParlin, Catherine; Sniehotta, Falko F; Howel, Denise; Rice, Stephen; McColl, Elaine

2018-01-01

Weight management in pregnancy guidelines exist, although dissemination alone is an ineffective means of implementation. Midwives identify the need for support to overcome complex barriers to practice. An evaluation of an intervention to support midwives' guideline implementation would require a large-scale cluster randomised controlled trial. A pilot study is necessary to explore the feasibility of delivery and evaluation prior to a definitive trial. The GestationaL Obesity Weight management: Implementation of National Guidelines (GLOWING) trial aims to test whether it is feasible and acceptable to deliver a behaviour change intervention to support midwives' implementation of weight management guidelines. GLOWING is a multi-centre parallel group pilot cluster randomised controlled trial comparing the delivery of a behaviour change intervention for midwives versus usual practice. Four NHS Trusts (clusters) will be randomised to intervention and control arms, stratified by size of maternity services. The intervention uses social cognitive theory and consists of face-to-face midwifery training plus information resources for routine practice. The main outcomes are whether the intervention and trial procedures are feasible and acceptable to participants and the feasibility of recruitment and data collection for a definitive trial. Target recruitment involves all eligible midwives in the intervention arm recruited to receive the intervention, 30 midwives and pregnant women per arm for baseline and outcome questionnaire data collection and 20 midwives and women to provide qualitative data. All quantitative and qualitative analyses will be descriptive with the purpose of informing the development of the definitive trial. This pilot study has been developed to support community midwives' implementation of guidelines. Community midwives have been selected as they usually carry out the booking appointment which includes measuring and discussing maternal body mass index. A cluster design is the gold standard in implementation research as there would be a high risk of contamination if randomisation was at individual midwife level: community midwives usually work in locality-based teams, interact on a daily basis, and share care of pregnant women. The results of the pilot trial will be used to further develop and refine GLOWING prior to a definitive trial to evaluate effectiveness and cost-effectiveness. ISRCTN46869894; retrospectively registered 25th May 2016.

Stochastic receding horizon control: application to an octopedal robot

NASA Astrophysics Data System (ADS)

Shah, Shridhar K.; Tanner, Herbert G.

2013-06-01

Miniature autonomous systems are being developed under ARL's Micro Autonomous Systems and Technology (MAST). These systems can only be fitted with a small-size processor, and their motion behavior is inherently uncertain due to manufacturing and platform-ground interactions. One way to capture this uncertainty is through a stochastic model. This paper deals with stochastic motion control design and implementation for MAST- specific eight-legged miniature crawling robots, which have been kinematically modeled as systems exhibiting the behavior of a Dubin's car with stochastic noise. The control design takes the form of stochastic receding horizon control, and is implemented on a Gumstix Overo Fire COM with 720 MHz processor and 512 MB RAM, weighing 5.5 g. The experimental results show the effectiveness of this control law for miniature autonomous systems perturbed by stochastic noise.

Implementation of robotic force control with position accommodation

NASA Technical Reports Server (NTRS)

Ryan, Michael J.

1992-01-01

As the need for robotic manipulation in fields such as manufacturing and telerobotics increases, so does the need for effective methods of controlling the interaction forces between the manipulators and their environment. Position Accommodation (PA) is a form of robotic force control where the nominal path of the manipulator is modified in response to forces and torques sensed at the tool-tip of the manipulator. The response is tailored such that the manipulator emulates a mechanical impedance to its environment. PA falls under the category of position-based robotic force control, and may be viewed as a form of Impedance Control. The practical implementations are explored of PA into an 18 degree-of-freedom robotic testbed consisting of two PUMA 560 arms mounted on two 3 DOF positioning platforms. Single and dual-arm architectures for PA are presented along with some experimental results. Characteristics of position-based force control are discussed, along with some of the limitations of PA.

Data-driven gradient algorithm for high-precision quantum control

NASA Astrophysics Data System (ADS)

Wu, Re-Bing; Chu, Bing; Owens, David H.; Rabitz, Herschel

2018-04-01

In the quest to achieve scalable quantum information processing technologies, gradient-based optimal control algorithms (e.g., grape) are broadly used for implementing high-precision quantum gates, but their performance is often hindered by deterministic or random errors in the system model and the control electronics. In this paper, we show that grape can be taught to be more effective by jointly learning from the design model and the experimental data obtained from process tomography. The resulting data-driven gradient optimization algorithm (d-grape) can in principle correct all deterministic gate errors, with a mild efficiency loss. The d-grape algorithm may become more powerful with broadband controls that involve a large number of control parameters, while other algorithms usually slow down due to the increased size of the search space. These advantages are demonstrated by simulating the implementation of a two-qubit controlled-not gate.

Sliding mode control of dissolved oxygen in an integrated nitrogen removal process in a sequencing batch reactor (SBR).

PubMed

Muñoz, C; Young, H; Antileo, C; Bornhardt, C

2009-01-01

This paper presents a sliding mode controller (SMC) for dissolved oxygen (DO) in an integrated nitrogen removal process carried out in a suspended biomass sequencing batch reactor (SBR). The SMC performance was compared against an auto-tuning PI controller with parameters adjusted at the beginning of the batch cycle. A method for cancelling the slow DO sensor dynamics was implemented by using a first order model of the sensor. Tests in a lab-scale reactor showed that the SMC offers a better disturbance rejection capability than the auto-tuning PI controller, furthermore providing reasonable performance in a wide range of operation. Thus, SMC becomes an effective robust nonlinear tool to the DO control in this process, being also simple from a computational point of view, allowing its implementation in devices such as industrial programmable logic controllers (PLCs).

Achieving the Framework Convention on Tobacco Control's potential by investing in national capacity.

PubMed

Wipfli, H; Stillman, F; Tamplin, S; da Costa e Silva, V Luiza; Yach, D; Samet, J

2004-12-01

May 2003 marked a critical achievement in efforts to stem the global tobacco epidemic, as the member states of the World Health Organization unanimously endorsed the Framework Convention on Tobacco Control (FCTC). However, the adoption of the FCTC signifies only the end of the beginning of effective global action to control tobacco. Over the next several years the utility of the FCTC process and the treaty itself will be tested as individual countries seek to ratify and implement the treaty's obligations. Significant barriers to the treaty's long term success exist in many countries. It is crucial that the international tobacco control community now refocuses its efforts on national capacity building and ensures that individual countries have the knowledge, tools, data, people, and organisations needed to implement the convention and develop sustained tobacco control programmes. This paper provides a model of national tobacco control capacity and offers a prioritised agenda for action.

Strategies for controlling item exposure in computerized adaptive testing with the partial credit model.

PubMed

Davis, Laurie Laughlin; Dodd, Barbara G

2008-01-01

Exposure control research with polytomous item pools has determined that randomization procedures can be very effective for controlling test security in computerized adaptive testing (CAT). The current study investigated the performance of four procedures for controlling item exposure in a CAT under the partial credit model. In addition to a no exposure control baseline condition, the Kingsbury-Zara, modified-within-.10-logits, Sympson-Hetter, and conditional Sympson-Hetter procedures were implemented to control exposure rates. The Kingsbury-Zara and the modified-within-.10-logits procedures were implemented with 3 and 6 item candidate conditions. The results show that the Kingsbury-Zara and modified-within-.10-logits procedures with 6 item candidates performed as well as the conditional Sympson-Hetter in terms of exposure rates, overlap rates, and pool utilization. These two procedures are strongly recommended for use with partial credit CATs due to their simplicity and strength of their results.

Nurse-led motivational interviewing to change the lifestyle of patients with type 2 diabetes (MILD-project): protocol for a cluster, randomized, controlled trial on implementing lifestyle recommendations

PubMed Central

Jansink, Renate; Braspenning, Jozé; van der Weijden, Trudy; Niessen, Louis; Elwyn, Glyn; Grol, Richard

2009-01-01

Background The diabetes of many patients is managed in general practice; healthcare providers aim to promote healthful behaviors, such as healthful diet, adequate physical activity, and smoking cessation. These measures may decrease insulin resistance, improve glycemic control, lipid abnormalities, and hypertension. They may also prevent cardiovascular disease and complications of diabetes. However, professionals do not adhere optimally to guidelines for lifestyle counseling. Motivational interviewing to change the lifestyle of patients with type 2 diabetes is intended to improve diabetes care in accordance with the national guidelines for lifestyle counseling. Primary care nurses will be trained in motivational interviewing embedded in structured care in general practice. The aim of this paper is to describe the design and methods of a study evaluating the effects of the nurses' training on patient outcomes. Methods/Design A cluster, randomized, controlled trial involving 70 general practices (35 practices in the intervention arm and 35 in the control arm) starting in March 2007. A total of 700 patients with type 2 diabetes will be recruited. The patients in the intervention arm will receive care from the primary care nurse, who will receive training in an implementation strategy with motivational interviewing as the core component. Other components of this strategy will be adaptation of the diabetes protocol to local circumstances, introduction of a social map for lifestyle support, and educational and supportive tools for sustaining motivational interviewing. The control arm will be encouraged to maintain usual care. The effect measures will be the care process, metabolic parameters (glycosylated hemoglobin, blood pressure and lipids), lifestyle (diet, physical activity, smoking, and alcohol), health-related quality of life, and patients' willingness to change behaviors. The measurements will take place at baseline and after 14 months. Discussion Applying motivational interviewing for patients with diabetes in primary care has been studied, but to our knowledge, no other study has yet evaluated the implementation and sustainability of motivating and involving patients in day-to-day diabetes care in general practice. If this intervention proves to be effective and cost-effective, large-scale implementation of this nurse-oriented intervention will be considered and anticipated. Trial registration Current Controlled Trials ISRCTN68707773. PMID:19183462

Alternative control techniques document: NOx emissions from industrial/commercial/institutional (ICI) boilers

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

Not Available

1994-03-01

Industrial, commercial, and institutional (ICI) boilers have been identified as a category that emits more than 25 tons of oxides of nitrogen (NOx) per year. This alternative control techniques (ACT) document provides technical information for use by State and local agencies to develop and implement regulatory programs to control NOx emissions from ICI boilers. Additional ACT documents are being developed for other stationary source categories. Chapter 2 summarizes the findings of this study. Chapter 3 presents information on the ICI boiler types, fuels, operation, and industry applications. Chapter 4 discusses NOx formation and uncontrolled NOx emission factors. Chapter 5 coversmore » alternative control techniques and achievable controlled emission levels. Chapter 6 presents the cost and cost effectiveness of each control technique. Chapter 7 describes environmental and energy impacts associated with implementing the NOx control techniques. Finally, Appendices A through G provide the detailed data used in this study to evaluate uncontrolled and controlled emissions and the costs of controls for several retrofit scenarios.« less

Brazilian doctors' perspective on the second opinion strategy before a C-section.

PubMed

Osis, Maria José Duarte; Cecatti, José Guilherme; de Pádua, Karla Simônia; Faúndes, Anibal

2006-04-01

To describe the opinion of doctors who participated in the Latin American Study on Cesarean section in Brazil regarding the second opinion strategy when faced with the decision of performing a C-section. Seventy-two doctors from the hospitals where the study took place (where the second opinion was routinely sought) and 70 from the control group answered a pre-tested self-administered structured questionnaire. Descriptive tables were prepared based on the frequency of relevant variables on opinion of physicians regarding: effectiveness of the application of the second opinion strategy; on whether they would recommend implementation of this strategy and reasons for not recommending it in private institutions; feasibility of the strategy implementation and reasons for not considering this implementation feasible in private institutions. Half of the doctors from the intervention hospitals (50%) and about two thirds of those in the control group (65%) evaluated the second opinion as being or having the potential of being effective/very effective in their institutions. The great majority of those interviewed from both intervention and control hospitals considered this strategy feasible in public (87% and 95% respectively) but not in private hospitals (64% and 70% respectively), mainly because in the latter the doctors would not accept interference from a colleague in their decision-making process. Although the second opinion strategy was perceived as effective in reducing C-section rates, doctors did not regard it feasible outside the public health system in Brazil.

The Healthy for Life Taekwondo Pilot Study: A Preliminary Evaluation of Effects on Executive Function and BMI, Feasibility, and Acceptability

PubMed Central

Lakes, Kimberley D.; Bryars, Tracy; Sirisinahal, Swetha; Salim, Nimrah; Arastoo, Sara; Emmerson, Natasha; Kang, Daniel; Shim, Lois; Wong, Doug; Kang, Chang Jin

2013-01-01

There is growing consensus that exercise improves cognitive functioning, but research is needed to identify exercise interventions that optimize effects on cognition. The objective of this pilot study was to evaluate Taekwondo implemented in public middle school physical education (PE). Two classes were randomly assigned to either: five sessions per week of PE or three sessions of PE and two sessions of Taekwondo. In PE sessions, evidence-based curriculum to address the Presidential Core Fitness Guidelines and California Physical Fitness Tests was implemented. Taekwondo sessions included traditional techniques and forms taught in an environment emphasizing respect and self-control. Sixty students were evaluated at baseline and during the last week of the intervention (nine months later). Differences in mean residualized change scores for parent-rated inhibitory behavioral control yielded a significant, large effect size (d =.95, p =.00), reflecting greater improvement among Taekwondo students. Results from an executive function computer-administered task revealed greater accuracy on the congruent trial (d = 2.00, p = .02) for Taekwondo students. Differences in mean residualized change scores for BMI z scores yielded a moderate, non-significant effect size (d = − .51, p = .16). The majority of Taekwondo students reported positive perceptions of Taekwondo and perceived self-improvement in self-control and physical fitness. Results suggest that Taekwondo is an exercise program that improves cognitive functioning and is both feasible and acceptable to implement in a public school setting. PMID:24563664

[Implementation of new guidelines for management of prelabour rupture of membranes did not have the desired effect].

PubMed

Kamper, Christina Hjørnet; Hvidman, Lone; Helmig, Rikke Bek

2014-02-03

Many resources are used in developing guidelines for the treatment and handling of different diseases and clinical situations. It is important to evaluate the effect of these guidelines; are they being followed and do they have the desired impact on patient care? This report describes a quality control evaluation of whether the implementation of a new PROM (prelabour rupture of membranes) management guideline at Department Y at the Aarhus University Hospital had the wanted effect on the length of labour, use of prophylactic antibiotics, frequency of neonatal admission and neonatal infection.

System dynamic modeling on construction waste management in Shenzhen, China.

PubMed

Tam, Vivian W Y; Li, Jingru; Cai, Hong

2014-05-01

This article examines the complexity of construction waste management in Shenzhen, Mainland China. In-depth analysis of waste generation, transportation, recycling, landfill and illegal dumping of various inherent management phases is explored. A system dynamics modeling using Stella model is developed. Effects of landfill charges and also penalties from illegal dumping are also simulated. The results show that the implementation of comprehensive policy on both landfill charges and illegal dumping can effectively control the illegal dumping behavior, and achieve comprehensive construction waste minimization. This article provides important recommendations for effective policy implementation and explores new perspectives for Shenzhen policy makers.

Receding horizon online optimization for torque control of gasoline engines.

PubMed

Kang, Mingxin; Shen, Tielong

2016-11-01

This paper proposes a model-based nonlinear receding horizon optimal control scheme for the engine torque tracking problem. The controller design directly employs the nonlinear model exploited based on mean-value modeling principle of engine systems without any linearizing reformation, and the online optimization is achieved by applying the Continuation/GMRES (generalized minimum residual) approach. Several receding horizon control schemes are designed to investigate the effects of the integral action and integral gain selection. Simulation analyses and experimental validations are implemented to demonstrate the real-time optimization performance and control effects of the proposed torque tracking controllers. Copyright © 2016 ISA. Published by Elsevier Ltd. All rights reserved.

