Adaptability of contingency management in justice settings: survey findings on attitudes toward using rewards.

PubMed

Murphy, Amy; Rhodes, Anne Giuranna; Taxman, Faye S

2012-09-01

Contingency management (CM) is widely recognized as an evidence-based practice, but it is not widely used in either treatment settings or justice settings. CM is perceived as adaptable in justice settings given the natural inclination to use contingencies to improve compliance to desired behaviors. In the Justice Steps implementation study, 5 federal district court jurisdictions agreed to consider implementing CM in specialized problem-solving courts or probation settings. A baseline survey (N = 186) examined the acceptance and feasibility of using rewards as a tool to manage offender compliance. The results of the survey revealed that most of the respondents believe that rewards are acceptable, with little difference between social and material rewards. Survey findings also showed that female justice workers and those who were not probation officers were more accepting of material rewards than their counterparts. Findings are consistent with prior research in drug treatment settings where there is little concern about using rewards. Copyright © 2012 Elsevier Inc. All rights reserved.

Adaptability of Contingency Management in Justice Settings: Survey Findings on Attitudes Towards Using Rewards

PubMed Central

Murphy, Amy; Rhodes, Anne Giuranna; Taxman, Faye S.

2011-01-01

Contingency management (CM) is widely recognized as an evidence-based practice, but it is not widely used in either treatment settings or justice settings. CM is perceived as adaptable in justice settings given the natural inclination to use contingencies to improve compliance to desired behaviors. In the Justice Steps implementation study, five federal district court jurisdictions agreed to consider implementing CM in specialized problem-solving courts or probation settings. A baseline survey (n=186) examined the acceptance and feasibility of using rewards as a tool to manage offender compliance. The results of the survey revealed that the majority of respondents believe that rewards are acceptable, with little difference between social and material rewards. Survey findings also showed that female justice workers and those who were not Probation Officers were more accepting of material rewards than their counterparts. Findings are consistent with prior research in drug treatment settings where there is little concern about using rewards. PMID:22209658

Developing a culturally competent health network: a planning framework and guide.

PubMed

Gertner, Eric J; Sabino, Judith N; Mahady, Erica; Deitrich, Lynn M; Patton, Jarret R; Grim, Mary Kay; Geiger, James F; Salas-Lopez, Debbie

2010-01-01

The number of cultural competency initiatives in healthcare is increasing due to many factors, including changing demographics, quality improvement and regulatory requirements, equitable care missions, and accreditation standards. To facilitate organization-wide transformation, a hospital or healthcare system must establish strategic goals, objectives, and implementation tasks for culturally competent provision of care. This article reports the largely successful results of a cultural competency program instituted at a large system in eastern Pennsylvania. Prior to the development of its cultural competency initiative, Lehigh Valley Health Network, Allentown, Pennsylvania, saw isolated activities producing innovative solutions to diversity and culture issues in the provision of equitable care. But it took a transformational event to support an organization-wide program in cultural competency by strengthening leadership buy-in and providing a sense of urgency, excitement, and shared vision among multiple stakeholders. A multidisciplinary task force, including senior leaders and a diverse group of employees, was created with the authority and responsibility to enact changes. Through a well-organized strategic planning process, existing patient and community demographic data were reviewed to describe existing disparities, a baseline assessment was completed, a mission statement was created, and clear metrics were developed. The strategic plan, which focused on five key areas (demographics, language-appropriate services, employees, training, and education/communication), was approved by the network's chief executive officer and senior managers to demonstrate commitment prior to implementation. Strategic plan implementation proceeded through a project structure consisting of subproject teams charged with achieving the following specific objectives: develop a cultural material repository, enhance employee recruitment/retention, establish a baseline assessment, standardize data collection, provide language-appropriate services, and develop an education program. Change management and project management methodologies; defined roles and responsibilities; and specific, measurable, attainable, realistic, and time-bound goals were used in the implementation. This process has supported organizational change, thereby promoting high-quality, safe, and equitable care through widespread expectations of culturally competent care delivery across the entire network. Using this "ecologic approach" will ensure long-term success.

Know Your Enemy - Implementation of Bioremediation within a Suspected DNAPL Source Zone Following High-Resolution Site Characterization at Contractors Road Heavy Equipment Area, Kennedy Space Center, Florida

NASA Technical Reports Server (NTRS)

Chrest, Anne; Daprato, Rebecca; Burcham, Michael; Johnson, Jill

2018-01-01

The National Aeronautics and Space Administration (NASA), Kennedy Space Center (KSC), has adopted high-resolution site characterization (HRSC) sampling techniques during baseline sampling prior to implementation of remedies to confirm and refine the conceptual site model (CSM). HRSC sampling was performed at Contractors Road Heavy Equipment Area (CRHE) prior to bioremediation implementation to verify the extent of the trichloroethene (TCE) dense non-aqueous phase liquid (DNAPL) source area (defined as the area with TCE concentrations above 1% solubility) and its daughter product dissolved plume that had been identified during previous HRSC events. The results of HRSC pre-bioremediation implementation sampling suggested that the TCE source area was larger than originally identified during initial site characterization activities, leading to a design refinement to improve electron donor distribution and increase the likelihood of achieving remedial objectives. Approach/Activities: HRSC was conducted from 2009 through 2014 to delineate the vertical and horizontal extent of chlorinated volatile organic compounds (CVOCs) in the groundwater. Approximately 2,340 samples were collected from 363 locations using direct push technology (DPT) groundwater sampling techniques. Samples were collected from up to 14 depth intervals at each location using a 4-foot sampling screen. This HRSC approach identified a narrow (approx. 5 to 30 feet wide), approximately 3,000 square foot TCE DNAPL source area (maximum detected TCE concentration of 160,000 micrograms per liter [micro-g/L] at DPT sampling location DPT0225). Prior to implementation of a bioremediation interim measure, HRSC baseline sampling was conducted using DPT groundwater sampling techniques. Concentrations of TCE were an order of magnitude lower than previous reported (12,000 micro-g/L maximum at DPT sampling location DPT0225) at locations sampled adjacent to previous sampling locations. To further evaluate the variability in concentrations observed additional sampling was conducted in 2016. The results identified higher concentrations than originally detected within the previously defined source area and the presence of source zone concentrations upgradient of the previously defined source area (maximum concentration observed 570,000 micro-g/L). The HRSC baseline sampling data allowed for a revision of the bioremediation design prior to implementation. Bioremediation was implemented within the eastern portion of the source area in November and December 2016 and quarterly performance monitoring was completed in March and June 2017. Reductions in CVOC concentrations from baseline were observed at all performance monitoring wells in the treatment area, and by June 2017, an approximate 95% CVOC mass reduction was observed based on monitoring well sampling results. Results/Lessons Learned: The results of this project suggest that, due to the complexity of DNAPL source zones, HRSC during pre-implementation baseline sampling in the TCE source zone was an essential strategy for verifying the treatment area and depth prior to remedy implementation. If the upgradient source zone mass was not identified prior to bioremediation implementation, the mass would have served as a long-term source for the dissolved plume.

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.

Adapted shared reading at school for minimally verbal students with autism.

PubMed

Mucchetti, Charlotte A

2013-05-01

Almost nothing is known about the capacity of minimally verbal students with autism to develop literacy skills. Shared reading is a regular practice in early education settings and is widely thought to encourage language and literacy development. There is some evidence that children with severe disabilities can be engaged in adapted shared reading activities. The current study examines the impact of teacher-led adapted shared reading activities on engagement and story comprehension in minimally verbal 5-6-year-old children with autism using a multiple baseline/alternating treatment design. Four students and three teachers participated. Teachers conducted adapted shared reading activities with modified books (visual supports, three-dimensional objects, simplified text) and used specific strategies for increasing student engagement. Student performance during adapted activities was compared to performance during standard shared reading sessions. All four students showed increased story comprehension and engagement during adapted shared reading. Average percentage of session engaged was 87%-100% during adapted sessions, compared with 41%-52% during baseline. Average number of correct responses to story comprehension questions was 4.2-4.8 out of 6 during adapted sessions compared with 1.2-2 during baseline. Visual supports, tactile objects, and specific teaching strategies offer ways for minimally verbal students to meaningfully participate in literacy activities. Future research should investigate adapted shared reading activities implemented classroom-wide as well as joint engagement, language, and literacy outcomes after using such activities over time.

Impact of a multidimensional infection control approach on central line-associated bloodstream infections rates in adult intensive care units of 8 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC)

PubMed Central

2013-01-01

Background Central line-associated bloodstream infections (CLABs) have long been associated with excess lengths of stay, increased hospital costs and mortality attributable to them. Different studies from developed countries have shown that practice bundles reduce the incidence of CLAB in intensive care units. However, the impact of the bundle strategy has not been systematically analyzed in the adult intensive care unit (ICU) setting in developing countries, such as Turkey. The aim of this study is to analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce the rates of CLAB in 13 ICUs of 13 INICC member hospitals from 8 cities of Turkey. Methods We conducted active, prospective surveillance before-after study to determine CLAB rates in a cohort of 4,017 adults hospitalized in ICUs. We applied the definitions of the CDC/NHSN and INICC surveillance methods. The study was divided into baseline and intervention periods. During baseline, active outcome surveillance of CLAB rates was performed. During intervention, the INICC multidimensional approach for CLAB reduction was implemented and included the following measures: 1- bundle of infection control interventions, 2- education, 3- outcome surveillance, 4- process surveillance, 5- feedback of CLAB rates, and 6- performance feedback on infection control practices. CLAB rates obtained in baseline were compared with CLAB rates obtained during intervention. Results During baseline, 3,129 central line (CL) days were recorded, and during intervention, we recorded 23,463 CL-days. We used random effects Poisson regression to account for clustering of CLAB rates within hospital across time periods. The baseline CLAB rate was 22.7 per 1000 CL days, which was decreased during the intervention period to 12.0 CLABs per 1000 CL days (IRR 0.613; 95% CI 0.43 – 0.87; P 0.007). This amounted to a 39% reduction in the incidence rate of CLAB. Conclusions The implementation of multidimensional infection control approach was associated with a significant reduction in the CLAB rates in adult ICUs of Turkey, and thus should be widely implemented. PMID:23641950

Genetic Associations with Plasma B12, B6, and Folate Levels in an Ischemic Stroke Population from the Vitamin Intervention for Stroke Prevention (VISP) Trial.

PubMed

Keene, Keith L; Chen, Wei-Min; Chen, Fang; Williams, Stephen R; Elkhatib, Stacey D; Hsu, Fang-Chi; Mychaleckyj, Josyf C; Doheny, Kimberly F; Pugh, Elizabeth W; Ling, Hua; Laurie, Cathy C; Gogarten, Stephanie M; Madden, Ebony B; Worrall, Bradford B; Sale, Michele M

2014-01-01

B vitamins play an important role in homocysteine metabolism, with vitamin deficiencies resulting in increased levels of homocysteine and increased risk for stroke. We performed a genome-wide association study (GWAS) in 2,100 stroke patients from the Vitamin Intervention for Stroke Prevention (VISP) trial, a clinical trial designed to determine whether the daily intake of high-dose folic acid, vitamins B6, and B12 reduce recurrent cerebral infarction. Extensive quality control (QC) measures resulted in a total of 737,081 SNPs for analysis. Genome-wide association analyses for baseline quantitative measures of folate, Vitamins B12, and B6 were completed using linear regression approaches, implemented in PLINK. Six associations met or exceeded genome-wide significance (P ≤ 5 × 10(-08)). For baseline Vitamin B12, the strongest association was observed with a non-synonymous SNP (nsSNP) located in the CUBN gene (P = 1.76 × 10(-13)). Two additional CUBN intronic SNPs demonstrated strong associations with B12 (P = 2.92 × 10(-10) and 4.11 × 10(-10)), while a second nsSNP, located in the TCN1 gene, also reached genome-wide significance (P = 5.14 × 10(-11)). For baseline measures of Vitamin B6, we identified genome-wide significant associations for SNPs at the ALPL locus (rs1697421; P = 7.06 × 10(-10) and rs1780316; P = 2.25 × 10(-08)). In addition to the six genome-wide significant associations, nine SNPs (two for Vitamin B6, six for Vitamin B12, and one for folate measures) provided suggestive evidence for association (P ≤ 10(-07)). Our GWAS study has identified six genome-wide significant associations, nine suggestive associations, and successfully replicated 5 of 16 SNPs previously reported to be associated with measures of B vitamins. The six genome-wide significant associations are located in gene regions that have shown previous associations with measures of B vitamins; however, four of the nine suggestive associations represent novel finding and warrant further investigation in additional populations.

Psychomotor testing predicts rate of skill acquisition for proficiency-based laparoscopic skills training.

PubMed

Stefanidis, Dimitrios; Korndorffer, James R; Black, F William; Dunne, J Bruce; Sierra, Rafael; Touchard, Cheri L; Rice, David A; Markert, Ronald J; Kastl, Peter R; Scott, Daniel J

2006-08-01

Laparoscopic simulator training translates into improved operative performance. Proficiency-based curricula maximize efficiency by tailoring training to meet the needs of each individual; however, because rates of skill acquisition vary widely, such curricula may be difficult to implement. We hypothesized that psychomotor testing would predict baseline performance and training duration in a proficiency-based laparoscopic simulator curriculum. Residents (R1, n = 20) were enrolled in an IRB-approved prospective study at the beginning of the academic year. All completed the following: a background information survey, a battery of 12 innate ability measures (5 motor, and 7 visual-spatial), and baseline testing on 3 validated simulators (5 videotrainer [VT] tasks, 12 virtual reality [minimally invasive surgical trainer-virtual reality, MIST-VR] tasks, and 2 laparoscopic camera navigation [LCN] tasks). Participants trained to proficiency, and training duration and number of repetitions were recorded. Baseline test scores were correlated to skill acquisition rate. Cutoff scores for each predictive test were calculated based on a receiver operator curve, and their sensitivity and specificity were determined in identifying slow learners. Only the Cards Rotation test correlated with baseline simulator ability on VT and LCN. Curriculum implementation required 347 man-hours (6-person team) and 795,000 dollars of capital equipment. With an attendance rate of 75%, 19 of 20 residents (95%) completed the curriculum by the end of the academic year. To complete training, a median of 12 hours (range, 5.5-21), and 325 repetitions (range, 171-782) were required. Simulator score improvement was 50%. Training duration and repetitions correlated with prior video game and billiard exposure, grooved pegboard, finger tap, map planning, Rey Figure Immediate Recall score, and baseline performance on VT and LCN. The map planning cutoff score proved most specific in identifying slow learners. Proficiency-based laparoscopic simulator training provides improvement in performance and can be effectively implemented as a routine part of resident education, but may require significant resources. Although psychomotor testing may be of limited value in the prediction of baseline laparoscopic performance, its importance may lie in the prediction of the rapidity of skill acquisition. These tests may be useful in optimizing curricular design by allowing the tailoring of training to individual needs.

Weqaya: A Population-Wide Cardiovascular Screening Program in Abu Dhabi, United Arab Emirates

PubMed Central

Harrison, Oliver; Al Siksek, Zaid

2012-01-01

Objectives. We sought to determine cardiovascular risk factor prevalence rates among adults in Abu Dhabi, United Arab Emirates. Methods. We used self-reported indicators, anthropometric measures, and blood tests to screen 50 138 adults aged 18 years or older taking part in a population-wide cardiovascular screening program. Results. Participants’ mean age was 36.82 years (SD = 14.3); 43% were men. Risk factor prevalence rates were as follows: obesity, 35%; overweight, 32%; central obesity, 55%; diabetes, 18%; prediabetes, 27%; dyslipidemia, 44%; and hypertension, 23.1%. In addition, 26% of men were smokers, compared with 0.8% of women. Age-standardized diabetes and prediabetes rates were 25% and 30%, respectively, and age-standardized rates of obesity and overweight were 41% and 34%. Conclusions. This population-wide cardiovascular screening program demonstrated a high cardiovascular burden for our small sample in Abu Dhabi. The data form a baseline against which interventions can be implemented and progress monitored as part of the population-wide Abu Dhabi Cardiovascular Disease Program. PMID:21940918

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

PubMed

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

2013-10-14

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

Are Birth-preparedness Programmes Effective? Results From a Field Trial in Siraha District, Nepal

PubMed Central

McPherson, Robert A.; Moore, Judith M.; Sharma, Meena

2006-01-01

The birth-preparedness package (BPP) promotes active preparation and decision-making for births, including pregnancy/postpartum periods, by pregnant women and their families. This paper describes a district-wide field trial of the BPP implemented through the government health system in Siraha, Nepal, during 2003–2004. The aim of the field trial was to determine the effectiveness of the BPP to positively influence planning for births, household-level behaviours that affect the health of pregnant and postpartum women and their newborns, and their use of selected health services for maternal and newborn care. Community health workers promoted desired behaviours through inter-personal counselling with individuals and groups. Content of messages included maternal and newborn-danger signs and encouraged the use of healthcare services and preparation for emergencies. Thirty-cluster baseline and endline household surveys of mothers of infants aged less than one year were used for estimating the change in key outcome indicators. Fifty-four percent of respondents (n=162) were directly exposed to BPP materials while pregnant. A composite index of seven indicators that measure knowledge of respondents, use of health services, and preparation for emergencies increased from 33% at baseline to 54% at endline (p=0.001). Five key newborn practices increased by 19 to 29 percentage points from baseline to endline (p values ranged from 0.000 to 0.06). Certain key maternal health indicators, such as skilled birth attendance and use of emergency obstetric care, did not change. The BPP can positively influence knowledge and intermediate health outcomes, such as household practices and use of some health services. The BPP can be implemented by government health services with minimal outside assistance but should be comprehensively integrated into the safe motherhood programme rather than implemented as a separate intervention. PMID:17591345

The Tupange Project in Kenya: A Multifaceted Approach to Increasing Use of Long-Acting Reversible Contraceptives

PubMed Central

Muthamia, Michael; Owino, Kenneth; Nyachae, Paul; Kilonzo, Margaret; Kamau, Mercy; Otai, Jane; Kabue, Mark; Keyonzo, Nelson

2016-01-01

ABSTRACT Background: Long-acting reversible contraceptives (LARCs) are safe and highly effective, and they have higher continuation rates than short-acting methods. Because only a small percentage of sexually active women in Kenya use LARCs, the Tupange project implemented a multifaceted approach to increase uptake of LARCs, particularly among the urban poor. The project included on-site mentoring, whole-site orientation, commodity security, quality improvement, and multiple demand-promotion and service-provision strategies, in the context of wide method choice. We report on activities in Nairobi between July 2011 and December 2014, the project implementation period. Methods: We used a household longitudinal survey of women of reproductive age to measure changes in the contraceptive prevalence rate (CPR) and other family planning-related variables. At baseline in July 2010, 2,676 women were interviewed; about 50% were successfully tracked and interviewed at endline in December 2014. A baseline service delivery point (SDP) survey of 112 health facilities and 303 service providers was conducted in July 2011, and an endline SDP survey was conducted in December 2014 to measure facility-based interventions. The SDP baseline survey was conducted after the household survey, as facilities were selected based on where clients said they obtained services. Results: The project led to significant increases in use of implants and intrauterine devices (IUDs). Uptake of implants increased by 6.5 percentage points, from 2.4% at baseline to 8.9% by endline, and uptake of IUDs increased by 2.1 percentage points, from 2.2% to 4.3%. By the endline survey, 37.7% of clients using pills and injectables at baseline had switched to LARCs. Contraceptive use among the poorest and poor wealth quintiles increased by 20.5 and 21.5 percentage points, respectively, from baseline to endline. Various myths and misconceptions reported about family planning methods declined significantly between baseline and endline. Conclusion: Training, commodity security, multiple service delivery models, and demand promotion were the cornerstones of a successful approach to reach the urban poor in Nairobi with LARCs. PMID:27540124

Lasting impact of an implemented self-management programme for people with type 2 diabetes referred from primary care: a one-group, before-after design.

PubMed

Fløde, Mari; Iversen, Marjolein M; Aarflot, Morten; Haltbakk, Johannes

2017-12-01

Research interventions in uniform clinical settings and in patients fulfilling well-defined inclusion criteria might show a more pronounced effect than implementing the same intervention in existing practice. Diabetes Self-Management Education (DSME) is complex, and should be assessed in existing practice as it is an intervention widely implemented. To examine the impact of an established group-based DSME in unselected people with type 2 diabetes referred from primary care. A one-group, before-after design was used for assessments before, immediately after, and 3 months after participation in a group-based DSME programme conducted at two Learning and Mastering Centres in Norway between November 2013 and June 2014. Participants completed a questionnaire before (n = 115), immediately after (n = 95) and 3 months after (n = 42) the DSME programme. Primary outcome measure was diabetes knowledge (Michigan Diabetes Knowledge Test). Also patient activation (Patient Activation Measure [PAM]) and self-efficacy (General Self-Efficacy scale [GSE]) were measured. Changes in outcome measures were analysed using paired t-tests for normally distributed data and Wilcoxon signed-rank test for skewed data. Mean knowledge improved significantly from baseline (p < 0.001). Changes persisted at the 3-month assessment. Mean PAM scores improved significantly from baseline (p < 0.001), and changes persisted for 3 months. Mean GSE scores improved from baseline (p = 0.022) and persisted for 3 months. However, when results were stratified for participants who responded at all three time points, GSE showed no change during the study period. The complexity self-management in the individual is challenging to reflect in DSME. This implemented DSME programme for people with type 2 diabetes improved levels of diabetes knowledge and patient activation, persisting for at least 3 months. Hence, the DSME programme appears to be robust beyond standardised research settings, in educating unselected diabetes patients referred from primary care. © 2017 Nordic College of Caring Science.

Linking molar organizational climate and strategic implementation climate to clinicians' use of evidence-based psychotherapy techniques: cross-sectional and lagged analyses from a 2-year observational study.

PubMed

Williams, Nathaniel J; Ehrhart, Mark G; Aarons, Gregory A; Marcus, Steven C; Beidas, Rinad S

2018-06-25

Behavioral health organizations are characterized by multiple organizational climates, including molar climate, which encompasses clinicians' shared perceptions of how the work environment impacts their personal well-being, and strategic implementation climate, which includes clinicians' shared perceptions of the extent to which evidence-based practice implementation is expected, supported, and rewarded by the organization. Theory suggests these climates have joint, cross-level effects on clinicians' implementation of evidence-based practice and that these effects may be long term (i.e., up to 2 years); however, no empirical studies have tested these relationships. We hypothesize that molar climate moderates implementation climate's concurrent and long-term relationships with clinicians' use of evidence-based practice such that strategic implementation climate will have its most positive effects when it is accompanied by a positive molar climate. Hypotheses were tested using data collected from 235 clinicians in 20 behavioral health organizations. At baseline, clinicians reported on molar climate and implementation climate. At baseline and at a 2-year follow-up, all clinicians who were present in the organizations reported on their use of cognitive-behavioral psychotherapy techniques, an evidence-based practice for youth psychiatric disorders. Two-level mixed-effects regression models tested whether baseline molar climate and implementation climate interacted in predicting clinicians' evidence-based practice use at baseline and at 2-year follow-up. In organizations with more positive molar climates at baseline, higher levels of implementation climate predicted increased evidence-based practice use among clinicians who were present at baseline and among clinicians who were present in the organizations at 2-year follow-up; however, in organizations with less positive molar climates, implementation climate was not related to clinicians' use of evidence-based practice at either time point. Optimizing clinicians' implementation of evidence-based practice in behavioral health requires attention to both molar climate and strategic implementation climate. Strategies that focus exclusively on implementation climate may not be effective levers for behavior change if the organization does not also engender a positive molar climate. These findings have implications for the development of implementation theory and effective implementation strategies.

Wide-Field Imaging Interferometry Spatial-Spectral Image Synthesis Algorithms

NASA Technical Reports Server (NTRS)

Lyon, Richard G.; Leisawitz, David T.; Rinehart, Stephen A.; Memarsadeghi, Nargess; Sinukoff, Evan J.

2012-01-01

Developed is an algorithmic approach for wide field of view interferometric spatial-spectral image synthesis. The data collected from the interferometer consists of a set of double-Fourier image data cubes, one cube per baseline. These cubes are each three-dimensional consisting of arrays of two-dimensional detector counts versus delay line position. For each baseline a moving delay line allows collection of a large set of interferograms over the 2D wide field detector grid; one sampled interferogram per detector pixel per baseline. This aggregate set of interferograms, is algorithmically processed to construct a single spatial-spectral cube with angular resolution approaching the ratio of the wavelength to longest baseline. The wide field imaging is accomplished by insuring that the range of motion of the delay line encompasses the zero optical path difference fringe for each detector pixel in the desired field-of-view. Each baseline cube is incoherent relative to all other baseline cubes and thus has only phase information relative to itself. This lost phase information is recovered by having point, or otherwise known, sources within the field-of-view. The reference source phase is known and utilized as a constraint to recover the coherent phase relation between the baseline cubes and is key to the image synthesis. Described will be the mathematical formalism, with phase referencing and results will be shown using data collected from NASA/GSFC Wide-Field Imaging Interferometry Testbed (WIIT).

The filter and calibration wheel for the ATHENA wide field imager

NASA Astrophysics Data System (ADS)

Rataj, M.; Polak, S.; Palgan, T.; Kamisiński, T.; Pilch, A.; Eder, J.; Meidinger, N.; Plattner, M.; Barbera, M.; Parodi, G.; D'Anca, Fabio

2016-07-01

The planned filter and calibration wheel for the Wide Field Imager (WFI) instrument on Athena is presented. With four selectable positions it provides the necessary functions, in particular an UV/VIS blocking filter for the WFI detectors and a calibration source. Challenges for the filter wheel design are the large volume and mass of the subsystem, the implementation of a robust mechanism and the protection of the ultra-thin filter with an area of 160 mm square. This paper describes performed trade-offs based on simulation results and describes the baseline design in detail. Reliable solutions are envisaged for the conceptual design of the filter and calibration wheel. Four different variant with different position of the filter are presented. Risk mitigation and the compliance to design requirements are demonstrated.

Process Evaluation and Costing of a Multifaceted Population-Wide Intervention to Reduce Salt Consumption in Fiji.

PubMed

Webster, Jacqui; Pillay, Arti; Suku, Arleen; Gohil, Paayal; Santos, Joseph Alvin; Schultz, Jimaima; Wate, Jillian; Trieu, Kathy; Hope, Silvia; Snowdon, Wendy; Moodie, Marj; Jan, Stephen; Bell, Colin

2018-01-30

This paper reports the process evaluation and costing of a national salt reduction intervention in Fiji. The population-wide intervention included engaging food industry to reduce salt in foods, strategic health communication and a hospital program. The evaluation showed a 1.4 g/day drop in salt intake from the 11.7 g/day at baseline; however, this was not statistically significant. To better understand intervention implementation, we collated data to assess intervention fidelity, reach, context and costs. Government and management changes affected intervention implementation, meaning fidelity was relatively low. There was no active mechanism for ensuring food companies adhered to the voluntary salt reduction targets. Communication activities had wide reach but most activities were one-off, meaning the overall dose was low and impact on behavior limited. Intervention costs were moderate (FJD $277,410 or $0.31 per person) but the strategy relied on multi-sector action which was not fully operationalised. The cyclone also delayed monitoring and likely impacted the results. However, 73% of people surveyed had heard about the campaign and salt reduction policies have been mainstreamed into government programs. Longer-term monitoring of salt intake is planned through future surveys and lessons from this process evaluation will be used to inform future strategies in the Pacific Islands and globally.

Process Evaluation and Costing of a Multifaceted Population-Wide Intervention to Reduce Salt Consumption in Fiji

PubMed Central

Webster, Jacqui; Pillay, Arti; Suku, Arleen; Gohil, Paayal; Santos, Joseph Alvin; Schultz, Jimaima; Wate, Jillian; Trieu, Kathy; Hope, Silvia; Snowdon, Wendy; Moodie, Marj; Jan, Stephen; Bell, Colin

2018-01-01

This paper reports the process evaluation and costing of a national salt reduction intervention in Fiji. The population-wide intervention included engaging food industry to reduce salt in foods, strategic health communication and a hospital program. The evaluation showed a 1.4 g/day drop in salt intake from the 11.7 g/day at baseline; however, this was not statistically significant. To better understand intervention implementation, we collated data to assess intervention fidelity, reach, context and costs. Government and management changes affected intervention implementation, meaning fidelity was relatively low. There was no active mechanism for ensuring food companies adhered to the voluntary salt reduction targets. Communication activities had wide reach but most activities were one-off, meaning the overall dose was low and impact on behavior limited. Intervention costs were moderate (FJD $277,410 or $0.31 per person) but the strategy relied on multi-sector action which was not fully operationalised. The cyclone also delayed monitoring and likely impacted the results. However, 73% of people surveyed had heard about the campaign and salt reduction policies have been mainstreamed into government programs. Longer-term monitoring of salt intake is planned through future surveys and lessons from this process evaluation will be used to inform future strategies in the Pacific Islands and globally. PMID:29385758

Changing the restaurant food environment to improve cardiovascular health in a rural community: implementation and evaluation of the Heart of New Ulm restaurant programme.

PubMed

Lindberg, Rebecca; Sidebottom, Abbey C; McCool, Brigitte; Pereira, Raquel F; Sillah, Arthur; Boucher, Jackie L

2018-04-01

The goals of the present study were to: (i) describe the implementation of a programme to improve the restaurant food environment in a rural community; and (ii) describe how practices changed in community restaurants. The intervention included a baseline assessment of all community restaurants (n 32) and a report on how they could increase the availability and promotion of healthful options. The assessment focused on sixteen healthy practices (HP) derived from the Nutrition Environment Measures Survey for Restaurants. Restaurants were invited to participate at gold, silver or bronze levels based on the number of HP attained. Participating restaurants received dietitian consultation, staff training and promotion of the restaurant. All community restaurants were reassessed 1·5 years after baseline. The restaurant programme was part of the Heart of New Ulm Project, a community-based CVD prevention programme in a rural community. All community restaurants (n 32) were included in the study. Over one-third (38 %) of community restaurants participated in the programme. At baseline, 22 % achieved at least a bronze level. This increased to 38 % at follow-up with most of the improvement among participating restaurants that were independently owned. Across all restaurants in the community, the HP showing the most improvement included availability of non-fried vegetables (63-84 %), fruits (41-53 %), smaller portions and whole grains. Findings demonstrate successes and challenges of improving healthful food availability and promotion in a community-wide restaurant programme.

Air quality impacts of distributed power generation in the South Coast Air Basin of California 1: Scenario development and modeling analysis

NASA Astrophysics Data System (ADS)

Rodriguez, M. A.; Carreras-Sospedra, M.; Medrano, M.; Brouwer, J.; Samuelsen, G. S.; Dabdub, D.

Distributed generation (DG) is generally defined as the operation of many small stationary power generators throughout an urban air basin. Although DG has the potential to supply a significant portion of the increased power demands in California and the rest of the United States, it may lead to increased levels of in-basin pollutants and adversely impact urban air quality. This study focuses on two main objectives: (1) the systematic characterization of DG installation in urban air basins, and (2) the simulation of potential air quality impacts using a state-of-the-art three-dimensional computational model. A general and systematic approach is devised to construct five realistic and 21 spanning scenarios of DG implementation in the South Coast Air Basin (SoCAB) of California. Realistic scenarios reflect an anticipated level of DG deployment in the SoCAB by the year 2010. Spanning scenarios are developed to determine the potential impacts of unexpected outcomes. Realistic implementations of DG in the SoCAB result in small differences in ozone and particulate matter concentrations in the basin compared to the baseline simulations. The baseline accounts for population increase, but does not consider any future emissions control measures. Model results for spanning implementations with extra high DG market penetration show that domain-wide ozone peak concentrations increase significantly. Also, air quality impacts of spanning implementations when DG operate during a 6-h period are larger than when the same amount of emissions are introduced during a 24-h period.

Evaluating Lean in healthcare.

PubMed

Burgess, Nicola; Radnor, Zoe

2013-01-01

The purpose of this paper is to present findings relating to how Lean is implemented in English hospitals. Lean implementation snapshots in English hospitals were conducted by content analysing all annual reports and web sites over two time periods, giving a thorough analysis of Lean's status in English healthcare. The article identifies divergent approaches to Lean implementation in English hospitals. These approaches are classified into a typology to facilitate an evaluation of how Lean is implemented. The findings suggest that implementation tends to be isolated rather than system-wide. A second dataset conveys Lean implementation trajectory across the time period. These data signal Lean's increasing use by English hospitals and shows progression towards an increasingly systemic approach. Data were collected using content analysis methods, which relies on how "Lean" methods were articulated within the annual report and/or on the organisation's web site, which indicates approaches taken by hospital staff implementing Lean. This research is the first to examine more closely "how" Lean is implemented in English hospitals. The emergent typology could prove relevant to other public sector organizations and service organisations more generally. The research also presents a first step to understanding Lean thinking in the English NHS. This article empirically analyses Lean implementation in English hospitals. It identifies divergent approaches that allow inferences about how far Lean is implemented in an organisation. Data represent a baseline for further analysis so that Lean implementation can be tracked.

Wide baseline stereo matching based on double topological relationship consistency

NASA Astrophysics Data System (ADS)

Zou, Xiaohong; Liu, Bin; Song, Xiaoxue; Liu, Yang

2009-07-01

Stereo matching is one of the most important branches in computer vision. In this paper, an algorithm is proposed for wide-baseline stereo vision matching. Here, a novel scheme is presented called double topological relationship consistency (DCTR). The combination of double topological configuration includes the consistency of first topological relationship (CFTR) and the consistency of second topological relationship (CSTR). It not only sets up a more advanced model on matching, but discards mismatches by iteratively computing the fitness of the feature matches and overcomes many problems of traditional methods depending on the powerful invariance to changes in the scale, rotation or illumination across large view changes and even occlusions. Experimental examples are shown where the two cameras have been located in very different orientations. Also, epipolar geometry can be recovered using RANSAC by far the most widely method adopted possibly. By the method, we can obtain correspondences with high precision on wide baseline matching problems. Finally, the effectiveness and reliability of this method are demonstrated in wide-baseline experiments on the image pairs.

BANNER: an executable survey of advances in biomedical named entity recognition.

PubMed

Leaman, Robert; Gonzalez, Graciela

2008-01-01

There has been an increasing amount of research on biomedical named entity recognition, the most basic text extraction problem, resulting in significant progress by different research teams around the world. This has created a need for a freely-available, open source system implementing the advances described in the literature. In this paper we present BANNER, an open-source, executable survey of advances in biomedical named entity recognition, intended to serve as a benchmark for the field. BANNER is implemented in Java as a machine-learning system based on conditional random fields and includes a wide survey of the best techniques recently described in the literature. It is designed to maximize domain independence by not employing brittle semantic features or rule-based processing steps, and achieves significantly better performance than existing baseline systems. It is therefore useful to developers as an extensible NER implementation, to researchers as a standard for comparing innovative techniques, and to biologists requiring the ability to find novel entities in large amounts of text.

Assessing the impacts of future climate conditions on the effectiveness of winter cover crops in reducing nitrate loads into the Chesapeake Bay Watershed using SWAT model

USGS Publications Warehouse

Lee, Sangchul; Sadeghi, Ali M.; Yeo, In-Young; McCarty, Gregory W.; Hively, W. Dean

2017-01-01

Winter cover crops (WCCs) have been widely implemented in the Coastal Plain of the Chesapeake Bay watershed (CBW) due to their high effectiveness at reducing nitrate loads. However, future climate conditions (FCCs) are expected to exacerbate water quality degradation in the CBW by increasing nitrate loads from agriculture. Accordingly, the question remains whether WCCs are sufficient to mitigate increased nutrient loads caused by FCCs. In this study, we assessed the impacts of FCCs on WCC nitrate reduction efficiency on the Coastal Plain of the CBW using Soil and Water Assessment Tool (SWAT) model. Three FCC scenarios (2085 – 2098) were prepared using General Circulation Models (GCMs), considering three Intergovernmnental Panel on Climate Change (IPCC) Special Report on Emissions Scenarios (SRES) greenhouse gas emission scenarios. We also developed six representative WCC implementation scenarios based on the most commonly used planting dates and species of WCCs in this region. Simulation results showed that WCC biomass increased by ~ 58 % under FCC scenarios, due to climate conditions conducive to the WCC growth. Prior to implementing WCCs, annual nitrate loads increased by ~ 43 % under FCC scenarios compared to the baseline scenario (2001 – 2014). When WCCs were planted, annual nitrate loads were substantially reduced by ~ 48 % and WCC nitrate reduction efficiency water ~ 5 % higher under FCC scenarios relative to the baseline. The increase rate of WCC nitrate reduction efficiency varied by FCC scenarios and WCC planting methods. As CO2 concentration was higher and winters were warmer under FCC scenarios, WCCs had greater biomass and therefore showed higher nitrate reduction efficiency. In response to FCC scenarios, the performance of less effective WCC practices (e.g., barley, wheat, and late planting) under the baseline indicated ~ 14 % higher increase rate of nitrate reduction efficiency compared to ones with better effectiveness under the baseline (e.g., rye and early planting), due to warmer temperatures. According to simulation results, WCCs were effective to mitigate nitrate loads accelerated by FCCs and therefore the role of WCCs in mitigating nitrate loads is even more important in the given FCCs.

Toward Robust Climate Baselining: Objective Assessment of Climate Change Using Widely Distributed Miniaturized Sensors for Accurate World-Wide Geophysical Measurements

DOE R&D Accomplishments Database

Teller, E.; Leith, C.; Canavan, G.; Marion, J.; Wood, L.

2001-11-13

A gap-free, world-wide, ocean-, atmosphere-, and land surface-spanning geophysical data-set of three decades time-duration containing the full set of geophysical parameters characterizing global weather is the scientific perquisite for defining the climate; the generally-accepted definition in the meteorological community is that climate is the 30-year running-average of weather. Until such a tridecadal climate baseline exists, climate change discussions inevitably will have a semi-speculative, vs. a purely scientific, character, as the baseline against which changes are referenced will at least somewhat uncertain.

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

Passive perception system for day/night autonomous off-road navigation

NASA Astrophysics Data System (ADS)

Rankin, Arturo L.; Bergh, Charles F.; Goldberg, Steven B.; Bellutta, Paolo; Huertas, Andres; Matthies, Larry H.

2005-05-01

Passive perception of terrain features is a vital requirement for military related unmanned autonomous vehicle operations, especially under electromagnetic signature management conditions. As a member of Team Raptor, the Jet Propulsion Laboratory developed a self-contained passive perception system under the DARPA funded PerceptOR program. An environmentally protected forward-looking sensor head was designed and fabricated in-house to straddle an off-the-shelf pan-tilt unit. The sensor head contained three color cameras for multi-baseline daytime stereo ranging, a pair of cooled mid-wave infrared cameras for nighttime stereo ranging, and supporting electronics to synchronize captured imagery. Narrow-baseline stereo provided improved range data density in cluttered terrain, while wide-baseline stereo provided more accurate ranging for operation at higher speeds in relatively open areas. The passive perception system processed stereo images and outputted over a local area network terrain maps containing elevation, terrain type, and detected hazards. A novel software architecture was designed and implemented to distribute the data processing on a 533MHz quad 7410 PowerPC single board computer under the VxWorks real-time operating system. This architecture, which is general enough to operate on N processors, has been subsequently tested on Pentium-based processors under Windows and Linux, and a Sparc based-processor under Unix. The passive perception system was operated during FY04 PerceptOR program evaluations at Fort A. P. Hill, Virginia, and Yuma Proving Ground, Arizona. This paper discusses the Team Raptor passive perception system hardware and software design, implementation, and performance, and describes a road map to faster and improved passive perception.

Active Ottumwa: Adapting Evidence-Based Recommendations to Promote Physical Activity in a Micropolitan New Destination Community

PubMed Central

Baquero, Barbara; Ashida, Sato; Daniel-Ulloa, Jason; Laroche, Helena H.; Haines, Heidi; Bucklin, Rebecca; Maldonado, Adriana; Coronado Garcia, Mayra; Berto, Sandy; Sewell, Dan; Janz, Kathleen; Gates, Claudia; Parker, Edith A.

2018-01-01

Background: Evidence-based interventions have been developed and tested to promote physical activity, but fewer studies have focused on identifying effective intervention strategies for mid-size rural communities, especially new immigrant destinations. We report here on the design and implementation of Active Ottumwa, a community-wide intervention using a lay health advisor approach to increase physical activity in a micropolitan new destination community in the rural state of Iowa. Methods: The Active Ottumwa study is part of a community-academic partnership in Ottumwa, IA. Evidence-based strategies recommended by the Community Guide for Preventive Services guided study implementation and included behavioral and social, campaign and informational, and environmental and policy approaches. Evaluation methods for this study are multi-faceted and include a cross-sectional community survey, longitudinal cohort assessment, observational data, key informant interviews, and project records. Results: We are currently in our second year of intervention implementation, with 45 lay health advisors (termed physical activity leaders here) trained to carry out behavioral and social intervention approaches, including walking groups, tai chi, and yoga. We have completed a communication and informational campaign utilizing five channels. Our longitudinal cohort has been recruited, with baseline and 12-month data collection completed. Conclusions: This study will assess the effectiveness and impact of a community-wide intervention to support physical activity. PMID:29734709

Active Ottumwa: Adapting Evidence-Based Recommendations to Promote Physical Activity in a Micropolitan New Destination Community.

PubMed

Baquero, Barbara; Kava, Christine M; Ashida, Sato; Daniel-Ulloa, Jason; Laroche, Helena H; Haines, Heidi; Bucklin, Rebecca; Maldonado, Adriana; Coronado Garcia, Mayra; Berto, Sandy; Sewell, Dan; Novak, Nicole; Janz, Kathleen; Gates, Claudia; Parker, Edith A

2018-05-04

Background : Evidence-based interventions have been developed and tested to promote physical activity, but fewer studies have focused on identifying effective intervention strategies for mid-size rural communities, especially new immigrant destinations. We report here on the design and implementation of Active Ottumwa, a community-wide intervention using a lay health advisor approach to increase physical activity in a micropolitan new destination community in the rural state of Iowa. Methods : The Active Ottumwa study is part of a community-academic partnership in Ottumwa, IA. Evidence-based strategies recommended by the Community Guide for Preventive Services guided study implementation and included behavioral and social, campaign and informational, and environmental and policy approaches. Evaluation methods for this study are multi-faceted and include a cross-sectional community survey, longitudinal cohort assessment, observational data, key informant interviews, and project records. Results : We are currently in our second year of intervention implementation, with 45 lay health advisors (termed physical activity leaders here) trained to carry out behavioral and social intervention approaches, including walking groups, tai chi, and yoga. We have completed a communication and informational campaign utilizing five channels. Our longitudinal cohort has been recruited, with baseline and 12-month data collection completed. Conclusions : This study will assess the effectiveness and impact of a community-wide intervention to support physical activity.

Development and Implementation of an Internet-Based Survivorship Care Program for Cancer Survivors Treated with Hematopoietic Stem Cell Transplantation

PubMed Central

Syrjala, Karen L.; Stover, Allison C.; Yi, Jean C.; Artherholt, Samantha B.; Romano, Eleni M.; Schoch, Gary; Stewart, Susan; Flowers, Mary E.D.

2011-01-01

Introduction The internet provides a widely accessible modality for meeting survivorship care needs of cancer survivors. In this paper we describe the development and implementation of an internet site designed as a base from which to conduct a randomized controlled trial to meet psycho-educational needs of hematopoietic stem cell transplantation (HSCT) survivors. Methods A cross-disciplinary team designed, wrote content and programmed an internet site for online study registration, consent, assessment, and study implementation. All 3–18 year survivors of HSCT for hematologic malignancy treated at one transplant center were approached by mail for participation. All study activities could be conducted without study staff contact. However, participants had options for phone or email contact with study staff as desired. Results Of 1775 participants approached for the study, 775 (58% of those eligible) consented and completed baseline assessment. Mean age was 51.7 (SD=12.5, age range 18–79), with 56% male. 57% required staff contact one or more times; a majority were for minor technical issues or delays in completion of enrollment or baseline assessment. Discussions/Conclusions This study demonstrated the potential for providing internet-based survivorship care to long-term survivors of HSCT. Although building a survivorship internet site requires a team with diverse expertise, once built, these resources can be implemented rapidly with large numbers of survivors. Implications for Cancer Survivors While internet-based services will not meet all the needs of cancer survivors, this methodology represents an important modality for augmenting onsite clinical services as a method for meeting psycho-educational, information and resource needs of cancer survivors. PMID:21544671

Determining registered nurses' readiness for evidence-based practice.

PubMed

Thiel, Linda; Ghosh, Yashowanto

2008-01-01

As health care systems worldwide move toward instituting evidence-based practice (EBP), its implementation can be challenging. Conducting a baseline assessment to determine nurses' readiness for EBP presents opportunities to plan strategies before implementation. Although a growing body of research literature is focused on implementing EBP, little attention has been paid to assessing nurses' readiness for EBP. The purpose of this study was to assess registered nurses' readiness for EBP in a moderate-sized acute care hospital in the Midwestern United States before implementation of a hospital-wide nursing EBP initiative. A descriptive cross-sectional survey design was used; 121 registered nurses completed the survey. The participants (n= 121) completed the 64-item Nurses' Readiness for Evidence-Based Practice Survey that allowed measurement of information needs, knowledge and skills, culture, and attitudes. Data were analyzed using descriptive statistics and a post hoc analysis. The majority (72.5%) of respondents indicated that when they needed information, they consulted colleagues and peers rather than using journals and books; 24% of nurses surveyed used the health database, Cumulative Index to Nursing & Allied Health Literature (CINAHL). The respondents perceived their EBP knowledge level as moderate. Cultural EBP scores were moderate, with unit scores being higher than organizational scores. The nurses' attitudes toward EBP were positive. The post hoc analysis showed many significant correlations. Nurses have access to technological resources and perceive that they have the ability to engage in basic information gathering but not in higher level evidence gathering. The elements important to EBP such as a workplace culture and positive attitudes are present and can be built upon. A "site-specific" baseline assessment provides direction in planning EBP initiatives. The Nurses' Readiness for EBP Survey is a streamlined tool with established reliability and validity.

Evaluation of CASL boiling model for DNB performance in full scale 5x5 fuel bundle with spacer grids

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

Kim, Seung Jun

As one of main tasks for FY17 CASL-THM activity, Evaluation study on applicability of the CASL baseline boiling model for 5x5 DNB application is conducted and the predictive capability of the DNB analysis is reported here. While the baseline CASL-boiling model (GEN- 1A) approach has been successfully implemented and validated with a single pipe application in the previous year’s task, the extended DNB validation for realistic sub-channels with detailed spacer grid configurations are tasked in FY17. The focus area of the current study is to demonstrate the robustness and feasibility of the CASL baseline boiling model for DNB performance inmore » a full 5x5 fuel bundle application. A quantitative evaluation of the DNB predictive capability is performed by comparing with corresponding experimental measurements (i.e. reference for the model validation). The reference data are provided from the Westinghouse Electricity Company (WEC). Two different grid configurations tested here include Non-Mixing Vane Grid (NMVG), and Mixing Vane Grid (MVG). Thorough validation studies with two sub-channel configurations are performed at a wide range of realistic PWR operational conditions.« less

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.

Research and Applications Modules (RAM), phase B study

NASA Technical Reports Server (NTRS)

1972-01-01

The research and applications modules (RAM) system is discussed. The RAM is a family of payload carrier modules that can be delivered to and retrieved from earth orbit by the space shuttle. The RAM's capability for implementing a wide range of manned and man-tended missions is described. The rams have evolved into three types; (1) pressurized RAMs, (2) unpressurized RAMs, and (3) pressurizable free-flying RAMs. A reference experiment plan for use as a baseline in the derivation and planning of the RAM project is reported. The plan describes the number and frequency of shuttle flights dedicated to RAM missions and the RAM payloads for the identified flights.

SeaWiFS Science Algorithm Flow Chart

NASA Technical Reports Server (NTRS)

Darzi, Michael

1998-01-01

This flow chart describes the baseline science algorithms for the Sea-viewing Wide Field-of-view Sensor (SeaWiFS) Data Processing System (SDPS). As such, it includes only processing steps used in the generation of the operational products that are archived by NASA's Goddard Space Flight Center (GSFC) Distributed Active Archive Center (DAAC). It is meant to provide the reader with a basic understanding of the scientific algorithm steps applied to SeaWiFS data. It does not include non-science steps, such as format conversions, and places the greatest emphasis on the geophysical calculations of the level-2 processing. Finally, the flow chart reflects the logic sequences and the conditional tests of the software so that it may be used to evaluate the fidelity of the implementation of the scientific algorithm. In many cases however, the chart may deviate from the details of the software implementation so as to simplify the presentation.

Using the Safer Clinical Systems approach and Model for Improvement methodology to decrease Venous Thrombo-Embolism in Elective Surgical Patients.

PubMed

Humphries, Angela; Peden, Carol; Jordan, Lesley; Crowe, Josephine; Peden, Carol

2016-01-01

A significant incidence of post-procedural deep vein thrombosis (DVT) and pulmonary embolus (PE) was identified in patients undergoing surgery at our hospital. Investigation showed an unreliable peri-operative process leading to patients receiving incorrect or missed venous thromboembolism (VTE) prophylaxis. The Trust had previously participated in a project funded by the Health Foundation using the "Safer Clinical Systems" methodology to assess, diagnose, appraise options, and implement interventions to improve a high risk medication pathway. We applied the methodology from that study to this cohort of patients demonstrating that the same approach could be applied in a different context. Interventions were linked to the greatest hazards and risks identified during the diagnostic phase. This showed that many surgical elective patients had no VTE risk assessment completed pre-operatively, leading to missed or delayed doses of VTE prophylaxis post-operatively. Collaborative work with stakeholders led to the development of a new process to ensure completion of the VTE risk assessment prior to surgery, which was implemented using the Model for Improvement methodology. The process was supported by the inclusion of a VTE check in the Sign Out element of the WHO Surgical Safety Checklist at the end of surgery, which also ensured that appropriate prophylaxis was prescribed. A standardised operation note including the post-operative VTE plan will be implemented in the near future. At the end of the project VTE risk assessments were completed for 100% of elective surgical patients on admission, compared with 40% in the baseline data. Baseline data also revealed that processes for chemical and mechanical prophylaxis were not reliable. Hospital wide interventions included standardisation of mechanical prophylaxis devices and anti-thromboembolic stockings (resulting in a cost saving of £52,000), and a Trust wide awareness and education programme. The education included increased emphasis on use of mechanical prophylaxis when chemical prophylaxis was contraindicated. VTE guidelines were also included in the existing junior Doctor guideline App. and a "CLOTS" anticoagulation webpage was developed and published on the hospital intranet. The improvement in VTE processes resulted in an 80% reduction in hospital associated thrombosis following surgery from 0.2% in January 2014 to 0.04% in December 2015 and a reduction in the number of all hospital associated VTE from a baseline median of 9 per month as of January 2014 to a median of 1 per month by December 2015.

Community-based interventions that work to reduce HIV stigma and discrimination: results of an evaluation study in Thailand.

PubMed

Jain, Aparna; Nuankaew, Ratana; Mongkholwiboolphol, Nungruthai; Banpabuth, Arunee; Tuvinun, Rachada; Oranop Na Ayuthaya, Pakprim; Richter, Kerry

2013-11-13

HIV stigma and discrimination are major issues affecting people living with HIV in their everyday lives. In Thailand, a project was implemented to address HIV stigma and discrimination within communities with four activities: (1) monthly banking days; (2) HIV campaigns; (3) information, education and communication (IEC) materials and (4) "Funfairs." This study evaluates the effect of project interventions on reducing community-level HIV stigma. A repeated cross-sectional design was developed to measure changes in HIV knowledge and HIV-related stigma domains among community members exposed to the project. Two cross-sectional surveys were implemented at baseline (respondent n=560) and endline (respondent n=560). T-tests were employed to assess changes on three stigma domains: fear of HIV infection through daily activity, shame associated with having HIV and blame towards people with HIV. Baseline scales were confirmed at endline, and each scale was regressed on demographic characteristics, HIV knowledge and exposure to intervention activities. No differences were observed in respondent characteristics at baseline and endline. Significant changes were observed in HIV transmission knowledge, fear of HIV infection and shame associated with having HIV from baseline to endline. Respondents exposed to three specific activities (monthly campaign, Funfair and IEC materials) were less likely to exhibit stigma along the dimensions of fear (3.8 points lower on average compared to respondents exposed to none or only one intervention; 95% CI: -7.3 to -0.3) and shame (4.1 points lower; 95% CI: -7.7 to -0.6), net of demographic controls and baseline levels of stigma. Personally knowing someone with HIV was associated with low fear and shame, and females were less likely to possess attitudes of shame compared to males. The multivariate linear models suggest that a combination of three interventions was critical in shifting community-level stigma--monthly campaign, Funfair and IEC materials. This is especially important given Thailand's new national AIDS strategy to reduce HIV-related stigma and discrimination by half by 2016. Knowing which interventions to invest in for HIV stigma reduction is crucial for country-wide expansion and scale-up of intervention activities.

Cognitive workload changes for nurses transitioning from a legacy system with paper documentation to a commercial electronic health record.

PubMed

Colligan, Lacey; Potts, Henry W W; Finn, Chelsea T; Sinkin, Robert A

2015-07-01

Healthcare institutions worldwide are moving to electronic health records (EHRs). These transitions are particularly numerous in the US where healthcare systems are purchasing and implementing commercial EHRs to fulfill federal requirements. Despite the central role of EHRs to workflow, the cognitive impact of these transitions on the workforce has not been widely studied. This study assesses the changes in cognitive workload among pediatric nurses during data entry and retrieval tasks during transition from a hybrid electronic and paper information system to a commercial EHR. Baseline demographics and computer attitude and skills scores were obtained from 74 pediatric nurses in two wards. They also completed an established and validated instrument, the NASA-TLX, that is designed to measure cognitive workload; this instrument was used to evaluate cognitive workload of data entry and retrieval. The NASA-TLX was administered at baseline (pre-implementation), 1, 5 and 10 shifts and 4 months post-implementation of the new EHR. Most nurse participants experienced significant increases of cognitive workload at 1 and 5 shifts after "go-live". These increases abated at differing rates predicted by participants' computer attitudes scores (p = 0.01). There is substantially increased cognitive workload for nurses during the early phases (1-5 shifts) of EHR transitions. Health systems should anticipate variability across workers adapting to "meaningful use" EHRs. "One-size-fits-all" training strategies may not be suitable and longer periods of technical support may be necessary for some workers. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Preoperative fasting among burns patients in an acute care setting: a best practice implementation project.

PubMed

Giuliani, Sara; McArthur, Alexa; Greenwood, John

2015-11-01

Major burn injury patients commonly fast preoperatively before multiple surgical procedures. The Societies of Anesthesiology in Europe and the United States recommend fasting from clear fluids for two hours and solids for six to eight hours preoperatively. However, at the Royal Adelaide Hospital, patients often fast from midnight proceeding the day of surgery. This project aims to promote evidence-based practice to minimize extended preoperative fasting in major burn patients. A baseline audit was conducted measuring the percentage compliance with audit criteria, specifically on preoperative fasting documentation and appropriate instructions in line with evidence-based guidelines. Strategies were then implemented to address areas of non-compliance, which included staff education, development of documentation tools and completion of a perioperative feeding protocol for major burn patients. Following this, a post implementation audit assessed the extent of change compared with the baseline audit results. Education on evidence-based fasting guidelines was delivered to 54% of staff. This resulted in a 19% improvement in compliance with fasting documentation and a 52% increase in adherence to appropriate evidence-based instructions. There was a notable shift from the most common fasting instruction being "fast from midnight" to "fast from 03:00 hours", with an overall four-hour reduction in fasting per theater admission. These results demonstrate that education improves compliance with documentation and preoperative fasting that is more reflective of evidence-based practice. Collaboration with key stakeholders and a hospital wide fasting protocol is warranted to sustain change and further advance compliance with evidence-based practice at an organizational level.

Owning the program technical baseline for future space systems acquisition: program technical baseline tracking tool

NASA Astrophysics Data System (ADS)

Nguyen, Tien M.; Guillen, Andy T.; Hant, James J.; Kizer, Justin R.; Min, Inki A.; Siedlak, Dennis J. L.; Yoh, James

2017-05-01

The U.S. Air Force (USAF) has recognized the needs for owning the program and technical knowledge within the Air Force concerning the systems being acquired to ensure success. This paper extends the previous work done by the authors [1-2] on the "Resilient Program Technical Baseline Framework for Future Space Systems" and "Portfolio Decision Support Tool (PDST)" to the development and implementation of the Program and Technical Baseline (PTB) Tracking Tool (PTBTL) for the DOD acquisition life cycle. The paper describes the "simplified" PTB tracking model with a focus on the preaward phases and discusses how to implement this model in PDST.

Wide-Baseline Stereo-Based Obstacle Mapping for Unmanned Surface Vehicles

PubMed Central

Mou, Xiaozheng; Wang, Han

2018-01-01

This paper proposes a wide-baseline stereo-based static obstacle mapping approach for unmanned surface vehicles (USVs). The proposed approach eliminates the complicated calibration work and the bulky rig in our previous binocular stereo system, and raises the ranging ability from 500 to 1000 m with a even larger baseline obtained from the motion of USVs. Integrating a monocular camera with GPS and compass information in this proposed system, the world locations of the detected static obstacles are reconstructed while the USV is traveling, and an obstacle map is then built. To achieve more accurate and robust performance, multiple pairs of frames are leveraged to synthesize the final reconstruction results in a weighting model. Experimental results based on our own dataset demonstrate the high efficiency of our system. To the best of our knowledge, we are the first to address the task of wide-baseline stereo-based obstacle mapping in a maritime environment. PMID:29617293

Learning by Doing: Developing a Baseline Information Literacy Assessment

ERIC Educational Resources Information Center

Kiel, Stephen; Burclaff, Natalie; Johnson, Catherine

2015-01-01

This paper details the design and implementation of an initial baseline assessment of information literacy skills at the University of Baltimore in Maryland. To provide practical advice and experience for a novice audience, the authors discuss how they approached the design and implementation of the study through the use of a rubric-based…

Faceting for direction-dependent spectral deconvolution

NASA Astrophysics Data System (ADS)

Tasse, C.; Hugo, B.; Mirmont, M.; Smirnov, O.; Atemkeng, M.; Bester, L.; Hardcastle, M. J.; Lakhoo, R.; Perkins, S.; Shimwell, T.

2018-04-01

The new generation of radio interferometers is characterized by high sensitivity, wide fields of view and large fractional bandwidth. To synthesize the deepest images enabled by the high dynamic range of these instruments requires us to take into account the direction-dependent Jones matrices, while estimating the spectral properties of the sky in the imaging and deconvolution algorithms. In this paper we discuss and implement a wideband wide-field spectral deconvolution framework (DDFacet) based on image plane faceting, that takes into account generic direction-dependent effects. Specifically, we present a wide-field co-planar faceting scheme, and discuss the various effects that need to be taken into account to solve for the deconvolution problem (image plane normalization, position-dependent Point Spread Function, etc). We discuss two wideband spectral deconvolution algorithms based on hybrid matching pursuit and sub-space optimisation respectively. A few interesting technical features incorporated in our imager are discussed, including baseline dependent averaging, which has the effect of improving computing efficiency. The version of DDFacet presented here can account for any externally defined Jones matrices and/or beam patterns.

[Implementation and results of the EU-wide baseline studies on the prevalence of Salmonella spp. in slaughter and breeding pigs in Austria].

PubMed

Kostenzer, Klaus; Much, Peter; Kornschober, Christian; Lassnig, Heimo; Köfer, Josef

2014-01-01

The Member States of the European Union are following a common strategy on the control of Salmonella and other foodborne pathogens (Anonym, 2003). Within that framework baseline studies on the most relevant animal populations have been carried out. This paper describes the implementation and the results of the baseline studies on Salmonella spp. in slaughter and breeding pigs in Austria. A total of 647 slaughter pigs were sampled in 28 slaughterhouses between October 2006 and September 2007. Samples were taken from the ileocaecal lymphnodes to detect infection in pigs and from the surface of the carcasses to detect contamination. Out of the 617 datasets included in the final analysis, Salmonella prevalences of 2% in lymphnodes and 1.1% on the carcass surface were observed. S. Derby, S. Enteritidis and S. Typhimurium were the three most frequently identified serovars. In an additional study, a total of 252 holdings with breeding pigs has been sampled between January and December combined multiplier herds. Respectively prevalences of 5, 8, 5, 3 and 9.1% were obtained, with S. Typhimurium being the most frequently isolated serovar. Overall, compared to neighbouring Member States a rather low prevalence of Salmonella spp. in pigs was documented for Austria, in particular in slaughter pigs.The serovar distribution seemed to be similar throughout the pig populations, some also being represented in Austrian human isolates. Contamination of feed seems to play a minor role considering the overall low prevalence, but nevertheless has to be taken into account in any future control or monitoring strategy for Salmonella spp. in pigs.

A preliminary analysis of the effects of coaching feedback on teacher implementation fidelity of first step to success.

PubMed

Rodriguez, Billie Jo; Loman, Sheldon L; Horner, Robert H

2009-01-01

First Step to Success (FSS) is a "manualized" intervention with documented effectiveness in reducing problem behaviors for young children at risk for school failure. This study is a preliminary analysis focusing on the role of performance feedback from FSS coaches on the fidelity with which teachers implemented FSS. Three typically developing students (2 kindergarten and 1 first grade) and their respective teachers served as participants. Student behavior and teacher implementation fidelity were assessed using a nonconcurrent multiple baseline design across student/teacher dyads, in which a no coaching baseline was followed by a performance feedback condition. The baseline phase showed modest levels of implementation fidelity and initial low levels of problem behavior followed by gradually increasing trends. A relation was demonstrated between coaching feedback and improved implementation fidelity. In addition, improved fidelity was associated with improvements in student problem behavior. Implications are drawn for clinical application of FSS and other "manualized" interventions.

Advanced musculoskeletal physiotherapists in post arthroplasty review clinics: a state wide implementation program evaluation.

PubMed

Harding, Paula; Burge, Angela; Walter, Kerrie; Shaw, Bridget; Page, Carolyn; Phan, Uyen; Terrill, Desiree; Liew, Susan

2018-03-01

To evaluate outcomes following a state-wide implementation of post arthroplasty review (PAR) clinics for patients following total hip and knee arthroplasty, led by advanced musculoskeletal physiotherapists in collaboration with orthopaedic specialists. A prospective observational study analysed data collected by 10 implementation sites (five metropolitan and five regional/rural centres) between September 2014 and June 2015. The Victorian Innovation and Reform Impact Assessment Framework was used to assess efficiency, effectiveness (access to care, safety and quality, workforce capacity, utilisation of skill sets, patient and workforce satisfaction) and sustainability (stakeholder engagement, succession planning and availability of ongoing funding). 2362 planned occasions of service (OOS) were provided for 2057 patients. Reduced patient wait times from referral to appointment were recorded and no adverse events occurred. Average cost savings across 10 sites was AUD$38 per OOS (Baseline $63, PAR clinic $35), representing a reduced pathway cost of 44%. Average annual predicted total value of increased orthopaedic specialist capacity was $11,950 per PAR clinic (range $6149 to $23,400). The Australian Orthopaedic Association review guidelines were met (8/10 sites, 80%) and patient-reported outcome measures were introduced as routine clinical care. High workforce and patient satisfaction were expressed. Eighteen physiotherapists were trained creating a sustainable workforce. Eight sites secured ongoing funding. The PAR clinics delivered a safe, cost-efficient model of care that improved patient access and quality of care compared to traditional specialist-led workforce models. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

A cluster randomized trial to evaluate external support for the implementation of positive behavioral interventions and supports by school personnel

PubMed Central

2014-01-01

Background Urban schools lag behind non-urban schools in attending to the behavioral health needs of their students. This is especially evident with regard to the level of use of evidence-based interventions with school children. Increased used of evidence-based interventions in urban schools would contribute to reducing mental health services disparities in low-income communities. School-wide positive behavioral interventions and supports (SWPBIS) is a service delivery framework that can be used to deliver universal preventive interventions and evidence-based behavioral health treatments, such as group cognitive behavioral therapy. In this article, we describe our ongoing research on creating internal capacity for program implementation. We also examine the cost-effectiveness and resulting school climate when two different levels of external support are provided to personnel as they implement a two-tier SWPBIS program. Methods/Design The study follows six K – 8 schools in the School District of Philadelphia randomly assigned to consultation support or consultation-plus-coaching support. Participants are: approximately 48 leadership team members, 180 school staff and 3,900 students in Tier 1, and 12 counselors, and 306 child participants in Tier 2. Children who meet inclusion criteria for Tier 2 will participate in group cognitive behavioral therapy for externalizing or anxiety disorders. The study has three phases, baseline/training, implementation, and sustainability. We will measure implementation outcomes, service outcomes, child outcomes, and cost. Discussion Findings from this study will provide evidence as to the appropriateness of school-wide prevention and treatment service delivery models for addressing services disparities in schools. The effectiveness and cost-effectiveness analyses of the two levels of training and consultation should help urban school districts and policymakers with the planning and deployment of cost-effective strategies for the implementation of evidence-based interventions for some of the most common behavioral health problems in school children. Trial registration ClinicalTrials.gov identifier: NCT01941069 PMID:24428904

A cluster randomized trial to evaluate external support for the implementation of positive behavioral interventions and supports by school personnel.

PubMed

Eiraldi, Ricardo; McCurdy, Barry; Khanna, Muniya; Mautone, Jennifer; Jawad, Abbas F; Power, Thomas; Cidav, Zuleyha; Cacia, Jaclyn; Sugai, George

2014-01-15

Urban schools lag behind non-urban schools in attending to the behavioral health needs of their students. This is especially evident with regard to the level of use of evidence-based interventions with school children. Increased used of evidence-based interventions in urban schools would contribute to reducing mental health services disparities in low-income communities. School-wide positive behavioral interventions and supports (SWPBIS) is a service delivery framework that can be used to deliver universal preventive interventions and evidence-based behavioral health treatments, such as group cognitive behavioral therapy. In this article, we describe our ongoing research on creating internal capacity for program implementation. We also examine the cost-effectiveness and resulting school climate when two different levels of external support are provided to personnel as they implement a two-tier SWPBIS program. The study follows six K - 8 schools in the School District of Philadelphia randomly assigned to consultation support or consultation-plus-coaching support. Participants are: approximately 48 leadership team members, 180 school staff and 3,900 students in Tier 1, and 12 counselors, and 306 child participants in Tier 2. Children who meet inclusion criteria for Tier 2 will participate in group cognitive behavioral therapy for externalizing or anxiety disorders. The study has three phases, baseline/training, implementation, and sustainability. We will measure implementation outcomes, service outcomes, child outcomes, and cost. Findings from this study will provide evidence as to the appropriateness of school-wide prevention and treatment service delivery models for addressing services disparities in schools. The effectiveness and cost-effectiveness analyses of the two levels of training and consultation should help urban school districts and policymakers with the planning and deployment of cost-effective strategies for the implementation of evidence-based interventions for some of the most common behavioral health problems in school children. ClinicalTrials.gov identifier: NCT01941069.

Implementing an overdose education and naloxone distribution program in a health system.

PubMed

Devries, Jennifer; Rafie, Sally; Polston, Gregory

To design and implement a health system-wide program increasing provision of take-home naloxone in patients at risk for opioid overdose, with the downstream aim of reducing fatalities. The program includes health care professional education and guidelines, development, and dissemination of patient education materials, electronic health record changes to promote naloxone prescriptions, and availability of naloxone in pharmacies. Academic health system, San Diego, California. University of California, San Diego Health (UCSDH), offers both inpatient and outpatient primary care and specialty services with 563 beds spanning 2 hospitals and 6 pharmacies. UCSDH is part of the University of California health system, and it serves as the county's safety net hospital. In January 2016, a multisite academic health system initiated a system-wide overdose education and naloxone distribution program to prevent opioid overdose and opioid overdose-related deaths. An interdisciplinary, interdepartmental team came together to develop and implement the program. To strengthen institutional support, naloxone prescribing guidelines were developed and approved for the health system. Education on naloxone for physicians, pharmacists, and nurses was provided through departmental trainings, bulletins, and e-mail notifications. Alerts in the electronic health record and preset naloxone orders facilitated co-prescribing of naloxone with opioid prescriptions. Electronic health record reports captured naloxone prescriptions ordered. Summary reports on the electronic health record measured naloxone reminder alerts and response rates. Since the start of the program, the health system has trained 252 physicians, pharmacists, and nurses in overdose education and take-home naloxone. There has been an increase in the number of prescriptions for naloxone from a baseline of 4.5 per month to an average of 46 per month during the 3 months following full implementation of the program including implementation of electronic health record alerts. Initiating and implementing an overdose education and naloxone distribution program is feasible in an academic health system. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

75 FR 57960 - Agency Forms Undergoing Paperwork Reduction Act Review

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-23

... respondents respondent (in hours) Student Student Effectiveness 10,158 1 35/60 Baseline Survey. 1st Student mid- 3,612 1 25/60 implementation survey. 2nd Student mid- 3,612 1 25/60 implementation survey. Student Effectiveness 8,126 1 35/60 Follow-up Survey. Principal Baseline principal survey.. 49 1 15/60 Mid...

Preliminary design and implementation of the baseline digital baseband architecture for advanced deep space transponders

NASA Technical Reports Server (NTRS)

Nguyen, T. M.; Yeh, H.-G.

1993-01-01

The baseline design and implementation of the digital baseband architecture for advanced deep space transponders is investigated and identified. Trade studies on the selection of the number of bits for the analog-to-digital converter (ADC) and optimum sampling schemes are presented. In addition, the proposed optimum sampling scheme is analyzed in detail. Descriptions of possible implementations for the digital baseband (or digital front end) and digital phase-locked loop (DPLL) for carrier tracking are also described.

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

Practical comparison of distributed ledger technologies for IoT

NASA Astrophysics Data System (ADS)

Red, Val A.

2017-05-01

Existing distributed ledger implementations - specifically, several blockchain implementations - embody a cacophony of divergent capabilities augmenting innovations of cryptographic hashes, consensus mechanisms, and asymmetric cryptography in a wide variety of applications. Whether specifically designed for cryptocurrency or otherwise, several distributed ledgers rely upon modular mechanisms such as consensus or smart contracts. These components, however, can vary substantially among implementations; differences involving proof-of-work, practical byzantine fault tolerance, and other consensus approaches exemplify distinct distributed ledger variations. Such divergence results in unique combinations of modules, performance, latency, and fault tolerance. As implementations continue to develop rapidly due to the emerging nature of blockchain technologies, this paper encapsulates a snapshot of sensor and internet of things (IoT) specific implementations of blockchain as of the end of 2016. Several technical risks and divergent approaches preclude standardization of a blockchain for sensors and IoT in the foreseeable future; such issues will be assessed alongside the practicality of IoT applications among Hyperledger, Iota, and Ethereum distributed ledger implementations suggested for IoT. This paper contributes a comparison of existing distributed ledger implementations intended for practical sensor and IoT utilization. A baseline for characterizing distributed ledger implementations in the context of IoT and sensors is proposed. Technical approaches and performance are compared considering IoT size, weight, and power limitations. Consensus and smart contracts, if applied, are also analyzed for the respective implementations' practicality and security. Overall, the maturity of distributed ledgers with respect to sensor and IoT applicability will be analyzed for enterprise interoperability.

Efficient Wide Baseline Structure from Motion

NASA Astrophysics Data System (ADS)

Michelini, Mario; Mayer, Helmut

2016-06-01

This paper presents a Structure from Motion approach for complex unorganized image sets. To achieve high accuracy and robustness, image triplets are employed and (an approximate) camera calibration is assumed to be known. The focus lies on a complete linking of images even in case of large image distortions, e.g., caused by wide baselines, as well as weak baselines. A method for embedding image descriptors into Hamming space is proposed for fast image similarity ranking. The later is employed to limit the number of pairs to be matched by a wide baseline method. An iterative graph-based approach is proposed formulating image linking as the search for a terminal Steiner minimum tree in a line graph. Finally, additional links are determined and employed to improve the accuracy of the pose estimation. By this means, loops in long image sequences are implicitly closed. The potential of the proposed approach is demonstrated by results for several complex image sets also in comparison with VisualSFM.

Investigation of FPGA-Based Real-Time Adaptive Digital Pulse Shaping for High-Count-Rate Applications

NASA Astrophysics Data System (ADS)

Saxena, Shefali; Hawari, Ayman I.

