Impact of Targeted Ocean Observations for Improving Ocean Model Initialization for Coupled Hurricane Forecasting

NASA Astrophysics Data System (ADS)

Halliwell, G. R.; Srinivasan, A.; Kourafalou, V. H.; Yang, H.; Le Henaff, M.; Atlas, R. M.

2012-12-01

The accuracy of hurricane intensity forecasts produced by coupled forecast models is influenced by errors and biases in SST forecasts produced by the ocean model component and the resulting impact on the enthalpy flux from ocean to atmosphere that powers the storm. Errors and biases in fields used to initialize the ocean model seriously degrade SST forecast accuracy. One strategy for improving ocean model initialization is to design a targeted observing program using airplanes and in-situ devices such as floats and drifters so that assimilation of the additional data substantially reduces errors in the ocean analysis system that provides the initial fields. Given the complexity and expense of obtaining these additional observations, observing system design methods such as OSSEs are attractive for designing efficient observing strategies. A new fraternal-twin ocean OSSE system based on the HYbrid Coordinate Ocean Model (HYCOM) is used to assess the impact of targeted ocean profiles observed by hurricane research aircraft, and also by in-situ float and drifter deployments, on reducing errors in initial ocean fields. A 0.04-degree HYCOM simulation of the Gulf of Mexico is evaluated as the nature run by determining that important ocean circulation features such as the Loop Current and synoptic cyclones and anticyclones are realistically simulated. The data-assimilation system is run on a 0.08-degree HYCOM mesh with substantially different model configuration than the nature run, and it uses a new ENsemble Kalman Filter (ENKF) algorithm optimized for the ocean model's hybrid vertical coordinates. The OSSE system is evaluated and calibrated by first running Observing System Experiments (OSEs) to evaluate existing observing systems, specifically quantifying the impact of assimilating more than one satellite altimeter, and also the impact of assimilating targeted ocean profiles taken by the NOAA WP-3D hurricane research aircraft in the Gulf of Mexico during the Deepwater Horizon oil spill. OSSE evaluation and calibration is then performed by repeating these two OSEs with synthetic observations and comparing the resulting observing system impact to determine if it differs from the OSE results. OSSEs are first run to evaluate different airborne sampling strategies with respect to temporal frequency of flights and the horizontal separation of upper-ocean profiles during each flight. They are then run to assess the impact of releasing multiple floats and gliders. Evaluation strategy focuses on error reduction in fields important for hurricane forecasting such as the structure of ocean currents and eddies, upper ocean heat content distribution, and upper-ocean stratification.

As Green as We Think? The Case of the College of Charleston Green Building Initiative

ERIC Educational Resources Information Center

Owens, Katharine A.; Halfacre-Hitchcock, Angela

2006-01-01

Purpose: This paper seeks to disseminate knowledge regarding the experiences of a student team in implementing a campus-level sustainability initiative, outlining the strategy to measure the potential impact of this initiative. Design/methodology/approach: Project design is a case study. Via interviewing and surveys, the study observed student and…

Framework for Testing the Effectiveness of Bat and Eagle Impact-Reduction Strategies at Wind Energy Projects

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

Sinclair, Karin; DeGeorge, Elise

2016-04-13

The objectives of this framework are to facilitate the study design and execution to test the effectiveness of bat and eagle impact-reduction strategies at wind energy sites. Through scientific field research, the wind industry and its partners can help determine if certain strategies are ready for operational deployment or require further development. This framework should be considered a living document to be improved upon as fatality-reduction technologies advance from the initial concepts to proven readiness (through project- and technology-specific testing) and as scientific field methods improve.

Building Perinatal Case Manager Capacity Using Quality Improvement.