Implementation of Adaptive Digital Controllers on Programmable Logic Devices

NASA Technical Reports Server (NTRS)

Gwaltney, David A.; King, Kenneth D.; Smith, Keary J.; Monenegro, Justino (Technical Monitor)

2002-01-01

Much has been made of the capabilities of FPGA's (Field Programmable Gate Arrays) in the hardware implementation of fast digital signal processing. Such capability also makes an FPGA a suitable platform for the digital implementation of closed loop controllers. Other researchers have implemented a variety of closed-loop digital controllers on FPGA's. Some of these controllers include the widely used proportional-integral-derivative (PID) controller, state space controllers, neural network and fuzzy logic based controllers. There are myriad advantages to utilizing an FPGA for discrete-time control functions which include the capability for reconfiguration when SRAM-based FPGA's are employed, fast parallel implementation of multiple control loops and implementations that can meet space level radiation tolerance requirements in a compact form-factor. Generally, a software implementation on a DSP (Digital Signal Processor) or microcontroller is used to implement digital controllers. At Marshall Space Flight Center, the Control Electronics Group has been studying adaptive discrete-time control of motor driven actuator systems using digital signal processor (DSP) devices. While small form factor, commercial DSP devices are now available with event capture, data conversion, pulse width modulated (PWM) outputs and communication peripherals, these devices are not currently available in designs and packages which meet space level radiation requirements. In general, very few DSP devices are produced that are designed to meet any level of radiation tolerance or hardness. The goal of this effort is to create a fully digital, flight ready controller design that utilizes an FPGA for implementation of signal conditioning for control feedback signals, generation of commands to the controlled system, and hardware insertion of adaptive control algorithm approaches. An alternative is required for compact implementation of such functionality to withstand the harsh environment encountered on spacecraft. Radiation tolerant FPGA's are a feasible option for reaching this goal.

Implementation of Adaptive Digital Controllers on Programmable Logic Devices

NASA Technical Reports Server (NTRS)

Gwaltney, David A.; King, Kenneth D.; Smith, Keary J.; Montenegro, Justino (Technical Monitor)

2002-01-01

Much has been made of the capabilities of Field Programmable Gate Arrays (FPGA's) in the hardware implementation of fast digital signal processing functions. Such capability also makes an FPGA a suitable platform for the digital implementation of closed loop controllers. Other researchers have implemented a variety of closed-loop digital controllers on FPGA's. Some of these controllers include the widely used Proportional-Integral-Derivative (PID) controller, state space controllers, neural network and fuzzy logic based controllers. There are myriad advantages to utilizing an FPGA for discrete-time control functions which include the capability for reconfiguration when SRAM- based FPGA's are employed, fast parallel implementation of multiple control loops and implementations that can meet space level radiation tolerance requirements in a compact form-factor. Generally, a software implementation on a Digital Signal Processor (DSP) device or microcontroller is used to implement digital controllers. At Marshall Space Flight Center, the Control Electronics Group has been studying adaptive discrete-time control of motor driven actuator systems using DSP devices. While small form factor, commercial DSP devices are now available with event capture, data conversion, Pulse Width Modulated (PWM) outputs and communication peripherals, these devices are not currently available in designs and packages which meet space level radiation requirements. In general, very few DSP devices are produced that are designed to meet any level of radiation tolerance or hardness. An alternative is required for compact implementation of such functionality to withstand the harsh environment encountered on spacemap. The goal of this effort is to create a fully digital, flight ready controller design that utilizes an FPGA for implementation of signal conditioning for control feedback signals, generation of commands to the controlled system, and hardware insertion of adaptive-control algorithm approaches. Radiation tolerant FPGA's are a feasible option for reaching this goal.

Scaling up malaria intervention "packages" in Senegal: using cost effectiveness data for improving allocative efficiency and programmatic decision-making.

PubMed

Faye, Sophie; Cico, Altea; Gueye, Alioune Badara; Baruwa, Elaine; Johns, Benjamin; Ndiop, Médoune; Alilio, Martin

2018-04-10

Senegal's National Malaria Control Programme (NMCP) implements control interventions in the form of targeted packages: (1) scale-up for impact (SUFI), which includes bed nets, intermittent preventive treatment in pregnancy, rapid diagnostic tests, and artemisinin combination therapy; (2) SUFI + reactive case investigation (focal test and treat); (3) SUFI + indoor residual spraying (IRS); (4) SUFI + seasonal malaria chemoprophylaxis (SMC); and, (5) SUFI + SMC + IRS. This study estimates the cost effectiveness of each of these packages to provide the NMCP with data for improving allocative efficiency and programmatic decision-making. This study is a retrospective analysis for the period 2013-2014 covering all 76 Senegal districts. The yearly implementation cost for each intervention was estimated and the information was aggregated into a package cost for all covered districts. The change in the burden of malaria associated with each package was estimated using the number of disability adjusted life-years (DALYs) averted. The cost effectiveness (cost per DALY averted) was then calculated for each package. The cost per DALY averted ranged from $76 to $1591 across packages. Using World Health Organization standards, 4 of the 5 packages were "very cost effective" (less than Senegal's GDP per capita). Relative to the 2 other packages implemented in malaria control districts, the SUFI + SMC package was the most cost-effective package at $76 per DALY averted. SMC seems to make IRS more cost effective: $582 per DALY averted for SUFI + IRS compared with $272 for the SUFI + IRS + SMC package. The SUFI + focal test and treat, implemented in malaria elimination districts, had a cost per DALY averted of $1591 and was only "cost-effective" (less than three times Senegal's per capita GDP). Senegal's choice of deploying malaria interventions by packages seems to be effectively targeting high burden areas with a wide range of interventions. However, not all districts showed the same level of performance, indicating that efficiency gains are still possible.

Digital redesign of anti-wind-up controller for cascaded analog system.

PubMed

Chen, Y S; Tsai, J S H; Shieh, L S; Moussighi, M M

2003-01-01

The cascaded conventional anti-wind-up (CAW) design method for integral controller is discussed. Then, the prediction-based digital redesign methodology is utilized to find the new pulse amplitude modulated (PAM) digital controller for effective digital control of the analog plant with input saturation constraint. The desired digital controller is determined from existing or pre-designed CAW analog controller. The proposed method provides a novel methodology for indirect digital design of a continuous-time unity output-feedback system with a cascaded analog controller as in the case of PID controllers for industrial control processes with the presence of actuator saturations. It enables us to implement an existing or pre-designed cascaded CAW analog controller via a digital controller effectively.

Twenty-five years of ecological recovery of East Fork Poplar Creek: review of environmental problems and remedial actions.

PubMed

Loar, James M; Stewart, Arthur J; Smith, John G

2011-06-01

In May 1985, a National Pollutant Discharge Elimination System permit was issued for the Department of Energy's Y-12 National Security Complex (Y-12 Complex) in Oak Ridge, Tennessee, USA, allowing discharge of effluents to East Fork Poplar Creek (EFPC). The effluents ranged from large volumes of chlorinated once-through cooling water and cooling tower blow-down to smaller discharges of treated and untreated process wastewaters, which contained a mixture of heavy metals, organics, and nutrients, especially nitrates. As a condition of the permit, a Biological Monitoring and Abatement Program (BMAP) was developed to meet two major objectives: demonstrate that the established effluent limitations were protecting the classified uses of EFPC, and document the ecological effects resulting from implementing a Water Pollution Control Program at the Y-12 Complex. The second objective is the primary focus of the other papers in this special series. This paper provides a history of pollution and the remedial actions that were implemented; describes the geographic setting of the study area; and characterizes the physicochemical attributes of the sampling sites, including changes in stream flow and temperature that occurred during implementation of the BMAP. Most of the actions taken under the Water Pollution Control Program were completed between 1986 and 1998, with as many as four years elapsing between some of the most significant actions. The Water Pollution Control Program included constructing nine new wastewater treatment facilities and implementation of several other pollution-reducing measures, such as a best management practices plan; area-source pollution control management; and various spill-prevention projects. Many of the major actions had readily discernable effects on the chemical and physical conditions of EFPC. As controls on effluents entering the stream were implemented, pollutant concentrations generally declined and, at least initially, the volume of water discharged from the Y-12 Complex declined. This reduction in discharge was of ecological concern and led to implementation of a flow management program for EFPC. Implementing flow management, in turn, led to substantial changes in chemical and physical conditions of the stream: stream discharge nearly doubled and stream temperatures decreased, becoming more similar to those in reference streams. While water quality clearly improved, meeting water quality standards alone does not guarantee protection of a waterbody's biological integrity. Results from studies on the ecological changes stemming from pollution-reduction actions, such as those presented in this series, also are needed to understand how best to restore or protect biological integrity and enhance ecological recovery in stream ecosystems. With a better knowledge of the ecological consequences of their decisions, environmental managers can better evaluate alternative actions and more accurately predict their effects.

Twenty-Five Years of Ecological Recovery of East Fork Poplar Creek: Review of Environmental Problems and Remedial Actions

NASA Astrophysics Data System (ADS)

Loar, James M.; Stewart, Arthur J.; Smith, John G.

2011-06-01

In May 1985, a National Pollutant Discharge Elimination System permit was issued for the Department of Energy's Y-12 National Security Complex (Y-12 Complex) in Oak Ridge, Tennessee, USA, allowing discharge of effluents to East Fork Poplar Creek (EFPC). The effluents ranged from large volumes of chlorinated once-through cooling water and cooling tower blow-down to smaller discharges of treated and untreated process wastewaters, which contained a mixture of heavy metals, organics, and nutrients, especially nitrates. As a condition of the permit, a Biological Monitoring and Abatement Program (BMAP) was developed to meet two major objectives: demonstrate that the established effluent limitations were protecting the classified uses of EFPC, and document the ecological effects resulting from implementing a Water Pollution Control Program at the Y-12 Complex. The second objective is the primary focus of the other papers in this special series. This paper provides a history of pollution and the remedial actions that were implemented; describes the geographic setting of the study area; and characterizes the physicochemical attributes of the sampling sites, including changes in stream flow and temperature that occurred during implementation of the BMAP. Most of the actions taken under the Water Pollution Control Program were completed between 1986 and 1998, with as many as four years elapsing between some of the most significant actions. The Water Pollution Control Program included constructing nine new wastewater treatment facilities and implementation of several other pollution-reducing measures, such as a best management practices plan; area-source pollution control management; and various spill-prevention projects. Many of the major actions had readily discernable effects on the chemical and physical conditions of EFPC. As controls on effluents entering the stream were implemented, pollutant concentrations generally declined and, at least initially, the volume of water discharged from the Y-12 Complex declined. This reduction in discharge was of ecological concern and led to implementation of a flow management program for EFPC. Implementing flow management, in turn, led to substantial changes in chemical and physical conditions of the stream: stream discharge nearly doubled and stream temperatures decreased, becoming more similar to those in reference streams. While water quality clearly improved, meeting water quality standards alone does not guarantee protection of a waterbody's biological integrity. Results from studies on the ecological changes stemming from pollution-reduction actions, such as those presented in this series, also are needed to understand how best to restore or protect biological integrity and enhance ecological recovery in stream ecosystems. With a better knowledge of the ecological consequences of their decisions, environmental managers can better evaluate alternative actions and more accurately predict their effects.

Evaluation of the implementation of the directly observed treatment strategy for tuberculosis in a large city.

PubMed

Lavôr, Débora Cristina Brasil da Silva; Pinheiro, Jair Dos Santos; Gonçalves, Maria Jacirema Ferreira

2016-04-01

To assess the degree of implementation of the Directly Observed Treatment, Short-course - DOTS for tuberculosis (TB) in a large city. Assessment of the implementation of the logic model, whose new cases of infectious pulmonary TB were recruited from specialized clinics and followed-up in basic health units. The judgment matrix covering the five components of the DOTS strategy were used. The result of the logic model indicates DOTS was partially implemented. In external, organizational and implementation contexts, the DOTS strategy was partially implemented; and, the effectiveness was not implemented. The partial implementation of the DOTS strategy in the city of Manaus did not reflect in TB control compliance, leading to low effectiveness of the program. Avaliar o grau de implantação da estratégia de tratamento diretamente observado (Directly Observed Treatment, Short-course - DOTS) para tuberculose (TB) em um município de grande porte. Avaliação de implantação por meio de modelo lógico, cujos casos novos de TB pulmonar bacilífera foram recrutados em ambulatórios especializados e acompanhados nas unidades básicas de saúde. Utilizou-se matriz de julgamento que abrange os cinco componentes da estratégia DOTS. O resultado do modelo lógico indica DOTS implantada parcialmente. Nos contextos externo, organizacional e de implantação, a estratégia DOTS está implantada parcialmente; e, na efetividade não está implantada. A implantação parcial da estratégia DOTS, na cidade de Manaus, reflete na não conformidade do controle da TB, levando à baixa efetividade do programa.

Implementation of Evidence-Based Employment Services in Specialty Mental Health

PubMed Central

Hamilton, Alison B; Cohen, Amy N; Glover, Dawn L; Whelan, Fiona; Chemerinski, Eran; McNagny, Kirk P; Mullins, Deborah; Reist, Christopher; Schubert, Max; Young, Alexander S

2013-01-01

Objective. Study a quality improvement approach for implementing evidence-based employment services at specialty mental health clinics. Data Sources/Study Setting. Semistructured interviews with clinicians and administrators before, during, and after implementation. Qualitative field notes, structured baseline and follow-up interviews with patients, semistructured interviews with patients after implementation, and administrative data. Study Design. Site-level controlled trial at four implementation and four control sites. Hybrid implementation–effectiveness study with mixed methods intervention evaluation design. Data Collection/Extraction Methods. Site visits, in-person and telephone interviews, patient surveys, patient self-assessment. A total of 801 patients completed baseline surveys and 53 clinicians and other clinical key stakeholders completed longitudinal qualitative interviews. Principal Findings. At baseline, sites varied in the availability, utilization, and quality of supported employment. Each site needed quality improvement for this service, though for differing reasons, with some needing development of the service itself and others needing increased service capacity. Improvements in knowledge, attitudes, beliefs, and referral behaviors were evident in mid- and postimplementation interviews, though some barriers persisted. Half of patients expressed an interest in working at baseline. Patients at implementation sites were 2.3 times more likely to receive employment services during the study year. Those who had a service visit were more likely to be employed at follow-up than those who did not. Conclusions. Studies of implementation and effectiveness require mixed methods to both enhance implementation in real time and provide context for interpretation of complex results. In this study, a quality improvement approach resulted in superior patient-level outcomes and improved clinician knowledge, attitudes, and behaviors, in the context of substantial variation among sites. PMID:24138608

Implementation and Research Priorities for FCTC Articles 13 and 16: Tobacco Advertising, Promotion, and Sponsorship and Sales to and by Minors

PubMed Central

2013-01-01

Introduction: Article 13 of the Framework Convention on Tobacco Control (FCTC) calls for a comprehensive ban on tobacco advertising, promotion, and sponsorship (TAPS), and Article 16 calls for prohibition of tobacco sales to and by minors. Although these mandates are based on sound science, many countries have found provision implementation to be rife with challenges. Objective: This paper reviews the history of tobacco marketing and minor access restrictions in high-, middle-, and low-income countries, identifying past challenges and successes. We consider current challenges to FCTC implementation, how these barriers can be addressed, and what research is necessary to support such efforts. Specifically, we identify implementation and research priorities for FCTC Articles 13 and 16. Discussion: Although a solid evidence base underpins the FCTC’s call for TAPS bans and minor access restrictions, we know substantially less about how best to implement these restrictions. Drawing on the regulatory experiences of high-, middle-, and low-income countries, we discern several implementation and research priorities, which are organized into 4 categories: policy enactment and enforcement, human capital expertise, the effects of FCTC marketing and youth access policies, and knowledge exchange and transfer among signatories. Future research should provide detailed case studies on implementation successes and failures, as well as insights into how knowledge of successful restrictions can be translated into tobacco control policy and practice and shared among different stakeholders. Conclusion: Tobacco marketing surveillance, sales-to-minors compliance checks, enforcement and evaluation of restriction policies, and capacity building and knowledge transfer are likely to prove central to effective implementation. PMID:23291641

Aerodynamic shape optimization of wing and wing-body configurations using control theory

NASA Technical Reports Server (NTRS)

Reuther, James; Jameson, Antony

1995-01-01

This paper describes the implementation of optimization techniques based on control theory for wing and wing-body design. In previous studies it was shown that control theory could be used to devise an effective optimization procedure for airfoils and wings in which the shape and the surrounding body-fitted mesh are both generated analytically, and the control is the mapping function. Recently, the method has been implemented for both potential flows and flows governed by the Euler equations using an alternative formulation which employs numerically generated grids, so that it can more easily be extended to treat general configurations. Here results are presented both for the optimization of a swept wing using an analytic mapping, and for the optimization of wing and wing-body configurations using a general mesh.