2017-07-01

Digital signal processing techniques have been widely used in radiation spectrometry to provide improved stability and performance with compact physical size over the traditional analog signal processing. In this paper, field-programmable gate array (FPGA)-based adaptive digital pulse shaping techniques are investigated for real-time signal processing. National Instruments (NI) NI 5761 14-bit, 250-MS/s adaptor module is used for digitizing high-purity germanium (HPGe) detector's preamplifier pulses. Digital pulse processing algorithms are implemented on the NI PXIe-7975R reconfigurable FPGA (Kintex-7) using the LabVIEW FPGA module. Based on the time separation between successive input pulses, the adaptive shaping algorithm selects the optimum shaping parameters (rise time and flattop time of trapezoid-shaping filter) for each incoming signal. A digital Sallen-Key low-pass filter is implemented to enhance signal-to-noise ratio and reduce baseline drifting in trapezoid shaping. A recursive trapezoid-shaping filter algorithm is employed for pole-zero compensation of exponentially decayed (with two-decay constants) preamplifier pulses of an HPGe detector. It allows extraction of pulse height information at the beginning of each pulse, thereby reducing the pulse pileup and increasing throughput. The algorithms for RC-CR2 timing filter, baseline restoration, pile-up rejection, and pulse height determination are digitally implemented for radiation spectroscopy. Traditionally, at high-count-rate conditions, a shorter shaping time is preferred to achieve high throughput, which deteriorates energy resolution. In this paper, experimental results are presented for varying count-rate and pulse shaping conditions. Using adaptive shaping, increased throughput is accepted while preserving the energy resolution observed using the longer shaping times.

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

Turner, Tom; Watson, Stuart

This paper describes how the level of environmental sustainability at the Solid Waste Processing plant at Research Sites Restoration Ltd (RSRL) Harwell was measured and improved. It provides reasons to improve environmental performance in an organisation, states best practice on how improvement should be conducted, and gives first-hand experience on how changes were implemented. In this paper sustainability is defined as 'meeting the needs of the present without compromising the ability of future generations to meet their own needs'. A baseline for environmental sustainability was created, by looking at multiple attributes. From this, a matrix was created to show howmore » the baseline environmental performance compared to best practice, and a gap analysis was performed. Results from this analysis showed areas for potential systematic improvement, and actions were created. Nearly all actions were implemented within one year, and environmental sustainability improved significantly. Most improvements cost no money to implement, and the few that did had to pass criteria in a business case. Results from a company-wide survey showed that the vast majority of employees felt that environmental issues were important, and that they were willing to help improve performance. Environmental awareness training was given to everyone in the department, and individuals were given measurable improvement targets. A focus group was set up and met regularly to agree improvements and monitor results. Environmental performance was publicised regularly to highlight successes and seek further engagement and improvement. Improvement ideas were encouraged and managed in a transparent way which showed clear prioritisation and accountability. The culture of environmental improvement changed visibly and results at the end of the first year showed that electricity consumption had reduced by 12.5%, and gas consumption had reduced by 7.3%. In less than two years over UK Pound 60,000 was saved on utility bills in the Waste Processing Plant. (authors)« less

An environmental disinfection odyssey: evaluation of sequential interventions to improve disinfection of Clostridium difficile isolation rooms.

PubMed

Sitzlar, Brett; Deshpande, Abhishek; Fertelli, Dennis; Kundrapu, Sirisha; Sethi, Ajay K; Donskey, Curtis J

2013-05-01

OBJECTIVE. Effective disinfection of hospital rooms after discharge of patients with Clostridium difficile infection (CDI) is necessary to prevent transmission. We evaluated the impact of sequential cleaning and disinfection interventions by culturing high-touch surfaces in CDI rooms after cleaning. DESIGN. Prospective intervention. SETTING. A Veterans Affairs hospital. INTERVENTIONS. During a 21-month period, 3 sequential tiered interventions were implemented: (1) fluorescent markers to provide monitoring and feedback on thoroughness of cleaning facility-wide, (2) addition of an automated ultraviolet radiation device for adjunctive disinfection of CDI rooms, and (3) enhanced standard disinfection of CDI rooms, including a dedicated daily disinfection team and implementation of a process requiring supervisory assessment and clearance of terminally cleaned CDI rooms. To determine the impact of the interventions, cultures were obtained from CDI rooms after cleaning and disinfection. RESULTS. The fluorescent marker intervention improved the thoroughness of cleaning of high-touch surfaces (from 47% to 81% marker removal; P < .0001). Relative to the baseline period, the prevalence of positive cultures from CDI rooms was reduced by 14% (P=.024), 48% (P <.001), and 89% (P=.006) with interventions 1, 2, and 3, respectively. During the baseline period, 67% of CDI rooms had positive cultures after disinfection, whereas during interventions periods 1, 2, and 3 the percentages of CDI rooms with positive cultures after disinfection were reduced to 57%, 35%, and 7%, respectively. CONCLUSIONS. An intervention that included formation of a dedicated daily disinfection team and implementation of a standardized process for clearing CDI rooms achieved consistent CDI room disinfection. Culturing of CDI rooms provides a valuable tool to drive improvements in environmental disinfection.

Survey of surveillance systems and select prevention activities for hepatitis B and C, European Union/European Economic Area, 2009.

PubMed

Duffell, E F; van de Laar, M J

2015-04-02

Hepatitis B and C viral infections are leading causes of hepatic cirrhosis and cancer. The incidence and prevalence of both hepatitis B and C varies across European countries. European wide surveillance data help to understand the dynamic epidemiology of hepatitis B and C, which is important for the implementation and effectiveness of prevention and control activities.Comparison of surveillance data between countries in Europe is hampered by the differences in national healthcare and reporting systems. This report presents the results of a survey in 2009 which was undertaken to collect baseline information on surveillance systems and core prevention programmes for hepatitis B and C in individual European Union/ European Economic Area countries. The results provide key information to aid the interpretation of surveillance data, and while indicating heterogeneity in national surveillance systems and programmes, they highlight the potential of these systems. This resource has supported the implementation of a standardised European enhanced surveillance programme.

National Machine Guarding Program: Part 1. Machine safeguarding practices in small metal fabrication businesses.

PubMed

Parker, David L; Yamin, Samuel C; Brosseau, Lisa M; Xi, Min; Gordon, Robert; Most, Ivan G; Stanley, Rodney

2015-11-01

Metal fabrication workers experience high rates of traumatic occupational injuries. Machine operators in particular face high risks, often stemming from the absence or improper use of machine safeguarding or the failure to implement lockout procedures. The National Machine Guarding Program (NMGP) was a translational research initiative implemented in conjunction with two workers' compensation insures. Insurance safety consultants trained in machine guarding used standardized checklists to conduct a baseline inspection of machine-related hazards in 221 business. Safeguards at the point of operation were missing or inadequate on 33% of machines. Safeguards for other mechanical hazards were missing on 28% of machines. Older machines were both widely used and less likely than newer machines to be properly guarded. Lockout/tagout procedures were posted at only 9% of machine workstations. The NMGP demonstrates a need for improvement in many aspects of machine safety and lockout in small metal fabrication businesses. © 2015 The Authors. American Journal of Industrial Medicine published by Wiley Periodicals, Inc.

Effectiveness of rapid prescreening and 10% rescreening in liquid-based Papanicolaou testing.

PubMed

Currens, Heather S; Nejkauf, Katharine; Wagner, Lynn; Raab, Stephen S

2012-01-01

Although rapid prescreening (RPS) has been shown to be an effective quality control procedure for detecting false-negative conventional Papanicolaou (Pap) tests, RPS has not been widely implemented in the United States. In our laboratory, cytotechnologists performed RPS in 3,567 liquid-based Pap tests: 1,911 SurePath (BD Diagnostics-TriPath, Burlington, NC) preparations that were manually screened and 1,656 ThinPrep Pap tests (Hologic, Bedford, MA) that were imaged using the ThinPrep Imaging System (Hologic). We compared the sensitivity of RPS, 10% rescreening (R-10%), and routine screening (RS). In contrast with previously published findings, we found that RS + RPS did not improve screening sensitivity compared with RS + R-10%. These results support the following hypotheses: (1) Higher baseline RS sensitivity as a result of Pap test diagnoses standardization implemented for quality improvement purposes decreases the performance impact of RPS. (2) R-10% and RPS quality assurance methods detect diagnostic failures caused by different types of cognitive errors.

Strengthening health systems capacity to monitor and evaluate programmes targeted at reducing abortion-related maternal mortality in Jessore district, Bangladesh.

PubMed

Huda, Fauzia Akhter; Ahmed, Anisuddin; Ford, Evelyn Rebecca; Johnston, Heidi Bart

2015-09-28

Abortion related deaths as a proportion of maternal mortality appears to have fallen dramatically in Bangladesh from 5 % in 2001 to 1 % in 2010. Yet complications from menstrual regulation (MR) and unsafe abortion continue to cause deleterious health, economic and social consequences for women in the country. This quasi experimental design study with a baseline (January to December 2008) and an endline survey (August to October 2009) was conducted in 69 public, private, and NGO sector health facilities in Jessore district of Bangladesh with the objective of adapting and implementing a set of process indicators, specifically to supplement the indicators for monitoring emergency obstetric care interventions. At the baseline, we collected retrospective data from all 69 health facilities that provided MR, legal abortion or post-abortion care (PAC), by reviewing their last one year's records. Three months after introducing the safe menstrual regulation and abortion care (SMRAC) model, endline data was collected. Signal function (critical services that facilities must perform in order to prevent and treat abortion complications) analysis was used to characterize facilities as providing basic care, comprehensive care, or neither. Facility mapping, and records on services provided and complications treated were used to further characterize service availability and to describe service use and quality. No facilities fulfilled criteria for 'comprehensive' care at either the baseline or end line while only one met the 'basic' criteria during the endline of the project. Recommended uterine evacuation technology, manual vacuum aspiration (MVA) was used for 100.0 % of MR clients but only for 8.0 % or fewer PAC patients. MR clients were 37.5 times more likely than PAC patients to leave facilities with a contraceptive method (75.0 % vs. 2.0 %). Persistent use of older uterine evacuation technologies was observed when recommended techniques were widely available in the facilities. Notable gaps were identified in providing post-abortion contraceptive services for women treated for PAC. By systematic implementation of the SMRAC model, health systems can track and measure progress and gaps in their implementation and identify strategies for further reduction of abortion-related morbidity and mortality in Bangladesh.

Autonomous Navigation by a Mobile Robot

NASA Technical Reports Server (NTRS)

Huntsberger, Terrance; Aghazarian, Hrand

2005-01-01

ROAMAN is a computer program for autonomous navigation of a mobile robot on a long (as much as hundreds of meters) traversal of terrain. Developed for use aboard a robotic vehicle (rover) exploring the surface of a remote planet, ROAMAN could also be adapted to similar use on terrestrial mobile robots. ROAMAN implements a combination of algorithms for (1) long-range path planning based on images acquired by mast-mounted, wide-baseline stereoscopic cameras, and (2) local path planning based on images acquired by body-mounted, narrow-baseline stereoscopic cameras. The long-range path-planning algorithm autonomously generates a series of waypoints that are passed to the local path-planning algorithm, which plans obstacle-avoiding legs between the waypoints. Both the long- and short-range algorithms use an occupancy-grid representation in computations to detect obstacles and plan paths. Maps that are maintained by the long- and short-range portions of the software are not shared because substantial localization errors can accumulate during any long traverse. ROAMAN is not guaranteed to generate an optimal shortest path, but does maintain the safety of the rover.

PIC microcontroller based external fast analog to digital converter to acquire wide-lined solid NMR spectra by BRUKER DRX and Avance-I spectrometers.

PubMed

Koczor, Bálint; Rohonczy, János

2015-01-01

Concerning many former liquid or hybrid liquid/solid NMR consoles, the built in Analog-to-Digital Converters (ADCs) are incapable of digitizing the fids at sampling rates in the MHz range. Regarding both strong anisotropic interactions in the solid state and wide chemical shift dispersion nuclei in solution phase such as (195)Pt, (119)Sn, (207)Pb etc., the spectrum range of interest might be in the MHz range. As determining the informative tensor components of anisotropic NMR interactions requires nonlinear fitting over the whole spectrum including the asymptotic baseline, it is prohibited by low sampling rates of the ADCs. Wide spectrum width is also useful in solution NMR, since windowing of wide chemical shift ranges is avoidable. We built an external analog to digital converter with 10 MHz maximal sampling rate, which can work simultaneously with the built in ADC of the spectrometer. The ADC was tested on both Bruker DRX and Avance-I NMR consoles. In addition to the analog channels it only requires three external digital lines of the NMR console. The ADC sends data to PC via USB. The whole process is controlled by software written in JAVA which is implemented under TopSpin. Copyright © 2015 Elsevier Inc. All rights reserved.

40 CFR 69.31 - New exemptions.

Code of Federal Regulations, 2014 CFR

2014-07-01

.... This exemption applies solely to the PSD major source baseline date and trigger date in the... applicable requirement that is triggered by, implemented or calculated from the PSD major source baseline... the Northern Mariana Islands, use January 13, 1997 as the PSD major source baseline date and trigger...

The relationship between baseline Organizational Readiness to Change Assessment subscale scores and implementation of hepatitis prevention services in substance use disorders treatment clinics: a case study

PubMed Central

2010-01-01

Background The Organizational Readiness to Change Assessment (ORCA) is a measure of organizational readiness for implementing practice change in healthcare settings that is organized based on the core elements and sub-elements of the Promoting Action on Research Implementation in Health Services (PARIHS) framework. General support for the reliability and factor structure of the ORCA has been reported. However, no published study has examined the utility of the ORCA in a clinical setting. The purpose of the current study was to examine the relationship between baseline ORCA scores and implementation of hepatitis prevention services in substance use disorders (SUD) clinics. Methods Nine clinic teams from Veterans Health Administration SUD clinics across the United States participated in a six-month training program to promote evidence-based practices for hepatitis prevention. A representative from each team completed the ORCA evidence and context subscales at baseline. Results Eight of nine clinics reported implementation of at least one new hepatitis prevention practice after completing the six-month training program. Clinic teams were categorized by level of implementation-high (n = 4) versus low (n = 5)-based on how many hepatitis prevention practices were integrated into their clinics after completing the training program. High implementation teams had significantly higher scores on the patient experience and leadership culture subscales of the ORCA compared to low implementation teams. While not reaching significance in this small sample, high implementation clinics also had higher scores on the research, clinical experience, staff culture, leadership behavior, and measurement subscales as compared to low implementation clinics. Conclusions The results of this study suggest that the ORCA was able to measure differences in organizational factors at baseline between clinics that reported high and low implementation of practice recommendations at follow-up. This supports the use of the ORCA to describe factors related to implementing practice recommendations in clinical settings. Future research utilizing larger sample sizes will be essential to support these preliminary findings. PMID:20546584

Large-scale linear rankSVM.

PubMed

Lee, Ching-Pei; Lin, Chih-Jen

2014-04-01

Linear rankSVM is one of the widely used methods for learning to rank. Although its performance may be inferior to nonlinear methods such as kernel rankSVM and gradient boosting decision trees, linear rankSVM is useful to quickly produce a baseline model. Furthermore, following its recent development for classification, linear rankSVM may give competitive performance for large and sparse data. A great deal of works have studied linear rankSVM. The focus is on the computational efficiency when the number of preference pairs is large. In this letter, we systematically study existing works, discuss their advantages and disadvantages, and propose an efficient algorithm. We discuss different implementation issues and extensions with detailed experiments. Finally, we develop a robust linear rankSVM tool for public use.

Telephone system operations evaluation : before AOS implementation

DOT National Transportation Integrated Search

1999-01-01

This study provides a detailed baseline analysis of telephone system performance before AOS : implementation. By the time of the preparation of this report, the phone system component of : AOS had not been implemented.

The System-Wide Effect of Real-Time Audiovisual Feedback and Postevent Debriefing for In-Hospital Cardiac Arrest: The Cardiopulmonary Resuscitation Quality Improvement Initiative.

PubMed

Couper, Keith; Kimani, Peter K; Abella, Benjamin S; Chilwan, Mehboob; Cooke, Matthew W; Davies, Robin P; Field, Richard A; Gao, Fang; Quinton, Sarah; Stallard, Nigel; Woolley, Sarah; Perkins, Gavin D

2015-11-01

To evaluate the effect of implementing real-time audiovisual feedback with and without postevent debriefing on survival and quality of cardiopulmonary resuscitation quality at in-hospital cardiac arrest. A two-phase, multicentre prospective cohort study. Three UK hospitals, all part of one National Health Service Acute Trust. One thousand three hundred and ninety-five adult patients who sustained an in-hospital cardiac arrest at the study hospitals and were treated by hospital emergency teams between November 2009 and May 2013. During phase 1, quality of cardiopulmonary resuscitation and patient outcomes were measured with no intervention implemented. During phase 2, staff at hospital 1 received real-time audiovisual feedback, whereas staff at hospital 2 received real-time audiovisual feedback supplemented by postevent debriefing. No intervention was implemented at hospital 3 during phase 2. The primary outcome was return of spontaneous circulation. Secondary endpoints included other patient-focused outcomes, such as survival to hospital discharge, and process-focused outcomes, such as chest compression depth. Random-effect logistic and linear regression models, adjusted for baseline patient characteristics, were used to analyze the effect of the interventions on study outcomes. In comparison with no intervention, neither real-time audiovisual feedback (adjusted odds ratio, 0.62; 95% CI, 0.31-1.22; p=0.17) nor real-time audiovisual feedback supplemented by postevent debriefing (adjusted odds ratio, 0.65; 95% CI, 0.35-1.21; p=0.17) was associated with a statistically significant improvement in return of spontaneous circulation or any process-focused outcome. Despite this, there was evidence of a system-wide improvement in phase 2, leading to improvements in return of spontaneous circulation (adjusted odds ratio, 1.87; 95% CI, 1.06-3.30; p=0.03) and process-focused outcomes. Implementation of real-time audiovisual feedback with or without postevent debriefing did not lead to a measured improvement in patient or process-focused outcomes at individual hospital sites. However, there was an unexplained system-wide improvement in return of spontaneous circulation and process-focused outcomes during the second phase of the study.

A pragmatic randomised controlled trial of an implementation intervention to increase healthy eating and physical activity-promoting policies, and practices in centre-based childcare services: study protocol.

PubMed

Finch, Meghan; Yoong, Sze Lin; Thomson, Rebecca J; Seward, Kirsty; Cooney, Mairead; Jones, Jannah; Fielding, Alison; Wiggers, John; Gillham, Karen; Wolfenden, Luke

2015-05-21

Promotion of healthy eating and physical activity in early childhood is recommended as a global chronic disease prevention strategy. Centre-based childcare services represent a promising setting to provide children with opportunities to improve healthy eating and physical activity. Evidence to inform implementation of childcare obesity prevention guidelines into routine practice in childcare, however, is lacking. This study aims to assess the effectiveness of an intervention, delivered to childcare staff, aiming to increasing service implementation of healthy eating and physical activity-promoting policies and practices. A pragmatic parallel group randomised controlled trial will be undertaken with 165 childcare services in the Hunter New England region of New South Wales, Australia. Services will be randomised to receive either a 10-month evidence-based performance review intervention with other resources to support practice change, or to a waitlist control group. The primary trial outcome is the proportion of services implementing all of the following recommended healthy eating and physical activity promoting practices: written nutrition, physical activity and small screen recreation policies; providing information to families regarding healthy eating (including breastfeeding), physical activity and small screen time; providing twice weekly healthy eating learning experiences to children; providing water and only plain milk to children; providing fundamental movement skills activities for children every day; and limiting and using electronic screen time more for educational purposes and learning experiences. Effectiveness will be assessed using a telephone interview of practice implementation with childcare staff at baseline and 12 months following baseline. 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. Australian New Zealand Clinical Trials Registry ACTRN12614000972628. 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.

Baseline budgeting for continuous improvement.

PubMed

Kilty, G L

1999-05-01

This article is designed to introduce the techniques used to convert traditionally maintained department budgets to baseline budgets. This entails identifying key activities, evaluating for value-added, and implementing continuous improvement opportunities. Baseline Budgeting for Continuous Improvement was created as a result of a newly named company president's request to implement zero-based budgeting. The president was frustrated with the mind-set of the organization, namely, "Next year's budget should be 10 to 15 percent more than this year's spending." Zero-based budgeting was not the answer, but combining the principles of activity-based costing and the Just-in-Time philosophy of eliminating waste and continuous improvement did provide a solution to the problem.

Using the Theory of Planned Behavior to predict implementation of harm reduction strategies among MDMA/ecstasy users.

PubMed

Davis, Alan K; Rosenberg, Harold

2016-06-01

This prospective study was designed to test whether the variables proposed by the Theory of Planned Behavior (TPB) were associated with baseline intention to implement and subsequent use of 2 MDMA/ecstasy-specific harm reduction interventions: preloading/postloading and pill testing/pill checking. Using targeted Facebook advertisements, an international sample of 391 recreational ecstasy users were recruited to complete questionnaires assessing their ecstasy consumption history, and their attitudes, subjective norms, perceived behavioral control, habit strength (past strategy use), and intention to use these two strategies. Attitudes, subjective norms, and perceived behavioral control were significantly associated with baseline intention to preload/postload and pill test/pill check. Out of the 391 baseline participants, 100 completed the two-month follow-up assessment. Baseline habit strength and frequency of ecstasy consumption during the three months prior to baseline were the only significant predictors of how often participants used the preloading/postloading strategy during the follow-up. Baseline intention to pill test/pill check was the only significant predictor of how often participants used this strategy during the follow-up. These findings provide partial support for TPB variables as both correlates of baseline intention to implement and predictors of subsequent use of these two strategies. Future investigations could assess whether factors related to ecstasy consumption (e.g., subjective level of intoxication, craving, negative consequences following consumption), and environmental factors (e.g., accessibility and availability of harm reduction resources) improve the prediction of how often ecstasy users employ these and other harm reduction strategies. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Multimedia Campaign Enhances Orthopaedic Patient Perceptions of Health Care Quality: A Prospective Analysis of Effect at a Military Treatment Facility.

PubMed

Sheean, Andrew J; Foster, James N; Aden, James K; Tubb, Creighton C; Johnson, Anthony E; Stinner, Daniel J

2017-07-01

The importance of patient satisfaction as a measure of quality has grown with initiatives intended to enhance demand for services, refocus reimbursement paradigms, encourage health care efficiencies, and ultimately improve clinical outcomes. The purpose of our performance improvement project was to (1) characterize the effect of a two-pronged multimedia initiative on patient perceptions of health care quality and satisfaction as assessed by the Army Provider Level Satisfaction Survey (APLSS) and (2) assess for differences in APLSS scores between the surgeons that did and did not participate in the program. Baseline APLSS data for our Department of Orthopaedic Surgery were collected and subsequently compared to APLSS results 3 months after the implementation of a department-wide multimedia campaign. The multimedia initiative consisted of two concurrently implemented interventions to the orthopaedic surgery outpatient clinics. One intervention involved placing large-framed posters about the orthopaedic clinic waiting areas on which were written, "We helped write the book," and included pictures of various orthopaedic textbooks of which attending surgeons and/or residents had contributed to as authors. The other intervention provided patients with surgeon "face sheets" upon arrival to their clinic appointments. These sheets included a picture of their attending surgeon, contact information for the surgeon's nurse care coordinator, and a brief biographical sketch of the surgeon's training, clinical interests and expertise, and other information at each surgeon's discretion. Among APLSS survey results for the orthopaedic surgery clinic including all surgeons, significant increases were observed between baseline data and 3-month data for Top 1 and Top 2 responses to the questions, "How satisfied do you feel about your visit?" and "Did your surgeon listen to you carefully about your concerns and questions?" (p = 0.003 and p = 0.004, respectively). The implementation of a multimedia campaign resulted in significant improvements among indices of orthopaedic patient satisfaction. We believe this model could be used at other military or nonmilitary treatment facilities as a means to engender patients' familiarity with their surgeon and prompt an appreciation for his/her expertise and enhance overall patient perceptions of department-wide health care quality. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Design-Comparable Effect Sizes in Multiple Baseline Designs: A General Modeling Framework

ERIC Educational Resources Information Center

Pustejovsky, James E.; Hedges, Larry V.; Shadish, William R.

2014-01-01

In single-case research, the multiple baseline design is a widely used approach for evaluating the effects of interventions on individuals. Multiple baseline designs involve repeated measurement of outcomes over time and the controlled introduction of a treatment at different times for different individuals. This article outlines a general…

A Simple Method to Control Positive Baseline Trend within Data Nonoverlap

ERIC Educational Resources Information Center

Parker, Richard I.; Vannest, Kimberly J.; Davis, John L.

2014-01-01

Nonoverlap is widely used as a statistical summary of data; however, these analyses rarely correct unwanted positive baseline trend. This article presents and validates the graph rotation for overlap and trend (GROT) technique, a hand calculation method for controlling positive baseline trend within an analysis of data nonoverlap. GROT is…

Caries Risk Assessment Item Importance

PubMed Central

Chaffee, B.W.; Featherstone, J.D.B.; Gansky, S.A.; Cheng, J.; Zhan, L.

2016-01-01

Caries risk assessment (CRA) is widely recommended for dental caries management. Little is known regarding how practitioners use individual CRA items to determine risk and which individual items independently predict clinical outcomes in children younger than 6 y. The objective of this study was to assess the relative importance of pediatric CRA items in dental providers’ decision making regarding patient risk and in association with clinically evident caries, cross-sectionally and longitudinally. CRA information was abstracted retrospectively from electronic patient records of children initially aged 6 to 72 mo at a university pediatric dentistry clinic (n = 3,810 baseline; n = 1,315 with follow-up). The 17-item CRA form included caries risk indicators, caries protective items, and clinical indicators. Conditional random forests classification trees were implemented to identify and assign variable importance to CRA items independently associated with baseline high-risk designation, baseline evident tooth decay, and follow-up evident decay. Thirteen individual CRA items, including all clinical indicators and all but 1 risk indicator, were independently and statistically significantly associated with student/resident providers’ caries risk designation. Provider-assigned baseline risk category was strongly associated with follow-up decay, which increased from low (20.4%) to moderate (30.6%) to high/extreme risk patients (68.7%). Of baseline CRA items, before adjustment, 12 were associated with baseline decay and 7 with decay at follow-up; however, in the conditional random forests models, only the clinical indicators (evident decay, dental plaque, and recent restoration placement) and 1 risk indicator (frequent snacking) were independently and statistically significantly associated with future disease, for which baseline evident decay was the strongest predictor. In this predominantly high-risk population under caries-preventive care, more individual CRA items were independently associated with providers’ risk determination than with future caries status. These university dental providers considered many items in decision making regarding patient risk, suggesting that, in turn, these comprehensive CRA forms could also aid individualized care, linking risk assessment to disease management. Knowledge Transfer Statement: Caries risk assessment (CRA) is widely recommended for patient-tailored, prevention-focused caries management. Studies show mixed predictive performance of pediatric CRA instruments, but little is known regarding how information captured in CRA forms guides clinical decision making. This study, in high-caries prevalence 6- to 72-mo-olds, demonstrates the following: 1) most items in a CRA instrument were independently associated with practitioners’ risk designations, 2) practitioners’ risk designations were significantly associated with future disease, and 3) of baseline measures associated with future caries, evident decay was the strongest independent indicator of future caries status. Although current disease (resulting from existing pathological and protective factor imbalance) may sufficiently predict future caries status in populations, other CRA items incorporated during risk categorization could aid practitioners to develop individualized intervention strategies against identified risk factors. PMID:27403458

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.

“Moving forward: a cross sectional baseline study of staff and student attitudes towards a totally smoke free university campus”

PubMed Central

2013-01-01

Background Baseline data were collected to inform the adoption, implementation and institutionalisation phases of a completely smoke free campus policy at a large Western Australian university with a diverse student and staff community. Methods An online survey was randomly emailed to staff and students to measure the attitudes towards and the acceptability and enforcement of the policy prior to implementation. In total, 969 respondents completed the survey. Results General attitudes towards smoking were negative. While smokers, ex-smokers and non-smokers were supportive of smoke free policy on campus, 65.7% of respondents felt the campus should be completely smoke free. Respondents indicated a smoke free policy should be stringently enforced. The majority of respondents reported that they had been exposed to second-hand smoke on campus (n = 768; 79.5%). Conclusion Theory of Organisational Change provides a useful framework to support the implementation of the completely smoke free policy in the University setting. The implementation process needs to consider the broad range of issues associated with implementing a completely smoke free policy and address issues such as safety of smokers, ensuring smokers are not marginalised and ensuring a comprehensive program is implemented. These baseline findings can be used to advocate for the implementation of a comprehensive range of strategies that recognise the addictive nature of tobacco smoking and address attitude and behaviour change, environmental adaptations and effective implementation of the policy. Administration should consider smokers and non-smokers when policy is implemented. PMID:23924040

Rapid ambiguity resolution over medium-to-long baselines based on GPS/BDS multi-frequency observables

NASA Astrophysics Data System (ADS)

Gong, Xiaopeng; Lou, Yidong; Liu, Wanke; Zheng, Fu; Gu, Shengfeng; Wang, Hua

2017-02-01

Medium-long baseline RTK positioning generally needs a long initial time to find an accurate position due to non-negligible atmospheric delay residual. In order to shorten the initial or re-convergence time, a rapid phase ambiguity resolution method is employed based on GPS/BDS multi-frequency observables in this paper. This method is realized by two steps. First, double-differenced un-combined observables (i.e., L1/L2 and B1/B2/B3 observables) are used to obtain a float solution with atmospheric delay estimated as random walk parameter by using Kalman filter. This model enables an easy and consistent implementation for different systems and different frequency observables and can readily be extended to use more satellite navigation systems (e.g., Galileo, QZSS). Additional prior constraints for atmospheric information can be quickly added as well, because atmospheric delay is parameterized. Second, in order to fix ambiguity rapidly and reliably, ambiguities are divided into three types (extra-wide-lane (EWL), wide-lane (WL) and narrow-lane (NL)) according to their wavelengths and are to be fixed sequentially by using the LAMBDA method. Several baselines ranging from 61 km to 232 km collected by Trimble and Panda receivers are used to validate the method. The results illustrate that it only takes approximately 1, 2 and 6 epochs (30 s intervals) to fix EWL, WL and NL ambiguities, respectively. More epochs' observables are needed to fix WL and NL ambiguity around local time 14:00 than other time mainly due to more active ionosphere activity. As for the re-convergence time, the simulated results show that 90% of epochs can be fixed within 2 epochs by using prior atmospheric delay information obtained from previously 5 min. Finally, as for positioning accuracy, meter, decimeter and centimeter level positioning results are obtained according to different ambiguity resolution performances, i.e., EWL, WL and NL fixed solutions.

Two year psychosocial and mental health outcomes for refugees subjected to restrictive or supportive immigration policies.

PubMed

Steel, Zachary; Momartin, Shakeh; Silove, Derrick; Coello, Marianio; Aroche, Jorge; Tay, Kuo Wei

2011-04-01

Australia has been at the forefront of implementing immigration policies that aim to limit the flow of asylum seekers over recent decades. Two controversial polices have been the use of immigration detention for unauthorized arrivals and the issuing of temporary protection visas (TPVs) for refugees who arrived without valid visas. We conducted a longitudinal survey over 2 years commencing in 2003 of 104 consecutive refugees from Iran and Afghanistan attending a state-wide early intervention program in New South Wales. The sample included those released from immigration detention on TPVs (n = 47) and others granted permanent protection visas prior to entering Australia (PPVs, n = 57). Psychological symptoms were assessed at baseline and follow-up by the Harvard Trauma Questionnaire (HTQ), the Hopkins symptom checklist-25 (HSCL), the GHQ-30 and the Penn State Worry Questionnaires (PSWQ). English language competency, daily living difficulties and coping-related activities were also assessed. The results indicated that TPVs had higher baseline scores than PPVs on the HTQ PTSD scale, the HSCL scales, and the GHQ. ANCOVA models adjusting for baseline symptom scores indicated an increase in anxiety, depression and overall distress for TPVs whereas PPVs showed improvement over time. PTSD remained high at follow-up for TPVs and low amongst PPVs with no significant change over time. The TPVs showed a significant increase in worry at follow-up. TPVs showed no improvement in their English language skills and became increasingly socially withdrawn whereas PPVs exhibited substantial language improvements and became more socially engaged. TPV holders also reported persistently higher levels of distress in relation to a wide range of post-migration living difficulties whereas PPVs reported few problems in meeting these resettlement challenges. The data suggest a pattern of growing mental distress, ongoing resettlement difficulties, social isolation, and difficulty in the acculturation process amongst refugees subject to restrictive immigration policies. Copyright © 2011 Elsevier Ltd. All rights reserved.

Phase retrieval based wavefront sensing experimental implementation and wavefront sensing accuracy calibration

NASA Astrophysics Data System (ADS)

Mao, Heng; Wang, Xiao; Zhao, Dazun

2009-05-01

As a wavefront sensing (WFS) tool, Baseline algorithm, which is classified as the iterative-transform algorithm of phase retrieval, estimates the phase distribution at pupil from some known PSFs at defocus planes. By using multiple phase diversities and appropriate phase unwrapping methods, this algorithm can accomplish reliable unique solution and high dynamic phase measurement. In the paper, a Baseline algorithm based wavefront sensing experiment with modification of phase unwrapping has been implemented, and corresponding Graphical User Interfaces (GUI) software has also been given. The adaptability and repeatability of Baseline algorithm have been validated in experiments. Moreover, referring to the ZYGO interferometric results, the WFS accuracy of this algorithm has been exactly calibrated.

Effects of implementation of a team model on physician and staff perceptions of a clinic's organizational and learning environments.

PubMed

Roth, Linda M; Markova, Tsveti; Monsur, Joseph C; Severson, Richard K

2009-06-01

Although teamwork is widely promoted by the Institute of Medicine, the American Academy of Family Physicians, and the Future of Family Medicine project, the health care literature does not provide clear direction on how to create or maintain high-functioning teams in ambulatory residency education. In 2004, we reorganized the clinical operation of our family medicine residency clinic into teams, each consisting of faculty, residents, and nursing and administrative staff. We hypothesized that operating within teams would have a positive effect on employees' job satisfaction and perceptions of our clinic's organizational and learning environments. We administered a confidential survey to faculty, residents, and staff annually over 5 years (2002-2006). Using questionnaire data from 2002-2003 as a baseline and data from 2004-2006 as a post-intervention measurement, we performed Mann-Whitney tests to assess the effect of the implementation of teams on employees' ratings of job satisfaction, individual autonomy, organizational commitment, goal attainment, physical characteristics and personnel arrangements within the clinic, learning opportunities for residents, teaching behaviors of faculty, roles of staff, and learning organization characteristics. After the implementation of teams, there was an improvement in ratings of learning opportunities and quality of teaching, job satisfaction, employee autonomy, staff roles, and staff attitudes toward residents. Implementing a team approach in a residency clinic can improve measures of physician and staff satisfaction and organizational function.

Plans for phase coherent long baseline interferometry for geophysical applications using the Anik-B communications satellite

NASA Technical Reports Server (NTRS)

Cannon, W. H.; Petrachenko, W. T.; Yen, J. L.; Galt, J. A.; Waltman, W. B.; Knoweles, S. H.; Popelar, J.

1980-01-01

A pilot project to establish an operational phase stable very long baseline interferometer (VLBI) for geophysical studies is described. Methods for implementation as well as practical applications are presented.

Baseline Year for the Baseline Year Test (in 40 CFR 93.119)

EPA Pesticide Factsheets

EPA OTAQ's State and Local Transportation Resources are for air quality and transportation government and community leaders. Updates on the adequacy of state implementation plans (SIPs), and transportation conformity regulations and guidance

SU-E-I-68: Practical Considerations On Implementation of the Image Gently Pediatric CT Protocols

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

Zhang, J; Adams, C; Lumby, C

Purpose: One limitation associated with the Image Gently pediatric CT protocols is practical implementation of the recommended manual techniques. Inconsistency as a result of different practice is a possibility among technologist. An additional concern is the added risk of data error that would result in over or underexposure. The Automatic Exposure Control (AEC) features automatically reduce radiation for children. However, they do not work efficiently for the patients of very small size and relative large size. This study aims to implement the Image Gently pediatric CT protocols in the practical setting while maintaining the use of AEC features for pediatricmore » patients of varying size. Methods: Anthropomorphological abdomen phantoms were scanned in a CT scanner using the Image Gently pediatric protocols, the AEC technique with a fixed adult baseline, and automatic protocols with various baselines. The baselines were adjusted corresponding to patient age, weight and posterioranterior thickness to match the Image Gently pediatric CT manual techniques. CTDIvol was recorded for each examination. Image noise was measured and recorded for image quality comparison. Clinical images were evaluated by pediatric radiologists. Results: By adjusting vendor default baselines used in the automatic techniques, radiation dose and image quality can match those of the Image Gently manual techniques. In practice, this can be achieved by dividing pediatric patients into three major groups for technologist reference: infant, small child, and large child. Further division can be done but will increase the number of CT protocols. For each group, AEC can efficiently adjust acquisition techniques for children. This implementation significantly overcomes the limitation of the Image Gently manual techniques. Conclusion: Considering the effectiveness in clinical practice, Image Gently Pediatric CT protocols can be implemented in accordance with AEC techniques, with adjusted baselines, to achieve the goal of providing the most appropriate radiation dose for pediatric patients of varying sizes.« less

Design and implementation of a sigma delta technology based pulse oximeter's acquisition stage

NASA Astrophysics Data System (ADS)

Rossi, E. E.; Peñalva, A.; Schaumburg, F.

2011-12-01

Pulse oximetry is a widely used tool in medical practice for estimating patient's fraction of hemoglobin bonded to oxygen. Conventional oximetry presents limitations when changes in the baseline, or low amplitude of signals involved occur. The aim of this paper is to simultaneously solve these constraints and to simplify the circuitry needed, by using ΣΔ technology. For this purpose, a board for the acquisition of the needed signals was developed, together with a PC managed software which controls it, and displays and processes in real time the information acquired. Also laboratory and field tests where designed and executed to verify the performance of this equipment in adverse situations. A simple, robust and economic instrument was achieved, capable of obtaining signals even in situations where conventional oximetry fails.

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.

Building a Unit-Level Mentored Program to Sustain a Culture of Inquiry for Evidence-Based Practice.

PubMed

Breckenridge-Sproat, Sara T; Throop, Meryia D; Raju, Dheeraj; Murphy, Deborah A; Loan, Lori A; Patrician, Patricia A

2015-01-01

This study tested the effectiveness of a dynamic educational and mentoring program, facilitated by unit-level mentors, to introduce, promote, and sustain an evidence-based practice (EBP) culture among nurses in a military healthcare setting. The need to identify gaps in practice, apply principles of EBP, and advance scientific applications in the pursuit of quality nursing care is as important to military healthcare as it is in the civilian sector. The Advancing Research through Close Collaboration Model guided the intervention and study. Three instruments were used: the Organizational Readiness for System-wide Integration of Evidence-Based Practice, EBP Beliefs, and EBP Implementation scales. The study took place in 3 military hospitals simultaneously undergoing facility and staff integration. Data were collected from staff nurses in the inpatient nursing units before and after a facilitated education and mentoring intervention. Three hundred sixty nurses (38%) completed baseline, and 325 (31%) completed follow-up surveys. Scores improved on all 3 measures following implementation of the program; however, the differences were statistically significant only for the Organizational Readiness for System-wide Integration of Evidence-Based Practice scale (70.96 vs 77.63, t = -3.95, P < .01). In the paired individual pretest/posttest subsample (n = 56), scores improved significantly on all 3 instruments. Despite typically high turnover rates of military personnel and restructuring of 3 facilities during the study period, the readiness for, beliefs about, and implementation of EBP improved. This study suggests that a commitment to an EBP culture may diffuse among individuals in an organization, even while experiencing significant change. It also demonstrates that a unit-level mentored EBP program is sustainable despite changes in organizational structure and workforce composition.

Sales of healthy snacks and beverages following the implementation of healthy vending standards in City of Philadelphia vending machines.

PubMed

Pharis, Meagan L; Colby, Lisa; Wagner, Amanda; Mallya, Giridhar

2018-02-01

We examined outcomes following the implementation of employer-wide vending standards, designed to increase healthy snack and beverage options, on the proportion of healthy v. less healthy sales, sales volume and revenue for snack and beverage vending machines. A single-arm evaluation of a policy utilizing monthly sales volume and revenue data provided by the contracted vendor during baseline, machine conversion and post-conversion time periods. Study time periods are full calendar years unless otherwise noted. Property owned or leased by the City of Philadelphia, USA. Approximately 250 vending machines over a 4-year period (2010-2013). At post-conversion, the proportion of sales attributable to healthy items was 40 % for snacks and 46 % for beverages. Healthy snack sales were 323 % higher (38·4 to 162·5 items sold per machine per month) and total snack sales were 17 % lower (486·8 to 402·1 items sold per machine per month). Healthy beverage sales were 33 % higher (68·2 to 90·6 items sold per machine per month) and there was no significant change in total beverage sales (213·2 to 209·6 items sold per machine per month). Revenue was 11 % lower for snacks ($US 468·30 to $US 415·70 per machine per month) and 21 % lower for beverages ($US 344·00 to $US 270·70 per machine per month). Sales of healthy vending items were significantly higher following the implementation of employer-wide vending standards for snack and beverage vending machines. Entities receiving revenue-based commission payments from vending machines should employ strategies to minimize potential revenue losses.

Automation in airport security X-ray screening of cabin baggage: Examining benefits and possible implementations of automated explosives detection.

PubMed

Hättenschwiler, Nicole; Sterchi, Yanik; Mendes, Marcia; Schwaninger, Adrian

2018-10-01

Bomb attacks on civil aviation make detecting improvised explosive devices and explosive material in passenger baggage a major concern. In the last few years, explosive detection systems for cabin baggage screening (EDSCB) have become available. Although used by a number of airports, most countries have not yet implemented these systems on a wide scale. We investigated the benefits of EDSCB with two different levels of automation currently being discussed by regulators and airport operators: automation as a diagnostic aid with an on-screen alarm resolution by the airport security officer (screener) or EDSCB with an automated decision by the machine. The two experiments reported here tested and compared both scenarios and a condition without automation as baseline. Participants were screeners at two international airports who differed in both years of work experience and familiarity with automation aids. Results showed that experienced screeners were good at detecting improvised explosive devices even without EDSCB. EDSCB increased only their detection of bare explosives. In contrast, screeners with less experience (tenure < 1 year) benefitted substantially from EDSCB in detecting both improvised explosive devices and bare explosives. A comparison of all three conditions showed that automated decision provided better human-machine detection performance than on-screen alarm resolution and no automation. This came at the cost of slightly higher false alarm rates on the human-machine system level, which would still be acceptable from an operational point of view. Results indicate that a wide-scale implementation of EDSCB would increase the detection of explosives in passenger bags and automated decision instead of automation as diagnostic aid with on screen alarm resolution should be considered. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

The implementation of best practice in medication administration across a health network: a multisite evidence-based audit and feedback project.

PubMed

Munn, Zachary; Scarborough, Alan; Pearce, Susanne; McArthur, Alexa; Kavanagh, Sheila; Girdler, Michelle; Stefan-Rasmus, Bernie; Breen, Helen; Farquhar, Shirley; Li, Jessie; Hutchinson, Steven; Stephenson, Matthew; McBeth, Helen; Kitson, Alison

2015-09-16

Medication errors present a significant risk to patient safety. The "rights" of medication administration represent one approach to potentially reducing this risk. The aim of this project was to implement an evidence-based audit and feedback project to improve compliance with best practice in this area across a health network. A baseline audit was conducted to determine compliance with evidence-based standards by trained observers. The results of this audit were analysed and fed back to staff. An analysis of barriers to compliance was undertaken by key staff within the organization, which was followed by the implementation of targeted strategies to improve compliance. A follow-up audit was conducted and the results compared to the baseline audit. There were improvements in the percentage of compliance across all of the eight criteria audited, with statistically significant improvements found in six of the eight. In general, compliance with the criteria was high in both the baseline and follow-up audits. This audit and feedback implementation project was successful in increasing compliance and knowledge in this area and providing future direction for sustaining evidence-based practice change. It is now planned to use this approach for rolling out future implementation projects within this health system. The Joanna Briggs Institute.

A Wirelessly Powered Smart Contact Lens with Reconfigurable Wide Range and Tunable Sensitivity Sensor Readout Circuitry

PubMed Central

Chiou, Jin-Chern; Hsu, Shun-Hsi; Huang, Yu-Chieh; Yeh, Guan-Ting; Liou, Wei-Ting; Kuei, Cheng-Kai

2017-01-01

This study presented a wireless smart contact lens system that was composed of a reconfigurable capacitive sensor interface circuitry and wirelessly powered radio-frequency identification (RFID) addressable system for sensor control and data communication. In order to improve compliance and reduce user discomfort, a capacitive sensor was embedded on a soft contact lens of 200 μm thickness using commercially available bio-compatible lens material and a standard manufacturing process. The results indicated that the reconfigurable sensor interface achieved sensitivity and baseline tuning up to 120 pF while consuming only 110 μW power. The range and sensitivity tuning of the readout circuitry ensured a reliable operation with respect to sensor fabrication variations and independent calibration of the sensor baseline for individuals. The on-chip voltage scaling allowed the further extension of the detection range and prevented the implementation of large on-chip elements. The on-lens system enabled the detection of capacitive variation caused by pressure changes in the range of 2.25 to 30 mmHg and hydration level variation from a distance of 1 cm using incident power from an RFID reader at 26.5 dBm. PMID:28067859

Extragalactic radio sources - Accurate positions from very-long-baseline interferometry observations

NASA Technical Reports Server (NTRS)

Rogers, A. E. E.; Counselman, C. C., III; Hinteregger, H. F.; Knight, C. A.; Robertson, D. S.; Shapiro, I. I.; Whitney, A. R.; Clark, T. A.

1973-01-01

Relative positions for 12 extragalactic radio sources have been determined via wide-band very-long-baseline interferometry (wavelength of about 3.8 cm). The standard error, based on consistency between results from widely separated periods of observation, appears to be no more than 0.1 sec for each coordinate of the seven sources that were well observed during two or more periods. The uncertainties in the coordinates determined for the other five sources are larger, but in no case exceed 0.5 sec.

Implementation of a cardiovascular disease prevention program among school-aged children: a pilot study.

PubMed

Addison, Clifton C; Jenkins, Brenda W; White, Monique S; Young, Lavon

2006-09-01

The objective of this study was to test students' knowledge of cardiovascular disease information and to determine if a carefully structured training program administered to high school students would increase their knowledge about cardiovascular disease and risk factors that are preventable. A pilot study was conducted during which fifty high school students from nine counties in the State of Mississippi were measured for their knowledge of hypertension both at baseline and after the completion of an intervention training activity. There were significant gains in knowledge between the pre-test and the post-test that the students completed. The gains in knowledge indicate that elimination of risk factors is possible if all health care and school-based prevention programs are implemented to positively impact changes in eating and physical activity behaviors. Students' involvement in such activities could translate into significant changes in risk factors at these ages and throughout their lifetime. It is widely accepted that these behavioral changes, if sustained into adulthood, could have the potential to influence cardiovascular risk reduction.

Implementation of a Cardiovascular Disease Prevention Program among School-Aged Children: A Pilot Study

PubMed Central

Addison, Clifton C.; Jenkins, Brenda W.; White, Monique S.; Young, Lavon

2006-01-01

The objective of this study was to test students’ knowledge of cardiovascular disease information and to determine if a carefully structured training program administered to high school students would increase their knowledge about cardiovascular disease and risk factors that are preventable. A pilot study was conducted during which fifty high school students from nine counties in the State of Mississippi were measured for their knowledge of hypertension both at baseline and after the completion of an intervention training activity. There were significant gains in knowledge between the pre-test and the post-test that the students completed. The gains in knowledge indicate that elimination of risk factors is possible if all health care and school-based prevention programs are implemented to positively impact changes in eating and physical activity behaviors. Students’ involvement in such activities could translate into significant changes in risk factors at these ages and throughout their lifetime. It is widely accepted that these behavioral changes, if sustained into adulthood, could have the potential to influence cardiovascular risk reduction. PMID:16968974

National machine guarding program: Part 1. Machine safeguarding practices in small metal fabrication businesses

PubMed Central

Yamin, Samuel C.; Brosseau, Lisa M.; Xi, Min; Gordon, Robert; Most, Ivan G.; Stanley, Rodney

2015-01-01

Background Metal fabrication workers experience high rates of traumatic occupational injuries. Machine operators in particular face high risks, often stemming from the absence or improper use of machine safeguarding or the failure to implement lockout procedures. Methods The National Machine Guarding Program (NMGP) was a translational research initiative implemented in conjunction with two workers' compensation insures. Insurance safety consultants trained in machine guarding used standardized checklists to conduct a baseline inspection of machine‐related hazards in 221 business. Results Safeguards at the point of operation were missing or inadequate on 33% of machines. Safeguards for other mechanical hazards were missing on 28% of machines. Older machines were both widely used and less likely than newer machines to be properly guarded. Lockout/tagout procedures were posted at only 9% of machine workstations. Conclusions The NMGP demonstrates a need for improvement in many aspects of machine safety and lockout in small metal fabrication businesses. Am. J. Ind. Med. 58:1174–1183, 2015. © 2015 The Authors. American Journal of Industrial Medicine published by Wiley Periodicals, Inc. PMID:26332060

Toward Robust Climate Baselining: Objective Assessment of Climate Change Using Widely Distributed Miniaturized Sensors for Accurate World-Wide Geophysical Measurements

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

Teller, E; Leith, C; Canavan, G

A gap-free, world-wide, ocean-, atmosphere-, and land surface-spanning geophysical data-set of three decades time-duration containing the full set of geophysical parameters characterizing global weather is the scientific perquisite for defining the climate; the generally-accepted definition in the meteorological community is that climate is the 30-year running-average of weather. Until such a tridecadal climate base line exists, climate change discussions inevitably will have a semi-speculative, vs. a purely scientific, character, as the baseline against which changes are referenced will be at least somewhat uncertain. The contemporary technology base provides ways-and-means for commencing the development of such a meteorological measurement-intensive climate baseline, moreover with a program budget far less than the {approx}more » $2.5 B/year which the US. currently spends on ''global change'' studies. In particular, the recent advent of satellite-based global telephony enables real-time control of, and data-return from, instrument packages of very modest scale, and Silicon Revolution-based sensor, data-processing and -storage advances permit 'intelligent' data-gathering payloads to be created with 10 gram-scale mass budgets. A geophysical measurement system implemented in such modern technology is a populous constellation 03 long-lived, highly-miniaturized robotic weather stations deployed throughout the weather-generating portions of the Earths atmosphere, throughout its oceans and across its land surfaces. Leveraging the technological advances of the OS, the filly-developed atmospheric weather station of this system has a projected weight of the order of 1 ounce, and contains a satellite telephone, a GPS receiver, a full set of atmospheric sensing instruments and a control computer - and has an operational life of the order of 1 year and a mass-production cost of the order of $$20. Such stations are effectively ''intra-atmospheric satellites'' but likely have serial-production unit costs only about twenty-billionths that of a contemporary NASA global change satellite, whose entirely-remote sensing capabilities they complement with entirely-local sensing. It's thus feasible to deploy millions of them, and thereby to intensively monitor all aspects of the Earths weather. Analogs of these atmospheric weather stations will be employed to provide comparable-quality reporting of oceanic and land-surface geophysical parameters affecting weather. This definitive climate baselining system could be in initial-prototype operation on a one-year time-scale, and in intermediate-scale, proof-of-principle operation within three years, at a total cost of {approx}$$95M. Steady-state operating costs are estimated to be {approx} $$75M/year, or {approx}3% of the current US. ''global change'' program-cost. Its data-return would be of great value very quickly as simply the best weather information, and within a few years as the definitive climatic variability-reporting system. It would become the generator of a definitive climate baseline at a total present-value cost of {approx}$$0.9 B.« less

Laser-ranging long-baseline differential atom interferometers for space

NASA Astrophysics Data System (ADS)

Chiow, Sheng-wey; Williams, Jason; Yu, Nan

2015-12-01

High-sensitivity differential atom interferometers (AIs) are promising for precision measurements in science frontiers in space, including gravity-field mapping for Earth science studies and gravitational wave detection. Difficulties associated with implementing long-baseline differential AIs have previously included the need for a high optical power, large differential Doppler shifts, and narrow dynamic range. We propose a configuration of twin AIs connected by a laser-ranging interferometer (LRI-AI) to provide precise information of the displacements between the two AI reference mirrors and also to phase-lock the two independent interferometer lasers over long distances, thereby drastically improving the practical feasibility of long-baseline differential AI measurements. We show that a properly implemented LRI-AI can achieve equivalent functionality to the conventional differential AI measurement configuration.

National baselines for the Sustainable Development Goals assessed in the SDG Index and Dashboards

NASA Astrophysics Data System (ADS)

Schmidt-Traub, Guido; Kroll, Christian; Teksoz, Katerina; Durand-Delacre, David; Sachs, Jeffrey D.

2017-08-01

The Sustainable Development Goals (SDGs) -- agreed in 2015 by all 193 member states of the United Nations and complemented by commitments made in the Paris Agreement -- map out a broad spectrum of economic, social and environmental objectives to be achieved by 2030. Reaching these goals will require deep transformations in every country, as well as major efforts in monitoring and measuring progress. Here we introduce the SDG Index and Dashboards as analytical tools for assessing countries' baselines for the SDGs that can be applied by researchers in the cross-disciplinary analyses required for implementation. The Index and Dashboards synthesize available country-level data for all 17 goals, and for each country estimate the size of the gap towards achieving the SDGs. They will be updated annually. All 149 countries for which sufficient data is available face significant challenges in achieving the goals, and many countries' development strategies are imbalanced across the economic, social and environmental priorities. We illustrate the analytical value of the index by examining its relationship with other widely used development indices and by showing how it accounts for cross-national differences in subjective well-being. Given significant data gaps, scope and coverage of the Index and Dashboards are limited, but we suggest that these analyses represent a starting point for a comprehensive assessment of national SDG baselines and can help policymakers determine priorities for early action and monitor progress. The tools also identify data gaps that must be closed for SDG monitoring.

Lean management in academic surgery.

PubMed

Collar, Ryan M; Shuman, Andrew G; Feiner, Sandra; McGonegal, Amy K; Heidel, Natalie; Duck, Mary; McLean, Scott A; Billi, John E; Healy, David W; Bradford, Carol R

2012-06-01

Lean is a management system designed to enhance productivity by eliminating waste. Surgical practice offers many opportunities for improving efficiency. Our objective was to determine whether systematic implementation of lean thinking in an academic otolaryngology operating room improves efficiency and profitability and preserves team morale and educational opportunities. In an 18-month prospective quasi-experimental study, a multidisciplinary task force systematically implemented lean thinking within an otolaryngology operating room of an academic health system. Operating room turnover time and turnaround time were measured during a baseline period; an observer-effect period in which workers were made aware that their efficiency was being measured but before implementing lean changes; and an intervention period after redesign principles had been used. The impact on teamwork, morale, and surgical resident education were measured during the baseline and intervention periods through validated surveys. A profit model was applied to estimate the financial implications of the study. There was no difference between the baseline and observer-effect periods of the study for turnover time (p = 0.98) or turnaround time (p = 0.20). During the intervention period, the mean turnover time and turnaround time were significantly shorter than during the baseline period (29 vs 38 minutes; p < 0.001 and 69 vs 89 minutes; p < 0.001, respectively). The composite morale score suggested improved morale after implementation (p = 0.011). Educational metrics were unchanged before and after implementation. The annual opportunity revenue for the involved operating room is $330,000; when extrapolated throughout the operating rooms, lean thinking could create 6,500 hours of capacity annually. Application of lean management techniques to a single operating room and surgical service improved operating room efficiency and morale, sustained resident education, and can provide considerable financial gains when scaled to an entire academic surgical suite. Copyright © 2012. Published by Elsevier Inc.

Baseline Optimization for the Measurement of CP Violation, Mass Hierarchy, and $$\\theta_{23}$$ Octant in a Long-Baseline Neutrino Oscillation Experiment

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

Bass, M.; Bishai, M.; Cherdack, D.

2015-03-19

Next-generation long-baseline electron neutrino appearance experiments will seek to discover C P violation, determine the mass hierarchy and resolve the θ 23 octant. In light of the recent precision measurements of θ 13 , we consider the sensitivity of these measurements in a study to determine the optimal baseline, including practical considerations regarding beam and detector performance. We conclude that a detector at a baseline of at least 1000 km in a wide-band muon neutrino beam is themore » optimal configuration.« less

Who are the innovators? Nursing homes implementing culture change.

PubMed

Grabowski, David C; Elliot, Amy; Leitzell, Brigitt; Cohen, Lauren W; Zimmerman, Sheryl

2014-02-01

A key directive of the Affordable Care Act of 2010 is to transform both institutional and community-based long-term care into a more person-centered system. In the nursing home industry, the culture change movement is central to this shift in philosophy. If policymakers are to further encourage implementation of culture change, they need to better understand the factors associated with implementation. Using logistic regression (N = 16,835), we examined the extent to which resident, facility, and state characteristics relate to a nursing home being identified by experts as having implemented culture change over the period 2004 through 2011. At baseline, the 291 facilities that were later identified by experts to have implemented culture change were more often nonprofit-owned, larger in size, and had fewer Medicaid and Medicare residents. Implementers also had better baseline quality with fewer health-related survey deficiencies and greater licensed practical nurse and nurse aide staffing. States experienced greater culture change implementation when they paid a higher Medicaid per diem. To date, nursing home culture change has been implemented differentially by higher resource facilities, and nursing homes have been responsive to state policy factors when implementing culture change.

Development and implementation of the Baltimore healthy carry-outs feasibility trial: process evaluation results

PubMed Central

2013-01-01

Background Prepared food sources, including fast food restaurants and carry-outs, are common in low-income urban areas. These establishments provide foods high in calories, sugar, fat, and sodium. The aims of the study were to (1) describe the development and implementation of a carry-out intervention to provide and promote healthy food choices in prepared food sources, and (2) to assess its feasibility through a process evaluation. Methods To promote healthy eating in this setting, a culturally appropriate intervention was developed based on formative research from direct observation, interviews and focus groups. We implemented a 7-month feasibility trial in 8 carry-outs (4 intervention and 4 comparison) in low-income neighborhoods in Baltimore, MD. The trial included three phases: 1) Improving menu boards and labeling to promote healthier items; 2) Promoting healthy sides and beverages and introducing new items; and 3) Introducing affordable healthier combo meals and improving food preparation methods. A process evaluation was conducted to assess intervention reach, dose received, and fidelity using sales receipts, carry-out visit observations, and an intervention exposure assessment. Results On average, Baltimore Healthy Carry-outs (BHC) increased customer reach at intervention carry-outs; purchases increased by 36.8% at the end of the study compared to baseline. Additionally, menu boards and labels were seen by 100.0% and 84.2% of individuals (n = 101), respectively, at study completion compared to baseline. Customers reported purchasing specific foods due to the presence of a photo on the menu board (65.3%) or menu labeling (42.6%), suggesting moderate to high dose received. Promoted entrée availability and revised menu and poster presence all demonstrated high fidelity and feasibility. Conclusions The results suggest that BHC is a culturally acceptable intervention. The program was also immediately adopted by the Baltimore City Food Policy Initiative as a city-wide intervention in its public markets. PMID:23837722

Development and implementation of the Baltimore healthy carry-outs feasibility trial: process evaluation results.

PubMed

Lee-Kwan, Seung Hee; Goedkoop, Sonja; Yong, Rachel; Batorsky, Benjamin; Hoffman, Vanessa; Jeffries, Jayne; Hamouda, Mohamed; Gittelsohn, Joel

2013-07-09

Prepared food sources, including fast food restaurants and carry-outs, are common in low-income urban areas. These establishments provide foods high in calories, sugar, fat, and sodium. The aims of the study were to (1) describe the development and implementation of a carry-out intervention to provide and promote healthy food choices in prepared food sources, and (2) to assess its feasibility through a process evaluation. To promote healthy eating in this setting, a culturally appropriate intervention was developed based on formative research from direct observation, interviews and focus groups. We implemented a 7-month feasibility trial in 8 carry-outs (4 intervention and 4 comparison) in low-income neighborhoods in Baltimore, MD. The trial included three phases: 1) Improving menu boards and labeling to promote healthier items; 2) Promoting healthy sides and beverages and introducing new items; and 3) Introducing affordable healthier combo meals and improving food preparation methods. A process evaluation was conducted to assess intervention reach, dose received, and fidelity using sales receipts, carry-out visit observations, and an intervention exposure assessment. On average, Baltimore Healthy Carry-outs (BHC) increased customer reach at intervention carry-outs; purchases increased by 36.8% at the end of the study compared to baseline. Additionally, menu boards and labels were seen by 100.0% and 84.2% of individuals (n = 101), respectively, at study completion compared to baseline. Customers reported purchasing specific foods due to the presence of a photo on the menu board (65.3%) or menu labeling (42.6%), suggesting moderate to high dose received. Promoted entrée availability and revised menu and poster presence all demonstrated high fidelity and feasibility. The results suggest that BHC is a culturally acceptable intervention. The program was also immediately adopted by the Baltimore City Food Policy Initiative as a city-wide intervention in its public markets.

Integrating Routine HIV Screening in the New York City Community Health Center Collaborative.

PubMed

Rodriguez, Vanessa; Lester, Deborah; Connelly-Flores, Alison; Barsanti, Franco A; Hernandez, Paloma

2016-01-01

One in seven of the 1.1 million people living in the United States infected with HIV are not aware of their HIV status. At the same time, many clinical settings have not adopted routine HIV screening, which promotes linkage to specialist medical care. We sought to improve HIV screening in a large community health center network by using a data-driven, collaborative learning approach and system-wide modifications, where counselor-based HIV screening and testing were replaced by health-care providers and medical assistants. Urban Health Plan, Inc., a network of federally qualified health centers in the boroughs of the Bronx and Queens in New York City, provided HIV screening training for its health-care providers. In January 2011, it modified its electronic medical record system to incorporate HIV test offering. This study compared the 2010 baseline year with the three-year implementation follow-up period (January 2011 through December 2013) to determine the number of eligible individuals for HIV testing, HIV tests offered and performed, HIV-positive individuals, and HIV cases linked to specialty care. A total of 26,853 individuals at baseline and 100,369 individuals in the implementation period were eligible for HIV testing. HIV testing was performed on 2,079 (8%) of 26,853 eligible individuals in 2010 and 49,646 (50%) of 100,369 eligible individuals from 2011 through 2013. HIV-positive status was determined in 19 (0.9%) of 2,079 tested individuals in 2010 and 166 (0.3%) of 49,646 tested individuals from 2011 through 2013. Linkage to care was observed in all 19 eligible individuals and 127 (77%) of 166 eligible individuals who tested HIV positive in 2010 and 2011-2013, respectively. This study enabled routine HIV implementation testing at a community health center network, which resulted in enhanced HIV testing, an increased number of HIV-positive cases identified, and a rise in the number of patients linked to HIV specialist care.

Impact of pulsed xenon ultraviolet light on hospital-acquired infection rates in a community hospital.

PubMed

Vianna, Pedro G; Dale, Charles R; Simmons, Sarah; Stibich, Mark; Licitra, Carmelo M

2016-03-01

The role of contaminated environments in the spread of hospital-associated infections has been well documented. This study reports the impact of a pulsed xenon ultraviolet no-touch disinfection system on infection rates in a community care facility. This study was conducted in a community hospital in Southern Florida. Beginning November 2012, a pulsed xenon ultraviolet disinfection system was implemented as an adjunct to traditional cleaning methods on discharge of select rooms. The technology uses a xenon flashlamp to generate germicidal light that damages the DNA of organisms in the hospital environment. The device was implemented in the intensive care unit (ICU), with a goal of using the pulsed xenon ultraviolet system for disinfecting all discharges and transfers after standard cleaning and prior to occupation of the room by the next patient. For all non-ICU discharges and transfers, the pulsed xenon ultraviolet system was only used for Clostridium difficile rooms. Infection data were collected for methicillin-resistant Staphylococcus aureus, C difficile, and vancomycin-resistant Enterococci (VRE). The intervention period was compared with baseline using a 2-sample Wilcoxon rank-sum test. In non-ICU areas, a significant reduction was found for C difficile. There was a nonsignificant decrease in VRE and a significant increase in methicillin-resistant S aureus. In the ICU, all infections were reduced, but only VRE was significant. This may be because of the increased role that environment plays in the transmission of this pathogen. Overall, there were 36 fewer infections in the whole facility and 16 fewer infections in the ICU during the intervention period than would have been expected based on baseline data. Implementation of pulsed xenon ultraviolet disinfection is associated with significant decreases in facility-wide and ICU infection rates. These outcomes suggest that enhanced environmental disinfection plays a role in the risk mitigation of hospital-acquired infections. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Costs and effects of a state-wide health promotion program in primary schools in Germany - the Baden-Württemberg Study: A cluster-randomized, controlled trial.

PubMed

Kesztyüs, Dorothea; Lauer, Romy; Kesztyüs, Tibor; Kilian, Reinhold; Steinacker, Jürgen M

2017-01-01

To evaluate the cost-effectiveness of the state-wide implementation of the health promotion program "Join the Healthy Boat" in primary schools in Germany. Cluster-randomized intervention trial with wait-list control group. Anthropometric data of 1733 participating children (7.1 ± 0.6 years) were taken by trained staff before and after a one year intervention period in the academic year 2010/11. Parents provided information about the health status, and the health behaviour of their children and themselves, parental anthropometrics, and socio-economic background variables. Incidence of abdominal obesity, defined as waist-to-height ratio (WHtR) ≥ 0.5, was determined. Generalized linear models were applied to account for the clustering of data within schools, and to adjust for baseline-values. Losses to follow-up and missing data were analysed. From a societal perspective, the overall costs, costs per pupil, and incremental cost-effectiveness ratio (ICER) to identify the costs per case of averted abdominal obesity were calculated. The final regression model for the incidence of abdominal obesity shows lower odds for the intervention group after an adjustment for grade, gender, baseline WHtR, and breakfast habits (odds ratio = 0.48, 95% CI [0.25; 0.94]). The intervention costs per child/year were €25.04. The costs per incidental case of averted abdominal obesity varied between €1515 and €1993, depending on the different dimensions of the target group. This study demonstrates the positive effects of state-wide, school-based health promotion on incidental abdominal obesity, at affordable costs and with proven cost-effectiveness. These results should support allocative decisions of policymakers. An early start to the prevention of abdominal obesity is of particular importance because of its close relationship to non-communicable diseases. German Clinical Trials Register (DRKS), Freiburg University, Germany, DRKS-ID: DRKS00000494.

Costs and effects of a state-wide health promotion program in primary schools in Germany – the Baden-Württemberg Study: A cluster-randomized, controlled trial

PubMed Central

Kesztyüs, Tibor; Kilian, Reinhold; Steinacker, Jürgen M

2017-01-01

Aim To evaluate the cost-effectiveness of the state-wide implementation of the health promotion program “Join the Healthy Boat” in primary schools in Germany. Methods Cluster-randomized intervention trial with wait-list control group. Anthropometric data of 1733 participating children (7.1 ± 0.6 years) were taken by trained staff before and after a one year intervention period in the academic year 2010/11. Parents provided information about the health status, and the health behaviour of their children and themselves, parental anthropometrics, and socio-economic background variables. Incidence of abdominal obesity, defined as waist-to-height ratio (WHtR) ≥ 0.5, was determined. Generalized linear models were applied to account for the clustering of data within schools, and to adjust for baseline-values. Losses to follow-up and missing data were analysed. From a societal perspective, the overall costs, costs per pupil, and incremental cost-effectiveness ratio (ICER) to identify the costs per case of averted abdominal obesity were calculated. Results The final regression model for the incidence of abdominal obesity shows lower odds for the intervention group after an adjustment for grade, gender, baseline WHtR, and breakfast habits (odds ratio = 0.48, 95% CI [0.25; 0.94]). The intervention costs per child/year were €25.04. The costs per incidental case of averted abdominal obesity varied between €1515 and €1993, depending on the different dimensions of the target group. Conclusion This study demonstrates the positive effects of state-wide, school-based health promotion on incidental abdominal obesity, at affordable costs and with proven cost-effectiveness. These results should support allocative decisions of policymakers. An early start to the prevention of abdominal obesity is of particular importance because of its close relationship to non-communicable diseases. Trial registration German Clinical Trials Register (DRKS), Freiburg University, Germany, DRKS-ID: DRKS00000494. PMID:28222101

Examining Barriers to Sustained Implementation of School-Wide Prevention Practices

ERIC Educational Resources Information Center

Turri, Mary G.; Mercer, Sterett H.; McIntosh, Kent; Nese, Rhonda N. T.; Strickland-Cohen, M. Kathleen; Hoselton, Robert

2016-01-01

The purpose of this study was to determine if an experimental 5-item measure of barriers to implementing and sustaining school-wide prevention practices, the "Assessment of Barriers to Implementation and Sustainability in Schools" (ABISS), would relate to objective measures of school-wide positive behavioral interventions and supports…

Effects of School-Wide Positive Behavior Support on Teacher Self-Efficacy

ERIC Educational Resources Information Center

Kelm, Joanna L.; McIntosh, Kent

2012-01-01

This study examined the relationships between implementation of a school-wide approach to behavior, School-wide Positive Behavior Support (SWPBS), and teacher self-efficacy. Twenty-two teachers from schools implementing SWPBS and 40 teachers from schools not implementing SWPBS completed a questionnaire measuring aspects of self-efficacy.…

Evaluation of a hospital-wide PACS: costs and benefits of the Hammersmith PACS installation

NASA Astrophysics Data System (ADS)

Bryan, Stirling; Keen, Justin; Buxton, Martin J.; Weatherburn, Gwyneth C.

1992-07-01

The unusual nature of sites chosen for hospital-wide PACS implementations and the very small number of proposed implementations make evaluation a complex task. The UK Department of Health is funding both the evaluation and implementation of a hospital-wide PACS. The Brunel University evaluation of the Hammersmith Hospital PACS has two main components: an economic evaluation of the costs and benefits of hospital-wide PACS installations and an exercise in monitoring the implementation process. This paper concentrates on the economic component.

Initial, successful implementation of sepsis guidelines in an emergency department.

PubMed

Plambech, Morten Z; Lurie, Andrew I; Ipsen, Helle L

2012-12-01

Early screening and treatment of sepsis can reduce mortality. Region Zealand established guidelines for the diagnosis and treatment of sepsis. We assess an interdisciplinary intervention for implementation of these guidelines at the Department of Emergency Medicine at Nykøbing Falster Hospital from July 2009 to August 2010. Structured training was imparted to personnel during the first 18 weeks. Electronically accessible guidelines, posters with diagnostic and treatment algorithms, pocket references and checklists were made available to encourage adherence to the guidelines. Key nurses and doctors encouraged compliance. Journal audits (at baseline, 18 weeks and one year) were undertaken to measure adherence to six elements of the sepsis guidelines: lactate measurement, oxygen and fluid treatment, timely antibiotic treatment, blood culture and planning of treatment monitoring. A total of 27 (baseline), 29 (18 weeks) and 48 (one year) patients were included for analysis. Adherence to 3-5 of the elements of the sepsis guidelines' six elements increased from 37% to 65% from baseline to the first follow-up at 18 weeks (p = 0.03). Adherence to 3-5 of the elements decreased from the first to the second follow-up at one year. Lactate measurement, blood culture and antibiotic administration increased from baseline to the one-year follow-up. The intervention had a positive effect on the implementation of guidelines. This effect was reduced one year after the baseline audit, possibly due to a decline in the focus on the intervention and/or personnel turnover in the department.

Multi-strategic intervention to enhance implementation of healthy canteen policy: a randomised controlled trial.