PubMed

Fitzgerald, Elaine

2015-01-01

Improving breastfeeding rates among Black women is a potential strategy to address disparities in health outcomes that disproportionately impact Black women and children. This quality improvement (QI) initiative aimed to improve perinatal case manager knowledge and self-efficacy to promote breastfeeding among Black, low-income women who use services through Boston Healthy Start Initiative. QI methodology was used to develop and test a two-part strategy for perinatal case managers to promote and support breastfeeding. A positive change was observed in infant feeding knowledge and case manager self-efficacy to promote breastfeeding. Among the 24 mothers participating in this QI initiative, 100% initiated and continued breastfeeding at 1 week postpartum, and 92% were breastfeeding at 2 weeks postpartum.

Managing coastal recreation impacts and visitor experience using GIS

Treesearch

Anna M. T. Gajda; Judson Brown; Grant Peregoodoff; Patrick Bartier

2000-01-01

A campsite monitoring program was initiated in Gwaii Haanas National Park Reserve/Haida Heritage Site to determine baseline levels of visitor impacts. These data were necessary to evaluate visitor management strategies and to act as reference points to measure changes in impacts over time. Using GIS, survey data were integrated with an ecological land classification,...

Brazilian health technology assessment bulletin: editorial process, dissemination strategies, critical appraisal, and initial impact.

PubMed

Silva, Marcus Tolentino; de Almeida, Rosimary Terezinha; Gava, Cintia Maria; Galvão, Taís Freire; da Silva, Edina Mariko Koga; Santos, Vania Cristina Canuto; Ronchini, Misani Akiko Kanamota; de Mesquita, Aline Monte; Elias, Flávia Tavares Silva; d'Oliveira, Alexandre Lemgruber Portugal; Atallah, Alvaro Nagib

2012-01-01

This study reports on the Brazilian experience of developing a specialized bulletin, the Brazilian Health Technology Assessment Bulletin (BRATS), on health technology assessments (HTA). The editorial process, format, and dissemination strategy of the publication are presented. A critical appraisal of the available issues was made using the checklist for HTA reports of the International Network of Agencies for Health Technology Assessment. The initial impact was estimated based on a retrospective observational measurement of the types of publications that cite the bulletin as a source of information. The publications citing BRATS were identified using Google Scholar. Since June 2008, fourteen issues of the bulletin have been produced. BRATS has not presented any significant limitation that would compromise generalizations of its results within the Brazilian context. The initial impact of the bulletin, however, has been small, which may be due to its exclusively electronic dissemination format and technical language. We found nine publications citing BRATS in Google Scholar. It is hoped that the bulletin will promote the continuity of HTA actions among health-sector managers and professionals in Brazil.

Development of a mentorship strategy: a knowledge translation case study.

PubMed

Straus, Sharon E; Graham, Ian D; Taylor, Mark; Lockyer, Jocelyn

2008-01-01

There are many theories and frameworks for achieving knowledge translation, and the assortment can be confusing to those responsible for planning, evaluation, or policymaking in knowledge translation. A conceptual framework developed by Graham and colleagues provides an approach that builds on the commonalities found in an assessment of planned-action theories. This article describes the application of this knowledge to action framework to a mentorship initiative in academic medicine. Mentorship influences career success but is threatened in academia by increased clinical, research, and administrative demands. A case study review was undertaken of the role of mentors, the experiences of mentors and mentees, and mentorship initiatives in developing and retaining clinician scientists at two universities in Alberta, Canada. This project involved relevant stakeholders including researchers, university administrators, and research funders. The knowledge to action framework was used to develop a strategy for mentorship for clinician researchers. The framework highlights the need to identify and engage stakeholders in the process of knowledge implementation. A series of initiatives were selected and tailored to barriers and facilitators to implementation of the mentorship initiative; strategies for evaluating the knowledge use and its impact on outcomes were developed. The knowledge to action framework can be used to develop a mentorship initiative for clinician researchers. Future work to evaluate the impact of this intervention on recruitment and retention is planned.

Dose as a Tool for Planning and Implementing Community-Based Health Strategies.