The effectiveness of clinical supervision for a group of ward managers based in a district general hospital: an evaluative study.

PubMed

Davis, Cynthia; Burke, Linda

2012-09-01

To present an evaluative audit assessing the effectiveness of clinical supervision for ward managers. A year-long project to introduce clinical supervision to ward managers was implemented and evaluated. The objectives were to evaluate staff perceptions of implementing clinical supervision and determine its outcomes. An audit evaluation process was used. Findings are presented against perceptions, implementation and reported outcomes of clinical supervision. Insights were gained into its relevance and importance to nurses and the organisation. Findings show that clinical supervision was perceived to be effective and helped improve patient care, but some feared it becoming a form of managerial control. Ward managers perceived advantages for personal and professional development from adopting this process. There is a need for greater understanding of clinical supervision before Trusts implement it. The introduction of a resource pack for clinical areas would also be of value. Finally, there needs to be a named person who has a special knowledge of clinical supervision to act as a champion and change agent in effecting implementation at both the executive level and within each clinical area. © 2011 Blackwell Publishing Ltd.

Control and synchronisation of a novel seven-dimensional hyperchaotic system with active control

NASA Astrophysics Data System (ADS)

Varan, Metin; Akgul, Akif

2018-04-01

In this work, active control method is proposed for controlling and synchronising seven-dimensional (7D) hyperchaotic systems. The seven-dimensional hyperchaotic system is considered for the implementation. Seven-dimensional hyperchaotic system is also investigated via time series, phase portraits and bifurcation diagrams. For understanding the impact of active controllers on global asymptotic stability of synchronisation and control errors, the Lyapunov function is used. Numerical analysis is done to reveal the effectiveness of applied active control method and the results are discussed.

75 FR 69791 - Risk Management Controls for Brokers or Dealers With Market Access

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-15

... relationship with the ultimate customer, can more effectively implement them. In addition, a broker or dealer... specific risk management controls and supervisory procedures to a customer that is a registered broker... such customer, based on its position in the transaction and relationship with the ultimate customer...

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

PubMed Central

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

2013-01-01

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

The role of public policies in reducing smoking prevalence: results from the Michigan SimSmoke tobacco policy simulation model.

PubMed

Levy, David T; Huang, An-Tsun; Havumaki, Joshua S; Meza, Rafael

2016-05-01

Michigan has implemented several of the tobacco control policies recommended by the World Health Organization MPOWER goals. We consider the effect of those policies and additional policies consistent with MPOWER goals on smoking prevalence and smoking-attributable deaths (SADs). The SimSmoke tobacco control policy simulation model is used to examine the effect of past policies and a set of additional policies to meet the MPOWER goals. The model is adapted to Michigan using state population, smoking, and policy data starting in 1993. SADs are estimated using standard attribution methods. Upon validating the model, SimSmoke is used to distinguish the effect of policies implemented since 1993 against a counterfactual with policies kept at their 1993 levels. The model is then used to project the effect of implementing stronger policies beginning in 2014. SimSmoke predicts smoking prevalence accurately between 1993 and 2010. Since 1993, a relative reduction in smoking rates of 22 % by 2013 and of 30 % by 2054 can be attributed to tobacco control policies. Of the 22 % reduction, 44 % is due to taxes, 28 % to smoke-free air laws, 26 % to cessation treatment policies, and 2 % to youth access. Moreover, 234,000 SADs are projected to be averted by 2054. With additional policies consistent with MPOWER goals, the model projects that, by 2054, smoking prevalence can be further reduced by 17 % with 80,000 deaths averted relative to the absence of those policies. Michigan SimSmoke shows that tobacco control policies, including cigarette taxes, smoke-free air laws, and cessation treatment policies, have substantially reduced smoking and SADs. Higher taxes, strong mass media campaigns, and cessation treatment policies would further reduce smoking prevalence and SADs.

The Role of Public Policies in Reducing Smoking Prevalence: Results from the Michigan SimSmoke Tobacco Policy Simulation Model

PubMed Central

Levy, David T.; Huang, An-Tsun; Havumaki, Joshua S.; Meza, Rafael

2016-01-01

Introduction Michigan has implemented several of the tobacco control policies recommended by the World Health Organization MPOWER goals. We consider the effect of those policies and additional policies consistent with MPOWER goals on smoking prevalence and smoking-attributable deaths (SADs). Methods The SimSmoke tobacco control policy simulation model is used to examine the effect of past policies and a set of additional policies to meet the MPOWER goals. The model is adapted to Michigan using state population, smoking and policy data starting in 1993. SADs are estimated using standard attribution methods. Upon validating the model, SimSmoke is used to distinguish the effect of policies implemented since 1993 against a counterfactual with policies kept at their 1993 levels. The model is then used to project the effect of implementing stronger policies beginning in 2014. Results SimSmoke predicts smoking prevalence accurately between 1993 and 2010. Since 1993, a relative reduction in smoking rates of 22% by 2013 and of 30% by 2054 can be attributed to tobacco control policies. Of the 22% reduction, 44% is due to taxes, 28% to smoke-free air laws, 26% to cessation treatment policies, and 2% to youth access. Moreover, 234,000 smoking-attributable deaths are projected to be averted by 2054. With additional policies consistent with MPOWER goals, the model projects that, by 2054, smoking prevalence can be further reduced by 17% with 80,000 deaths averted relative to the absence of those policies. Conclusions Michigan SimSmoke shows that tobacco control policies, including cigarette taxes, smoke-free air laws and cessation treatment policies, have substantially reduced smoking and smoking-attributable deaths. Higher taxes, strong mass media campaigns and cessation treatment policies would further reduce smoking prevalence and smoking-attributable deaths. PMID:26983616

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

PubMed

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

2013-01-01

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

Implementation and evaluation of a clinical pathway for TRAM breast reconstruction.

PubMed

Hwang, T G; Wilkins, E G; Lowery, J C; Gentile, J

2000-02-01

Among strategies recently proposed to reduce practice variation, promote quality, and control costs in health care delivery, the concept of the clinical pathway has received considerable attention. Because transverse rectus abdominis musculocutaneous (TRAM) breast reconstruction is a common and often costly intervention, this institution sought to evaluate cost and quality outcomes of a clinical pathways program for this procedure. The TRAM reconstruction clinical pathway was implemented in April of 1996 to standardize postoperative care in this patient population. Outcomes of consecutive pathway cases for the first 14 months of the program were assessed in a retrospective cohort design, by using all nonpathway TRAM cases from the 18 months immediately before pathway implementation as controls. Outcomes assessed included length of hospital stay, postoperative complications, total postoperative charges, and total postoperative costs in relative value units. Data on these dependent variables were collected from hospital charts and billing records. The effects of pathway implementation on the outcomes of interest were analyzed by using analysis of covariance to control for potential confounding by other independent variables, including surgical site (unilateral versus bilateral reconstructions), technique (pedicle versus free TRAMs), timing (immediate versus delayed reconstructions), and patient age. Finally, a comparison of variances in the outcomes of interest between the two groups was analyzed by using an Ftest. For all statistical tests, p values of < or = 0.05 were considered significant. Twenty-nine patients were treated in the TRAM pathway group, whereas the control population included 40 nonpathway patients. After implementation of the TRAM pathway, length of stay decreased from 6.0 to 5.2 days; total postoperative charges were reduced from $8587 to $7744; and total postoperative relative value unit utilization declined from 1686 to 1104. Analysis of covariance showed that the decreases in length of hospital stay and relative value units in the TRAM pathway were statistically significant (p = 0.05 and p = 0.007, respectively). By contrast, no significant increase in complications was observed after pathway implementation. Variability in the TRAM pathway group, as measured by SD, decreased significantly for both length of hospital stay (p = 0.039) and relative value units (p = 0.023). Implementation of the TRAM reconstruction clinical pathway resulted in significant declines in length of hospital stay and total costs. These decreases in resource utilization had no significant effect on postoperative complication rates. Although additional research is needed to further assess the impact of clinical pathways, this approach offers considerable promise for improving the cost-effectiveness of health care.

A multi-refuge study to evaluate the effectiveness of growing-season and dormant-season burns to control cattail

USGS Publications Warehouse

Gleason, Robert A.; Tangen, Brian A.; Laubhan, Murray K.; Lor, Socheata

2012-01-01

Proliferation of invasive cattails (for example, Typha x glauca, T. angustifolia) is a concern of wetland managers across the country, and numerous methods have been used to control the spatial extent and density of the plant. To date, however, no single method has proven widely or consistently effective at reducing the long-term growth and spread of these species. We performed a multi-refuge study to evaluate the relative effects of growing-season and dormant-season prescribed burns on cattail production and to gain insight on variables such as soil moisture, groundwater, and biomass that affect the efficacy of burning as a control method. Results indicate total cattail cover recovers to pre-burn levels within 1 year regardless of whether the controlled burn was implemented during the growing season or dormant season. Growing-season burns, however, did result in lower aboveground and belowground cattail biomass 1-year post-burn, whereas no significant change in biomass was detected for dormant-season burns. Study results support the premise that burns implemented during the growing season should have a greater effect on nutrient reserves and cattail re-growth. Results from this and other studies suggest long-term research that incorporates multiple management strategies will be required to evaluate the potential of prescribed burning as a method to control cattail.

Implications of alternative assumptions regarding future air pollution control in scenarios similar to the Representative Concentration Pathways

NASA Astrophysics Data System (ADS)

Chuwah, Clifford; van Noije, Twan; van Vuuren, Detlef P.; Hazeleger, Wilco; Strunk, Achim; Deetman, Sebastiaan; Beltran, Angelica Mendoza; van Vliet, Jasper

2013-11-01

The uncertain, future development of emissions of short-lived trace gases and aerosols forms a key factor for future air quality and climate forcing. The Representative Concentration Pathways (RCPs) only explore part of this range as they all assume that worldwide ambitious air pollution control policies will be implemented. In this study, we explore how different assumptions on future air pollution policy and climate policy lead to different concentrations of air pollutants for a set of RCP-like scenarios developed using the IMAGE model. These scenarios combine low and high air pollution variants of the scenarios with radiative forcing targets in 2100 of 2.6 W m-2 and 6.0 W m-2. Simulations using the global atmospheric chemistry and transport model TM5 for the present-day climate show that both climate mitigation and air pollution control policies have large-scale effects on pollutant concentrations, often of similar magnitude. If no further air pollution policies would be implemented, pollution levels could be considerably higher than in the RCPs, especially in Asia. Air pollution control measures could significantly reduce the warming by tropospheric ozone and black carbon and the cooling by sulphate by 2020, and in the longer term contribute to enhanced warming by methane. These effects tend to cancel each other on a global scale. According to our estimates the effect of the worldwide implementation of air pollution control measures on the total global mean direct radiative forcing in 2050 is +0.09 W m-2 in the 6.0 W m-2 scenario and -0.16 W m-2 in the 2.6 W m-2 scenario.

Community-based screening intervention for depression affects suicide rates among middle-aged Japanese adults.

PubMed

Oyama, H; Sakashita, T

2017-06-01

It has been suggested that screening interventions may be effective for suicide prevention. Few studies, however, have reported their effects on outcome measures, including death by suicide among middle-aged adults. We used a quasi-experimental parallel cluster design with matched community-based intervention and control municipalities (total eligible population: 90 000) in Japan. At-risk residents within the intervention area were invited for universal depression screening and subsequent care/support. We compared changes in suicide incidence of adults aged 40-64 years for the 4-year pre- and post-implementation periods in the intervention group with the control group and the whole country. Incidence rate ratios (IRRs) of the outcomes were adjusted for age group, gender and interaction terms, using mixed-effects negative binomial regression models. Suicide rates among intervention and control subgroups were compared. The screening procedure was offered to 52% of the intervention group, and 61% of those contacted responded over the implementation period. Suicide rates decreased more in the intervention group [IRR 0.57, 95% (CI) 0.41-0.78; F 1,36 = 12.52, p = 0.001] than the control group (IRR proportion 1.63, 95% CI 1.06-2.48; F 1,82 = 5.20, p = 0.025) or the whole country (IRR proportion 1.64, 95% CI 1.16-2.34; F 1,42 = 8.21, p = 0.006). Sensitivity analyses confirmed the results from the primary analysis. There were lower suicide rates among both respondents and non-respondents to the screening than in the control group during the implementation period. Prevention efforts involved in the depression screening intervention were probably successful in reducing suicide rates.

Measurement of Software Project Management Effectiveness

DTIC Science & Technology

2008-12-01

with technical, financial, policy, and non -technical concerns of stakeholders, to develop and select suitable risk control actions, and implementation...not intervene in their projects and therefore affect their views. In most research experiments, researchers apply a controlled event, method or...enable a consistency check among the responses and for other research purposes. Therefore, for the risk control area model, only the responses from

[The implementation gap in asthma prevention and control?].

PubMed

Demoly, Pascal; Just, Jocelyne; Annesi-Maesano, Isabella; Bousquet, Jean; Michel, François-Bernard

2014-01-01

Asthma and allergic diseases generally start early in life and persist throughout life but, for reasons we do not yet understand, they sometimes appear later Prevention, early diagnosis and treatment of these major chronic respiratory diseases is a recognized priority for EU public health policy and for the United Nations. As factors favoring allergy (rapid urbanization, pollution, climate change and infections) are not expected to change in the foreseeable future, it is crucial to develop, strengthen and optimize prevention and treatment. We have developed tools to control asthma but are still unable to prevent children from developing asthma and allergic diseases. This article examines what works and what does not, and analyzes the "missing links" between the creation and effective implementation of a prevention program, otherwise known as the implementation gap.

A cost and utility analysis of NIM/CAMAC standards and equipment for shuttle payload data acquisition and control systems. Volume 3: Tasks 3 and 4

NASA Technical Reports Server (NTRS)

1976-01-01

The modifications for the Nuclear Instrumentation Modular (NIM) and Computer Automated Measurement Control (CAMAC) equipment, designed for ground based laboratory use, that would be required to permit its use in the Spacelab environments were determined. The cost of these modifications were estimated and the most cost effective approach to implementing them were identified. A shared equipment implementation in which the various Spacelab users draw their required complement of standard NIM and CAMAC equipment for a given flight from a common equipment pool was considered. The alternative approach studied was a dedicated equipment implementation in which each of the users is responsible for procuring either their own NIM/CAMAC equipment or its custom built equivalent.