PubMed

Wolfenden, Luke; Nathan, Nicole; Janssen, Lisa M; Wiggers, John; Reilly, Kathryn; Delaney, Tessa; Williams, Christopher M; Bell, Colin; Wyse, Rebecca; Sutherland, Rachel; Campbell, Libby; Lecathelinais, Christophe; Oldmeadow, Chris; Freund, Megan; Yoong, Sze Lin

2017-01-11

Internationally, governments have implemented school-based nutrition policies to restrict the availability of unhealthy foods from sale. The aim of the trial was to assess the effectiveness of a multi-strategic intervention to increase implementation of a state-wide healthy canteen policy. The impact of the intervention on the energy, total fat, and sodium of children's canteen purchases and on schools' canteen revenue was also assessed. Australian primary schools with a canteen were randomised to receive a 12-14-month, multi-strategic intervention or to a no intervention control group. The intervention sought to increase implementation of a state-wide healthy canteen policy which required schools to remove unhealthy items (classified as 'red' or 'banned') from regular sale and encouraged schools to 'fill the menu' with healthy items (classified as 'green'). The intervention strategies included allocation of a support officer to assist with policy implementation, engagement of school principals and parent committees, consensus processes with canteen managers, training, provision of tools and resources, academic detailing, performance feedback, recognition and marketing initiatives. Data were collected at baseline (April to September, 2013) and at completion of the implementation period (November, 2014 to April, 2015). Seventy schools participated in the trial. Relative to control, at follow-up, intervention schools were significantly more likely to have menus without 'red' or 'banned' items (RR = 21.11; 95% CI 3.30 to 147.28; p ≤ 0.01) and to have at least 50% of menu items classified as 'green' (RR = 3.06; 95% CI 1.64 to 5.68; p ≤ 0.01). At follow-up, student purchases from intervention school canteens were significantly lower in total fat (difference = -1.51 g; 95% CI -2.84 to -0.18; p = 0.028) compared to controls, but not in energy (difference = -132.32 kJ; 95% CI -280.99 to 16.34; p = 0.080) or sodium (difference = -46.81 mg; 95% CI -96.97 to 3.35; p = 0.067). Canteen revenue did not differ significantly between groups. Poor implementation of evidence-based school nutrition policies is a problem experienced by governments internationally, and one with significant implications for public health. The study makes an important contribution to the limited experimental evidence regarding strategies to improve implementation of school nutrition policies and suggests that, with multi-strategic support, implementation of healthy canteen policies can be achieved in most schools. Australian New Zealand Clinical Trials Registry ( ACTRN12613000311752 ).

Effectiveness of a multi-strategy intervention in increasing the implementation of vegetable and fruit breaks by Australian primary schools: a non-randomized controlled trial

PubMed Central

2012-01-01

Background Limited evidence exists describing the effectiveness of strategies in facilitating the implementation of vegetable and fruit programs by schools on a population wide basis. The aim of this study was to examine the effectiveness of a multi-strategy intervention in increasing the population-wide implementation of vegetable and fruit breaks by primary schools and to determine if intervention effectiveness varied by school characteristics. Methods A quasi-experimental study was conducted in primary schools in the state of New South Wales, Australia. All primary schools in one region of the state (n = 422) received a multi-strategy intervention. A random sample of schools (n = 406) in the remainder of the state served as comparison schools. The multi-strategy intervention to increase vegetable and fruit breaks involved the development and provision of: program consensus and leadership; staff training; program materials; incentives; follow-up support; and implementation feedback. Comparison schools had access to routine information-based Government support. Data to assess the prevalence of vegetable and fruit breaks were collected by telephone from Principals of the intervention and comparison schools at baseline (2006–2007) and 11 to 15 months following the commencement of the intervention (2009–2010). GEE analysis was used to examine the change in the prevalence of vegetable and fruit breaks in intervention schools compared to comparison schools. Results At follow-up, prevalence of vegetable and fruit breaks increased significantly in both intervention (50.3 % to 82.0 %, p < 0.001) and comparison (45.4 % to 60.9 % p < 0.001) schools. The increase in prevalence in intervention schools was significantly larger than among comparison schools (OR 2.36; 95 % CI 1.60-3.49, p <0.001). The effect size was similar between schools regardless of the rurality or socioeconomic status of school location, school size or government or non-government school type. Conclusion The findings suggest that a multi-strategy intervention can significantly increase the implementation of vegetable and fruit breaks by a large number of Australian primary schools. PMID:22889085

Effectiveness of a multi-strategy intervention in increasing the implementation of vegetable and fruit breaks by Australian primary schools: a non-randomized controlled trial.

PubMed

Nathan, Nicole; Wolfenden, Luke; Bell, Andrew C; Wyse, Rebecca; Morgan, Philip J; Butler, Michelle; Sutherland, Rachel; Milat, Andrew J; Hector, Debra; Wiggers, John

2012-08-13

Limited evidence exists describing the effectiveness of strategies in facilitating the implementation of vegetable and fruit programs by schools on a population wide basis. The aim of this study was to examine the effectiveness of a multi-strategy intervention in increasing the population-wide implementation of vegetable and fruit breaks by primary schools and to determine if intervention effectiveness varied by school characteristics. A quasi-experimental study was conducted in primary schools in the state of New South Wales, Australia. All primary schools in one region of the state (n = 422) received a multi-strategy intervention. A random sample of schools (n = 406) in the remainder of the state served as comparison schools. The multi-strategy intervention to increase vegetable and fruit breaks involved the development and provision of: program consensus and leadership; staff training; program materials; incentives; follow-up support; and implementation feedback. Comparison schools had access to routine information-based Government support. Data to assess the prevalence of vegetable and fruit breaks were collected by telephone from Principals of the intervention and comparison schools at baseline (2006-2007) and 11 to 15 months following the commencement of the intervention (2009-2010). GEE analysis was used to examine the change in the prevalence of vegetable and fruit breaks in intervention schools compared to comparison schools. At follow-up, prevalence of vegetable and fruit breaks increased significantly in both intervention (50.3% to 82.0%, p < 0.001) and comparison (45.4% to 60.9% p < 0.001) schools. The increase in prevalence in intervention schools was significantly larger than among comparison schools (OR 2.36; 95% CI 1.60-3.49, p <0.001). The effect size was similar between schools regardless of the rurality or socioeconomic status of school location, school size or government or non-government school type. The findings suggest that a multi-strategy intervention can significantly increase the implementation of vegetable and fruit breaks by a large number of Australian primary schools.

Revealing and Resolving Patient Safety Defects: The Impact of Leadership WalkRounds on Frontline Caregiver Assessments of Patient Safety

PubMed Central

Frankel, Allan; Grillo, Sarah Pratt; Pittman, Mary; Thomas, Eric J; Horowitz, Lisa; Page, Martha; Sexton, Bryan

2008-01-01

Objective To evaluate the impact of rigorous WalkRounds on frontline caregiver assessments of safety climate, and to clarify the steps and implementation of rigorous WalkRounds. Data Sources/Study Setting Primary outcome variables were baseline and post WalkRounds safety climate scores from the Safety Attitudes Questionnaire (SAQ). Secondary outcomes were safety issues elicited through WalkRounds. Study period was August 2002 to April 2005; seven hospitals in Massachusetts agreed to participate; and the project was implemented in all patient care areas. Study Design Prospective study of the impact of rigorously applied WalkRounds on frontline caregivers assessments of safety climate in their patient care area. WalkRounds were conducted weekly and according to the seven-step WalkRounds Guide. The SAQ was administered at baseline and approximately 18 months post-WalkRounds implementation to all caregivers in patient care areas. Results Two of seven hospitals complied with the rigorous WalkRounds approach; hospital A was an academic teaching center and hospital B a community teaching hospital. Of 21 patient care areas, SAQ surveys were received from 62 percent of respondents at baseline and 60 percent post WalkRounds. At baseline, 10 of 21 care areas (48 percent) had safety climate scores below 60 percent, whereas post-WalkRounds three care areas (14 percent) had safety climate scores below 60 percent without improving by 10 points or more. Safety climate scale scores in hospital A were 62 percent at baseline and 77 percent post-WalkRounds (t=2.67, p=.03), and in hospital B were 46 percent at baseline and 56 percent post WalkRounds (t=2.06, p=.06). Main safety issues by category were equipment/facility (A [26 percent] and B [33 percent]) and communication (A [24 percent] and B [18 percent]). Conclusions WalkRounds implementation requires significant organizational will; sustainability requires outstanding project management and leadership engagement. In the patient care areas that rigorously implemented WalkRounds, frontline caregiver assessments of patient safety increased. SAQ results such as safety climate scores facilitate the triage of quality improvement efforts, and provide consensus assessments of frontline caregivers that identify themes for improvement. PMID:18671751

Impact evaluation of a community-based intervention to reduce risky sexual behaviour among female sex workers in Shanghai, China.

PubMed

Liu, Juan; Calzavara, Liviana; Mendelsohn, Joshua B; O'Leary, Ann; Kang, Laiyi; Pan, Qichao; Myers, Ted; Ren, Jinma; Cha, Yanfeng; Shi, Guozheng; Liu, Xiaofeng; Tian, Xiuhong; Fan, Huili; Ni, Yinqing; Remis, Robert S

2015-02-14

Female sex workers (FSWs) are at risk for sexually transmitted infections (STIs), including HIV. We implemented an HIV/STI preventive intervention among FSWs in Shanghai that aimed to increase condom use, improve HIV knowledge, and reduce STI and HIV incidence. From six districts in Shanghai, 750 randomly selected venue-based FSWs were allocated to either a behavioural intervention or control group. In the intervention and control groups, 221 and 278 participants, respectively, had at least one follow-up at three or six months. In analysis, we randomly selected 57 lost to follow-up cases in the intervention group and imputed baseline values to equalize the arms at n = 278 (74.1% follow-up rate in each group). The impacts of the intervention on condom use, HIV/STI risk perception and knowledge, and STI incidence were assessed using either a logistic or linear model, adjusting for the baseline measure of the outcome and venue type. The intervention improved consistent condom use with any partner type in the previous month (AOR = 2.09, 95% CI, 1.43-3.04, p = 0.0001). Consistent condom use with clients in the three most recent sex acts increased in both arms, and with primary partners in the intervention arm, but there was no difference between groups after adjusting for baseline condom use and venue type. There were no differences in cumulative incidence of any STI (i.e., chlamydia, gonorrhoea, syphilis) between groups. HIV transmission knowledge (p = 0.0001), condom use skill (p = 0.0421), and self-efficacy for using condoms (p = 0.0071) were improved by the intervention. HIV-related stigma declined (p = 0.0119) and HIV and STI risk perception were improved (4.6 to 13.9%, and 9.4 to 20.0%, respectively). The intervention was associated with these improvements after adjusting for the baseline measure and venue type. Following a preventive intervention among Shanghai FSWs, our findings demonstrate that a simple, community-based educational intervention improved overall condom use, HIV and STI knowledge, and attitudes in relation to HIV/AIDS. The intervention should be implemented widely after tailoring educational materials regarding condom negotiation with different partner types (i.e., commercial sex clients and primary partners).

Changing Epistemological Beliefs with Nature of Science Implementations

ERIC Educational Resources Information Center

Johnson, Keith; Willoughby, Shannon

2018-01-01

This article discusses our investigation regarding nature of science (NOS) implementations and epistemological beliefs within an undergraduate introductory astronomy course. The five year study consists of two years of baseline data in which no explicit use of NOS material was implemented, then three years of subsequent data in which specific NOS…

The System-Wide Effect of Real-Time Audiovisual Feedback and Postevent Debriefing for In-Hospital Cardiac Arrest: The Cardiopulmonary Resuscitation Quality Improvement Initiative*

PubMed Central

Couper, Keith; Kimani, Peter K.; Abella, Benjamin S.; Chilwan, Mehboob; Cooke, Matthew W.; Davies, Robin P.; Field, Richard A.; Gao, Fang; Quinton, Sarah; Stallard, Nigel; Woolley, Sarah

2015-01-01

Objective: To evaluate the effect of implementing real-time audiovisual feedback with and without postevent debriefing on survival and quality of cardiopulmonary resuscitation quality at in-hospital cardiac arrest. Design: A two-phase, multicentre prospective cohort study. Setting: Three UK hospitals, all part of one National Health Service Acute Trust. Patients: One thousand three hundred and ninety-five adult patients who sustained an in-hospital cardiac arrest at the study hospitals and were treated by hospital emergency teams between November 2009 and May 2013. Interventions: During phase 1, quality of cardiopulmonary resuscitation and patient outcomes were measured with no intervention implemented. During phase 2, staff at hospital 1 received real-time audiovisual feedback, whereas staff at hospital 2 received real-time audiovisual feedback supplemented by postevent debriefing. No intervention was implemented at hospital 3 during phase 2. Measurements and Main Results: The primary outcome was return of spontaneous circulation. Secondary endpoints included other patient-focused outcomes, such as survival to hospital discharge, and process-focused outcomes, such as chest compression depth. Random-effect logistic and linear regression models, adjusted for baseline patient characteristics, were used to analyze the effect of the interventions on study outcomes. In comparison with no intervention, neither real-time audiovisual feedback (adjusted odds ratio, 0.62; 95% CI, 0.31–1.22; p = 0.17) nor real-time audiovisual feedback supplemented by postevent debriefing (adjusted odds ratio, 0.65; 95% CI, 0.35–1.21; p = 0.17) was associated with a statistically significant improvement in return of spontaneous circulation or any process-focused outcome. Despite this, there was evidence of a system-wide improvement in phase 2, leading to improvements in return of spontaneous circulation (adjusted odds ratio, 1.87; 95% CI, 1.06–3.30; p = 0.03) and process-focused outcomes. Conclusions: Implementation of real-time audiovisual feedback with or without postevent debriefing did not lead to a measured improvement in patient or process-focused outcomes at individual hospital sites. However, there was an unexplained system-wide improvement in return of spontaneous circulation and process-focused outcomes during the second phase of the study. PMID:26186567

Clinical governance is "ACE"--using the EFQM excellence model to support baseline assessment.

PubMed

Holland, K; Fennell, S

2000-01-01

The introduction of clinical governance in the "new NHS" means that National Health Service (NHS) organisations are now accountable for the quality of the services they provide to their local communities. As part of the implementation of clinical governance in the NHS, Trusts and health authorities had to complete a baseline assessment of their capability and capacity by September 1999. Describes one Trust's approach to developing and implementing its baseline assessment tool, based upon its existing use of the European Foundation for Quality Management (EFQM) Excellence Model. An initial review of the process suggests that the model provides an adaptable framework for the development of a comprehensive and practical assessment tool and that self-assessment ensures ownership of action plans at service level.

Work factors and psychological distress in nurses' aides: a prospective cohort study

PubMed Central

Eriksen, Willy; Tambs, Kristian; Knardahl, Stein

2006-01-01

Background Nurses' aides (assistant nurses), the main providers of practical patient care in many countries, are doing both emotional and heavy physical work, and are exposed to frequent social encounters in their job. There is scarce knowledge, though, of how working conditions are related to psychological distress in this occupational group. The aim of this study was to identify work factors that predict the level of psychological distress in nurses' aides. Methods The sample of this prospective study comprised 5076 Norwegian nurses' aides, not on leave when they completed a mailed questionnaire in 1999. Of these, 4076 (80.3 %) completed a second questionnaire 15 months later. A wide spectrum of physical, psychological, social, and organisational work factors were measured at baseline. Psychological distress (anxiety and depression) was assessed at baseline and follow-up by the SCL-5, a short version of Hopkins Symptom Checklist-25. Results In a linear regression model of the level of psychological distress at follow-up, with baseline level of psychological distress, work factors, and background factors as independent variables, work factors explained 2 % and baseline psychological distress explained 34 % of the variance. Exposures to role conflicts, exposures to threats and violence, working in apartment units for the aged, and changes in the work situation between baseline and follow-up that were reported to result in less support and encouragement were positively associated with the level of psychological distress. Working in psychiatric departments, and changes in the work situation between baseline and follow-up that gave lower work pace were negatively associated with psychological distress. Conclusion The study suggests that work factors explain only a modest part of the psychological distress in nurses' aides. Exposures to role conflicts and threats and violence at work may contribute to psychological distress in nurses' aides. It is important that protective measures against violent patients are implemented, and that occupational health officers offer victims of violence appropriate support or therapy. It is also important that health service organisations focus on reducing role conflicts, and that leaders listen to and consider the views of the staff. PMID:17132172

Adaptive Baseline Enhances EM-Based Policy Search: Validation in a View-Based Positioning Task of a Smartphone Balancer

PubMed Central

Wang, Jiexin; Uchibe, Eiji; Doya, Kenji

2017-01-01

EM-based policy search methods estimate a lower bound of the expected return from the histories of episodes and iteratively update the policy parameters using the maximum of a lower bound of expected return, which makes gradient calculation and learning rate tuning unnecessary. Previous algorithms like Policy learning by Weighting Exploration with the Returns, Fitness Expectation Maximization, and EM-based Policy Hyperparameter Exploration implemented the mechanisms to discard useless low-return episodes either implicitly or using a fixed baseline determined by the experimenter. In this paper, we propose an adaptive baseline method to discard worse samples from the reward history and examine different baselines, including the mean, and multiples of SDs from the mean. The simulation results of benchmark tasks of pendulum swing up and cart-pole balancing, and standing up and balancing of a two-wheeled smartphone robot showed improved performances. We further implemented the adaptive baseline with mean in our two-wheeled smartphone robot hardware to test its performance in the standing up and balancing task, and a view-based approaching task. Our results showed that with adaptive baseline, the method outperformed the previous algorithms and achieved faster, and more precise behaviors at a higher successful rate. PMID:28167910

Implementing and sustaining a hand hygiene culture change programme at Auckland District Health Board.

PubMed

Roberts, Sally A; Sieczkowski, Christine; Campbell, Taima; Balla, Greg; Keenan, Andrew

2012-05-11

In January 2009 Auckland District Health Board commenced implementation of the Hand Hygiene New Zealand (HHNZ) programme to bring about a culture change and to improve hand hygiene compliance by healthcare workers. We describe the implementation process and assess the effectiveness of this programme 36 months after implementation. In keeping with the HHNZ guideline the implementation was divided into five steps: roll-out and facility preparation, baseline evaluation, implementation, follow-up evaluation and sustainability. The process measure was improvement in hand hygiene compliance and the outcome measure was Staphylococcus aureus clinical infection and bacteraemia rates. The mean (95% CI; range) baseline compliance rates for the national reporting wards was 35% (95% CI 24-46%, 25-61%). The overall compliance by the 7th audit period was 60% (95% CI 46-74; range 47-91). All healthcare worker groups had improvement in compliance. The reduction in healthcare-associated S. aureus bacteraemia rates following the implementation was statistically significant (p=0.027). Compliance with hand hygiene improved following implementation of a culture change programme. Sustaining this improvement requires commitment and strong leadership at a senior level both nationally and within each District Health Board.

Guidelines and mHealth to Improve Quality of Hypertension and Type 2 Diabetes Care for Vulnerable Populations in Lebanon: Longitudinal Cohort Study

PubMed Central

Paik, Kenneth E; Hei Tam, Hok; Fahed, Zeina; Winkler, Eric; Kontunen, Kaisa; Mkanna, Abdalla; Burnham, Gilbert

2017-01-01

Background Given the protracted nature of the crisis in Syria, the large noncommunicable disease (NCD) caseload of Syrian refugees and host Lebanese, and the high costs of providing NCD care, the implications for Lebanon’s health system are vast. Objective The aim of this study was to evaluate the effectiveness of treatment guidelines and a mobile health (mHealth) app on quality of care and health outcomes in primary care settings in Lebanon. Methods A longitudinal cohort study was implemented from January 2015 to August 2016 to evaluate the effectiveness of treatment guidelines and an mHealth app on quality of care and health outcomes for Syrian and Lebanese patients in Lebanese primary health care (PHC) facilities. Results Compared with baseline record extraction, recording of blood pressure (BP) readings (−11.4%, P<.001) and blood sugar measurements (−6.9%, P=.03) significantly decreased following the implementation of treatment guidelines. Recording of BP readings also decreased after the mHealth phase as compared with baseline (−8.4%, P=.001); however, recording of body mass index (BMI) reporting increased at the end of the mHealth phase from baseline (8.1%, P<.001) and the guidelines phase (7.7%, P<.001). There were a great proportion of patients for whom blood sugar, BP, weight, height, and BMI were recorded using the tablet compared with in paper records; however, only differences in BMI were statistically significant (31.6% higher in app data as compared with paper records; P<.001). Data extracted from the mHealth app showed that a higher proportion of providers offered lifestyle counseling compared with the counseling reported in patients’ paper records (health diet counseling; 77.3% in app data vs 8.8% in paper records, P<.001 and physical activity counseling and 59.7% in app vs 7.1% in paper records, P<.001). There were statistically significant increases in all four measures of patient-provider interaction across study phases. Provider inquiry of medical history increased by 16.6% from baseline following guideline implementation and by 28.2% from baseline to mHealth implementation (P<.001). From baseline, patient report of provider inquiry regarding medication complications increased in the guidelines and mHealth phases by 12.9% and 59.6%, respectively, (P<.001). The proportion of patients reporting that providers asked other questions relevant to their illness increased from baseline through guidelines implementation by 27.8% and to mHealth implementation by 66.3% (P<.001). Follow-up scheduling increased from baseline to the guidelines phase by 20.6% and the mHealth phase by 39.8% (P<.001). Conclusions Results from this study of an mHealth app in 10 PHC facilities in Lebanon indicate that the app has potential to improve adherence to guidelines and quality of care. Further studies are necessary to determine the effects of patient-controlled health record apps on provider adherence to treatment guidelines, as well as patients’ long-term medication and treatment adherence and disease control. PMID:29046266

"Leaning" the process of venous thromboembolism prophylaxis.

PubMed

Biffl, Walter L; Beno, Matthew; Goodman, Philip; Bahia, Amit; Sabel, Allison; Snow, Karen; Steele, Andrew W; Swartwood, Claire; Thienelt, Christiane; MacKenzie, Thomas D; Mehler, Philip S

2011-03-01

Lean principles have been used at Denver Health Medical Center since 2005 to streamline nonclinical processes. Despite allocation of significant resources, particularly the expense of low molecular weight heparin (LMWH), to prophylaxis of venous thromboembolism (VTE), the incidence of postoperative VTE was significantly worse than national benchmarks. VTE risk factors were not consistently assessed, and the prescribing of prophylaxis varied widely. Lean was employed to standardize and implement risk assessment and evidence-based VTE prophylaxis for the institution. In a rapid improvement event, a multidisciplinary group formulated an evidence-based risk assessment tool and clinical practice guideline for VTE prophylaxis, with plans for hospitalwide implementation and monitoring. The effects were immediate and improved steadily with feedback to clinicians. Within six months, compliance with the standard approached 100%. One year after implementation, the use of LMWH decreased more than 60% below baseline, and the use of sequential compression devices decreased by nearly 30%. With increased use of unfractionated heparin, the cost savings on VTE prophylaxis exceeded $15,000 per month, for a total of $425,000 since implementation. Moreover, the incidence of VTE decreased markedly during the same period. By reducing VTE rates, a total cost savings of $6.2 million was estimated for the past 28 months. Applying Lean to the clinical management of VTE prophylaxis improved compliance with standards and saved the hospital a significant amount of money. This was achieved without compromising clinical outcomes. This experience could be replicated at other institutions.

Effects of Video Modeling on Treatment Integrity of Behavioral Interventions

ERIC Educational Resources Information Center

DiGennaro-Reed, Florence D.; Codding, Robin; Catania, Cynthia N.; Maguire, Helena

2010-01-01

We examined the effects of individualized video modeling on the accurate implementation of behavioral interventions using a multiple baseline design across 3 teachers. During video modeling, treatment integrity improved above baseline levels; however, teacher performance remained variable. The addition of verbal performance feedback increased…

System-wide lean implementation in health care: A multiple case study.

PubMed

Centauri, Federica; Mazzocato, Pamela; Villa, Stefano; Marsilio, Marta

2018-05-01

Background Lean practices have been widely used by health care organizations to meet efficiency, performance and quality improvement needs. The lean health care literature shows that the effective implementation of lean requires a holistic system-wide approach. However, there is still limited evidence on what drives effective system-wide lean implementation in health care. The existing literature suggests that a deeper understanding of how lean interventions interact with the organizational context is necessary to identify the critical variables to successfully sustain system-wide lean strategies. Purpose and methodology: A multiple case study of three Italian hospitals is conducted with the aim to explore the organizational conditions that are relevant for an effective system-wide lean implementation. A conceptual framework, built on socio-technical system schemas, is used to guide data collection and analysis. The analysis points out the importance to support lean implementation with an integrated and coordinated strategy involving the social, technical, and external components of the overall hospital system.

Site systems engineering fiscal year 1999 multi-year work plan (MYWP) update for WBS 1.8.2.2

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

GRYGIEL, M.L.

1998-10-08

Manage the Site Systems Engineering process to provide a traceable integrated requirements-driven, and technically defensible baseline. Through the Site Integration Group(SIG), Systems Engineering ensures integration of technical activities across all site projects. Systems Engineering's primary interfaces are with the RL Project Managers, the Project Direction Office and with the Project Major Subcontractors, as well as with the Site Planning organization. Systems Implementation: (1) Develops, maintains, and controls the site integrated technical baseline, ensures the Systems Engineering interfaces between projects are documented, and maintain the Site Environmental Management Specification. (2) Develops and uses dynamic simulation models for verification of the baselinemore » and analysis of alternatives. (3) Performs and documents fictional and requirements analyses. (4) Works with projects, technology management, and the SIG to identify and resolve technical issues. (5) Supports technical baseline information for the planning and budgeting of the Accelerated Cleanup Plan, Multi-Year Work Plans, Project Baseline Summaries as well as performance measure reporting. (6) Works with projects to ensure the quality of data in the technical baseline. (7) Develops, maintains and implements the site configuration management system.« less

Effectiveness and Acceptability of Parent-Implemented Behavior Interventions for Children with Autism in Three African American Families

ERIC Educational Resources Information Center

Robertson, Rachel E.

2016-01-01

No studies of parent-implemented behavior interventions for children with autism spectrum disorders (ASD) have purposefully examined their effectiveness and acceptability with African American families. The present study used a multiple baseline across participants design to evaluate the effectiveness of parent-implemented differential…

Design and baseline characteristics of the 10 Small Steps Study: a randomised controlled trial of an intervention to promote healthy behaviour using a lifestyle score and personalised feedback.

PubMed

Parekh, Sanjoti; Vandelanotte, Corneel; King, David; Boyle, Frances M

2012-03-12

Non-communicable diseases (NCDs) are the leading causes of death globally and are associated with a limited set of common, modifiable health behaviours: tobacco use, physical inactivity, harmful use of alcohol and unhealthy diet. General practice offers an ideal avenue for addressing such health behaviours on a population-wide basis. This paper describes the protocol of a multiple health behaviour change intervention designed for implementation in general practice and summarises the baseline characteristics of its participants. The 10 Small Steps (10SS) study, a randomised controlled trial, involved 4,678 adult general practice patients in Queensland, Australia. Self-reported data were collected to establish the proportion of participants meeting recommended guidelines for ten health behaviours: physical activity, body mass index, alcohol, smoking and six dietary behaviours. Participants were randomised to four groups: contact at baseline only ('single intervention' and corresponding control group) and contact at baseline and 3 months ('dual intervention' and corresponding control group). At each contact the participants received a computer-tailored feedback and one page information sheet according to their allocation to intervention or control groups. Change in the intervention group compared to the control group was assessed at 3 and12 months after baseline data collection.Responses were summed to calculate an individual lifestyle score (the Prudence Score), which ranged from 0 to 10. The baseline response was 56.5% (4678 of 8343 invited participants) and the study sample was primarily female (68.7%) with an average age of 47 years. The mean Prudence Score was 5.8 (95%CI 5.75-5.85). Baseline data from the 10SS study show that nearly all participants engage in some health behaviours but relatively few adhere simultaneously to a core set of dietary and lifestyle behaviours associated with risk of NCDs. Ample scope exists to improve health behaviour to reduce NCDs in the general practice setting and the 10SS study trial will provide data on the extent to which a minimal computer-tailored intervention can meet this objective. The protocol developed for the 10SS study has potential for translation into routine general practice as it has minimal impact on practice routine whilst contributing to primary prevention objectives. The Australian New Zealand Clinical Trials Registry ACTRN12611001213932.

Genome-wide linkage scan for submaximal exercise heart rate in the HERITAGE family study.

PubMed

Spielmann, Nadine; Leon, Arthur S; Rao, D C; Rice, Treva; Skinner, James S; Rankinen, Tuomo; Bouchard, Claude

2007-12-01

The purpose of this study was to identify regions of the human genome linked to submaximal exercise heart rates in the sedentary state and in response to a standardized 20-wk endurance training program in blacks and whites of the HERITAGE Family Study. A total of 701 polymorphic markers covering the 22 autosomes were used in the genome-wide linkage scan, with 328 sibling pairs from 99 white nuclear families and 102 pairs from 115 black family units. Steady-state heart rates were measured at the relative intensity of 60% maximal oxygen uptake (HR60) and at the absolute intensity of 50 W (HR50). Baseline phenotypes were adjusted for age, sex, and baseline body mass index (BMI) and training responses (posttraining minus baseline, Delta) were adjusted for age, sex, baseline BMI, and baseline value of the phenotype. Two analytic strategies were used, a multipoint variance components and a regression-based multipoint linkage analysis. In whites, promising linkages (LOD > 1.75) were identified on 18q21-q22 for baseline HR50 (LOD = 2.64; P = 0.0002) and DeltaHR60 (LOD = 2.10; P = 0.0009) and on chromosome 2q33.3 for DeltaHR50 (LOD = 2.13; P = 0.0009). In blacks, evidence of promising linkage for baseline HR50 was detected with several markers within the chromosomal region 10q24-q25.3 (peak LOD = 2.43, P = 0.0004 with D10S597). The most promising regions for fine mapping in the HERITAGE Family Study were found on 2q33 for HR50 training response in whites, on 10q25-26 for baseline HR60 in blacks, and on 18q21-22 for both baseline HR50 and DeltaHR60 in whites.

Baseline values of immunologic parameters in the lizard Salvator merianae (Teiidae, Squamata)

PubMed Central

Mestre, Ana Paula; Amavet, Patricia Susana; Siroski, Pablo Ariel

2017-01-01

The genus Salvator is widely distributed throughout South America. In Argentina, the species most abundant widely distributed is Salvator merianae. Particularly in Santa Fe province, the area occupied by populations of these lizards overlaps with areas where agriculture was extended. With the aim of established baseline values for four immunologic biomarkers widely used, 36 tegu lizards were evaluated tacking into account different age classes and both sexes. Total leukocyte counts were not different between age classes. Of the leucocytes count, eosinophils levels were higher in neonates compared with juvenile and adults; nevertheless, the heterophils group was the most prevalent leukocyte in the peripheral blood in all age classes. Lymphocytes, monocytes, heterophils, azurophils and basophils levels did not differ with age. Natural antibodies titres were higher in the adults compared with neonates and juveniles lizards. Lastly, complement system activity was low in neonates compared with juveniles and adults. Statistical analysis within each age group showed that gender was not a factor in the outcomes. Based on the results, we concluded that S. merianae demonstrated age (but not gender) related differences in the immune parameters analyzed. Having established baseline values for these four widely-used immunologic biomarkers, ongoing studies will seek to optimize the use of the S. merianae model in future research. PMID:28652981

Baseline values of immunologic parameters in the lizard Salvator merianae (Teiidae, Squamata).

PubMed

Mestre, Ana Paula; Amavet, Patricia Susana; Siroski, Pablo Ariel

2017-01-01

The genus Salvator is widely distributed throughout South America. In Argentina, the species most abundant widely distributed is Salvator merianae . Particularly in Santa Fe province, the area occupied by populations of these lizards overlaps with areas where agriculture was extended. With the aim of established baseline values for four immunologic biomarkers widely used, 36 tegu lizards were evaluated tacking into account different age classes and both sexes. Total leukocyte counts were not different between age classes. Of the leucocytes count, eosinophils levels were higher in neonates compared with juvenile and adults; nevertheless, the heterophils group was the most prevalent leukocyte in the peripheral blood in all age classes. Lymphocytes, monocytes, heterophils, azurophils and basophils levels did not differ with age. Natural antibodies titres were higher in the adults compared with neonates and juveniles lizards. Lastly, complement system activity was low in neonates compared with juveniles and adults. Statistical analysis within each age group showed that gender was not a factor in the outcomes. Based on the results, we concluded that S. merianae demonstrated age (but not gender) related differences in the immune parameters analyzed. Having established baseline values for these four widely-used immunologic biomarkers, ongoing studies will seek to optimize the use of the S. merianae model in future research.

Effects of Functional Mobility Skills Training for Adults with Severe Multiple Disabilities

ERIC Educational Resources Information Center

Whinnery, Stacie B.; Whinnery, Keith W.

2011-01-01

This study investigated the effects of a functional mobility program on the functional standing and walking skills of five adults with developmental disabilities. The Mobility Opportunities Via Education (MOVE) Curriculum was implemented using a multiple-baseline across subjects design. Repeated measures were taken during baseline, intervention…

Over Target Baseline: Lessons Learned from the NASA SLS Booster Element

NASA Technical Reports Server (NTRS)

Carroll, Truman J.

2016-01-01

Goal of the presentation is to teach, and then model, the steps necessary to implement an Over Target Baseline (OTB). More than a policy and procedure session, participants will learn from recent first hand experience the challenges and benefits that come from successfully executing an OTB.

Far-Field Acoustic Characteristics of Multiple Blade-Vane Configurations for a High Tip Speed Fan

NASA Technical Reports Server (NTRS)

Woodward, Richard P.; Gazzaniga, John A.; Hughes, Christopher

2004-01-01

The acoustic characteristics of a model high-speed fan stage were measured in the NASA Glenn 9- by 15-Foot Low Speed Wind Tunnel at takeoff and approach flight conditions. The fan was designed for a corrected rotor tip speed of 442 m/s (1450 ft/s), and had a powered core, or booster stage, giving the model a nominal bypass ratio of 5. A simulated engine pylon and nozzle bifurcation was contained within the bypass duct. The fan stage consisted of all combinations of 3 possible rotors, and 3 stator vane sets. The 3 rotors were (1) wide chord, (2) forward swept, and (3) shrouded. The 3 stator sets were (1) baseline, moderately swept, (2) swept and leaned, and (3) swept integral vane/frame which incorporated some of the swept and leaned features as well as eliminated the downstream support structure. The baseline configuration is considered to be the wide chord rotor with the radial vane stator. A flyover Effective Perceived Noise Level (EPNL) code was used to generate relative EPNL values for the various configurations. The swept and leaned stator showed a 3 EPNdB reduction at lower fan speeds relative to the baseline stator; while the swept integral vane/frame stator showed lowest noise levels at high fan speeds. The baseline, wide chord rotor was typically the quietest of the three rotors. A tone removal study was performed to assess the acoustic benefits of removing the fundamental rotor interaction tone and its harmonics. Reprocessing the acoustic results with the bypass tone removed had the most impact on reducing fan noise at transonic rotor speeds. Removal of the bypass rotor interaction tones (BPF and nBPF) showed up to a 6 EPNdB noise reduction at transonic rotor speeds relative to noise levels for the baseline (wide chord rotor and radial stator; all tones present) configuration.

On Internal Validity in Multiple Baseline Designs

ERIC Educational Resources Information Center

Pustejovsky, James E.

2014-01-01

Single-case designs are a class of research designs for evaluating intervention effects on individual cases. The designs are widely applied in certain fields, including special education, school psychology, clinical psychology, social work, and applied behavior analysis. The multiple baseline design (MBD) is the most frequently used single-case…

Moderate Baseline Vagal Tone Predicts Greater Prosociality in Children

ERIC Educational Resources Information Center

Miller, Jonas G.; Kahle, Sarah; Hastings, Paul D.

2017-01-01

Vagal tone is widely believed to be an important physiological aspect of emotion regulation and associated positive behaviors. However, there is inconsistent evidence for relations between children's baseline vagal tone and their helpful or prosocial responses to others (Hastings & Miller, 2014). Recent work in adults suggests a quadratic…

Nursing leadership at the crossroads: evidence-based practice 'Matching Michigan-minimizing catheter related blood stream infections'(*).

PubMed

Goeschel, Christine A

2011-01-01

a highly successful intervention to reduce infections in intensive care units (ICUs) is now being widely replicated and involved significant nursing leadership. The objective of this manuscript is to describe briefly the intervention, and more explicitly the implications for nursing leadership as quality improvement and patient safety become global healthcare priorities. collaborative cohort study in over 100 ICUs in the United States to implement and evaluate interventions to improve patients' safety. conceptual model aimed at improving clinicians' use of five evidence-based recommendations to reduce rates of catheter-related bloodstream infections rates, with measurement and feedback of infection rates. one hundred and three ICUs contributed 1981 ICU-months of data representing 375,757 catheter-days. The median rate of catheter-related bloodstream infection per 1000 catheter-days decreased from 2.7 infections at baseline to 0 at 3 months after implementation of the study intervention (P ≤ 0·002), and the mean rate per 1000 catheter-days decreased from 7.7 at baseline to 1.4 at 16-18 months of follow-up (P < 0·002). During the sustainability period, the mean bloodstream infection rate did not significantly change from the initial 18 month postimplementation period (-1%, 95% confidence interval -9% to 7%). Eighty seven percent of the original study participants had data available for the sustainability study. broad use of this intervention with achievement of similar results could substantially reduce the morbidity and costs associated with catheter-related bloodstream infections. the initial Michigan study and the follow-up analysis, that demonstrated sustained improvements, are leading to similar projects in other countries, include the Matching Michigan project in England. Discussing not only the technical components of the program, but also the nursing leadership aspects may assist nurses just embarking on this work.

Nurturing 21st century physician knowledge, skills and attitudes with medical home innovations: the Wright Center for Graduate Medical Education teaching health center curriculum experience

PubMed Central

Palamaner Subash Shantha, Ghanshyam; Gollamudi, Lakshmi Rani; Sheth, Jignesh; Ebersole, Brian; Gardner, Katlyn J.; Nardella, Julie; Ruddy, Meaghan P.; Meade, Lauren

2015-01-01

Purpose. The effect of patient centered medical home (PCMH) curriculum interventions on residents’ self-reported and demonstrated knowledge, skills and attitudes in PCMH competency arenas (KSA) is lacking in the literature. This study aimed to assess the impact of PCMH curricular innovations on the KSA of Internal Medicine residents. Methods. Twenty four (24) Internal Medicine residents—12 Traditional (TR) track residents and 12 Teaching Health Center (THC) track residents—began training in Academic Year (AY) 2011 at the Wright Center for Graduate Medical Education (WCGME). They were followed through AY2013, covering three years of training. PCMH curricular innovations were focally applied July 2011 until May 2012 to THC residents. These curricular innovations were spread program-wide in May 2012. Semi-annual, validated PCMH Clinician Assessments assessing KSA were started in AY2011 and were completed by all residents. Results. Mean KSA scores of TR residents were similar to those of THC residents at baseline for all PCMH competencies. In May 2012, mean scores of THC residents were significantly higher than TR residents for most KSA. After program-wide implementation of PCMH innovations, mean scores of TR residents for all KSA improved and most became equalized to those of THC residents. Globally improved KSA scores of THC and TR residents were maintained through May 2014, with the majority of improvements above baseline and reaching statistical significance. Conclusions. PCMH curricular innovations inspired by Health Resources and Services Administration (HRSA’s) Teaching Health Center funded residency program expansion quickly and consistently improved the KSA of Internal Medicine residents. PMID:25699213

Association of intervention outcomes with practice capacity for change: Subgroup analysis from a group randomized trial

PubMed Central

Litaker, David; Ruhe, Mary; Weyer, Sharon; Stange, Kurt C

2008-01-01

Background The relationship between health care practices' capacity for change and the results and sustainability of interventions to improve health care delivery is unclear. Methods In the setting of an intervention to increase preventive service delivery (PSD), we assessed practice capacity for change by rating motivation to change and instrumental ability to change on a one to four scale. After combining these ratings into a single score, random effects models tested its association with change in PSD rates from baseline to immediately after intervention completion and 12 months later. Results Our measure of practices' capacity for change varied widely at baseline (range 2–8; mean 4.8 ± 1.6). Practices with greater capacity for change delivered preventive services to eligible patients at higher rates after completion of the intervention (2.7% per unit increase in the combined effort score, p < 0.001). This relationship persisted for 12 months after the intervention ended (3.1%, p < 0.001). Conclusion Greater capacity for change is associated with a higher probability that a practice will attain and sustain desired outcomes. Future work to refine measures of this practice characteristic may be useful in planning and implementing interventions that result in sustained, evidence-based improvements in health care delivery. PMID:18485216

Supported Employment for the Reintegration of Disability Pensioners with Mental Illnesses: A Randomized Controlled Trial.

PubMed

Viering, Sandra; Jäger, Matthias; Bärtsch, Bettina; Nordt, Carlos; Rössler, Wulf; Warnke, Ingeborg; Kawohl, Wolfram

2015-01-01

Work is beneficial for the recovery from mental illness. Although the approach of individual placement and support (IPS) has been shown to be effective in Europe, it has not yet been widely implemented in European health care systems. The aim of this randomized controlled trial was to assess the effectiveness of IPS for disability pensioners with mental illnesses new on disability benefits in Switzerland. In the study at hand, 250 participants were randomly assigned to either the control or the intervention group. The participants in the intervention group received job coaching according to IPS during 2 years. The control group received no structured support. Both groups were interviewed at baseline and followed up every 6 months (baseline, 6, 12, 16, 18, 24 months) for 2 years. Primary outcome was to obtain a job in the competitive employment. IPS was more effective for the reintegration into the competitive employment market for disability pensioners than the control condition. Thirty-two percent of the participants of the intervention group and 12% of the control group obtained new jobs in the competitive employment. IPS is also effective for the reintegration into competitive employment of people with mental illness receiving disability pensions.

Baseline requirements can hinder trades in water quality trading programs: Evidence from the Conestoga watershed.

PubMed

Ghosh, Gaurav; Ribaudo, Marc; Shortle, James

2011-08-01

The U.S. Environmental Protection Agency (USEPA) and the U.S. Department of Agriculture (USDA) are promoting point/nonpoint trading as a way of reducing the costs of meeting water quality goals. Farms can create offsets by implementing management practices such as conservation tillage, nutrient management and buffer strips. To be eligible to sell offsets or credits, farmers must first comply with baseline requirements. USEPA guidance recommends that the baseline for nonpoint sources be management practices that are consistent with the water quality goal. A farmer would not be able to create offsets until the minimum practice standards are met. An alternative baseline is those practices being implemented at the time the trading program starts, or when the farmer enters the program. The selection of the baseline affects the efficiency and equity of the trading program. It has major implications for which farmers benefit from trading, the cost of nonpoint source offsets, and ultimately the number of offsets that nonpoint sources can sell to regulated point sources. We use a simple model of the average profit-maximizing dairy farmer operating in the Conestoga watershed in Pennsylvania to evaluate the implications of baseline requirements on the cost and quantity of offsets that can be produced for sale in a water quality trading market, and which farmers benefit most from trading. Published by Elsevier Ltd.

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

Diefenderfer, Heida L.; Thom, Ronald M.; Borde, Amy B.

This report is the second annual report of a six-year project to evaluate the cumulative effects of habitat restoration projects in the Columbia River Estuary, conducted by Pacific Northwest National Laboratory's Marine Sciences Laboratory, NOAA's National Marine Fisheries Service Pt. Adams Biological Field Station, and the Columbia River Estuary Study Taskforce for the US Army Corps of Engineers. In 2005, baseline data were collected on two restoration sites and two associated reference sites in the Columbia River estuary. The sites represent two habitat types of the estuary--brackish marsh and freshwater swamp--that have sustained substantial losses in area and that maymore » play important roles for salmonids. Baseline data collected included vegetation and elevation surveys, above and below-ground biomass, water depth and temperature, nutrient flux, fish species composition, and channel geometry. Following baseline data collection, three kinds of restoration actions for hydrological reconnection were implemented in several locations on the sites: tidegate replacements (2) at Vera Slough, near the city of Astoria in Oregon State, and culvert replacements (2) and dike breaches (3) at Kandoll Farm in the Grays River watershed in Washington State. Limited post-restoration data were collected: photo points, nutrient flux, water depth and temperature, and channel cross-sections. In subsequent work, this and additional post-restoration data will be used in conjunction with data from other sites to estimate net effects of hydrological reconnection restoration projects throughout the estuary. This project is establishing methods for evaluating the effectiveness of individual projects and a framework for assessing estuary-wide cumulative effects including a protocol manual for monitoring restoration and reference sites.« less

Decreased rates of shoulder dystocia and brachial plexus injury via an evidence-based practice bundle.

PubMed

Sienas, Laura E; Hedriana, Herman L; Wiesner, Suzanne; Pelletreau, Barbara; Wilson, Machelle D; Shields, Laurence E

2017-02-01

To evaluate whether a standardized approach to identify pregnant women at risk for shoulder dystocia (SD) is associated with reduced incidence of SD and brachial plexus injury (BPI). Between 2011 and 2015, prospective data were collected from 29 community-based hospitals in the USA during implementation of an evidence-based practice bundle, including an admission risk assessment, required "timeout" before operative vaginal delivery (OVD), and low-fidelity SD drills. All women with singleton vertex pregnancies admitted for vaginal delivery were included. Rates of SD, BPI, OVD, and cesarean delivery were compared between a baseline period (January 2011-September 2013) and an intervention period (October 2013-June 2015), during which there was a system-wide average bundle compliance of 90%. There was a significant reduction in the incidence of SD (17.6%; P=0.028), BPI (28.6%; P=0.018), and OVD (18.0%; P<0.001) after implementation of the evidence-based practice bundle. There was a nonsignificant reduction in primary (P=0.823) and total (P=0.396) cesarean rates, but no association between SD drills and incidence of BPI. Implementation of a standard evidence-based practice bundle was found to be associated with a significant reduction in the incidence of SD and BPI. Utilization of low-fidelity drills was not associated with a reduction in BPI. © 2016 International Federation of Gynecology and Obstetrics.

Disease Management of Early Childhood Caries: ECC Collaborative Project

PubMed Central

Lee, Jessica Y.

2014-01-01

Until recently, the standard of care for early childhood caries (ECC) has been primarily surgical and restorative treatment with little emphasis on preventing and managing the disease itself. It is now recognized that surgical treatment alone does not address the underlying etiology of the disease. Despite costly surgeries and reparative treatment, the onset and progression of caries are likely to continue. A successful rebalance of risk and protective factors may prevent, slow down, or even arrest dental caries and its progression. An 18-month risk-based chronic disease management (DM) approach to address ECC in preschool children was implemented as a quality improvement (QI) collaborative by seven teams of oral health care providers across the United States. In the aggregate, fewer DM children experienced new cavitation, pain, and referrals to the operating room (OR) for restorative treatment compared to baseline historical controls. The teams found that QI methods facilitated adoption of the DM approach and resulted in improved care to patients and better outcomes overall. Despite these successes, the wide scale adoption and spread of the DM approach may be limited unless health policy and payment reforms are enacted to compensate providers for implementing DM protocols in their practice. PMID:24723953

Disease Management of Early Childhood Caries: ECC Collaborative Project.

PubMed

Ng, Man Wai; Ramos-Gomez, Francisco; Lieberman, Martin; Lee, Jessica Y; Scoville, Richard; Hannon, Cindy; Maramaldi, Peter

2014-01-01

Until recently, the standard of care for early childhood caries (ECC) has been primarily surgical and restorative treatment with little emphasis on preventing and managing the disease itself. It is now recognized that surgical treatment alone does not address the underlying etiology of the disease. Despite costly surgeries and reparative treatment, the onset and progression of caries are likely to continue. A successful rebalance of risk and protective factors may prevent, slow down, or even arrest dental caries and its progression. An 18-month risk-based chronic disease management (DM) approach to address ECC in preschool children was implemented as a quality improvement (QI) collaborative by seven teams of oral health care providers across the United States. In the aggregate, fewer DM children experienced new cavitation, pain, and referrals to the operating room (OR) for restorative treatment compared to baseline historical controls. The teams found that QI methods facilitated adoption of the DM approach and resulted in improved care to patients and better outcomes overall. Despite these successes, the wide scale adoption and spread of the DM approach may be limited unless health policy and payment reforms are enacted to compensate providers for implementing DM protocols in their practice.

Academic Procrastination and Goal Accomplishment: A Combined Experimental and Individual Differences Investigation

PubMed Central

Gustavson, Daniel E.; Miyake, Akira

2017-01-01

This study examined the relationship between academic procrastination and goal accomplishment in two novel ways. First, we experimentally tested whether undergraduate students (N = 177) could reduce their academic procrastination over a course of three weeks after performing goal-related exercises to set so-called SMART goals and/or to prepare those students with specific strategies to resist their temptations (forming implementation intentions). Second, we conducted systematic regression analyses to examine whether academic procrastination at baseline uniquely predicts later goal-related outcomes, controlling for various correlated variables, including personality traits (e.g., impulsivity), motivational factors (e.g., motivation for the generated goals), and situational factors (e.g., memory for the goals). Results indicated that neither the SMART-goal nor implementation-intention intervention significantly reduced academic procrastination in the three-week interval, even when relevant moderating variables were examined. Initial levels of academic procrastination, however, were predictive of the success of accomplishing the goals generated during the initial exercises, above and beyond a wide range of other candidate correlates. These results provided new correlational evidence for the association between academic procrastination and goal accomplishment, but suggest a need for further research to understand what interventions are effective at reducing academic procrastination. PMID:28943742

Academic Procrastination and Goal Accomplishment: A Combined Experimental and Individual Differences Investigation.

PubMed

Gustavson, Daniel E; Miyake, Akira

2017-02-01

This study examined the relationship between academic procrastination and goal accomplishment in two novel ways. First, we experimentally tested whether undergraduate students ( N = 177) could reduce their academic procrastination over a course of three weeks after performing goal-related exercises to set so-called SMART goals and/or to prepare those students with specific strategies to resist their temptations (forming implementation intentions). Second, we conducted systematic regression analyses to examine whether academic procrastination at baseline uniquely predicts later goal-related outcomes, controlling for various correlated variables, including personality traits (e.g., impulsivity), motivational factors (e.g., motivation for the generated goals), and situational factors (e.g., memory for the goals). Results indicated that neither the SMART-goal nor implementation-intention intervention significantly reduced academic procrastination in the three-week interval, even when relevant moderating variables were examined. Initial levels of academic procrastination, however, were predictive of the success of accomplishing the goals generated during the initial exercises, above and beyond a wide range of other candidate correlates. These results provided new correlational evidence for the association between academic procrastination and goal accomplishment, but suggest a need for further research to understand what interventions are effective at reducing academic procrastination.

A quality improvement project to improve the Medicare and Medicaid Services (CMS) sepsis bundle compliance rate in a large healthcare system.

PubMed

Raschke, Robert A; Groves, Robert H; Khurana, Hargobind S; Nikhanj, Nidhi; Utter, Ethel; Hartling, Didi; Stoffer, Brenda; Nunn, Kristina; Tryon, Shona; Bruner, Michelle; Calleja, Maria; Curry, Steven C

2017-01-01

Sepsis is a leading cause of mortality and morbidity in hospitalised patients. The Centers for Medicare and Medicaid Services (CMS) mandated that US hospitals report sepsis bundle compliance rate as a quality process measure in October 2015. The specific aim of our study was to improve the CMS sepsis bundle compliance rate from 30% to 40% across 20 acute care hospitals in our healthcare system within 1 year. The study included all adult inpatients with sepsis sampled according to CMS specifications from October 2015 to September 2016. The CMS sepsis bundle compliance rate was tracked monthly using statistical process control charting. A baseline rate of 28.5% with 99% control limits was established. We implemented multiple interventions including computerised decision support systems (CDSSs) to increase compliance with the most commonly missing bundle elements. Compliance reached 42% (99% statistical process control limits 18.4%-38.6%) as CDSS was implemented system-wide, but this improvement was not sustained after CMS changed specifications of the outcome measure. Difficulties encountered elucidate shortcomings of our study methodology and of the CMS sepsis bundle compliance rate as a quality process measure.

Teen Pregnancy Prevention: Implementation of a Multicomponent, Community-Wide Approach.

PubMed

Mueller, Trisha; Tevendale, Heather D; Fuller, Taleria R; House, L Duane; Romero, Lisa M; Brittain, Anna; Varanasi, Bala

2017-03-01

This article provides an overview and description of implementation activities of the multicomponent, community-wide initiatives of the Teenage Pregnancy Prevention Program initiated in 2010 by the Office of Adolescent Health and the Centers for Disease Control and Prevention. The community-wide initiatives applied the Interactive Systems Framework for dissemination and implementation through training and technical assistance on the key elements of the initiative: implementation of evidence-based teen pregnancy prevention (TPP) interventions; enhancing quality of and access to youth-friendly reproductive health services; educating stakeholders about TPP; working with youth in communities most at risk of teen pregnancy; and mobilizing the community to garner support. Of nearly 12,000 hours of training and technical assistance provided, the majority was for selecting, implementing, and evaluating an evidence-based TPP program. Real-world implementation of a community-wide approach to TPP takes time and effort. This report describes implementation within each of the components and shares lessons learned during planning and implementation phases of the initiative. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Reformulated Gasoline Foreign Refinery Rules (Short-Term Energy Outlook Supplement January 1998)

EIA Publications

1998-01-01

On August 27, 1997, the Environmental Protection Agency (EPA) promulgated revised the rules that allow foreign refiners to establish and use individual baselines, but it would not be mandatory (the optional use of an individual refinery baseline is not available to domestic refiners.) If a foreign refiner did not establish and use an individual baseline, the gasoline they export to the United States would be regulated through the importer, and subject to the importer's baseline (most likely the statutory baseline). Specific regulatory provisions are implemented to ensure that the option to use an individual baseline would not lead to adverse environmental impacts. This involves monitoring the average quality of imported gasoline, and if a specified benchmark is exceeded, remedial action would be taken by adjusting the requirements applicable to imported gasoline.

Late Holocene Marsh Expansion in Southern San Francisco Bay, California: Implications for the Use of Historic Baselines as Restoration Targets

EPA Science Inventory

Currently, the largest tidal wetlands restoration project on the US Pacific Coast is being planned and implemented in southern San Francisco Bay; however, knowledge of baseline conditions of salt marsh extent in the region prior to European settlement is limited. Here, analysis o...

Spacelab Level 4 programmatic Implementation Assessment Study. Volume 3: Optimization and programmatics

NASA Technical Reports Server (NTRS)

1978-01-01

Alternate level 4 integration approaches were synthesized and evaluated to establish the most cost effective experiment integration approach. Program baseline system trade studies are described, as well as Spacelab equipment utilization. Programmatic analysis of the baseline program was evaluated; the 2/3 and 1/3 traffic models were also considered.

WindPACT Reference Wind Turbines

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

Dykes, Katherine L; Rinker, Jennifer

To fully understand how loads and turbine cost scale with turbine size, it is necessary to have identical turbine models that have been scaled to different rated powers. The report presents the WindPACT baseline models, which are a series of four baseline models that were designed to facilitate investigations into the scalings of loads and turbine cost with size. The models have four different rated powers (750 kW, 1.5 MW, 3.0 MW, and 5.0 MW), and each model was designed to its specified rated power using the same design methodology. The models were originally implemented in FAST_AD, the predecessor tomore » NREL's open-source wind turbine simulator FAST, but have yet to be implemented in FAST. This report contains the specifications for all four WindPACT baseline models - including structural, aerodynamic, and control specifications - along with the inherent assumptions and equations that were used to calculate the model parameters. It is hoped that these baseline models will serve as extremely useful resources for investigations into the scalings of costs, loads, or optimization routines.« less

Effects of School-Wide Positive Behavioral Interventions and Supports on Child Behavior Problems

PubMed Central

Waasdorp, Tracy E.; Leaf, Philip J.

2012-01-01

OBJECTIVE: School-Wide Positive Behavioral Interventions and Supports (SWPBIS) is a universal prevention strategy currently implemented in >16 000 schools across the United States. SWPBIS intends to reduce students’ behavior problems by altering staff behaviors and developing systems and supports to meet children’s behavioral needs. The current study reports intervention effects on child behaviors and adjustment from an effectiveness trial of SWPBIS. METHODS: The sample of 12 344 elementary school children was 52.9% male, 45.1% African American, and 46.1% Caucasian. Approximately 49% received free or reduced-priced meals, and 12.9% received special education services at baseline. The trial used a group randomized controlled effectiveness design implemented in 37 elementary schools. Multilevel analyses were conducted on teachers’ ratings of children’s behavior problems, concentration problems, social-emotional functioning, prosocial behavior, office discipline referrals, and suspensions at 5 time points over the course of 4 school years. RESULTS: The multilevel results indicated significant effects of SWPBIS on children’s behavior problems, concentration problems, social-emotional functioning, and prosocial behavior. Children in SWPBIS schools also were 33% less likely to receive an office discipline referral than those in the comparison schools. The effects tended to be strongest among children who were first exposed to SWPBIS in kindergarten. CONCLUSIONS: These findings provide support for the hypothesized reduction in behavior problems and improvements in prosocial behavior and effective emotion regulation after training in SWPBIS. The SWPBIS framework appears to be a promising approach for reducing problems and promoting adjustment among elementary school children. PMID:23071207

VizieR Online Data Catalog: VLBA observations of the COSMOS field (Herrera Ruiz+, 2017)

NASA Astrophysics Data System (ADS)

Herrera Ruiz, N.; Middelberg, E.; Deller, A.; Norris, R. P.; Best, P. N.; Brisken, W.; Schinnerer, E.; Smolcic, V.; Delvecchio, I.; Momjian, E.; Bomans, D.; Scoville, N. Z.; Carilli, C.

2017-07-01

Wide-field Very Long Baseline Interferometry observations were made of all known radio sources in the COSMOS field at 1.4GHz using the Very Long Baseline Array (VLBA). We also collected complementary multiwavelength information from the literature for the VLBA detected sources. (2 data files).

Feasibility and Effectiveness of Parent-Child Interaction Therapy with Victims of Domestic Violence: A Pilot Study

PubMed Central

Herschell, Amy D.; Scudder, Ashley B.; Schaffner, Kristen F.; Slagel, Leslie A.

2016-01-01

Parent-Child Interaction Therapy (PCIT) is an evidence-based treatment for young children (aged 2.5 to 7 years) with externalizing behavior problems. Since its development, PCIT has been applied to a wide array of childhood problems and has a significant evidence base for families with histories of child physical abuse. The current study extended the existing literature by testing the effectiveness and feasibility of PCIT in an urban domestic violence shelter with community-based clinicians delivering the treatment. Seven clinicians implemented PCIT with parent-child dyads which included 21 preschool (M = 4.57 years; SD = 1.50) children. Families completed assessments at baseline, mid-treatment, and post-treatment. Nine families completed PCIT (43%). Completion of PCIT was associated with improved child behavior, parenting practices, and mental health symptoms. Considerations for treatment delivery and future directions are discussed. PMID:28503060

Feasibility and Effectiveness of Parent-Child Interaction Therapy with Victims of Domestic Violence: A Pilot Study.

PubMed

Herschell, Amy D; Scudder, Ashley B; Schaffner, Kristen F; Slagel, Leslie A

2017-01-01

Parent-Child Interaction Therapy (PCIT) is an evidence-based treatment for young children (aged 2.5 to 7 years) with externalizing behavior problems. Since its development, PCIT has been applied to a wide array of childhood problems and has a significant evidence base for families with histories of child physical abuse. The current study extended the existing literature by testing the effectiveness and feasibility of PCIT in an urban domestic violence shelter with community-based clinicians delivering the treatment. Seven clinicians implemented PCIT with parent-child dyads which included 21 preschool ( M = 4.57 years; SD = 1.50) children. Families completed assessments at baseline, mid-treatment, and post-treatment. Nine families completed PCIT (43%). Completion of PCIT was associated with improved child behavior, parenting practices, and mental health symptoms. Considerations for treatment delivery and future directions are discussed.

Identifying species from the air: UAVs and the very high resolution challenge for plant conservation.

PubMed

Baena, Susana; Moat, Justin; Whaley, Oliver; Boyd, Doreen S

2017-01-01

The Pacific Equatorial dry forest of Northern Peru is recognised for its unique endemic biodiversity. Although highly threatened the forest provides livelihoods and ecosystem services to local communities. As agro-industrial expansion and climatic variation transform the region, close ecosystem monitoring is essential for viable adaptation strategies. UAVs offer an affordable alternative to satellites in obtaining both colour and near infrared imagery to meet the specific requirements of spatial and temporal resolution of a monitoring system. Combining this with their capacity to produce three dimensional models of the environment provides an invaluable tool for species level monitoring. Here we demonstrate that object-based image analysis of very high resolution UAV images can identify and quantify keystone tree species and their health across wide heterogeneous landscapes. The analysis exposes the state of the vegetation and serves as a baseline for monitoring and adaptive implementation of community based conservation and restoration in the area.

Shuttle mission simulator baseline definition report, volume 1

NASA Technical Reports Server (NTRS)

Burke, J. F.; Small, D. E.

1973-01-01

A baseline definition of the space shuttle mission simulator is presented. The subjects discussed are: (1) physical arrangement of the complete simulator system in the appropriate facility, with a definition of the required facility modifications, (2) functional descriptions of all hardware units, including the operational features, data demands, and facility interfaces, (3) hardware features necessary to integrate the items into a baseline simulator system to include the rationale for selecting the chosen implementation, and (4) operating, maintenance, and configuration updating characteristics of the simulator hardware.

A Spherical Harmonic Analysis of the Ooty Wide Field Array (OWFA) Visibility Signal

NASA Astrophysics Data System (ADS)

Chatterjee, Suman; Bharadwaj, Somnath

2018-04-01

Considering redshifted 21-cm intensity mapping with the upcoming OWFA whose field of view subtends ˜57° in the N-S direction, we present a formalism which relates the measured visibilities to the spherical harmonic coefficients of the sky signal. We use this to calculate window functions which relate the two-visibility correlations i.e. the correlation between the visibilities measured at two baselines and two frequencies, to different multipoles of the multi-frequency angular power spectrum Cℓ(ν1, ν2). The formalism here is validated using simulations. We also present approximate closed form analytical expressions which can be used to calculate the window functions. Comparing the widely adopted flat sky approximation, we find that its predictions match those of our spherical harmonic formalism to within 16% across the entire OWFA baseline range. The match improves at large baselines where we have <5% deviations.

Predictors of Sustained Implementation of School-Wide Positive Behavioral Interventions and Supports

ERIC Educational Resources Information Center

McIntosh, Kent; Mercer, Sterett H.; Nese, Rhonda N. T.; Strickland-Cohen, M. Kathleen; Hoselton, Robert

2016-01-01

In this analysis of extant data from 3,011 schools implementing school-wide positive behavioral interventions and supports (SWPBIS) across multiple years, we assessed the predictive power of various school characteristics and speed of initial implementation on sustained fidelity of implementation of SWPBIS at 1, 3, and 5 years. In addition, we…

Implementation of treat-to-target in rheumatoid arthritis through a Learning Collaborative: Rationale and design of the TRACTION trial.

PubMed

Solomon, Daniel H; Lee, Sara B; Zak, Agnes; Corrigan, Cassandra; Agosti, Jenifer; Bitton, Asaf; Harrold, Leslie; Losina, Elena; Lu, Bing; Pincus, Ted; Radner, Helga; Smolen, Josef; Katz, Jeffrey N; Fraenkel, Liana

2016-08-01

Treat-to-target (TTT) is a recommended strategy in the management of rheumatoid arthritis (RA), but various data sources suggest that its uptake in routine care in the US is suboptimal. Herein, we describe the design of a randomized controlled trial of a Learning Collaborative to facilitate implementation of TTT. We recruited 11 rheumatology sites from across the US and randomized them into the following two groups: one received the Learning Collaborative intervention in Phase 1 (month 1-9) and the second formed a wait-list control group to receive the intervention in Phase 2 (months 10-18). The Learning Collaborative intervention was designed using the Model for Improvement, consisting of a Change Package with corresponding principles and action phases. Phase 1 intervention practices had nine learning sessions, collaborated using a web-based tool, and shared results of plan-do-study-act cycles and monthly improvement metrics collected at each practice. The wait-list control group sites had no intervention during Phase 1. The primary trial outcome is the implementation of TTT as measured by chart review, comparing the differences from baseline to end of Phase 1, between intervention and control sites. All intervention sites remained engaged in the Learning Collaborative throughout Phase 1, with a total of 38 providers participating. The primary trial outcome measures are currently being collected by the study team through medical record review. If the Learning Collaborative is an effective means for improving implementation of TTT, this strategy could serve as a way of implementing disseminating TTT more widely. Copyright © 2016 Elsevier Inc. All rights reserved.

Scaling-up health information systems to improve HIV treatment: An assessment of initial patient monitoring systems in Mozambique.

PubMed

Hochgesang, Mindy; Zamudio-Haas, Sophia; Moran, Lissa; Nhampossa, Leopoldo; Packel, Laura; Leslie, Hannah; Richards, Janise; Shade, Starley B

2017-01-01

The rapid scale-up of HIV care and treatment in resource-limited countries requires concurrent, rapid development of health information systems to support quality service delivery. Mozambique, a country with an 11.5% prevalence of HIV, has developed nation-wide patient monitoring systems (PMS) with standardized reporting tools, utilized by all HIV treatment providers in paper or electronic form. Evaluation of the initial implementation of PMS can inform and strengthen future development as the country moves towards a harmonized, sustainable health information system. This assessment was conducted in order to 1) characterize data collection and reporting processes and PMS resources available and 2) provide evidence-based recommendations for harmonization and sustainability of PMS. This baseline assessment of PMS was conducted with eight non-governmental organizations that supported the Ministry of Health to provide 90% of HIV care and treatment in Mozambique. The study team conducted structured and semi-structured surveys at 18 health facilities located in all 11 provinces. Seventy-nine staff were interviewed. Deductive a priori analytic categories guided analysis. Health facilities have implemented paper and electronic monitoring systems with varying success. Where in use, robust electronic PMS facilitate facility-level reporting of required indicators; improve ability to identify patients lost to follow-up; and support facility and patient management. Challenges to implementation of monitoring systems include a lack of national guidelines and norms for patient level HIS, variable system implementation and functionality, and limited human and infrastructure resources to maximize system functionality and information use. This initial assessment supports the need for national guidelines to harmonize, expand, and strengthen HIV-related health information systems. Recommendations may benefit other countries with similar epidemiologic and resource-constrained environments seeking to improve PMS implementation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Implementing health promotion activities using community-engaged approaches in Asian American faith-based organizations in New York City and New Jersey.

PubMed

Kwon, S C; Patel, S; Choy, C; Zanowiak, J; Rideout, C; Yi, S; Wyatt, L; Taher, M D; Garcia-Dia, M J; Kim, S S; Denholm, T K; Kavathe, R; Islam, N S

2017-09-01

Faith-based organizations (FBOs) (e.g., churches, mosques, and gurdwaras) can play a vital role in health promotion. The Racial and Ethnic Approaches to Community Health for Asian Americans (REACH FAR) Project is implementing a multi-level and evidence-based health promotion and hypertension (HTN) control program in faith-based organizations serving Asian American (AA) communities (Bangladeshi, Filipino, Korean, Asian Indian) across multiple denominations (Christian, Muslim, and Sikh) in New York/New Jersey (NY/NJ). This paper presents baseline results and describes the cultural adaptation and implementation process of the REACH FAR program across diverse FBOs and religious denominations serving AA subgroups. Working with 12 FBOs, informed by implementation research and guided by a cultural adaptation framework and community-engaged approaches, REACH FAR strategies included (1) implementing healthy food policies for communal meals and (2) delivering a culturally-linguistically adapted HTN management coaching program. Using the Ecological Validity Model (EVM), the program was culturally adapted across congregation and faith settings. Baseline measures include (i) Congregant surveys assessing social norms and diet (n = 946), (ii) HTN participant program surveys (n = 725), (iii) FBO environmental strategy checklists (n = 13), and (iv) community partner in-depth interviews assessing project feasibility (n = 5). We describe the adaptation process and baseline assessments of FBOs. In year 1, we reached 3790 (nutritional strategies) and 725 (HTN program) via AA FBO sites. Most AA FBOs lack nutrition policies and present prime opportunities for evidence-based multi-level interventions. REACH FAR presents a promising health promotion implementation program that may result in significant community reach.

Carrier phase ambiguity resolution for the Global Positioning System applied to geodetic baselines up to 2000 km

NASA Technical Reports Server (NTRS)

Blewitt, Geoffrey

1989-01-01

A technique for resolving the ambiguities in the GPS carrier phase data (which are biased by an integer number of cycles) is described which can be applied to geodetic baselines up to 2000 km in length and can be used with dual-frequency P code receivers. The results of such application demonstrated that a factor of 3 improvement in baseline accuracy could be obtained, giving centimeter-level agreement with coordinates inferred by very-long-baseline interferometry in the western United States. It was found that a method using pseudorange data is more reliable than one using ionospheric constraints for baselines longer than 200 km. It is recommended that future GPS networks have a wide spectrum of baseline lengths (ranging from baselines shorter than 100 km to those longer than 1000 km) and that GPS receivers be used which can acquire dual-frequency P code data.

Impact of an electronic health record operating room management system in ophthalmology on documentation time, surgical volume, and staffing.

PubMed

Sanders, David S; Read-Brown, Sarah; Tu, Daniel C; Lambert, William E; Choi, Dongseok; Almario, Bella M; Yackel, Thomas R; Brown, Anna S; Chiang, Michael F

2014-05-01

Although electronic health record (EHR) systems have potential benefits, such as improved safety and quality of care, most ophthalmology practices in the United States have not adopted these systems. Concerns persist regarding potential negative impacts on clinical workflow. In particular, the impact of EHR operating room (OR) management systems on clinical efficiency in the ophthalmic surgery setting is unknown. To determine the impact of an EHR OR management system on intraoperative nursing documentation time, surgical volume, and staffing requirements. For documentation time and circulating nurses per procedure, a prospective cohort design was used between January 10, 2012, and January 10, 2013. For surgical volume and overall staffing requirements, a case series design was used between January 29, 2011, and January 28, 2013. This study involved ophthalmic OR nurses (n = 13) and surgeons (n = 25) at an academic medical center. Electronic health record OR management system implementation. (1) Documentation time (percentage of operating time documenting [POTD], absolute documentation time in minutes), (2) surgical volume (procedures/time), and (3) staffing requirements (full-time equivalents, circulating nurses/procedure). Outcomes were measured during a baseline period when paper documentation was used and during the early (first 3 months) and late (4-12 months) periods after EHR implementation. There was a worsening in total POTD in the early EHR period (83%) vs paper baseline (41%) (P < .001). This improved to baseline levels by the late EHR period (46%, P = .28), although POTD in the cataract group remained worse than at baseline (64%, P < .001). There was a worsening in absolute mean documentation time in the early EHR period (16.7 minutes) vs paper baseline (7.5 minutes) (P < .001). This improved in the late EHR period (9.2 minutes) but remained worse than in the paper baseline (P < .001). While cataract procedures required more circulating nurses in the early EHR (mean, 1.9 nurses/procedure) and late EHR (mean, 1.5 nurses/procedure) periods than in the paper baseline (mean, 1.0 nurses/procedure) (P < .001), overall staffing requirements and surgical volume were not significantly different between the periods. Electronic health record OR management system implementation was associated with worsening of intraoperative nursing documentation time especially in shorter procedures. However, it is possible to implement an EHR OR management system without serious negative impacts on surgical volume and staffing requirements.

Improving Implementation of Function-Based Interventions: Self-Monitoring, Data Collection, and Data Review

ERIC Educational Resources Information Center

Pinkelman, Sarah E.; Horner, Robert H.

2017-01-01

The success of function-based interventions depends not just on the quality of procedures but also on the extent to which procedures are implemented as planned. Too often in schools, effort is committed to functional assessment and behavior support plan design, only to be followed by weak implementation. This study used a multiple baseline across…

Training Paraprofessionals to Improve Socialization in Students with ASD

PubMed Central

Koegel, Robert L.; Kim, Sunny; Koegel, Lynn Kern

2014-01-01

An important line of research relates to whether school personnel, such as paraprofessionals, who are present during unstructured social periods, such as lunch-recess, could successfully implement interventions to improve socialization between students with ASD and their typical peers in a group setting. Therefore, within the context of a multiple baseline across participants design, we assessed whether training paraprofessionals to provide social interventions would enhance social development in students with ASD in a group setting. Results showed that paraprofessionals who were not providing any social opportunities during baseline were able to meet fidelity of implementation following a brief training. Consequently, the children with ASD increased their levels of engagement and rates of initiation with typically developing peers following intervention. Implications for training paraprofessionals to implement effective social interventions for students with ASD are discussed. PMID:24671749

Programmatic management of multidrug-resistant tuberculosis: models from three countries.

PubMed

Furin, J; Bayona, J; Becerra, M; Farmer, P; Golubkov, A; Hurtado, R; Joseph, J K; Keshavjee, S; Ponomarenko, O; Rich, M; Shin, S

2011-10-01

Although multidrug-resistant tuberculosis (MDR-TB) is a major global health problem, there is a gap in programmatic treatment implementation. This study describes MDR-TB treatment models in three countries--Peru, Russia and Lesotho-- using qualitative data collected over a 13-year period. A program analysis is presented for each country focusing on baseline medical care, initial implementation and program evolution. A pattern analysis revealed six overarching themes common to all three programs: 1) importance of baseline assessments, 2) early identification of key collaborators, 3) identification of initial locus of care, 4) minimization of patient-incurred costs, 5) targeted interventions for vulnerable populations and 6) importance of technical assistance and funding. Site commonalities and differences in each of these areas were analyzed. It is recommended that all programs providing MDR-TB treatment address these six areas during program development and implementation.