PubMed

Kuo, Elena S; Harner, Lisa T; Frost, Madeline C; Cheadle, Allen; Schwartz, Pamela M

2018-05-01

A major challenge in community-based health promotion is implementing strategies that could realistically improve health at the population level. Population dose methodology was developed to help understand the combined impact of multiple strategies on population-level health behaviors. This paper describes one potential use of dose: as a tool for working collaboratively with communities to increase impact when planning and implementing community-level initiatives. Findings are presented from interviews conducted with 11 coordinators who used dose for planning and implementing local efforts with community coalitions. During early-stage planning, dose was used as a tool for strategic planning, and as a framework to build consensus among coalition partners. During implementation, a dose lens was used to revise strategies to increase their reach (the number of people exposed to the intervention) or strength (the relative change in behavior for each exposed person) to create population-level impact. A case study is presented, illustrating how some community coalitions and evaluators currently integrate dose into the planning and implementation of place-based healthy eating and active living strategies. Finally, a planning checklist was developed for program coordinators and evaluators. 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.

Effectiveness of a grant program's efforts to promote synergy within its funded initiatives: perceptions of participants of the Southern Rural Access Program.

PubMed

Pathman, Donald E; Chuang, Emmeline; Weiner, Bryan J

2008-12-18

Foundations and public agencies commonly fund focused initiatives for individual grantees. These discrete, stand-alone initiatives can risk failure by being carried out in isolation. Fostering synergy among grantees' initiatives is one strategy proposed for promoting the success and impact of grant programs. We evaluate an explicit strategy to build synergy within the Robert Wood Johnson Foundation's Southern Rural Access Program (SRAP), which awarded grants to collaboratives within eight southeastern U.S. states to strengthen basic health care services in targeted rural counties. We interviewed 39 key participants of the SRAP, including the program director within each state and the principal subcontractors heading the program's funded initiatives that supported heath professionals' recruitment, retention and training, made loans to health care providers, and built networks among providers. Interews were recorded and transcribed. Two investigators independently coded the transcripts and a third investigator distilled the main points. Participants generally perceived that the SRAP yielded more synergies than other grant programs in which they had participated and that these synergies added to the program's impact. The synergies most often noted were achieved through relationship building among grantees and with outside agencies, sharing information and know-how, sharing resources, combining efforts to yield greater capacity, joining voices to advocate for common goals, and spotting gaps in services offered and then filling these gaps. The SRAP's strategies that participants felt fostered synergy included targeting funding to culturally and geographically similar states, supporting complementary types of initiatives, promoting opportunities to network through semi-annual meetings and regular conference calls, and the advocacy efforts of the program's leadership. Participants noted that synergies were sometimes hindered by turf issues and politics and the conflicting perspectives and cultures of participating organizations and racial groups. Inadequate funding through the SRAP, restricting program involvement to only a few needy counties, and instances of over- and under-involvement by the program's leadership were sometimes felt to inhibit synergies and/or their sustainability. Participants of the SRAP generally perceived that the SRAP's deliberate strategies yielded synergies that added to the program's impact.

Effectiveness of a grant program's efforts to promote synergy within its funded initiatives: perceptions of participants of the Southern Rural Access Program

PubMed Central

Pathman, Donald E; Chuang, Emmeline; Weiner, Bryan J

2008-01-01

Background Foundations and public agencies commonly fund focused initiatives for individual grantees. These discrete, stand-alone initiatives can risk failure by being carried out in isolation. Fostering synergy among grantees' initiatives is one strategy proposed for promoting the success and impact of grant programs. We evaluate an explicit strategy to build synergy within the Robert Wood Johnson Foundation's Southern Rural Access Program (SRAP), which awarded grants to collaboratives within eight southeastern U.S. states to strengthen basic health care services in targeted rural counties. Methods We interviewed 39 key participants of the SRAP, including the program director within each state and the principal subcontractors heading the program's funded initiatives that supported heath professionals' recruitment, retention and training, made loans to health care providers, and built networks among providers. Interews were recorded and transcribed. Two investigators independently coded the transcripts and a third investigator distilled the main points. Results Participants generally perceived that the SRAP yielded more synergies than other grant programs in which they had participated and that these synergies added to the program's impact. The synergies most often noted were achieved through relationship building among grantees and with outside agencies, sharing information and know-how, sharing resources, combining efforts to yield greater capacity, joining voices to advocate for common goals, and spotting gaps in services offered and then filling these gaps. The SRAP's strategies that participants felt fostered synergy included targeting funding to culturally and geographically similar states, supporting complementary types of initiatives, promoting opportunities to network through semi-annual meetings and regular conference calls, and the advocacy efforts of the program's leadership. Participants noted that synergies were sometimes hindered by turf issues and politics and the conflicting perspectives and cultures of participating organizations and racial groups. Inadequate funding through the SRAP, restricting program involvement to only a few needy counties, and instances of over- and under-involvement by the program's leadership were sometimes felt to inhibit synergies and/or their sustainability. Conclusion Participants of the SRAP generally perceived that the SRAP's deliberate strategies yielded synergies that added to the program's impact. PMID:19094212