Biomechanical modeling and load-carrying simulation of lower limb exoskeleton.

PubMed

Zhu, Yanhe; Zhang, Guoan; Zhang, Chao; Liu, Gangfeng; Zhao, Jie

2015-01-01

This paper introduces novel modern equipment-a lower extremity exoskeleton, which can implement the mutual complement and the interaction between human intelligence and the robot's mechanical strength. In order to provide a reference for the exoskeleton structure and the drive unit, the human biomechanics were modeled and analyzed by LifeModeler and Adams software to derive each joint kinematic parameter. The control was designed to implement the zero-force interaction between human and exoskeleton. Furthermore, simulations were performed to verify the control and assist effect. In conclusion, the system scheme of lower extremity exoskeleton is demonstrated to be feasible.

Implementation of ionizing radiation environment requirements for Space Station

NASA Technical Reports Server (NTRS)

Boeder, Paul A.; Watts, John W.

1993-01-01

Proper functioning of Space Station hardware requires that the effects of high-energy ionizing particles from the natural environment and (possibly) from man-made sources be considered during design. At the Space Station orbit of 28.5-deg inclination and 330-440 km altitude, geomagnetically trapped protons and electrons contribute almost all of the dose, while galactic cosmic rays and anomalous cosmic rays may produce Single Event Upsets (SEUs), latchups, and burnouts of microelectronic devices. Implementing ionizing radiation environment requirements for Space Station has been a two part process, including the development of a description of the environment for imposing requirements on the design and the development of a control process for assessing how well the design addresses the effects of the ionizing radiation environment. We will review both the design requirements and the control process for addressing ionizing radiation effects on Space Station.

New food safety law: effectiveness on the ground.

PubMed

Drew, Christa A; Clydesdale, Fergus M

2015-01-01

The demand for safety in the US food supply from production to consumption necessitates a scientific, risk-based strategy for the management of microbiological, chemical, and physical hazards in food. The key to successful management is an increase in systematic collaboration and communication and in enforceable procedures with all domestic and international stakeholders. The enactment of the Food Safety Modernization Act (FSMA) aims to prevent or reduce large-scale food-borne illness outbreaks through stricter facility registration and records standards, mandatory prevention-based controls, increased facility inspections in the United States and internationally, mandatory recall authority, import controls, and increased consumer communication. The bill provisions are expected to cost $1.4 billion over the next four years. Effective implementation of the FSMA's 50 rules, reports, studies, and guidance documents in addition to an increased inspection burden requires further funding appropriations. Additional full-time inspectors and unprecedented foreign compliance is necessary for the full and effective implementation of the FSMA.

Effect of intensity and program delivery on the translation of DPP to worksites: A randomized controlled trial of Fuel Your Life

PubMed Central

DeJoy, David M.; Vandenberg, Robert J.; Corso, Phaedra; Padilla, Heather; Zuercher, Heather

2016-01-01

Objective To evaluate the effectiveness of the Fuel Your Life program, an adaptation of the Diabetes Prevention Program, utilizing implementation strategies commonly used in worksite programs – telephone coaching, small group coaching and self-study. Methods The primary outcomes of BMI and weight were examined in a randomized control trial conducted with city/county employees. Results Although the majority of participants in all three groups lost some weight, the phone group lost significantly more weight (4.9 lbs.), followed by the small groups (3.4 lbs.) and the self-study (2.7 lbs.). Of the total participants, 28.3% of the phone group, 20.6% of the small group and 15.7 of the self-study group lost 5% or more of their body weight. Conclusions Fuel Your Life (DPP) can be effectively disseminated using different implementation strategies that are tailored to the workplace. PMID:27820761

Visual Servoing for an Autonomous Hexarotor Using a Neural Network Based PID Controller.

PubMed

Lopez-Franco, Carlos; Gomez-Avila, Javier; Alanis, Alma Y; Arana-Daniel, Nancy; Villaseñor, Carlos

2017-08-12

In recent years, unmanned aerial vehicles (UAVs) have gained significant attention. However, we face two major drawbacks when working with UAVs: high nonlinearities and unknown position in 3D space since it is not provided with on-board sensors that can measure its position with respect to a global coordinate system. In this paper, we present a real-time implementation of a servo control, integrating vision sensors, with a neural proportional integral derivative (PID), in order to develop an hexarotor image based visual servo control (IBVS) that knows the position of the robot by using a velocity vector as a reference to control the hexarotor position. This integration requires a tight coordination between control algorithms, models of the system to be controlled, sensors, hardware and software platforms and well-defined interfaces, to allow the real-time implementation, as well as the design of different processing stages with their respective communication architecture. All of these issues and others provoke the idea that real-time implementations can be considered as a difficult task. For the purpose of showing the effectiveness of the sensor integration and control algorithm to address these issues on a high nonlinear system with noisy sensors as cameras, experiments were performed on the Asctec Firefly on-board computer, including both simulation and experimenta results.

Visual Servoing for an Autonomous Hexarotor Using a Neural Network Based PID Controller

PubMed Central

Lopez-Franco, Carlos; Alanis, Alma Y.; Arana-Daniel, Nancy; Villaseñor, Carlos

2017-01-01

In recent years, unmanned aerial vehicles (UAVs) have gained significant attention. However, we face two major drawbacks when working with UAVs: high nonlinearities and unknown position in 3D space since it is not provided with on-board sensors that can measure its position with respect to a global coordinate system. In this paper, we present a real-time implementation of a servo control, integrating vision sensors, with a neural proportional integral derivative (PID), in order to develop an hexarotor image based visual servo control (IBVS) that knows the position of the robot by using a velocity vector as a reference to control the hexarotor position. This integration requires a tight coordination between control algorithms, models of the system to be controlled, sensors, hardware and software platforms and well-defined interfaces, to allow the real-time implementation, as well as the design of different processing stages with their respective communication architecture. All of these issues and others provoke the idea that real-time implementations can be considered as a difficult task. For the purpose of showing the effectiveness of the sensor integration and control algorithm to address these issues on a high nonlinear system with noisy sensors as cameras, experiments were performed on the Asctec Firefly on-board computer, including both simulation and experimenta results. PMID:28805689

Implementation science in cancer prevention and control: a decade of grant funding by the National Cancer Institute and future directions.

PubMed

Neta, Gila; Sanchez, Michael A; Chambers, David A; Phillips, Siobhan M; Leyva, Bryan; Cynkin, Laurie; Farrell, Margaret M; Heurtin-Roberts, Suzanne; Vinson, Cynthia

2015-01-08

The National Cancer Institute (NCI) has supported implementation science for over a decade. We explore the application of implementation science across the cancer control continuum, including prevention, screening, treatment, and survivorship. We reviewed funding trends of implementation science grants funded by the NCI between 2000 and 2012. We assessed study characteristics including cancer topic, position on the T2-T4 translational continuum, intended use of frameworks, study design, settings, methods, and replication and cost considerations. We identified 67 NCI grant awards having an implementation science focus. R01 was the most common mechanism, and the total number of all awards increased from four in 2003 to 15 in 2012. Prevention grants were most frequent (49.3%) and cancer treatment least common (4.5%). Diffusion of Innovations and Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) were the most widely reported frameworks, but it is unclear how implementation science models informed planned study measures. Most grants (69%) included mixed methods, and half reported replication and cost considerations (49.3%). Implementation science in cancer research is active and diverse but could be enhanced by greater focus on measures development, assessment of how conceptual frameworks and their constructs lead to improved dissemination and implementation outcomes, and harmonization of measures that are valid, reliable, and practical across multiple settings.

Sustaining program effectiveness after implementation: The case of the self-management of well-being group intervention for older adults.

PubMed

Goedendorp, Martine M; Kuiper, Daphne; Reijneveld, Sijmen A; Sanderman, Robbert; Steverink, Nardi

2017-06-01

The Self-Management of Well-being (SMW) group intervention for older women was implemented in health and social care. Our aim was to assess whether effects of the SMW intervention were comparable with the original randomized controlled trial (RCT). Furthermore, we investigated threats to effectiveness, such as participant adherence, group reached, and program fidelity. In the implementation study (IMP) 287 and RCT 142 women participated. We compared scores on self-management ability and well-being of the IMP and RCT. For adherence, drop-out rates and session attendance were compared. Regarding reach, we compared participants' baseline characteristics. Professionals completed questions regarding program fidelity. No significant differences were found on effect outcomes and adherence between IMP and RCT (all p≥0.135). Intervention effect sizes were equal (0.47-0.59). IMP participants were significantly less lonely and more likely to be married, but had lower well-being. Most professionals followed the protocol, with only minimal deviations. The effectiveness of the SMW group intervention was reproduced after implementation, with similar participant adherence, minimal changes in the group reached, and high program fidelity. The SMW group intervention can be transferred to health and social care without loss of effectiveness. Implementation at a larger scale is warranted. Copyright © 2017 Elsevier B.V. All rights reserved.

Bio-inspired online variable recruitment control of fluidic artificial muscles

NASA Astrophysics Data System (ADS)

Jenkins, Tyler E.; Chapman, Edward M.; Bryant, Matthew

2016-12-01

This paper details the creation of a hybrid variable recruitment control scheme for fluidic artificial muscle (FAM) actuators with an emphasis on maximizing system efficiency and switching control performance. Variable recruitment is the process of altering a system’s active number of actuators, allowing operation in distinct force regimes. Previously, FAM variable recruitment was only quantified with offline, manual valve switching; this study addresses the creation and characterization of novel, on-line FAM switching control algorithms. The bio-inspired algorithms are implemented in conjunction with a PID and model-based controller, and applied to a simulated plant model. Variable recruitment transition effects and chatter rejection are explored via a sensitivity analysis, allowing a system designer to weigh tradeoffs in actuator modeling, algorithm choice, and necessary hardware. Variable recruitment is further developed through simulation of a robotic arm tracking a variety of spline position inputs, requiring several levels of actuator recruitment. Switching controller performance is quantified and compared with baseline systems lacking variable recruitment. The work extends current variable recruitment knowledge by creating novel online variable recruitment control schemes, and exploring how online actuator recruitment affects system efficiency and control performance. Key topics associated with implementing a variable recruitment scheme, including the effects of modeling inaccuracies, hardware considerations, and switching transition concerns are also addressed.

42 CFR 422.503 - General provisions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... oversight and control over the MA organization's policies and personnel to ensure that management actions... management aspects of the organization. (iii) At a minimum, an executive manager whose appointment and... effectiveness of the compliance programs. (C)(1) Each MA organization must establish and implement effective...

42 CFR 422.503 - General provisions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... oversight and control over the MA organization's policies and personnel to ensure that management actions... management aspects of the organization. (iii) At a minimum, an executive manager whose appointment and... effectiveness of the compliance programs. (C)(1) Each MA organization must establish and implement effective...

Communication Needs Assessment for Distributed Turbine Engine Control

NASA Technical Reports Server (NTRS)

Culley, Dennis E.; Behbahani, Alireza R.

2008-01-01

Control system architecture is a major contributor to future propulsion engine performance enhancement and life cycle cost reduction. The control system architecture can be a means to effect net weight reduction in future engine systems, provide a streamlined approach to system design and implementation, and enable new opportunities for performance optimization and increased awareness about system health. The transition from a centralized, point-to-point analog control topology to a modular, networked, distributed system is paramount to extracting these system improvements. However, distributed engine control systems are only possible through the successful design and implementation of a suitable communication system. In a networked system, understanding the data flow between control elements is a fundamental requirement for specifying the communication architecture which, itself, is dependent on the functional capability of electronics in the engine environment. This paper presents an assessment of the communication needs for distributed control using strawman designs and relates how system design decisions relate to overall goals as we progress from the baseline centralized architecture, through partially distributed and fully distributed control systems.

An Examination of Strategy Implementation During Abstract Nonlinguistic Category Learning in Aphasia

PubMed Central

Kiran, Swathi

2015-01-01

Purpose Our purpose was to study strategy use during nonlinguistic category learning in aphasia. Method Twelve control participants without aphasia and 53 participants with aphasia (PWA) completed a computerized feedback-based category learning task consisting of training and testing phases. Accuracy rates of categorization in testing phases were calculated. To evaluate strategy use, strategy analyses were conducted over training and testing phases. Participant data were compared with model data that simulated complex multi-cue, single feature, and random pattern strategies. Learning success and strategy use were evaluated within the context of standardized cognitive–linguistic assessments. Results Categorization accuracy was higher among control participants than among PWA. The majority of control participants implemented suboptimal or optimal multi-cue and single-feature strategies by testing phases of the experiment. In contrast, a large subgroup of PWA implemented random patterns, or no strategy, during both training and testing phases of the experiment. Conclusions Person-to-person variability arises not only in category learning ability but also in the strategies implemented to complete category learning tasks. PWA less frequently developed effective strategies during category learning tasks than control participants. Certain PWA may have impairments of strategy development or feedback processing not captured by language and currently probed cognitive abilities. PMID:25908438

PubMed

Balmaceda, Carlos; Espinoza, Manuel A; Diaz, Janepsy

2015-12-01

Bioequivalence has become a standard request for drug commercialization in most high income countries, and significant efforts have been made to implement it in many low and middle income countries. In Chile, the requirement of bioequivalency has been gradually implemented since 2008, associated to a communicational campaign to inform the general population about its scope and importance. The objective of this study is to estimate the effect of the implementation of bioequivalence on the prices of products that have been affected by this policy. We conducted a difference in difference study in a set of 30 chronic use drugs, selected from the eighty clinical guidelines published by the Chilean Ministry of Health. The effect was assessed according to the date when the corresponding ministerial decree was published. A control drugs was selected for each analyzed medication in order to estimate the effect of implementation independently of other factors of the market. We identified three groups of drugs: (i) those which experimented a significant increment of price due to bioequivalence; (ii) those where prices decreased; and (iii) those where prices did not (significantly changed) decrease. A sensitivity analysis complemented the study results and identified the significant effect of the date when the bioequivalence was implemented. It is concluded that the implementation of bioequivalence in Chile had a significant effect on prices of some medications. However, the magnitude and direction of such effect depends on the characteristics of the particular market defined by each drug. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Effect of a population-level performance dashboard intervention on maternal-newborn outcomes: an interrupted time series study.

PubMed

Weiss, Deborah; Dunn, Sandra I; Sprague, Ann E; Fell, Deshayne B; Grimshaw, Jeremy M; Darling, Elizabeth; Graham, Ian D; Harrold, JoAnn; Smith, Graeme N; Peterson, Wendy E; Reszel, Jessica; Lanes, Andrea; Walker, Mark C; Taljaard, Monica

2018-06-01

To assess the effect of the Maternal Newborn Dashboard on six key clinical performance indicators in the province of Ontario, Canada. Interrupted time series using population-based data from the provincial birth registry covering a 3-year period before implementation of the Dashboard and 2.5 years after implementation (November 2009 through March 2015). All hospitals in the province of Ontario providing maternal-newborn care (n=94). A hospital-based online audit and feedback programme. Rates of the six performance indicators included in the Dashboard. 2.5 years after implementation, the audit and feedback programme was associated with statistically significant absolute decreases in the rates of episiotomy (decrease of 1.5 per 100 women, 95% CI 0.64 to 2.39), induction for postdates in women who were less than 41 weeks at delivery (decrease of 11.7 per 100 women, 95% CI 7.4 to 16.0), repeat caesarean delivery in low-risk women performed before 39 weeks (decrease of 10.4 per 100 women, 95% CI 9.3 to 11.5) and an absolute increase in the rate of appropriately timed group B streptococcus screening (increase of 2.8 per 100, 95% CI 2.2 to 3.5). The audit and feedback programme did not significantly affect the rates of unsatisfactory newborn screening blood samples or formula supplementation at discharge. No statistically significant effects were observed for the two internal control outcomes or the four external control indicators-in fact, two external control indicators (episiotomy and postdates induction) worsened relative to before implementation. An electronic audit and feedback programme implemented in maternal-newborn hospitals was associated with clinically relevant practice improvements at the provincial level in the majority of targeted indicators. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Will the circle be unbroken: a history of the U.S. National Ambient Air Quality Standards.