Medication safety initiative in reducing medication errors.

PubMed

Nguyen, Elisa E; Connolly, Phyllis M; Wong, Vivian

2010-01-01

The purpose of the study was to evaluate whether a Medication Pass Time Out initiative was effective and sustainable in reducing medication administration errors. A retrospective descriptive method was used for this research, where a structured Medication Pass Time Out program was implemented following staff and physician education. As a result, the rate of interruptions during the medication administration process decreased from 81% to 0. From the observations at baseline, 6 months, and 1 year after implementation, the percent of doses of medication administered without interruption improved from 81% to 99%. Medication doses administered without errors at baseline, 6 months, and 1 year improved from 98% to 100%.

The effects of behavioral skills training on implementation of the picture exchange communication system.

PubMed

Rosales, Rocio; Stone, Karen; Rehfeldt, Ruth Anne

2009-01-01

The effectiveness of a behavioral skills training (BST) package to teach the implementation of the first three phases of the picture exchange communication system (PECS) was evaluated with 3 adults who had no history teaching any functional communication system. A multiple baseline design across participants was used to evaluate the effectiveness of the training package, which consisted of a video, written and verbal instructions, modeling, rehearsal, and feedback. Results showed significant improvements relative to baseline in a short amount of training time and that skills generalized to a learner with a severe developmental disability. Skills were maintained at 1 month follow-up for 1 participant.

Implementation of a mandatory checklist of protocols and objectives improves compliance with a wide range of evidence-based intensive care unit practices.

PubMed

Byrnes, Matthew C; Schuerer, Douglas J E; Schallom, Marilyn E; Sona, Carrie S; Mazuski, John E; Taylor, Beth E; McKenzie, Wendi; Thomas, James M; Emerson, Jeffrey S; Nemeth, Jennifer L; Bailey, Ruth A; Boyle, Walter A; Buchman, Timothy G; Coopersmith, Craig M

2009-10-01

To determine a) if a checklist covering a diverse group of intensive care unit protocols and objectives would improve clinician consideration of these domains and b) if improved consideration would change practice patterns. Pre- and post observational study. A 24-bed surgical/burn/trauma intensive care unit in a teaching hospital. A total of 1399 patients admitted between June 2006 and May 2007. The first component of the study evaluated whether mandating verbal review of a checklist covering 14 intensive care unit best practices altered verbal consideration of these domains. Evaluation was performed using real-time bedside audits on morning rounds. The second component evaluated whether the checklist altered implementation of these domains by changing practice patterns. Evaluation was performed by analyzing data from the Project IMPACT database after patients left the intensive care unit. Verbal consideration of evaluable domains improved from 90.9% (530/583) to 99.7% (669/671, p < .0001) after verbal review of the checklist was mandated. Bedside consideration improved on the use of deep venous thrombosis prophylaxis (p < .05), stress ulcer prophylaxis (p < .01), oral care for ventilated patients (p < 0.01), electrolyte repletion (p < .01), initiation of physical therapy (p < .05), and documentation of restraint orders (p < .0001). Mandatory verbal review of the checklist resulted in a greater than two-fold increase in transferring patients out of the intensive care unit on telemetry (16% vs. 35%, p < .0001) and initiation of physical therapy (28% vs. 42%, p < .0001) compared with baseline practice. A mandatory verbal review of a checklist covering a wide range of objectives and goals at each patient's bedside is an effective method to improve both consideration and implementation of intensive care unit best practices. A bedside checklist is a simple, cost-effective method to prevent errors of omission in basic domains of intensive care unit management that might otherwise be forgotten in the setting of more urgent care requirements.

Impact of bioethanol fuel implementation in transport based on modelled acetaldehyde concentration in the urban environment.

PubMed

Sundvor, Ingrid; López-Aparicio, Susana

2014-10-15

This study shows the results obtained from emission and air dispersion modelling of acetaldehyde in the city of Oslo and associated with the circulation of bioethanol vehicles. Two scenarios of bioethanol implementation, both realistic and hypothetical, have been considered under winter conditions; 1) realistic baseline scenario, which corresponds to the current situation in Oslo where one bus line is running with bioethanol (E95; 95% ethanol-5% petrol) among petrol and diesel vehicles; and 2) a hypothetical scenario characterized by a full implementation of high-blend bioethanol (i.e. E85) as fuel for transportation, and thus an entire bioethanol fleet. The results indicate that a full implementation of bioethanol will have a certain impact on urban air quality due to direct emissions of acetaldehyde. Acetaldehyde emissions are estimated to increase by 233% and concentration levels increase up to 650% with regard to the baseline. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

Reduction of Broad-Spectrum Antimicrobial Use in a Tertiary Children's Hospital Post Antimicrobial Stewardship Program Guideline Implementation.

PubMed

Lee, Kelley R; Bagga, Bindiya; Arnold, Sandra R

2016-03-01

The core strategies recommended for antimicrobial stewardship programs, formulary restriction with preauthorization and prospective audit and feedback, can be difficult to implement with limited resources; therefore, we took an approach of guideline development and education with the goal of reducing overall antibiotic use and unwarranted use of broad-spectrum antimicrobials. Retrospective chart review before and after intervention. Le Bonheur Children's Hospital pediatric, neonatal, and cardiac ICUs. All patients in our pediatric, neonatal, and cardiac ICUs within the time frame of the study. Baseline review in our ICUs revealed excessive use of broad-spectrum antibiotics and inconsistency in managing common pediatric infections. Guidelines were developed and implemented using cycles of education, retrospective review, and feedback. Purchasing and antibiotic use data were obtained to assess changes before and after guideline implementation. Unit-specific days of therapy were measured using periodic chart audit. Segmented regression analysis was used to assess changes in purchasing and broad-spectrum antibiotic days of therapy. The change in median monthly purchases was assessed using 2-tail Student t test. Hospital-wide targeted broad-spectrum antibiotic days of therapy/1,000 patient-days during the preimplementation year averaged 105 per month and decreased 33% to 70 per month during the postimplementation year. The overall antibiotic days of therapy decreased 41%, 21%, and 18%, and targeted broad-spectrum antibiotic days of therapy decreased by 99%, 75%, and 61% in the cardiac, pediatric, and neonatal ICUs, respectively, after guideline implementation. Yearly purchases of our most common broad-spectrum antibiotics decreased 62% from $230,059 to $86,887 after guideline implementation. Median monthly purchases of these drugs before implementation were $19,389 and $11,043 after implementation (p < 0.001). Guideline implementation was successful in reducing targeted broad-spectrum antibiotic use and acquisition cost. Programs with very limited resources may find similar implementation of guidelines effective to provide initial success, so that putting into practice one of the more resource intensive core strategies, such as prospective audit and feedback, may be feasible.

Baseline Analyses of SIG Applications and SIG-Eligible and SIG-Awarded Schools. NCEE 2011-4019

ERIC Educational Resources Information Center

Hurlburt, Steven; Le Floch, Kerstin Carlson; Therriault, Susan Bowles; Cole, Susan

2011-01-01

The Study of School Turnaround is an examination of the implementation of School Improvement Grants (SIG) authorized under Title I section 1003(g) of the "Elementary and Secondary Education Act" and supplemented by the "American Recovery and Reinvestment Act of 2009." "Baseline Analyses of SIG Applications and SIG-Eligible…

Patient baseline characteristics in an open-label multinational study of betahistine in recurrent peripheral vestibular vertigo: the OSVaLD study.

PubMed

Pérez-Garrigues, H; Kuessner, D; Benecke, H

2007-11-01

OSVaLD (Observational Study in patients suffering from recurrent peripheral vestibular Vertigo to Assess the effect of betahistine 48 mg/day on quality of Life and Dizziness symptoms) is a 3-month, open-label, multi-national post-marketing surveillance study of betahistine 48 mg/day in the management of patients with vertigo of less than 5 years in duration. The aim of the study is to examine the burden of disease associated with vertigo, as determined by scores on the Dizziness Handicap Inventory (DHI), Short Form-36 (SF-36) questionnaire and the Hospital Anxiety and Depression Scale (HADS). Changes in DHI, SF-36 and HADS scores between baseline and 3 months are used to assess the therapeutic effects of betahistine. Participants (n = 2037) have been recruited from 13 countries in four continents (North and South America, Asia and Europe), representing a wide range of cultural and linguistic traditions. Approximately two-thirds of the patients are women. Sixty per cent of patients have diagnoses of peripheral vestibular vertigo of unknown pathology or benign paroxysmal positional vertigo; 13% have a diagnosis of Ménière's disease. All three of the instruments used characterize this as a population with extensive vertigo-attributable morbidity at baseline. The mean DHI score of the population is 63.7 +/- 15.7 (DHI scale: 0 = no handicap; 100 = major self-perceived handicap), SF-36 scores in all domains are below the population average for the USA and the HADS indicated that > 50% of patients exhibit symptoms of anxiety or depression or both, including 9% who have severe manifestations of either or both conditions. This report describes the design and implementation of OSVaLD and presents baseline demographic and clinical features of the patients. Full results of the study, anticipated in 2007, will provide more details about the manifestations of vertigo in routine practice and the response to betahistine.

Multifamily Group Psychoeducation in New York State: Implementation and Fidelity Outcomes.

PubMed

Kealey, Edith M; Leckman-Westin, Emily; Jewell, Thomas C; Finnerty, Molly T

2015-11-01

The study examined implementation outcomes from a large state initiative to support dissemination of multifamily group (MFG) psychoeducation in outpatient mental health settings. Thirty-one sites participated in the project. Baseline training in the MFG model was followed by monthly expert consultation delivered in either a group (16 sites) or individual format (15 sites). Research staff assessed fidelity to the MFG model by telephone at baseline and 12, 18, and 24 months and documented time to completion of three key milestones: holding a family joining session, a family educational workshop, and an MFG meeting. Intent-to-train analyses found that 12 sites (39%) achieved high fidelity to the MFG model, and 20 (65%) achieved moderate or high fidelity. Mean scores on the Family Psychoeducation Fidelity Assessment Scale increased over time. Twenty-five sites (81%) conducted at least one joining session, and 20 (65%) conducted at least one MFG. Mean±SD time from baseline to the first group was 11.75±4.78 months. Programs that held the first joining session within four to 12 months after training were significantly more likely than programs that did not to conduct a group (p<.05). No significant differences were found by consultation format. Implementation of moderate- to high-fidelity MFG programs in routine outpatient mental health settings is feasible. Sites that moved very quickly or very slowly in early implementation stages were less likely to be successful in conducting an MFG. More research on the efficiency and effectiveness of consultation formats is needed to guide future implementation efforts.

78 FR 65302 - Agency Information Collection Activities; Comment Request; Evaluation of a District Wide...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-31

...; Comment Request; Evaluation of a District Wide Implementation of a Professional Learning Community... Professional Learning Community Initiative. OMB Control Number: 1850--NEW. Type of Review: A new information... need for systematic information about district-wide implementation of professional learning communities...

Streamline Your Project: A Lifecycle Model.

ERIC Educational Resources Information Center

Viren, John

2000-01-01

Discusses one approach to project organization providing a baseline lifecycle model for multimedia/CBT development. This variation of the standard four-phase model of Analysis, Design, Development, and Implementation includes a Pre-Analysis phase, called Definition, and a Post-Implementation phase, known as Maintenance. Each phase is described.…

A study of Michigan safety belt use prior to implementation of standard enforcement

DOT National Transportation Integrated Search

2000-02-01

Reported here are the results of a direct observation survey of safety belt use conducted in January 2000 to provide a baseline rate from which to measure safety belt use trends following the implementation of standard enforcement in Michigan. In thi...

An Evaluation of the Implementation of Hand Held Health Records with Adults with Learning Disabilities: A Cluster Randomized Controlled Trial

ERIC Educational Resources Information Center

Turk, Vicky; Burchell, Sarah; Burrha, Sukhjinder; Corney, Roslyn; Elliott, Sandra; Kerry, Sally; Molloy, Catherine; Painter, Kerry

2010-01-01

Background: Personal health records were implemented with adults with learning disabilities (AWLD) to try to improve their health-care. Materials and Method: Forty GP practices were randomized to the Personal Health Profile (PHP) implementation or control group. Two hundred and one AWLD were interviewed at baseline and 163 followed up after 12…

Nutritional screening, assessment and implementation strategies for adults in an Australian acute tertiary hospital: a best practice implementation report.

PubMed

Smith, Louise; Chapman, Amanda; Flowers, Kelli; Wright, Kylie; Chen, Tanghua; O'Connor, Charmaine; Astorga, Cecilia; Francis, Nevenka; Vigh, Gia; Wainwright, Craig

2018-01-01

The project aimed to improve the effectiveness of nutritional screening and assessment practices through clinical audits and the implementation of evidence-based practice recommendations. In the absence of optimal nutrition, health may decline and potentially manifest as adverse health outcomes. In a hospitalized person, poor nutrition may adversely impact on the person's outcome. If the nutritional status can be ascertained, nutritional needs can be addressed and potential risks minimized.The overall purpose of this project was to review and monitor staff compliance with nutritional screening and assessment best practice recommendations ensuring there is timely, relevant and structured nutritional therapeutic practices that support safe, compassionate and person-centered care in adults in a tertiary hospital in South Western Sydney, Australia, in the acute care setting. A baseline retrospective chart audit was conducted and measured against 10 best practice criteria in relation to nutritional screening and assessment practices. This was followed by a facilitated multidisciplinary focus group to identify targeted strategies, implementation of targeted strategies, and a post strategy implementation chart audit.The project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRIP) tool, including evidence from other available supporting literature, for promoting change in healthcare practice. The baseline audit revealed deficits between current practice and best practice across the 10 criteria. Barriers for implementation of nutritional screening and assessment best practice criteria were identified by the focus group and an education strategy was implemented. There were improved outcomes across all best practice criteria in the follow-up audit. The baseline audit revealed gaps between current practice and best practice. Through the implementation of a targeted education program and resource package, outcomes improved in the follow up audit. The findings indicated that engagement from multidisciplinary team members and consumers was effective in developing tailored education that improved knowledge of best practice. This was demonstrated by an increase in the percentage of compliance across the 10 criteria, although leaving room for more improvement. A policy has been developed for implementation and future audits are planned to measure whether improved practices have been sustained.

Implementing meta-analysis from genome-wide association studies for pork quality traits

USDA-ARS?s Scientific Manuscript database

Pork quality plays an important role in the meat processing industry, thus different methodologies have been implemented to elucidate the genetic architecture of traits affecting meat quality. One of the most common and widely used approaches is to perform genome-wide association (GWA) studies. Howe...

ISO 50001 and SEP Faster and Cheaper - Exploring the Enterprise-Wide Approach

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

Liu, Jingjing; Rao, Prakash; Therkelsen, Peter

ISO 50001 and other management systems (e.g., ISO 9001 and ISO 14001) allow for implementation and certification at the enterprise level. The "Central Office" concept, which allows a small group of employees to manage and facilitate the organization’s energy management system (EnMS) at the enterprise level, was introduced within the ISO 50003 standard to provide guidance to ISO 50001 certification bodies. Four industrial companies have partnered with the United States Department of Energy to pilot the enterprise-wide ISO 50001/SEP concept under the Better Buildings Superior Energy Performance (SEP) Enterprise-wide Accelerator. Each organization developed a Central Office to host their EnMSmore » while implementing ISO 50001/SEP at multiple physically separated sites. The four corporate partners tailored their Central Office implementation model to meet their own specific circumstances and needs. This paper reviews the commonalities, differences, and benefits of each of these enterprise-wide implementation models, including organizational structures, Central Office staff responsibilities, and key strategies. The cost savings and benefits of using the enterprise-wide approach were assessed, including the cost per site compared with that of a conventional, single-site ISO 50001/SEP implementation approach. This paper also discusses the drivers for the cost reductions realized through these enterprise-wide approaches. The four partner companies worked with 30 total sites. On average, these 30 sites improved energy performance by 5% annually over their SEP achievement periods, saved more than $600,000 annually in energy costs and reduced implementation cost for ISO 50001 and SEP by $19,000 and 0.8 Full Time Equivalent × years (FTE-yr) of staff time per site. The results can inform other organizations seeking to implement enterprise-wide ISO 50001/SEP, as well as energy efficiency organizations seeking to promote wider adoption of ISO 50001 implementation.« less

Design and Implementation of a Research-Informed Water Conservation Education Program

ERIC Educational Resources Information Center

Thompson, Ruthanne; Coe, Alice; Klaver, Irene; Dickson, Kenneth

2011-01-01

Informed by the results of a baseline research study of regional citizen knowledge and understanding concerning watershed issues, a team of university faculty and classroom teachers designed and implemented a water conservation education program to address lacking areas of watershed knowledge. The authors developed age-appropriate, hands-on…

Training Shelter Volunteers to Teach Dog Compliance

ERIC Educational Resources Information Center

Howard, Veronica J.; DiGennaro Reed, Florence D.

2014-01-01

This study examined the degree to which training procedures influenced the integrity of behaviorally based dog training implemented by volunteers of an animal shelter. Volunteers were taught to implement discrete-trial obedience training to teach 2 skills (sit and wait) to dogs. Procedural integrity during the baseline and written instructions…

Gaining Control and Predictability of Software-Intensive Systems Development and Sustainment

DTIC Science & Technology

2015-02-04

implementation of the baselines, audits , and technical reviews within an overarching systems engineering process (SEP; Defense Acquisition University...warfighters’ needs. This management and metrics effort supplements and supports the system’s technical development through the baselines, audits and...other areas that could be researched and added into the nine-tier model. Areas including software metrics, quality assurance , software-oriented

Sustaining the Control of Schistosoma mansoni in Western Côte d'Ivoire: Baseline Findings before the Implementation of a Randomized Trial

PubMed Central

Assaré, Rufin K.; Hürlimann, Eveline; Ouattara, Mamadou; N'Guessan, Nicaise A.; Tian-Bi, Yves-Nathan T.; Yapi, Ahoua; Yao, Patrick K.; Coulibaly, Jean T.; Knopp, Stefanie; N'Goran, Eliézer K.; Utzinger, Jürg

2016-01-01

We report baseline findings before the implementation of a 4-year intervention trial designed to assess the impact of three different school-based treatment schedules with praziquantel to sustain the control of intestinal schistosomiasis. The baseline survey was conducted in 75 schools of western Côte d'Ivoire previously identified with moderate Schistosoma mansoni endemicity (prevalence: 10–24% in children aged 13–14 years). Three stool samples collected over consecutive days were subjected to duplicate Kato-Katz thick smears each. A questionnaire was administered to collect village-specific information that is relevant for schistosomiasis transmission. Overall, 4,953 first graders (aged 5–8 years) and 7,011 school children (aged 9–12 years) had complete parasitologic data. The overall prevalence of S. mansoni was 5.4% among first graders and 22.1% in 9- to 12-year-old children. Open defecation was practiced in all villages. The current baseline findings will be important to better understand the dynamics of S. mansoni prevalence and intensity over the course of this trial that might be governed by village characteristics and specific treatment interventions. PMID:26598571

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).

Lichen bioindication of biodiversity, air quality, and climate: baseline results from monitoring in Washington, Oregon, and California.

Treesearch

Sarah Jovan

2008-01-01

Lichens are highly valued ecological indicators known for their sensitivity to a wide variety of environmental stressors like air quality and climate change. This report summarizes baseline results from the U.S. Department of Agriculture, Forest Service, Forest Inventory and Analysis (FIA) Lichen Community Indicator covering the first full cycle of data collection (...

Effectiveness of the Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) dissemination project: a science to prenatal care practice partnership.

PubMed

Windsor, Richard; Clark, Jeannie; Cleary, Sean; Davis, Amanda; Thorn, Stephanie; Abroms, Lorien; Wedeles, John

2014-01-01

This study evaluated the effectiveness of the Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) Program selected by the West Virginia-Right From The Start Project for state-wide dissemination. A process evaluation documented the fidelity of SCRIPT delivery by Designated Care Coordinators (DCC), licensed nurses and social workers who provide home-based case management to Medicaid-eligible clients in all 55 counties. We implemented a quasi-experimental, non-randomized, matched Comparison (C) Group design. The SCRIPT Experimental E Group (N = 259) were all clients in 2009-2010 that wanted to quit, provided a screening carbon monoxide (CO), and received a SCRIPT home visit. The (C) Group was derived from all clients in 2006-2007 who had the same CO assessments as E Group clients and reported receiving cessation counseling. We stratified the baseline CO of E Group clients into 10 strata, and randomly selected the same number of (C) Group clients (N = 259) from each matched strata to evaluate the effectiveness of the SCRIPT Program. There were no significant baseline differences in the E and (C) Group. A Process Evaluation documented a significant increase in the fidelity of DCC delivery of SCRIPT Program procedures: from 63 % in 2006 to 74 % in 2010. Significant increases were documented in the E Group cessation rate (+9.3 %) and significant reduction rate (+4.5 %), a ≥50 % reduction from a baseline CO. Perinatal health case management staff can deliver the SCRIPT Program, and Medicaid-supported clients can change smoking behavior, even very late in pregnancy. When multiple biases were analyzed, we concluded the SCRIPT Dissemination Project was the most plausible reason for the significant changes in behavior.

The Work-It Study for people with arthritis: Study protocol and baseline sample characteristics.

PubMed

Keysor, Julie J; AlHeresh, Rawan; Vaughan, Molly; LaValley, Michael P; Allaire, Saralynn

2016-06-14

People with arthritis are at risk of work disability. Job accommodation and educational programs delivered before imminent work loss can minimize work disability, yet are not currently being widely implemented. The Work-It Study is a randomized controlled trial testing the efficacy of a problem solving program delivered by physical and occupational therapy practitioners to prevent work loss over a two-year period among people with arthritis and rheumatological conditions. The purpose of this paper is to describe the protocol of the randomized controlled trial, and describe the baseline characteristics of the subjects and their work outcomes. 287 participants were recruited from the Boston area in Massachusetts, USA. Eligible participants were aged between 21-65, self-reported a physicians' diagnosis of arthritis, rheumatic condition, or chronic back pain, reported a concern about working now or in the near future due to your health, worked at least 15 hours a week, had plans to continue working, and worked or lived in Massachusetts. Subjects were recruited through community sources and rheumatology offices. Participants in the experimental group received a structured interview and an education and resource packet, while participants in the control received the resource packet only. The baseline characteristics and work related outcomes of the participants were analyzed. To our knowledge, the Work-It Study is the largest and most diverse randomized controlled trial to date aiming to identify and problem solve work-related barriers, promote advocacy, and foster work disability knowledge among people with chronic disabling musculoskeletal conditions. Despite advances in medical management of arthritis and other rheumatological and musculoskeletal conditions, many people still have concerns about their ability to remain employed and are seeking strategies to help them sustain employment.

Rationale, design, and baseline characteristics of a community-based comparative effectiveness trial to prevent type 2 diabetes in economically disadvantaged adults: the RAPID Study.

PubMed

Ackermann, Ronald T; Finch, Emily A; Schmidt, Karen K; Hoen, Helena M; Hays, Laura M; Marrero, David G; Saha, Chandan

2014-01-01

Reaching Out and Preventing Increases in Diabetes (RAPID) is a community-based randomized trial evaluating the comparative costs and effectiveness of a group-based adaption of the DPP lifestyle intervention developed and implemented in partnership with the YMCA. RAPID enrolled adult primary care patients, with BMI 24 kg/m(2) or higher and abnormal glucose metabolism (HbA1c 5.7-6.9% or fasting plasma glucose 100-125 mg/dL). 509 participants were enrolled and randomized to one of two groups: standard clinical advice plus free-of-charge access to a group-based adaption of the DPP offered by the Y, versus standard clinical advice alone. Key outcomes for future analysis will include differences in body weight and other cardiovascular risk factors over a 24-month intervention period. At baseline, RAPID participants had a mean (SD) age of 51 ± 12.1 years, weight of 225.1 ± 56.2 lbs, and BMI of 36.9 ± 8.6 kg/m(2). 70.7% were women, 57.2% were African American, 35.4% were non-Hispanic White, and 3.2% were Hispanic. Mean HbA1c was 6.05 ± 0.34%. Additionally, 55.4% of participants had a baseline systolic blood pressure of ≥130 mmHg, 33.1% had a total blood cholesterol exceeding 200mg/dL, and 74% reported a household income of <$25,000. The RAPID Study successfully randomized a large cohort of participants with a wide distribution of age, body weight, and race who are at high risk for developing type 2 diabetes. © 2013.

Geostationary Coastal and Air Pollution Events (GeoCAPE) Wide Angle Spectrometer (WAS)

NASA Technical Reports Server (NTRS)

Kotecki, Carl; Chu, Martha; Mannino, Antonio; Marx, Catherine Trout; Bowers, Gregory A.; Bolognese, Jeffrey A.; Matson, Elizabeth A.; McBirney, Thomas R.; Earle, Cleland P.; Choi, Michael K.;

Evaluating a Social and Emotional Learning Curriculum, "Strong Kids", Implemented School-Wide

ERIC Educational Resources Information Center

Kramer, Thomas J.

2013-01-01

The goal of this study was to explore whether "Strong Kids" could result in improved social and emotional competence when implemented as a school-wide universal intervention. No prior studies have examined this question. This study also evaluated whether teachers could implement "Strong Kids" as it was designed and whether they…

Exploring Barriers to Implementing a School-Wide Positive Behavioral Intervention and Support Program

ERIC Educational Resources Information Center

Gay, Ronald Lynn

2016-01-01

This study examined factors related to the implementation of a School Wide Positive Behavioral Intervention and Support (SWPBIS) program at a large middle school in the United States. Parent Teacher Student Association volunteers at the school reported that teacher fidelity to implementation of SWPBIS activities was inconsistent, threatening the…

Large-Scale Implementation of Check-In, Check-Out: A Descriptive Study

ERIC Educational Resources Information Center

Hawken, Leanne S.; Bundock, Kaitlin; Barrett, Courtenay A.; Eber, Lucille; Breen, Kimberli; Phillips, Danielle

2015-01-01

Check-In, Check-Out (CICO) is one of the most widely implemented Tier 2 behavior interventions in a school-wide system of Positive Behavior Interventions and Supports (PBIS). Much literature has documented implementation of CICO across individual schools or districts. The Illinois PBIS Network, currently known as the Midwest PBIS Network, has…

THE EFFECTS OF BEHAVIORAL SKILLS TRAINING ON IMPLEMENTATION OF THE PICTURE EXCHANGE COMMUNICATION SYSTEM

PubMed Central

Rosales, Rocio; Stone, Karen; Rehfeldt, Ruth Anne

2009-01-01

The effectiveness of a behavioral skills training (BST) package to teach the implementation of the first three phases of the picture exchange communication system (PECS) was evaluated with 3 adults who had no history teaching any functional communication system. A multiple baseline design across participants was used to evaluate the effectiveness of the training package, which consisted of a video, written and verbal instructions, modeling, rehearsal, and feedback. Results showed significant improvements relative to baseline in a short amount of training time and that skills generalized to a learner with a severe developmental disability. Skills were maintained at 1 month follow-up for 1 participant. PMID:20190917

Perceived Enablers and Barriers Related to Sustainability of School-Wide Positive Behavioral Interventions and Supports

ERIC Educational Resources Information Center

Pinkelman, Sarah E.; McIntosh, Kent; Rasplica, Caitlin K.; Berg, Tricia; Strickland-Cohen, M. Kathleen

2015-01-01

The purpose of this study was to identify the most important perceived enablers and barriers regarding sustainability of school-wide positive behavioral interventions and supports. School personnel representing 860 schools implementing or preparing to implement school-wide positive behavioral interventions and supports completed an open-ended…

Teachers' Personal and Professional Influences Related to School-Wide Positive Behavior Supports (SWPBS)

ERIC Educational Resources Information Center

Broskey, Matthew

2017-01-01

This study focused on understanding teachers' personal and professional experiences that influence the fidelity of implementation of a school-wide positive behavior support (SWPBS) program within their classrooms. Research has focused on the implementation fidelity of school-wide positive support programs, academic impact on students, teacher…

Perceptions of Contextual Features Related to Implementation and Sustainability of School-Wide Positive Behavior Support

ERIC Educational Resources Information Center

McIntosh, Kent; Predy, Larissa K.; Upreti, Gita; Hume, Amanda E.; Turri, Mary G.; Mathews, Susanna

2014-01-01

The purpose of this study was to assess the perceived importance of specific contextual variables for initial implementation and sustainability of School-Wide Positive Behavior Support (SWPBS). A large, national sample of 257 school team members completed the "School-Wide Universal Behavior Sustainability Index: School Teams", a…

Examining the association between implementation and outcomes : state-wide scale-up of school-wide positive behavior intervention and supports.

PubMed

Pas, Elise T; Bradshaw, Catherine P

2012-10-01

Although there is an established literature supporting the efficacy of a variety of prevention programs, there has been less empirical work on the translation of such research to everyday practice or when scaled-up state-wide. There is a considerable need for more research on factors that enhance implementation of programs and optimize outcomes, particularly in school settings. The current paper examines how the implementation fidelity of an increasingly popular and widely disseminated prevention model called, School-wide Positive Behavioral Interventions and Supports (SW-PBIS), relates to student outcomes within the context of a state-wide scale-up effort. Data come from a scale-up effort of SW-PBIS in Maryland; the sample included 421 elementary and middle schools trained in SW-PBIS. SW-PBIS fidelity, as measured by one of three fidelity measures, was found to be associated with higher math achievement, higher reading achievement, and lower truancy. School contextual factors were related to implementation levels and outcomes. Implications for scale-up efforts of behavioral and mental health interventions and measurement considerations are discussed.

School-wide PBIS: An Example of Applied Behavior Analysis Implemented at a Scale of Social Importance.

PubMed

Horner, Robert H; Sugai, George

2015-05-01

School-wide Positive Behavioral Interventions and Supports (PBIS) is an example of applied behavior analysis implemented at a scale of social importance. In this paper, PBIS is defined and the contributions of behavior analysis in shaping both the content and implementation of PBIS are reviewed. Specific lessons learned from implementation of PBIS over the past 20 years are summarized.

Implementation and Performance of Factorized Back projection on Low-Cost Commercial-Off-the-Shelf Hardware

DTIC Science & Technology

performance on a low cost, low size, weight, and power (SWAP) computer : a Raspberry Pi Model B. For a comparison of performance, a baseline implementation...improvement factor of 2-3 compared to filtered backprojection. Execution on a single Raspberry Pi is too slow for real-time imaging. However, factorized...backprojection is easily parallelized, and we include a discussion of parallel implementation across multiple Pis .

Assessment of Coastal Governance for Climate Change Adaptation in Kenya

NASA Astrophysics Data System (ADS)

Ojwang, Lenice; Rosendo, Sergio; Celliers, Louis; Obura, David; Muiti, Anastasia; Kamula, James; Mwangi, Maina

2017-11-01

The coastline of Kenya already experiences effects of climate change, adding to existing pressures such as urbanization. Integrated coastal management (ICM) is increasingly recognized as a key policy response to deal with the multiple challenges facing coastal zones, including climate change. It can create an enabling governance environment for effective local action on climate change by facilitating a structured approach to dealing with coastal issues. It encompasses the actions of a wide range of actors, including local governments close to people and their activities affected by climate change. Functioning ICM also offers opportunities for reducing risks and building resilience. This article applied a modified capitals approach framework (CAF), consisting of five "capitals," to assess the status of county government capacity to respond to climate change within the context of coastal governance in three county governments in Kenya. The baseline was defined in terms of governance relating to the implementation of the interrelated policy systems of ICM and coastal climate change adaptation (CCA). The CAF framework provided a systematic approach to building a governance baseline against which to assess the progress of county governments in responding to climate change. It identified gaps in human capacity, financial resource allocation to adaptation and access to climate change information. Furthermore, it showed that having well-developed institutions, including regulatory frameworks at the national level can facilitate but does not automatically enable adaptation at the county level.

The effect of governance mechanisms on food safety in the supply chain: Evidence from the Lebanese dairy sector.

PubMed

Abebe, Gumataw K; Chalak, Ali; Abiad, Mohamad G

2017-07-01

Food safety is a key public health issue worldwide. This study aims to characterise existing governance mechanisms - governance structures (GSs) and food safety management systems (FSMSs) - and analyse the alignment thereof in detecting food safety hazards, based on empirical evidence from Lebanon. Firm-to-firm and public baseline are the dominant FSMSs applied in a large-scale, while chain-wide FSMSs are observed only in a small-scale. Most transactions involving farmers are relational and market-based in contrast to (large-scale) processors, which opt for hierarchical GSs. Large-scale processors use a combination of FSMSs and GSs to minimise food safety hazards albeit potential increase in coordination costs; this is an important feature of modern food supply chains. The econometric analysis reveals contract period, on-farm inspection and experience having significant effects in minimising food safety hazards. However, the potential to implement farm-level FSMS is influenced by formality of the contract, herd size, trading partner choice, and experience. Public baseline FSMSs appear effective in controlling food safety hazards; however, this may not be viable due to the scarcity of public resources. We suggest public policies to focus on long-lasting governance mechanisms by introducing incentive schemes and farm-level FSMSs by providing loans and education to farmers. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.

Individual changes in clozapine levels after smoking cessation: results and a predictive model.

PubMed

Meyer, J M

2001-12-01

Published reports document 20-40% lower mean serum clozapine concentrations in smokers compared with nonsmokers due to enzyme induction. Despite the increase in nonsmoking psychiatric facilities in the United States, previous studies have not tracked individual changes in serum clozapine levels after smoking cessation. Clozapine level changes were analyzed in 11 patients at Oregon State Hospital who were on stable clozapine doses, before and after implementation of a hospital-wide nonsmoking policy. A mean increase in clozapine levels of 71.9% (442.4 ng/ml +/- 598.8 ng/ml) occurred upon smoking cessation (p < .034) from a baseline level of 550.2 ng/ml (+/- 160.18 ng/ml). One serious adverse event, aspiration pneumonia, was associated with a nonsmoking serum clozapine level of 3066 ng/ml. Elimination of statistically extreme results generated a mean increase of 57.4 % or 284.1 ng/ml (+/- 105.2 ng/ml) for the remaining cases (p < .001) and permitted construction of a linear model which explains 80.9% of changes in clozapine levels upon smoking cessation (F = 34.9;p = .001): clozapine level as nonsmoker = 45.3 + 1.474 (clozapine level as smoker). These findings suggest that significant increases in clozapine levels upon smoking cessation may be predicted by use of a model. Those with high baseline levels should be monitored for serious adverse events.

Rapid spread of complex change: a case study in inpatient palliative care.

PubMed

Della Penna, Richard; Martel, Helene; Neuwirth, Esther B; Rice, Jennifer; Filipski, Marta I; Green, Jennifer; Bellows, Jim

2009-12-29

Based on positive findings from a randomized controlled trial, Kaiser Permanente's national executive leadership group set an expectation that all Kaiser Permanente and partner hospitals would implement a consultative model of interdisciplinary, inpatient-based palliative care (IPC). Within one year, the number of IPC consultations program-wide increased almost tenfold from baseline, and the number of teams nearly doubled. We report here results from a qualitative evaluation of the IPC initiative after a year of implementation; our purpose was to understand factors supporting or impeding the rapid and consistent spread of a complex program. Quality improvement study using a case study design and qualitative analysis of in-depth semi-structured interviews with 36 national, regional, and local leaders. Compelling evidence of impacts on patient satisfaction and quality of care generated 'pull' among adopters, expressed as a remarkably high degree of conviction about the value of the model. Broad leadership agreement gave rise to sponsorship and support that permeated the organization. A robust social network promoted knowledge exchange and built on an existing network with a strong interest in palliative care. Resource constraints, pre-existing programs of a different model, and ambiguous accountability for implementation impeded spread. A complex, hospital-based, interdisciplinary intervention in a large health care organization spread rapidly due to a synergy between organizational 'push' strategies and grassroots-level pull. The combination of push and pull may be especially important when the organizational context or the practice to be spread is complex.

High-risk population health management--achieving improved patient outcomes and near-term financial results.

PubMed

Lynch, J P; Forman, S A; Graff, S; Gunby, M C

2000-07-01

A managed care organization sought to achieve efficiencies in care delivery and cost savings by anticipating and better caring for its frail and least stable members. Time sequence case study of program intervention across an entire managed care population in its first year compared with the prior baseline year. Key attributes of the intervention included predictive registries of at-risk members based on existing data, relentless focus on the high-risk group, an integrated clinical and psychosocial approach to assessments and are planning, a reengineered care management process, secured Internet applications enabling rapid implementation and broad connectivity, and population-based outcomes metrics derived from widely used measures of resource utilization and functional status. Concentrating on the highest-risk group, which averaged just 1.1% prevalence in the total membership, yielded bottom line results. When the year before program implementation (July 1997 through June 1998) was compared with the subsequent year, the total population's annualized commercial admission rate was reduced 5.3%, and seniors' was reduced 3.0%. A claims-paid analysis exclusively of the highest-risk group revealed that their efficiencies and savings overwhelmingly contributed to the membershipwide effect. This subgroup's costs dropped 35.7% from preprogram levels of $2590 per member per month (excluding pharmaceuticals). During the same time, patient-derived cross-sectional functional status rose 12.5%. A sharply focused, Internet-deployed case management strategy achieved economic and functional status results on a population basis and produced systemwide savings in its first year of implementation.

Individualization and quality improvement: two new scales to complement measurement of program fidelity.

PubMed

Bond, Gary R; Drake, Robert E; Rapp, Charles A; McHugo, Gregory J; Xie, Haiyi

2009-09-01

Fidelity scales have been widely used to assess program adherence to the principles of an evidence-based practice, but they do not measure important aspects of quality of care. Pragmatic scales measuring clinical quality of services are needed to complement fidelity scales measuring structural aspects of program implementation. As part of the instrumentation developed for the National Implementing Evidence-Based Practices Project, we piloted a new instrument with two 5-item quality scales, Individualization (a client-level quality scale) and Quality Improvement (an organizational-level quality scale). Pairs of independent fidelity assessors conducted fidelity reviews in 49 sites in 8 states at baseline and at four subsequent 6-month intervals over a 2-year follow-up period. The assessors followed a standardized protocol to administer these quality scales during daylong site visits; during these same visits they assessed programs on fidelity to the evidence-based practice that the site was seeking to implement. Assessors achieved acceptable interrater reliability for both Individualization and Quality Improvement. Principal components factor analysis confirmed the 2-scale structure. The two scales were modestly correlated with each other and with the evidence-based practice fidelity scales. Over the first year, Individualization and Quality Improvement improved, but showed little or no improvement during the last year of follow-up. The two newly developed scales showed adequate psychometric properties in this preliminary study, but further research is needed to assess their validity and utility in routine clinical practice.

An Education Intervention to Enhance Staff Self-Efficacy to Provide Dementia Care in an Acute Care Hospital in Canada

PubMed Central

Gillies, Leslie; Coker, Esther; Pizzacalla, Anne; Montemuro, Maureen; Suva, Grace; McLelland, Victoria

2016-01-01

Education is needed for enhanced capacity of acute hospitals to provide dementia care. A nonrandomized controlled, repeated-measures design was used to evaluate a dementia education program delivered to an intervention group (IG, n = 468), compared to a wait-listed group (n = 277), representing separate sites of a multisite hospital. Participants completed self-efficacy for dementia and satisfaction measures and provided written descriptions of dementia care collected at baseline, postintervention (IG only), and at 8-week follow-up. Oral narratives were gathered from IG participants 8 weeks postintervention. The IG demonstrated significant improvement in self-efficacy scores from baseline to immediately postintervention (P < .001), sustained at 8 weeks. There were no changes from baseline to 8 weeks postintervention evident in the wait-listed group (P = .21). Intervention group participants described positive impacts including implementation of person-centered care approaches. Implementation of dementia care education programs throughout hospital settings is promising for the enhancement of dementia care. PMID:27659392

Aspects of the Patient-centered Medical Home currently in place: initial findings from preparing the personal physician for practice.

PubMed

Carney, Patricia A; Eiff, M Patrice; Saultz, John W; Douglass, Alan B; Tillotson, Carrie J; Crane, Steven D; Jones, Samuel M; Green, Larry A

2009-10-01

The Patient-centered Medical Home (PCMH) is a central concept in the evolving debate about American health care reform. We studied family medicine residency training programs' continuity clinics to assess baseline status of implementing PCMH components and to compare implementation status between community-based and university training programs. We conducted a survey 24 continuity clinics in 14 residency programs that are part of the Preparing the Personal Physicians for Practice (P(4)) program. We asked questions about aspects of P(4) that had been already implemented at the beginning of the P(4) program. We defined high implementation as aspects that were present in >50% of clinics and low implementation as those present in <50% of clinics. We compared features at university-based and community-based clinics. High areas of implementation were having an electronic health record (EHR), fully secured remote access, electronic patient notes/scheduling/billing, chronic disease management registries, and open-access scheduling. Low areas of implementation included hospital EHR with computerized physician order entry, asynchronous communication with patients, ongoing population-based QA using EHR, use of preventive registries, and practice-based research using EHR. Few differences were noted between university- and community-based residency programs. Many features of the PCMH were already established at baseline in programs participating in P(4).

ParticipACTION after 5 years of relaunch: a quantitative survey of Canadian organizational awareness and capacity regarding physical activity initiatives.

PubMed

Faulkner, Guy; Ramanathan, Subha; Plotnikoff, Ronald C; Berry, Tanya; Deshpande, Sameer; Latimer-Cheung, Amy E; Rhodes, Ryan E; Tremblay, Mark S; Spence, John C

2018-04-01

ParticipACTION is a Canadian physical activity communications and social marketing organization relaunched in 2007. This study assesses the capacity of Canadian organizations to adopt, implement, and promote physical activity initiatives. The four objectives were to compare findings from baseline (2008) and follow-up (2013) with respect to: (1) awareness of ParticipACTION; (2) organizational capacity to adopt, implement and promote physical activity initiatives; (3) potential differences in capacity based on organizational size, sector, and mandate; and (4) assess perceptions of ParticipACTION five years after relaunch. In this cross-sectional study, representatives from local, provincial/territorial, and national organizations completed an online survey assessing capacity to adopt, implement, and promote physical activity. Descriptive statistics and one-way analyses of variance were conducted to examine the objectives. Response rate for opening an email survey invitation and consenting to participate was 40.6% (685/1688) and 540 surveys were completed. Awareness of ParticipACTION increased from 54.6% at baseline to 93.9% at follow-up (Objective 1). Findings at both baseline and follow-up reflected good organizational capacity to adopt, implement and promote physical activity (Objective 2) although some varied by organizational sector and mandate (Objective 3). Most respondents reported that ParticipACTION provided positive leadership (65.3%), but there was less agreement regarding ParticipACTION's facilitation of infrastructure (44.0%) or organizational will/motivation (47.1%)(Objective 4). Canadian organizations continue to report having good capacity to adopt, implement, and promote physical activity. There was no discernible change in capacity indicators five years after ParticipACTION's relaunch although its broader contribution to the physical activity sector was endorsed.

Implementing an early childhood school-based mental health promotion intervention in low-resource Ugandan schools: study protocol for a cluster randomized controlled trial.

PubMed

Huang, Keng-Yen; Nakigudde, Janet; Calzada, Esther; Boivin, Michael J; Ogedegbe, Gbenga; Brotman, Laurie Miller

2014-12-01

Children in Sub-Saharan Africa (SSA) are burdened by significant unmet mental health needs, but this region has limited access to mental health workers and resources to address these needs. Despite the successes of numerous school-based interventions for promoting child mental health, most evidence-based interventions are not available in SSA. This study will investigate the transportability of an evidence-based program from a developed country (United States) to a SSA country (Uganda). The approach includes task-shifting to early childhood teachers and consists of professional development (five days) to introduce strategies for effective behavior management and positive teacher-student interactions, and group-based consultation (14 sessions) to support adoption of effective practices and tailoring to meet the needs of individual students. The design of this study is guided by two implementation frameworks, the Consolidated Framework for Implementation Research and the Teacher Training Implementation Model, that consider multidimensional aspects of intervention fidelity and contextual predictors that may influence implementation and teacher outcomes. Using a cluster randomized design, 10 schools in Uganda will be randomized to either the intervention group (five schools) or the waitlist control group (five schools). A total of 80 to 100 early childhood teachers will be enrolled in the study. Teacher utilization of evidence-based strategies and practices will be assessed at baseline, immediate post-intervention (six months after baseline), and at seven months post-intervention (during a new academic year). Fidelity measures will be assessed throughout the program implementation period (during professional development and consultation sessions). Individual teacher and contextual factors will be assessed at baseline. Data will be collected from multiple sources. Linear mixed-effect modeling, adjusting for school nesting, will be applied to address study questions. The study will produce important information regarding the value of an evidence-based early intervention, and a theory-guided implementation process and tools designed for use in implementing early childhood evidence-based programs in SSA countries or resource-constrained community settings. This trial was registered with ClinicalTrials.gov (registration number: NCT097115) on 15 May 2013.

Effect of a Stewardship Intervention on Adherence to Uncomplicated Cystitis and Pyelonephritis Guidelines in an Emergency Department Setting

PubMed Central

Hecker, Michelle T.; Fox, Clinton J.; Son, Andrea H.; Cydulka, Rita K.; Siff, Jonathan E.; Emerman, Charles L.; Sethi, Ajay K.; Muganda, Christine P.; Donskey, Curtis J.

2014-01-01

Objective To evaluate adherence to uncomplicated urinary tract infections (UTI) guidelines and UTI diagnostic accuracy in an emergency department (ED) setting before and after implementation of an antimicrobial stewardship intervention. Methods The intervention included implementation of an electronic UTI order set followed by a 2 month period of audit and feedback. For women age 18 – 65 with a UTI diagnosis seen in the ED with no structural or functional abnormalities of the urinary system, we evaluated adherence to guidelines, antimicrobial use, and diagnostic accuracy at baseline, after implementation of the order set (period 1), and after audit and feedback (period 2). Results Adherence to UTI guidelines increased from 44% (baseline) to 68% (period 1) to 82% (period 2) (P≤.015 for each successive period). Prescription of fluoroquinolones for uncomplicated cystitis decreased from 44% (baseline) to 14% (period 1) to 13% (period 2) (P<.001 and P = .7 for each successive period). Unnecessary antibiotic days for the 200 patients evaluated in each period decreased from 250 days to 119 days to 52 days (P<.001 for each successive period). For 40% to 42% of cases diagnosed as UTI by clinicians, the diagnosis was deemed unlikely or rejected with no difference between the baseline and intervention periods. Conclusions A stewardship intervention including an electronic order set and audit and feedback was associated with increased adherence to uncomplicated UTI guidelines and reductions in unnecessary antibiotic therapy and fluoroquinolone therapy for cystitis. Many diagnoses were rejected or deemed unlikely, suggesting a need for studies to improve diagnostic accuracy for UTI. PMID:24498394

Practice, science and governance in interaction: European effort for the system-wide implementation of the International Classification of Functioning, Disability and Health (ICF) in Physical and Rehabilitation Medicine.

PubMed

Stucki, Gerold; Zampolini, Mauro; Juocevicius, Alvydas; Negrini, Stefano; Christodoulou, Nicolas

2017-04-01

Since its launch in 2001, relevant international, regional and national PRM bodies have aimed to implement the International Classification of Functioning, Disability and Health (ICF) in Physical and Rehabilitation Medicine (PRM), whereby contributing to the development of suitable practical tools. These tools are available for implementing the ICF in day-to-day clinical practice, standardized reporting of functioning outcomes in quality management and research, and guiding evidence-informed policy. Educational efforts have reinforced PRM physicians' and other rehabilitation professionals' ICF knowledge, and numerous implementation projects have explored how the ICF is applied in clinical practice, research and policy. Largely lacking though is the system-wide implementation of ICF in day-to-day practice across all rehabilitation services of national health systems. In Europe, system-wide implementation of ICF requires the interaction between practice, science and governance. Considering its mandate, the UEMS PRM Section and Board have decided to lead a European effort towards system-wide ICF implementation in PRM, rehabilitation and health care at large, in interaction with governments, non-governmental actors and the private sector, and aligned with ISPRM's collaboration plan with WHO. In this paper we present the current PRM internal and external policy agenda towards system-wide ICF implementation and the corresponding implementation action plan, while highlighting priority action steps - promotion of ICF-based standardized reporting in national quality management and assurance programs, development of unambiguous rehabilitation service descriptions using the International Classification System for Service Organization in Health-related Rehabilitation, development of Clinical Assessment Schedules, qualitative linkage and quantitative mapping of data to the ICF, and the cultural adaptation of the ICF Clinical Data Collection Tool in European languages.

Taking School-Based Substance Abuse Prevention to Scale: District-Wide Implementation of Keep a Clear Mind

ERIC Educational Resources Information Center

Jowers, Keri L.; Bradshaw, Catherine P.; Gately, Sherry

2007-01-01

Public schools are under increased pressure to implement evidence-based substance abuse prevention programs. A number of model programs have been identified, but little research has examined the effectiveness of these programs when "brought to scale" or implemented district-wide. The current paper summarizes the application of the Adelman and…

School-Wide Positive Behavioral Interventions and Supports: A Snapshot of Implementation in Schools Serving Students with Significant Disabilities

ERIC Educational Resources Information Center

Schelling, Amy L.; Harris, Monica L.

2016-01-01

Implementation of school-wide positive behavioral interventions and supports (SWPBIS) in K-12 schools is well documented in the literature. However, far less documentation can be found in the literature related to its implementation with students with significant intellectual and other developmental disabilities being served in either typical or…

Data Decision-Making and Program-Wide Implementation of the Pyramid Model. Roadmap to Effective Intervention Practices #7

ERIC Educational Resources Information Center

Fox, Lise; Veguilla, Myrna; Perez Binder, Denise

2014-01-01

The Technical Assistance Center on Social Emotional Intervention for Young Children (TACSEI) Roadmap on "Data Decision-Making and Program-Wide Implementation of the Pyramid Model" provides programs with guidance on how to collect and use data to ensure the implementation of the Pyramid Model with fidelity and decision-making that…

Strategies for Effecting System-Wide Pedagogical Change: Identifying and Addressing the Gap between Organizational and Pedagogical Implementation

ERIC Educational Resources Information Center

Weinberger, Yehudith

2018-01-01

The study described here analyses a faculty-wide change designed to foster the communication proficiencies of students in a large teacher education college, gathering data from various sources over three years of the new agenda's implementation. Qualitative and quantitative data analysis revealed that implementation was progressing on two distinct…

Put Me in Coach: A Transcendental Phenomenological Study Examining School Wide Positive Behavior Support Coaches' Experience with Program Implementation

ERIC Educational Resources Information Center

Rieffannacht, Kimberlie Beth

2016-01-01

The purpose of this transcendental phenomenological study was to describe lived experience during School Wide Positive Behavior Support (SWPBS) implementation for School Wide Positive Behavior coaches in Pennsylvania public schools. Participants, identified as co-researchers throughout this study, included 11 SWPBS coaches selected from seven…

A Long-Term Leisure Program for Individuals with Intellectual Disability in Residential Care Settings: Research to Practice

ERIC Educational Resources Information Center

Fox, Robert A.; Burke, Amie M.; Fung, Michael P.

2013-01-01

We studied the effectiveness of an individually-tailored leisure program implemented by direct care staff in a residential program for 28 adults with severe to profound intellectual disability using a multiple baseline design across two homes over a 1.5 year baseline and treatment period followed by another nearly 1.5 year maintenance phase. The…

Deployment Pulmonary Health

DTIC Science & Technology

2015-02-11

A similar risk-based approach may be appropriate for deploying military personnel. e) If DoD were to consider implementing a large- scale pre...quality of existing spirometry programs prior to considering a larger scale pre-deployment effort. Identifying an accelerated decrease in spirometry...baseline spirometry on a wider scale . e) Conduct pre-deployment baseline spirometry if there is a significant risk of exposure to a pulmonary hazard based

Distance Education in Georgia's Public School Districts: Baseline Data on Utilization and the Perceived Barriers to Implementation and Expansion

ERIC Educational Resources Information Center

Tankersley, William J.; Burnham, James F.

2007-01-01

Interest in distance education, particularly online education, is increasing in public school districts throughout the United States. In an effort to aid those who are involved in the planning and administration of K-12 distance education programs in Georgia, the authors sought to gather and report baseline data on the current utilization of…

Climate Action Planning Process | Climate Neutral Research Campuses | NREL

Science.gov Websites

Action Planning Process Climate Action Planning Process For research campuses, NREL has developed a five-step process to develop and implement climate action plans: Determine baseline energy consumption Analyze technology options Prepare a plan and set priorities Implement the climate action plan Measure and

In-Home Parent Training of Functional Analysis Skills

ERIC Educational Resources Information Center

Stokes, John V.; Luiselli, James K.

2008-01-01

We taught two sets of parents to conduct a functional analysis (FA) under simulated conditions in their homes. Relative to a baseline (pre-training) phase, the accuracy of FA implementation by parents improved when they were given verbal, written, and video performance feedback. When training concluded, parents were able to implement FA accurately…

FY2016 Update on ILAW Glass Testing for Disposal at IDF

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

Brown, E. E.; Swanberg, D. J.; Muller, Isabelle S.

2017-04-12

This status report provides a FY2016 update on work performed to collect information on the corrosion behavior of LAW glasses to support the IDF PA. In addition to the development of the baseline operating envelope for the WTP, since 2003, VSL has developed a wide range of LAW formulations that achieve considerably higher waste loadings than the WTP baseline formulations.

Experience measuring performance improvement in multiphase picture archiving and communications systems implementations.

PubMed

Reed, G; Reed, D H

1999-05-01

When planning a picture archiving and communications system (PACS) implementation and determining which equipment will be implemented in earlier and later phases, collection and analysis of selected data will aid in setting implementation priorities. If baseline data are acquired relative to performance objectives, the same information used for implementation planning can be used to measure performance improvement and outcomes. The main categories of data to choose from are: (1) financial data; (2) productivity data; (3) operational parameters; (4) clinical data; and (5) information about customer satisfaction. In the authors' experience, detailed workflow data have not proved valuable in measuring PACS performance and outcomes. Reviewing only one category of data in planning will not provide adequate basis for targeting operational improvements that will lead to the most significant gains. Quality improvement takes into account all factors in production: human capacity, materials, operating capital and assets. Once we have identified key areas of focus for quality improvement in each phase, we can translate objectives into implementation requirements and finally into detailed functional and performance requirements. Here, Integration Resources reports its experience measuring PACS performance relative to phased implementation strategies for three large medical centers. Each medical center had its own objectives for overcoming image management, physical/geographical, and functional/technical barriers. The report outlines (1) principal financial and nonfinancial measures used as performance indicators; (2) implementation strategies chosen by each of the three medical centers; and (3) the results of those strategies as compared with baseline data.

Patient Awareness and Expectations of Pharmacist Services During Hospital Stay.

PubMed

King, Philip K; Martin, Steven J; Betka, Eric M

2017-10-01

There are insufficient data in the United States regarding patient awareness and expectations of hospital pharmacist availability and services. The objective of this research is to assess patient awareness and expectations of hospital pharmacist services and to determine whether a marketing campaign for pharmacist services increases patient awareness and expectations. Eligible inpatients were surveyed before and after implementation of a hospital-wide pharmacist services marketing campaign (12 items; Likert scale of 1 [strongly disagree] to 4 [strongly agree]; maximum total score of 48) regarding awareness of pharmacist services. The primary outcome was the change in median total survey scores from baseline. Other outcomes included the frequency of patient requests for pharmacists. Similar numbers of patients completed the survey before and after the campaign (intervention, n = 140, vs control, n = 147). Awareness of pharmacist availability and services was increased (41 [interquartile ranges, IQRs: 36-46] vs 37 [IQR 31-43]; P < .001). Patients were 7 times more likely to request a pharmacist following the marketing campaign implementation. Awareness among inpatients of pharmacist services is low. Marketing pharmacist availability and services to patients in the hospital improves awareness and expectations for pharmacist-provided care and increases the frequency of patient-initiated interaction between pharmacists and patients. This could improve patient outcomes as pharmacists become more integrally involved in direct patient care.

AnnoSys—implementation of a generic annotation system for schema-based data using the example of biodiversity collection data

PubMed Central

Kusber, W.-H.; Tschöpe, O.; Güntsch, A.; Berendsohn, W. G.

2017-01-01

Abstract Biological research collections holding billions of specimens world-wide provide the most important baseline information for systematic biodiversity research. Increasingly, specimen data records become available in virtual herbaria and data portals. The traditional (physical) annotation procedure fails here, so that an important pathway of research documentation and data quality control is broken. In order to create an online annotation system, we analysed, modeled and adapted traditional specimen annotation workflows. The AnnoSys system accesses collection data from either conventional web resources or the Biological Collection Access Service (BioCASe) and accepts XML-based data standards like ABCD or DarwinCore. It comprises a searchable annotation data repository, a user interface, and a subscription based message system. We describe the main components of AnnoSys and its current and planned interoperability with biodiversity data portals and networks. Details are given on the underlying architectural model, which implements the W3C OpenAnnotation model and allows the adaptation of AnnoSys to different problem domains. Advantages and disadvantages of different digital annotation and feedback approaches are discussed. For the biodiversity domain, AnnoSys proposes best practice procedures for digital annotations of complex records. Database URL: https://annosys.bgbm.fu-berlin.de/AnnoSys/AnnoSys PMID:28365735

Prowess - A Software Model for the Ooty Wide Field Array

NASA Astrophysics Data System (ADS)

Marthi, Visweshwar Ram

2017-03-01

One of the scientific objectives of the Ooty Wide Field Array (OWFA) is to observe the redshifted H i emission from z ˜ 3.35. Although predictions spell out optimistic outcomes in reasonable integration times, these studies were based purely on analytical assumptions, without accounting for limiting systematics. A software model for OWFA has been developed with a view to understanding the instrument-induced systematics, by describing a complete software model for the instrument. This model has been implemented through a suite of programs, together called Prowess, which has been conceived with the dual role of an emulator as well as observatory data analysis software. The programming philosophy followed in building Prowess enables a general user to define an own set of functions and add new functionality. This paper describes a co-ordinate system suitable for OWFA in which the baselines are defined. The foregrounds are simulated from their angular power spectra. The visibilities are then computed from the foregrounds. These visibilities are then used for further processing, such as calibration and power spectrum estimation. The package allows for rich visualization features in multiple output formats in an interactive fashion, giving the user an intuitive feel for the data. Prowess has been extensively used for numerical predictions of the foregrounds for the OWFA H i experiment.

'Fit for school' - a school-based water, sanitation and hygiene programme to improve child health: Results from a longitudinal study in Cambodia, Indonesia and Lao PDR.

PubMed

Duijster, Denise; Monse, Bella; Dimaisip-Nabuab, Jed; Djuharnoko, Pantjawidi; Heinrich-Weltzien, Roswitha; Hobdell, Martin; Kromeyer-Hauschild, Katrin; Kunthearith, Yung; Mijares-Majini, Maria Carmela; Siegmund, Nicole; Soukhanouvong, Panith; Benzian, Habib

2017-04-05

The Fit for School (FIT) programme integrates school health and Water, Sanitation and Hygiene interventions, which are implemented by the Ministries of Education in four Southeast Asian countries. This paper describes the findings of a Health Outcome Study, which aimed to assess the two-year effect of the FIT programme on the parasitological, weight, and oral health status of children attending schools implementing the programme in Cambodia, Indonesia and Lao PDR. The study was a non-randomized clustered controlled trial with a follow-up period of two years. The intervention group consisted of children attending public elementary schools implementing the FIT programme, including daily group handwashing with soap and toothbrushing with fluoride toothpaste, biannual school-based deworming; as well as construction of group handwashing facilities. Control schools implemented the regular government health education curriculum and biannual deworming. Per school, a random selection of six to seven-year-old grade-one students was drawn. Data on parasitological infections, anthropometric measurements, dental caries, odontogenic infections and sociodemographic characteristics were collected at baseline and at follow-up (24 months later). Data were analysed using the χ 2 -test, Mann Whitney U-test and multilevel logistic and linear regression. A total of 1847 children (mean age = 6.7 years, range 6.0-8.0 years) participated in the baseline survey. Of these, 1499 children were available for follow-up examination - 478, 486 and 535 children in Cambodia, Indonesia and Lao PDR, respectively. In all three countries, children in intervention schools had a lower increment in the number of decayed, missing and filled permanent teeth between baseline and follow-up, in comparison to children in controls schools. The preventive fraction was 24% at average. The prevalence of soil-transmitted helminth infection (which was unexpectedly low at baseline), the prevalence of thinness and the prevalence of odontogenic infections did not significantly differ between baseline and follow-up, nor between intervention and control schools. The study found that the FIT programme significantly contributed to the prevention of dental caries in children. This study describes the challenges, learnings and, moreover, the importance of conducting real-life implementation research to evaluate health programmes to transform school settings into healthy learning environments for children. The study is retrospectively registered with the German Clinical Trials Register, University of Freiburg (Trial registration number: DRKS00004485, date of registration: 26th of February, 2013).

Nationwide implementation of integrated community case management of childhood illness in Rwanda

PubMed Central

Mugeni, Catherine; Levine, Adam C; Munyaneza, Richard M; Mulindahabi, Epiphanie; Cockrell, Hannah C; Glavis-Bloom, Justin; Nutt, Cameron T; Wagner, Claire M; Gaju, Erick; Rukundo, Alphonse; Habimana, Jean Pierre; Karema, Corine; Ngabo, Fidele; Binagwaho, Agnes

2014-01-01

ABSTRACT Background: Between 2008 and 2011, Rwanda introduced integrated community case management (iCCM) of childhood illness nationwide. Community health workers in each of Rwanda's nearly 15,000 villages were trained in iCCM and equipped for empirical diagnosis and treatment of pneumonia, diarrhea, and malaria; for malnutrition surveillance; and for comprehensive reporting and referral services. Methods: We used data from the Rwanda health management information system (HMIS) to calculate monthly all-cause under-5 mortality rates, health facility use rates, and community-based treatment rates for childhood illness in each district. We then compared a 3-month baseline period prior to iCCM implementation with a seasonally matched comparison period 1 year after iCCM implementation. Finally, we compared the actual changes in all-cause child mortality and health facility use over this time period with the changes that would have been expected based on baseline trends in Rwanda. Results: The number of children receiving community-based treatment for diarrhea and pneumonia increased significantly in the 1-year period after iCCM implementation, from 0.83 cases/1,000 child-months to 3.80 cases/1,000 child-months (P = .01) and 0.25 cases/1,000 child-months to 5.28 cases/1,000 child-months (P<.001), respectively. On average, total under-5 mortality rates declined significantly by 38% (P<.001), and health facility use declined significantly by 15% (P = .006). These decreases were significantly greater than would have been expected based on baseline trends. Conclusions: This is the first study to demonstrate decreases in both child mortality and health facility use after implementing iCCM of childhood illness at a national level. While our study design does not allow for direct attribution of these changes to implementation of iCCM, these results are in line with those of prior studies conducted at the sub-national level in other low-income countries. PMID:25276592

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

PubMed

Anderson, Cynthia M; Borgmeier, Chris

2010-01-01

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

An Integrated Framework for Modeling Air Carrier Behavior, Policy, and Impacts in the U.S. Air Transportation System

NASA Technical Reports Server (NTRS)

Horio, Brant M.; Kumar, Vivek; DeCicco, Anthony H.; Hasan, Shahab; Stouffer, Virginia L.; Smith, Jeremy C.; Guerreiro, Nelson M.

2015-01-01

The implementation of the Next Generation Air Transportation System (NextGen) in the United States is an ongoing challenge for policymakers due to the complexity of the air transportation system (ATS) with its broad array of stakeholders and dynamic interdependencies between them. The successful implementation of NextGen has a hard dependency on the active participation of U.S. commercial airlines. To assist policymakers in identifying potential policy designs that facilitate the implementation of NextGen, the National Aeronautics and Space Administration (NASA) and LMI developed a research framework called the Air Transportation System Evolutionary Simulation (ATS-EVOS). This framework integrates large empirical data sets with multiple specialized models to simulate the evolution of the airline response to potential future policies and explore consequential impacts on ATS performance and market dynamics. In the ATS-EVOS configuration presented here, we leverage the Transportation Systems Analysis Model (TSAM), the Airline Evolutionary Simulation (AIRLINE-EVOS), the Airspace Concept Evaluation System (ACES), and the Aviation Environmental Design Tool (AEDT), all of which enable this research to comprehensively represent the complex facets of the ATS and its participants. We validated this baseline configuration of ATS-EVOS against Airline Origin and Destination Survey (DB1B) data and subject matter expert opinion, and we verified the ATS-EVOS framework and agent behavior logic through scenario-based experiments that explored potential implementations of a carbon tax, congestion pricing policy, and the dynamics for equipage of new technology by airlines. These experiments demonstrated ATS-EVOS's capabilities in responding to a wide range of potential NextGen-related policies and utility for decision makers to gain insights for effective policy design.

Long-Baseline Neutrino Facility (LBNF) and Deep Underground Neutrino Experiment (DUNE): Conceptual Design Report. Volume 1: The LBNF and DUNE Projects

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

Acciarri, R.

2016-01-22

This document presents the Conceptual Design Report (CDR) put forward by an international neutrino community to pursue the Deep Underground Neutrino Experiment at the Long-Baseline Neutrino Facility (LBNF/DUNE), a groundbreaking science experiment for long-baseline neutrino oscillation studies and for neutrino astrophysics and nucleon decay searches. The DUNE far detector will be a very large modular liquid argon time-projection chamber (LArTPC) located deep underground, coupled to the LBNF multi-megawatt wide-band neutrino beam. DUNE will also have a high-resolution and high-precision near detector.

Maximizing School Counselors' Efforts by Implementing School-Wide Positive Behavioral Interventions and Supports: A Case Study from the Field

ERIC Educational Resources Information Center

Goodman-Scott, Emily

2014-01-01

School-Wide Positive Behavioral Interventions and Supports (PBIS) are school-wide, data-driven frameworks for promoting safe schools and student learning. This article explains PBIS and provides practical examples of PBIS implementation by describing a school counselor-run PBIS framework in one elementary school, as part of a larger, district-wide…

Uncertainty Estimation Improves Energy Measurement and Verification Procedures

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

Walter, Travis; Price, Phillip N.; Sohn, Michael D.

2014-05-14

Implementing energy conservation measures in buildings can reduce energy costs and environmental impacts, but such measures cost money to implement so intelligent investment strategies require the ability to quantify the energy savings by comparing actual energy used to how much energy would have been used in absence of the conservation measures (known as the baseline energy use). Methods exist for predicting baseline energy use, but a limitation of most statistical methods reported in the literature is inadequate quantification of the uncertainty in baseline energy use predictions. However, estimation of uncertainty is essential for weighing the risks of investing in retrofits.more » Most commercial buildings have, or soon will have, electricity meters capable of providing data at short time intervals. These data provide new opportunities to quantify uncertainty in baseline predictions, and to do so after shorter measurement durations than are traditionally used. In this paper, we show that uncertainty estimation provides greater measurement and verification (M&V) information and helps to overcome some of the difficulties with deciding how much data is needed to develop baseline models and to confirm energy savings. We also show that cross-validation is an effective method for computing uncertainty. In so doing, we extend a simple regression-based method of predicting energy use using short-interval meter data. We demonstrate the methods by predicting energy use in 17 real commercial buildings. We discuss the benefits of uncertainty estimates which can provide actionable decision making information for investing in energy conservation measures.« less

Technical Basis for PNNL Beryllium Inventory

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

Johnson, Michelle Lynn

2014-07-09

The Department of Energy (DOE) issued Title 10 of the Code of Federal Regulations Part 850, “Chronic Beryllium Disease Prevention Program” (the Beryllium Rule) in 1999 and required full compliance by no later than January 7, 2002. The Beryllium Rule requires the development of a baseline beryllium inventory of the locations of beryllium operations and other locations of potential beryllium contamination at DOE facilities. The baseline beryllium inventory is also required to identify workers exposed or potentially exposed to beryllium at those locations. Prior to DOE issuing 10 CFR 850, Pacific Northwest Nuclear Laboratory (PNNL) had documented the beryllium characterizationmore » and worker exposure potential for multiple facilities in compliance with DOE’s 1997 Notice 440.1, “Interim Chronic Beryllium Disease.” After DOE’s issuance of 10 CFR 850, PNNL developed an implementation plan to be compliant by 2002. In 2014, an internal self-assessment (ITS #E-00748) of PNNL’s Chronic Beryllium Disease Prevention Program (CBDPP) identified several deficiencies. One deficiency is that the technical basis for establishing the baseline beryllium inventory when the Beryllium Rule was implemented was either not documented or not retrievable. In addition, the beryllium inventory itself had not been adequately documented and maintained since PNNL established its own CBDPP, separate from Hanford Site’s program. This document reconstructs PNNL’s baseline beryllium inventory as it would have existed when it achieved compliance with the Beryllium Rule in 2001 and provides the technical basis for the baseline beryllium inventory.« less

The Early Impact of an Administrative Processing Fee on Manuscript Submissions at The Journal of Bone & Joint Surgery.

PubMed

Nwachukwu, Benedict U; Schairer, William W; So, Conan; Bernstein, Jaime L; Herndon, James; Dodwell, Emily R

2016-10-05

There was a dramatic increase in the volume of manuscripts submitted to The Journal of Bone & Joint Surgery (JBJS) between 2009 and 2012. This resulted in increased journal administrative costs. To offset this financial burden, in May 2013, JBJS started charging authors an administrative processing fee at the time of submission. The purpose of this study was to assess the impact of the administrative fee on the volume and characteristics of manuscripts submitted to JBJS. Our analysis included 866 manuscripts submitted to JBJS between November 2012 and November 2013. We compared manuscripts submitted 6 months prior to fee implementation and prior to the announcement (denoted as the baseline group), in the several months prior to fee implementation but after the fee implementation announcement (denoted as the fee announcement group), and in the 6 months after fee implementation (denoted as the fee implementation group). Manuscripts were reviewed for institutional and author demographic characteristics, as well as for general study characteristics. In the first full calendar year (2014) after the implementation of the fee, the annual volume of submissions to JBJS declined by 33.5% compared with the annual submission volume in 2010 to 2012. In a comparative analysis, the geographical region of origin (p = 0.003), level of evidence (p < 0.0001), funding, and specialty differed between the 3 submission periods. However, subgroup analyses demonstrated that differences were attributable to the fee announcement group and that there were few important differences between the baseline and fee implementation groups. Reporting of funding information improved significantly between the baseline and fee implementation groups; in the post-fee implementation period, studies were more likely to have declared no external funding source (p = 0.001). The administrative processing fee at JBJS has been associated with a decrease in submission volume, but, overall, there has not been a change in the characteristics of studies submitted. However, decreased overall volume implies a decrease in the absolute number of high-level studies submitted to the journal. Administrative processing fees at high-volume journals may be a financially viable way to offset high administrative costs without substantially changing the characteristics of submitted articles. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Process Waste Assessment for the Diana Laser Laboratory

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

Phillips, N.M.

1993-12-01

This Process Waste Assessment was conducted to evaluate the Diana Laser Laboratory, located in the Combustion Research Facility. It documents the hazardous chemical waste streams generated by the laser process and establishes a baseline for future waste minimization efforts. This Process Waste Assessment will be reevaluated in approximately 18 to 24 months, after enough time has passed to implement recommendations and to compare results with the baseline established in this assessment.

Combining biological and psychosocial baseline variables did not improve prediction of outcome of a very-low-energy diet in a clinic referral population.

PubMed

Sumithran, P; Purcell, K; Kuyruk, S; Proietto, J; Prendergast, L A

2018-02-01

Consistent, strong predictors of obesity treatment outcomes have not been identified. It has been suggested that broadening the range of predictor variables examined may be valuable. We explored methods to predict outcomes of a very-low-energy diet (VLED)-based programme in a clinically comparable setting, using a wide array of pre-intervention biological and psychosocial participant data. A total of 61 women and 39 men (mean ± standard deviation [SD] body mass index: 39.8 ± 7.3 kg/m 2 ) underwent an 8-week VLED and 12-month follow-up. At baseline, participants underwent a blood test and assessment of psychological, social and behavioural factors previously associated with treatment outcomes. Logistic regression, linear discriminant analysis, decision trees and random forests were used to model outcomes from baseline variables. Of the 100 participants, 88 completed the VLED and 42 attended the Week 60 visit. Overall prediction rates for weight loss of ≥10% at weeks 8 and 60, and attrition at Week 60, using combined data were between 77.8 and 87.6% for logistic regression, and lower for other methods. When logistic regression analyses included only baseline demographic and anthropometric variables, prediction rates were 76.2-86.1%. In this population, considering a wide range of biological and psychosocial data did not improve outcome prediction compared to simply-obtained baseline characteristics. © 2017 World Obesity Federation.