Heat Islands

EPA Pesticide Factsheets

EPA's Heat Island Effect Site provides information on heat islands, their impacts, mitigation strategies, related research, a directory of heat island reduction initiatives in U.S. communities, and EPA's Heat Island Reduction Program.

Building Perinatal Case Manager Capacity Using Quality Improvement

PubMed Central

Fitzgerald, Elaine

2015-01-01

ABSTRACT Improving breastfeeding rates among Black women is a potential strategy to address disparities in health outcomes that disproportionately impact Black women and children. This quality improvement (QI) initiative aimed to improve perinatal case manager knowledge and self-efficacy to promote breastfeeding among Black, low-income women who use services through Boston Healthy Start Initiative. QI methodology was used to develop and test a two-part strategy for perinatal case managers to promote and support breastfeeding. A positive change was observed in infant feeding knowledge and case manager self-efficacy to promote breastfeeding. Among the 24 mothers participating in this QI initiative, 100% initiated and continued breastfeeding at 1 week postpartum, and 92% were breastfeeding at 2 weeks postpartum. PMID:26937160

Strategies for Impact: Enabling E-Learning Project Initiatives

ERIC Educational Resources Information Center

Csete, Josephine; Evans, Jennifer

2013-01-01

Purpose: The paper aims to focus on institutional initiatives to embed e-learning in a university in Hong Kong, from 2006-12, through large-scale funding of 43 e-learning projects. It outlines the guiding principles behind the university's e-learning development and discusses the significance of various procedures and practices in project…

The Seeds to Success Modified Field Test: Findings from the Impact and Implementation Studies

ERIC Educational Resources Information Center

Boller, Kimberly; Del Grosso, Patricia; Blair, Randall; Jolly, Yumiko; Fortson, Ken; Paulsell, Diane; Lundquist, Eric; Hallgren, Kristin; Kovac, Martha

2010-01-01

In 2006, the Bill & Melinda Gates Foundation launched the Early Learning Initiative (ELI) to improve the school readiness of Washington State's children through three main strategies: (1) development of high-quality, community-wide early learning initiatives in two communities; (2) enhancement of statewide systems that support early…

Technology Transfer and Innovation Initiatives in Strategic Management: Generating an Alternative Perspective

ERIC Educational Resources Information Center

Major, E.

2003-01-01

This paper taps the strategic management discipline to inform our understanding of technology transfer and innovation (TTI) initiatives. With special focus on the UK Foresight programme it considers the impacts that the resource-based and core competence approaches to strategy can have on understanding the nature and effectiveness of TTI…

Cognitive load during route selection increases reliance on spatial heuristics.