PubMed

Bachmann, John

2007-06-01

In celebration of the 100th anniversary of the Air & Waste Management Association, this review examines the history of air quality management (AQM) in the United States over the last century, with an emphasis on the ambient standards programs established by the landmark 1970 Clean Air Act (CAA) Amendments. The current CAA system is a hybrid of several distinct air pollution control philosophies, including the recursive or circular system driven by ambient standards. Although this evolving system has resulted in tremendous improvements in air quality, it has been far from perfect in terms of timeliness and effectiveness. The paper looks at several periods in the history of the U.S. program, including: (1) 1900-1970, spanning the early smoke abatement and smog control programs, the first federal involvement, and the development of a hybrid AQM approach in the 1970 CAA; (2) 1971-1976, when the first National Ambient Air Quality Standards (NAAQS) were set and implemented; (3) 1977-1993, a period of the first revisions to the standards, new CAA Amendments, delays in implementation and decision-making, and key science/policy/legislative developments that would alter both the focus and scale of air pollution programs and how they are implemented; and (4) 1993-2006, the second and third wave of NAAQS revisions and their implementation in the context of the 1990 CAA. This discussion examines where NAAQS have helped drive implementation programs and how improvements in both effects and air quality/control sciences influenced policy and legislation to enhance the effectiveness of the system over time. The review concludes with a look toward the future of AQM, emphasizing challenges and ways to meet them. The most significant of these is the need to make more efficient progress toward air quality goals, while adjusting the system to address the growing intersections between air quality management and climate change.

Effect of an oral healthcare protocol in nursing homes on care staffs' knowledge and attitude towards oral health care: a cluster-randomised controlled trial.

PubMed

Janssens, Barbara; De Visschere, Luc; van der Putten, Gert-Jan; de Lugt-Lustig, Kersti; Schols, Jos M G A; Vanobbergen, Jacques

2016-06-01

To explore the impact of a supervised implementation of an oral healthcare protocol, in addition to education, on nurses' and nurses' aides' oral health-related knowledge and attitude. A random sample of 12 nursing homes, accommodating a total of 120-150 residents, was obtained using stratified cluster sampling with replacement. The intervention included the implementation of an oral healthcare protocol and three different educational stages. One of the investigators supervised the implementation process, supported by a dental hygienist. A 34-item questionnaire was developed and validated to evaluate the knowledge and attitude of nurses and nurses' aides at baseline and 6 months after the start of the intervention. Linear mixed-model analyses were performed to explore differences in knowledge and attitude at 6 months after implementation. At baseline, no significant differences were observed between the intervention and the control group for both knowledge (p = 0.42) and attitude (p = 0.37). Six months after the start of the intervention, significant differences were found between the intervention and the control group for the variable knowledge in favour of the intervention group (p < 0.0001) but not for the variable attitude (p = 0.78). Out of the mixed model with attitude as the dependent variable, it can be concluded that age (p = 0.031), educational level (p = 0.009) and ward type (p = 0.014) have a significant effect. The mixed model with knowledge as the dependent variable resulted in a significant effect of the intervention (p = 0.001) and the educational level (p = 0.009). The supervised implementation of an oral healthcare protocol significantly increased the knowledge of nurses and nurses' aides. In contrast, no significant improvements could be demonstrated in attitude. © 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

Epidemiology and economic impact of health care-associated infections and cost-effectiveness of infection control measures at a Thai university hospital.

PubMed

Rattanaumpawan, Pinyo; Thamlikitkul, Visanu

2017-02-01

Data on clinical and economic impact of health care-associated infections (HAIs) from resource limited countries are limited. We aimed to determine epidemiology and economic impact of HAIs and cost-effectiveness of infection prevention and control measures in a resource-limited setting. A retrospective cohort study was conducted among hospitalized patients at Siriraj Hospital, Thailand. Results from the cohort were subsequently used to conduct cost-effective analysis (CEA) to compare the comprehensive implementation of individualized bundling infection control measures (IBICMs) with regular infection control care. From February-May 2013, there were 515 hospitalizations (497 patients) with 7,848 hospitalization days. Cumulative incidence of HAIs was 23.30%, and the incidence rate of HAIs was 18.66 ± 44.19 per 1,000 hospitalization days. Hospital mortality among those with and without HAIs was 33.33% and 20.00%, respectively (P < .001). The adjusted cost attributable to HAIs was $704.72 ± $226.73 (P < .001). CEA identified IBICMs as a non-dominated strategy, with an incremental cost-effectiveness ratio of -$20,444.62 per life saved. HAI is significantly related with higher hospital mortality, longer length of stay, and higher hospitalization costs. IBICMs were confirmed to be cost-effective at Siriraj Hospital. Implementing this intervention could improve care quality and save costs. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Effects of a randomized controlled trial to assess the six-months effects of a school based smoking prevention program in Saudi Arabia.

PubMed

Mohammed, Mutaz; Eggers, Sander Matthijs; Alotaiby, Fahad F; de Vries, Nanne; de Vries, Hein

2016-09-01

To examine the efficacy of a smoking prevention program which aimed to address smoking related cognitions and smoking behavior among Saudi adolescents age 13 to 15. A randomized controlled trial was used. Respondents in the experimental group (N=698) received five in-school sessions, while those in the control group (N=683) received no smoking prevention information (usual curriculum). Post-intervention data was collected six months after baseline. Logistic regression analysis was applied to assess effects on smoking initiation, and linear regression analysis was applied to assess changes in beliefs and analysis of covariance (ANCOVA) was used to assess intervention effects. All analyses were adjusted for the nested structure of students within schools. At post-intervention respondents from the experimental group reported in comparison with those from the control group a significantly more negative attitude towards smoking, stronger social norms against smoking, higher self-efficacy towards non-smoking, more action planning to remain a non-smoker, and lower intentions to smoke in the future. Smoking initiation was 3.2% in the experimental group and 8.8% in the control group (p<0.01). The prevention program reinforced non-smoking cognitions and non-smoking behavior. Therefore it is recommended to implement the program at a national level in Saudi-Arabia. Future studies are recommended to assess long term program effects and the conditions favoring national implementation of the program. Copyright © 2016 Elsevier Inc. All rights reserved.

Interventions in sports settings to reduce risky alcohol consumption and alcohol-related harm: a systematic review.

PubMed

Kingsland, Melanie; Wiggers, John H; Vashum, Khanrin P; Hodder, Rebecca K; Wolfenden, Luke

2016-01-21

Elevated levels of risky alcohol consumption and alcohol-related harm have been reported for sportspeople and supporters compared to non-sporting populations. Limited systematic reviews have been conducted to assess the effect of interventions targeting such behaviours. A review was undertaken to determine if interventions implemented in sports settings decreased alcohol consumption and related harms. Studies were included that implemented interventions within sports settings; measured alcohol consumption or alcohol-related injury or violence and were either randomised controlled trials, staggered enrollment trials, stepped-wedged trials, quasi-randomised trials, quasi-experimental trials or natural experiments. Studies without a parallel comparison group were excluded. Studies from both published and grey literature were included. Two authors independently screened potential studies against the eligibility criteria, and two authors independently extracted data from included studies and assessed risk of bias. The results of included studies were synthesised narratively. The title and abstract of 6382 papers and the full text of 45 of these papers were screened for eligibility. Three studies met the inclusion criteria for the review. One of the included studies was a randomised controlled trial (RCT) of a cognitive-behavioural intervention with athletes within an Olympic training facility in the USA. The study reported a significant change in alcohol use between pre-test and follow-up between intervention and control groups. The other two studies were RCTs in community sports clubs in Ireland and Australia. The Australian study found a significant intervention effect for both risky alcohol consumption at sports clubs and overall risk of alcohol-related harm. The Irish study found no significant intervention effect. A limited number of studies have been conducted to assess the effect of interventions implemented in sports settings on alcohol consumption and related harms. While two of the three studies found significant intervention effects, it is difficult to determine the extent to which such effects are generalisable. Further controlled trials are required in this setting. PROSPERO CRD42014001739.

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

Dentz, Jordan; Ansanelli, Eric; Henderson, Hugh

Domestic hot water (DHW) heating is the second largest energy end use in U.S. buildings, exceeded only by space conditioning. Recirculation systems consisting of a pump and piping loop(s) are commonly used in multifamily buildings to reduce wait time for hot water at faucets; however, constant pumping increases energy consumption by exposing supply and return line piping to continuous heat loss, even during periods when there is no demand for hot water. In this study, ARIES installed and tested two types of recirculation controls in a pair of buildings in order to evaluate their energy savings potential. Demand control, temperaturemore » modulation controls, and the simultaneous operation of both were compared to the baseline case of constant recirculation. Additionally, interactive effects between DHW control fuel reductions and space conditioning (heating and cooling) were estimated in order to make more realistic predictions of the payback and financial viability of retrofitting DHW systems with these controls. Results showed that DHW fuel consumption reduced by 7% after implementing the demand control technique, 2% after implementing temperature modulation, and 15% after implementing demand control and temperature modulation techniques simultaneously; recirculation pump runtime was reduced to 14 minutes or less per day. With space heating and cooling interactions included, the estimated annual cost savings were 8%, 1%, and 14% for the respective control techniques. Possible complications in the installation, commissioning and operation of the controls were identified and solutions offered.« less

Evaluating long-term effectiveness of sleeping sickness control measures in Guinea.

PubMed

Pandey, Abhishek; Atkins, Katherine E; Bucheton, Bruno; Camara, Mamadou; Aksoy, Serap; Galvani, Alison P; Ndeffo-Mbah, Martial L

2015-10-22

Human African Trypanosomiasis threatens human health across Africa. The subspecies T.b. gambiense is responsible for the vast majority of reported HAT cases. Over the past decade, expanded control efforts accomplished a substantial reduction in HAT transmission, spurring the WHO to include Gambian HAT on its roadmap for 2020 elimination. To inform the implementation of this elimination goal, we evaluated the likelihood that current control interventions will achieve the 2020 target in Boffa prefecture in Guinea, which has one of the highest prevalences for HAT in the country, and where vector control measures have been implemented in combination with the traditional screen and treat strategy. We developed a three-species mathematical model of HAT and used a Bayesian melding approach to calibrate the model to epidemiological and entomological data from Boffa. From the calibrated model, we generated the probabilistic predictions regarding the likelihood that the current HAT control programs could achieve elimination by 2020 in Boffa. Our model projections indicate that if annual vector control is implemented in combination with annual or biennial active case detection and treatment, the probability of eliminating HAT as public health problem in Boffa by 2020 is over 90%. Annual implementation of vector control alone has a significant impact but a decreased chance of reaching the objective (77%). However, if the ongoing control efforts are interrupted, HAT will continue to remain a public health problem. In the presence of a non-human animal transmission reservoir, intervention strategies must be maintained at high coverage, even after 2020 elimination, to prevent HAT reemerging as a public health problem. Complementing active screening and treatment with vector control has the potential to achieve the elimination target before 2020 in the Boffa focus. However, surveillance must continue after elimination to prevent reemergence.

WHO Parents Skills Training (PST) programme for children with developmental disorders and delays delivered by Family Volunteers in rural Pakistan: study protocol for effectiveness implementation hybrid cluster randomized controlled trial.

PubMed

Hamdani, S U; Akhtar, P; Zill-E-Huma; Nazir, H; Minhas, F A; Sikander, S; Wang, D; Servilli, C; Rahman, A

2017-01-01

Development disorders and delays are recognised as a public health priority and included in the WHO mental health gap action programme (mhGAP). Parents Skills Training (PST) is recommended as a key intervention for such conditions under the WHO mhGAP intervention guide. However, sustainable and scalable delivery of such evidence based interventions remains a challenge. This study aims to evaluate the effectiveness and scaled-up implementation of locally adapted WHO PST programme delivered by family volunteers in rural Pakistan. The study is a two arm single-blind effectiveness implementation-hybrid cluster randomised controlled trial. WHO PST programme will be delivered by 'family volunteers' to the caregivers of children with developmental disorders and delays in community-based settings. The intervention consists of the WHO PST along with the WHO mhGAP intervention for developmental disorders adapted for delivery using the android application on a tablet device. A total of 540 parent-child dyads will be recruited from 30 clusters. The primary outcome is child's functioning, measured by WHO Disability Assessment Schedule - child version (WHODAS-Child) at 6 months post intervention. Secondary outcomes include children's social communication and joint engagement with their caregiver, social emotional well-being, parental health related quality of life, family empowerment and stigmatizing experiences. Mixed method will be used to collect data on implementation outcomes. Trial has been retrospectively registered at ClinicalTrials.gov (NCT02792894). This study addresses implementation challenges in the real world by incorporating evidence-based intervention strategies with social, technological and business innovations. If proven effective, the study will contribute to scaled-up implementation of evidence-based packages for public mental health in low resource settings. Registered with ClinicalTrials.gov as Family Networks (FaNs) for Children with Developmental Disorders and Delays. Identifier: NCT02792894 Registered on 6 July 2016.

Vibration suppression of planar truss structures utilizing uniform damping control

NASA Technical Reports Server (NTRS)

Andersen, G. C.; Silverberg, L. M.

1986-01-01

A variety of methods has been devised for vibrational control of a structure using both passive and active controls. Presented in this paper is a relatively new method for vibration suppression, uniform damping control. This method consists of implementing a control law which tends to dampen each vibrational mode of the structure at the same desirable exponential rate. The unique aspects of this method are that the control law is not explicitly dependent on the structural stiffness, the control forces are directly proportional to the distribution of the structural mass, and the control law is natural and decentralized. The control law was applied to a flexible planar truss structure and the various aspects of implementation of the control law examined are: actuator/sensor number, placement, and the impact of the actuator/sensor number and placement on the necessary control 'power' requirements such as peak power loads, total power requirements, etc. Also examined are the effects of using a limited number of active members in terms of the vibrational performance when compared with the 'ideal' distributed control law.