Impact of the CHOICES Intervention in Preventing Alcohol-Exposed Pregnancies in American Indian Women.

PubMed

Hanson, Jessica D; Nelson, Morgan E; Jensen, Jamie L; Willman, Amy; Jacobs-Knight, Jacque; Ingersoll, Karen

2017-04-01

Fetal alcohol spectrum disorders (FASD) comprise a continuum of lifelong outcomes in those born prenatally exposed to alcohol. Although studies have shown no differences in rates by race, FASD is of particular concern for American Indian communities. One tribally run prevention program is the Oglala Sioux Tribe (OST) CHOICES Program, which is modeled after the evidence-based CHOICES program that was focused on preconceptional prevention of alcohol-exposed pregnancy (AEP) by reducing risky drinking in women at risk for pregnancy and/or preventing unintended pregnancy. The OST CHOICES Program was made culturally appropriate for American Indian women and implemented with 3 communities, 2 on the reservation and 1 off. Data on drinking, sexual activity, and contraception use were collected at baseline and 3 and 6 months postintervention. Data were analyzed using descriptive statistics, 1-way analysis of variance, and a random intercept generalized estimating equation model. A total of 193 nonpregnant American Indian women enrolled in the OST CHOICES Program, and all were at risk for AEP because of binge drinking and being at risk for an unintended pregnancy. Fifty-one percent of participants completed both 3- and 6-month follow-ups. Models showed a significant decrease in AEP risk from baseline at both 3- and 6-month follow-ups, indicating the significant impact of the OST CHOICES intervention. Women in the OST CHOICES Program were more likely to reduce their risk for AEP by utilizing contraception, rather than decreasing binge drinking. Even with minor changes to make the CHOICES intervention culturally and linguistically appropriate and the potential threats to program validity those changes entail, we found a significant impact in reducing AEP risk. This highlights the capacity for the CHOICES intervention to be implemented in a wide variety of settings and populations. Copyright © 2017 by the Research Society on Alcoholism.

Measurable improvement in patient safety culture: A departmental experience with incident learning.

PubMed

Kusano, Aaron S; Nyflot, Matthew J; Zeng, Jing; Sponseller, Patricia A; Ermoian, Ralph; Jordan, Loucille; Carlson, Joshua; Novak, Avrey; Kane, Gabrielle; Ford, Eric C

2015-01-01

Rigorous use of departmental incident learning is integral to improving patient safety and quality of care. The goal of this study was to quantify the impact of a high-volume, departmental incident learning system on patient safety culture. A prospective, voluntary, electronic incident learning system was implemented in February 2012 with the intent of tracking near-miss/no-harm incidents. All incident reports were reviewed weekly by a multiprofessional team with regular department-wide feedback. Patient safety culture was measured at baseline with validated patient safety culture survey questions. A repeat survey was conducted after 1 and 2 years of departmental incident learning. Proportional changes were compared by χ(2) or Fisher exact test, where appropriate. Between 2012 and 2014, a total of 1897 error/near-miss incidents were reported, representing an average of 1 near-miss report per patient treated. Reports were filed by a cross section of staff, with the majority of incidents reported by therapists, dosimetrists, and physicists. Survey response rates at baseline and 1 and 2 years were 78%, 80%, and 80%, respectively. Statistically significant and sustained improvements were noted in several safety metrics, including belief that the department was openly discussing ways to improve safety, the sense that reports were being used for safety improvement, and the sense that changes were being evaluated for effectiveness. None of the surveyed dimensions of patient safety culture worsened. Fewer punitive concerns were noted, with statistically significant decreases in the worry of embarrassment in front of colleagues and fear of getting colleagues in trouble. A comprehensive incident learning system can identify many areas for improvement and is associated with significant and sustained improvements in patient safety culture. These data provide valuable guidance as incident learning systems become more widely used in radiation oncology. Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

A Longitudinal Study of Mental Health Consumer/Survivor Initiatives: Part 2--A Quantitative Study of Impacts of Participation on New Members

ERIC Educational Resources Information Center

Nelson, Geoffrey; Ochocka, Joanna; Janzen, Rich; Trainor, John

2006-01-01

To evaluate the impacts of participation in mental health Consumer/Survivor Initiatives (CSIs), we used a nonequivalent control group design to compare new, active participants in CSIs ( n = 61) with nonactive participants ( n = 57) at baseline, 9-month, and 18-month follow-up intervals. The two groups were comparable at baseline on a wide range…

Activating multi-ethnic youth for smoking prevention: design, baseline findings, and implementation of project SPLASH.

PubMed

Glanz, Karen; Lunde, Kevin B; Leakey, Tricia; Maddock, Jay; Koga, Karin; Yamauchi, Jessica; Maskarinec, Gertraud; Shigaki, Dorothy

2007-01-01

Achieving significant reductions in tobacco use by youth is an important challenge. There is a pressing need to develop and evaluate innovative strategies that stimulate youth involvement and are effective in multi-ethnic populations. This article describes an innovative tobacco prevention trial, and reports baseline characteristics of participants and findings about implementation of the curriculum. The aim of Project SPLASH is to evaluate the impact of a school-based smoking prevention intervention that emphasizes active involvement of middle school students, on rates of smoking initiation and regular smoking in a multi-ethnic cohort of youth in Hawaii. Project SPLASH is a group randomized trial that compares a 2-year innovative intervention with a social influence prevention program, in 20 public schools in Hawaii. The main outcome is mean 30-day smoking prevalence rates. The response rate was 78.4%. Approximately 1 in 4 students had tried smoking and 30-day smoking prevalence at baseline was 8%. Intervention and control groups were comparable in terms of tobacco use, gender, ethnicity, behavioral, environmental, and psychosocial characteristics. Differences in ethnic identification, socio-economic status, acculturation, and involvement in prevention activities may be due to chance. The intervention was well implemented by teachers across both the intervention and control school classes. For this study, 20 schools in Hawaii with close to 4000 participating students were recruited. Student smoking behavior and curriculum implementation were comparable by group status. The intervention study has the potential to elucidate how youth respond to an intervention with student involvement that incorporates cognitive and social action components.

A targeted noise reduction observational study for reducing noise in a neonatal intensive unit.

PubMed

Chawla, S; Barach, P; Dwaihy, M; Kamat, D; Shankaran, S; Panaitescu, B; Wang, B; Natarajan, G

2017-09-01

Excessive noise in neonatal intensive care units (NICUs) can interfere with infants' growth, development and healing.Local problem:Sound levels in our NICUs exceeded the recommended levels by the World Health Organization. We implemented a noise reduction strategy in an urban, tertiary academic medical center NICU that included baseline noise measurements. We conducted a survey involving staff and visitors regarding their opinions and perceptions of noise levels in the NICU. Ongoing feedback to staff after each measurement cycle was provided to improve awareness, engagement and adherence with noise reduction strategies. After widespread discussion with active clinician involvement, consensus building and iterative testing, changes were implemented including: lowering of equipment alarm sounds, designated 'quiet times' and implementing a customized education program for staff. A multiphase noise reduction quality improvement (QI) intervention to reduce ambient sound levels in a patient care room in our NICUs by 3 dB (20%) over 18 months. The noise in the NICU was reduced by 3 dB from baseline. Mean (s.d.) baseline, phase 2, 3 and 4 noise levels in the two NICUs were: LAeq: 57.0 (0.84), 56.8 (1.6), 55.3 (1.9) and 54.5 (2.6) dB, respectively (P<0.01). Adherence with the planned process measure of 'quiet times' was >90%. Implementing a multipronged QI initiative resulted in significant noise level reduction in two multipod NICUs. It is feasible to reduce noise levels if QI interventions are coupled with active engagement of the clinical staff and following continuous process of improvement methods, measurements and protocols.

Using e-Coaching to Support an Early Intervention Provider's Implementation of a Functional Assessment-Based Intervention

ERIC Educational Resources Information Center

Fettig, Angel; Barton, Erin E.; Carter, Alice S.; Eisenhower, Abbey S.

2016-01-01

This study examined the effects of e-coaching on the implementation of a functional assessment-based intervention delivered by an early intervention provider in reducing challenging behaviors during home visits. A multiple baseline design across behavior support plan components was used with a provider-child dyad. The e-coaching intervention…

Effects of Coaching on the Implementation of Functional Assessment-Based Parent Intervention in Reducing Challenging Behaviors

ERIC Educational Resources Information Center

Fettig, Angel; Schultz, Tia R.; Sreckovic, Melissa A.

2015-01-01

This study examined the effects of coaching on the implementation of functional assessment--based parent intervention in reducing children's challenging behaviors. A multiple baseline across participants design was used with three parent-child dyads with children between the ages of 2 and 5 years. The intervention consisted of training and delayed…

SPAWAR Strategic Plan Execution Year 2017

DTIC Science & Technology

2017-01-11

the PEO C4I domain. Completed C4I Baseline implementation activities including product roadmap system reviews, realignment of product fielding within...preloading applications in the CANES production facility to reduce installation timelines • Implemented Installation Management Office alignment and...software update process • For candidate technologies (endeavors) in the innovation pipeline, identified key attributes and acceleration factors that

An Evaluation of Video Modeling with Embedded Instructions to Teach Implementation of Stimulus Preference Assessments

ERIC Educational Resources Information Center

Rosales, Rocío; Gongola, Leah; Homlitas, Christa

2015-01-01

A multiple baseline design across participants was used to evaluate the effects of video modeling with embedded instructions on training teachers to implement 3 preference assessments. Each assessment was conducted with a confederate learner or a child with autism during generalization probes. All teachers met the predetermined mastery criterion,…

The Effects of Behavioral Skills Training on Implementation of the Picture Exchange Communication System

ERIC Educational Resources Information Center

Rosales, Rocio; Stone, Karen; Rehfeldt, Ruth Anne

2009-01-01

The effectiveness of a behavioral skills training (BST) package to teach the implementation of the first three phases of the picture exchange communication system (PECS) was evaluated with 3 adults who had no history teaching any functional communication system. A multiple baseline design across participants was used to evaluate the effectiveness…

Reconsidering the advantages of the three-dimensional representation of the interferometric transform for imaging with non-coplanar baselines and wide fields of view

NASA Astrophysics Data System (ADS)

Smith, D. M. P.; Young, A.; Davidson, D. B.

2017-07-01

Radio telescopes with baselines that span thousands of kilometres and with fields of view that span tens of degrees have been recently deployed, such as the Low Frequency Array, and are currently being developed, such as the Square Kilometre Array. Additionally, there are proposals for space-based instruments with all-sky imaging capabilities, such as the Orbiting Low Frequency Array. Such telescopes produce observations with three-dimensional visibility distributions and curved image domains. In most work to date, the visibility distribution has been converted to a planar form to compute the brightness map using a two-dimensional Fourier transform. The celestial sphere is faceted in order to counter pixel distortion at wide angles, with each such facet requiring a unique planar form of the visibility distribution. Under the above conditions, the computational and storage complexities of this approach can become excessive. On the other hand, when using the direct Fourier transform approach, which maintains the three-dimensional shapes of the visibility distribution and celestial sphere, the non-coplanar visibility component requires no special attention. Furthermore, as the celestial samples are placed directly on the curved surface of the celestial sphere, pixel distortion at wide angles is avoided. In this paper, a number of examples illustrate that under these conditions (very long baselines and very wide fields of view) the costs of the direct Fourier transform may be comparable to (or even lower than) methods that utilise the two-dimensional fast Fourier transform.

Acceptance and attitudes of healthcare staff towards the introduction of clinical pharmacy service: a descriptive cross-sectional study from a tertiary care hospital in Sri Lanka.

PubMed

Shanika, Lelwala Guruge Thushani; Wijekoon, Chandrani Nirmala; Jayamanne, Shaluka; Coombes, Judith; Coombes, Ian; Mamunuwa, Nilani; Dawson, Andrew Hamilton; De Silva, Hithanadura Asita

2017-01-18

Multidisciplinary patient management including a clinical pharmacist shows an improvement in patient quality use of medicine. Implementation of a clinical pharmacy service represents a significant novel change in practice in Sri Lanka. Although attitudes of doctors and nurses are an important determinant of successful implementation, there is no Sri Lankan data about staff attitudes to such changes in clinical practice. This study determines the level of acceptance and attitudes of doctors and nurses towards the introduction of a ward-based clinical pharmacy service in Sri Lanka. This is a descriptive cross-sectional sub-study which determines the acceptance and attitudes of healthcare staff about the introduction of a clinical pharmacy service to a tertiary care hospital in Sri Lanka. The level of acceptance of pharmacist's recommendations regarding drug-related problems (DRPs) was measured. Data regarding attitudes were collected through a pre-tested self-administered questionnaires distributed to doctors (baseline, N =13, post-intervention period, N = 12) and nurses (12) worked in professorial medical unit at baseline and post-intervention period. A total of 274 (272 to doctors and 2 to nurses) recommendations regarding DRPs were made. Eighty three percent (225/272) and 100% (2/2) of the recommendations were accepted by doctors and nurses, respectively. The rate of implementation of pharmacist's recommendations by doctors was 73.5% (200/272) (95% CI 67.9 - 78.7%; P < 0.001). The response rate of doctors was higher at the post-intervention period (92.3%; 12/13) compared to the baseline (66.7%; 8/12). At the post-intervention survey 91.6% of doctors were happy to work with competent clinical pharmacists and accepted the necessity of this service to improve standards of care. The nurses' rate of response at baseline and post-intervention surveys were 80.0 and 0.0% respectively. Their perceptions on the role of clinical pharmacist were negative at baseline survey. There was high acceptance and implementation of clinical pharmacist's recommendations regarding DRPs by the healthcare team. The doctors' views and attitudes were positive regarding the inclusion of a ward-based pharmacist to the healthcare team. However there is a need to improve liaison between clinical pharmacist and nursing staff. Sri Lanka Clinical Trials Registry SLCTR/2013/029 Date: 13 September 2013; retrospectively registered.

The healthy options for nutrition environments in schools (Healthy ONES) group randomized trial: using implementation models to change nutrition policy and environments in low income schools

PubMed Central

2012-01-01

Background The Healthy Options for Nutrition Environments in Schools (Healthy ONES) study was an evidence-based public health (EBPH) randomized group trial that adapted the Institute for Healthcare Improvement’s (IHI) rapid improvement process model to implement school nutrition policy and environmental change. Methods A low-income school district volunteered for participation in the study. All schools in the district agreed to participate (elementary = 6, middle school = 2) and were randomly assigned within school type to intervention (n = 4) and control (n =4) conditions following a baseline environmental audit year. Intervention goals were to 1) eliminate unhealthy foods and beverages on campus, 2) develop nutrition services as the main source on campus for healthful eating (HE), and 3) promote school staff modeling of HE. Schools were followed across a baseline year and two intervention years. Longitudinal assessment of height and weight was conducted with second, third, and sixth grade children. Behavioral observation of the nutrition environment was used to index the amount of outside foods and beverages on campuses. Observations were made monthly in each targeted school environment and findings were presented as items per child per week. Results From an eligible 827 second, third, and sixth grade students, baseline height and weight were collected for 444 second and third grade and 135 sixth grade students (51% reach). Data were available for 73% of these enrolled students at the end of three years. Intervention school outside food and beverage items per child per week decreased over time and control school outside food and beverage items increased over time. The effects were especially pronounced for unhealthy foods and beverage items. Changes in rates of obesity for intervention school (28% baseline, 27% year 1, 30% year 2) were similar to those seen for control school (22% baseline, 22% year 1, 25% year 2) children. Conclusions Healthy ONES adaptation of IHI’s rapid improvement process provided a promising model for implementing nutrition policy and environmental changes that can be used in a variety of school settings. This approach may be especially effective in assisting schools to implement the current federally-mandated wellness policies. PMID:22734945

Online Removal of Baseline Shift with a Polynomial Function for Hemodynamic Monitoring Using Near-Infrared Spectroscopy.

PubMed

Zhao, Ke; Ji, Yaoyao; Li, Yan; Li, Ting

2018-01-21

Near-infrared spectroscopy (NIRS) has become widely accepted as a valuable tool for noninvasively monitoring hemodynamics for clinical and diagnostic purposes. Baseline shift has attracted great attention in the field, but there has been little quantitative study on baseline removal. Here, we aimed to study the baseline characteristics of an in-house-built portable medical NIRS device over a long time (>3.5 h). We found that the measured baselines all formed perfect polynomial functions on phantom tests mimicking human bodies, which were identified by recent NIRS studies. More importantly, our study shows that the fourth-order polynomial function acted to distinguish performance with stable and low-computation-burden fitting calibration (R-square >0.99 for all probes) among second- to sixth-order polynomials, evaluated by the parameters R-square, sum of squares due to error, and residual. This study provides a straightforward, efficient, and quantitatively evaluated solution for online baseline removal for hemodynamic monitoring using NIRS devices.

CryoSat Ice Processor: High-Level Overview of Baseline-C Data and Quality-Control

NASA Astrophysics Data System (ADS)

Mannan, R.; Webb, E.; Hall, A.; Bouffard, J.; Femenias, P.; Parrinello, T.; Bouffard, J.; Brockley, D.; Baker, S.; Scagliola, M.; Urien, S.

2016-08-01

Since April 2015, the CryoSat ice products have been generated with the new Baseline-C Instrument Processing Facilities (IPFs). This represents a major upgrade to the CryoSat ice IPFs and is the baseline for the second CryoSat Reprocessing Campaign. Baseline- C introduces major evolutions with respect to Baseline- B, most notably the release of freeboard data within the L2 SAR products, following optimisation of the SAR retracker. Additional L2 improvements include a new Arctic Mean Sea Surface (MSS) in SAR; a new tuneable land ice retracker in LRM; and a new Digital Elevation Model (DEM) in SARIn. At L1B new attitude fields have been introduced and existing datation and range biases reduced. This paper provides a high level overview of the changes and evolutions implemented at Baseline-C in order to improve CryoSat L1B and L2 data characteristics and exploitation over polar regions. An overview of the main Quality Control (QC) activities performed on operational Baseline-C products is also presented.

Identifying species from the air: UAVs and the very high resolution challenge for plant conservation

PubMed Central

Moat, Justin; Whaley, Oliver; Boyd, Doreen S.

2017-01-01

The Pacific Equatorial dry forest of Northern Peru is recognised for its unique endemic biodiversity. Although highly threatened the forest provides livelihoods and ecosystem services to local communities. As agro-industrial expansion and climatic variation transform the region, close ecosystem monitoring is essential for viable adaptation strategies. UAVs offer an affordable alternative to satellites in obtaining both colour and near infrared imagery to meet the specific requirements of spatial and temporal resolution of a monitoring system. Combining this with their capacity to produce three dimensional models of the environment provides an invaluable tool for species level monitoring. Here we demonstrate that object-based image analysis of very high resolution UAV images can identify and quantify keystone tree species and their health across wide heterogeneous landscapes. The analysis exposes the state of the vegetation and serves as a baseline for monitoring and adaptive implementation of community based conservation and restoration in the area. PMID:29176860

A Multidisciplinary Initiative to Increase Inpatient Discharges Before Noon.

PubMed

Kane, Marlena; Weinacker, Ann; Arthofer, Rudolph; Seay-Morrison, Timothy; Elfman, Wesley; Ramirez, Mark; Ahuja, Neera; Pickham, David; Hereford, James; Welton, Mark

2016-12-01

The aim of this study is to evaluate the effect of 2 hospital-wide interventions on achieving a discharge-before-noon rate of 40%. A multidisciplinary team led by administrative and physician leadership developed a plan to diminish capacity constraints by minimizing late afternoon hospital discharges using 2 patient flow management techniques. The study was a preintervention/postintervention retrospective analysis observing all inpatients discharged across 19 inpatient units in a 484-bed, academic teaching hospital measuring calendar month discharge-before-noon percentage, patient satisfaction, and readmission rates. Patient satisfaction and readmission rates were used as baseline metrics. The discharge-before-noon percentage increased from 14% in the 11-month preintervention period to an average of 24% over the 11-month postintervention period, whereas patient satisfaction scores and readmission rates remained stable. Implementation of the 2 interventions successfully increased the percentage of discharges before noon yet did not achieve the goal of 40%. Patient satisfaction and readmission rates were not negatively impacted by the program.

Vision-Based Georeferencing of GPR in Urban Areas

PubMed Central

Barzaghi, Riccardo; Cazzaniga, Noemi Emanuela; Pagliari, Diana; Pinto, Livio

2016-01-01

Ground Penetrating Radar (GPR) surveying is widely used to gather accurate knowledge about the geometry and position of underground utilities. The sensor arrays need to be coupled to an accurate positioning system, like a geodetic-grade Global Navigation Satellite System (GNSS) device. However, in urban areas this approach is not always feasible because GNSS accuracy can be substantially degraded due to the presence of buildings, trees, tunnels, etc. In this work, a photogrammetric (vision-based) method for GPR georeferencing is presented. The method can be summarized in three main steps: tie point extraction from the images acquired during the survey, computation of approximate camera extrinsic parameters and finally a refinement of the parameter estimation using a rigorous implementation of the collinearity equations. A test under operational conditions is described, where accuracy of a few centimeters has been achieved. The results demonstrate that the solution was robust enough for recovering vehicle trajectories even in critical situations, such as poorly textured framed surfaces, short baselines, and low intersection angles. PMID:26805842

The value of reducing hospital-acquired pressure ulcer prevalence: an illustrative analysis.

PubMed

Spetz, Joanne; Brown, Diane S; Aydin, Carolyn; Donaldson, Nancy

2013-04-01

The aim of this study was to assess the cost savings associated with implementing nursing approaches to prevent hospital-acquired pressure ulcers (HAPU). Hospitals face substantial costs associated with the treatment of HAPUs. Interventions have been demonstrated as effective for HAPU prevention and management, but it is widely perceived that preventative measures are expensive and, thus, may not be a good use of resources. A return-on-investment (ROI) framework from the Agency for Healthcare Research and Quality (AHRQ) Quality Indicators Toolkit was used for this study. The researchers identified achievable improvements in HAPU rates from data from the Collaborative Alliance for Nursing Outcomes and measured costs and savings associated with HAPU reduction from published literature. The analysis produced a baseline ROI ratio of 1.61 and net savings of $127.51 per patient. Hospital-acquired pressure ulcer surveillance and prevention can be cost saving for hospitals and should be considered by nurse executives as a strategy to support quality outcomes.

Positive Behavior Support in Schools (PBSIS): An Administrative Perspective on the Implementation of a Comprehensive School-Wide Intervention in an Urban Charter School

ERIC Educational Resources Information Center

Christofferson, Remi Dabney; Callahan, Kathe

2015-01-01

This research explores the implementation of a school-wide intervention program that was designed to foster and instill intrinsic values based on an external reward system. The Positive Behavior Support in Schools (PBSIS) is an intervention intended to improve the climate of schools using system-wide positive behavioral interventions to discourage…

Product retrieval time in small tobacco retail outlets before and after the Australian plain packaging policy: real-world study.

PubMed

Wakefield, Melanie; Bayly, Megan; Scollo, Michelle

2014-01-01

We aimed to assess change in cigarette pack retrieval time in small retail outlets following the introduction of plain packaging in Australia in 1 December 2012. A sample of 303 milk bars, convenience stores, petrol stations and newsagents was selected in four capital cities, stratified by area socioeconomic status. In June and September (baseline months), the first 2 weeks of December 2012, and February 2013, stores were visited by trained fieldworkers who requested a cigarette pack of a pre-determined brand, variant and pack size, unobtrusively recording the time from the end of the request to when the pack was scanned or placed on the counter. In multivariate analysis, December retrieval time (12.43 s) did not differ from June (10.91 s; p=0.410) or February (10.37 s; p=0.382), but was slower than September (9.84 s; p=0.024). In December, retrieval time declined as days after plain packaging implementation increased (β=-0.21, p=0.011), returning to the baseline range by the second week of implementation. This pattern was not observed in baseline months or in February. Sensitivity analyses showed that results were robust to the variability in purchasing circumstances in tobacco retail outlets. Retailers quickly gained experience with the new plain packaging legislation, evidenced by retrieval time having returned to the baseline range by the second week of implementation and remaining so several months later. The long retrieval times predicted by tobacco industry-funded retailer groups and the consequent costs they predicted would fall upon small retailers from plain packaging are unlikely to eventuate.

Fault-free behavior of reliable multiprocessor systems: FTMP experiments in AIRLAB

NASA Technical Reports Server (NTRS)

Clune, E.; Segall, Z.; Siewiorek, D.

1985-01-01

This report describes a set of experiments which were implemented on the Fault tolerant Multi-Processor (FTMP) at NASA/Langley's AIRLAB facility. These experiments are part of an effort to formulate and evaluate validation methodologies for fault-tolerant computers. This report deals with the measurement of single parameters (baselines) of a fault free system. The initial set of baseline experiments lead to the following conclusions: (1) The system clock is constant and independent of workload in the tested cases; (2) the instruction execution times are constant; (3) the R4 frame size is 40mS with some variation; (4) the frame stretching mechanism has some flaws in its implementation that allow the possibility of an infinite stretching of frame duration. Future experiments are planned. Some will broaden the results of these initial experiments. Others will measure the system more dynamically. The implementation of a synthetic workload generation mechanism for FTMP is planned to enhance the experimental environment of the system.

Automated localisation of Mars rovers using co-registered HiRISE-CTX-HRSC orthorectified images and wide baseline Navcam orthorectified mosaics

NASA Astrophysics Data System (ADS)

Tao, Yu; Muller, Jan-Peter; Poole, William

2016-12-01

We present a wide range of research results in the area of orbit-to-orbit and orbit-to-ground data fusion, achieved within the EU-FP7 PRoVisG project and EU-FP7 PRoViDE project. We focus on examples from three Mars rover missions, i.e. MER-A/B and MSL, to provide examples of a new fully automated offline method for rover localisation. We start by introducing the mis-registration discovered between the current HRSC and HiRISE datasets. Then we introduce the HRSC to CTX and CTX to HiRISE co-registration workflow. Finally, we demonstrate results of wide baseline stereo reconstruction with fixed mast position rover stereo imagery and its application to ground-to-orbit co-registration with HiRISE orthorectified image. We show examples of the quantitative assessment of recomputed rover traverses, and extensional exploitation of the co-registered datasets in visualisation and within an interactive web-GIS.

Preliminary design trade-offs for a multi-mission stored cryogen cooler

NASA Technical Reports Server (NTRS)

Sherman, A.

1978-01-01

Preliminary design studies were performed for a multi-mission solid cryogen cooler having a wide range of application for both the shuttle sortie and free flyer missions. This multi-mission cooler (MMC) is designed to be utilized with various solid cryogens to meet a wide range of instrument cooling from 10 K (with solid hydrogen) to 90 K. The baseline cooler utilizes two stages of solid cryogen and incorporates an optional, higher temperature third stage which is cooled by either a passive radiator or a thermoelectric cooler. The MMC has an interface which can accommodate a wide variety of instrument configurations. A shrink fit adapter is incorporated which allows a drop-in instrument integration. The baseline design provides cooling of approximately 1 watt over a 60 to 100 K temperature range and about 0.5 watts from 15 to 60 K for a one year lifetime. For low cooling loads and with use of the optional radiator shield, cooling lifetimes as great as 8 years are predicted.

Baseline-dependent sampling and windowing for radio interferometry: data compression, field-of-interest shaping, and outer field suppression

NASA Astrophysics Data System (ADS)

Atemkeng, M.; Smirnov, O.; Tasse, C.; Foster, G.; Keimpema, A.; Paragi, Z.; Jonas, J.

2018-07-01

Traditional radio interferometric correlators produce regular-gridded samples of the true uv-distribution by averaging the signal over constant, discrete time-frequency intervals. This regular sampling and averaging then translate to be irregular-gridded samples in the uv-space, and results in a baseline-length-dependent loss of amplitude and phase coherence, which is dependent on the distance from the image phase centre. The effect is often referred to as `decorrelation' in the uv-space, which is equivalent in the source domain to `smearing'. This work discusses and implements a regular-gridded sampling scheme in the uv-space (baseline-dependent sampling) and windowing that allow for data compression, field-of-interest shaping, and source suppression. The baseline-dependent sampling requires irregular-gridded sampling in the time-frequency space, i.e. the time-frequency interval becomes baseline dependent. Analytic models and simulations are used to show that decorrelation remains constant across all the baselines when applying baseline-dependent sampling and windowing. Simulations using MeerKAT telescope and the European Very Long Baseline Interferometry Network show that both data compression, field-of-interest shaping, and outer field-of-interest suppression are achieved.

Successful implementation of a neonatal pain and sedation protocol at 2 NICUs.

PubMed

Deindl, Philipp; Unterasinger, Lukas; Kappler, Gregor; Werther, Tobias; Czaba, Christine; Giordano, Vito; Frantal, Sophie; Berger, Angelika; Pollak, Arnold; Olischar, Monika

2013-07-01

To evaluate the implementation of a neonatal pain and sedation protocol at 2 ICUs. The intervention started with the evaluation of local practice, problems, and staff satisfaction. We then developed and implemented the Vienna Protocol for Neonatal Pain and Sedation. The protocol included well-defined strategies for both nonpharmacologic and pharmacologic interventions based on regular assessment of a translated version of the Neonatal Pain Agitation and Sedation Scale and titration of analgesic and sedative therapy according to aim scores. Health care staff was trained in the assessment by using a video-based tutorial and bedside teaching. In addition, we performed reevaluation, retraining, and random quality checks. Frequency and quality of assessments, pharmacologic therapy, duration of mechanical ventilation, and outcome were compared between baseline (12 months before implementation) and 12 months after implementation. Cumulative median (interquartile range) opiate dose (baseline dose of 1.4 [0.5-5.9] mg/kg versus intervention group dose of 2.7 [0.4-57] mg/kg morphine equivalents; P = .002), pharmacologic interventions per episode of continuous sedation/analgesia (4 [2-10] vs 6 [2-13]; P = .005), and overall staff satisfaction (physicians: 31% vs 89%; P < .001; nurses: 17% vs 55%; P < .001) increased after implementation. Time on mechanical ventilation, length of stay at the ICU, and adverse outcomes were similar before and after implementation. Implementation of a neonatal pain and sedation protocol at 2 ICUs resulted in an increase in opiate prescription, pharmacologic interventions, and staff satisfaction without affecting time on mechanical ventilation, length of intensive care stay, and adverse outcomes.

Implementation and evaluation of Australian pharmacists' diabetes care services.

PubMed

Armour, Carol L; Taylor, Susan J; Hourihan, Fleur; Smith, Carlene; Krass, Ines

2004-01-01

To implement and evaluate a specialized service for type 2 diabetes mellitus in the community pharmacy. Parallel group, multisite, control versus intervention, repeated measures design, with three different regions in New South Wales, Australia, used as intervention regions, then matched with control regions as much as possible. Following training, pharmacists followed a clinical protocol over 9 months, with approximately monthly intervention site visits during which blood glucose readings were downloaded and discussed with the patient, interventions were documented, and goals set with each patient. Quality of life, well-being, risk of nonadherence, and glycosylated hemoglobin (A1C) values at the beginning and end of the study. Blood glucose levels were measured in intervention patients only. A total of 106 intervention and 82 control patients completed the study. Patient groups were similar at baseline. Pharmacists delivered 1,459 interventions and blood glucose levels were significantly reduced in all intervention regions. The proportion of patients with A1C values greater than 7% was similar in control sites at baseline (54%) and after 9 months (61%). In intervention sites this proportion was significantly reduced, from 72% at baseline to 53% after 9 months. Well-being and the risk of nonadherence were significantly improved in intervention patients. Implementation of a specialized service for diabetes in community pharmacy resulted in better diabetes control and health care outcomes for the patient.

Hartmann test for the James Webb Space Telescope

NASA Astrophysics Data System (ADS)

Knight, J. Scott; Feinberg, Lee; Howard, Joseph; Acton, D. Scott; Whitman, Tony L.; Smith, Koby

2016-07-01

The James Webb Space Telescope's (JWST) end-to-end optical system will be tested in a cryogenic vacuum environment before launch at NASA Johnson Space Center's (JSC) Apollo-era, historic Chamber A thermal vacuum facility. During recent pre-test runs with a prototype "Pathfinder" telescope, the vibration in this environment was found to be challenging for the baseline test approach, which uses phase retrieval of images created by three sub-apertures of the telescope. To address the vibration, an alternate strategy implemented using classic Hartmann test principles combined with precise mirror mechanisms to provide a testing approach that is insensitive to the dynamics environment of the chamber. The measurements and sensitivities of the Hartmann approach are similar to those using phase retrieval over the original sparse aperture test. The Hartmann test concepts have been implemented on the JWST Test Bed Telescope, which provided the rationale and empirical evidence indicating that this Hartmann style approach would be valuable in supplementing the baseline test approach. This paper presents a Hartmann approach implemented during the recent Pathfinder test along with the test approach that is currently being considered for the full optical system test of JWST. Comparisons are made between the baseline phase retrieval approach and the Hartmann approach in addition to demonstrating how the two test methodologies support each other to reduce risk during the JWST full optical system test.

Impact of the introduction of neuraxial labor analgesia on mode of delivery at an urban maternity hospital in China.

PubMed

Hu, Ling-Qun; Zhang, Jin; Wong, Cynthia A; Cao, Qinying; Zhang, Guohua; Rong, Huijuan; Li, Xia; McCarthy, Robert J

2015-04-01

To evaluate the association between the introduction of neuraxial (epidural) labor analgesia and mode of delivery in a large urban maternity hospital in China. A single-intervention impact study was conducted at Shijiazhuang Obstetrics and Gynecology Hospital in Shijiazhuang. Baseline data collection occurred between August 1 and December 31, 2009, when no analgesic method was routinely employed during labor. An intervention was then implemented, consisting of a neuraxial labor analgesia service. The service was fully operational from September 1, 2010, and data were collected to August 31, 2011. The mode of delivery was compared between the different periods. Neuraxial analgesia rate was used in none of the 3787 deliveries during the baseline period and 3429 (33.5%) of 10 230 in the implementation period. Cesareans were performed in 1533 (40.5%) deliveries in the baseline period and 3441 (33.6%) in the implementation period (difference -6.8%, 99.8% confidence interval [CI] -9.7% to -3.9%; P<0.0017). The proportion of vaginal deliveries in which forceps were used was unchanged (difference -0.8%, 99.8% CI -0.7% to 2.2%; P=0.92). The introduction of epidural analgesia reduced the frequency of cesarean delivery, which improved obstetric and neonatal outcomes. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Centipod WEC, Advanced Controls, Resultant LCOE

DOE Data Explorer

McCall, Alan

2016-02-15

Project resultant LCOE model after implementation of MPC controller. Contains AEP, CBS, model documentation, and LCOE content model. This is meant for comparison with this project's baseline LCOE model.

Space shuttle guidance, navigation and control design equations. Volume 4: Deorbit and atmospheric operations

NASA Technical Reports Server (NTRS)

Cox, K. J.

1971-01-01

A baseline set of equations which fulfill the computation requirements for guidance, navigation, and control of the space shuttle orbiter vehicle is presented. All shuttle mission phases are covered from prelaunch through landing/rollout. The spacecraft flight mode and the aircraft flight mode are addressed. The baseline equations may be implemented in a single guidance, navigation, and control computer or may be distributed among several subsystem computers.

Report of the Evaluation of the Race/Human Relations Program. Student and Staff Program and Long Range Goals. Baseline Year 1982-83. Evaluation Services Department Report No. 348.

ERIC Educational Resources Information Center

Tomblin, Elizabeth A.; And Others

In response to a 1982 Superior Court order, a centrally developed, sequential program for improving race/human relations in the San Diego City Schools was developed and field tested or implemented during the 1982-83 school year. This systematic evaluation reports on the student program, "Conflict"; the staff program; and baseline data…

Establishing a Product Baseline for Global Positioning System Satellites through Functional and Physical Configuration Audits

DTIC Science & Technology

2011-09-01

PBL may see changes as the design is actually implemented . Such changes are typically for practical reasons of adapting to either specific...shall use a configuration management approach to establish and control product attributes and the product baseline across the total system life cycle... practice that helps prevent government interference in subcontracts, holds the prime contractor accountable for their end product (s), limits the potential

Integrated Advanced Sounding Unit-A (AMSU-A). Configuration Management Plan

NASA Technical Reports Server (NTRS)

Cavanaugh, J.

1996-01-01

The purpose of this plan is to identify the baseline to be established during the development life cycle of the integrated AMSU-A, and define the methods and procedures which Aerojet will follow in the implementation of configuration control for each established baseline. Also this plan establishes the Configuration Management process to be used for the deliverable hardware, software, and firmware of the Integrated AMSU-A during development, design, fabrication, test, and delivery.

Baseline Error Analysis and Experimental Validation for Height Measurement of Formation Insar Satellite

NASA Astrophysics Data System (ADS)

Gao, X.; Li, T.; Zhang, X.; Geng, X.

2018-04-01

In this paper, we proposed the stochastic model of InSAR height measurement by considering the interferometric geometry of InSAR height measurement. The model directly described the relationship between baseline error and height measurement error. Then the simulation analysis in combination with TanDEM-X parameters was implemented to quantitatively evaluate the influence of baseline error to height measurement. Furthermore, the whole emulation validation of InSAR stochastic model was performed on the basis of SRTM DEM and TanDEM-X parameters. The spatial distribution characteristics and error propagation rule of InSAR height measurement were fully evaluated.

Predicting Abandonment of School-Wide Behavior Support Interventions

ERIC Educational Resources Information Center

Nese, Rhonda N. T.; McIntosh, Kent; Nese, Joseph F. T.; Ghemraoui, Adam; Bloom, Jerry; Johnson, Nanci W.; Phillips, Danielle; Richter, Mary F.; Hoselton, Robert

2016-01-01

This study examines predictors of abandonment of evidence-based practices through descriptive analyses of extant state-level training data, fidelity of implementation data, and nationally reported school demographic data across 915 schools in 3 states implementing school-wide positive behavioral interventions and supports (SWPBIS). Schools…

Efficacy of Individualized Clinical Coaching in a Virtual Reality Classroom for Increasing Teachers' Fidelity of Implementation of Discrete Trial Teaching

ERIC Educational Resources Information Center

Garland, Krista Vince; Vasquez, Eleazar, III; Pearl, Cynthia

2012-01-01

Discrete-trials teaching (DTT) is an evidence-based practice used in educational programs for children with autism spectrum disorders (ASD). Although there is strong demand for preparing teachers to effectively implement DTT, there is a scarcity of published research on such studies. A multiple baseline across participants design was utilized to…

Nonlinear Dynamic Inversion Baseline Control Law: Architecture and Performance Predictions

NASA Technical Reports Server (NTRS)

Miller, Christopher J.

2011-01-01

A model reference dynamic inversion control law has been developed to provide a baseline control law for research into adaptive elements and other advanced flight control law components. This controller has been implemented and tested in a hardware-in-the-loop simulation; the simulation results show excellent handling qualities throughout the limited flight envelope. A simple angular momentum formulation was chosen because it can be included in the stability proofs for many basic adaptive theories, such as model reference adaptive control. Many design choices and implementation details reflect the requirements placed on the system by the nonlinear flight environment and the desire to keep the system as basic as possible to simplify the addition of the adaptive elements. Those design choices are explained, along with their predicted impact on the handling qualities.

ParticipACTION: Baseline assessment of the 'new ParticipACTION': A quantitative survey of Canadian organizational awareness and capacity

PubMed Central

2009-01-01

Background ParticipACTION is a Canadian physical activity (PA) communications and social marketing organization that was relaunched in 2007 after a six-year hiatus. This study assesses the baseline awareness and capacity of Canadian organizations that promote physical activity, to adopt, implement and promote ParticipACTION's physical activity campaign. The three objectives were: (1) to determine organizational awareness of both the 'original' and 'new' ParticipACTION; (2) to report baseline levels of three organizational capacity domains (i.e., to adopt, implement and externally promote physical activity initiatives); and, (3) to explore potential differences in those domains based on organizational size, sector and primary mandate. Methods Organizations at local, provincial/territorial, and national levels were sent an invitation via email prior to the official launch of ParticipACTION to complete an on-line survey. The survey assessed their organization's capacity to adopt, implement and externally promote a new physical activity campaign within their organizational mandates. Descriptive statistics were employed to address the first two study objectives. A series of one-way analysis of variance were conducted to examine the third objective. Results The response rate was 29.7% (268/902). The majority of responding organizations had over 40 employees and had operated for over 10 years. Education was the most common primary mandate, followed by sport and recreation. Organizations were evenly distributed between government and not-for-profits. Approximately 96% of respondents had heard of the 'original' ParticipACTION while 54.6% had heard of the 'new' ParticipACTION (Objective 1). Findings indicate good organizational capacity in Canada to promote physical activity (Objective 2) based on reported means of approximately 4.0 (on 5-point scales) for capacity to adopt, implement, and externally promote new physical activity campaigns. Capacity to adopt new physical activity campaigns differed by organizational sector and mandate, and capacity to implement differed by organizational mandate (Objective 3). Conclusion At baseline, and without specific details of the campaign, respondents believe they have good capacity to work with ParticipACTION. ParticipACTION may do well to capitalize on the existing strong organizational capacity components of leadership, infrastructure and 'will' of national organizations to facilitate the success of its future campaigns. PMID:19995457

Wide field/planetary camera optics study. [for the large space telescope

NASA Technical Reports Server (NTRS)

1979-01-01

Design feasibility of the baseline optical design concept was established for the wide field/planetary camera (WF/PC) and will be used with the space telescope (ST) to obtain high angular resolution astronomical information over a wide field. The design concept employs internal optics to relay the ST image to a CCD detector system. Optical design performance predictions, sensitivity and tolerance analyses, manufacturability of the optical components, and acceptance testing of the two mirror Cassegrain relays are discussed.

Changes in Consumer Purchases in Stores Participating in an Obesity Prevention Initiative.

PubMed

Woodward-Lopez, Gail; Kao, Janice; Kuo, Elena S; Rauzon, Suzanne; Taylor, Anthony C; Goette, Christina; Collins, Carole; Gonzalez, Esmeralda P; Ronshausen, Danielle R; Boyle, Kathryn; Williamson, Dana; Cheadle, Allen

2018-05-01

From 2011 to 2014, small stores in three communities participated in a community-wide obesity prevention initiative. The study aimed to determine how participation in the initiative influenced store environments and consumer purchases. Pre- and post-intervention without control. Structured observations of the store environments and intercept surveys of adult shoppers at all stores, and of children at two stores, conducted at baseline and follow-up. Manager/owner interviews regarding perceived impacts of the intervention conducted at follow-up. Shoppers at nine small stores in three diverse, low-income communities in Northern California. The store interventions were determined locally with combinations of strategies such as product displays, healthier options, marketing and promotion, store layout, and facility improvements that were implemented to varying degrees at each site. Changes in store environments and purchases of select foods and beverages. Stores experienced consistent, but not always significant, declines in purchases of sweets and chips and increases in purchases of fruits and vegetables at select stores. Decreases in purchases of targeted sugar-sweetened beverages were offset by increases in purchases of other sugar-sweetened beverages. Changes in store environments and promotional activities varied widely from store to store and corresponded to variations in changes in purchasing. The owners/managers perceived benefits to their bottom line and community/customer relations, but challenges were identified that may account for the varied degree of implementation. Substantive improvements in fruit and vegetable availability and promotion were needed to achieve a measurable impact on purchases but reducing purchases of unhealthy foods, like sweets and chips, required a less consistent intensive effort. These findings suggest it may be challenging to achieve the consistent and targeted implementation of changes and ongoing promotional efforts at a large enough proportion of stores where residents shop that would be required to get measurable impacts at the community level. This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health. Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

IRBM for the Rio Conchos Basin as a Restoration and Conservation Tool

NASA Astrophysics Data System (ADS)

Barrios, E.; Rodriguez, J. A.; de La Maza, M.

2007-12-01

The Rio Conchos basin is the main water supply for the people of the State of Chihuahua and the middle and lower Rio Bravo in northern Mexico. Flowing for about 850 km from the highlands of the Sierra Tarahumara towards the wide valleys of the Chihuahuan Desert, the river presents recurrent periods of water stress and its basin of 6.7 million of hectares experiences a wide spectrum of problems such us long drought periods, water over allocation and extraction, water pollution, severe soil use changes. Besides, drastic soil moisture reduction is forecasted by effects of climate change. These natural and anthropological harmful situations impose a serious stress for this important and beautiful river and the rest of the basin hydrological resources. The WWF-Gonzalo Rio Arronte Alliance and its partners USAID, The Coca Cola Company and RICOH are implementing since 2004 an Integrated River Basin Management (IRBM) strategy to recover the natural integrity of the Rio Conchos in the form of environmental flow. The strategy includes the five basic working lines: i) development of river basin scientific knowledge, ii) strengthen of local institutional capacities, iii) development of demonstrative projects, iv) strengthen of indigenous communities, v) education and communication. Although the implementation of the IRBM program is expected to show main results until the year 2050, some interesting results have been obtained. The strategy has provided i) new basic knowledge about the basin dynamic events such as soil change use rates, baseline values of biological integrity, water economic values, among others; ii) strong program acceptance by government and main water users (farmers), and the integration of a working group formed by government, academia and NGO's; iii) local acceptance and understanding of benefits about basin management (soil recovery, reforestation, ecological sanitation) through demonstrative projects; iv) social organization; v) few advances in education and communications have been obtained. Some of the negative results of program implementation are lack of positive acceptance by powerful groups and a couple of NGO's currently working in the basin, and low credibility from indigenous governors (leaders of the Tarahumara group).

Use of antipsychotic medications for the management of delirium: an audit of current practice in the acute care setting.

PubMed

Tropea, J; Slee, J; Holmes, A C N; Gorelik, A; Brand, C A

2009-02-01

Despite delirium being common in older hospitalized people, little is known about its management. The aims of this study are (1) to describe the pharmacological management of delirium in an acute care setting as a baseline measure prior to the implementation of newly developed Australian guidelines; and (2) to determine what areas of delirium pharmacological management need to be targeted for future practical guideline implementation and quality improvement activities. A medical record audit was conducted using a structured audit form. All patients aged 65 years and over who were admitted to a general medical or orthopaedic unit of the Royal Melbourne Hospital between 1 March 2006 and 28 February 2007 and coded with delirium were included. Data on the use of antipsychotic medications for the management of delirium in relation to best practice recommendations were assessed. Overall 174 episodes of care were included in the analysis. Antipsychotic medications were used for the management of most patients with severe behavioral and or emotional disturbance associated with delirium. There was variation in the prescribing patterns of antipsychotic agents and the documentation of medication management plans. Less than a quarter of patients prescribed antipsychotic medication were started on a low dose and very few were reviewed on a regular basis. A wide range of practice is seen in the use of antipsychotic agents to manage older patients with severe symptoms associated with delirium. The findings highlight the need to implement evidence-based guideline recommendations with a focus on improving the consistency in the pharmacological management and documentation processes.

Is an advance care planning model feasible in community palliative care? A multi-site action research approach.

PubMed

Blackford, Jeanine; Street, Annette

2012-09-01

This article reports a study to determine the feasibility of an advance care planning model developed with Australian community palliative care services. An effective advance care planning programme involves an organizational wide commitment and preparedness for health service reform to embed advance care planning into routine practice. Internationally, such programmes have been implemented predominantly in aged and acute care with more recent work in primary care. A multi-site action research was conducted over a 16-month period in 2007-2009 with three Victorian community palliative care services. Using mixed method data collection strategies to assess feasibility, we conducted a baseline audit of staff and clients; analysed relevant documents (client records, policies, procedures and quality improvement strategies) pre-implementation and post-implementation and conducted key informant interviews (n = 9). Three community palliative care services: one regional and two metropolitan services in Victoria, Australia. The services demonstrated that it was feasible to embed the Model into their organizational structures. Advance care planning conversations and involvement of family was an important outcome measure rather than completion rate of advance care planning documents in community settings. Services adapted and applied their own concept of community, which widened the impact of the model. Changes to quality audit processes were essential to consolidate the model into routine palliative care practice. An advance care planning model is feasible for community palliative care services. Quality audit processes are an essential component of the Model with documentation of advance care planning discussion established as an important outcome measure. © 2011 Blackwell Publishing Ltd.

Strategies for Success of Women Faculty in Science: The ADVANCE Program at the University of Rhode Island

NASA Astrophysics Data System (ADS)

Wishner, K.; Silver, B.; Boudreaux-Bartels, F.; Harlow, L.; Knickle, H.; Mederer, H.; Peckham, J.; Roheim, C.; Trubatch, J.; Webster, K.

2004-12-01

The NSF-funded ADVANCE program seeks to increase the recruitment and retention of women faculty in science, technology, engineering, and mathematics (STEM) disciplines as part of a national goal of creating a broad-based scientific workforce able to effectively address societal demands. The University of Rhode Island, a recipient of an Institutional Transformation ADVANCE grant in 2003, has begun a campus-wide initiative. The 5 goals are (1) to increase the numbers of women STEM faculty, (2) to provide faculty development opportunities, (3) to improve networks of professional and social support, (4) to assess the academic work environment for all faculty, and (5) to implement long-term changes throughout the university that promote a supportive work environment for women STEM faculty. Accomplishments during the first year include (1) hiring several ADVANCE Assistant Professors, (2) developing workshops on critical skills for junior faculty (grant writing, negotiations, mentoring), (3) initiating a series of lunch meetings where pertinent topical and work-family issues are discussed informally, (4) awarding small Incentive grants for research and other projects that enhance the careers of women STEM faculty, (5) developing and modifying university policies on family leave and dual career couple recruitment, (6) developing and implementing quantitative and qualitative assessment tools for baseline and ongoing campus-wide work climate surveys within the context of a theoretical model for change, and (7) offering directed self-study workshops for entire departments using a trained facilitator. The ADVANCE Assistant Professor position, unique to URI's program, allows a new hire to spend the first 2-3 years developing a research program without teaching obligations. ADVANCE pays their salary during this time, at which point they transition to a regular faculty position. During this first of five years of NSF funding, the ADVANCE program has been met with campus wide enthusiasm and interest from both faculty and administration. Further, the program has the potential for invigorating not only STEM departments, but also the wider university, in offering innovative and engaging workshops and policies, as well as providing an opportunity for ongoing self-study through bi-annual surveys across the university.

An Ecosystem-Based Approach to Assess the Status of a Mediterranean Ecosystem, the Posidonia oceanica Seagrass Meadow

PubMed Central

Personnic, Sébastien; Boudouresque, Charles F.; Astruch, Patrick; Ballesteros, Enric; Blouet, Sylvain; Bellan-Santini, Denise; Bonhomme, Patrick; Thibault-Botha, Delphine; Feunteun, Eric; Harmelin-Vivien, Mireille; Pergent, Gérard; Pergent-Martini, Christine; Pastor, Jérémy; Poggiale, Jean-Christophe; Renaud, Florent; Thibaut, Thierry; Ruitton, Sandrine

2014-01-01

Biotic indices, which reflect the quality of the environment, are widely used in the marine realm. Sometimes, key species or ecosystem engineers are selected for this purpose. This is the case of the Mediterranean seagrass Posidonia oceanica, widely used as a biological quality element in the context of the European Union Water Framework Directive (WFD). The good quality of a water body and the apparent health of a species, whether or not an ecosystem engineer such as P. oceanica, is not always indicative of the good structure and functioning of the whole ecosystem. A key point of the recent Marine Strategy Framework Directive (MSFD) is the ecosystem-based approach. Here, on the basis of a simplified conceptual model of the P. oceanica ecosystem, we have proposed an ecosystem-based index of the quality of its functioning, compliant with the MSFD requirements. This index (EBQI) is based upon a set of representative functional compartments, the weighting of these compartments and the assessment of the quality of each compartment by comparison of a supposed baseline. The index well discriminated 17 sites in the north-western Mediterranean (French Riviera, Provence, Corsica, Catalonia and Balearic Islands) covering a wide range of human pressure levels. The strong points of the EBQI are that it is easy to implement, non-destructive, relatively robust, according to the selection of the compartments and to their weighting, and associated with confidence indices that indicate possible weakness and biases and therefore the need for further field data acquisition. PMID:24933020

Low-frequency interferometry: Design, calibration, and analysis towards detecting the epoch of reionization

NASA Astrophysics Data System (ADS)

Parsons, Aaron Robert

Low-frequency interferometry provides us with the possibility of directly observing, via red-shifted 21cm emission, the ionization of the primordial intergalactic medium by radiation from the first stars and black holes. Building such interferometers presents daunting technical challenges related to the cross-correlation, calibration, and analysis of data from large antenna arrays with wide fields-of-view in an observing band below 200 MHz. Addressing cross-correlation data processing, I present a general-purpose correlator architecture that uses standard 10-Gbit Ethernet switches to pass data between flexible hardware modules containing Field Programmable Gate Array chips. These chips are programmed using open-source signal processing libraries developed to be flexible, scalable, and chip-independent. This work reduces the time and cost of implementing a wide range of signal processing systems, and facilitates upgrading to new generations of processing technology. This correlator architecture is supporting the incremental build-out of the Precision Array for Probing the Epoch of Reionization. Targeting calibration concerns, I present a filtering technique that can be applied to individual baselines of wide-bandwidth, wide-field interferometric data to geometrically select regions on the celestial sphere that contain primary calibration sources. The technique relies on the Fourier transformation of wide-band frequency spectra from a given baseline to obtain one-dimensional "delay images", and then the transformation of a time-series of delay images to obtain two-dimensional "delay/delayrate images." These filters are augmented by a one-dimensional, complex CLEAN algorithm has been developed to compensate for data-excision effects related to the removal of radio frequency interference. This approach allows CLEANed, source-isolated data to be used to isolate bandpass and primary beam gain functions. These techniques are applied to PAPER data as a demonstration of their value in calibrating a new generation of low-frequency radio interferometers with wide relative bandwidths and large fields-of-view. Finally, I describe PAPER's overall architecture and summarize two PAPER deployments: a 4-antenna array in of Western Australia and an 8-antenna array in Green Bank, WV. After reporting on system characterization and data analysis techniques, I present an all-sky map synthesized between 139 MHz and 174 MHz using data from both arrays that reaches down to 80 mJy (4.9 K, for a beam size of 2.15e-5 steradians at 154 MHz), with a 10 mJy (620 mK) thermal noise level that indicates what would be achievable with better foreground subtraction. I calculate angular power spectra (Cℓ) in a cold patch and determine them to be dominated by point sources. Although the sample variance of foregrounds dominates errors in these power spectra, I measure a thermal noise level of 310 mK at ℓ = 100 for a 1.46-MHz band centered at 164.5 MHz. This sensitivity level is approximately three orders of magnitude in temperature above the expected level of 21cm fluctuations associated with reionization.

Effects of peer-mediated implementation of visual scripts in middle school.

PubMed

Ganz, Jennifer B; Heath, Amy K; Lund, Emily M; Camargo, Siglia P H; Rispoli, Mandy J; Boles, Margot; Plaisance, Lauren

2012-05-01

Although research has investigated the impact of peer-mediated interventions and visual scripts on social and communication skills in children with autism spectrum disorders, no studies to date have investigated peer-mediated implementation of scripts. This study investigated the effects of peer-implemented scripts on a middle school student with autism, intellectual impairments, and speech-language impairment via a multiple baseline single-case research design across behaviors. The target student demonstrated improvements in three communicative behaviors when implemented by a trained peer; however, behaviors did not generalize to use with an untrained typically developing peer.

Leveraging the Partnership for Patients' Initiative to Improve Patient Safety and Quality Within the Military Health System.

PubMed

King, Heidi B; Kesling, Kimberly; Birk, Carmen; Walker, Theodore; Taylor, Heather; Datena, Michael; Burgess, Brittany; Bower, Lyndsay

2017-03-01

Partnership for Patients (PfP) was a national initiative sponsored by the Department of Health and Human Services, Centers for Medicare and Medicaid Services, to reduce preventable hospital acquired conditions (HACs) by 40% and readmissions (within 30 days) by 20%, by the end of 2013 (as compared to the baseline of CY2010). Along with partners across the nation, the Assistant Secretary of Defense for Health Affairs, Dr. Jonathan Woodson, pledged to support PfP in June 2011. Participation of the Military Health System (MHS) in PfP marked the implementation of the first enterprise-wide patient safety initiative. Three phases of the MHS initiative were developed to meet the aims of the national PfP initiative: (1) Planning and Design, (2) Implementation, and (3) Monitoring and Sustainment. The Planning and Design phase focused on the identification of evidence-based practices (Table III); the development of implementation guides; the implementation of various communication, education, and improvement strategies; and the development of methods by which to track progress and share successes. The implementation phase focused on identifying roles and responsibilities across all levels of care; creating, disseminating, and implementing evidence-based practices at participating military treatment facilities; and establishing a structured learning action network. Finally, during the monitoring and sustainment phase, per the guidance of the Agency for Healthcare Research and Quality, an overall HAC rate was developed for quarterly analysis. The HAC rate per 1,000 dispositions (i.e., discharges) was an aggregate of all PfP HACs. Using the HAC rate, the improvement rate was calculated by comparing the current quarter's HAC rate to the baseline (CY2010). This allowed the MHS to track the overall progress across the enterprise. The MHS achieved a number of accomplishments, including a 15.8% cumulative reduction in HACs by the end of 2013, an 11.1% reduction in readmissions, avoided nearly 500 harm events since PfP implementation, and approximately $13.5 million in cost avoidance (on the basis of national cost estimate data available at the beginning of the PfP initiative). The two most critical lessons learned for the MHS during the PfP initiative are (1) continuous leadership engagement and inspection is vital to ensure field workers are engaged with safety and quality expectations and (2) applying a "one-size-fits-all" approach to improve a large delivery system is not effective. In addition, it is most impactful when local military treatment facility-level teams are involved in determining strategies to implement evidence-based standard processes and protocols that reduce variation when integrating practice change into daily operations. The MHS will continue to integrate PfP efforts into improvement activities by leveraging lessons learned from this initiative and determining how they can be applied to other areas of care and/or patient safety and quality initiatives. The Patient Safety Improvement Collaborative has committed to oversee and support the establishment and implementation of ongoing, focused patient safety and quality initiatives across the MHS using a collaborative vision to engage all levels of leadership and staff, and to ensure sustained improvements. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Supporting Parent Engagement in Programme-Wide Behavioural Intervention Implementation

ERIC Educational Resources Information Center

Cummings, Katrina P.

2017-01-01

Positive behaviour intervention and support (PBIS) models are evolving as an effective means to promote social and emotional competence among young children and address challenging behaviours. This study was designed to gain insights into parental involvement in programme-wide implementation of the "Pyramid" model. Interviews were…

Predicting Abandonment of School-Wide Positive Behavioral Interventions and Supports

ERIC Educational Resources Information Center

Nese, Rhonda; McIntosh, Kent; Nese, Joseph; Hoselton, Robert; Bloom, Jerry; Johnson, Nanci; Richter, Mary; Phillips, Danielle; Ghemraoui, Adam

2016-01-01

This study examines predictors of abandonment of evidence-based practices through descriptive analyses of extant state-level training data, fidelity of implementation data, and nationally reported school demographic data across 915 schools in three states implementing school-wide positive behavioral interventions and supports (SWPBIS). Schools…

Longitudinal study of household smoking ban adoption among Korean Americans.

PubMed

Hughes, Suzanne C; Corcos, Isabel A; Hofstetter, C Richard; Hovell, Melbourne F; Irvin, Veronica L

2009-11-01

Few longitudinal studies have examined the adoption of bans on smoking in private homes. This longitudinal study examined: (1) the prevalence of home smoking bans at baseline, (2) the incidence and predictors of new ban implementation by follow-up, and (3) the reasons for banning smoking and the difficulties with enforcement. The sample consisted of 1360 adults of Korean descent residing in California who were interviewed by telephone (in English/Korean) at baseline during 2001-2002 and re-interviewed in 2006-2007. Data analyses were conducted in 2007-2008. The proportion of respondents with a complete household smoking ban grew from 59% at baseline to 91% by the follow-up interview. Among the 552 respondents who did not have a ban at baseline, 84% had adopted a ban by follow-up. Three baseline factors independently predicted ban adoption during the follow-up period: the presence of a nonsmoking respondent or spouse, the presence of nonsmoking family members, and respondent's belief that secondhand smoke caused lung cancer. The most highly rated reasons for banning smoking were as follows: because smoke annoys others, to protect family members, to avoid the odor, to discourage youth from smoking, and to encourage smokers to quit. Finally, respondents indicated that they would find it most difficult to ask their parent-in-law not to smoke. The proportion of households with smoking bans increased substantially, but households with smokers or family members who smoke remained less likely to implement bans. The importance of culturally sensitive programs to promote household bans cannot be overstated.

Multibaseline interferometric SAR at millimeterwaves test of an algorithm on real data and a synthetic scene

NASA Astrophysics Data System (ADS)

Essen, Helmut; Brehm, Thorsten; Boehmsdorff, Stephan

2007-10-01

Interferometric Synthetic Aperture Radar has the capability to provide the user with the 3-D-Information of land surfaces. To gather data with high height estimation accuracy it is necessary to use a wide interferometric baseline or a high radar frequency. However the problem of resolving the phase ambiguity at smaller wavelengths is more critical than at longer wavelengths, as the unambiguous height interval is inversely proportional to the radar wavelength. To solve this shortcoming, a multiple baseline approach can be used with a number of neighbouring horns and an increasing baselength going from narrow to wide. The narrowest, corresponding to adjacent horns, is then assumed to be unambiguous in phase. This initial interferogram is used as a starting point for the algorithm, which in the next step, unwraps the interferogram with the next wider baseline using the coarse height information to solve the phase ambiguities. This process is repeated consecutively until the interferogram with highest precision is unwrapped. On the expense of this multi-channel-approach the algorithm is simple and robust, and even the amount of processing time is reduced considerably, compared to traditional methods. The multiple baseline approach is especially adequate for millimeterwave radars as antenna horns with relatively small aperture can be used, while a sufficient 3-dB beamwidth is maintained. The paper describes the multiple baseline algorithm and shows the results of tests on real data and a synthetic area. Possibilities and limitations of this approach are discussed. Examples of digital elevation maps derived from measured data at millimeterwaves are shown.

Incorporating pharmacy student activities into an antimicrobial stewardship program in a long-term acute care hospital.

PubMed

Benson, John M

2014-02-01

The impact on antimicrobial costs of an antimicrobial stewardship program (ASP) that integrated pharmacy students as integral members was evaluated. Demographic and discharge disposition data and antimicrobial acquisition cost data were retrospectively collected for all patients admitted to Promise Hospital of Salt Lake between June 1, 2009, and May 31, 2012. During this study, the primary role of pharmacy students in the ASP was to monitor all infection-related patient problems in the facility and meet daily with the infectious diseases pharmacist and clinical pharmacist to develop recommendations for optimizing antimicrobial use. The primary outcome measure was the mean antimicrobial acquisition cost per patient per day, calculated before ASP implementation (baseline period) and two years after ASP implementation (intervention period). The acquisition costs of antimicrobial agents per patient day were compared before and two years after implementation of the ASP involving pharmacy students. Statistical significance was determined using Student's t test for continuous data and the chi-square test for nominal data. The rate of patient discharge to skilled nursing facilities was significantly higher during the intervention period versus the baseline period (p = 0.016); no other significant comparisons were found. The mean ± S.D. antimicrobial costs per patient day were $75.37 ± $11.85 in the baseline period and $64.13 ± $13.78 in the intervention period (p = 0.022). This difference represents a cost savings of $261,630 during the two-year intervention period. Decreased antimicrobial costs were observed over a two-year period after implementation of an ASP that incorporated pharmacy students as integral members of the program.

Long-term outcomes of an antimicrobial stewardship program implemented in a hospital with low baseline antibiotic use.

PubMed

Jenkins, Timothy C; Knepper, Bryan C; Shihadeh, Katherine; Haas, Michelle K; Sabel, Allison L; Steele, Andrew W; Wilson, Michael L; Price, Connie S; Burman, William J; Mehler, Philip S

2015-06-01

To evaluate the long-term outcomes of an antimicrobial stewardship program (ASP) implemented in a hospital with low baseline antibiotic use. Quasi-experimental, interrupted time-series study. Public safety net hospital with 525 beds. Implementation of a formal ASP in July 2008. We conducted a time-series analysis to evaluate the impact of the ASP over a 6.25-year period (July 1, 2008-September 30, 2014) while controlling for trends during a 3-year preintervention period (July 1, 2005-June 30, 2008). The primary outcome measures were total antibacterial and antipseudomonal use in days of therapy (DOT) per 1,000 patient-days (PD). Secondary outcomes included antimicrobial costs and resistance, hospital-onset Clostridium difficile infection, and other patient-centered measures. During the preintervention period, total antibacterial and antipseudomonal use were declining (-9.2 and -5.5 DOT/1,000 PD per quarter, respectively). During the stewardship period, both continued to decline, although at lower rates (-3.7 and -2.2 DOT/1,000 PD, respectively), resulting in a slope change of 5.5 DOT/1,000 PD per quarter for total antibacterial use (P=.10) and 3.3 DOT/1,000 PD per quarter for antipseudomonal use (P=.01). Antibiotic expenditures declined markedly during the stewardship period (-$295.42/1,000 PD per quarter, P=.002). There were variable changes in antimicrobial resistance and few apparent changes in C. difficile infection and other patient-centered outcomes. In a hospital with low baseline antibiotic use, implementation of an ASP was associated with sustained reductions in total antibacterial and antipseudomonal use and declining antibiotic expenditures. Common ASP outcome measures have limitations.

Can volunteer companions prevent falls among inpatients? A feasibility study using a pre-post comparative design

PubMed Central

Giles, Lynne C; Bolch, Denise; Rouvray, Robyn; McErlean, Beth; Whitehead, Craig H; Phillips, Paddy A; Crotty, Maria

2006-01-01

Background Falls in hospital are frequent and their consequences place an increased burden on health services. We evaluated a falls prevention strategy consisting of the introduction of volunteers to 'sit' with patients identified as being at high risk of falling. Methods Two four bed 'safety bays' located on medical wards in two hospitals within southern Adelaide were used. Ward fall rates (expressed as falls per 1000 occupied bed days) were compared in the baseline period (February-May 2002) with the implementation period (February – May 2003) using incident rate ratios and 95% confidence intervals. The number of hours of volunteered time was also collected. Results No patient falls occurred on either site when volunteers were present. However, there was no significant impact on overall ward fall rates. In the baseline period, there were 70 falls in 4828 OBDs (14.5 falls per 1000 OBDs). During the implementation period, there were 82 falls in 5300 OBDs (15.5 falls per 1000 OBD). The IRR for falls in the implementation versus baseline period was 1.07 (95%CI 0.77 – 1.49; P = 0.346). Volunteers carried out care activities (e.g. cutting up food), provided company, and on occasions advocated on behalf of the patients. Volunteers donated 2345 hours, at an estimated value to the hospitals of almost $57,000. Conclusion Volunteers may play an important and cost-effective role in enhancing health care and can prevent falls in older hospital patients when they are present. Full implementation of this program would require the recruitment of adequate numbers of volunteers willing to sit with all patients considered at risk of falling in hospital. The challenge for future work in this area remains the sustainability of falls prevention strategies. PMID:16895609

Can volunteer companions prevent falls among inpatients? A feasibility study using a pre-post comparative design.

PubMed

Giles, Lynne C; Bolch, Denise; Rouvray, Robyn; McErlean, Beth; Whitehead, Craig H; Phillips, Paddy A; Crotty, Maria

2006-08-09

Falls in hospital are frequent and their consequences place an increased burden on health services. We evaluated a falls prevention strategy consisting of the introduction of volunteers to 'sit' with patients identified as being at high risk of falling. Two four bed 'safety bays' located on medical wards in two hospitals within southern Adelaide were used. Ward fall rates (expressed as falls per 1000 occupied bed days) were compared in the baseline period (February-May 2002) with the implementation period (February - May 2003) using incident rate ratios and 95% confidence intervals. The number of hours of volunteered time was also collected. No patient falls occurred on either site when volunteers were present. However, there was no significant impact on overall ward fall rates. In the baseline period, there were 70 falls in 4828 OBDs (14.5 falls per 1000 OBDs). During the implementation period, there were 82 falls in 5300 OBDs (15.5 falls per 1000 OBD). The IRR for falls in the implementation versus baseline period was 1.07 (95%CI 0.77 - 1.49; P = 0.346). Volunteers carried out care activities (e.g. cutting up food), provided company, and on occasions advocated on behalf of the patients. Volunteers donated 2345 hours, at an estimated value to the hospitals of almost $57,000. Volunteers may play an important and cost-effective role in enhancing health care and can prevent falls in older hospital patients when they are present. Full implementation of this program would require the recruitment of adequate numbers of volunteers willing to sit with all patients considered at risk of falling in hospital. The challenge for future work in this area remains the sustainability of falls prevention strategies.

Changes in implementation of two evidence-based psychotherapies for PTSD in VA residential treatment programs: a national investigation.

PubMed

Cook, Joan M; Dinnen, Stephanie; Thompson, Richard; Simiola, Vanessa; Schnurr, Paula P

2014-04-01

There has been little investigation of the natural course of evidence-based treatments (EBTs) over time following the draw-down of initial implementation efforts. Thus, we undertook qualitative interviews with the providers at 38 U.S. Department of Veterans Affairs' residential treatment programs for posttraumatic stress disorder (PTSD) to understand implementation and adaptation of 2 EBTs, prolonged exposure (PE), and cognitive processing therapy (CPT), at 2 time points over a 4-year period. The number of providers trained in the therapies and level of training improved over time. At baseline, of the 179 providers eligible per VA training requirements, 65 (36.4%) had received VA training in PE and 111 (62.0%) in CPT with 17 (9.5%) completing case consultation or becoming national trainers in both PE and CPT. By follow-up, of the increased number of 190 eligible providers, 87 (45.8%) had received VA training in PE and 135 (71.1%) in CPT, with 69 (36.3%) and 81 (42.6%) achieving certification, respectively. Twenty-two programs (57.9%) reported no change in PE use between baseline and follow-up, whereas 16 (42.1%) reported an increase. Twenty-four (63.2%) programs reported no change in their use of CPT between baseline and follow-up, 12 (31.6%) programs experienced an increase, and 2 (5.2%) programs experienced a decrease in use. A significant number of providers indicated that they made modifications to the manuals (e.g., tailoring, lengthening). Reasons for adaptations are discussed. The need to dedicate time and resources toward the implementation of EBTs is noted. Published 2014. This article is a US Government work and is in the public domain in the USA.

Prevention of falls in acute hospital settings: a multi-site audit and best practice implementation project.

PubMed

Stephenson, Matthew; Mcarthur, Alexa; Giles, Kristy; Lockwood, Craig; Aromataris, Edoardo; Pearson, Alan

2016-02-01

To assess falls prevention practices in Australian hospitals and implement interventions to promote best practice. A multi-site audit using eight evidence-based audit criteria. Following a baseline audit, barriers to compliance were identified and targeted. Two follow-up audit cycles assessed the sustainability of practice change. Nine acute care hospitals around Australia, including a mix of public and private. One medical ward and one surgical ward from each hospital were involved. A clinical leader from each hospital, trained in evidence implementation, conducted the audits and implementation strategies in their setting. Multi-component falls prevention interventions were utilized, designed to target specific barriers to compliance identified at each hospital. Common interventions involved staff and patient education. Percentage compliance with falls prevention audit criteria and change in compliance between baseline and follow-up audits. Fall rate data were also analysed. Mean overall compliance at baseline across all hospitals was 50.4% (range 30.8-76.6%). At the first follow-up, this had increased to 74.5% (range 59.4-87.4%), which was sustained at the second follow-up (74.1%, range 48.6-84.4%). There were no statistically significant differences between compliance rates in medical versus surgical wards or in private versus public hospitals. Despite sustained practice improvement, reported fall rates remained unchanged. The focus on staff education possibly led to improved reporting of falls, which may explain the apparent lack of effect on fall rates. Clinical audit and feedback is an effective strategy to promote quality improvement in falls prevention practices in acute hospital settings. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Long-Term Outcomes of an Antimicrobial Stewardship Program Implemented in a Hospital with Low Baseline Antibiotic Use

PubMed Central

Jenkins, Timothy C.; Knepper, Bryan C.; Shihadeh, Katherine; Haas, Michelle K.; Sabel, Allison L.; Steele, Andrew W.; Wilson, Michael L.; Price, Connie S.; Burman, William J.; Mehler, Philip S.