PubMed

Brunyé, Tad T; Martis, Shaina B; Taylor, Holly A

2018-05-01

Planning routes from maps involves perceiving the symbolic environment, identifying alternate routes and applying explicit strategies and implicit heuristics to select an option. Two implicit heuristics have received considerable attention, the southern route preference and initial segment strategy. This study tested a prediction from decision-making theory that increasing cognitive load during route planning will increase reliance on these heuristics. In two experiments, participants planned routes while under conditions of minimal (0-back) or high (2-back) working memory load. In Experiment 1, we examined how memory load impacts the southern route heuristic. In Experiment 2, we examined how memory load impacts the initial segment heuristic. Results replicated earlier results demonstrating a southern route preference (Experiment 1) and initial segment strategy (Experiment 2) and further demonstrated that evidence for heuristic reliance is more likely under conditions of concurrent working memory load. Furthermore, the extent to which participants maintained efficient route selection latencies in the 2-back condition predicted the magnitude of this effect. Together, results demonstrate that working memory load increases the application of heuristics during spatial decision making, particularly when participants attempt to maintain quick decisions while managing concurrent task demands.

Energy Savings Calculations for Heat Island Reduction Strategies in Baton Rouge, Sacramento and Salt Lake City

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

Konopacki, S.; Akbari, H.

2000-03-01

In 1997, the US Environmental Protection Agency (EPA) established the ''Heat Island Reduction Initiative'', to quantify the potential benefits of Heat Island Reduction (HIR) strategies (i.e., shade trees, reflective roofs, reflective pavements and urban vegetation) to reduce cooling energy use in buildings, lower the ambient air temperature and improve urban air quality in cities, and reduce CO2 emissions from power plants. Under this initiative, the Urban Heat Island Pilot Project (UHIPP) was created with the objective to investigate the potential of HIR strategies in residential and commercial buildings in three initial UHIPP cities: Baton Rouge, Sacramento and Salt Lake City.more » This paper summarizes our efforts to calculate the annual energy savings, peak power avoidance and annual C02 reduction of HIR strategies in the three initial cities. In this analysis, we focused on three building types that offer most savings potential: single-family residence, office and retail store. Each building type was characterized in detail by old or new construction and with a gas furnace or an electric heat pump. We defined prototypical building characteristics for each building type and simulated the impact of HIR strategies on building cooling and heating energy use and peak power demand using the DOE-2.IE model. Our simulations included the impact of (1) strategically-placed shade trees near buildings [direct effect], (2) use of high-albedo roofing material on building [direct effect], (3) combined strategies I and 2 [direct effect], (4) urban reforestation with high-albedo pavements and building surfaces [indirect effect] and (5) combined strategies 1, 2 and 4 [direct and indirect effects]. We then estimated the total roof area of air-conditioned buildings in each city using readily obtainable data to calculate the metropolitan-wide impact of HIR strategies. The results show, that in Baton Rouge, potential annual energy savings of $15M could be realized by rate-payers from the combined direct and indirect effects of HIR strategies. Additionally, peak power avoidance is estimated at 133 MW and the reduction in annual carbon emissions at 41 kt. In Sacramento, the potential annual energy savings is estimated at $26M, with an avoidance of 486 MW in peak power and a reduction in annual carbon of 92 kt. In Salt Lake City, the potential annual energy savings is estimated at $4M, with an avoidance of 85 MW in peak power and a reduction in annual carbon of 20 kt.« less

Exploring the role of traditional ecological knowledge in climate change initiatives

Treesearch

Kirsten Vinyeta; Kathy Lynn

2013-01-01

Indigenous populations are projected to face disproportionate impacts as a result of climate change in comparison to nonindigenous populations. For this reason, many American Indian and Alaska Native tribes are identifying and implementing culturally appropriate strategies to assess climate impacts and adapt to projected changes. Traditional ecological knowledge (TEK...

Do transition towns have the potential to promote health and well-being? A health impact assessment of a transition town initiative.