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

PubMed

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

2018-01-25

This paper reports on the feasibility, acceptability, and effectiveness of an innovative implementation strategy named "systems consultation" aimed at improving adherence to clinical guidelines for opioid prescribing in primary care. While clinical guidelines for opioid prescribing have been developed, they have not been widely implemented, even as opioid abuse reaches epidemic levels. We tested a blended implementation strategy consisting of several discrete implementation strategies, including audit and feedback, academic detailing, and external facilitation. The study compares four intervention clinics to four control clinics in a randomized matched-pairs design. Each systems consultant aided clinics on implementing the guidelines during a 6-month intervention consisting of monthly site visits and teleconferences/videoconferences. The mixed-methods evaluation employs the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Quantitative outcomes are compared using time series analysis. Qualitative methods included focus groups, structured interviews, and ethnographic field techniques. Seven clinics were randomly approached to recruit four intervention clinics. Each clinic designated a project team consisting of six to eight staff members, each with at least one prescriber. Attendance at intervention meetings was 83%. More than 80% of staff respondents agreed or strongly agreed with the statements: "I am more familiar with guidelines for safe opioid prescribing" and "My clinic's workflow for opioid prescribing is easier." At 6 months, statistically significant improvements were noted in intervention clinics in the percentage of patients with mental health screens, treatment agreements, urine drug tests, and opioid-benzodiazepine co-prescribing. At 12 months, morphine-equivalent daily dose was significantly reduced in intervention clinics compared to controls. The cost to deliver the strategy was $7345 per clinic. Adaptations were required to make the strategy more acceptable for primary care. Qualitatively, intervention clinics reported that chronic pain was now treated using approaches similar to those employed for other chronic conditions, such as hypertension and diabetes. The systems consultation implementation strategy demonstrated feasibility, acceptability, and effectiveness in a study involving eight primary care clinics. This multi-disciplinary strategy holds potential to mitigate the prevalence of opioid addiction and ultimately may help to improve implementation of clinical guidelines across healthcare. ClinicalTrials.gov (NCT02433496). https://clinicaltrials.gov/ct2/show/NCT02433496 Registered May 5, 2015.

Hepatitis C virus testing perspectives among primary care physicians in four large primary care settings.

PubMed

Jewett, Amy; Garg, Arika; Meyer, Katherine; Wagner, Laura Danielle; Krauskopf, Katherine; Brown, Kimberly A; Pan, Jen-Jung; Massoud, Omar; Smith, Bryce D; Rein, David B

2015-03-01

In 1998, the Centers for Disease Control and Prevention (CDC) published Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease, recommending HCV testing for populations most likely to be infected with HCV. However, the implementation of risk-based screening has not been widely adopted in health care settings, and 45% to 85% of infected U.S. adults remain unidentified. To develop a better understanding of why CDC's 1998 recommendations have had limited success in identifying persons with HCV infection and provide information about how CDC's 2012 Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born During 1945-1965 may be implemented more effectively. Qualitative data were collected and analyzed from a multidisciplinary team as part of the Birth Cohort Evaluation to Advance Screening and Testing for Hepatitis C project. Nineteen providers were asked open-ended questions to identify current perspectives, practices, facilitators, and barriers to HCV screening and testing. Providers were affiliated with Henry Ford Hospital, Mount Sinai Hospital, the University of Alabama, and the University of Texas Health Science Center. Respondents reported the complexity of the 1998 recommendations, and numerous indicated risk factors were major barriers to effective implementation. Other hindrances to hepatitis C testing included physician discomfort in asking questions about socially undesirable behaviors and physician uncertainty about patient insurance coverage. Implementation of the CDC's 2012 recommendations could be more successful than the 1998 recommendations due to their relative simplicity; however, effective strategies need to be used for dissemination and implementation for full success. © 2014 Society for Public Health Education.

The Design, Implementation, and Evaluation of a Digital Interactive Globe System Integrated into an Earth Science Course

ERIC Educational Resources Information Center

Liou, Wei-Kai; Bhagat, Kaushal Kumar; Chang, Chun-Yen

2018-01-01

The aim of this study is to design and implement a digital interactive globe system (DIGS), by integrating low-cost equipment to make DIGS cost-effective. DIGS includes a data processing unit, a wireless control unit, an image-capturing unit, a laser emission unit, and a three-dimensional hemispheric body-imaging screen. A quasi-experimental study…

77 FR 30900 - Approval and Promulgation of Implementation Plans; New Mexico; Albuquerque/Bernalillo County...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-24

... in implementing the New Mexico Air Quality Control Act, the joint Air Quality Control Board (AQCB... Department in implementing the New Mexico Air Quality Control Act, the joint Air Quality Control Board (AQCB... Promulgation of Implementation Plans; New Mexico; Albuquerque/Bernalillo County; Fees for Permits and...

Influenza A (H1N1-2009) pandemic in Singapore--public health control measures implemented and lessons learnt.

PubMed

Tay, Joanne; Ng, Yeuk Fan; Cutter, Jeffery L; James, Lyn

2010-04-01

We describe the public health control measures implemented in Singapore to limit the spread of influenza A (H1N1-2009) and mitigate its social effects. We also discuss the key learning points from this experience. Singapore's public health control measures were broadly divided into 2 phases: containment and mitigation. Containment strategies included the triage of febrile patients at frontline healthcare settings, admission and isolation of confirmed cases, mandatory Quarantine Orders (QO) for close contacts, and temperature screening at border entry points. After sustained community transmission became established, containment shifted to mitigation. Hospitals only admitted H1N1-2009 cases based on clinical indications, not for isolation. Mild cases were managed in the community. Contact tracing and QOs tapered off, and border temperature screening ended. The 5 key lessons learnt were: (1) Be prepared, but retain flexibility in implementing control measures; (2) Surveillance, good scientific information and operational research can increase a system's ability to manage risk during a public health crisis; (3) Integrated systems-level responses are essential for a coherent public health response; (4) Effective handling of manpower surges requires creative strategies; and (5) Communication must be strategic, timely, concise and clear. Singapore's effective response to the H1N1-2009 pandemic, founded on experience in managing the 2003 SARS epidemic, was a whole-of-government approach towards pandemic preparedness planning. Documenting the measures taken and lessons learnt provides a learning opportunity for both doctors and policy makers, and can help fortify Singapore's ability to respond to future major disease outbreaks.

Shaking table experimentation on adjacent structures controlled by passive and semi-active MR dampers

NASA Astrophysics Data System (ADS)

Basili, M.; De Angelis, M.; Fraraccio, G.

2013-06-01

This paper presents the results of shaking table tests on adjacent structures controlled by passive and semi-active MR dampers. The aim was to demonstrate experimentally the effectiveness of passive and semi-active strategies in reducing structural vibrations due to seismic excitation. The physical model at issue was represented by two adjacent steel structures, respectively of 4 and 2 levels, connected at the second level by a MR damper. When the device operated in semi-active mode, an ON-OFF control algorithm, derived by the Lyapunov stability theory, was implemented and experimentally validated. Since the experimentation concerned adjacent structures, two control objectives have been reached: global and selective protection. In case of global protection, the attention was focused on protecting both structures, whereas, in case of selective protection, the attention was focused on protecting only one structure. For each objective the effectiveness of passive control has been compared with the situation of no control and then the effectiveness of semi-active control has been compared with the passive one. The quantities directly compared have been: measured displacements, accelerations and force-displacement of the MR damper, moreover some global response quantities have been estimated from experimental measures, which are the base share force and the base bending moment, the input energy and the energy dissipated by the device. In order to evaluate the effectiveness of the control action in both passive and semi-active case, an energy index EDI, previously defined and already often applied numerically, has been utilized. The aspects investigated in the experimentation have been: the implementation and validation of the control algorithm for selective and global protection, the MR damper input voltage influence, the kind of seismic input and its intensity.

In Support of a Distinction between Voluntary and Stimulus-Driven Control: A Review of the Literature on Proportion Congruent Effects.

PubMed

Bugg, Julie M; Crump, Matthew J C

2012-01-01

Cognitive control is by now a large umbrella term referring collectively to multiple processes that plan and coordinate actions to meet task goals. A common feature of paradigms that engage cognitive control is the task requirement to select relevant information despite a habitual tendency (or bias) to select goal-irrelevant information. At least since the 1970s, researchers have employed proportion congruent (PC) manipulations to experimentally establish selection biases and evaluate the mechanisms used to control attention. PC manipulations vary the frequency with which irrelevant information conflicts (i.e., is incongruent) with relevant information. The purpose of this review is to summarize the growing body of literature on PC effects across selective attention paradigms, beginning first with Stroop, and then describing parallel effects in flanker and task-switching paradigms. The review chronologically tracks the expansion of the PC manipulation from its initial implementation at the list-wide level, to more recent implementations at the item-specific and context-specific levels. An important theoretical aim is demonstrating that PC effects at different levels (e.g., list-wide vs. item or context-specific) support a distinction between voluntary forms of cognitive control, which operate based on anticipatory information, and relatively automatic or reflexive forms of cognitive control, which are rapidly triggered by the processing of particular stimuli or stimulus features. A further aim is to highlight those PC manipulations that allow researchers to dissociate stimulus-driven control from other stimulus-driven processes (e.g., S-R responding; episodic retrieval). We conclude by discussing the utility of PC manipulations for exploring the distinction between voluntary control and stimulus-driven control in other relevant paradigms.

In Support of a Distinction between Voluntary and Stimulus-Driven Control: A Review of the Literature on Proportion Congruent Effects

PubMed Central

Bugg, Julie M.; Crump, Matthew J. C.

2012-01-01

Cognitive control is by now a large umbrella term referring collectively to multiple processes that plan and coordinate actions to meet task goals. A common feature of paradigms that engage cognitive control is the task requirement to select relevant information despite a habitual tendency (or bias) to select goal-irrelevant information. At least since the 1970s, researchers have employed proportion congruent (PC) manipulations to experimentally establish selection biases and evaluate the mechanisms used to control attention. PC manipulations vary the frequency with which irrelevant information conflicts (i.e., is incongruent) with relevant information. The purpose of this review is to summarize the growing body of literature on PC effects across selective attention paradigms, beginning first with Stroop, and then describing parallel effects in flanker and task-switching paradigms. The review chronologically tracks the expansion of the PC manipulation from its initial implementation at the list-wide level, to more recent implementations at the item-specific and context-specific levels. An important theoretical aim is demonstrating that PC effects at different levels (e.g., list-wide vs. item or context-specific) support a distinction between voluntary forms of cognitive control, which operate based on anticipatory information, and relatively automatic or reflexive forms of cognitive control, which are rapidly triggered by the processing of particular stimuli or stimulus features. A further aim is to highlight those PC manipulations that allow researchers to dissociate stimulus-driven control from other stimulus-driven processes (e.g., S-R responding; episodic retrieval). We conclude by discussing the utility of PC manipulations for exploring the distinction between voluntary control and stimulus-driven control in other relevant paradigms. PMID:23060836

Translation of an Effective Tai Chi Intervention Into a Community-Based Falls-Prevention Program

PubMed Central

Li, Fuzhong; Harmer, Peter; Glasgow, Russell; Mack, Karin A.; Sleet, David; Fisher, K. John; Kohn, Melvin A.; Millet, Lisa M.; Mead, Jennifer; Xu, Junheng; Lin, Mei-Li; Yang, Tingzhong; Sutton, Beth; Tompkins, Yvaughn

2008-01-01

Tai Chi—Moving for Better Balance, a falls-prevention program developed from a randomized controlled trial for community-based use, was evaluated with the RE-AIM framework in 6 community centers. The program had a 100% adoption rate and 87% reach into the target older adult population. All centers implemented the intervention with good fidelity, and participants showed significant improvements in health-related outcome measures. This evidence-based tai chi program is practical to disseminate and can be effectively implemented and maintained in community settings. PMID:18511723

Diabetes Guidelines May Delay Timely Adjustments During Treatment and Might Contribute to Clinical Inertia

PubMed Central

Zanella, Maria Teresa

2014-01-01

Abstract Clinical inertia and poor knowledge by many physicians play an important role in delaying diabetes control. Among other guidelines, the Position Statement of the American Diabetes Association/European Association for the Study of Diabetes on Management of Hyperglycemia in Type 2 Diabetes is a respected guideline with high impact on this subject in terms of influencing physicians in the definition of strategic approach to overcome poor glycemic control. But, on the other hand, it carries a recommendation that might contribute to clinical inertia because it can delay the needed implementation of more vigorous, intensive, and effective strategies to overcome poor glycemic control within a reasonable time frame during the evolution of the disease. The same is true with other respected algorithms from different diabetes associations. Together with pharmacological interventions, diabetes education and more intensive blood glucose monitoring in the initial phases after the diagnosis are key strategies for the effective control of diabetes. The main reason why a faster glycemic control should be implemented in an effective and safe way is to boost the confidence and the compliance of the patient to the recommendations of the diabetes care team. Better and faster results in glycemic control can only be safely achieved with educational strategies, structured self-monitoring of blood glucose, and adequate pharmacological therapy in the majority of cases. PMID:24892463

Diabetes guidelines may delay timely adjustments during treatment and might contribute to clinical inertia.

PubMed

Pimazoni-Netto, Augusto; Zanella, Maria Teresa

2014-11-01

Clinical inertia and poor knowledge by many physicians play an important role in delaying diabetes control. Among other guidelines, the Position Statement of the American Diabetes Association/European Association for the Study of Diabetes on Management of Hyperglycemia in Type 2 Diabetes is a respected guideline with high impact on this subject in terms of influencing physicians in the definition of strategic approach to overcome poor glycemic control. But, on the other hand, it carries a recommendation that might contribute to clinical inertia because it can delay the needed implementation of more vigorous, intensive, and effective strategies to overcome poor glycemic control within a reasonable time frame during the evolution of the disease. The same is true with other respected algorithms from different diabetes associations. Together with pharmacological interventions, diabetes education and more intensive blood glucose monitoring in the initial phases after the diagnosis are key strategies for the effective control of diabetes. The main reason why a faster glycemic control should be implemented in an effective and safe way is to boost the confidence and the compliance of the patient to the recommendations of the diabetes care team. Better and faster results in glycemic control can only be safely achieved with educational strategies, structured self-monitoring of blood glucose, and adequate pharmacological therapy in the majority of cases.

The Potential of Coaching as a Strategy to Improve the Effectiveness of School-Based Substance Use Prevention Curricula

ERIC Educational Resources Information Center

Ringwalt, Christopher L.; Pankratz, Melinda M.; Hansen, William B.; Dusenbury, Linda; Jackson-Newsom, Julia; Giles, Steven M.; Brodish, Paul H.

2009-01-01

Research-based substance use prevention curricula typically yield small effects when implemented by school teachers under real-world conditions. Using a randomized controlled trial, the authors examined whether expert coaching improves the effectiveness of the All Stars prevention curriculum. Although a positive effect on students' cigarette use…

Testing the leadership and organizational change for implementation (LOCI) intervention in substance abuse treatment: a cluster randomized trial study protocol.

PubMed

Aarons, Gregory A; Ehrhart, Mark G; Moullin, Joanna C; Torres, Elisa M; Green, Amy E

2017-03-03

Evidence-based practice (EBP) implementation represents a strategic change in organizations that requires effective leadership and alignment of leadership and organizational support across organizational levels. As such, there is a need for combining leadership development with organizational strategies to support organizational climate conducive to EBP implementation. The leadership and organizational change for implementation (LOCI) intervention includes leadership training for workgroup leaders, ongoing implementation leadership coaching, 360° assessment, and strategic planning with top and middle management regarding how they can support workgroup leaders in developing a positive EBP implementation climate. This test of the LOCI intervention will take place in conjunction with the implementation of motivational interviewing (MI) in 60 substance use disorder treatment programs in California, USA. Participants will include agency executives, 60 program leaders, and approximately 360 treatment staff. LOCI will be tested using a multiple cohort, cluster randomized trial that randomizes workgroups (i.e., programs) within agency to either LOCI or a webinar leadership training control condition in three consecutive cohorts. The LOCI intervention is 12 months, and the webinar control intervention takes place in months 1, 5, and 8, for each cohort. Web-based surveys of staff and supervisors will be used to collect data on leadership, implementation climate, provider attitudes, and citizenship. Audio recordings of counseling sessions will be coded for MI fidelity. The unit of analysis will be the workgroup, randomized by site within agency and with care taken that co-located workgroups are assigned to the same condition to avoid contamination. Hierarchical linear modeling (HLM) will be used to analyze the data to account for the nested data structure. LOCI has been developed to be a feasible and effective approach for organizations to create a positive climate and fertile context for EBP implementation. The approach seeks to cultivate and sustain both effective general and implementation leadership as well as organizational strategies and support that will remain after the study has ended. Development of a positive implementation climate for MI should result in more positive service provider attitudes and behaviors related to the use of MI and, ultimately, higher fidelity in the use of MI. This study is registered with Clinicaltrials.gov ( NCT03042832 ), 2 February 2017, retrospectively registered.