2016-01-01

Objective To evaluate the long-term outcomes of an antimicrobial stewardship program (ASP) implemented in a hospital with low baseline antibiotic use Design Quasi-experimental, interrupted-time series study Setting 525-bed public safety-net hospital Intervention Implementation of a formal ASP in July 2008 Methods We conducted a time-series analysis to evaluate the impact of the ASP over a 6.25-year period (July 1, 2008 – September 30, 2014) while controlling for trends during a 3-year preintervention period (July 1, 2005 – June 30, 2008). The primary outcome measures were total antibacterial and antipseudomonal use in days of therapy (DOT) per 1000 patient-days (PD). Secondary outcomes included antimicrobial costs and resistance, hospital-onset C. difficile infection, and other patient-centered measures. Results During the preintervention period, total antibacterial and antipseudomonal use were declining (−9.2 and −5.5 DOT/1000 PD per quarter, respectively). During the stewardship period, both continued to decline, although at lower rates (−3.7 and −2.2 DOT/1000 PD, respectively), resulting in a slope change of 5.5 DOT/1000 PD per quarter for total antibacterial use (P = .10) and 3.3 DOT/100 PD per quarter for antipseudomonal use (P = .01). Antibiotic expenditures declined markedly during the stewardship period (−$295.42/1000PD per quarter, p=.002). There were variable changes in antimicrobial resistance and few apparent changes in C. difficile infection and other patient-centered outcomes. Conclusion In a hospital with low baseline antibiotic use, implementation of an ASP was associated with sustained reductions in total antibacterial and antipseudomonal use and declining antibiotic expenditures; however, this study highlights limitations of commonly used stewardship outcome measures. PMID:25740560

Deploying a Route Optimization EFB Application for Commercial Airline Operational Trials

NASA Technical Reports Server (NTRS)

Roscoe, David A.; Vivona, Robert A.; Woods, Sharon E.; Karr, David A.; Wing, David J.

2016-01-01

The Traffic Aware Planner (TAP), developed for NASA Langley Research Center to support the Traffic Aware Strategic Aircrew Requests (TASAR) project, is a flight-efficiency software application developed for an Electronic Flight Bag (EFB). Tested in two flight trials and planned for operational testing by two commercial airlines, TAP is a real-time trajectory optimization application that leverages connectivity with onboard avionics and broadband Internet sources to compute and recommend route modifications to flight crews to improve fuel and time performance. The application utilizes a wide range of data, including Automatic Dependent Surveillance Broadcast (ADS-B) traffic, Flight Management System (FMS) guidance and intent, on-board sensors, published winds and weather, and Special Use Airspace (SUA) schedules. This paper discusses the challenges of developing and deploying TAP to various EFB platforms, our solutions to some of these challenges, and lessons learned, to assist commercial software developers and hardware manufacturers in their efforts to implement and extend TAP functionality in their environments. EFB applications (such as TAP) typically access avionics data via an ARINC 834 Simple Text Avionics Protocol (STAP) server hosted by an Aircraft Interface Device (AID) or other installed hardware. While the protocol is standardized, the data sources, content, and transmission rates can vary from aircraft to aircraft. Additionally, the method of communicating with the AID may vary depending on EFB hardware and/or the availability of onboard networking services, such as Ethernet, WIFI, Bluetooth, or other mechanisms. EFBs with portable and installed components can be implemented using a variety of operating systems, and cockpits are increasingly incorporating tablet-based technologies, further expanding the number of platforms the application may need to support. Supporting multiple EFB platforms, AIDs, avionics datasets, and user interfaces presents a challenge for software developers and the management of their code baselines. Maintaining multiple baselines to support all deployment targets can be extremely cumbersome and expensive. Certification also needs to be considered when developing the application. Regardless of whether the software is itself destined to be certified, data requirements in support of the application and user interface elements may introduce certification requirements for EFB manufacturers and the airlines. The example of TAP, the challenges faced, solutions implemented, and lessons learned will give EFB application and hardware developers insight into future potential requirements in deploying TAP or similar flight-deck EFB applications.

Better Decisions through Consultation and Collaboration

EPA Pesticide Factsheets

This manual discusses the benefits of public involvement to agency decision makers, including expanding shared baseline knowledge, generating support for the decision, and developing ongoing relationships that will help in implementing decisions.

Effects of video modeling on treatment integrity of behavioral interventions.

PubMed

Digennaro-Reed, Florence D; Codding, Robin; Catania, Cynthia N; Maguire, Helena

2010-01-01

We examined the effects of individualized video modeling on the accurate implementation of behavioral interventions using a multiple baseline design across 3 teachers. During video modeling, treatment integrity improved above baseline levels; however, teacher performance remained variable. The addition of verbal performance feedback increased treatment integrity to 100% for all participants, and performance was maintained 1 week later. Teachers found video modeling to be more socially acceptable with performance feedback than alone, but rated both positively.

Evidence-Based Bundles and Cesarean Delivery Surgical Site Infections: A Systematic Review and Meta-analysis.

PubMed

Carter, Ebony B; Temming, Lorene A; Fowler, Susan; Eppes, Catherine; Gross, Gilad; Srinivas, Sindhu K; Macones, George A; Colditz, Graham A; Tuuli, Methodius G

2017-10-01

To estimate the association of implementation of evidence-based bundles with surgical site infection rates after cesarean delivery. We searched MEDLINE through PubMed, EMBASE, Scopus, the Cochrane Database of Systematic Reviews, Google Scholar, and ClinicalTrials.gov. We searched electronic databases for randomized controlled trials and observational studies comparing evidence-based infection prevention bundles for cesarean delivery, defined as implementation of three or more processes proven to prevent surgical site infection such as chlorhexidine skin preparation, antibiotic prophylaxis, and hair clipping, with usual care. The primary outcome was overall surgical site infection, defined using Centers for Disease Control and Prevention's National Healthcare Safety Network criteria. Secondary outcomes were superficial or deep surgical site infection and endometritis. Quality of studies and heterogeneity were assessed using validated measures. Pooled relative risks (RRs) with 95% CIs were calculated using random-effects models. Numbers needed to treat were estimated for outcomes with significant reduction. We found no randomized controlled trials. Fourteen preintervention and postintervention studies met inclusion criteria. Eight were full-text articles, and six were published abstracts. Quality of most of the primary studies was adequate with regard to the intervention, but modest in terms of implementation. The rate of surgical site infection was significantly lower after implementing an evidence-based bundle (14 studies: pooled rates 6.2% baseline compared with 2.0% intervention, pooled RR 0.33, 95% CI 0.25-0.43, number needed to treat=24). Evidence-based bundles were also associated with a lower rate of superficial or deep surgical site infection (six studies: pooled rate 5.9% baseline compared with 1.1% intervention, pooled RR 0.19, 95% CI 0.12-0.32, number needed to treat=21). The rate of endometritis was low at baseline and not significantly different after intervention (six studies: pooled rate 1.3% baseline compared with 0.9% intervention, pooled RR 0.57, 95% CI 0.31-1.06). Evidence-based bundles are associated with a significant reduction in surgical site infection after cesarean delivery.

Implementation of a cystic fibrosis lung transplant referral patient decision aid in routine clinical practice: an observational study.

PubMed

Stacey, Dawn; Vandemheen, Katherine L; Hennessey, Rosamund; Gooyers, Tracy; Gaudet, Ena; Mallick, Ranjeeta; Salgado, Josette; Freitag, Andreas; Berthiaume, Yves; Brown, Neil; Aaron, Shawn D

2015-02-07

The decision to have lung transplantation as treatment for end-stage lung disease from cystic fibrosis (CF) has benefits and serious risks. Although patient decision aids are effective interventions for helping patients reach a quality decision, little is known about implementing them in clinical practice. Our study evaluated a sustainable approach for implementing a patient decision aid for adults with CF considering referral for lung transplantation. A prospective pragmatic observational study was guided by the Knowledge-to-Action Framework. Healthcare professionals in all 23 Canadian CF clinics were eligible. We surveyed participants regarding perceived barriers and facilitators to patient decision aid use. Interventions tailored to address modifiable identified barriers included training, access to decision aids, and conference calls. The primary outcome was >80% use of the decision aid in year 2. Of 23 adult CF clinics, 18 participated (78.2%) and 13 had healthcare professionals attend training. Baseline barriers were healthcare professionals' inadequate knowledge for supporting patients making decisions (55%), clarifying patients' values for outcomes of options (58%), and helping patients handle conflicting views of others (71%). Other barriers were lack of time (52%) and needing to change how transplantation is discussed (42%). Baseline facilitators were healthcare professionals feeling comfortable discussing bad transplantation outcomes (74%), agreeing the decision aid would be easy to experiment with (71%) and use in the CF clinic (87%), and agreeing that using the decision aid would not require reorganization of the CF clinic (90%). After implementing the decision aid with interventions tailored to the barriers, decision aid use increased from 29% at baseline to 85% during year 1 and 92% in year 2 (p < 0.001). Compared to baseline, more healthcare professionals at the end of the study were confident in supporting decision-making (p = 0.03) but continued to feel inadequate ability with supporting patients to handle conflicting views (p = 0.01). Most Canadian CF clinics agreed to participate in the study. Interventions were used to target identified modifiable barriers to using the patient decision aid in routine CF clinical practice. CF clinics reported using it with almost all patients in the second year.

An Analysis of Implementation Strategies in a School-Wide Vocabulary Intervention

ERIC Educational Resources Information Center

Roskos, Katheen A.; Moe, Jennifer Randazzo; Rosemary, Catherine

2017-01-01

From an improvement research perspective, this study explores strategies used to implement a school-wide vocabulary intervention into language arts instruction at an urban elementary school. Academic language time, an innovative change in the instructional delivery system, allots time and structure for deliberate teaching of cross-disciplinary…

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.

Profile of NASA software engineering: Lessons learned from building the baseline

NASA Technical Reports Server (NTRS)

Hall, Dana; Mcgarry, Frank

1993-01-01

It is critically important in any improvement activity to first understand the organization's current status, strengths, and weaknesses and, only after that understanding is achieved, examine and implement promising improvements. This fundamental rule is certainly true for an organization seeking to further its software viability and effectiveness. This paper addresses the role of the organizational process baseline in a software improvement effort and the lessons we learned assembling such an understanding for NASA overall and for the NASA Goddard Space Flight Center in particular. We discuss important, core data that must be captured and contrast that with our experience in actually finding such information. Our baselining efforts have evolved into a set of data gathering, analysis, and crosschecking techniques and information presentation formats that may prove useful to others seeking to establish similar baselines for their organization.

Constraints on Pacific plate kinematics and dynamics with global positioning system measurements

NASA Technical Reports Server (NTRS)

Dixon, T. H.; Golombek, M. P.; Thornton, C. L.

1985-01-01

A measurement program designed to investigate kinematic and dynamic aspects of plate tectonics in the Pacific region by means of satellite observations is proposed. Accuracy studies are summarized showing that for short baselines (less than 100 km), the measuring accuracy of global positioning system (GPS) receivers can be in the centimeter range. For longer baselines, uncertainty in the orbital ephemerides of the GPS satellites could be a major source of error. Simultaneous observations at widely (about 300 km) separated fiducial stations over the Pacific region, should permit an accuracy in the centimeter range for baselines of up to several thousand kilometers. The optimum performance level is based on the assumption of that fiducial baselines are known a priori to the centimeter range. An example fiducial network for a GPS study of the South Pacific region is described.

Enhancing organizational capacity to provide cancer control programs among Latino churches: design and baseline findings of the CRUZA Study.

PubMed

Allen, Jennifer D; Torres, Maria Idali; Tom, Laura S; Rustan, Sarah; Leyva, Bryan; Negron, Rosalyn; Linnan, Laura A; Jandorf, Lina; Ospino, Hosffman

2015-04-09

Faith-based organizations (FBOs) have been successful in delivering health promotion programs for African Americans, though few studies have been conducted among Latinos. Even fewer have focused on organizational change, which is required to sustain community-based initiatives. We hypothesized that FBOs serving Latinos would be more likely to offer evidence-based strategies (EBS) for cancer control after receiving a capacity enhancement intervention to implement health programs, and designed the CRUZA trial to test this hypothesis. This paper describes the CRUZA design and baseline findings. We identified Catholic parishes in Massachusetts that provided Spanish-language mass (n = 65). A baseline survey assessed organizational characteristics relevant to adoption of health programs, including readiness for adoption, "fit" between innovation and organizational mission, implementation climate, and organizational culture. In the next study phase, parishes that completed the baseline assessment will be recruited to a randomized cluster trial, with the parish as the unit of analysis. Both groups will receive a Program Manual and Toolkit. Capacity Enhancement parishes will also be offered technical support, assistance forming health committees and building inter-institutional partnerships, and skills-based training. Of the 49 parishes surveyed at baseline (75%), one-third (33%) reported having provided at least one health program in the prior year. However, only two program offerings were cancer-specific. Nearly one-fifth (18%) had an active health ministry. There was a high level of organizational readiness to adopt cancer control programs, high congruence between parish missions and CRUZA objectives, moderately conducive implementation climates, and organizational cultures supportive of CRUZA programming. Having an existing health ministry was significantly associated with having offered health programs within the past year. Relationships between health program offerings and other organizational characteristics were not statistically significant. Findings suggest that many parishes do not offer cancer control programs, yet many may be ready to do so. However, the perceptions about existing organizational practices and policies may not be conducive to program initiation. A capacity enhancement intervention may hold promise as a means of increasing health programming. The efficacy of such an intervention will be tested in phase two of this study.

A Cluster-randomized Trial of a Centralized Clinical Pharmacy Cardiovascular Risk Service to Improve Guideline Adherence

PubMed Central

Carter, Barry L.; Coffey, Christopher S.; Chrischilles, Elizabeth A.; Ardery, Gail; Ecklund, Dixie; Gryzlak, Brian; Vander Weg, Mark W.; James, Paul A.; Christensen, Alan J.; Parker, Christopher P.; Gums, Tyler; Finkelstein, Rachel J; Uribe, Liz; Polgreen, Linnea A.

2015-01-01

Background Numerous studies have demonstrated the value of including pharmacists in team-based care to improve adherence to cardiovascular (CV) guidelines, medication adherence and risk factor control but there is limited information on whether these models can be successfully implemented more widely in diverse settings and populations. The purpose of this study is to evaluate whether a centralized, web-based CV risk service (CVRS) managed by clinical pharmacists will improve guideline adherence in multiple primary care medical offices with diverse geographic and patient characteristics. Methods This study is a prospective trial in 20 primary care offices stratified by the percent of under-represented minorities and then randomized to either the CVRS intervention or usual care. The intervention will last for 12 months and all subjects will have research visits at baseline and 12 months. The primary outcome is the difference in guideline adherence between groups. Data will also be abstracted from the medical record at 24 months to determine if the intervention effect is sustained after it is discontinued. Conclusions This study expects to enroll subjects through 2016 with results expected in 2019. This study will provide information on whether a distant, centralized CV risk service can be implemented in large numbers of medical offices, if it is effective in diverse populations, and if the effect can be sustained long-term. PMID:26111939

Digital Front End for Wide-Band VLBI Science Receiver

NASA Technical Reports Server (NTRS)

Jongeling, Andre; Sigman, Elliott; Navarro, Robert; Goodhart, Charles; Rogstad, Steve; Chandra, Kumar; Finley, Sue; Trinh, Joseph; Soriano, Melissa; White, Les;

Baseline Assessment of Campus-Wide General Health Status and Mental Health: Opportunity for Tailored Suicide Prevention and Mental Health Awareness Programming

ERIC Educational Resources Information Center

Hawley, Lisa D.; MacDonald, Michael G.; Wallace, Erica H.; Smith, Julia; Wummel, Brian; Wren, Patricia A.

2016-01-01

Objective: A campus-wide assessment examined the physical and mental health status of a midsize midwestern public university. Participants: Two thousand and forty-nine students, faculty, and staff on a single college campus were assessed in March-April 2013. Methods: Participants completed an online survey with sections devoted to demographics,…

On the possibility of producing definitive magnetic observatory data within less than one year

NASA Astrophysics Data System (ADS)

Mandić, Igor; Korte, Monika

2017-04-01

Geomagnetic observatory data are fundamental in geomagnetic field studies and are widely used in other applications. Often they are combined with satellite and ground survey data. Unfortunately, the observatory definitive data are only available with a time lag ranging from several months up to more than a year. The reason for this lag is the annual production of the final calibration values, i.e. baselines that are used to correct preliminary data from continuously recording magnetometers. In this paper, we will show that the preparation of definitive geomagnetic data is possible within a calendar year and presents an original method for prompt and automatic estimation of the observatory baselines. The new baselines, obtained in a mostly automatic manner, are compared with the baselines reported on INTERMAGNET DVDs for the 2009-2011 period. The high quality of the baselines obtained by the proposed method indicates its suitability for data processing in fully automatic observatories when automated absolute instruments will be deployed at remote sites.

The VLBI time delay function for synchronous orbits

NASA Technical Reports Server (NTRS)

Rosenbaum, B.

1972-01-01

The VLBI is a satellite tracking technique that to date was applied largely to the tracking of synchronous orbits. These orbits are favorable for VLBI in that the remote satellite range allows continuous viewing from widely separated stations. The primary observable, geometric time delay is the time difference for signal propagation between satellite and baseline terminals. Extraordinary accuracy in angular position data on the satellite can be obtained by observation from baselines of continental dimensions. In satellite tracking though the common objective is to derive orbital elements. A question arises as to how the baseline vector bears on the accuracy of determining the elements. Our approach to this question is to derive an analytic expression for the time delay function in terms of Kepler elements and station coordinates. The analysis, which is for simplicity based on elliptic motion, shows that the resolution for the inclination of the orbital plane depends on the magnitude of the baseline polar component and the resolution for in-plane elements depends on the magnitude of a projected equatorial baseline component.

Teaching foster grandparents to train severely handicapped persons.

PubMed Central

Fabry, P L; Reid, D H

1978-01-01

Five foster grandparents were taught training skills for use in their daily interactions with severely handicapped persons in an institution. Following baseline, specific teaching procedures consisting of teacher instructions, prompts, modelling, and praise were implemented. The grandparents' frequency of training three skill areas increased as the specific teaching was implemented in multiple-baseline format. The total amount of training continued as teacher instructions, prompts, and modelling were terminated and praise continued, although the grandparents spent their training time emphasizing only two of the three skill areas. Teacher presence was gradually reduced over an 11-week period, with no decrease in grandparents' frequency of training. Four of the foster grandchildren, all profoundly retarded and multiply handicapped, demonstrated progress throughout the study. Results were discussed in light of the available contributions of foster grandparents in institutional settings and maintenance of staff training. PMID:148446

Patient safety ward round checklist via an electronic app: implications for harm prevention.

PubMed

Keller, C; Arsenault, S; Lamothe, M; Bostan, S R; O'Donnell, R; Harbison, J; Doherty, C P

2017-11-06

Patient safety is a value at the core of modern healthcare. Though awareness in the medical community is growing, implementing systematic approaches similar to those used in other high reliability industries is proving difficult. The aim of this research was twofold, to establish a baseline for patient safety practices on routine ward rounds and to test the feasibility of implementing an electronic patient safety checklist application. Two research teams were formed; one auditing a medical team to establish a procedural baseline of "usual care" practice and an intervention team concurrently was enforcing the implementation of the checklist. The checklist was comprised of eight standard clinical practice items. The program was conducted over a 2-week period and 1 month later, a retrospective analysis of patient charts was conducted using a global trigger tool to determine variance between the experimental groups. Finally, feedback from the physician participants was considered. The results demonstrated a statistically significant difference on five variables of a total of 16. The auditing team observed low adherence to patient identification (0.0%), hand decontamination (5.5%), and presence of nurse on ward rounds (6.8%). Physician feedback was generally positive. The baseline audit demonstrated significant practice bias on daily ward rounds which tended to omit several key-proven patient safety practices such as prompting hand decontamination and obtaining up to date reports from nursing staff. Results of the intervention arm demonstrate the feasibility of using the Checklist App on daily ward rounds.

Interventions to Improve Safe Sleep Among Hospitalized Infants at Eight Children's Hospitals.

PubMed

Kuhlmann, Stephanie; Ahlers-Schmidt, Carolyn R; Lukasiewicz, Gloria; Truong, Therese Macasiray

2016-02-01

Within hospital pediatric units, there is a lack of consistent application or modeling of the American Academy of Pediatrics recommendations for safe infant sleep. The purpose of this study was to improve safe sleep practices for infants in nonneonatal pediatric units with implementation of specific interventions. This multi-institutional study was conducted by using baseline observations collected for sleep location, position, and environment (collectively, "safe sleep") of infants admitted to pediatric units. Interventions consisted of: (1) staff education, including a commitment to promote safe sleep; (2) implementing site-generated safe sleep policies; (3) designating supply storage in patient rooms; and/or (4) caregiver education. Postintervention observations of safe sleep were collected. Eight hospitals participated from the Inpatient FOCUS Group of the Children's Hospital Association. Each site received institutional review board approval/exemption. Safe sleep was observed for 4.9% of 264 infants at baseline and 31.2% of 234 infants postintervention (P<.001). Extra blankets, the most common of unsafe items, were present in 77% of cribs at baseline and 44% postintervention. However, the mean number of unsafe items observed in each sleeping environment was reduced by >50% (P=.001). Implementation of site-specific interventions seems to improve overall safe sleep in inpatient pediatric units, although continued improvement is needed. Specifically, extra items are persistently left in the sleeping environment. Moving forward, hospitals should evaluate their compliance with American Academy of Pediatrics recommendations and embrace initiatives to improve modeling of safe sleep. Copyright © 2016 by the American Academy of Pediatrics.

Before and after study of bar workers' perceptions of the impact of smoke-free workplace legislation in the Republic of Ireland.

PubMed

Pursell, Lisa; Allwright, Shane; O'Donovan, Diarmuid; Paul, Gillian; Kelly, Alan; Mullally, Bernie J; D'Eath, Maureen

2007-06-29

To compare support for, and perceptions of, the impacts of smoke-free workplace legislation among bar workers in the Republic of Ireland (ROI) pre- and post-implementation, and to identify predictors of support for the legislation. Public houses (pubs) in three areas of the ROI. Comparisons pre- and post-implementation of smoke-free workplace legislation. From a largely non-random selection, 288 bar workers volunteered for the baseline survey; 220 were followed up one year later (76.4%). Level of support for the legislation, attitude statements concerning potential impacts of the law and modelled predictors of support for the legislation. Pre-implementation 59.5% of participants supported the legislation, increasing to 76.8% post-implementation. Support increased among smokers by 27.3 percentage points from 39.4% to 66.7% (p < 0.001) and among non-smokers by 12.4% percentage points from 68.8% to 81.2% (p = 0.003).Pre-legislation three-quarters of participants agreed that the legislation would make bars more comfortable and was needed to protect workers' health. Post-legislation these proportions increased to over 90% (p < 0.001). However, negative perceptions also increased, particularly for perceptions that the legislation has a negative impact on business (from 50.9% to 62.7%, p = 0.008) and that fewer people would visit pubs (41.8% to 62.7%, p < 0.001). After adjusting for relevant covariates, including responses to the attitude statements, support for the ban increased two to three-fold post-implementation. Regardless of their views on the economic impact, most participants agreed, both pre- and post-implementation, that the legislation was needed to protect bar workers' health. Smoke-free legislation had the support of three-quarters of a large sample of bar workers in the ROI. However, this group holds complex sets of both positive and negative perspectives on the legislation. Of particular importance is that negative economic perceptions did not diminish the widely held perception that the ban is needed to protect workers' health.

Implementation of evidence-based weekend service recommendations for allied health managers: a cluster randomised controlled trial protocol.

PubMed

Sarkies, Mitchell N; White, Jennifer; Morris, Meg E; Taylor, Nicholas F; Williams, Cylie; O'Brien, Lisa; Martin, Jenny; Bardoel, Anne; Holland, Anne E; Carey, Leeanne; Skinner, Elizabeth H; Bowles, Kelly-Ann; Grant, Kellie; Philip, Kathleen; Haines, Terry P

2018-04-24

It is widely acknowledged that health policy and practice do not always reflect current research evidence. Whether knowledge transfer from research to practice is more successful when specific implementation approaches are used remains unclear. A model to assist engagement of allied health managers and clinicians with research implementation could involve disseminating evidence-based policy recommendations, along with the use of knowledge brokers. We developed such a model to aid decision-making for the provision of weekend allied health services. This protocol outlines the design and methods for a multi-centre cluster randomised controlled trial to evaluate the success of research implementation strategies to promote evidence-informed weekend allied health resource allocation decisions, especially in hospital managers. This multi-centre study will be a three-group parallel cluster randomised controlled trial. Allied health managers from Australian and New Zealand hospitals will be randomised to receive either (1) an evidence-based policy recommendation document to guide weekend allied health resource allocation decisions, (2) the same policy recommendation document with support from a knowledge broker to help implement weekend allied health policy recommendations, or (3) a usual practice control group. The primary outcome will be alignment of weekend allied health service provision with policy recommendations. This will be measured by the number of allied health service events (occasions of service) occurring on weekends as a proportion of total allied health service events for the relevant hospital wards at baseline and 12-month follow-up. Evidence-based policy recommendation documents communicate key research findings in an accessible format. This comparatively low-cost research implementation strategy could be combined with using a knowledge broker to work collaboratively with decision-makers to promote knowledge transfer. The results will assist managers to make decisions on resource allocation, based on evidence. More generally, the findings will inform the development of an allied health model for translating research into practice. This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) ( ACTRN12618000029291 ). Universal Trial Number (UTN): U1111-1205-2621.

Barriers Associated with Implementing a Campus-Wide Smoke-Free Policy

ERIC Educational Resources Information Center

Harbison, Philip Adam; Whitman, Marilyn V.

2008-01-01

Purpose: The purpose of this study is to review the barriers associated with implementing a campus-wide smoke-free policy as perceived by the American Cancer Society's Colleges against Cancer (CAC) Program chapter representatives. Design/methodology/approach: Four focus group sessions were conducted at the annual CAC National Leadership Summit in…

10 CFR Appendix C to Subpart D of... - Classes of Actions that Normally Require EAs But Not Necessarily EISs

Code of Federal Regulations, 2011 CFR

2011-01-01

.../construction/operation of energy system prototypes C13. Import/export natural gas, minor new construction... Marketing Administration system-wide vegetation management program. C6Implementation of a Power Marketing Administration system-wide erosion control program. C7Establishment and implementation of contracts, policies...

Staff Concerns in Schools Planning for and Implementing School-Wide Positive Behavior Interventions and Supports

ERIC Educational Resources Information Center

Tyre, Ashli D.; Feuerborn, Laura L.; Woods, Leslie

2018-01-01

Understanding staff concerns about a systemic change effort allows leadership teams to better anticipate and address staff needs for professional development and support. In this study, staff concerns in nine schools planning for or implementing School-Wide Positive Behavior Interventions and Supports (SWPBIS) were explored using the…

Comparability of Fidelity Measures for Assessing Tier 1 School-Wide Positive Behavioral Interventions and Supports

ERIC Educational Resources Information Center

Mercer, Sterett H.; McIntosh, Kent; Hoselton, Robert

2017-01-01

Several reliable and valid fidelity surveys are commonly used to assess Tier 1 implementation in School-Wide Positive Behavioral Interventions and Supports (SWPBIS); however, differences across surveys complicate consequential decisions regarding school implementation status when multiple measures are compared. To address this concern, the current…

Perceived Enablers and Barriers Related to Sustainability of School-Wide Positive Behavioral Interventions and Supports

ERIC Educational Resources Information Center

Pinkelman, Sarah; McIntosh, Kent; Raspica, Caitlin; Berg, Tricia; Strickland-Cohen, M. Kathleen

2015-01-01

The purpose of this study was to identify the most important perceived enablers and barriers regarding sustainability of School-wide Positive Behavioral Interventions and Supports (SWPBIS). School personnel representing 860 schools implementing or preparing to implement SWPBIS completed an open-ended survey of factors regarding its sustainability.…

Examining the Association Between Implementation and Outcomes

PubMed Central

Pas, Elise T.; Bradshaw, Catherine P.

2012-01-01

Although there is an established literature supporting the efficacy of a variety of prevention programs, there has been less empirical work on the tran of such research to everyday practice or when scaled-up state-wide. There is a considerable need for more research on factors that enhance implementation of programs and optimize outcomes, particularly in school settings. The current paper examines how the implementation fidelity of an increasingly popular and widely disseminated prevention model called, School-wide Positive Behavioral Interventions and Supports (SW-PBIS), relates to student outcomes within the context of a state-wide scale-up effort. Data come from a scale-up effort of SW-PBIS in Maryland; the sample included 421 elementary and middle schools trained in SW-PBIS. SW-PBIS fidelity, as measured by one of three fidelity measures, was found to be associated with higher math achievement, higher reading achievement, and lower truancy. School contextual factors were related to implementation levels and outcomes. Implications for scale-up efforts of behavioral and mental health interventions and measurement considerations are discussed. PMID:22836758

Avionics test bed development plan

NASA Technical Reports Server (NTRS)

Harris, L. H.; Parks, J. M.; Murdock, C. R.

1981-01-01

A development plan for a proposed avionics test bed facility for the early investigation and evaluation of new concepts for the control of large space structures, orbiter attached flex body experiments, and orbiter enhancements is presented. A distributed data processing facility that utilizes the current laboratory resources for the test bed development is outlined. Future studies required for implementation, the management system for project control, and the baseline system configuration are defined. A background analysis of the specific hardware system for the preliminary baseline avionics test bed system is included.

Establishing a store baseline during interim storage of waste packages and a review of potential technologies for base-lining

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

McTeer, Jennifer; Morris, Jenny; Wickham, Stephen

Interim storage is an essential component of the waste management lifecycle, providing a safe, secure environment for waste packages awaiting final disposal. In order to be able to monitor and detect change or degradation of the waste packages, storage building or equipment, it is necessary to know the original condition of these components (the 'waste storage system'). This paper presents an approach to establishing the baseline for a waste-storage system, and provides guidance on the selection and implementation of potential base-lining technologies. The approach is made up of two sections; assessment of base-lining needs and definition of base-lining approach. Duringmore » the assessment of base-lining needs a review of available monitoring data and store/package records should be undertaken (if the store is operational). Evolutionary processes (affecting safety functions), and their corresponding indicators, that can be measured to provide a baseline for the waste-storage system should then be identified in order for the most suitable indicators to be selected for base-lining. In defining the approach, identification of opportunities to collect data and constraints is undertaken before selecting the techniques for base-lining and developing a base-lining plan. Base-lining data may be used to establish that the state of the packages is consistent with the waste acceptance criteria for the storage facility and to support the interpretation of monitoring and inspection data collected during store operations. Opportunities and constraints are identified for different store and package types. Technologies that could potentially be used to measure baseline indicators are also reviewed. (authors)« less

Implementation of a School-wide Clinical Intervention Documentation System

PubMed Central

Stevenson, T. Lynn; Fox, Brent I.; Andrus, Miranda; Carroll, Dana

2011-01-01

Objective. To evaluate the effectiveness and impact of a customized Web-based software program implemented in 2006 for school-wide documentation of clinical interventions by pharmacy practice faculty members, pharmacy residents, and student pharmacists. Methods. The implementation process, directed by a committee of faculty members and school administrators, included preparation and refinement of the software, user training, development of forms and reports, and integration of the documentation process within the curriculum. Results. Use of the documentation tool consistently increased from May 2007 to December 2010. Over 187,000 interventions were documented with over $6.2 million in associated cost avoidance. Conclusions. Successful implementation of a school-wide documentation tool required considerable time from the oversight committee and a comprehensive training program for all users, with ongoing monitoring of data collection practices. Data collected proved to be useful to show the impact of faculty members, residents, and student pharmacists at affiliated training sites. PMID:21829264

An evaluation of video modeling with embedded instructions to teach implementation of stimulus preference assessments.

PubMed

Rosales, Rocío; Gongola, Leah; Homlitas, Christa

2015-01-01

A multiple baseline design across participants was used to evaluate the effects of video modeling with embedded instructions on training teachers to implement 3 preference assessments. Each assessment was conducted with a confederate learner or a child with autism during generalization probes. All teachers met the predetermined mastery criterion, and 2 of the 3 demonstrated skill maintenance at 1-month follow-up.

An Incentive Program for Nurse Aides Implementation Report: Description and Evaluation. Illinois Long Term Care Research and Demonstration Projects Series. Final Report.

ERIC Educational Resources Information Center

Sinke, Mary

This study examined a nursing aide recognition program in a nursing home with 50 nurses and 200 nurse aides. Before the program was implemented, baseline data on job satisfaction were gathered with a questionnaire. A one-page description of the program and an evaluation tool were distributed to the nurse aides at their information sessions. Nurse…

Quality Improvement Initiative on Pain Knowledge, Assessment, and Documentation Skills of Pediatric Nurses.

PubMed

Margonary, Heather; Hannan, Margaret S; Schlenk, Elizabeth A

2017-01-01

Pain treatment begins with a nurse’s assessment, which relies on effective assessment skills. Hospital settings have implemented pain assessment education, but there is limited evidence in pediatric transitional care settings. The purpose of this quality improvement (QI) initiative was to develop, implement, and evaluate an evidence-based pain education session with 20 nurses in a pediatric specialty hospital that provides transitional care. Specific aims were to assess nurses’ knowledge and attitudes of pain, and evaluate assessment skills based on nurses’ documentation. A prospective pre-post design with three assessments (baseline, post-intervention, and one-month follow-up) was used. The Shriner’s Pediatric Nurses’ Knowledge and Attitudes Regarding Pain questionnaire and an electronic health record review were completed at each assessment. There was significant improvement in nurses’ knowledge and attitudes of pain after the education session (F[2,6] = 50.281, p < 0.0001) from baseline to post-intervention (p < 0.0001), which was maintained at follow-up (p = 0.009). Pain assessment frequency by nurses significantly increased from 43.1% at baseline to 64.8% at post-intervention, and 67.7% at follow-up (χ²[2] = 20.55, p < 0.0001). Developmentally appropriate pain scale usage increased significantly, from 13.1% at baseline to 77.4% at post-intervention, and 81.8% at follow-up (χ²[2] = 169.19, p < 0.0001). Nursing interventions for pain increased significantly, from 33.3% at baseline to 84.0% at post-intervention, and stabilized at 80.0% at follow-up (χ²[2] = 8.91, p = 0.012). Frequency of pain reassessments did not show a statistically significant change, decreasing from 77.8% at baseline to 44.0% at post-intervention and 40.0% at follow-up (χ²[2]= 3.538, p = 0.171). Nurses’ pain knowledge and documentation of assessment skills were improved in this QI initiative.

Network Adjustment of Orbit Errors in SAR Interferometry

NASA Astrophysics Data System (ADS)

Bahr, Hermann; Hanssen, Ramon

2010-03-01

Orbit errors can induce significant long wavelength error signals in synthetic aperture radar (SAR) interferograms and thus bias estimates of wide-scale deformation phenomena. The presented approach aims for correcting orbit errors in a preprocessing step to deformation analysis by modifying state vectors. Whereas absolute errors in the orbital trajectory are negligible, the influence of relative errors (baseline errors) is parametrised by their parallel and perpendicular component as a linear function of time. As the sensitivity of the interferometric phase is only significant with respect to the perpendicular base-line and the rate of change of the parallel baseline, the algorithm focuses on estimating updates to these two parameters. This is achieved by a least squares approach, where the unwrapped residual interferometric phase is observed and atmospheric contributions are considered to be stochastic with constant mean. To enhance reliability, baseline errors are adjusted in an overdetermined network of interferograms, yielding individual orbit corrections per acquisition.

Administrative Perspectives on Technology Integration: The Globaloria--MyGLife Program in West Virginia

ERIC Educational Resources Information Center

Chapman, William E., Jr.

2009-01-01

The reputed benefits of using technology in schools have been the topic of many research studies. When the World Wide Workshop Foundation implemented their Globaloria program The reputed benefits of using technology in schools have been the topic of many research studies. When the World Wide Workshop Foundation implemented their Globaloria program…

Children Placed at Risk for Learning and Behavioral Difficulties: Implementing a School-Wide System of Early Identification and Intervention.

ERIC Educational Resources Information Center

O'Shaughnessy, Tam E.; Lane, Kathleen L.; Gresham, Frank M.; Beebe-Frankenberger, Margaret E.

2003-01-01

This article describes a school-wide system of early identification and intervention for children recognized as being at risk for learning and behavior difficulties. Suggested guidelines for implementing such a program include: evaluating existing theory, knowledge, and practice; providing ongoing professional development; creating a school-wide…

Professional Capacity Building for School Counselors through School-Wide Positive Behavior Interventions and Supports Implementation

ERIC Educational Resources Information Center

Betters-Bubon, Jennifer; Donohue, Peg

2016-01-01

The implementation of school-wide positive behavioral interventions and supports (SWPBIS) has been shown to reduce behavioral incidents and lead to more positive school climates. Despite the growing popularity in schools, there lacks clear understanding of the school counselor role in this approach. We present the perspectives of an elementary…

It's Not Just the Therapist: Therapist and Country-Wide Experience Predict Therapist Adherence and Adolescent Outcome

ERIC Educational Resources Information Center

Lange, Aurelie M. C.; van der Rijken, Rachel E. A.; Busschbach, Jan J. V.; Delsing, Marc J. M. H.; Scholte, Ron H. J.

2017-01-01

Objective: Therapist adherence is a quality indicator in routine clinical care when evaluating the success of the implementation of an intervention. The current study investigated whether therapist adherence mediates the association between therapist, team, and country-wide experience (i.e. number of years since implementation in the country) on…

Principal Leadership and School Culture with a School-Wide Implementation of Professional Crisis Management: A Redemptive v. Punitive Model

ERIC Educational Resources Information Center

Adams, Mark Thomas

2013-01-01

This qualitative study investigated the nature of the relationship between principal leadership and school culture within a school-wide implementation of Professional Crisis Management (PCM). PCM is a comprehensive and fully integrated system designed to manage crisis situations effectively, safely, and with dignity. While designed primarily to…

Sleep restriction therapy for insomnia is associated with reduced objective total sleep time, increased daytime somnolence, and objectively impaired vigilance: implications for the clinical management of insomnia disorder.

PubMed

Kyle, Simon D; Miller, Christopher B; Rogers, Zoe; Siriwardena, A Niroshan; Macmahon, Kenneth M; Espie, Colin A

2014-02-01

To investigate whether sleep restriction therapy (SRT) is associated with reduced objective total sleep time (TST), increased daytime somnolence, and impaired vigilance. Within-subject, noncontrolled treatment investigation. Sleep research laboratory. Sixteen patients [10 female, mean age = 47.1 (10.8) y] with well-defined psychophysiological insomnia (PI), reporting TST ≤ 6 h. Patients were treated with single-component SRT over a 4-w protocol, sleeping in the laboratory for 2 nights prior to treatment initiation and for 3 nights (SRT night 1, 8, 22) during the acute interventional phase. The psychomotor vigilance task (PVT) was completed at seven defined time points [day 0 (baseline), day 1,7,8,21,22 (acute treatment) and day 84 (3 mo)]. The Epworth Sleepiness Scale (ESS) was completed at baseline, w 1-4, and 3 mo. Subjective sleep outcomes and global insomnia severity significantly improved before and after SRT. There was, however, a robust decrease in PSG-defined TST during acute implementation of SRT, by an average of 91 min on night 1, 78 min on night 8, and 69 min on night 22, relative to baseline (P < 0.001; effect size range = 1.60-1.80). During SRT, PVT lapses were significantly increased from baseline (at three of five assessment points, all P < 0.05; effect size range = 0.69-0.78), returning to baseline levels by 3 mo (P = 0.43). A similar pattern was observed for RT, with RTs slowing during acute treatment (at four of five assessment points, all P < 0.05; effect size range = 0.57-0.89) and returning to pretreatment levels at 3 mo (P = 0.78). ESS scores were increased at w 1, 2, and 3 (relative to baseline; all P < 0.05); by 3 mo, sleepiness had returned to baseline (normative) levels (P = 0.65). For the first time we show that acute sleep restriction therapy is associated with reduced objective total sleep time, increased daytime sleepiness, and objective performance impairment. Our data have important implications for implementation guidelines around the safe and effective delivery of cognitive behavioral therapy for insomnia.

Initiating NTD programs targeting schistosomiasis and soil-transmitted helminthiasis in two provinces of the Democratic Republic of the Congo: Establishment of baseline prevalence for mass drug administration.

PubMed

Kabore, Achille; Ibikounle, Moudachirou; Tougoue, Jean Jacques; Mupoyi, Sylvain; Ndombe, Martin; Shannon, Scott; Ottesen, Eric A; Mukunda, Faustin; Awaca, Naomi

2017-02-01

Schistosomiasis (SCH) and soil-transmitted helminthiasis (STH) are widely distributed in the Democratic Republic of the Congo (DRC) and constitute a serious public health problem. As recommended by the World Health Organization (WHO), before launching mass chemotherapy to control these diseases, parasitological surveys were conducted in sentinel sites in six health zones (HZs) in Bandundu and Maniema provinces. Baseline prevalence and intensity of infection for SCH and STH were determined to establish the appropriate treatment plan using Praziquantel (PZQ) and Albendazole (ALB). Parasitological surveys were conducted from April to May 2015 in twenty-six selected sampling units (schools) for baseline mapping in six HZs: Fifty school children (25 females and 25 males) aged 9-15 years were randomly selected per sampling unit. A total of 1300 samples (urine and stool) were examined using haematuria dipsticks, parasite-egg filtration and the point-of-care Circulating Cathodic Antigen (POC-CCA) assay for urine samples and the Kato-Katz technique for stool specimens. Three species of schistosomes (S. mansoni, S. haematobium and S. intercalatum) and three groups of STH (hookworm, Ascaris and Trichuris) were detected at variable prevalence and intensity among the schools, the HZs and the provinces. In Bandundu, no SCH was detected by either Kato-Katz or the POC-CCA technique, despite a high prevalence of STH with 68% and 80% at Kiri and Pendjua HZs, respectively. In Maniema, intestinal schistosomiasis was detected by both Kato-Katz and POC-CCA with an average prevalence by Kato-Katz of 32.8% and by POC-CCA of 42.1%. Comparative studies confirmed the greater sensitivity (and operational feasibility) of the POC-CCA test on urine compared to Kato-Katz examination of stool for diagnosing intestinal schistosomiasis even in areas of comparatively light infections. STH was widely distributed and present in all HZs with a mean prevalence (95% CI) of 59.62% (46.00-65.00%). The prevalence of hookworm, roundworm and whipworm were 51.62% (32.40%-71.50%), 15.77% (0.50%-39.60%) and 13.46 (0.50%-33.20%), respectively. This study provided the evidence base for implementing programs targeting SCH and STH in these Health Zones. Observations also reinforce the operational value and feasibility of the POC-CCA test to detect S. mansoni and, for the first time, S. intercalatum infections in a routine NTD program setting. Copyright © 2016 Elsevier B.V. All rights reserved.

Evaluation of a statewide dissemination and implementation of physical activity intervention in afterschool programs: a nonrandomized trial.

PubMed

Beets, Michael W; Glenn Weaver, R; Turner-McGrievy, Gabrielle; Saunders, Ruth P; Webster, Collin A; Moore, Justin B; Brazendale, Keith; Chandler, Jessica

2017-12-01

In 2015, YMCA-operated afterschool programs (ASPs) across South Carolina pledged to achieve the national standard that calls for every child to accumulate 30 min/day of moderate-to-vigorous physical activity (MVPA) during program time. This study shares the first-year findings related to the dissemination, implementation, and outcomes associated with the statewide intervention to achieve the MVPA Standard. Twenty ASPs were sampled from all YMCA-operated ASPs (N = 97) and visited at baseline (spring 2015) and first-year follow-up (spring 2016). Programs were provided standardized professional development training to increase the MVPA children accumulated while attending ASPs. The training focused on extending the scheduled time for activity opportunities and modifying commonly played games to increase MVPA. The RE-AIM framework was used to evaluate the statewide intervention. Accelerometer-derived MVPA was the primary outcome. Implementation was evaluated via direct observation. Intent-to-treat (ITT) and as-treated comparisons were conducted in summer 2016. Reach/adoption was variable, with attendance at trainings ranging from 0 to 100% across ASPs. Effectiveness of the intervention using ITT models indicated no changes from baseline in the percentage of programs meeting the MVPA standard for boys or girls. Implementation levels also varied and were related to increases in both boys' and girls' MVPA for moderate and high implementers. Findings indicate improvements in MVPA can be made from attending the trainings and implementing some or all of the training components. Additional work is necessary to identify ways to ensure staff attend trainings to implement strategies and to identify which specific factors contributed to increases in MVPA.

Evaluation of Electronic Health Record Implementation in Ophthalmology at an Academic Medical Center (An American Ophthalmological Society Thesis)

PubMed Central

Chiang, Michael F.; Read-Brown, Sarah; Tu, Daniel C.; Choi, Dongseok; Sanders, David S.; Hwang, Thomas S.; Bailey, Steven; Karr, Daniel J.; Cottle, Elizabeth; Morrison, John C.; Wilson, David J.; Yackel, Thomas R.

2013-01-01

Purpose: To evaluate three measures related to electronic health record (EHR) implementation: clinical volume, time requirements, and nature of clinical documentation. Comparison is made to baseline paper documentation. Methods: An academic ophthalmology department implemented an EHR in 2006. A study population was defined of faculty providers who worked the 5 months before and after implementation. Clinical volumes, as well as time length for each patient encounter, were collected from the EHR reporting system. To directly compare time requirements, two faculty providers who utilized both paper and EHR systems completed time-motion logs to record the number of patients, clinic time, and nonclinic time to complete documentation. Faculty providers and databases were queried to identify patient records containing both paper and EHR notes, from which three cases were identified to illustrate representative documentation differences. Results: Twenty-three faculty providers completed 120,490 clinical encounters during a 3-year study period. Compared to baseline clinical volume from 3 months pre-implementation, the post-implementation volume was 88% in quarter 1, 93% in year 1, 97% in year 2, and 97% in year 3. Among all encounters, 75% were completed within 1.7 days after beginning documentation. The mean total time per patient was 6.8 minutes longer with EHR than paper (P<.01). EHR documentation involved greater reliance on textual interpretation of clinical findings, whereas paper notes used more graphical representations, and EHR notes were longer and included automatically generated text. Conclusion: This EHR implementation was associated with increased documentation time, little or no increase in clinical volume, and changes in the nature of ophthalmic documentation. PMID:24167326

The Effectiveness of Ultra-Low Magnitude Reinforcers: Findings From a "Real-World" Application of Contingency Management.

PubMed

Kropp, Frankie; Lewis, Daniel; Winhusen, Theresa

2017-01-01

Research has consistently found contingency management (CM) to be an effective tool in increasing desired patient behaviors in substance use disorder (SUD) treatment. Despite the strong evidence for the effectiveness of this intervention, practical issues and the cost of implementing CM in treatment programs have been significant barriers to adoption. To evaluate the impact of a CM program designed and implemented by university-affiliated methadone clinic staff to increase patient group attendance. The CM program consisted of a weekly raffle for patients attending clinician-led group counseling and/or in-clinic Methadone Anonymous (MA) groups in which slips with patient ID#s were entered and one ID slip was drawn per week with a fee credit for a dose of methadone ($15) as the prize. The CM program continued for 12 months. Group attendance was tracked before, during, and after CM implementation as part of ongoing clinic service utilization monitoring. Following the implementation of CM, attendance at any clinician-led or MA groups increased significantly from baseline to month 1 (X 2 =5.78, p<0.05) but this increase was not sustained beyond month 6. Analysis of attendance by type of group revealed that clinician-led group attendance did not increase significantly but there was a significant increase in in-clinic MA group attendance from baseline to month 1 (X 2 =20.27, p<0.001), which was sustained through the 12-month implementation period (X 2 =11.21, p<0.001) and through 3 months post-implementation (X 2 =14.73; p<0.001). A low-cost, simple CM intervention implemented by clinic staff was associated with significant increases in the target behavior of increasing group attendance. Copyright © 2016 Elsevier Inc. All rights reserved.

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.

[Effectiveness of integrated early childhood development intervention on nurturing care for children aged 0-35 months in rural China].

PubMed

Shi, H F; Zhang, J X; Wang, X L; Xu, Y Y; Dong, S L; Zhao, C X; Huang, X N; Zhao, Q; Chen, X F; Zhou, Y; O'Sullivan, Margo; Pouwels, Ron; Scherpbier, Robert W

2018-02-02

Objective: To explore whether Integrated Early Childhood Development (IECD) program has effectively improved the nurturing care for children aged 0-35 months in rural China. Methods: IECD has been implemented by the government of China with support from the United Nations Children's Fund (UNICEF) in four poverty-stricken rural counties since 2014. The interventions targeting the five key components of nurturing care (i.e. child and caregiver health, child nutrition, early learning support, child protection and social security) were delivered through the IECD program to children aged 0 to 35 months and their caregivers. A population-based intervention trial was designed to evaluate intervention effectiveness with data collected in 2013 (baseline) and 2016 (mid-term). The changes of nurturing care in the intervention and control group were analyzed by using a difference-in-differences (DID) model. This approach provided adjustment for sociodemographic and other confounding factors. Results: The baseline and mid-term survey enrolled 1 468 and 1 384 children in the intervention group, and 1 485 and 1 361 in the control group. After two years of implementation, the prevalence of caregiver's depression in the intervention group showed a decrease of 9.1% (mid-term 34.8% (479/1 377) vs. baseline 43.9% (621/1 414)), whereas that in control group showed a decrease of 1.6% (mid-term 34.3% (464/1 353) vs. baseline 35.9% (509/1 419)). With the confounding adjusted in the difference-in-differences model, the decrease of the caregiver's depression prevalence in the intervention group was 7.0% greater than that in the control group ( P= 0.008). The qualified rate of minimum meal frequency in the intervention group showed an increase of 10.4% (mid-term 69.0% (532/771) vs. baseline 58.6% (481/821)), whereas the qualified rate in the intervention group showed an increase of 2.9% (mid-term 66.4% (469/706) vs. baseline 63.5% (508/800)). With the confounding adjusted in the difference-in-differences model, the increase of the qualified rate in the intervention group was 8.2% greater than that in the control group ( P= 0.021). The proportion of violent discipline by caregivers in the intervention group showed a decrease of 6.2% (mid-term 49.1% (478/973) vs. baseline 55.3% (554/1 001)), whereas the proportion in control group showed an increase of 4.5% (mid-term 58.4% (560/959) vs. baseline 53.9% (558/1 036)), and with the confounding adjusted in the difference-in-differences model, the difference in increase rate between two groups was 11.0% ( P= 0.001). The proportion of families with three or more children's books in the intervention group showed an increase of 12.7% (mid-term 42.7% (588/1 378) vs. baseline 30.0% (432/1 440)), whereas the proportion of the control group showed an increase of 4.2% (mid-term 25.7% (349/1 357) vs. baseline 21.5% (298/1 388)), and with the confounding adjusted in the difference-in-differences model, the difference in increase rate between two groups was 6.1% ( P= 0.007). Conclusions: The IECD intervention strategy implemented in rural China effectively improved the mental health of caregivers, optimizes families' child feeding and early stimulation behaviors, while reducing violent discipline and other risk factors. IECD provides better nurturing care for the early development of children aged 0-35 months in rural China.

A study protocol testing the implementation, efficacy, and cost effectiveness of the ezParent program in pediatric primary care

PubMed Central

Schoeny, Michael; Risser, Heather; Johnson, Tricia

2016-01-01

Introduction Up to 20% of children demonstrate behavior problems that interfere with relationship development and academic achievement. Parent participation in behavioral parent training programs has been shown to decrease child problem behaviors and promote positive parent-child relationships. However, attendance and parent involvement in face-to-face parent training remain low. Testing the implementation, efficacy, and cost of alternative delivery models is needed to (a) increase the reach and sustainability of parent training interventions and (b) address the barriers to parent participation and implementation of such programs, specifically in primary health care settings. The purpose of this paper is to describe the study protocol evaluating the implementation, efficacy, and cost-effectiveness of delivering the tablet-based ezParent program in pediatric primary care sites. Methods The implementation of the ezParent in four pediatric primary care sites will be evaluated using a descriptive design and cost-effectiveness analysis. The efficacy of the ezParent will be tested using a randomized controlled trial design with 312 parents of 2 to 5 year old children from pediatric primary care settings. Data on parenting and child behavior outcomes will be obtained from all participants at baseline, and 3, 6, and 12 months post baseline. Discussion Integrating and evaluating the implementation of the ezParent in pediatric primary care is an innovative opportunity to promote positive parenting with potential for universal access to the preschool population and for low cost by building on existing infrastructure in pediatric primary care. PMID:27592122

A Fully Customized Baseline Removal Framework for Spectroscopic Applications.

PubMed

Giguere, Stephen; Boucher, Thomas; Carey, C J; Mahadevan, Sridhar; Dyar, M Darby

2017-07-01

The task of proper baseline or continuum removal is common to nearly all types of spectroscopy. Its goal is to remove any portion of a signal that is irrelevant to features of interest while preserving any predictive information. Despite the importance of baseline removal, median or guessed default parameters are commonly employed, often using commercially available software supplied with instruments. Several published baseline removal algorithms have been shown to be useful for particular spectroscopic applications but their generalizability is ambiguous. The new Custom Baseline Removal (Custom BLR) method presented here generalizes the problem of baseline removal by combining operations from previously proposed methods to synthesize new correction algorithms. It creates novel methods for each technique, application, and training set, discovering new algorithms that maximize the predictive accuracy of the resulting spectroscopic models. In most cases, these learned methods either match or improve on the performance of the best alternative. Examples of these advantages are shown for three different scenarios: quantification of components in near-infrared spectra of corn and laser-induced breakdown spectroscopy data of rocks, and classification/matching of minerals using Raman spectroscopy. Software to implement this optimization is available from the authors. By removing subjectivity from this commonly encountered task, Custom BLR is a significant step toward completely automatic and general baseline removal in spectroscopic and other applications.

The use of real-time feedback via wireless technology to improve hand hygiene compliance.

PubMed

Marra, Alexandre R; Sampaio Camargo, Thiago Zinsly; Magnus, Thyago Pereira; Blaya, Rosangela Pereira; Dos Santos, Gilson Batista; Guastelli, Luciana Reis; Rodrigues, Rodrigo Dias; Prado, Marcelo; Victor, Elivane da Silva; Bogossian, Humberto; Monte, Julio Cesar Martins; dos Santos, Oscar Fernando Pavão; Oyama, Carlos Kazume; Edmond, Michael B

2014-06-01

Hand hygiene (HH) is widely regarded as the most effective preventive measure for health care-associated infection. However, there is little robust evidence on the best interventions to improve HH compliance or whether a sustained increase in compliance can reduce rates of health care-associated infection. To evaluate the effectiveness of a real-time feedback to improve HH compliance in the inpatient setting, we used a quasiexperimental study comparing the effect of real-time feedback using wireless technology on compliance with HH. The study was conducted in two 20-bed step-down units at a private tertiary care hospital. Phase 1 was a 3-month baseline period in which HH counts were performed by electronic handwash counters. After a 1-month washout period, a 7-month intervention was performed in one step-down unit while the other unit served as a control. HH, as measured by dispensing episodes, was significantly higher in the intervention unit (90.1 vs 73.1 dispensing episodes/patient-day, respectively, P = .001). When the intervention unit was compared with itself before and after implementation of the wireless technology, there was also a significant increase in HH after implementation (74.5 vs 90.1 episodes/patient-day, respectively, P = .01). There was also an increase in mean alcohol-based handrub consumption between the 2 phases (68.9 vs 103.1 mL/patient-day, respectively, P = .04) in the intervention unit. We demonstrated an improvement in alcohol gel usage via implementation of real-time feedback via wireless technology. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

A Comprehensive Program to Reduce Rates of Hospital-Acquired Pressure Ulcers in a System of Community Hospitals.

PubMed

Englebright, Jane; Westcott, Ruth; McManus, Kathryn; Kleja, Kacie; Helm, Colleen; Korwek, Kimberly M; Perlin, Jonathan B

2018-03-01

The prevention of hospital-acquired pressure ulcers (PrUs) has significant consequences for patient outcomes and the cost of care. Providers are challenged with evaluating available evidence and best practices, then implementing programs and motivating change in various facility environments. In a large system of community hospitals, the Reducing Hospital Acquired-PrUs Program was developed to provide a toolkit of best practices, timely and appropriate data for focusing efforts, and continuous implementation support. Baseline data on PrU rates helped focus efforts on the most vulnerable patients and care situations. Facilities were empowered to use and adapt available resources to meet local needs and to share best practices for implementation across the system. Outcomes were measured by the rate of hospital-acquired PrUs, as gathered from patient discharge records. The rate of hospital-acquired stage III and IV PrUs decreased 66.3% between 2011 and 2013. Of the 149 participating facilities, 40 (27%) had zero hospital-acquired stage III and IV PrUs and 77 (52%) had a reduction in their PrU rate. Rates of all PrUs documented as present on admission did not change during this period. A comparison of different strategies used by the most successful facilities illustrated the necessity of facility-level flexibility and recognition of local workflows and patient demographics. Driven by the combination of a repository of evidence-based tools and best practices, readily available data on PrU rates, and local flexibility with processes, the Reducing Hospital Acquired-PrUs Program represents the successful operationalization of improvement in a wide variety of facilities.

Suitability assessment of the urban water management transition in the Indonesian context - A case study of Surabaya

NASA Astrophysics Data System (ADS)

Sholihah, Mar'atus; Anityasari, Maria; Maftuhah, Diesta Iva

2017-06-01

The rapidly growing urban population, the increasing impact of climate change, and the constantly decreasing availability of the good quality water become the major triggers that force urban water professionals to continuously focus on sustainable urban water management (SUWM). The city as a focal point of population growth in the world has become a critical object for its resiliency, not only in terms of the environmental deterioration but also of the water supplies security. As a response to the current condition, the framework of urban water management transition has been introduced as a sort of transformation for a city to achieve SUWM. Water Sensitive City (WSC) is the ultimate goal of this framework which integrates water access and supply security, public health protection, flood prevention, environmental protection and livability, and economic sustainability. Recently, the urban water management transition and WSC concept are going to be implemented in some cities in Indonesia, including Surabaya. However, in addition to provide a wide range of benefits, the implementation of WSC also brings challenges. In terms of geographical and social aspect, public policy, and the citizen behavior, the cities in Indonesia are undoubtedly different with those in Australian where the concept was developed. Hence, assessing the suitability of urban water management transition in the Indonesian context can be perceived as the most important phase in this whole plan. A case study of Surabaya would be identified as a baseline to measure whether the proposed sequence of urban water management transition is suitable for Indonesian local context. The research aimed to assess the suitability of the framework to be implemented in Indonesia and to propose the modified framework which is more suitable for local context in Indonesia.

Characterization of envelope glycoprotein gp41 genotype and phenotypic susceptibility to enfuvirtide at baseline and on treatment in the phase III clinical trials TORO-1 and TORO-2.

PubMed

Melby, T; Sista, P; DeMasi, R; Kirkland, T; Roberts, N; Salgo, M; Heilek-Snyder, G; Cammack, N; Matthews, T J; Greenberg, M L

2006-05-01

Enfuvirtide (T-20) is the first entry inhibitor approved for treatment of HIV infection and acts by inhibiting conformational changes in the viral envelope protein gp41 that are necessary for fusion of the virus and host cell membranes. Here we present genotypic and phenotypic data on viral envelopes obtained at baseline (n = 627) and after 48 weeks of enfuvirtide treatment (n = 302) from patients in the TORO (T-20 versus Optimized Regimen Only)-1 and -2 phase III pivotal studies. The amino acid sequence at residues 36-45 of gp41 was highly conserved at baseline except for polymorphism of approximately 16% at position 42. Substitutions within gp41 residues 36-45 on treatment were observed in virus from 92.7% of patients who met protocol defined virological failure criteria and occurred in nearly all cases (98.8%) when decreases in susceptibility to enfuvirtide from baseline of greater than 4-fold were observed. Consistent with previous observations, a wide range of baseline susceptibilities (spanning 3 logs) was observed; however, lower in vitro baseline susceptibility was not significantly associated with a decreased virological response in vivo. Virological response was also independent of baseline coreceptor tropism and viral subtype.

Determination of the Territorial Sea Baseline - Measurement Aspect

NASA Astrophysics Data System (ADS)

Specht, Cezary; Weintrit, Adam; Specht, Mariusz; Dabrowski, Pawel

2017-12-01

Determining the course of the territorial sea baseline (TSB) of the coastal state is the basis for establishing its maritime boundaries, thus becoming indirect part of maritime policy of the state. Besides the following aspects: legal and methodological as described in the conventions, acts, standards and regulations, equally important is the issue of measurement methodology with respect to the boundaries of the territorial sea. The publication discussed accuracy requirements of the TSB measurement implementation, the relationship of sea level with a choice of the method of its determination, and discussed the implementation of such a measurement on a selected example. As the test reservoir was used the 400-meter stretch of the public beach in Gdynia. During the measurements they used the GNSS geodetic receiver operating in real time based on the geodetic network - VRSnet.pl. Additionally, a comparison was made of the applied method with analogous measurements of the TSB performed in 1999.

Using Perseverative Interests to Improve Interactions Between Adolescents with Autism and their Typical Peers in School Settings

PubMed Central

Koegel, Robert; Fredeen, Rosy; Kim, Sunny; Danial, John; Rubinstein, Derek; Koegel, Lynn

2013-01-01

The literature suggests that adolescents with ASD typically are not socially engaged during unstructured school activities and do not initiate social activities with typically developing peers. This study assessed whether implementing socialization opportunities in the form of lunch clubs based around aspects of the adolescents with ASD’s perseverative interests would promote positive direct and generalized social interaction between the target adolescent and their typically developing peers. A repeated measures multiple baseline experimental design (with two reversals) was implemented across participants. During baseline measures, the participants did not show social engagement or initiations. During intervention, results showed large increases in both social engagement and initiations. Generalization measures also showed that the target adolescents improved their social engagements and initiations with typically developing peers throughout unstructured lunchtime activities. These results have implications for understanding variables related to social development in autism. PMID:24163577

Change Analysis in Structural Laser Scanning Point Clouds: The Baseline Method

PubMed Central

Shen, Yueqian; Lindenbergh, Roderik; Wang, Jinhu

2016-01-01

A method is introduced for detecting changes from point clouds that avoids registration. For many applications, changes are detected between two scans of the same scene obtained at different times. Traditionally, these scans are aligned to a common coordinate system having the disadvantage that this registration step introduces additional errors. In addition, registration requires stable targets or features. To avoid these issues, we propose a change detection method based on so-called baselines. Baselines connect feature points within one scan. To analyze changes, baselines connecting corresponding points in two scans are compared. As feature points either targets or virtual points corresponding to some reconstructable feature in the scene are used. The new method is implemented on two scans sampling a masonry laboratory building before and after seismic testing, that resulted in damages in the order of several centimeters. The centres of the bricks of the laboratory building are automatically extracted to serve as virtual points. Baselines connecting virtual points and/or target points are extracted and compared with respect to a suitable structural coordinate system. Changes detected from the baseline analysis are compared to a traditional cloud to cloud change analysis demonstrating the potential of the new method for structural analysis. PMID:28029121

Change Analysis in Structural Laser Scanning Point Clouds: The Baseline Method.

PubMed

Shen, Yueqian; Lindenbergh, Roderik; Wang, Jinhu

2016-12-24

A method is introduced for detecting changes from point clouds that avoids registration. For many applications, changes are detected between two scans of the same scene obtained at different times. Traditionally, these scans are aligned to a common coordinate system having the disadvantage that this registration step introduces additional errors. In addition, registration requires stable targets or features. To avoid these issues, we propose a change detection method based on so-called baselines. Baselines connect feature points within one scan. To analyze changes, baselines connecting corresponding points in two scans are compared. As feature points either targets or virtual points corresponding to some reconstructable feature in the scene are used. The new method is implemented on two scans sampling a masonry laboratory building before and after seismic testing, that resulted in damages in the order of several centimeters. The centres of the bricks of the laboratory building are automatically extracted to serve as virtual points. Baselines connecting virtual points and/or target points are extracted and compared with respect to a suitable structural coordinate system. Changes detected from the baseline analysis are compared to a traditional cloud to cloud change analysis demonstrating the potential of the new method for structural analysis.

Characteristics of insufficiently active participants that benefit from health-enhancing physical activity (HEPA) promotion programs implemented in the sports club setting.

PubMed

Ooms, Linda; Leemrijse, Chantal; Collard, Dorine; Schipper-van Veldhoven, Nicolette; Veenhof, Cindy

2018-06-01

Health-enhancing physical activity (HEPA) promotion programs are implemented in sports clubs. The purpose of this study was to examine the characteristics of the insufficiently active participants that benefit from these programs. Data of three sporting programs, developed for insufficiently active adults, were used for this study. These sporting programs were implemented in different sports clubs in the Netherlands. Participants completed an online questionnaire at baseline and after six months (n = 458). Of this sample, 35.1% (n = 161) was insufficiently active (i.e. not meeting HEPA levels) at baseline. Accordingly, two groups were compared: participants who were insufficiently active at baseline, but increased their physical activity to HEPA levels after six months (activated group, n = 86) versus participants who were insufficiently active both at baseline and after six months (non-activated group, n = 75). Potential associated characteristics (demographic, social, sport history, physical activity) were included as independent variables in bivariate and multivariate logistic regression analyses. The percentage of active participants increased significantly from baseline to six months (from 64.9 to 76.9%, p < 0.05). The bivariate logistic regression analyses showed that participants in the activated group were more likely to receive support from family members with regard to their sport participation (62.8% vs. 42.7%, p = 0.02) and spent more time in moderate-intensity physical activity (128 ± 191 min/week vs. 70 ± 106 min/week, p = 0.02) at baseline compared with participants in the non-activated group. These results were confirmed in the multivariate logistic regression analyses: when receiving support from most family members, there is a 216% increase in the odds of being in the activated group (OR = 2.155; 95% CI: 1.118-4.154, p = 0.02) and for each additional 1 min/week spent in moderate-intensity physical activity, the odds increases with 0.3% (OR = 1.003; 95% CI: 1.001-1.006, p = 0.02). The results suggest that HEPA sporting programs can be used to increase HEPA levels of insufficiently active people, but it seems a challenge to reach the least active ones. It is important that promotional strategies and channels are tailored to the target group. Furthermore, strategies that promote family support may enhance the impact of the programs.

Tracing the policy implementation of commitments made by national governments and other entities at the Third Global Forum on Human Resources for Health

PubMed Central

van de Pas, Remco; Veenstra, Anika; Gulati, Daniel; Van Damme, Wim; Cometto, Giorgio

2017-01-01

We conducted a follow-up analysis of the implementation of the Human Resources for Health (HRH) commitments made by country governments and other actors at the Third Global Forum on HRH in 2013. Since then member states of the WHO endorsed Universal Health Coverage as the main policy objective whereby health systems strengthening, including reinforcement of the health workforce, can contribute to several Sustainable Development Goals. Now is the right time to trace the implementation of these commitments and to assess their contribution to broader global health objectives. The baseline data for this policy tracing study consist of the categorisation and analysis of the HRH commitments conducted in 2014. This analysis was complemented in application of the health policy triangle as its main analytical framework. An online survey and a guideline for semistructured interviews were developed to collect data. Information on the implementation of the commitments is available in 49 countries (86%). The need for multi-actor approaches for HRH policy development is universally recognised. A suitable political window and socioeconomic situation emerge as crucial factors for sustainable HRH development. However, complex crises in different parts of the world have diverted attention from investment in HRH development. The analysis indicates that investment in the health workforce and corresponding policy development relies on political leadership, coherent government strategies, institutional capacity and intersectoral governance mechanisms. The institutional capacity to shoulder such complex tasks varies widely across countries. For several countries, the commitment process provided an opportunity to invest in, develop and reform the health workforce. Nevertheless, the quality of HRH monitoring mechanisms requires more attention. In conclusion, HRH challenges, their different pathways and the intersectorality of the required responses are a concern for all the countries analysed. There is hence a need for national governments and stakeholders across the globe to share responsibilities and invest in this vital issue in a co-ordinated manner. PMID:29104768

Clinical informatics in undergraduate teaching of health informatics.

PubMed

Pantazi, Stefan V; Pantazi, Felicia; Daly, Karen

2011-01-01

We are reporting on a recent experience with Health Informatics (HI) teaching at undergraduate degree level to an audience of HI and Pharmacy students. The important insight is that effective teaching of clinical informatics must involve highly interactive, applied components in addition to the traditional theoretical material. This is in agreement with general literature underlining the importance of simulations and role playing in teaching and is well supported by our student evaluation results. However, the viability and sustainability of such approaches to teaching hinges on significant course preparation efforts. These efforts consist of time-consuming investigations of informatics technologies, applications and systems followed by the implementation of workable solutions to a wide range of technical problems. In effect, this approach to course development is an involved process that relies on a special form of applied research whose technical complexity could explain the dearth of published reports on similar approaches in HI education. Despite its difficulties, we argue that this approach can be used to set a baseline for clinical informatics training at undergraduate level and that its implications for HI education in Canada are of importance.

A weight-loss intervention program designed for Mexican-American women: cultural adaptations and results.

PubMed

Lindberg, Nangel M; Stevens, Victor J; Vega-López, Sonia; Kauffman, Tia L; Calderón, Mariana Rosales; Cervantes, María Antonieta

2012-12-01

This study assessed the feasibility of a culturally-appropriate weight-loss intervention targeting obese Spanish-speaking Mexican women. This 12-month weight-loss program was based on behavioral interventions previously used successfully with English-speaking participants. Cultural adaptations included: female interventionists, minimal written materials, emphasis on group activities, focus on Mexican traditions and beliefs, and skill-building approach to food measurement. All sessions were conducted in Spanish. The study had few exclusionary criteria, which allowed participation of women with a wide range of literacy levels. Recruitment exceeded expectations, with 47 participants enrolling in the program. Not counting participants who became pregnant during the study, attendance at 6 and 12 months was 62 and 50 % respectively. Mean weight loss at 6 and 12 months was 5.3 and 7.2 kg, respectively, with a mean reduction in BMI of 4.0 and 5.5 kg/m(2) from baseline to 6 and 12 months, respectively. This pilot study shows that it is feasible to develop and implement culturally-appropriate behavioral lifestyle interventions for obesity treatment in Mexican-American women.

The Urbis Project: Identification and Characterization of Potential Urban Development Areas as a Web-Based Service

NASA Astrophysics Data System (ADS)

Manzke, Nina; Kada, Martin; Kastler, Thomas; Xu, Shaojuan; de Lange, Norbert; Ehlers, Manfred

2016-06-01

Urban sprawl and the related landscape fragmentation is a Europe-wide challenge in the context of sustainable urban planning. The URBan land recycling Information services for Sustainable cities (URBIS) project aims for the development, implementation, and validation of web-based information services for urban vacant land in European functional urban areas in order to provide end-users with site specific characteristics and to facilitate the identification and evaluation of potential development areas. The URBIS services are developed based on open geospatial data. In particular, the Copernicus Urban Atlas thematic layers serve as the main data source for an initial inventory of sites. In combination with remotely sensed data like SPOT5 images and ancillary datasets like OpenStreetMap, detailed site specific information is extracted. Services are defined for three main categories: i) baseline services, which comprise an initial inventory and typology of urban land, ii) update services, which provide a regular inventory update as well as an analysis of urban land use dynamics and changes, and iii) thematic services, which deliver specific information tailored to end-users' needs.

Real-time multi-channel stimulus artifact suppression by local curve fitting.

PubMed

Wagenaar, Daniel A; Potter, Steve M

2002-10-30

We describe an algorithm for suppression of stimulation artifacts in extracellular micro-electrode array (MEA) recordings. A model of the artifact based on locally fitted cubic polynomials is subtracted from the recording, yielding a flat baseline amenable to spike detection by voltage thresholding. The algorithm, SALPA, reduces the period after stimulation during which action potentials cannot be detected by an order of magnitude, to less than 2 ms. Our implementation is fast enough to process 60-channel data sampled at 25 kHz in real-time on an inexpensive desktop PC. It performs well on a wide range of artifact shapes without re-tuning any parameters, because it accounts for amplifier saturation explicitly and uses a statistic to verify successful artifact suppression immediately after the amplifiers become operational. We demonstrate the algorithm's effectiveness on recordings from dense monolayer cultures of cortical neurons obtained from rat embryos. SALPA opens up a previously inaccessible window for studying transient neural oscillations and precisely timed dynamics in short-latency responses to electric stimulation. Copyright 2002 Elsevier Science B.V.

An assessment of Qatar's coral communities in a regional context.