Remote telescope control of site testing with ASCOM

NASA Astrophysics Data System (ADS)

Ji, Kaifan; Liang, Bo; Peng, Yajie; Wang, Feng

2012-04-01

Remote telescope control is significant important for the astronomical site testing. Basing on ASCOM standard, a prototype of remote telescope control system has been implemented. In this paper, the details of the system design, both server end and client end, are introduced. We tested the prototype on a narrow-band dial-up networking and controlled a real remote telescope successfully. The result indicates that it is effective to control remote telescope and other devices with ASCOM.

Controlling droplet-transmitted respiratory infections

PubMed Central

Hogg, William; Huston, Patricia

2006-01-01

OBJECTIVE To promote incorporation of new guidelines on control of respiratory infections into family physicians’ practices. SOURCES OF INFORMATION The World Health Organization website on pandemic influenza, the Canadian Pandemic Influenza Plan, the Ontario guidelines on respiratory infection control, and research on implementing guidelines into family practice were reviewed. We also researched and calculated what the costs of implementing the guidelines would be. MAIN MESSAGE Effective control of respiratory infections in physicians’ offices can be achieved by displaying signs in the waiting room, having reception staff give masks to patients with cough and fever, instructing these patients to clean their hands with alcohol gel and to sit at least 1 m from others, inquiring about patients’ or their close contacts’ recent travel, using disinfectant wipes to clean possibly contaminated surfaces in waiting rooms and examining areas, and having staff and care providers wear masks and wash hands or use alcohol gel. The approximate annual cost of incorporating the guidelines is about $800 per physician. CONCLUSION Because the outbreak of an influenza pandemic is likely imminent, implementing standard guidelines for control of respiratory infections in primary care offices seems wise. Following these guidelines would help prevent patients and staff from contracting serious respiratory illnesses. PMID:17279182

Design and implementation of the tree-based fuzzy logic controller.

PubMed

Liu, B D; Huang, C Y

1997-01-01

In this paper, a tree-based approach is proposed to design the fuzzy logic controller. Based on the proposed methodology, the fuzzy logic controller has the following merits: the fuzzy control rule can be extracted automatically from the input-output data of the system and the extraction process can be done in one-pass; owing to the fuzzy tree inference structure, the search spaces of the fuzzy inference process are largely reduced; the operation of the inference process can be simplified as a one-dimensional matrix operation because of the fuzzy tree approach; and the controller has regular and modular properties, so it is easy to be implemented by hardware. Furthermore, the proposed fuzzy tree approach has been applied to design the color reproduction system for verifying the proposed methodology. The color reproduction system is mainly used to obtain a color image through the printer that is identical to the original one. In addition to the software simulation, an FPGA is used to implement the prototype hardware system for real-time application. Experimental results show that the effect of color correction is quite good and that the prototype hardware system can operate correctly under the condition of 30 MHz clock rate.

Implementation of GINA guidelines in Ho Chi Minh City: a model for Viet Nam.

PubMed

Tho, N V; Loan, H T H; Thao, N T P; Dung, N T T; Lan, L T T

2012-12-21

The Global Initiative for Asthma (GINA) guidelines have not been implemented effectively in primary care settings in Viet Nam. To estimate the proportion of patients with controlled asthma and the direct health care costs of managing asthma according to GINA guidelines at four out-patient clinics in Ho Chi Minh City (HCMC), Viet Nam. One hundred and six patients with asthma were treated and followed up according to GINA guidelines for 12 months. Clinical and pulmonary function responses and direct health care costs were evaluated every 3 months during the study. The proportion of patients with controlled asthma rose from 1.0% at the start of the study to 36.8% by the end of the study (P < 0.0001). The proportion of patients who had at least one hospitalisation per year decreased significantly, from 32.1% to 5.7% (P < 0.0001). The annual per patient median direct health care cost was US$169. Using asthma controllers continuously gave better asthma control than using them intermittently (OR 12.9, 95%CI 4.7-35.7). The implementation of GINA guidelines at out-patient clinics in HCMC, Viet Nam, improved asthma control with modest direct health care costs.

40 CFR 52.1224 - General requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Minnesota § 52.1224 General requirements. (a... information and data was delegated to the Minnesota Pollution Control Agency effective October 6, 1977. [37 FR...

40 CFR 52.1224 - General requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

...) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Minnesota § 52.1224 General requirements. (a... information and data was delegated to the Minnesota Pollution Control Agency effective October 6, 1977. [37 FR...

40 CFR 52.1224 - General requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Minnesota § 52.1224 General requirements. (a... information and data was delegated to the Minnesota Pollution Control Agency effective October 6, 1977. [37 FR...

40 CFR 52.1224 - General requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Minnesota § 52.1224 General requirements. (a... information and data was delegated to the Minnesota Pollution Control Agency effective October 6, 1977. [37 FR...

40 CFR 52.1224 - General requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Minnesota § 52.1224 General requirements. (a... information and data was delegated to the Minnesota Pollution Control Agency effective October 6, 1977. [37 FR...

Comprehensive sector-wide strategies to prevent and control obesity: what are the potential health and broader societal benefits? A case study from Australia.

PubMed

Kite, James; Hector, Debra J; St George, Alexis; Pedisic, Zeljko; Phongsavan, Philayrath; Bauman, Adrian; Mitchell, Jo; Bellew, Bill

2015-09-30

Several countries have recently established multistakeholder strategies to prevent or control overweight and obesity; however, studies have not yet been done on their effectiveness and likely impact. This study's objectives were to (i) explore sector-wide benefits and impacts likely to accrue from implementing an obesity prevention strategy in the Australian state of New South Wales; (ii) discuss the wider implications of the findings for research and practice; and (iii) strengthen the case for sustained implementation of a comprehensive, intersectoral approach. A case study approach, including evidence reviews and illustrative epidemiological models, was used to show potential benefits from meeting selected targets and objectives specified in the strategy. For adults, improved health outcomes potentially include reductions in all-cause mortality, cardiovascular disease, type 2 diabetes, various cancers, osteoarthritis, infant mortality and healthcare costs. Potential benefits beyond the health sector involve disability payments, absenteeism, worker productivity, workplace injuries and insurance claims. For children and adolescents, improved health outcomes potentially include metabolic risk factors, dental health, prehypertension/hypertension, cardiovascular disease risk factors, depression, rates of mortality in hospitalised children, bullying and otitis media. Sector-wide health, social and economic benefits from successful implementation of multisector obesity prevention strategies are likely to be substantial if specified targets are achieved. Epidemiological modelling described in this paper for selected examples provides illustrative rather than comprehensive evidence for potential benefits. Process evaluation of the extent of implementation of these multisectoral strategies, together with the accumulated data on intervention effectiveness, will determine their potential population health benefit. Quantifying the health and social benefits that are likely to accrue if comprehensive sector-wide obesity prevention and control strategies are established can strengthen advocacy for their sustained implementation.

Process evaluation of a randomised controlled trial of a diabetes prevention intervention in Dutch primary health care: the SLIMMER study.

PubMed

van Dongen, Ellen Ji; Duijzer, Geerke; Jansen, Sophia C; Ter Beek, Josien; Huijg, Johanna M; Leerlooijer, Joanne N; Hiddink, Gerrit J; Feskens, Edith Jm; Haveman-Nies, Annemien

2016-11-01

To investigate (i) how the SLIMMER intervention was delivered and received in Dutch primary health care and (ii) how this could explain intervention effectiveness. A randomised controlled trial was conducted and subjects were randomly allocated to the intervention (10-month combined dietary and physical activity intervention) or the control group. A process evaluation including quantitative and qualitative methods was conducted. Data on process indicators (recruitment, reach, dose received, acceptability, implementation integrity and applicability) were collected via semi-structured interviews with health-care professionals (n 45) and intervention participant questionnaires (n 155). SLIMMER was implemented in Dutch primary health care in twenty-five general practices, eleven dietitians, nine physiotherapist practices and fifteen sports clubs. Subjects at increased risk of developing type 2 diabetes were included. It was possible to recruit the intended high-risk population (response rate 54 %) and the SLIMMER intervention was very well received by both participants and health-care professionals (mean acceptability rating of 82 and 80, respectively). The intervention programme was to a large extent implemented as planned and was applicable in Dutch primary health care. Higher dose received and participant acceptability were related to improved health outcomes and dietary behaviour, but not to physical activity behaviour. The present study showed that it is feasible to implement a diabetes prevention intervention in Dutch primary health care. Higher dose received and participant acceptability were associated with improved health outcomes and dietary behaviour. Using an extensive process evaluation plan to gain insight into how an intervention is delivered and received is a valuable way of identifying intervention components that contribute to implementation integrity and effective prevention of type 2 diabetes in primary health care.

Scaling-up vaccine production: implementation aspects of a biomass growth observer and controller.

PubMed

Soons, Zita I T A; van den IJssel, Jan; van der Pol, Leo A; van Straten, Gerrit; van Boxtel, Anton J B

2009-04-01

This study considers two aspects of the implementation of a biomass growth observer and specific growth rate controller in scale-up from small- to pilot-scale bioreactors towards a feasible bulk production process for whole-cell vaccine against whooping cough. The first is the calculation of the oxygen uptake rate, the starting point for online monitoring and control of biomass growth, taking into account the dynamics in the gas-phase. Mixing effects and delays are caused by amongst others the headspace and tubing to the analyzer. These gas phase dynamics are modelled using knowledge of the system in order to reconstruct oxygen consumption. The second aspect is to evaluate performance of the monitoring and control system with the required modifications of the oxygen consumption calculation on pilot-scale. In pilot-scale fed-batch cultivation good monitoring and control performance is obtained enabling a doubled concentration of bulk vaccine compared to standard batch production.

A quasi-experimental test of an intervention to increase the use of thiazide-based treatment regimens for people with hypertension.

PubMed

Ashton, Carol M; Khan, Myrna M; Johnson, Michael L; Walder, Annette; Stanberry, Elizabeth; Beyth, Rebecca J; Collins, Tracie C; Gordon, Howard S; Haidet, Paul; Kimmel, Barbara; Kolpakchi, Anna; Lu, Lee B; Naik, Aanand D; Petersen, Laura A; Singh, Hardeep; Wray, Nelda P

2007-02-13

Despite recent high-quality evidence for their cost-effectiveness, thiazides are underused for controlling hypertension. The goal of this study was to design and test a practice-based intervention aimed at increasing the use of thiazide-based antihypertensive regimens. This quasi-experimental study was carried out in general medicine ambulatory practices of a large, academically-affiliated Veterans Affairs hospital. The intervention group consisted of the practitioners (13 staff and 215 trainees), nurses, and patients (3,502) of the teaching practice; non-randomized concurrent controls were the practitioners (31 providers) and patients (18,292) of the non-teaching practices. Design of the implementation intervention was based on Rogers' Diffusion of Innovations model. Over 10.5 months, intervention teams met weekly or biweekly and developed and disseminated informational materials among themselves and to trainees, patients, and administrators. These teams also reviewed summary electronic-medical-record data on thiazide use and blood pressure (BP) goal attainment. Outcome measures were the proportion of hypertensive patients prescribed a thiazide-based regimen, and the proportion of hypertensive patients attaining BP goals regardless of regimen. Thirty-three months of time-series data were available; statistical process control charts, change point analyses, and before-after analyses were used to estimate the intervention's effects. Baseline use of thiazides and rates of BP control were higher in the intervention group than controls. During the intervention, thiazide use and BP control increased in both groups, but changes occurred earlier in the intervention group, and primary change points were observed only in the intervention group. Overall, the pre-post intervention difference in proportion of patients prescribed thiazides was greater in intervention patients (0.091 vs. 0.058; p = 0.0092), as was the proportion achieving BP goals (0.092 vs. 0.044; p = 0.0005). At the end of the implementation period, 41.4% of intervention patients were prescribed thiazides vs. 30.6% of controls (p < 0.001); 51.6% of intervention patients had achieved BP goals vs. 44.3% of controls (p < 0.001). This multi-faceted intervention appears to have resulted in modest improvements in thiazide prescribing and BP control. The study also demonstrates the value of electronic medical records for implementation research, how Rogers' model can be used to design and launch an implementation strategy, and how all members of a clinical microsystem can be involved in an implementation effort.

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

PubMed

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

2017-10-23

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

What hinders implementation of the WHO FCTC Article 5.3? - The case of South Korea.

PubMed

Lee, Sungkyu

2016-10-01

The aims of this study are to identify what hinders implementation of the WHO Framework Convention on Tobacco Control (FCTC) Article 5.3 in Korea, and to provide suggestions for the implementation of Article 5.3. Official governmental documents on tobacco control were reviewed. We also searched news articles for data triangulation. There were three factors that hindered the implementation of Article 5.3 in Korea. Firstly, there has been legal conflict between two tobacco-related laws, one of which is designed to promote the tobacco industry. The other is designed to promote public health. Secondly, the government has had economic interests in the tobacco industry, and its lack of action to effectively regulate the tobacco industry's corporate social responsibility (CSR) practices has hindered the implementation of Article 5.3. Thirdly, the tobacco industry's lobby and active interference in the policy-making process has been a barrier. To fully implement Article 5.3, this study suggests: defusing legal conflict between tobacco-related laws; not considering tobacco industry as a stakeholder; regulating tobacco industry's CSR activities; raising awareness of tobacco industry interference; securing transparency between the government and tobacco industry; and establishing a core group or a committee under the government to implement Article 5.3.

The implementation of a Hazard Analysis and Critical Control Point management system in a peanut butter ice cream plant.

PubMed

Hung, Yu-Ting; Liu, Chi-Te; Peng, I-Chen; Hsu, Chin; Yu, Roch-Chui; Cheng, Kuan-Chen

2015-09-01

To ensure the safety of the peanut butter ice cream manufacture, a Hazard Analysis and Critical Control Point (HACCP) plan has been designed and applied to the production process. Potential biological, chemical, and physical hazards in each manufacturing procedure were identified. Critical control points for the peanut butter ice cream were then determined as the pasteurization and freezing process. The establishment of a monitoring system, corrective actions, verification procedures, and documentation and record keeping were followed to complete the HACCP program. The results of this study indicate that implementing the HACCP system in food industries can effectively enhance food safety and quality while improving the production management. Copyright © 2015. Published by Elsevier B.V.

Creating Cooperative Classrooms: Effects of a Two-Year Staff Development Program

ERIC Educational Resources Information Center

Krol, Karen; Sleegers, Peter; Veenman, Simon; Voeten, Marinus

2008-01-01

In this study, the implementation effects of a staff development program on cooperative learning (CL) for Dutch elementary school teachers were studied. A pre-test-post-test non-equivalent control group design was used to investigate program effects on the instructional behaviours of teachers. Based on observations of teacher behaviour during…

Iterative Purification and Effect Size Use with Logistic Regression for Differential Item Functioning Detection

ERIC Educational Resources Information Center

French, Brian F.; Maller, Susan J.