PubMed

Burt, John A; Smith, Edward G; Warren, Christopher; Dupont, Jennifer

2016-04-30

Qatar's once extensive coral communities have undergone considerable change in recent decades. We quantitatively surveyed three coral assemblages in Qatar to assess current status, and compared these against 14 sites in Bahrain and the United Arab Emirates to evaluate Qatar in a larger biogeographic context. Umm Al-Arshan had the highest species richness of 17 sites examined in the southern Arabian Gulf, as well as the highest coral cover and the only Acropora observed on sites in Qatar. Coral cover and richness were more modest at Fuwayrit and Al-Ashat, reflecting greater impacts from earlier stress events. Two distinct communities were identified across the southern Gulf, with Umm Al-Arshan clustering with high-cover, mixed merulinid/poritid assemblages that were less impacted by earlier bleaching and long-term stress, while Fuwayrit and Al-Ashat grouped with a lower-cover, stress-tolerant community characteristic of more extreme environments in the southern Gulf. We recommend implementation of a nation-wide baseline assessment of coral communities to guide development of an MPA network and long-term coral monitoring program for Qatar. Copyright © 2015 Elsevier Ltd. All rights reserved.

The ALMA Phasing System: A Beamforming Capability for Ultra-high-resolution Science at (Sub)Millimeter Wavelengths

NASA Astrophysics Data System (ADS)

Matthews, L. D.; Crew, G. B.; Doeleman, S. S.; Lacasse, R.; Saez, A. F.; Alef, W.; Akiyama, K.; Amestica, R.; Anderson, J. M.; Barkats, D. A.; Baudry, A.; Broguière, D.; Escoffier, R.; Fish, V. L.; Greenberg, J.; Hecht, M. H.; Hiriart, R.; Hirota, A.; Honma, M.; Ho, P. T. P.; Impellizzeri, C. M. V.; Inoue, M.; Kohno, Y.; Lopez, B.; Martí-Vidal, I.; Messias, H.; Meyer-Zhao, Z.; Mora-Klein, M.; Nagar, N. M.; Nishioka, H.; Oyama, T.; Pankratius, V.; Perez, J.; Phillips, N.; Pradel, N.; Rottmann, H.; Roy, A. L.; Ruszczyk, C. A.; Shillue, B.; Suzuki, S.; Treacy, R.

2018-01-01

The Atacama Millimeter/submillimeter Array (ALMA) Phasing Project (APP) has developed and deployed the hardware and software necessary to coherently sum the signals of individual ALMA antennas and record the aggregate sum in Very Long Baseline Interferometry (VLBI) Data Exchange Format. These beamforming capabilities allow the ALMA array to collectively function as the equivalent of a single large aperture and participate in global VLBI arrays. The inclusion of phased ALMA in current VLBI networks operating at (sub)millimeter wavelengths provides an order of magnitude improvement in sensitivity, as well as enhancements in u–v coverage and north–south angular resolution. The availability of a phased ALMA enables a wide range of new ultra-high angular resolution science applications, including the resolution of supermassive black holes on event horizon scales and studies of the launch and collimation of astrophysical jets. It also provides a high-sensitivity aperture that may be used for investigations such as pulsar searches at high frequencies. This paper provides an overview of the ALMA Phasing System design, implementation, and performance characteristics.

Community Health Workers as Social Marketers of Injectable Contraceptives: A Case Study from Ethiopia.

PubMed

Weidert, Karen; Gessessew, Amanuel; Bell, Suzanne; Godefay, Hagos; Prata, Ndola

2017-03-24

Ethiopia has made notable progress in increasing awareness and knowledge of family planning and is considered a success story among funders and program planners. Yet unmet need among rural women (28.6%) is almost double that of urban women (15.5%), with a wide gap in total fertility rate depending on urban (2.6) or rural (5.5) residence. This study investigates the impact of a service delivery model that combines community-based distribution (CBD) of contraception with social marketing in Tigray, Ethiopia, to create a more sustainable approach to CBD. Between September 2011 and October 2013, 626 volunteer CHWs were recruited and trained to administer depot medroxyprogesterone acetate (DMPA) injections and provide counseling and referrals to the health post for other methods; the project implementation period ended in June 2014. The CHWs received a supply of DMPA injections in the form of a microloan from a drug revolving fund; the CHWs charged women a minimal fee (5 birr, or US$0.29), determined based on willingness-to-pay data, for each DMPA injection; and the CHWs returned part of the fee (3 birr) to the drug revolving fund while keeping the remaining portion (2 birr). The CHWs also promoted demand for family planning through door-to-door outreach and community meetings. Existing health extension workers (HEWs) provided regular supervision of the CHWs, supplemented by in-depth supervision visits from study coordinators. Baseline and endline representative surveys of women of reproductive age, as well as of participating CHWs, were conducted. In addition, DMPA provision data from the CHWs were collected. Between October 2011 and June 2014, the CHWs served in total 8,604 women and administered an estimated 15,410 DMPA injections, equivalent to providing 3,853 couple-years of protection. There was a 25% significant increase in contraceptive use among surveyed women, from 30.1% at baseline to 37.7% at endline, with DMPA use largely responsible for this increase. Changes in quality of family planning markers from baseline suggested services improved between baseline and endline: nearly 50% more women reported being told about side effects and what to do if they experience side effects, and 25% more women said they were told about other methods of contraception. The results from household surveys at baseline and endline suggest that CHWs in this model made a significant contribution to family planning in the region. © Weidert et al.

Community Health Workers as Social Marketers of Injectable Contraceptives: A Case Study from Ethiopia

PubMed Central

Weidert, Karen; Gessessew, Amanuel; Bell, Suzanne; Godefay, Hagos; Prata, Ndola

2017-01-01

ABSTRACT Ethiopia has made notable progress in increasing awareness and knowledge of family planning and is considered a success story among funders and program planners. Yet unmet need among rural women (28.6%) is almost double that of urban women (15.5%), with a wide gap in total fertility rate depending on urban (2.6) or rural (5.5) residence. This study investigates the impact of a service delivery model that combines community-based distribution (CBD) of contraception with social marketing in Tigray, Ethiopia, to create a more sustainable approach to CBD. Between September 2011 and October 2013, 626 volunteer CHWs were recruited and trained to administer depot medroxyprogesterone acetate (DMPA) injections and provide counseling and referrals to the health post for other methods; the project implementation period ended in June 2014. The CHWs received a supply of DMPA injections in the form of a microloan from a drug revolving fund; the CHWs charged women a minimal fee (5 birr, or US$0.29), determined based on willingness-to-pay data, for each DMPA injection; and the CHWs returned part of the fee (3 birr) to the drug revolving fund while keeping the remaining portion (2 birr). The CHWs also promoted demand for family planning through door-to-door outreach and community meetings. Existing health extension workers (HEWs) provided regular supervision of the CHWs, supplemented by in-depth supervision visits from study coordinators. Baseline and endline representative surveys of women of reproductive age, as well as of participating CHWs, were conducted. In addition, DMPA provision data from the CHWs were collected. Between October 2011 and June 2014, the CHWs served in total 8,604 women and administered an estimated 15,410 DMPA injections, equivalent to providing 3,853 couple-years of protection. There was a 25% significant increase in contraceptive use among surveyed women, from 30.1% at baseline to 37.7% at endline, with DMPA use largely responsible for this increase. Changes in quality of family planning markers from baseline suggested services improved between baseline and endline: nearly 50% more women reported being told about side effects and what to do if they experience side effects, and 25% more women said they were told about other methods of contraception. The results from household surveys at baseline and endline suggest that CHWs in this model made a significant contribution to family planning in the region. PMID:28275087

Design, Implementation and Validation of a Europe-Wide Pedagogical Framework for E-Learning

ERIC Educational Resources Information Center

Granic, Andrina; Mifsud, Charles; Cukusic, Maja

2009-01-01

Within the context of a Europe-wide project UNITE, a number of European partners set out to design, implement and validate a pedagogical framework (PF) for e- and m-Learning in secondary schools. The process of formulating and testing the PF was an evolutionary one that reflected the experiences and skills of the various European partners and…

Building SWPBIS Capacity in Rural Schools through Building-Based Coaching: Early Findings from a District-Based Model

ERIC Educational Resources Information Center

Cavanaugh, Brian; Swan, Meaghan

2015-01-01

School-wide Positive Behavioral Interventions and Supports (SWPBIS) is a widely used framework for supporting student social and academic behavior. Implementation science indicates that one effective way to implement and scale-up practices, such as SWPBIS, is through coaching; thus, there is a need for efficient, cost-effective methods to develop…

The Implementation of Life Space Crisis Intervention as a School-Wide Strategy for Reducing Violence and Supporting Students' Continuation in Public Schools

ERIC Educational Resources Information Center

Ramin, John E.

2011-01-01

The purpose of this study was to explore the effectiveness of implementing Life Space Crisis Intervention as a school-wide strategy for reducing school violence. Life Space Crisis Intervention (LSCI) is a strength-based verbal interaction strategy (Long, Fecser, Wood, 2001). LSCI utilizes naturally occurring crisis situations as teachable…

GPU Acceleration of DSP for Communication Receivers.

PubMed

Gunther, Jake; Gunther, Hyrum; Moon, Todd

2017-09-01

Graphics processing unit (GPU) implementations of signal processing algorithms can outperform CPU-based implementations. This paper describes the GPU implementation of several algorithms encountered in a wide range of high-data rate communication receivers including filters, multirate filters, numerically controlled oscillators, and multi-stage digital down converters. These structures are tested by processing the 20 MHz wide FM radio band (88-108 MHz). Two receiver structures are explored: a single channel receiver and a filter bank channelizer. Both run in real time on NVIDIA GeForce GTX 1080 graphics card.

Orogen-Wide InSAR Time Series for Detecting Deformation Sources: The Zagros and Makran of Southern Iran

NASA Astrophysics Data System (ADS)

Lohman, R. B.; Barnhart, W. D.

2011-12-01

We present interferometric synthetic aperture radar (InSAR) time series maps that span the eastern Zagros (Fars Arc) collisional belt and western Makran accretionary prism of Southern Iran. Given the upcoming availability of large volumes of SAR data from new platforms, such as Sentinel 1 and potentially DESDynI, we explore computationally efficient approaches for extracting deformation time series when the signal of interest is small compared to the level of noise in individual interferograms. We use 12 descending and 2 ascending multi-frame (2-4 frames) Envisat tracks and 2 ascending ALOS tracks spanning 2003-2010 and 2006-2010. We implement a linear inversion, similar to the Small Baseline Subset (SBaS) technique, to derive surface displacements at individual acquisition dates from trees of interferograms with perpendicular baselines less than 350m for Envisat and 1500m for ALOS pairs. This spatially extensive dataset allows us to investigate several attributes of interferometry that vary spatially and temporally over large distances, including changes in phase coherence relative to elevation and relief as well as land use. Through synthetic tests and observed data, we explore various sources of potential error in calculation of time series, including variable coherence of pixels between interferograms in a single track, ambiguities in phase unwrapping, and orbital ramp estimation over scenes with variable correlated noise structure. We present examples of detected signals with both temporally variable characteristics and small magnitudes, including surface/subsurface salt deformation, aseismic deformation across Minab-Zendan-Palami strike-slip zone, and subsidence due to hydrocarbon extraction.

Surviving sepsis: a trust-wide approach. A multi-disciplinary team approach to implementing evidence-based guidelines.

PubMed

Gerber, Karin

2010-01-01

To share an experience of examining the true extent of the number of patients with severe sepsis being admitted, and the overall compliance with existing treatment guidelines in a district general hospital (DGH). Because of its aggressive, multi-factorial nature, sepsis is a rapid killer. Mortality associated with severe sepsis remains unacceptably high: 30-50%. When shock is present, mortality is reported to be even higher: 50-60%. The rapid diagnosis and management of sepsis is vital to successful treatment. The International Surviving Sepsis Campaign (SSC) was developed to help meet the challenges of sepsis and to improve its management, diagnosis and treatment. The overall aim is to reduce mortality from sepsis by 25% by 2009. Data on the number of patients admitted with severe sepsis to the DGH were previously unknown. The aim of the baseline audits was to determine the true extent of the problem and baseline mortality rates, resulting in an action plan to provide evidence-based care to patients with sepsis regardless of where in the hospital they were located. It was found that 11% of the patients audited presented with signs of severe sepsis and demonstrated elements of poor compliance with some elements of existing treatment guidelines as set out by the resuscitation component of the Surviving Sepsis Care Bundle. As an international campaign introduced predominantly within critical care, within this DGH the SSC teams' innovative approach has resulted in: * Better educated staff; * Objectives agreed within multi-disciplinary teams; * The appropriate assessment of resources; * Standardization of practice in terms of patients presenting with severe sepsis.

Assessing the food environment of a rural community: baseline findings from the heart of New Ulm project, Minnesota, 2010-2011.

PubMed

Pereira, Raquel F; Sidebottom, Abbey C; Boucher, Jackie L; Lindberg, Rebecca; Werner, Rebecca

2014-03-06

Changes in the food environment in the United States during the past few decades have contributed to increased rates of obesity, diabetes, and heart disease. Improving the food environment may be an effective primary prevention strategy to address these rising disease rates. The purpose of this study was to assess the consumer food environment of a rural community with high rates of obesity and low levels of fruit and vegetable consumption. Findings were used to identify food environment intervention strategies to be implemented as part of a larger community-based heart disease prevention program. We used the Nutrition Environment Measures Survey for Restaurants (NEMS-R) and Stores (NEMS-S) to assess 34 restaurants, 3 grocery stores, and 5 convenience stores in New Ulm, Minnesota. At least half of the restaurants offered nonfried vegetables and 100% fruit juice. Only 32% had at least 1 entrée or 1 main dish salad that met standards for "healthy." Fewer than half (41%) had fruit available and under one-third offered reduced-size portions (29%) or whole-grain bread (26%). Grocery stores had more healthful items available, but findings were mixed on whether these items were made available at a lower price than less healthful items. Convenience stores were less likely to have fruits and vegetables and less likely to carry more healthful products (except milk) than grocery stores. Baseline findings indicated opportunities to improve availability, quality, and price of foods to support more healthful eating. A community-wide food environment assessment can be used to strategically plan targeted interventions.

Limitations of studies on school-based nutrition education interventions for obesity in China: a systematic review and meta-analysis.

PubMed

Kong, Kaimeng; Liu, Jie; Tao, Yexuan

2016-01-01

School-based nutrition education has been widely implemented in recent years to fight the increasing prevalence of childhood obesity in China. A comprehensive literature search was performed using six databases to identify studies of school-based nutrition education interventions in China. The methodological quality and the risk of bias of selected literature were evaluated. Stratified analysis was performed to identify whether different methodologies influenced the estimated effect of the intervention. Seventeen articles were included in the analysis. Several of the included studies had inadequate intervention duration, inappropriate randomization methods, selection bias, unbalanced baseline characteristics between control and intervention groups, and absent sample size calculation. Overall, the studies showed no significant impact of nutrition education on obesity (OR=0.76; 95% CI=0.55-1.05; p=0.09). This can be compared with an OR of 0.68 for interventions aimed at preventing malnutrition and an OR of 0.49 for interventions aimed at preventing iron-deficiency anemia. When studies with unbalanced baseline characteristics between groups and selection bias in the study subjects were excluded, the impact of nutrition education on obesity was significant (OR=0.73; 95% CI=0.55-0.98; p=0.003). An analysis stratified according to the duration of intervention revealed that the intervention was effective only when it lasted for more than 2 years (OR=0.49, 95% CI=0.42-0.58; p<0.001). Studies of school-based nutrition education programs in China have some important limitations that might affect the estimated effectiveness of the intervention.

Evaluation of a user guidance reminder to improve the quality of electronic prescription messages.

PubMed

Dhavle, A A; Corley, S T; Rupp, M T; Ruiz, J; Smith, J; Gill, R; Sow, M

2014-01-01

Prescribers' inappropriate use of the free-text Notes field in new electronic prescriptions can create confusion and workflow disruptions at receiving pharmacies that often necessitates contact with prescribers for clarification. The inclusion of inappropriate patient direction (Sig) information in the Notes field is particularly problematic. We evaluated the effect of a targeted watermark, an embedded overlay, reminder statement in the Notes field of an EHR-based e-prescribing application on the incidence of inappropriate patient directions (Sig) in the Notes field. E-prescriptions issued by the same exact cohort of 97 prescribers were collected over three time periods: baseline, three months after implementation of the reminder, and 15 months post implementation. Three certified and experienced pharmacy technicians independently reviewed all e-prescriptions for inappropriate Sig-related information in the Notes field. A physician reviewer served as the final adjudicator for e-prescriptions where the three reviewers could not reach a consensus. ANOVA and post hoc Tukey HSD tests were performed on group comparisons where statistical significance was evaluated at p<0.05. The incidence of inappropriate Sig-related information in the Notes field decreased from a baseline of 2.8% to 1.8% three months post-implementation and remained stable after 15 months. In addition, prescribers' use of the Notes decreased by 22% after 3 months and had stabilized at 18.7% below baseline after 15 months. Insertion of a targeted watermark reminder statement in the Notes field of an e-prescribing application significantly reduced the incidence of inappropriate Sig-related information in Notes and decreased prescribers' use of this field.

Impact of Implementing Antibiotic Stewardship Programs in 15 Small Hospitals: A Cluster-Randomized Intervention.

PubMed

Stenehjem, Edward; Hersh, Adam L; Buckel, Whitney R; Jones, Peter; Sheng, Xiaoming; Evans, R Scott; Burke, John P; Lopansri, Bert K; Srivastava, Rajendu; Greene, Tom; Pavia, Andrew T

2018-02-23

Studies on the implementation of antibiotic stewardship programs (ASPs) in small hospitals are limited. Accreditation organizations now require all hospitals to have ASPs. The objective of this cluster-randomized intervention was to assess the effectiveness of implementing ASPs in Intermountain Healthcare's 15 small hospitals. Each hospital was randomized to 1 of 3 ASPs of escalating intensity. Program 1 hospitals were provided basic antibiotic stewardship education and tools, access to an infectious disease hotline, and antibiotic utilization data. Program 2 hospitals received those interventions plus advanced education, audit and feedback for select antibiotics, and locally controlled antibiotic restrictions. Program 3 hospitals received program 2 interventions plus audit and feedback on the majority of antibiotics, and an infectious diseases-trained clinician approved restricted antibiotics and reviewed microbiology results. Changes in total and broad-spectrum antibiotic use within programs (intervention versus baseline) and the difference between programs in the magnitude of change in antibiotic use (eg, program 3 vs 1) were evaluated with mixed models. Program 3 hospitals showed reductions in total (rate ratio, 0.89; confidence interval, .80-.99) and broad-spectrum (0.76; .63-.91) antibiotic use when the intervention period was compared with the baseline period. Program 1 and 2 hospitals did not experience a reduction in antibiotic use. Comparison of the magnitude of effects between programs showed a similar trend favoring program 3, but this was not statistically significant. Only the most intensive ASP intervention was associated with reduction in total and broad-spectrum antibiotic use when compared with baseline. NCT03245879.

Randomised controlled trial of a web-based programme in sustaining best practice alcohol management practices at community sports clubs: a study protocol

PubMed Central

McFadyen, Tameka; Kingsland, Melanie; Tindall, Jennifer; Rowland, Bosco; Sherker, Shauna; Gillham, Karen; Heaton, Rachael; Clinton-McHarg, Tara; Lecathelinais, Christophe; Brooke, Daisy; Wiggers, John

2018-01-01

Introduction Community-based interventions have been found to effectively increase the implementation of alcohol management practices and reduce excessive alcohol use and alcohol-related harm at sports clubs. However, once implementation support ceases there may be a reduction in such intervention effects. Thus, ongoing contribution to improving the health of the community is diminished; sustaining practice implementation is a key determinant to address this. One possible solution to the strategic and logistical challenges of sustainability involves the use of the web. The primary aim of this study is to assess the effectiveness of a web-based programme in sustaining the implementation of alcohol management practices by community football clubs. The secondary aim is to assess the effectiveness of the programme in preventing excessive alcohol consumption and alcohol-related harm among members of community football clubs. Methods and analysis The study will employ a repeat randomised controlled trial design and be conducted in regional and metropolitan areas within two states of Australia. Community level football clubs who are currently accredited with an existing alcohol management programme (‘Good Sports’) and implementing at least 10 of the 13 core alcohol management practices (eg, not serving alcohol to <18-year-olds) required by the programme will be recruited and randomised to either a web-based sustainability programme or a ‘minimal contact’ programme. The primary outcome measures are the proportion of football clubs implementing ≥10 of the 13 required alcohol management practices and the mean number of those practices being implemented at 3-year follow-up. Secondary outcomes include: the proportion of club members who report risky drinking at their club, the Alcohol Use Disorder Identification Test (AUDIT) score and mean AUDIT score of club members. Outcome data will be collected via observation at the club during a 1-day visit to a home game, conducted by trained research assistants at baseline and follow-up. Ethics and dissemination The study was approved by The University of Newcastle Human Research Ethics Committee (reference: H-2013-0429). Study findings will be disseminated widely through peer-reviewed publications and conference presentations. Trial registration number ACTRN12614000746639; Pre-results. PMID:29362250

50 CFR 648.90 - NE multispecies assessment, framework procedures and specifications, and flexible area action...

Code of Federal Regulations, 2013 CFR

2013-10-01

..., and DAS baselines, adjustments for steaming time, etc.; modifications to capacity measures, such as... affect the implementation of AMs based upon the distribution in effect at the time of the overage that...

A school-based application of modified habit reversal for Tourette syndrome via a translator: a case study.

PubMed

Gilman, Rich; Connor, Nancy; Haney, Michelle

2005-11-01

A school-based modified habit reversal intervention was utilized with an adolescent diagnosed with Tourette syndrome who recently immigrated from Mexico. Because the student possessed little proficiency of the English language, an interpreter was needed to help implement the procedure. The frequency of motor tics markedly decreased from baseline to intervention across classroom settings. Results of two follow-up phases revealed that motor tic levels remained below those observed in the baseline phase. Implications and limitations of these findings are noted.

An intervention to improve paediatric and newborn care in Kenyan district hospitals: understanding the context.

PubMed

English, Mike; Ntoburi, Stephen; Wagai, John; Mbindyo, Patrick; Opiyo, Newton; Ayieko, Philip; Opondo, Charles; Migiro, Santau; Wamae, Annah; Irimu, Grace

2009-07-23

It is increasingly appreciated that the interpretation of health systems research studies is greatly facilitated by detailed descriptions of study context and the process of intervention. We have undertaken an 18-month hospital-based intervention study in Kenya aiming to improve care for admitted children and newborn infants. Here we describe the baseline characteristics of the eight hospitals as environments receiving the intervention, as well as the general and local health system context and its evolution over the 18 months. Hospital characteristics were assessed using previously developed tools assessing the broad structure, process, and outcome of health service provision for children and newborns. Major health system or policy developments over the period of the intervention at a national level were documented prospectively by monitoring government policy announcements, the media, and through informal contacts with policy makers. At the hospital level, a structured, open questionnaire was used in face-to-face meetings with senior hospital staff every six months to identify major local developments that might influence implementation. These data provide an essential background for those seeking to understand the generalisability of reports describing the intervention's effects, and whether the intervention plausibly resulted in these effects. Hospitals had only modest capacity, in terms of infrastructure, equipment, supplies, and human resources available to provide high-quality care at baseline. For example, hospitals were lacking between 30 to 56% of items considered necessary for the provision of care to the seriously ill child or newborn. An increase in spending on hospital renovations, attempts to introduce performance contracts for health workers, and post-election violence were recorded as examples of national level factors that might influence implementation success generally. Examples of factors that might influence success locally included frequent and sometimes numerous staff changes, movements of senior departmental or administrative staff, and the presence of local 'donor' partners with alternative priorities. The effectiveness of interventions delivered at hospital level over periods realistically required to achieve change may be influenced by a wide variety of factors at national and local levels. We have demonstrated how dynamic such contexts are, and therefore the need to consider context when interpreting an intervention's effectiveness.

Fourier Transform Fringe-Pattern Analysis of an Absolute Distance Michelson Interferometer for Space-Based Laser Metrology.

NASA Astrophysics Data System (ADS)

Talamonti, James Joseph

1995-01-01

Future NASA proposals include the placement of optical interferometer systems in space for a wide variety of astrophysical studies including a vastly improved deflection test of general relativity, a precise and direct calibration of the Cepheid distance scale, and the determination of stellar masses (Reasenberg et al., 1988). There are also plans for placing large array telescopes on the moon with the ultimate objective of being able to measure angular separations of less than 10 mu-arc seconds (Burns, 1990). These and other future projects will require interferometric measurement of the (baseline) distance between the optical elements comprising the systems. Eventually, space qualifiable interferometers capable of picometer (10^{-12}m) relative precision and nanometer (10^{ -9}m) absolute precision will be required. A numerical model was developed to emulate the capabilities of systems performing interferometric noncontact absolute distance measurements. The model incorporates known methods to minimize signal processing and digital sampling errors and evaluates the accuracy limitations imposed by spectral peak isolation using Hanning, Blackman, and Gaussian windows in the Fast Fourier Transform Technique. We applied this model to the specific case of measuring the relative lengths of a compound Michelson interferometer using a frequency scanned laser. By processing computer simulated data through our model, the ultimate precision is projected for ideal data, and data containing AM/FM noise. The precision is shown to be limited by non-linearities in the laser scan. A laboratory system was developed by implementing ultra-stable external cavity diode lasers into existing interferometric measuring techniques. The capabilities of the system were evaluated and increased by using the computer modeling results as guidelines for the data analysis. Experimental results measured 1-3 meter baselines with <20 micron precision. Comparison of the laboratory and modeling results showed that the laboratory precisions obtained were of the same order of magnitude as those predicted for computer generated results under similar conditions. We believe that our model can be implemented as a tool in the design for new metrology systems capable of meeting the precisions required by space-based interferometers.

Safety of the two-step tuberculin skin test in Indian health care workers.

PubMed

Christopher, Devasahayam J; Shankar, Deepa; Datey, Ashima; Zwerling, Alice; Pai, Madhukar

2014-12-01

Health care workers (HCW) in low and middle income countries are at high risk of nosocomial tuberculosis infection. Periodic screening of health workers for both TB disease and infection can play a critical role in TB infection control. Occupational health programs that implement serial tuberculin skin testing (TST) are advised to use a two-step baseline TST. This helps to ensure that boosting of waned immune response is not mistaken as new TB infection (i.e. conversion). However, there are no data on safety of the two-step TST in the Indian context where HCWs are repeatedly exposed. Nursing students were recruited from 2007 to 2009 at the Christian Medical College and Hospital, Vellore, India. Consenting nursing students were screened with a baseline two-step TST at the time of recruitment. From 2007 to 2008 adverse events were recorded when reported during the TST reading (Cohort A). Nurses recruited in the final study year (2009) answered an investigator administered questionnaire assessing all likely side-effects Cohort B). This information was extracted from the case report forms and analysed. Between 2007 and 09, 800 trainees consented to participate in the annual TB screening study and 779 did not have a past history of TB or recall a positive TST and were selected to administer TST. Of these, 755 returned for reading the result and had complete data and were included for the final analysis - 623 subjects in (cohort A) and 132 in (cohort B). These were included for the final analysis. In cohort A only 1.3% reported adverse events. In cohort B, as per the investigator administered questionnaire; 25% reported minor side effects. Itching and local pain were the most common side effects encountered. There were no major adverse events reported. In particular, the adverse events were similar in the second step of the test and not more severe. Screening of HCWs with two-step TST for LTBI is simple and safe, and hence suitable for wide scale implementation in high-burden settings such as India. Copyright © 2014 Asian-African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.

Cattle producers' economic incentives for preventing bovine brucellosis under uncertainty.

PubMed

Roberts, Trenton W; Peck, Dannele E; Ritten, John P

2012-12-01

Cattle in the Greater Yellowstone Ecosystem occasionally contract bovine brucellosis from free-ranging elk and bison. Cattle producers use a variety of brucellosis prevention activities to reduce their herds' risk of contracting brucellosis, such as: (1) having state agency personnel haze elk off private land, (2) fencing haystacks, (3) administering adult booster vaccination, (4) spaying heifers, (5) altering the winter-feeding schedule of cattle, (6) hiring riders to prevent cattle-elk commingling, and (7) delaying grazing on high-risk allotments. Their brucellosis prevention decisions are complicated, however, by several sources of uncertainty, including the following: a cattle herd's baseline risk of contracting brucellosis, the inherent randomness of brucellosis outbreaks, the cost of implementing prevention activities, and the activities' effectiveness. This study eliminates one source of uncertainty by estimating the cost of implementing brucellosis prevention activities on a representative cow/calf-long yearling operation in the southern GYE. It then reports the minimum level of effectiveness each prevention activity must achieve to justify investment by a risk-neutral producer. Individual producers face different levels of baseline risk, however, and the US government's brucellosis-response policy is constantly evolving. We therefore estimate breakeven levels of effectiveness for a range of baseline risks and government policies. Producers, animal health experts, and policymakers can use this study's results to determine which brucellosis prevention activities are unlikely to generate sufficient expected benefits to cover their cost of implementation. Results also demonstrate the influence of government policy on producers' incentives to prevent brucellosis. Policies that increase the magnitude of economic loss a producer incurs when their herd contracts brucellosis subsequently decrease prevention activities' breakeven levels of effectiveness, and increase producers' incentives to implement those activities. Producers' incentives to implement prevention activities also increase as activities' costs decrease. Policymakers can easily adapt the results of this analysis to help target cost-share agreements to producers and prevention activities most likely to generate positive expected net benefits. Epidemiologists can also use our results to help prioritize future research on the technical effectiveness of various brucellosis prevention activities. Copyright © 2012 Elsevier B.V. All rights reserved.

“The 3/3 Strategy”: A Successful Multifaceted Hospital Wide Hand Hygiene Intervention Based on WHO and Continuous Quality Improvement Methodology

PubMed Central

Mestre, Gabriel; Berbel, Cristina; Tortajada, Purificación; Alarcia, Margarita; Coca, Roser; Gallemi, Gema; Garcia, Irene; Fernández, Mari Mar; Aguilar, Mari Carmen; Martínez, José Antonio; Rodríguez-Baño, Jesús

2012-01-01

Background Only multifaceted hospital wide interventions have been successful in achieving sustained improvements in hand hygiene (HH) compliance. Methodology/Principal Findings Pre-post intervention study of HH performance at baseline (October 2007– December 2009) and during intervention, which included two phases. Phase 1 (2010) included multimodal WHO approach. Phase 2 (2011) added Continuous Quality Improvement (CQI) tools and was based on: a) Increase of alcohol hand rub (AHR) solution placement (from 0.57 dispensers/bed to 1.56); b) Increase in frequency of audits (three days every three weeks: “3/3 strategy”); c) Implementation of a standardized register form of HH corrective actions; d) Statistical Process Control (SPC) as time series analysis methodology through appropriate control charts. During the intervention period we performed 819 scheduled direct observation audits which provided data from 11,714 HH opportunities. The most remarkable findings were: a) significant improvements in HH compliance with respect to baseline (25% mean increase); b) sustained high level (82%) of HH compliance during intervention; c) significant increase in AHRs consumption over time; c) significant decrease in the rate of healthcare-acquired MRSA; d) small but significant improvements in HH compliance when comparing phase 2 to phase 1 [79.5% (95% CI: 78.2–80.7) vs 84.6% (95% CI:83.8–85.4), p<0.05]; e) successful use of control charts to identify significant negative and positive deviations (special causes) related to the HH compliance process over time (“positive”: 90.1% as highest HH compliance coinciding with the “World hygiene day”; and “negative”:73.7% as lowest HH compliance coinciding with a statutory lay-off proceeding). Conclusions/Significance CQI tools may be a key addition to WHO strategy to maintain a good HH performance over time. In addition, SPC has shown to be a powerful methodology to detect special causes in HH performance (positive and negative) and to help establishing adequate feedback to healthcare workers. PMID:23110061

Implementing ADM1 for plant-wide benchmark simulations in Matlab/Simulink.

PubMed

Rosen, C; Vrecko, D; Gernaey, K V; Pons, M N; Jeppsson, U

2006-01-01

The IWA Anaerobic Digestion Model No.1 (ADM1) was presented in 2002 and is expected to represent the state-of-the-art model within this field in the future. Due to its complexity the implementation of the model is not a simple task and several computational aspects need to be considered, in particular if the ADM1 is to be included in dynamic simulations of plant-wide or even integrated systems. In this paper, the experiences gained from a Matlab/Simulink implementation of ADM1 into the extended COST/IWA Benchmark Simulation Model (BSM2) are presented. Aspects related to system stiffness, model interfacing with the ASM family, mass balances, acid-base equilibrium and algebraic solvers for pH and other troublesome state variables, numerical solvers and simulation time are discussed. The main conclusion is that if implemented properly, the ADM1 will also produce high-quality results in dynamic plant-wide simulations including noise, discrete sub-systems, etc. without imposing any major restrictions due to extensive computational efforts.

The Progress of US Hospitals in Addressing Community Health Needs.

PubMed

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

2017-02-01

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

Effectiveness of a multimodal hand hygiene campaign and obstacles to success in Addis Ababa, Ethiopia.

PubMed

Schmitz, Karen; Kempker, Russell R; Tenna, Admasu; Stenehjem, Edward; Abebe, Engida; Tadesse, Lia; Jirru, Ermias Kacha; Blumberg, Henry M

2014-03-17

Hand hygiene is the cornerstone of infection control and reduces rates of healthcare associated infection. There are limited data evaluating hand hygiene adherence and hand hygiene campaign effect in resource-limited settings, especially in Sub-Saharan Africa. This study assessed the impact of implementing a World Health Organization (WHO)-recommended multimodal hand hygiene campaign at a hospital in Ethiopia. This study included a before-and-after assessment of health care worker (HCW) adherence with WHO hand hygiene guidelines. It was implemented in three phases: 1) baseline evaluation of hand hygiene adherence and hospital infrastructure; 2) intervention (distribution of commercial hand sanitizer and implementation of an abbreviated WHO-recommended multimodal hand hygiene campaign); and 3) post-intervention evaluation of HCW hand hygiene adherence. HCWs' perceptions of the campaign and hand sanitizer tolerability were assessed through a survey performed in the post-intervention period. At baseline, hand washing materials were infrequently available, with only 20% of sinks having hand-washing materials. There was a significant increase in hand hygiene adherence among HCWs following implementation of a WHO multimodal hand hygiene program. Adherence increased from 2.1% at baseline (21 hand hygiene actions/1000 opportunities for hand hygiene) to 12.7% (127 hand hygiene actions /1000 opportunities for hand hygiene) after the implementation of the hand hygiene campaign (OR = 6.8, 95% CI 4.2-10.9). Hand hygiene rates significantly increased among all HCW types except attending physicians. Independent predictors of HCW hand hygiene compliance included performing hand hygiene in the post-intervention period (aOR = 5.7, 95% CI 3.5-9.3), in the emergency department (aOR = 4.9, 95% CI 2.8-8.6), during patient care that did not involve Attending Physician Rounds (aOR = 2.4, 95% CI 1.2-4.5), and after patient contact (aOR = 2.1, 95% CI 1.4-3.3). In the perceptions survey, 64.0% of HCWs indicated preference for commercially manufactured hand sanitizer and 71.4% indicated their hand hygiene adherence would improve with commercial hand sanitizer. There was a significant increase in hand hygiene adherence among Ethiopian HCWs following the implementation of a WHO-recommended multimodal hand hygiene campaign. Dissatisfaction with the current WHO-formulation for hand sanitizer was identified as a barrier to hand hygiene adherence in our setting.

Design and Hospital-Wide Implementation of a Standardized Discharge Summary in an Electronic Health Record

PubMed Central

Dean, Shannon M; Gilmore-Bykovskyi, Andrea; Buchanan, Joel; Ehlenfeldt, Brad; Kind, Amy JH

2016-01-01

Background The hospital discharge summary is the primary method used to communicate a patient's plan of care to the next provider(s). Despite the existence of regulations and guidelines outlining the optimal content for the discharge summary and its importance in facilitating an effective transition to post-hospital care, incomplete discharge summaries remain a common problem that may contribute to poor post-hospital outcomes. Electronic health records (EHRs) are regularly used as a platform upon which standardization of content and format can be implemented. Objective We describe here the design and hospital-wide implementation of a standardized discharge summary using an EHR. Methods We employed the evidence-based Replicating Effective Programs implementation strategy to guide the development and implementation during this large-scale project. Results Within 18 months, 90% of all hospital discharge summaries were written using the standardized format. Hospital providers found the template helpful and easy to use, and recipient providers perceived an improvement in the quality of discharge summaries compared to those sent from our hospital previously. Conclusions Discharge summaries can be standardized and implemented hospital-wide with both author and recipient provider satisfaction, especially if evidence-based implementation strategies are employed. The use of EHR tools to guide clinicians in writing comprehensive discharge summaries holds promise in improving the existing deficits in communication at transitions of care. PMID:28334559

Quality improvement of International Classification of Diseases, 9th revision, diagnosis coding in radiation oncology: single-institution prospective study at University of California, San Francisco.

PubMed

Chen, Chien P; Braunstein, Steve; Mourad, Michelle; Hsu, I-Chow J; Haas-Kogan, Daphne; Roach, Mack; Fogh, Shannon E

2015-01-01

Accurate International Classification of Diseases (ICD) diagnosis coding is critical for patient care, billing purposes, and research endeavors. In this single-institution study, we evaluated our baseline ICD-9 (9th revision) diagnosis coding accuracy, identified the most common errors contributing to inaccurate coding, and implemented a multimodality strategy to improve radiation oncology coding. We prospectively studied ICD-9 coding accuracy in our radiation therapy--specific electronic medical record system. Baseline ICD-9 coding accuracy was obtained from chart review targeting ICD-9 coding accuracy of all patients treated at our institution between March and June of 2010. To improve performance an educational session highlighted common coding errors, and a user-friendly software tool, RadOnc ICD Search, version 1.0, for coding radiation oncology specific diagnoses was implemented. We then prospectively analyzed ICD-9 coding accuracy for all patients treated from July 2010 to June 2011, with the goal of maintaining 80% or higher coding accuracy. Data on coding accuracy were analyzed and fed back monthly to individual providers. Baseline coding accuracy for physicians was 463 of 661 (70%) cases. Only 46% of physicians had coding accuracy above 80%. The most common errors involved metastatic cases, whereby primary or secondary site ICD-9 codes were either incorrect or missing, and special procedures such as stereotactic radiosurgery cases. After implementing our project, overall coding accuracy rose to 92% (range, 86%-96%). The median accuracy for all physicians was 93% (range, 77%-100%) with only 1 attending having accuracy below 80%. Incorrect primary and secondary ICD-9 codes in metastatic cases showed the most significant improvement (10% vs 2% after intervention). Identifying common coding errors and implementing both education and systems changes led to significantly improved coding accuracy. This quality assurance project highlights the potential problem of ICD-9 coding accuracy by physicians and offers an approach to effectively address this shortcoming. Copyright © 2015. Published by Elsevier Inc.

Impact of Process Optimization and Quality Improvement Measures on Neonatal Feeding Outcomes at an All-Referral Neonatal Intensive Care Unit.

PubMed

Jadcherla, Sudarshan R; Dail, James; Malkar, Manish B; McClead, Richard; Kelleher, Kelly; Nelin, Leif

2016-07-01

We hypothesized that the implementation of a feeding quality improvement (QI) program among premature neonates accelerates feeding milestones, safely lowering hospital length of stay (LOS) compared with the baseline period. Baseline data were collected for 15 months (N = 92) prior to initiating the program, which involved development and implementation of a standardized feeding strategy in eligible premature neonates. Process optimization, implementation of feeding strategy, monitoring compliance, multidisciplinary feeding rounds, and continuous education strategies were employed. The main outcomes included the ability and duration to reach enteral feeds-120 (mL/kg/d), oral feeds-120 (mL/kg/d), and ad lib oral feeding. Balancing measures included growth velocities, comorbidities, and LOS. Comparing baseline versus feeding program (N = 92) groups, respectively, the feeding program improved the number of infants receiving trophic feeds (34% vs 80%, P < .002), trophic feeding duration (14.8 ± 10.3 days vs 7.6 ± 8.1 days, P < .0001), time to enteral feeds-120 (16.3 ± 15.4 days vs 11.4 ± 10.4 days, P < .04), time from oral feeding onset to oral feeds-120 (13.2 ± 16.7 days vs 19.5 ± 15.3 days, P < .0001), time from oral feeds-120 to ad lib feeds at discharge (22.4 ± 27.2 days vs 18.6 ± 21.3 days, P < .01), weight velocity (24 ± 6 g/d vs 27 ± 11 g/d, P < .03), and LOS (104.2 ± 51.8 vs 89.3 ± 46.0, P = .02). Mortality, readmissions within 30 days, and comorbidities were similar. Process optimization and the implementation of a standardized feeding strategy minimize practice variability, accelerating the attainment of enteral and oral feeding milestones and decreasing LOS without increasing adverse morbidities. © 2015 American Society for Parenteral and Enteral Nutrition.

Trauma Quality Improvement: Reducing Triage Errors by Automating the Level Assignment Process.

PubMed

Stonko, David P; O Neill, Dillon C; Dennis, Bradley M; Smith, Melissa; Gray, Jeffrey; Guillamondegui, Oscar D

2018-04-12

Trauma patients are triaged by the severity of their injury or need for intervention while en route to the trauma center according to trauma activation protocols that are institution specific. Significant research has been aimed at improving these protocols in order to optimize patient outcomes while striving for efficiency in care. However, it is known that patients are often undertriaged or overtriaged because protocol adherence remains imperfect. The goal of this quality improvement (QI) project was to improve this adherence, and thereby reduce the triage error. It was conducted as part of the formal undergraduate medical education curriculum at this institution. A QI team was assembled and baseline data were collected, then 2 Plan-Do-Study-Act (PDSA) cycles were implemented sequentially. During the first cycle, a novel web tool was developed and implemented in order to automate the level assignment process (it takes EMS-provided data and automatically determines the level); the tool was based on the existing trauma activation protocol. The second PDSA cycle focused on improving triage accuracy in isolated, less than 10% total body surface area burns, which we identified to be a point of common error. Traumas were reviewed and tabulated at the end of each PDSA cycle, and triage accuracy was followed with a run chart. This study was performed at Vanderbilt University Medical Center and Medical School, which has a large level 1 trauma center covering over 75,000 square miles, and which sees urban, suburban, and rural trauma. The baseline assessment period and each PDSA cycle lasted 2 weeks. During this time, all activated, adult, direct traumas were reviewed. There were 180 patients during the baseline period, 189 after the first test of change, and 150 after the second test of change. All were included in analysis. Of 180 patients, 30 were inappropriately triaged during baseline analysis (3 undertriaged and 27 overtriaged) versus 16 of 189 (3 undertriaged and 13 overtriaged) following implementation of the web tool (p = 0.017 for combined errors). Overtriage dropped further from baseline to 10/150 after the second test of change (p = 0.005). The total number of triaged patients dropped from 92.3/week to 75.5/week after the second test of change. There was no statistically significant change in the undertriage rate. The combination of web tool implementation and protocol refinement decreased the combined triage error rate by over 50% (from 16.7%-7.9%). We developed and tested a web tool that improved triage accuracy, and provided a sustainable method to enact future quality improvement. This web tool and QI framework would be easily expandable to other hospitals. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Effects of Implementing School-Wide Positive Behavioural Interventions and Supports on Problem Behaviour and Academic Achievement in a Canadian Elementary School

ERIC Educational Resources Information Center

Kelm, Joanna L.; McIntosh, Kent; Cooley, Sharon

2014-01-01

Although there is much research on School-Wide Positive Behavioural Interventions and Supports (PBIS) in the United States, there is little such research in Canada. The purpose of the current study was to provide a case study example of the relation between implementing PBIS and student academic and behavioural outcomes, as well as student…

Plasma levels of sIL-2Rα: associations with clinical cardiovascular events and genome- wide association scan

PubMed Central

Durda, Peter; Sabourin, Jeremy; Lange, Ethan M.; Nalls, Mike A.; Mychaleckyj, Josyf C.; Jenny, Nancy Swords; Li, Jin; Walston, Jeremy; Harris, Tamara B.; Psaty, Bruce M.; Valdar, William; Liu, Yongmei; Cushman, Mary; Reiner, Alex P.; Tracy, Russell P.; Lange, Leslie A.

2017-01-01

Objective Interleukin-2 receptor subunit alpha (IL-2Rα) regulates lymphocyte activation, which plays an important role in atherosclerosis. Associations between soluble IL-2Rα and cardiovascular disease (CVD) have not been widely studied and little is known about the genetic determinants of sIL-2Rα levels. Approach and Results We measured baseline levels of sIL- 2Rα in 4408 European-American (EA) and 766 African-American (AA) adults from the Cardiovascular Health Study (CHS) and examined associations with baseline CVD risk factors, subclinical CVD and incident CVD events. We also performed a genome-wide association study (GWAS) for sIL-2Rα in CHS (2964 EAs and 683 AAs) and further combined CHS EA results with those from two other EA cohorts in a meta-analysis (N=4464 EAs). In age, sex- and race- adjusted models, sIL-2Rα was positively associated with current smoking, type 2 diabetes, hypertension, insulin, waist circumference, C-reactive protein, interleukin-6, fibrinogen, internal carotid wall thickness, all-cause mortality, CVD mortality, and incident CVD, stroke and heart failure. When adjusted for baseline CVD risk factors and subclinical CVD, associations with all- cause mortality, CVD mortality and heart failure remained significant in both EAs and AAs. In the EA GWAS analysis, we observed 52 single nucleotide polymorphisms (SNPs) in the chromosome 10p15-14 region, which contains IL2RA, IL15RA and RMB17, that reached genome-wide significance (p<5×10-8). The most significant SNP was rs7911500 (p=1.31×10-75). The EA meta-analysis results were highly consistent with CHS-only results. No SNPs reached statistical significance in the AAs. Conclusions These results support a role for sIL-2Rα in atherosclerosis and provide evidence for multiple associated SNPs at chromosome 10p15-14. PMID:26293465

Construct Validation of a Measure to Assess Sustainability of School-Wide Behavior Interventions

ERIC Educational Resources Information Center

Hume, Amanda; McIntosh, Kent

2013-01-01

This study assessed aspects of construct validity of the School-wide Universal Behavior Sustainability Index-School Teams (SUBSIST), a measure evaluating critical features of the school context related to sustainability of school-wide interventions. Participants at 217 schools implementing School-wide Positive Behavior Support (SWPBS) were…

Implementation of a multidisciplinary guideline improves preterm infant admission temperatures.

PubMed

Harer, M W; Vergales, B; Cady, T; Early, A; Chisholm, C; Swanson, J R

2017-11-01

Hypothermia is a common problem in preterm infants immediately following delivery.Local problem:The rate of admission hypothermia in our neonatal intensive care unit (NICU) was above the rate of comparable NICUs in the Vermont Oxford Network. To reduce the rate of preterm admission hypothermia, a quality improvement (QI) project was implemented, utilizing the plan-do-study-act (PDSA) methodology. A guideline for delivery room thermoregulation management in <35-week infants at the University of Virginia was created and put into practice by a multidisciplinary team. Clinical practice changes in the guideline included: increasing operating room temperatures, obtaining a 10-min axillary temperature, using an exothermic mattress for all infants <35 weeks, and using a polyethylene wrap for infants <32 weeks. The baseline rate of hypothermia (<36.5 °CC) was 63%. Three PDSA cycles data were completed on 168 consecutive preterm births. The post-implementation rate of hypothermia (<36.5 °C) was reduced to 30% (P<0.001). The incidence of moderate hypothermia (< 36 °C) was reduced from a baseline of 29% to a rate of 9% (P<0.001). Use of a multidisciplinary guideline to increase preterm NICU admission temperatures resulted in a decrease in hypothermic infants.

Linking Infectious and Narcology Care (LINC) in Russia: design, intervention and implementation protocol.

PubMed

Gnatienko, Natalia; Han, Steve C; Krupitsky, Evgeny; Blokhina, Elena; Bridden, Carly; Chaisson, Christine E; Cheng, Debbie M; Walley, Alexander Y; Raj, Anita; Samet, Jeffrey H

2016-05-04

Russia and Eastern Europe have one of the fastest growing HIV epidemics in the world. While countries in this region have implemented HIV testing within addiction treatment systems, linkage to HIV care from these settings is not yet standard practice. The Linking Infectious and Narcology Care (LINC) intervention utilized peer-led strengths-based case management to motivate HIV-infected patients in addiction treatment to obtain HIV care. This paper describes the protocol of a randomized controlled trial evaluating the effectiveness of the LINC intervention in St. Petersburg, Russia. Participants (n = 349) were recruited from the inpatient wards at the City Addiction Hospital in St. Petersburg, Russia. After completing a baseline assessment, participants were randomly assigned to receive either the LINC intervention or standard of care. Participants returned for research assessments 6 and 12 months post-baseline. Primary outcomes were assessed via chart review at HIV treatment locations. LINC holds the potential to offer an effective approach to coordinating HIV care for people who inject drugs in Russia. The LINC intervention utilizes existing systems of care in Russia, minimizing adoption of substantial infrastructure for implementation. Trial Registration NCT01612455.

Simulating large atmospheric phase screens using a woofer-tweeter algorithm.

PubMed

Buscher, David F

2016-10-03

We describe an algorithm for simulating atmospheric wavefront perturbations over ranges of spatial and temporal scales spanning more than 4 orders of magnitude. An open-source implementation of the algorithm written in Python can simulate the evolution of the perturbations more than an order-of-magnitude faster than real time. Testing of the implementation using metrics appropriate to adaptive optics systems and long-baseline interferometers show accuracies at the few percent level or better.

Improving metabolic monitoring in patients maintained on antipsychotics in Penang, Malaysia.

PubMed

Hor, Esther Sl; Subramaniam, Sivasangari; Koay, Jun Min; Bharathy, Arokiamary; Vasudevan, Umadevi; Panickulam, Joseph J; Ng, InnTiong; Arif, Nor Hayati; Russell, Vincent

2016-02-01

To evaluate the monitoring of metabolic parameters among outpatients maintained on antipsychotic medications in a general hospital setting in Malaysia and to assess the impact of a local monitoring protocol. By performing a baseline audit of files from a random sample of 300 patients prescribed antipsychotic medications for at least 1 year; we determined the frequency of metabolic monitoring. The findings informed the design of a new local protocol, on which clinical staff was briefed. We re-evaluated metabolic monitoring immediately after implementation, in a small sample of new referrals and current patients. We explored staff perceptions of the initiative with a follow-up focus group, 6 months post-implementation. The baseline audit revealed a sub-optimal frequency of metabolic parameter recording. Re-audit, following implementation of the new protocol, revealed improved monitoring but persisting deficits. Dialogue with the clinical staff led to further protocol modification, clearer definition of staff roles and use of a standard recording template. Focus group findings revealed positive perceptions of the initiative, but persisting implementation barriers, including cultural issues surrounding waist circumference measurement. Responding to challenges in achieving improved routine metabolic monitoring of patients maintained on antipsychotics required on-going dialogue with the clinical staff, in order to address both service pressures and cultural concerns. © The Royal Australian and New Zealand College of Psychiatrists 2015.

PRogram In Support of Moms (PRISM): a pilot group randomized controlled trial of two approaches to improving depression among perinatal women.

PubMed

Byatt, Nancy; Moore Simas, Tiffany A; Biebel, Kathleen; Sankaran, Padma; Pbert, Lori; Weinreb, Linda; Ziedonis, Douglas; Allison, Jeroan

2017-10-10

This pilot study was designed to inform a larger effectiveness trial by: (1) assessing the feasibility of the PRogram In Support of Moms (PRISM) and our study procedures; and, (2) determining the extent to which PRISM as compared to an active comparison group, the Massachusetts Child Access Psychiatry Program (MCPAP) for Moms alone, improves depression among perinatal women. Four practices were randomized to either PRISM or MCPAP for Moms alone, a state-wide telephonic perinatal psychiatry program. PRISM includes MCPAP for Moms plus implementation assistance with local champions, training, and implementation of office prompts and procedures to enhance depression screening, assessment and treatment. Patients with Edinburgh Postnatal Depression Scales (EPDS) ≥ 10 were recruited during pregnancy, and completed the EPDS and a structured interview at baseline and 3-12 weeks' postpartum. Among MCPAP for Moms alone practices, patients' (n = 9) EPDS scores improved from 15.22 to 10.11 (p = 0.010), whereas in PRISM practices patients' (n = 21) EPDS scores improved from 13.57 to 6.19 (p = 0.001); the between groups difference-of-differences was 2.27 (p = 0.341). PRISM was beneficial for patients, clinicians, and support staff. Both PRISM and MCPAP for Moms alone improve depression symptom severity and the percentage of women with an EPDS >10. The improvement difference between groups was not statistically significant due to limited power associated with small sample size.

A reflective teaching challenge to motivate educational innovation.

PubMed

Edwards, Roger A; Kirwin, Jennifer; Gonyeau, Michael; Matthews, S James; Lancaster, Jason; DiVall, Margarita

2014-06-17

To describe a teaching challenge intended to increase faculty use of evidence-based and student-centered instructional strategies in the demanding school of pharmacy context with technology-savvy students. A teaching challenge was created that required faculty members to incorporate a "new-to-you" innovative teaching method in a class, course, or experiential activity. The method was linked to at least 1 of 7 evidence-based principles for effective teaching. Faculty members were exposed to colleagues' teaching strategies via brief voluntary presentations at department meetings. A post-challenge survey provided assessment data about the challenge. Responses to a baseline survey provided additional information about what faculty members were already doing (52% response rate). Eighty-one percent of faculty respondents completed the challenge. A wide array of new strategies (13 categories such as flipped classrooms and social media) was implemented and 75% included the use of technology. Nearly all respondents (96%) thought that participation in the challenge was worth the effort and planned to participate again the following year. All faculty members intended to continue using their new strategy and 56% planned additional modifications with future implementations. The challenge demonstrated how multiple goals of curricular improvement, faculty development, and student-centered instruction could be achieved together. The teaching challenge motivated most of the faculty members to try something new to them. Links between evidence-based principles and day-to-day activities were strengthened. The new-to-you design placed the challenge within reach of faculty members regardless of their background, subject, or experience.

Online learning algorithm for time series forecasting suitable for low cost wireless sensor networks nodes.

PubMed

Pardo, Juan; Zamora-Martínez, Francisco; Botella-Rocamora, Paloma

2015-04-21

Time series forecasting is an important predictive methodology which can be applied to a wide range of problems. Particularly, forecasting the indoor temperature permits an improved utilization of the HVAC (Heating, Ventilating and Air Conditioning) systems in a home and thus a better energy efficiency. With such purpose the paper describes how to implement an Artificial Neural Network (ANN) algorithm in a low cost system-on-chip to develop an autonomous intelligent wireless sensor network. The present paper uses a Wireless Sensor Networks (WSN) to monitor and forecast the indoor temperature in a smart home, based on low resources and cost microcontroller technology as the 8051MCU. An on-line learning approach, based on Back-Propagation (BP) algorithm for ANNs, has been developed for real-time time series learning. It performs the model training with every new data that arrive to the system, without saving enormous quantities of data to create a historical database as usual, i.e., without previous knowledge. Consequently to validate the approach a simulation study through a Bayesian baseline model have been tested in order to compare with a database of a real application aiming to see the performance and accuracy. The core of the paper is a new algorithm, based on the BP one, which has been described in detail, and the challenge was how to implement a computational demanding algorithm in a simple architecture with very few hardware resources.

Online Learning Algorithm for Time Series Forecasting Suitable for Low Cost Wireless Sensor Networks Nodes

PubMed Central

Pardo, Juan; Zamora-Martínez, Francisco; Botella-Rocamora, Paloma

2015-01-01

Time series forecasting is an important predictive methodology which can be applied to a wide range of problems. Particularly, forecasting the indoor temperature permits an improved utilization of the HVAC (Heating, Ventilating and Air Conditioning) systems in a home and thus a better energy efficiency. With such purpose the paper describes how to implement an Artificial Neural Network (ANN) algorithm in a low cost system-on-chip to develop an autonomous intelligent wireless sensor network. The present paper uses a Wireless Sensor Networks (WSN) to monitor and forecast the indoor temperature in a smart home, based on low resources and cost microcontroller technology as the 8051MCU. An on-line learning approach, based on Back-Propagation (BP) algorithm for ANNs, has been developed for real-time time series learning. It performs the model training with every new data that arrive to the system, without saving enormous quantities of data to create a historical database as usual, i.e., without previous knowledge. Consequently to validate the approach a simulation study through a Bayesian baseline model have been tested in order to compare with a database of a real application aiming to see the performance and accuracy. The core of the paper is a new algorithm, based on the BP one, which has been described in detail, and the challenge was how to implement a computational demanding algorithm in a simple architecture with very few hardware resources. PMID:25905698

Phase II (baseline) report for the Greater Yellowstone Regional Traveler and Weather Information System (GYRTWIS)

DOT National Transportation Integrated Search

2002-09-11

In an effort to make road and weather information more readily available to travelers and maintenance personnel, Montana is implementing the Greater Yellowstone Regional Traveler and Weather Information System (GYRTWIS). GYRTWIS replaces the existing...

Sandia National Laboratories site-wide hydrogeologic characterization project calendar year 1992 annual report

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

Crowson, D.; Gibson, J.D.; Haase, C.S.

1993-10-01

The Sandia National Laboratories, New Mexico (SNL/NM) Site-Wide Hydrogeologic Characterization (SWHC) project has been implemented as part of the SNL/NM Environmental Restoration (ER) Program to develop the regional hydrogeologic framework and baseline for the approximately 100 mi of Kirtland Air Force Base (KAFB) and adjacent withdrawn public lands upon which SNL/NM has performed research and development activities. Additionally, the SWHC project will investigate and characterize generic hydrogeologic issues associated with the 172 ER sites owned by SNL/NM across its facilities on KAFB. As called for in the Hazardous and Solid Waste Amendments (HSWA) to the Resource Conservation and Recovery Actmore » (RCRA) Part B permit agreement between the U.S. Environmental Protection Agency (EPA) as the permitter and the U.S. Department of Energy (DOE) and SNL/NM as the permittees, an annual report is to be prepared by the SWHC project team. This document serves two primary purposes: (1) to identify and describe the conceptual framework for the hydrogeologic system underlying SNL/NM and (2) to describe characterization activities undertaken in the preceding year that add to our understanding (reduce our uncertainties) regarding the conceptual and quantitative hydrogeologic framework. This SWHC project annual report focuses primarily on purpose 1, providing a summary description of the current {open_quotes}state of knowledge{close_quotes} of the Sandia National Laboratories/Kirtland Air Force Base (SNL/KAFB) hydrogeologic setting.« less

An urban systems framework to assess the trans-boundary food-energy-water nexus: implementation in Delhi, India

NASA Astrophysics Data System (ADS)

Ramaswami, Anu; Boyer, Dana; Singh Nagpure, Ajay; Fang, Andrew; Bogra, Shelly; Bakshi, Bhavik; Cohen, Elliot; Rao-Ghorpade, Ashish

2017-02-01

This paper develops a generalizable systems framework to analyze the food-energy-water (FEW) nexus from an urban systems perspective, connecting in- and trans-boundary interactions, quantifying multiple environmental impacts of community-wide FEW provisioning to cities, and visualizing FEW supply-chain risks posed to cities by the environment. Delhi’s community-wide food demand includes household consumption by socio-economic-strata, visitors- and industrial food-use. This demand depends 90%, 76%, and 86% on trans-boundary supply of FEW, respectively. Supply chain data reveal unique features of trans-boundary FEW production regions (e.g. irrigation-electricity needs and GHG intensities of power-plants), yielding supply chain-informed coupled energy-water-GHG footprints of FEW provisioning to Delhi. Agri-food supply contributes to both GHG (19%) and water-footprints (72%-82%) of Delhi’s FEW provisioning, with milk, rice and wheat dominating these footprints. Analysis of FEW interactions within Delhi found >75% in-boundary water-use for food is for urban agriculture and >76% in-boundary energy-use for food is from cooking fuels. Food waste-to-energy and energy-intensity of commercial and industrial food preparation are key data gaps. Visualizing supply chains shows >75% of water embodied in Delhi’s FEW supply is extracted from locations over-drafting ground water. These baseline data enable evaluation of future urban FEW scenarios, comparing impacts of demand shifts, production shifts, and emerging technologies and policies, within and outside of cities.

A literature review of learning collaboratives in mental health care: used but untested.

PubMed

Nadeem, Erum; Olin, S Serene; Hill, Laura Campbell; Hoagwood, Kimberly Eaton; Horwitz, Sarah McCue

2014-09-01

Policy makers have increasingly turned to learning collaboratives (LCs) as a strategy for improving usual care through the dissemination of evidence-based practices. The purpose of this review was to characterize the state of the evidence for use of LCs in mental health care. A systematic search of major academic databases for peer-reviewed articles on LCs in mental health care generated 421 unique articles across a range of disciplines; 28 mental health articles were selected for full-text review, and 20 articles representing 16 distinct studies met criteria for final inclusion. Articles were coded to identify the LC components reported, the focus of the research, and key findings. Most of the articles included assessments of provider- or patient-level variables at baseline and post-LC. Only one study included a comparison condition. LC targets ranged widely, from use of a depression screening tool to implementation of evidence-based treatments. Fourteen crosscutting LC components (for example, in-person learning sessions, phone meetings, data reporting, leadership involvement, and training in quality improvement methods) were identified. The LCs reviewed reported including, on average, seven components, most commonly in-person learning sessions, plan-do-study-act cycles, multidisciplinary quality improvement teams, and data collection for quality improvement. LCs are being used widely in mental health care, although there is minimal evidence of their effectiveness and unclear reporting in regard to specific components. Rigorous observational and controlled research studies on the impact of LCs on targeted provider- and patient-level outcomes are greatly needed.

Outcome Evaluation of a Policy-Mandated Lifestyle and Environmental Modification Program in a National Job Training Center.

PubMed

Jimenez, Elizabeth Yakes; Harris, Amanda; Luna, Donald; Velasquez, Daniel; Slovik, Jonathan; Kong, Alberta

2017-06-01

Excess weight gain is common when adolescents become young adults, but there are no obesity prevention or weight management interventions that have been tested for emerging adults who follow non-traditional post-secondary paths, such as enrolling in job training programs. We evaluated Healthy Eating & Active Lifestyles (HEALs), a policy-mandated lifestyle education/environmental modification program, at a job training center for low-income 16-24 year olds. We examined average change in body mass index (BMI) z-score from baseline to 6 months for emerging adults (aged 16-24 years) in pre-HEALs implementation (n = 125) and post-HEALs implementation (n = 126) cohorts living at the job training center, by baseline weight status. In both cohorts, average BMI z-score significantly increased from baseline to 6 months for students with BMI < 25. Average BMI z-score significantly decreased for the overweight (BMI 25 to <30; -0.11, p = .03) and obese (BMI ≥ 30; -0.11, p = .001) students only within the post-HEALs cohort; changes within the pre-HEALs cohort and between cohorts were not significant. HEALs may promote positive weight-related trends for overweight/obese students, but prevention efforts for non-overweight/obese students need to be improved.

Implementation of Premixed Equilibrium Chemistry Capability in OVERFLOW

NASA Technical Reports Server (NTRS)

Olsen, M. E.; Liu, Y.; Vinokur, M.; Olsen, T.

2003-01-01

An implementation of premixed equilibrium chemistry has been completed for the OVERFLOW code, a chimera capable, complex geometry flow code widely used to predict transonic flowfields. The implementation builds on the computational efficiency and geometric generality of the solver.

Implementation of Premixed Equilibrium Chemistry Capability in OVERFLOW

NASA Technical Reports Server (NTRS)

Olsen, Mike E.; Liu, Yen; Vinokur, M.; Olsen, Tom

2004-01-01

An implementation of premixed equilibrium chemistry has been completed for the OVERFLOW code, a chimera capable, complex geometry flow code widely used to predict transonic flowfields. The implementation builds on the computational efficiency and geometric generality of the solver.

Advanced solar receivers for space power

NASA Technical Reports Server (NTRS)

Strumpf, H. J.; Coombs, M. G.; Lacy, D. E.

1988-01-01

A study has been conducted to generate and evaluate advanced solar heat receiver concepts suitable for orbital application with Brayton and Stirling engine cycles in the 7-kW size range. The generated receiver designs have thermal storage capability and, when implemented, will be lighter, smaller, and/or more efficient than baseline systems such as the configuration used for the Brayton solar receiver under development by Garrett AiResearch for the NASA Space Station. In addition to the baseline designs, four other receiver concepts were designed and evaluated with respect to Brayton and Stirling engines. These concepts include a higher temperature version of the baseline receiver, a packed bed receiver, a plate-fin receiver, and a heat pipe receiver. The thermal storage for all designs is provided by the melting and freezing of a salt.

Rationale and design of the Multicenter Medication Reconciliation Quality Improvement Study (MARQUIS).

PubMed

Salanitro, Amanda H; Kripalani, Sunil; Resnic, Joanne; Mueller, Stephanie K; Wetterneck, Tosha B; Haynes, Katherine Taylor; Stein, Jason; Kaboli, Peter J; Labonville, Stephanie; Etchells, Edward; Cobaugh, Daniel J; Hanson, David; Greenwald, Jeffrey L; Williams, Mark V; Schnipper, Jeffrey L

2013-06-25

Unresolved medication discrepancies during hospitalization can contribute to adverse drug events, resulting in patient harm. Discrepancies can be reduced by performing medication reconciliation; however, effective implementation of medication reconciliation has proven to be challenging. The goals of the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) are to operationalize best practices for inpatient medication reconciliation, test their effect on potentially harmful unintentional medication discrepancies, and understand barriers and facilitators of successful implementation. Six U.S. hospitals are participating in this quality improvement mentored implementation study. Each hospital has collected baseline data on the primary outcome: the number of potentially harmful unintentional medication discrepancies per patient, as determined by a trained on-site pharmacist taking a "gold standard" medication history. With the guidance of their mentors, each site has also begun to implement one or more of 11 best practices to improve medication reconciliation. To understand the effect of the implemented interventions on hospital staff and culture, we are performing mixed methods program evaluation including surveys, interviews, and focus groups of front line staff and hospital leaders. At baseline the number of unintentional medication discrepancies in admission and discharge orders per patient varies by site from 2.35 to 4.67 (mean=3.35). Most discrepancies are due to history errors (mean 2.12 per patient) as opposed to reconciliation errors (mean 1.23 per patient). Potentially harmful medication discrepancies averages 0.45 per patient and varies by site from 0.13 to 0.82 per patient. We discuss several barriers to implementation encountered thus far. In the end, we anticipate that MARQUIS tools and lessons learned have the potential to decrease medication discrepancies and improve patient outcomes. Clinicaltrials.gov identifier NCT01337063.

Implementation of a Surgical Safety Checklist: Impact on Surgical Team Perspectives

PubMed Central

Papaconstantinou, Harry T.; Jo, ChanHee; Reznik, Scott I.; Smythe, W. Roy; Wehbe-Janek, Hania

2013-01-01

Background The World Health Organization (WHO) surgical safety checklist has been shown to decrease mortality and complications and has been adopted worldwide. However, system flaws and human errors persist. Identifying provider perspectives of patient safety initiatives may identify strategies for improvement. The purpose of this study was to determine provider perspectives of surgical safety checklist implementation in an effort to improve initiatives that enhance surgical patients' safety. Methods In September 2010, a WHO-adapted surgical safety checklist was implemented at our institution. Surgical teams were invited to complete a checklist-focused questionnaire 1 month before and 1 year after implementation. Baseline and follow-up results were compared. Results A total of 437 surgical care providers responded to the survey: 45% of providers responded at baseline and 64% of providers responded at follow-up. Of the total respondents, 153 (35%) were nurses, 104 (24%) were anesthesia providers, and 180 (41%) were surgeons. Overall, we found an improvement in the awareness of patient safety and quality of care, with significant improvements in the perception of the value of and participation in the time-out process, in surgical team communication, and in the establishment and clarity of patient care needs. Some discordance was noted between surgeons and other surgical team members, indicating that barriers in communication still exist. Overall, approximately 65% of respondents perceived that the checklist improved patient safety and patient care; however, we found a strong negative perception of operating room efficiency. Conclusion Implementation of a surgical safety checklist improves perceptions of surgical safety. Barriers to implementation exist, but staff feedback may be used to enhance the sustainability and success of patient safety initiatives. PMID:24052757

Rationale and design of the Multicenter Medication Reconciliation Quality Improvement Study (MARQUIS)

PubMed Central

2013-01-01

Background Unresolved medication discrepancies during hospitalization can contribute to adverse drug events, resulting in patient harm. Discrepancies can be reduced by performing medication reconciliation; however, effective implementation of medication reconciliation has proven to be challenging. The goals of the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) are to operationalize best practices for inpatient medication reconciliation, test their effect on potentially harmful unintentional medication discrepancies, and understand barriers and facilitators of successful implementation. Methods Six U.S. hospitals are participating in this quality improvement mentored implementation study. Each hospital has collected baseline data on the primary outcome: the number of potentially harmful unintentional medication discrepancies per patient, as determined by a trained on-site pharmacist taking a “gold standard” medication history. With the guidance of their mentors, each site has also begun to implement one or more of 11 best practices to improve medication reconciliation. To understand the effect of the implemented interventions on hospital staff and culture, we are performing mixed methods program evaluation including surveys, interviews, and focus groups of front line staff and hospital leaders. Discussion At baseline the number of unintentional medication discrepancies in admission and discharge orders per patient varies by site from 2.35 to 4.67 (mean=3.35). Most discrepancies are due to history errors (mean 2.12 per patient) as opposed to reconciliation errors (mean 1.23 per patient). Potentially harmful medication discrepancies averages 0.45 per patient and varies by site from 0.13 to 0.82 per patient. We discuss several barriers to implementation encountered thus far. In the end, we anticipate that MARQUIS tools and lessons learned have the potential to decrease medication discrepancies and improve patient outcomes. Trial registration Clinicaltrials.gov identifier NCT01337063 PMID:23800355

Improving the implementation of NICE public health workplace guidance: an evaluation of the effectiveness of action-planning workshops in NHS trusts in England.

PubMed

Jones, Sarah; Sloan, David; Evans, Hannah E R; Williams, Sian

2015-08-01

There is evidence that health and well-being of the National Health Service (NHS) workforce affects organizational and patient outcomes. A Cochrane review of the effectiveness of clinical audit to improve quality of care has shown great variation between studies, depending on the design and intensity of support offered. This study evaluates the effectiveness of an organizational audit methodology with (1) action-planning workshops and follow-up and (2) audit feedback alone, to support the implementation of the National Institute for Health and Care Excellence (NICE) workplace guidance. Two rounds of audit using a self-administered online questionnaire were conducted. An overall implementation score was devised for each trust. Following round 1, interviews were conducted with a cohort of trusts with high scores. The interviews used a theory-based framework to identify predictors of and barriers to successful implementation. From this, the content for action-planning workshops was devised and workshops held with lower scoring trusts. The remaining trusts received only written feedback on their audit results. Changes in the implementation score between rounds 1 and 2 were compared within and between cohorts. The median improvement in scores between rounds 1 and 2 was statistically significant except where baseline score was high. The improvement for trusts who received workshops was very much better than those who did not (P < 0.001). This difference remained after adjustment using stratification by baseline score (P = 0.001). Audit, combined with action-planning workshops and follow-up, appears to be more effective in improving implementation of NICE workplace health and well-being guidance than audit with feedback alone. © 2015 John Wiley & Sons, Ltd.

The prevention and reduction of weight loss in an acute tertiary care setting: protocol for a pragmatic stepped wedge randomised cluster trial (the PRoWL project)

PubMed Central

2013-01-01

Background Malnutrition, with accompanying weight loss, is an unnecessary risk in hospitalised persons and often remains poorly recognised and managed. The study aims to evaluate a hospital-wide multifaceted intervention co-facilitated by clinical nurses and dietitians addressing the nutritional care of patients, particularly those at risk of malnutrition. Using the best available evidence on reducing and preventing unplanned weight loss, the intervention (introducing universal nutritional screening; the provision of oral nutritional supplements; and providing red trays and additional support for patients in need of feeding) will be introduced by local ward teams in a phased way in a large tertiary acute care hospital. Methods/Design A pragmatic stepped wedge randomised cluster trial with repeated cross section design will be conducted. The unit of randomisation is the ward, with allocation by a random numbers table. Four groups of wards (n = 6 for three groups, n = 7 for one group) will be randomly allocated to each intervention time point over the trial. Two trained local facilitators (a nurse and dietitian for each group) will introduce the intervention. The primary outcome measure is change in patient’s body weight, secondary patient outcomes are: length of stay, all-cause mortality, discharge destinations, readmission rates and ED presentations. Patient outcomes will be measured on one ward per group, with 20 patients measured per ward per time period by an unblinded researcher. Including baseline, measurements will be conducted at five time periods. Staff perspectives on the context of care will be measured with the Alberta Context Tool. Discussion Unplanned and unwanted weight loss in hospital is common. Despite the evidence and growing concern about hospital nutrition there are very few evaluations of system-wide nutritional implementation programs. This project will test the implementation of a nutritional intervention across one hospital system using a staged approach, which will allow sequential rolling out of facilitation and project support. This project is one of the first evidence implementation projects to use the stepped wedge design in acute care and we will therefore be testing the appropriateness of the stepped wedge design to evaluate such interventions. Trial registration ACTRN12611000020987 PMID:23924302

Estimating mean QALYs in trial-based cost-effectiveness analysis: the importance of controlling for baseline utility.

PubMed

Manca, Andrea; Hawkins, Neil; Sculpher, Mark J

2005-05-01

In trial-based cost-effectiveness analysis baseline mean utility values are invariably imbalanced between treatment arms. A patient's baseline utility is likely to be highly correlated with their quality-adjusted life-years (QALYs) over the follow-up period, not least because it typically contributes to the QALY calculation. Therefore, imbalance in baseline utility needs to be accounted for in the estimation of mean differential QALYs, and failure to control for this imbalance can result in a misleading incremental cost-effectiveness ratio. This paper discusses the approaches that have been used in the cost-effectiveness literature to estimate absolute and differential mean QALYs alongside randomised trials, and illustrates the implications of baseline mean utility imbalance for QALY calculation. Using data from a recently conducted trial-based cost-effectiveness study and a micro-simulation exercise, the relative performance of alternative estimators is compared, showing that widely used methods to calculate differential QALYs provide incorrect results in the presence of baseline mean utility imbalance regardless of whether these differences are formally statistically significant. It is demonstrated that multiple regression methods can be usefully applied to generate appropriate estimates of differential mean QALYs and an associated measure of sampling variability, while controlling for differences in baseline mean utility between treatment arms in the trial. Copyright 2004 John Wiley & Sons, Ltd

Small pulmonary nodules in baseline and incidence screening rounds of low-dose CT lung cancer screening

PubMed Central

Walter, Joan E.; Oudkerk, Matthijs

2017-01-01

Currently, lung cancer screening by low-dose computed tomography (LDCT) is widely recommended for high-risk individuals by US guidelines, but there still is an ongoing debate concerning respective recommendations for European countries. Nevertheless, the available data regarding pulmonary nodules released by lung cancer screening studies could improve future screening guidelines, as well as the clinical practice of incidentally detected pulmonary nodules on routine CT scans. Most lung cancer screening trials present results for baseline and incidence screening rounds separately, clustering pulmonary nodules initially found at baseline screening and newly detected pulmonary nodules after baseline screening together. This approach does not appreciate possible differences among pulmonary nodules detected at baseline and firstly detected at incidence screening rounds and is heavily influenced by methodological differences of the respective screening trials. This review intends to create a basis for assessing non-calcified pulmonary nodules detected during LDCT lung cancer screening in a more clinical relevant manner. The aim is to present data of non-calcified pulmonary baseline nodules and new non-calcified pulmonary incident nodules without clustering them together, thereby also simplifying translation to the clinical practice of incidentally detected pulmonary nodules. Small pulmonary nodules newly detected at incidence screening rounds of LDCT lung cancer screening may possess a greater lung cancer probability than pulmonary baseline nodules at a smaller size, which is essential for the development of new guidelines. PMID:28331823

A Systematic Review and Meta-Analysis of Baseline Ohip-Edent Scores.

PubMed

Duale, J M J; Patel, Y A; Wu, J; Hyde, T P

2018-03-01

OHIP-EDENT is widely used in the literature to assess Oral-Health-Related-Quality-of-Life (OHRQoL) for edentulous patients. However the normal variance and mean of the baseline OHIP scores has not been reported. It would facilitate critical appraisal of studies if we had knowledge of the normal variation and mean of baseline OHIP-EDENT scores. An established figure for baseline OHIP-EDENT, obtained from a meta-analysis, would simplify comparisons of studies and quantify variations in initial OHRQoL of the trial participants. The aim of this study is to quantify a normal baseline value for pre-operative OHIP-EDENT scores by a systematic review and meta-analysis of the available literature. A systematic literature review was carried. 83 papers were identified that included OHIP-EDENT values. After screening and eligibility assessment, 7 papers were selected and included in the meta-analysis. A meta-analysis for the 7 papers by a random-effect model yielded a mean baseline OHIP-EDENT score of 28.63 with a 95% Confidence intervals from 21.93 to 35.34. A pre-operative baseline OHIP-EDENT has been established by meta-analysis of published papers. This will facilitate the comparison of the initial OHRQoL of one study population to that found elsewhere in the published literature. Copyright© 2018 Dennis Barber Ltd.

Intraoperative Endotracheal Cuff Pressure Study: How Education and Availability of Manometers Help Guide Safer Pressures.

PubMed

Stevens, Gregory J; Warfel, Joel W; Aden, James K; Blackwell, Scott D

2018-02-13

Endotracheal intubation is a medical procedure that is often indicated in both the perioperative and critical care environments. Cuffed endotracheal tubes (ETT) allow for safer and more efficient delivery of positive pressure ventilation, as well as create a barrier to reduce the risk of micro-aspiration and anesthetic pollution in the operating room environment. Over-inflation of the endotracheal cuff can lead to serious and harmful sequelae. This study aimed to assess if departmental education paired with ready access to a manometer to assess cuff pressure would result in an improvement in the proportion of ETT cuff pressures in the goal range. A quality improvement study was conducted at the San Antonio Military Medical Center (SAMMC; Department of Defense hospital in San Antonio, TX). The initiative was divided into three key periods: pre-implementation, implementation, and post-implementation. During the pre-implementation period, ETT cuff pressures were obtained to assess the baseline state of ETT cuff pressures for patients in the operating room; the proportion of in-range (20-30 cmH2O) pressures was calculated. During the implementation phase, operating rooms were equipped with manometers and anesthesia departmental education was performed regarding the use of the manometers. Three months later, post-implementation cuff pressures were measured in the OR, and the proportion of in-range pressures was again calculated. The pre-implementation data showed an average cuff pressure of 48.92 cmH2O and a median of 38.5 cmH2O. Of the 100 pre-implementation pressures, 20 were in the goal range. Post-implementation data had an average cuff pressure of 41.96 cmH2O and a median of 30 cmH2O. A chi-squared test of pressures in the safe range from the pre-implementation versus post-implementation values yielded a highly significant p-value of 0.0003. The data from this study clearly demonstrated a statistically significant improvement in the proportion of in-range cuff pressures following the quality improvement initiative. This study supports the use of department-wide education and the availability of manometers in each OR to yield safer cuff pressures for intubated patients. This study did not aim to determine an optimal ETT cuff pressure, but utilized data already available to determine a safe cuff pressure. Further research needs to be performed to assess whether routine monitoring of cuff pressure results in improved patient outcomes. Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2018. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Korean Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer's Disease: Methodology and Baseline Sample Characteristics.

PubMed

Byun, Min Soo; Yi, Dahyun; Lee, Jun Ho; Choe, Young Min; Sohn, Bo Kyung; Lee, Jun-Young; Choi, Hyo Jung; Baek, Hyewon; Kim, Yu Kyeong; Lee, Yun-Sang; Sohn, Chul-Ho; Mook-Jung, Inhee; Choi, Murim; Lee, Yu Jin; Lee, Dong Woo; Ryu, Seung-Ho; Kim, Shin Gyeom; Kim, Jee Wook; Woo, Jong Inn; Lee, Dong Young

2017-11-01

The Korean Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer's disease (KBASE) aimed to recruit 650 individuals, aged from 20 to 90 years, to search for new biomarkers of Alzheimer's disease (AD) and to investigate how multi-faceted lifetime experiences and bodily changes contribute to the brain changes or brain pathologies related to the AD process. All participants received comprehensive clinical and neuropsychological evaluations, multi-modal brain imaging, including magnetic resonance imaging, magnetic resonance angiography, [ 11 C]Pittsburgh compound B-positron emission tomography (PET), and [ 18 F]fluorodeoxyglucose-PET, blood and genetic marker analyses at baseline, and a subset of participants underwent actigraph monitoring and completed a sleep diary. Participants are to be followed annually with clinical and neuropsychological assessments, and biannually with the full KBASE assessment, including neuroimaging and laboratory tests. As of March 2017, in total, 758 individuals had volunteered for this study. Among them, in total, 591 participants-291 cognitively normal (CN) old-aged individuals, 74 CN young- and middle-aged individuals, 139 individuals with mild cognitive impairment (MCI), and 87 individuals with AD dementia (ADD)-were enrolled at baseline, after excluding 162 individuals. A subset of participants (n=275) underwent actigraph monitoring. The KBASE cohort is a prospective, longitudinal cohort study that recruited participants with a wide age range and a wide distribution of cognitive status (CN, MCI, and ADD) and it has several strengths in its design and methodologies. Details of the recruitment, study methodology, and baseline sample characteristics are described in this paper.

Exploring multi-level system factors facilitating educator training and implementation of evidence-based practices (EBP): a study protocol.

PubMed

Stahmer, Aubyn C; Suhrheinrich, Jessica; Schetter, Patricia L; McGee Hassrick, Elizabeth

2018-01-08

This study examines how system-wide (i.e., region, district, and school) mechanisms such as leadership support, training requirements, structure, collaboration, and education affect the use of evidence-based practices (EBPs) in schools and how this affects the outcomes for students with autism spectrum disorder (ASD). Despite growing evidence for the positive effects of EBPs for ASD, these practices are not consistently or effectively used in schools. Although special education programs are mandated to use EBPs, there are very few evidence-based methods for selecting, implementing, and sustaining EBPs. Research focuses primarily on teacher training, without attention to contextual factors (e.g., implementation climate, attitudes toward EBPs, resource allocation, and social networks) that may impact outcomes. Using an implementation science framework, this project will prospectively examine relations between system-wide factors and teachers' use of EBPs and student education outcomes. Survey data will be collected from approximately 85 regional special education directors, 170 regional program specialists, 265 district special education directors, 265 behavior specialists, 925 school principals, 3538 special education teachers, and 2700 paraprofessionals. Administrative data for the students with ASD served by participating teachers will be examined. A total of 79 regional-, district-, and school-level personnel will also participate in social network interviews. Mixed methods, including surveys, administrative data, and observational checklists, will be used to gather in-depth information about system-wide malleable factors that relate to positive teacher implementation of EBPs and student outcomes. Multi-level modeling will be used to assess system-wide malleable factors related to EBP implementation which will be linked to the trainer, teacher, and student outcomes and examined based on moderators (e.g., district size, Special Education Local Plan Area structure, teachers' ASD experience). Finally, a dynamic social network approach will be used to map EBP-related connectivity across all levels of the system for selected regions. Dynamic network analysis will be used to gauge the degree to which and ways that EBP trainings, resources, and interventions are shared (or not shared) among school staff. Results are expected to inform the development of system-wide interventions to improve the school-based implementation of EBPs for students with ASD.

EPA Brownfields Area-Wide Planning Recipients Selected for FY13 Grant Funding

EPA Pesticide Factsheets

EPA has selected the following entities as Brownfields Area-Wide Planning grant recipients. These recipients will work with their local community members, other stakeholders and project partners to develop an area-wide plan and implementation strategy for

Activation of the mesocortical dopamine system by feeding: lack of a selective response to stress.

PubMed

Taber, M T; Fibiger, H C

1997-03-01

There is wide agreement that catecholamine systems in the prefrontal cortex are activated by stressful stimuli. To date, however, the extent to which other stimuli can increase the activity of these systems has received little attention. In the present study, the effects of tail pinch stress and feeding on dopamine and noradrenaline release in the prefrontal cortex of rats were examined using in vivo brain microdialysis. Both stimuli increased dopamine release, with peak effects reaching 212% above baseline for tail pinch and 165% above baseline for feeding. The effects of the two stimuli on peak dopamine release were not significantly different. Both stimuli also significantly increased noradrenaline release, with peak effects reaching 128% above baseline for tail pinch and 98% above baseline for feeding. The effects of the two stimuli on peak noradrenaline release were not significantly different. These results indicate that activation of catecholaminergic afferents to the prefrontal cortex is not specific to stress, but also occurs in response to non-stressors with positive motivational valence.

Critical Features Predicting Sustained Implementation of School-Wide Positive Behavioral Interventions and Supports

ERIC Educational Resources Information Center

Mathews, Susanna; McIntosh, Kent; Frank, Jennifer L.; May, Seth L.

2014-01-01

The current study explored the extent to which a common measure of perceived implementation of critical features of Positive Behavioral Interventions and Supports (PBIS) predicted fidelity of implementation 3 years later. Respondents included school personnel from 261 schools across the United States implementing PBIS. School teams completed the…

Examining the Implementation of Technology-Based Blended Algebra I Curriculum at Scale

ERIC Educational Resources Information Center

Karam, Rita; Pane, John F.; Griffin, Beth Ann; Robyn, Abby; Phillips, Andrea; Daugherty, Lindsay

2017-01-01

Studies on blended education pay little attention to implementation, thus limiting the understanding of how such programs contribute to student math learning. This article examines the implementation of a widely used blended algebra curriculum and the relationship between implementation and student outcomes. The study was conducted in 74 middle…

Reliability and Normative Reference Values for the Vestibular/Ocular Motor Screening (VOMS) Tool in Youth Athletes.

PubMed

Moran, Ryan N; Covassin, Tracey; Elbin, R J; Gould, Dan; Nogle, Sally

2018-05-01

The Vestibular/Ocular Motor Screening (VOMS) measure is a newly developed vestibular and ocular motor symptom provocation screening tool for sport-related concussions. Baseline data, psychometric properties, and reliability of the VOMS are needed to further understand the applications of this tool, especially in the youth population, where research is scarce. To establish normative data and document the internal consistency and false-positive rate of the VOMS in a sample of nonconcussed youth athletes. Cross-sectional study; Level of evidence, 3. A total of 423 youth athletes (male = 278, female = 145) between the ages of 8 and 14 years completed baseline VOMS screening before the start of their respective sport seasons. Internal consistency was measured with Cronbach α and inter-item correlations. Approximately 60% of youth athletes reported no symptom provocation on baseline VOMS assessment, with 9% to 13% scoring over the cutoff levels (score of ≥2 for any individual VOMS symptom, near point convergence distance of ≥5 cm). The VOMS displayed a high internal consistency (Cronbach α = .97) at baseline among youth athletes. The current findings provide preliminary support for the implementation of VOMS baseline assessment into clinical practice, due to a high internal consistency, strong relationships between VOMS items, and a low false-positive rate at baseline in youth athletes.

Tank waste remediation system configuration management implementation plan

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

Vann, J.M.

1998-03-31

The Tank Waste Remediation System (TWRS) Configuration Management Implementation Plan describes the actions that will be taken by Project Hanford Management Contract Team to implement the TWRS Configuration Management program defined in HNF 1900, TWRS Configuration Management Plan. Over the next 25 years, the TWRS Project will transition from a safe storage mission to an aggressive retrieval, storage, and disposal mission in which substantial Engineering, Construction, and Operations activities must be performed. This mission, as defined, will require a consolidated configuration management approach to engineering, design, construction, as-building, and operating in accordance with the technical baselines that emerge from themore » life cycles. This Configuration Management Implementation Plan addresses the actions that will be taken to strengthen the TWRS Configuration Management program.« less

Setting temporal baselines for biodiversity: the limits of available monitoring data for capturing the full impact of anthropogenic pressures

PubMed Central

Mihoub, Jean-Baptiste; Henle, Klaus; Titeux, Nicolas; Brotons, Lluís; Brummitt, Neil A.; Schmeller, Dirk S.

2017-01-01

Temporal baselines are needed for biodiversity, in order for the change in biodiversity to be measured over time, the targets for biodiversity conservation to be defined and conservation progress to be evaluated. Limited biodiversity information is widely recognized as a major barrier for identifying temporal baselines, although a comprehensive quantitative assessment of this is lacking. Here, we report on the temporal baselines that could be drawn from biodiversity monitoring schemes in Europe and compare those with the rise of important anthropogenic pressures. Most biodiversity monitoring schemes were initiated late in the 20th century, well after anthropogenic pressures had already reached half of their current magnitude. Setting temporal baselines from biodiversity monitoring data would therefore underestimate the full range of impacts of major anthropogenic pressures. In addition, biases among taxa and organization levels provide a truncated picture of biodiversity over time. These limitations need to be explicitly acknowledged when designing management strategies and policies as they seriously constrain our ability to identify relevant conservation targets aimed at restoring or reversing biodiversity losses. We discuss the need for additional research efforts beyond standard biodiversity monitoring to reconstruct the impacts of major anthropogenic pressures and to identify meaningful temporal baselines for biodiversity. PMID:28134310

Overcoming complexities: Damage detection using dictionary learning framework

NASA Astrophysics Data System (ADS)

Alguri, K. Supreet; Melville, Joseph; Deemer, Chris; Harley, Joel B.

2018-04-01

For in situ damage detection, guided wave structural health monitoring systems have been widely researched due to their ability to evaluate large areas and their ability detect many types of damage. These systems often evaluate structural health by recording initial baseline measurements from a pristine (i.e., undamaged) test structure and then comparing later measurements with that baseline. Yet, it is not always feasible to have a pristine baseline. As an alternative, substituting the baseline with data from a surrogate (nearly identical and pristine) structure is a logical option. While effective in some circumstance, surrogate data is often still a poor substitute for pristine baseline measurements due to minor differences between the structures. To overcome this challenge, we present a dictionary learning framework to adapt surrogate baseline data to better represent an undamaged test structure. We compare the performance of our framework with two other surrogate-based damage detection strategies: (1) using raw surrogate data for comparison and (2) using sparse wavenumber analysis, a precursor to our framework for improving the surrogate data. We apply our framework to guided wave data from two 108 mm by 108 mm aluminum plates. With 20 measurements, we show that our dictionary learning framework achieves a 98% accuracy, raw surrogate data achieves a 92% accuracy, and sparse wavenumber analysis achieves a 57% accuracy.

Design-to-cost

NASA Technical Reports Server (NTRS)

Bradley, F. E.

1974-01-01

Attempts made to design to costs equipment, vehicles and subsystems for various space projects are discussed. A systematic approach, based on mission requirement analysis, definition of a mission baseline design, benefit and cost analysis, and a benefit-cost analysis was proposed for implementing the cost control program.

Addressing the third delay: implementing a novel obstetric triage system in Ghana.

PubMed

Goodman, David M; Srofenyoh, Emmanuel K; Ramaswamy, Rohit; Bryce, Fiona; Floyd, Liz; Olufolabi, Adeyemi; Tetteh, Cecilia; Owen, Medge D

2018-01-01

Institutional delivery has been proposed as a method for reducing maternal morbidity and mortality, but little is known about how referral hospitals in low-resource settings can best manage the expected influx of patients. In this study, we assess the impact of an obstetric triage improvement programme on reducing hospital-based delay in a referral hospital in Accra, Ghana. An Active Implementation Framework is used to describe a 5-year intervention to introduce and monitor obstetric triage capabilities. Baseline data, collected from September to November 2012, revealed significant delays in patient assessment on arrival. A triage training course and monitoring of quality improvement tools occurred in 2013 and 2014. Implementation barriers led to the construction of a free-standing obstetric triage pavilion, opened January 2015, with dedicated midwives. Data were collected at three time intervals following the triage pavilion opening and compared with baseline including: referral indications, patient and labour characteristics, waiting time from arrival to assessment and the documentation of a care plan. An obstetric triage improvement programme reduced the median (IQR) patient waiting time from facility arrival to first assessment by a midwife from 40 min (15-100) to 5 min (2-6) (p<0.001) over the 5-year intervention. The triage pavilion enhanced performance resulting in the elimination of previous delays associated with the time of admission and disease acuity. Care plan documentation increased from 51% to 96%. Obstetric triage, when properly implemented, reduced delay in a busy, low-resource hospital. The implementation process was sustained under local leadership during transition to a new hospital.

HIV policy implementation in two health and demographic surveillance sites in Uganda: findings from a national policy review, health facility surveys and key informant interviews.

PubMed

McRobie, Ellen; Wringe, Alison; Nakiyingi-Miiro, Jessica; Kiweewa, Francis; Lutalo, Tom; Nakigozi, Gertrude; Todd, Jim; Eaton, Jeffrey William; Zaba, Basia; Church, Kathryn

2017-04-05

Successful HIV testing, care and treatment policy implementation is essential for realising the reductions in morbidity and mortality those policies are designed to target. While adoption of new HIV policies is rapid, less is known about the facility-level implementation of new policies and the factors influencing this. We assessed implementation of national policies about HIV testing, treatment and retention at health facilities serving two health and demographic surveillance sites (HDSS) (10 in Kyamulibwa, 14 in Rakai). Ugandan Ministry of Health HIV policy documents were reviewed in 2013, and pre-determined indicators were extracted relating to the content and nature of guidance on HIV service provision. Facility-level policy implementation was assessed via a structured questionnaire administered to in-charge staff from each health facility. Implementation of policies was classified as wide (≥75% facilities), partial (26-74% facilities) or minimal (≤25% facilities). Semi-structured interviews were conducted with key informants (policy-makers, implementers, researchers) to identify factors influencing implementation; data were analysed using the Framework Method of thematic analysis. Most policies were widely implemented in both HDSS (free testing, free antiretroviral treatment (ART), WHO first-line regimen as standard, Option B+). Both had notable implementation gaps for policies relating to retention on treatment (availability of nutritional supplements, support groups or isoniazid preventive therapy). Rakai implemented more policies relating to provision of antiretroviral treatment than Kyamulibwa and performed better on quality of care indicators, such as frequency of stock-outs. Factors facilitating implementation were donor investment and support, strong scientific evidence, low policy complexity, phased implementation and effective planning. Limited human resources, infrastructure and health management information systems were perceived as major barriers to effective implementation. Most HIV policies were widely implemented in the two settings; however, gaps in implementation coverage prevail and the value of ensuring complete coverage of existing policies should be considered against the adoption of new policies in regard to resource needs and health benefits.

Global tectonics and space geodesy.

PubMed

Gordon, R G; Stein, S

1992-04-17

Much of the success of plate tectonics can be attributed to the near rigidity of tectonic plates and the availability of data that describe the rates and directions of motion across narrow plate boundaries \\m=~\\1 to 60 kilometers wide. Nonetheless, many plate boundaries in both continental and oceanic lithosphere are not narrow but are hundreds to thousands of kilometers wide. Wide plate boundary zones cover \\m=~\\15 percent of Earth's surface area. Space geodesy, which includes very long baseline radio interferometry, satellite laser ranging, and the global positioning system, is providing the accurate long-distance measurements needed to estimate the present motion across and within wide plate boundary zones. Space geodetic data show that plate velocities averaged over years are remarkably similar to velocities averaged over millions of years.

Reproductive Maturation of the Tropical Clawed Frog, Xenopus tropicalis

EPA Science Inventory

The model species Xenopus tropicalis is being widely used in developmental biology and amphibian toxicology studies. In order to increase our understanding of the role of steroid hormones in maturation in this species, we collected baseline reproductive data from metamorphosis t...

Immediate post-concussion assessment and cognitive testing (ImPACT) practices of sports medicine professionals.

PubMed

Covassin, Tracey; Elbin, Robert J; Stiller-Ostrowski, Jennifer L; Kontos, Anthony P

2009-01-01

Computerized neurocognitive testing is becoming popular among clinicians evaluating sport-related concussions across all levels of sport. Baseline neurocognitive testing has been recommended to provide more accurate representation of the preconcussion cognitive status of individual athletes. However, little is known about the use of baseline neurocognitive testing in concussion assessment and management. To examine implementation and practice trends of sports medicine professionals using baseline neurocognitive testing at the high school and collegiate levels. Quantitative survey research. Online survey. Certified athletic trainers (ATs) from approximately 1209 US institutions listed on the ImPACT Web site were recruited. A total of 399 ATs completed the survey, for a response return rate of 32.7%. Survey questions addressed educational level, years of certification, employment setting, percentage of athletes baseline tested, and accuracy of baseline tests. Other items addressed postconcussive neurocognitive testing protocols and scenarios for return-to-play decisions based on neurocognitive testing. Nearly all ATs (94.7%) administered baseline computerized neurocognitive testing to their athletes. However, only 51.9% examined these baseline tests for validity. The majority of ATs indicated that they administer baseline neurocognitive tests most frequently to football players (88.4%), followed by women's soccer players (78.8%) and men's soccer players (71.2%). Nearly all respondents (95.5%) stated that they would not return a symptomatic athlete to play if the athlete's neurocognitive scores were back to baseline. However, when asked if they would return an athlete who is symptom free but who scores below his or her baseline, 86.5% responded no, 9.8% responded yes, and 3.8% indicated that it depended on the importance of the competition. The use of baseline testing, baseline testing readministration, and postconcussion protocols among ATs is increasing. However, the ATs in this study reported that they relied more on symptoms than on neurocognitive test scores when making return-to-play decisions.

Modelling fluid accumulation in the neck using simple baseline fluid metrics: implications for sleep apnea.

PubMed

Vena, Daniel; Yadollahi, A; Bradley, T Douglas

2014-01-01

Obstructive sleep apnea (OSA) is a common respiratory disorder among adults. Recently we have shown that sedentary lifestyle causes an increase in diurnal leg fluid volume (LFV), which can shift into the neck at night when lying down to sleep and increase OSA severity. The purpose of this work was to investigate various metrics that represent baseline fluid retention in the legs and examine their correlation with neck fluid volume (NFV) and to develop a robust model for predicting fluid accumulation in the neck. In 13 healthy awake non-obese men, LFV and NFV were recorded continuously and simultaneously while standing for 5 minutes and then lying supine for 90 minutes. Simple regression was used to examine correlations between baseline LFV, baseline neck circumference (NC) and change in LFV with the outcome variables: change in NC (ΔNC) and in NFV (ΔNFV90) after lying supine for 90 minutes. An exhaustive grid search was implemented to find combinations of input variables which best modeled outcomes. We found strong positive correlations between baseline LFV (supine and standing) and ΔNFV90. Models developed for predicting ΔNFV90 included baseline standing LFV, baseline NC combined with change in LFV after lying supine for 90 minutes. These correlations and the developed models suggest that a greater baseline LFV might contribute to increased fluid accumulation in the neck. These results give more evidence that sedentary lifestyle might play a role in the pathogenesis of OSA by increasing the baseline LFV. The best models for predicting ΔNC include baseline LFV and NC; they improved accuracies of estimating ΔNC over individual predictors, suggesting that a combination of baseline fluid metrics is a good predictor of the change in NC while lying supine. Future work is aimed at adding additional baseline demographic features to improve model accuracy and eventually use it as a screening tool to predict severity of OSA prior to sleep.

Surgical Practical Skills Learning Curriculum: Implementation and Interns' Confidence Perceptions.

PubMed

Acosta, Danilo; Castillo-Angeles, Manuel; Garces-Descovich, Alejandro; Watkins, Ammara A; Gupta, Alok; Critchlow, Jonathan F; Kent, Tara S

To provide an overview of the practical skills learning curriculum and assess its effects over time on the surgical interns' perceptions of their technical skills, patient management, administrative tasks, and knowledge. An 84-hour practical skills curriculum composed of didactic, simulation, and practical sessions was implemented during the 2015 to 2016 academic year for general surgery interns. Totally, 40% of the sessions were held during orientation, whereas the remainder sessions were held throughout the academic year. Interns' perceptions of their technical skills, administrative tasks, patient management, and knowledge were assessed by the practical skills curriculum residents' perception survey at various time points during their intern year (baseline, midpoint, and final). Interns were also asked to fill out an evaluation survey at the completion of each session to obtain feedback on the curriculum. General Surgery Residency program at a tertiary care academic institution. 20 General Surgery categorical and preliminary interns. Significant differences were found over time in interns' perceptions on their technical skills, patient management, administrative tasks, and knowledge (p < 0.001 for all). The results were also statistically significant when accounting for a prior boot camp course in medical school, intern status (categorical or preliminary), and gender (p < 0.05 for all). Differences in interns' perceptions occurred both from baseline to midpoint, and from midpoint to final time point evaluations (p < 0.001 for all). Prior surgical boot camp in medical school status, intern status (categorical vs. preliminary), and gender did not differ in the interns' baseline perceptions of their technical skills, patient management, administrative tasks, and knowledge (p > 0.05 for all). Implementation of a Practical Skills Curriculum in surgical internships can improve interns' confidence perception on their technical skills, patient management skills, administrative tasks, and knowledge. Copyright © 2018. Published by Elsevier Inc.

Impact of live medication therapy management on cholesterol values in patients with cardiovascular disease.

PubMed

Thumar, Ricky; Zaiken, Kathy

2014-01-01

To compare the impact of clinical pharmacist (CP) recommendations through a live, primary care-based, medication therapy management (MTM) protocol on low-density-lipoprotein (LDL) cholesterol in patients who have cardiovascular disease (CVD) with standard, chart-review MTM. Patients with established CVD who were not at their LDL goal were identified and analyzed by either a chart-review MTM service or a live, one-on-one pharmacist-physician MTM service over a 6-month timeframe. For the chart-review MTM service, recommendations were communicated through an electronic medical record (EMR) that the physician and pharmacist had access to. Primary outcomes included mean LDL reduction from baseline, number of patients achieving their LDL goal, and percent of implemented CP recommendations. Mean LDL reduction from baseline in the chart-review MTM group and the live MTM group was 36 mg/dL ± 23.2 mg/dL (P = 0.001) and 62 mg/dL ± 28.3 mg/dL (P = 0.001), respectively. The difference between these two groups was statistically significant (P = 0.001). The chart-review MTM group had 30% of patients reach their LDL goal with 66.3% of CP recommendations implemented compared to 51.3% and 86.3% for the same parameters in the live MTM group (P = 0.006 and P = 0.003, respectively). Although both MTM services provide a significant LDL reduction from baseline in patients with CVD, live MTM provides significantly greater LDL reductions, implemented CP recommendations, and goal attainment than chart-review MTM. Thus, live MTM services are more effective than chart-review MTM services, at least within the clinics that these protocols were assessed for the purposes of this study.

Shaping the Social: design of a settings-based intervention study to improve well-being and reduce smoking and dropout in Danish vocational schools.

PubMed

Andersen, Susan; Tolstrup, Janne Schurmann; Rod, Morten Hulvej; Ersbøll, Annette Kjær; Sørensen, Betina Bang; Holmberg, Teresa; Johansen, Christoffer; Stock, Christiane; Laursen, Bjarne; Zinckernagel, Line; Øllgaard, Anne Louise; Ingholt, Liselotte

2015-06-20

The social environment at schools is an important setting to promote educational attainment, and health and well-being of young people. However, within upper secondary education there is a need for evidence-based school intervention programmes. The Shaping the Social intervention is a comprehensive programme integrating social and educational activities to promote student well-being and reduce smoking and dropout in upper secondary vocational education. The evaluation design is reported here. The evaluation employed a non-randomised cluster controlled design, and schools were selected to either implement the intervention or continue with normal practice for comparison. In the baseline survey conducted 2011-2012, 2,329 students from four intervention schools and 3,371 students from six comparison schools answered a computer-based questionnaire during class, representing 73% and 81% of eligible students, and 22% of all technical/agricultural vocational schools in Denmark. Follow-up assessment was conducted 10 weeks after baseline and at the same time teachers of the intervention classes answered a questionnaire about implementation. School dropout rates will be tracked via national education registers through a 2-year follow-up period. Shaping the Social was designed to address that students at Danish vocational schools constitute a high risk population concerning health behaviour as well as school dropout by modifying the school environment, alongside developing appropriate evaluation strategies. To address difficulties in implementing settings-based interventions, as highlighted in prior research, the strategy was to involve intervention schools in the development of the intervention. Baseline differences will be included in the effectiveness analysis, so will the impact of likely mediators and moderators of the intervention. ISRCTN57822968. Date of registration: 16/01/2013.

Implementation of Finite Rate Chemistry Capability in OVERFLOW

NASA Technical Reports Server (NTRS)

Olsen, M. E.; Venkateswaran, S.; Prabhu, D. K.

2004-01-01

An implementation of both finite rate and equilibrium chemistry have been completed for the OVERFLOW code, a chimera capable, complex geometry flow code widely used to predict transonic flow fields. The implementation builds on the computational efficiency and geometric generality of the solver.

The self-calibration method for multiple systems at the CHARA Array

NASA Astrophysics Data System (ADS)

O'Brien, David

The self-calibration method, a new interferometric technique at the CHARA Array, has been used to derive orbits for several spectroscopic binaries. This method uses the wide component of a hierarchical triple system to calibrate visibility measurements of the triple's close binary system. At certain baselines and separations, the calibrator in one of these systems can be observed quasi-simultaneously with the target. Depending on the orientation of the CHARA observation baseline relative to the orientation of the wide orbit of the triple system, separated fringe packets may be observed. A sophisticated observing scheme must be put in place to ensure the existence of separated fringe packets on nights of observation. Prior to the onset of this project, the reduction of separated fringe packet data had never included the goal of deriving visibilities for both fringe packets, so new data reduction software has been written. Visibilities obtained with separated fringe packet data for the target close binary are run through both Monte Carlo simulations and grid search programs in order to determine the best-fit orbital elements of the close binary. Several targets have been observed in this fashion, and orbits have been derived for seven targets, including three new orbits. Derivation of the orbit of the close pair in a triple system allows for the calculation of the mutual inclination, which is the angle between the planes of the wide and close orbit. Knowledge of this quantity may give insight into the formation processes that create multiple star systems. INDEX WORDS: Long-baseline interferometry, Self calibration, Separated fringe packets, Triple systems, Close binaries, Multiple systems, Orbital parameters, Near-infrared interferometry

Global Implementation of Genomic Medicine: We Are Not Alone

PubMed Central

Manolio, Teri A.; Abramowicz, Marc; Al-Mulla, Fahd; Anderson, Warwick; Balling, Rudi; Berger, Adam C.; Bleyl, Steven; Chakravarti, Aravinda; Chantratita, Wasun; Chisholm, Rex L.; Dissanayake, Vajira H. W.; Dunn, Michael; Dzau, Victor J.; Han, Bok-Ghee; Hubbard, Tim; Kolbe, Anne; Korf, Bruce; Kubo, Michiaki; Lasko, Paul; Leego, Erkki; Mahasirimongkol, Surakameth; Majumdar, Partha P.; Matthijs, Gert; McLeod, Howard L.; Metspalu, Andres; Meulien, Pierre; Miyano, Satoru; Naparstek, Yaakov; O’Rourke, P. Pearl; Patrinos, George P.; Rehm, Heidi L.; Relling, Mary V.; Rennert, Gad; Rodriguez, Laura Lyman; Roden, Dan M.; Shuldiner, Alan R.; Sinha, Sukdev; Tan, Patrick; Ulfendahl, Mats; Ward, Robyn; Williams, Marc S.; Wong, John E.L.; Green, Eric D.; Ginsburg, Geoffrey S.

2016-01-01

Advances in high-throughput genomic technologies coupled with a growing number of genomic results potentially useful in clinical care have led to ground-breaking genomic medicine implementation programs in various nations. Many of these innovative programs capitalize on unique local capabilities arising from the structure of their health care systems or their cultural or political milieu, as well as from unusual burdens of disease or risk alleles. Many such programs are being conducted in relative isolation and might benefit from sharing of approaches and lessons learned in other nations. The National Human Genome Research Institute recently brought together 25 of these groups from around the world to describe and compare projects, examine the current state of implementation and desired near-term capabilities, and identify opportunities for collaboration to promote the responsible implementation of genomic medicine. The wide variety of nascent programs in diverse settings demonstrates that implementation of genomic medicine is expanding globally in varied and highly innovative ways. Opportunities for collaboration abound in the areas of evidence generation, health information technology, education, workforce development, pharmacogenomics, and policy and regulatory issues. Several international organizations that are already facilitating effective research collaborations should engage to ensure implementation proceeds collaboratively without potentially wasteful duplication. Efforts to coalesce these groups around concrete but compelling signature projects, such as global eradication of genetically-mediated drug reactions or developing a truly global genomic variant data resource across a wide number of ethnicities, would accelerate appropriate implementation of genomics to improve clinical care world-wide. PMID:26041702

Validation of a heteroscedastic hazards regression model.

PubMed

Wu, Hong-Dar Isaac; Hsieh, Fushing; Chen, Chen-Hsin

2002-03-01

A Cox-type regression model accommodating heteroscedasticity, with a power factor of the baseline cumulative hazard, is investigated for analyzing data with crossing hazards behavior. Since the approach of partial likelihood cannot eliminate the baseline hazard, an overidentified estimating equation (OEE) approach is introduced in the estimation procedure. It by-product, a model checking statistic, is presented to test for the overall adequacy of the heteroscedastic model. Further, under the heteroscedastic model setting, we propose two statistics to test the proportional hazards assumption. Implementation of this model is illustrated in a data analysis of a cancer clinical trial.

Multiplexed EFPI sensors with ultra-high resolution

NASA Astrophysics Data System (ADS)

Ushakov, Nikolai; Liokumovich, Leonid

2014-05-01

An investigation of performance of multiplexed displacement sensors based on extrinsic Fabry-Perot interferometers has been carried out. We have considered serial and parallel configurations and analyzed the issues and advantages of the both. We have also extended the previously developed baseline demodulation algorithm for the case of a system of multiplexed sensors. Serial and parallel multiplexing schemes have been experimentally implemented with 3 and 4 sensing elements, respectively. For both configurations the achieved baseline standard deviations were between 30 and 200 pm, which is, to the best of our knowledge, more than an order less than any other multiplexed EFPI resolution ever reported.

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.

Test Review for Preschool-Wide Evaluation Tool (PreSET) Manual: Assessing Universal Program-Wide Positive Behavior Support in Early Childhood

ERIC Educational Resources Information Center

Rodriguez, Billie Jo

2013-01-01

The Preschool-Wide Evaluation Tool (PreSET; Steed & Pomerleau, 2012) is published by Paul H. Brookes Publishing Company in Baltimore, MD. The PreSET purports to measure universal and program-wide features of early childhood programs' implementation fidelity of program-wide positive behavior intervention and support (PW-PBIS) and is,…

Implementation of emergency department transfer communication measures in Minnesota critical access hospitals.

PubMed

Klingner, Jill; Moscovice, Ira; Casey, Michelle; McEllistrem Evenson, Alex

2015-01-01

Previously published findings based on field tests indicated that emergency department patient transfer communication measures are feasible and worthwhile to implement in rural hospitals. This study aims to expand those findings by focusing on the wide-scale implementation of these measures in the 79 Critical Access Hospitals (CAHs) in Minnesota from 2011 to 2013. Information was obtained from interviews with key informants involved in implementing the emergency department patient transfer communication measures in Minnesota as part of required statewide quality reporting. The first set of interviews targeted state-level organizations regarding their experiences working with providers. A second set of interviews targeted quality and administrative staff from CAHs regarding their experiences implementing measures. Implementing the measures in Minnesota CAHs proved to be successful in a number of respects, but informants also faced new challenges. Our recommendations, addressed to those seeking to successfully implement these measures in other states, take these challenges into account. Field-testing new quality measure implementations with volunteers may not be indicative of a full-scale implementation that requires facilities to participate. The implementation team's composition, communication efforts, prior relationships with facilities and providers, and experience with data collection and abstraction tools are critical factors in successfully implementing required reporting of quality measures on a wide scale. © 2014 National Rural Health Association.

The effectiveness of computerized order entry at reducing preventable adverse drug events and medication errors in hospital settings: a systematic review and meta-analysis

PubMed Central

2014-01-01

Background The Health Information Technology for Economic and Clinical Health (HITECH) Act subsidizes implementation by hospitals of electronic health records with computerized provider order entry (CPOE), which may reduce patient injuries caused by medication errors (preventable adverse drug events, pADEs). Effects on pADEs have not been rigorously quantified, and effects on medication errors have been variable. The objectives of this analysis were to assess the effectiveness of CPOE at reducing pADEs in hospital-related settings, and examine reasons for heterogeneous effects on medication errors. Methods Articles were identified using MEDLINE, Cochrane Library, Econlit, web-based databases, and bibliographies of previous systematic reviews (September 2013). Eligible studies compared CPOE with paper-order entry in acute care hospitals, and examined diverse pADEs or medication errors. Studies on children or with limited event-detection methods were excluded. Two investigators extracted data on events and factors potentially associated with effectiveness. We used random effects models to pool data. Results Sixteen studies addressing medication errors met pooling criteria; six also addressed pADEs. Thirteen studies used pre-post designs. Compared with paper-order entry, CPOE was associated with half as many pADEs (pooled risk ratio (RR) = 0.47, 95% CI 0.31 to 0.71) and medication errors (RR = 0.46, 95% CI 0.35 to 0.60). Regarding reasons for heterogeneous effects on medication errors, five intervention factors and two contextual factors were sufficiently reported to support subgroup analyses or meta-regression. Differences between commercial versus homegrown systems, presence and sophistication of clinical decision support, hospital-wide versus limited implementation, and US versus non-US studies were not significant, nor was timing of publication. Higher baseline rates of medication errors predicted greater reductions (P < 0.001). Other context and implementation variables were seldom reported. Conclusions In hospital-related settings, implementing CPOE is associated with a greater than 50% decline in pADEs, although the studies used weak designs. Decreases in medication errors are similar and robust to variations in important aspects of intervention design and context. This suggests that CPOE implementation, as subsidized under the HITECH Act, may benefit public health. More detailed reporting of the context and process of implementation could shed light on factors associated with greater effectiveness. PMID:24894078

Processes and challenges of community mobilisation for latrine promotion under Nirmal Bharat Abhiyan in rural Odisha, India.

PubMed

Routray, Parimita; Torondel, Belen; Jenkins, Marion W; Clasen, Thomas; Schmidt, Wolf-Peter

2017-05-16

Despite efforts to eradicate it, open defecation remains widely practiced in India, especially in rural areas. Between 2013 and 2014, 50 villages in one district of Odisha, India, received a sanitation programme under the Nirmal Bharat Abhiyan (NBA - "Clean India Campaign"), the successor of India's Total Sanitation Campaign. This paper documents the strategies and processes of NBA community mobilisation for latrine promotion in these villages and assesses the strengths and limitations of the mobilisation activities. NBA's community mobilisation activities were observed and assessed against the programme's theory of change in 10 randomly selected programme villages from start to finish. Additional data was collected through review of documents, individual interviews (n = 80) and focus group discussions (n = 26) with staff of the implementing NGOs and community members. Our study revealed the lack of a consistent implementation strategy, lack of capacities and facilitation skills of NGO staff to implement sanitation programmes, political interference, challenges in accessing government financial incentives for latrine construction, and lack of clarity on the roles and responsibilities among government and NGO staff, leading to failure in translating government policies into sustainable actions. Social divisions and village dynamics related to gender and caste further constrained the effectiveness of mobilisation activities. Meetings were often dominated by male members of upper caste households, and excluded low caste community members and views of women. Community discussions revolved largely around the government's cash incentive for latrines. Activities aimed at creating demand for sanitation and use of latrines often resonated poorly with community members. An assessment by the implementers, 1 year after community mobilisation found 19% of households had a completed latrine across the 50 villages, a marginal increase of 7 percentage points over baseline. In this setting, the Government of India's NBA programme to increase rural sanitation coverage and use is hampered by political, programmatic, logistical and socio-structural constraints. Sanitation demand generation was difficult for local implementing NGOs as village populations had lost trust in organisations due to previous indications of fraud. Agencies or organisations implementing sanitation campaigns and conducting sanitation promotions need to enhance their staff's knowledge and build capacity in order to address important social heterogeneity within villages. This trial's registration number is NCT01214785 (October 4, 2010).

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

PubMed

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

2016-11-01

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

Implementation of cold risk management in occupational safety, occupational health and quality practices. Evaluation of a development process and its effects at the finnish maritime administration.

PubMed

Risikko, Tanja; Remes, Jouko; Hassi, Juhani

2008-01-01

Cold is a typical environmental risk factor in outdoor work in northern regions. It should be taken into account in a company's occupational safety, health and quality systems. A development process for improving cold risk management at the Finnish Maritime Administration (FMA) was carried out by FMA and external experts. FMA was to implement it. Three years after the development phase, the outcomes and implementation were evaluated. The study shows increased awareness about cold work and few concrete improvements. Concrete improvements in occupational safety and health practices could be seen in the pilot group. However, organization-wide implementation was insufficient, the main reasons being no organization-wide practices, unclear process ownership, no resources and a major reorganization process. The study shows a clear need for expertise supporting implementation. The study also presents a matrix for analyzing the process.

Impact of a daily 10-minute strength and flexibility program in a manufacturing plant.

PubMed

Pronk, S J; Pronk, N P; Sisco, A; Ingalls, D S; Ochoa, C

1995-01-01

In summary, employees' flexibility and mood showed modest improvements following the implementation of a plant-wide, 10-minute, daily flexibility and strength program. The initial six-week pilot study, administered prior to the plant-wide program implementation, successfully assessed program feasibility, assessed the efficiency of program implementation, identified administrative and logistical concerns, and generated pilot data needed to secure managerial support. Despite the noted significant increases in grip strength in the pilot study, no increases were observed following the six months of plant-wide implementation. This may be related to the differences in low average pretest grip strength for the pilot study compared to the higher scores for the main study population. The pilot study subjects may have received a sufficient exercise stimulus to increase grip strength over the course of six weeks. In contrast, this may not have been the case for the main study subjects due to their higher initial mean grip strength. An increased number of exercises designed to directly impact grip strength may be needed to improve this parameter.

Improving Standards of Care in Obstructed Labour: A Criteria-Based Audit at a Referral Hospital in a Low-Resource Setting in Tanzania

PubMed Central

2016-01-01

Objective In low-resource settings, obstructed labour is strongly associated with severe maternal morbidity and intrapartum asphyxia, and consequently maternal and perinatal deaths. This study evaluated the impact of a criteria-based audit of the diagnosis and management of obstructed labour in a low-resource setting. Methods A baseline criteria-based audit was conducted from October 2013 to March 2014, followed by a workshop in which stakeholders gave feedback on interventions agreed upon to improve obstetric care. The implemented interventions included but were not limited to introducing standard guidelines for diagnosis and management of obstructed labour, agreeing on mandatory review by specialist for cases that are assigned caesarean section, re-training and supervision on use and interpretation of partograph and, strengthening team work between doctors, mid-wives and theatre staff. After implementing these interventions in March, a re-audit was performed from July 2015 to November, 2015, and the results were compared to those of the baseline audit. Results Two hundred and sixty deliveries in the baseline survey and 250 deliveries in the follow-up survey were audited. Implementing the new criteria improved the diagnosis from 74% to 81% (p = 0.049) and also the management of obstructed labour from 4.2% at baseline audit to 9.2% at re-audit (p = 0.025). Improved detection of prolonged labour through heightened observation of regular contractions, protracted cervical dilatation, protracted descent of presenting part, arrested cervical dilation, and severe moulding contributed to improved standards of diagnosis (all p < 0.04). Patient reviews by senior obstetricians increased from 34% to 43% (p = 0.045) and reduced time for caesarean section intervention from the median time of 120 to 90 minutes (p = 0.001) improved management (all p < 0.05). Perinatal outcomes, neonatal distress and fresh stillbirths, were reduced from 16% to. 8.8% (p = 0.01). Conclusion A criteria-based audit proved to be a feasible and useful tool in improving diagnosis and management of obstructed labour using available resources. Some of the observed changes in practice were of modest magnitude implying demand for further improvements, while sustaining those already put in place. PMID:27893765

Use of Xpert MTB/RIF in Decentralized Public Health Settings and Its Effect on Pulmonary TB and DR-TB Case Finding in India.

PubMed

Sachdeva, Kuldeep Singh; Raizada, Neeraj; Sreenivas, Achuthan; Van't Hoog, Anna H; van den Hof, Susan; Dewan, Puneet K; Thakur, Rahul; Gupta, R S; Kulsange, Shubhangi; Vadera, Bhavin; Babre, Ameet; Gray, Christen; Parmar, Malik; Ghedia, Mayank; Ramachandran, Ranjani; Alavadi, Umesh; Arinaminpathy, Nimalan; Denkinger, Claudia; Boehme, Catharina; Paramasivan, C N

2015-01-01

Xpert MTB/RIF, the first automated molecular test for tuberculosis, is transforming the diagnostic landscape in high-burden settings. This study assessed the impact of up-front Xpert MTB/RIF testing on detection of pulmonary tuberculosis (PTB) and rifampicin-resistant PTB (DR-TB) cases in India. This demonstration study was implemented in 18 sub-district level TB programme units (TUs) in India in diverse geographic and demographic settings covering a population of 8.8 million. A baseline phase in 14 TUs captured programmatic baseline data, and an intervention phase in 18 TUs had Xpert MTB/RIF offered to all presumptive TB patients. We estimated changes in detection of TB and DR-TB, the former using binomial regression models to adjust for clustering and covariates. In the 14 study TUs, which participated in both phases, 10,675 and 70,556 presumptive TB patients were enrolled in the baseline and intervention phase, respectively, and 1,532 (14.4%) and 14,299 (20.3%) bacteriologically confirmed PTB cases were detected. The implementation of Xpert MTB/RIF was associated with increases in both notification rates of bacteriologically confirmed TB cases (adjusted incidence rate ratio [aIRR] 1.39; CI 1.18-1.64), and proportion of bacteriological confirmed TB cases among presumptive TB cases (adjusted risk ratio (aRR) 1.33; CI 1.6-1.52). Compared with the baseline strategy of selective drug-susceptibility testing only for PTB cases at high risk of drug-resistant TB, Xpert MTB/RIF implementation increased rifampicin resistant TB case detection by over fivefold. Among, 2765 rifampicin resistance cases detected, 1055 were retested with conventional drug susceptibility testing (DST). Positive predictive value (PPV) of rifampicin resistance detected by Xpert MTB/RIF was 94.7% (CI 91.3-98.1), in comparison to conventional DST. Introduction of Xpert MTB/RIF as initial diagnostic test for TB in public health facilities significantly increased case-notification rates of all bacteriologically confirmed TB by 39% and rifampicin-resistant TB case notification by fivefold.

Changes in hospitality workers' exposure to secondhand smoke following the implementation of New York's smoke-free law.

PubMed

Farrelly, M C; Nonnemaker, J M; Chou, R; Hyland, A; Peterson, K K; Bauer, U E

2005-08-01

To assess the impact on hospitality workers' exposure to secondhand smoke of New York's smoke-free law that prohibits smoking in all places of employment, including restaurants, bars, and bowling facilities. Pre-post longitudinal follow up design. Restaurants, bars, and bowling facilities in New York State. At baseline, 104 non-smoking workers in restaurants, bars, and bowling facilities were recruited with newspaper ads, flyers, and radio announcements. Of these, 68 completed a telephone survey and provided at least one saliva cotinine specimen at baseline. At three, six, and 12 month follow up studies, 47, 38, and 32 workers from the baseline sample of 68 completed a telephone survey and provided at least one saliva cotinine specimen. The smoke-free law went into effect 24 July 2003. Self reported sensory and respiratory symptoms and exposure to secondhand smoke; self administered saliva cotinine specimens. Analyses were limited to subjects in all four study periods who completed a telephone survey and provided at least one saliva cotinine specimen. All analyses were limited to participants who completed both an interview and a saliva specimen for all waves of data collection (n = 30) and who had cotinine concentrations < or = 15 ng/ml (n = 24). Hours of exposure to secondhand smoke in hospitality jobs decreased from 12.1 hours (95% confidence interval (CI) 8.0 to 16.3 hours) to 0.2 hours (95% CI -0.1 to 0.5 hours) (p < 0.01) and saliva cotinine concentration decreased from 3.6 ng/ml (95% CI 2.6 to 4.7 ng/ml) to 0.8 ng/ml (95% CI 0.4 to 1.2 ng/ml) (p < 0.01) from baseline to the 12 month follow up. The prevalence of workers reporting sensory symptoms declined from 88% (95% CI 66% to 96%) to 38% (95% CI 20% to 59%) (p < 0.01); there was no change in the overall prevalence of upper respiratory symptoms (p < 0.16). New York's smoke-free law had its intended effect of protecting hospitality workers from exposure to secondhand smoke within three months of implementation. One year after implementation, the results suggest continued compliance with the law.

Improving Standards of Care in Obstructed Labour: A Criteria-Based Audit at a Referral Hospital in a Low-Resource Setting in Tanzania.

PubMed

Mgaya, Andrew H; Kidanto, Hussein L; Nystrom, Lennarth; Essén, Birgitta

2016-01-01

In low-resource settings, obstructed labour is strongly associated with severe maternal morbidity and intrapartum asphyxia, and consequently maternal and perinatal deaths. This study evaluated the impact of a criteria-based audit of the diagnosis and management of obstructed labour in a low-resource setting. A baseline criteria-based audit was conducted from October 2013 to March 2014, followed by a workshop in which stakeholders gave feedback on interventions agreed upon to improve obstetric care. The implemented interventions included but were not limited to introducing standard guidelines for diagnosis and management of obstructed labour, agreeing on mandatory review by specialist for cases that are assigned caesarean section, re-training and supervision on use and interpretation of partograph and, strengthening team work between doctors, mid-wives and theatre staff. After implementing these interventions in March, a re-audit was performed from July 2015 to November, 2015, and the results were compared to those of the baseline audit. Two hundred and sixty deliveries in the baseline survey and 250 deliveries in the follow-up survey were audited. Implementing the new criteria improved the diagnosis from 74% to 81% (p = 0.049) and also the management of obstructed labour from 4.2% at baseline audit to 9.2% at re-audit (p = 0.025). Improved detection of prolonged labour through heightened observation of regular contractions, protracted cervical dilatation, protracted descent of presenting part, arrested cervical dilation, and severe moulding contributed to improved standards of diagnosis (all p < 0.04). Patient reviews by senior obstetricians increased from 34% to 43% (p = 0.045) and reduced time for caesarean section intervention from the median time of 120 to 90 minutes (p = 0.001) improved management (all p < 0.05). Perinatal outcomes, neonatal distress and fresh stillbirths, were reduced from 16% to. 8.8% (p = 0.01). A criteria-based audit proved to be a feasible and useful tool in improving diagnosis and management of obstructed labour using available resources. Some of the observed changes in practice were of modest magnitude implying demand for further improvements, while sustaining those already put in place.

Use of Xpert MTB/RIF in Decentralized Public Health Settings and Its Effect on Pulmonary TB and DR-TB Case Finding in India

PubMed Central

Sachdeva, Kuldeep Singh; Raizada, Neeraj; Sreenivas, Achuthan; van't Hoog, Anna H.; van den Hof, Susan; Dewan, Puneet K.; Thakur, Rahul; Gupta, R. S.; Kulsange, Shubhangi; Vadera, Bhavin; Babre, Ameet; Gray, Christen; Parmar, Malik; Ghedia, Mayank; Ramachandran, Ranjani; Alavadi, Umesh; Arinaminpathy, Nimalan; Denkinger, Claudia; Boehme, Catharina; Paramasivan, C. N.

2015-01-01

Background Xpert MTB/RIF, the first automated molecular test for tuberculosis, is transforming the diagnostic landscape in high-burden settings. This study assessed the impact of up-front Xpert MTB/RIF testing on detection of pulmonary tuberculosis (PTB) and rifampicin-resistant PTB (DR-TB) cases in India. Methods This demonstration study was implemented in 18 sub-district level TB programme units (TUs) in India in diverse geographic and demographic settings covering a population of 8.8 million. A baseline phase in 14 TUs captured programmatic baseline data, and an intervention phase in 18 TUs had Xpert MTB/RIF offered to all presumptive TB patients. We estimated changes in detection of TB and DR-TB, the former using binomial regression models to adjust for clustering and covariates. Results In the 14 study TUs, which participated in both phases, 10,675 and 70,556 presumptive TB patients were enrolled in the baseline and intervention phase, respectively, and 1,532 (14.4%) and 14,299 (20.3%) bacteriologically confirmed PTB cases were detected. The implementation of Xpert MTB/RIF was associated with increases in both notification rates of bacteriologically confirmed TB cases (adjusted incidence rate ratio [aIRR] 1.39; CI 1.18-1.64), and proportion of bacteriological confirmed TB cases among presumptive TB cases (adjusted risk ratio (aRR) 1.33; CI 1.6-1.52). Compared with the baseline strategy of selective drug-susceptibility testing only for PTB cases at high risk of drug-resistant TB, Xpert MTB/RIF implementation increased rifampicin resistant TB case detection by over fivefold. Among, 2765 rifampicin resistance cases detected, 1055 were retested with conventional drug susceptibility testing (DST). Positive predictive value (PPV) of rifampicin resistance detected by Xpert MTB/RIF was 94.7% (CI 91.3-98.1), in comparison to conventional DST. Conclusion Introduction of Xpert MTB/RIF as initial diagnostic test for TB in public health facilities significantly increased case-notification rates of all bacteriologically confirmed TB by 39% and rifampicin-resistant TB case notification by fivefold. PMID:25996389

Collective Bargaining As an Instrument of Change.

ERIC Educational Resources Information Center

Ayers, Steven V.

1998-01-01

The Hilton Central School District, New York, utilized the collective bargaining process to create a financial incentive that would motivate teachers to achieve a baseline level of technological competency. Describes the negotiated agreement, results obtained during the initial year of implementation, and future plans. (MLF)

Late Holocene Marsh Expansion in Southern San Francisco Bay, California

EPA Science Inventory

Currently, the largest tidal wetlands restoration project on the US Pacific Coast is being planned and implemented in southern San Francisco Bay; however, knowledge of baseline conditions of salt marsh extent in the region prior to European settlement is limited. Here, analysis o...

Residual Risk Assessment for the Ferroalloys Source Category in Support of the September Supplemental Proposal

EPA Pesticide Factsheets

This document contains the methods and the results of baseline risk assessments (i.e., after the implementation of the MACT standard) and the results of the post-control scenario risk assessment performed for the ferroalloys source category.

76 FR 24512 - Laguna Cartagena National Wildlife Refuge, Lajas, Puerto Rico; Draft Comprehensive Conservation...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-02

... enforcement officer. Alternative C (Wetland Restoration Emphasis) Under this alternative, we would concentrate... limited baseline biological information. Active habitat wetland management would be implemented by... National Wildlife Refuge. Alternative B (Wildlife Diversity and Habitat Restoration, Proposed) Under this...

Software Cost-Estimation Model

NASA Technical Reports Server (NTRS)

Tausworthe, R. C.

1985-01-01

Software Cost Estimation Model SOFTCOST provides automated resource and schedule model for software development. Combines several cost models found in open literature into one comprehensive set of algorithms. Compensates for nearly fifty implementation factors relative to size of task, inherited baseline, organizational and system environment and difficulty of task.

Study of tracking and data acquisition system for the 1990's. Volume 4: TDAS space segment architecture

NASA Technical Reports Server (NTRS)

Orr, R. S.

1984-01-01

Tracking and data acquisition system (TDAS) requirements, TDAS architectural goals, enhanced TDAS subsystems, constellation and networking options, TDAS spacecraft options, crosslink implementation, baseline TDAS space segment architecture, and treat model development/security analysis are addressed.

Enterprise-wide worklist management.

PubMed

Locko, Roberta C; Blume, Hartwig; Goble, John C

2002-01-01

Radiologists in multi-facility health care delivery networks must serve not only their own departments but also departments of associated clinical facilities. We describe our experience with a picture archiving and communication system (PACS) implementation that provides a dynamic view of relevant radiological workload across multiple facilities. We implemented a distributed query system that permits management of enterprise worklists based on modality, body part, exam status, and other criteria that span multiple compatible PACSs. Dynamic worklists, with lesser flexibility, can be constructed if the incompatible PACSs support specific DICOM functionality. Enterprise-wide worklists were implemented across Generations Plus/Northern Manhattan Health Network, linking radiology departments of three hospitals (Harlem, Lincoln, and Metropolitan) with 1465 beds and 4260 ambulatory patients per day. Enterprise-wide, dynamic worklist management improves utilization of radiologists and enhances the quality of care across large multi-facility health care delivery organizations. Integration of other workflow-related components remain a significant challenge.

Optimized design and analysis of preclinical intervention studies in vivo

PubMed Central

Laajala, Teemu D.; Jumppanen, Mikael; Huhtaniemi, Riikka; Fey, Vidal; Kaur, Amanpreet; Knuuttila, Matias; Aho, Eija; Oksala, Riikka; Westermarck, Jukka; Mäkelä, Sari; Poutanen, Matti; Aittokallio, Tero

2016-01-01

Recent reports have called into question the reproducibility, validity and translatability of the preclinical animal studies due to limitations in their experimental design and statistical analysis. To this end, we implemented a matching-based modelling approach for optimal intervention group allocation, randomization and power calculations, which takes full account of the complex animal characteristics at baseline prior to interventions. In prostate cancer xenograft studies, the method effectively normalized the confounding baseline variability, and resulted in animal allocations which were supported by RNA-seq profiling of the individual tumours. The matching information increased the statistical power to detect true treatment effects at smaller sample sizes in two castration-resistant prostate cancer models, thereby leading to saving of both animal lives and research costs. The novel modelling approach and its open-source and web-based software implementations enable the researchers to conduct adequately-powered and fully-blinded preclinical intervention studies, with the aim to accelerate the discovery of new therapeutic interventions. PMID:27480578

Optimized design and analysis of preclinical intervention studies in vivo.

PubMed

Laajala, Teemu D; Jumppanen, Mikael; Huhtaniemi, Riikka; Fey, Vidal; Kaur, Amanpreet; Knuuttila, Matias; Aho, Eija; Oksala, Riikka; Westermarck, Jukka; Mäkelä, Sari; Poutanen, Matti; Aittokallio, Tero

2016-08-02

Recent reports have called into question the reproducibility, validity and translatability of the preclinical animal studies due to limitations in their experimental design and statistical analysis. To this end, we implemented a matching-based modelling approach for optimal intervention group allocation, randomization and power calculations, which takes full account of the complex animal characteristics at baseline prior to interventions. In prostate cancer xenograft studies, the method effectively normalized the confounding baseline variability, and resulted in animal allocations which were supported by RNA-seq profiling of the individual tumours. The matching information increased the statistical power to detect true treatment effects at smaller sample sizes in two castration-resistant prostate cancer models, thereby leading to saving of both animal lives and research costs. The novel modelling approach and its open-source and web-based software implementations enable the researchers to conduct adequately-powered and fully-blinded preclinical intervention studies, with the aim to accelerate the discovery of new therapeutic interventions.

Use of System Safety Risk Assessments for the Space Shuttle Reusable Solid Rocket Motor (RSRM)

NASA Technical Reports Server (NTRS)

Greenhalgh, Phillip O.; McCool, Alex (Technical Monitor)

2001-01-01

This paper discusses the System Safety approach used to assess risk for the Space Shuttle Reusable Solid Rocket Motor (RSRM). Previous to the first RSRM flight in the fall of 1988, all systems were analyzed extensively to assure that hazards were identified, assessed and that the baseline risk was understood and appropriately communicated. Since the original RSRM baseline was established, Thiokol and NASA have implemented a number of initiatives that have further improved the RSRM. The robust design, completion of rigorous testing and flight success of the RSRM has resulted in a wise reluctance to make changes. One of the primary assessments required to accompany the documentation of each proposed change and aid in the decision making process is a risk assessment. Documentation supporting proposed changes, including the risk assessments from System Safety, are reviewed and assessed by Thiokol and NASA technical management. After thorough consideration, approved changes are implemented adding improvements to and reducing risk of the Space Shuttle RSRM.

Reducing the frequency and severity of migraine headaches in the workplace: implementing evidence-based interventions.

PubMed

Parker, Catherine; Waltman, Nancy

2012-01-01

The impact of migraine headaches on worker productivity and quality of life is significant. A medical center employee health department implemented an evidence-based, multicomponent intervention to manage migraine headaches for a population of more than 3,500 employees. The intervention consisted of education to identify and avoid headache triggers, coaching on dietary and lifestyle changes, and prescriptions for medications to prevent and treat headaches. This article presents preliminary data on the feasibility and effectiveness of the intervention. The frequency and severity of headaches were measured at baseline and 3, 6, 9, and 12 months after baseline using the Migraine Disability Assessment questionnaire. At 12 months, 28 participants who completed testing reported that the frequency of headaches had decreased by 76.1%, severity by 31.3%, and perception of disability by 66.5%. This pilot study used a convenience sample and no control group. However, results are promising and recommendations are made for future studies. Copyright 2012, SLACK Incorporated.

An Intelligent Decision System for Intraoperative Somatosensory Evoked Potential Monitoring.

PubMed

Fan, Bi; Li, Han-Xiong; Hu, Yong

2016-02-01

Somatosensory evoked potential (SEP) is a useful, noninvasive technique widely used for spinal cord monitoring during surgery. One of the main indicators of a spinal cord injury is the drop in amplitude of the SEP signal in comparison to the nominal baseline that is assumed to be constant during the surgery. However, in practice, the real-time baseline is not constant and may vary during the operation due to nonsurgical factors, such as blood pressure, anaesthesia, etc. Thus, a false warning is often generated if the nominal baseline is used for SEP monitoring. In current practice, human experts must be used to prevent this false warning. However, these well-trained human experts are expensive and may not be reliable and consistent due to various reasons like fatigue and emotion. In this paper, an intelligent decision system is proposed to improve SEP monitoring. First, the least squares support vector regression and multi-support vector regression models are trained to construct the dynamic baseline from historical data. Then a control chart is applied to detect abnormalities during surgery. The effectiveness of the intelligent decision system is evaluated by comparing its performance against the nominal baseline model by using the real experimental datasets derived from clinical conditions.

Mercury exposure may suppress baseline corticosterone levels in juvenile birds.

PubMed

Herring, Garth; Ackerman, Joshua T; Herzog, Mark P

2012-06-05

Mercury exposure has been associated with a wide variety of negative reproductive responses in birds, however few studies have examined the potential for chick impairment via the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis regulates corticosterone levels during periods of stress. We examined the relationship between baseline fecal corticosterone metabolite concentrations and mercury concentrations in down feathers of recently hatched (<3 days) and blood of older (15-37 days) Forster's tern (Sterna forsteri) chicks in San Francisco Bay, California. Baseline fecal corticosterone metabolite concentrations were negatively correlated with mercury concentrations in blood of older chicks (decreasing by 81% across the range of observed mercury concentrations) while accounting for positive correlations between corticosterone concentrations and number of fledgling chicks within the colony and chick age. In recently hatched chicks, baseline fecal corticosterone metabolite concentrations were weakly negatively correlated with mercury concentrations in down feathers (decreasing by 45% across the range of observed mercury concentrations) while accounting for stronger positive correlations between corticosterone concentrations and colony nest abundance and date. These results indicate that chronic mercury exposure may suppress baseline corticosterone concentrations in tern chicks and suggests that a juvenile bird's ability to respond to stress may be reduced via the downregulation of the HPA axis.

Mercury exposure may suppress baseline corticosterone levels in juvenile birds

USGS Publications Warehouse

Herring, Garth; Ackerman, Joshua T.; Herzog, Mark P.

2012-01-01

Mercury exposure has been associated with a wide variety of negative reproductive responses in birds, however few studies have examined the potential for chick impairment via the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis regulates corticosterone levels during periods of stress. We examined the relationship between baseline fecal corticosterone metabolite concentrations and mercury concentrations in down feathers of recently hatched (Sterna forsteri) chicks in San Francisco Bay, California. Baseline fecal corticosterone metabolite concentrations were negatively correlated with mercury concentrations in blood of older chicks (decreasing by 81% across the range of observed mercury concentrations) while accounting for positive correlations between corticosterone concentrations and number of fledgling chicks within the colony and chick age. In recently hatched chicks, baseline fecal corticosterone metabolite concentrations were weakly negatively correlated with mercury concentrations in down feathers (decreasing by 45% across the range of observed mercury concentrations) while accounting for stronger positive correlations between corticosterone concentrations and colony nest abundance and date. These results indicate that chronic mercury exposure may suppress baseline corticosterone concentrations in tern chicks and suggests that a juvenile bird's ability to respond to stress may be reduced via the downregulation of the HPA axis.

CALS Baseline Architecture Analysis of Weapons System. Technical Information: Army, Draft. Volume 8

DOT National Transportation Integrated Search

1989-09-01

This effort was performed to provide a common framework for analysis and planning of CALS initiatives across the military services, leading eventually to the development of a common DoD-wide architecture for CALS. This study addresses Army technical ...

Subsonic Ultra Green Aircraft Research

NASA Technical Reports Server (NTRS)

Bradley, Marty K.; Droney, Christopher K.

2011-01-01

This Final Report summarizes the work accomplished by the Boeing Subsonic Ultra Green Aircraft Research (SUGAR) team in Phase 1, which includes the time period of October 2008 through March 2010. The team consisted of Boeing Research and Technology, Boeing Commercial Airplanes, General Electric, and Georgia Tech. The team completed the development of a comprehensive future scenario for world-wide commercial aviation, selected baseline and advanced configurations for detailed study, generated technology suites for each configuration, conducted detailed performance analysis, calculated noise and emissions, assessed technology risks, and developed technology roadmaps. Five concepts were evaluated in detail: 2008 baseline, N+3 reference, N+3 high span strut braced wing, N+3 gas turbine battery electric concept, and N+3 hybrid wing body. A wide portfolio of technologies was identified to address the NASA N+3 goals. Significant improvements in air traffic management, aerodynamics, materials and structures, aircraft systems, propulsion, and acoustics are needed. Recommendations for Phase 2 concept and technology projects have been identified.

Facilitators and barriers to effective scale-up of an evidence-based multilevel HIV prevention intervention.

PubMed

Kegeles, Susan M; Rebchook, Gregory; Tebbetts, Scott; Arnold, Emily

2015-04-17

Since the scale-up of HIV/AIDS prevention evidence-based interventions (EBIs) has not been simple, it is important to examine processes that occur in the translation of the EBIs into practice that affect successful implementation. The goal of this paper is to examine facilitators and barriers to effective implementation that arose among 72 community-based organizations as they moved into practice a multilevel HIV prevention intervention EBI, the Mpowerment Project, for young gay and bisexual men. CBOs that were implementing the Mpowerment Project participated in this study and were assessed at baseline, and 6-months, 1 year, and 2 years post-baseline. Semi-structured telephone interviews were conducted separately with individuals at each CBO. Study data came from 647 semi-structured interviews and extensive notes and commentaries from technical assistance providers. Framework Analysis guided the analytic process. Barriers and facilitators to implementation was the overarching thematic framework used across all the cases in our analysis. Thirteen themes emerged regarding factors that influence the successful implementation of the MP. These were organized into three overarching themes: HIV Prevention System Factors, Community Factors, and Intervention Factors. The entire HIV Prevention System, including coordinators, supervisors, executive directors, funders, and national HIV prevention policies, all influenced implementation success. Other Prevention System Factors that affected the effective translation of the EBI into practice include Knowledge About Intervention, Belief in the Efficacy of the Intervention, Desire to Change Existing Prevention Approach, Planning for Intervention Before Implementation, Accountability, Appropriateness of Individuals for Coordinator Positions, Evaluation of Intervention, and Organizational Stability. Community Factors included Geography and Sociopolitical Climate. Intervention Factors included Intervention Characteristics and Adaptation Issues. The entire ecological system in which an EBI occurs affects implementation. It is imperative to focus capacity-building efforts on getting individuals at different levels of the HIV Prevention System into alignment regarding understanding and believing in the program's goals and methods. For a Prevention Support System to be maximally useful, it must address facilitators or barriers to implementation, address the right people, and use modalities to convey information that are acceptable for users of the system.

Study of space shuttle orbiter system management computer function. Volume 1: Analysis, baseline design

NASA Technical Reports Server (NTRS)

1975-01-01

A system analysis of the shuttle orbiter baseline system management (SM) computer function is performed. This analysis results in an alternative SM design which is also described. The alternative design exhibits several improvements over the baseline, some of which are increased crew usability, improved flexibility, and improved growth potential. The analysis consists of two parts: an application assessment and an implementation assessment. The former is concerned with the SM user needs and design functional aspects. The latter is concerned with design flexibility, reliability, growth potential, and technical risk. The system analysis is supported by several topical investigations. These include: treatment of false alarms, treatment of off-line items, significant interface parameters, and a design evaluation checklist. An in-depth formulation of techniques, concepts, and guidelines for design of automated performance verification is discussed.