2007-01-01

Two unresolved implementation issues with logistic regression (LR) for differential item functioning (DIF) detection include ability purification and effect size use. Purification is suggested to control inaccuracies in DIF detection as a result of DIF items in the ability estimate. Additionally, effect size use may be beneficial in controlling…

Canadian Firearms Legislation and Effects on Homicide 1974 to 2008

ERIC Educational Resources Information Center

Langmann, Caillin

2012-01-01

Canada has implemented legislation covering all firearms since 1977 and presents a model to examine incremental firearms control. The effect of legislation on homicide by firearm and the subcategory, spousal homicide, is controversial and has not been well studied to date. Legislative effects on homicide and spousal homicide were analyzed using…

Cost-Effective Control of Infectious Disease Outbreaks Accounting for Societal Reaction.

PubMed

Fast, Shannon M; González, Marta C; Markuzon, Natasha

2015-01-01

Studies of cost-effective disease prevention have typically focused on the tradeoff between the cost of disease transmission and the cost of applying control measures. We present a novel approach that also accounts for the cost of social disruptions resulting from the spread of disease. These disruptions, which we call social response, can include heightened anxiety, strain on healthcare infrastructure, economic losses, or violence. The spread of disease and social response are simulated under several different intervention strategies. The modeled social response depends upon the perceived risk of the disease, the extent of disease spread, and the media involvement. Using Monte Carlo simulation, we estimate the total number of infections and total social response for each strategy. We then identify the strategy that minimizes the expected total cost of the disease, which includes the cost of the disease itself, the cost of control measures, and the cost of social response. The model-based simulations suggest that the least-cost disease control strategy depends upon the perceived risk of the disease, as well as media intervention. The most cost-effective solution for diseases with low perceived risk was to implement moderate control measures. For diseases with higher perceived severity, such as SARS or Ebola, the most cost-effective strategy shifted toward intervening earlier in the outbreak, with greater resources. When intervention elicited increased media involvement, it remained important to control high severity diseases quickly. For moderate severity diseases, however, it became most cost-effective to implement no intervention and allow the disease to run its course. Our simulation results imply that, when diseases are perceived as severe, the costs of social response have a significant influence on selecting the most cost-effective strategy.

Cost-Effective Control of Infectious Disease Outbreaks Accounting for Societal Reaction

PubMed Central

Fast, Shannon M.; González, Marta C.; Markuzon, Natasha

2015-01-01

Background Studies of cost-effective disease prevention have typically focused on the tradeoff between the cost of disease transmission and the cost of applying control measures. We present a novel approach that also accounts for the cost of social disruptions resulting from the spread of disease. These disruptions, which we call social response, can include heightened anxiety, strain on healthcare infrastructure, economic losses, or violence. Methodology The spread of disease and social response are simulated under several different intervention strategies. The modeled social response depends upon the perceived risk of the disease, the extent of disease spread, and the media involvement. Using Monte Carlo simulation, we estimate the total number of infections and total social response for each strategy. We then identify the strategy that minimizes the expected total cost of the disease, which includes the cost of the disease itself, the cost of control measures, and the cost of social response. Conclusions The model-based simulations suggest that the least-cost disease control strategy depends upon the perceived risk of the disease, as well as media intervention. The most cost-effective solution for diseases with low perceived risk was to implement moderate control measures. For diseases with higher perceived severity, such as SARS or Ebola, the most cost-effective strategy shifted toward intervening earlier in the outbreak, with greater resources. When intervention elicited increased media involvement, it remained important to control high severity diseases quickly. For moderate severity diseases, however, it became most cost-effective to implement no intervention and allow the disease to run its course. Our simulation results imply that, when diseases are perceived as severe, the costs of social response have a significant influence on selecting the most cost-effective strategy. PMID:26288274

[Level of implementation of the Program for Safety and Health at Work in Antioquia, Colombia].

PubMed

Vega-Monsalve, Ninfa Del Carmen

2017-07-13

This study describes the level of implementation of the Program for Safety and Health at Work in companies located in the Department of Antioquia, Colombia, and associated factors. A cross-sectional survey included 73 companies with more than 50 workers each and implementation of the program. A total of 65 interviews were held, in addition to 73 checklists and process reviews. The companies showed suboptimal compliance with the management model for workplace safety and health proposed by the International Labor Organization (ILO). The component with the best development was Organization (87%), and the worst was Policy (67%). Company executives contended that the causes of suboptimal implementation were the limited commitment by area directors and scarce budget resources. Risk management mostly aimed to comply with the legal requirements in order to avoid penalties, plus documenting cases. There was little implementation of effective checks and controls to reduce the sources of work accidents. The study concludes that workers' health management lacks effective strategies.

Cost-effectiveness analysis of population-based tobacco control strategies in the prevention of cardiovascular diseases in Tanzania

PubMed Central

Ngalesoni, Frida; Ruhago, George; Mayige, Mary; Oliveira, Tiago Cravo; Robberstad, Bjarne; Norheim, Ole Frithjof; Higashi, Hideki

2017-01-01

Background Tobacco consumption contributes significantly to the global burden of disease. The prevalence of smoking is estimated to be increasing in many low-income countries, including Tanzania, especially among women and youth. Even so, the implementation of tobacco control measures has been discouraging in the country. Efforts to foster investment in tobacco control are hindered by lack of evidence on what works and at what cost. Aims We aim to estimate the cost and cost-effectiveness of population-based tobacco control strategies in the prevention of cardiovascular diseases (CVD) in Tanzania. Materials and methods A cost-effectiveness analysis was performed using an Excel-based Markov model, from a governmental perspective. We employed an ingredient approach and step-down methodologies in the costing exercise following a government perspective. Epidemiological data and efficacy inputs were derived from the literature. We used disability-adjusted life years (DALYs) averted as the outcome measure. A probabilistic sensitivity analysis was carried out with Ersatz to incorporate uncertainties in the model parameters. Results Our model results showed that all five tobacco control strategies were very cost-effective since they fell below the ceiling ratio of one GDP per capita suggested by the WHO. Increase in tobacco taxes was the most cost-effective strategy, while a workplace smoking ban was the least cost-effective option, with a cost-effectiveness ratio of US$5 and US$267, respectively. Conclusions Even though all five interventions are deemed very cost-effective in the prevention of CVD in Tanzania, more research on budget impact analysis is required to further assess the government’s ability to implement these interventions. PMID:28767722

A Virtual Information-Action Workspace for Command and Control

NASA Astrophysics Data System (ADS)

Lintern, Gavan; Naikar, Neelam

2002-10-01

Information overload has become a critical challenge within military Command and Control. However, the problem is not so much one of too much information but of abundant information that is poorly organized and poorly represented. In addition, the capabilities to test the effects of decisions before they are implemented and to monitor the progress of events after a decision is implemented are primitive. A virtual information-action workspace could be designed to resolve these issues. The design of such a space would require a detailed understanding of the specific information needed to support decision making in Command and Control. That information can be obtained with the use of knowledge acquisition and knowledge representation tools from the field of applied cognitive psychology. In addition, it will be necessary to integrate forms for perception and action into a virtual space that will support access to the information and that will provide means for testing and implementing decisions. This paper presents a rationale for a virtual information-action workspace and outlines an approach to its design.

The Simulation of Read-time Scalable Coherent Interface

NASA Technical Reports Server (NTRS)

Li, Qiang; Grant, Terry; Grover, Radhika S.

1997-01-01

Scalable Coherent Interface (SCI, IEEE/ANSI Std 1596-1992) (SCI1, SCI2) is a high performance interconnect for shared memory multiprocessor systems. In this project we investigate an SCI Real Time Protocols (RTSCI1) using Directed Flow Control Symbols. We studied the issues of efficient generation of control symbols, and created a simulation model of the protocol on a ring-based SCI system. This report presents the results of the study. The project has been implemented using SES/Workbench. The details that follow encompass aspects of both SCI and Flow Control Protocols, as well as the effect of realistic client/server processing delay. The report is organized as follows. Section 2 provides a description of the simulation model. Section 3 describes the protocol implementation details. The next three sections of the report elaborate on the workload, results and conclusions. Appended to the report is a description of the tool, SES/Workbench, used in our simulation, and internal details of our implementation of the protocol.

A systematic review of children's dietary interventions with parents as change agents: Application of the RE-AIM framework.

PubMed

Schlechter, Chelsey R; Rosenkranz, Richard R; Guagliano, Justin M; Dzewaltowski, David A

2016-10-01

Interventions targeting children's dietary behavior often include strategies that target parents as implementation agents of change, though parent involvement on intervention effectiveness is unclear. The present study systematically assessed (1) reporting of reach, effectiveness, adoption, implementation and maintenance (RE-AIM) of child dietary intervention studies with parents as change agents and (2) evaluated within these studies the comparative effectiveness of interventions with and without a parent component. The search was conducted in PubMed, PsycINFO, and Cochrane Library. Eligible studies were required to include a condition with a parental component, a comparison/control group, and target a child dietary behavior outcome. Forty-nine articles met criteria. Raters extracted RE-AIM and parent implementation information for each study. Effectiveness (72.5%) was the highest reported RE-AIM element, followed by reach (27.5%), adoption (12.5%), implementation (10%), and maintenance (2.5%). Median reporting of parent implementation was highest for adoption and enactment (20%), followed by receipt (7.5%), and maintenance (2.5%). Six studies tested comparative effectiveness of parental involvement on child dietary outcomes. Current RE-AIM reporting among children's dietary interventions is inchoate. The contribution of parental involvement on intervention effectiveness remains unclear. Increased focus should be placed on reporting of external validity information, to enable better translation of research to practical applications. Copyright © 2016. Published by Elsevier Inc.

The Effect of the MassHealth Hospital Pay-for-Performance Program on Quality

PubMed Central

Ryan, Andrew M; Blustein, Jan

2011-01-01

Objective To test the effect of Massachusetts Medicaid's (MassHealth) hospital-based pay-for-performance (P4P) program, implemented in 2008, on quality of care for pneumonia and surgical infection prevention (SIP). Data Hospital Compare process of care quality data from 2004 to 2009 for acute care hospitals in Massachusetts (N = 62) and other states (N = 3,676) and American Hospital Association data on hospital characteristics from 2005. Study Design Panel data models with hospital fixed effects and hospital-specific trends are estimated to test the effect of P4P on composite quality for pneumonia and SIP. This base model is extended to control for the completeness of measure reporting. Further sensitivity checks include estimation with propensity-score matched control hospitals, excluding hospitals in other P4P programs, varying the time period during which the program was assumed to have an effect, and testing the program effect across hospital characteristics. Principal Findings Estimates from our preferred specification, including hospital fixed effects, trends, and the control for measure completeness, indicate small and nonsignificant program effects for pneumonia (−0.67 percentage points, p>.10) and SIP (−0.12 percentage points, p>.10). Sensitivity checks indicate a similar pattern of findings across specifications. Conclusions Despite offering substantial financial incentives, the MassHealth P4P program did not improve quality in the first years of implementation. PMID:21210796

Neural changes in control implementation of a continuous task.

PubMed

Lungu, Ovidiu V; Binenstock, Meagan M; Pline, Megan A; Yeaton, Jennifer R; Carey, James R

2007-03-14

It is commonly agreed that control implementation, being a resource-consuming endeavor, is not exerted continuously or in simple tasks. However, most research in the field was done using tasks that varied the need for control on a trial-by-trial basis (e.g., Stroop, flanker) in a discrete manner. In this case, the anterior cingulate cortex (ACC) was found to monitor the need for control, whereas regions in the prefrontal cortex (PFC) were found to be involved in control implementation. Whether or not the same control mechanism would be used in continuous tasks was an open question. In our study, we found that in a continuous task, the same neural substrate subserves control monitoring (ACC) but that the neural substrate of control implementation changes over time. Early in the task, regions in the PFC were involved in control implementation, whereas later the control was taken over by subcortical structures, specifically the caudate. Our results suggest that humans possess a flexible control mechanism, with a specific structure dedicated to monitoring the need for control and with multiple structures involved in control implementation.

Evaluation of interventions on road traffic injuries in Peru: a qualitative approach

PubMed Central

2012-01-01

Background Evaluation of interventions on road traffic injuries (RTI) going beyond the assessment of impact to include factors underlying success or failure is an important complement to standard impact evaluations. We report here how we used a qualitative approach to assess current interventions implemented to reduce RTIs in Peru. Methods We performed in-depth interviews with policymakers and technical officers involved in the implementation of RTI interventions to get their insight on design, implementation and evaluation aspects. We then conducted a workshop with key stakeholders to analyze the results of in-depth interviews, and to further discuss and identify key programmatic considerations when designing and implementing RTI interventions. We finally performed brainstorming sessions to assess potential system-wide effects of a selected intervention (Zero Tolerance), and to identify adaptation and redesign needs for this intervention. Results Key programmatic components were consistently identified that should be considered when designing and implementing RTI interventions. They include effective and sustained political commitment and planning; sufficient and sustained budget allocation; training, supervision, monitoring and evaluation of implemented policies; multisectoral participation; and strong governance and accountability. Brainstorming sessions revealed major negative effects of the selected intervention on various system building blocks. Conclusions Our approach revealed substantial caveats in current RTI interventions in Peru, and fundamental negative effects on several components of the sectors and systems involved. It also highlighted programmatic issues that should be applied to guarantee an effective implementation and evaluation of these policies. The findings from this study were discussed with key stakeholders for consideration in further designing and planning RTI control interventions in Peru. PMID:22269578

Evaluation of interventions on road traffic injuries in Peru: a qualitative approach.

PubMed

Huicho, Luis; Adam, Taghreed; Rosales, Edmundo; Paca-Palao, Ada; López, Luis; Luna, Diego; Miranda, J Jaime

2012-01-23

Evaluation of interventions on road traffic injuries (RTI) going beyond the assessment of impact to include factors underlying success or failure is an important complement to standard impact evaluations. We report here how we used a qualitative approach to assess current interventions implemented to reduce RTIs in Peru. We performed in-depth interviews with policymakers and technical officers involved in the implementation of RTI interventions to get their insight on design, implementation and evaluation aspects. We then conducted a workshop with key stakeholders to analyze the results of in-depth interviews, and to further discuss and identify key programmatic considerations when designing and implementing RTI interventions. We finally performed brainstorming sessions to assess potential system-wide effects of a selected intervention (Zero Tolerance), and to identify adaptation and redesign needs for this intervention. Key programmatic components were consistently identified that should be considered when designing and implementing RTI interventions. They include effective and sustained political commitment and planning; sufficient and sustained budget allocation; training, supervision, monitoring and evaluation of implemented policies; multisectoral participation; and strong governance and accountability. Brainstorming sessions revealed major negative effects of the selected intervention on various system building blocks. Our approach revealed substantial caveats in current RTI interventions in Peru, and fundamental negative effects on several components of the sectors and systems involved. It also highlighted programmatic issues that should be applied to guarantee an effective implementation and evaluation of these policies. The findings from this study were discussed with key stakeholders for consideration in further designing and planning RTI control interventions in Peru.

Connected Vehicle-Enabled Weather Responsive Traffic Management

DOT National Transportation Integrated Search

2018-04-01

Weather Responsive Traffic Management (WRTM) is an initiative under the Federal Highway Administration's (FHWA) Road Weather Management Program that supports traffic management agencies and professionals in implementing effective advisory, control, a...