PubMed

Richardson, J; Nichols, A; Henry, T

2012-11-01

Climate change and energy vulnerability present significant challenges for the development and sustainability of our communities. The adverse effects will most likely impact on those already experiencing poverty, as energy and food costs will rise, thus increasing inequalities in health. Transition town initiatives seek to build cohesive sustainable communities to prepare for a future with limited oil and a changing climate. Increasingly, public health practitioners are interested in the role of transition towns as a community development initiative, and their potential to support the wider public health agenda. Health impact assessment (HIA) is an evidence-based process that aims to predict the positive and negative impacts of a strategy, proposal or development. The HIA process provides an opportunity to promote sustainable communities by ensuring that new strategies and developments are considered in the context of their contribution to the health and well-being of local populations. The aim of this study was to use an HIA to examine the potential health and well-being benefits of two related transition town initiatives. A rapid HIA to consider the potential lifestyle changes and health and well-being impacts of Transition Together/Transition Streets (TT/TS) projects. An HIA template was used to assess key documents related to the TT/TS initiatives and those related to the characteristics of the community. Additionally, meetings with 12 key informants (four involved in TT/TS and eight purposively selected for their local knowledge) were held using the HIA template to focus the discussion. The findings highlight the associated lifestyle changes such as increased physical activity and healthy eating, and possible social and well-being benefits of engagement in such an initiative. Engagement may be limited to those already concerned about environmental issues. This paper illustrates the important links between transition towns and the wider public health agenda, and demonstrates how an HIA can be applied to a community-based initiative. It provides a means by which transition town initiatives can demonstrate health and well-being benefits, whilst raising concerns about inclusivity and equity. Copyright © 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Developing a promotional strategy: important questions for social marketing.

PubMed

Thackeray, Rosemary; Neiger, Brad L; Hanson, Carl L

2007-10-01

Health practitioners often use the terms marketing and promotion interchangeably. Yet, promotion is just one element of an overall marketing strategy. To realize the greatest impact there must be a combination of all the marketing components, including product, price, place, and promotion. The purpose of this article is to clarify the role of promotion and describe key elements of developing a promotional strategy within the broader context of a social marketing initiative.

The impact of the U.S. supercomputing initiative will be global

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

Crawford, Dona

2016-01-15

Last July, President Obama issued an executive order that created a coordinated federal strategy for HPC research, development, and deployment called the U.S. National Strategic Computing Initiative (NSCI). However, this bold, necessary step toward building the next generation of supercomputers has inaugurated a new era for U.S. high performance computing (HPC).

The Texas Tech Prep Consortia: Strategies for Advancing Academic and Technical Education.

ERIC Educational Resources Information Center

Hensley, Oliver D., Ed.; And Others

This book contains 30 chapters on the tech prep initiative in Texas: "The Identity of Tech Prep in Texas" (Tunstall); "A Snap-Shot of the Impact of the Tech Prep Initiative in the Governor's 24 Planning Regions" (Brown); "The Tech Prep Consortium Directors: The Architects for the Future of Texas" (Hensley et al.);…

77 FR 65364 - Mid-Atlantic Fishery Management Council (MAFMC); Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-26

... Economic Impact, Governance and Regulatory Process goals, objectives and strategies initially drafted on... and threats on science and data and ecosystem based fishery management. No formal actions will be...

Energy savings for heat-island reduction strategies in Chicago and Houston (including updates for Baton Rouge, Sacramento, and Salt Lake City)

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

Konopacki, S.; Akbari, H.

2002-02-28

In 1997, the U.S. Environmental Protection Agency (EPA) established the ''Heat Island Reduction Initiative'' to quantify the potential benefits of Heat-Island Reduction (HIR) strategies (i.e., shade trees, reflective roofs, reflective pavements and urban vegetation) to reduce cooling-energy use in buildings, lower the ambient air temperature and improve urban air quality in cities, and reduce CO2 emissions from power plants. Under this initiative, the Urban Heat Island Pilot Project (UHIPP) was created with the objective of investigating the potential of HIR strategies in residential and commercial buildings in three initial UHIPP cities: Baton Rouge, LA; Sacramento, CA; and Salt Lake City,more » UT. Later two other cities, Chicago, IL and Houston, TX were added to the UHIPP. In an earlier report we summarized our efforts to calculate the annual energy savings, peak power avoidance, and annual CO2 reduction obtainable from the introduction of HIR strategies in the initial three cities. This report summarizes the results of our study for Chicago and Houston. In this analysis, we focused on three building types that offer the highest potential savings: single-family residence, office and retail store. Each building type was characterized in detail by vintage and system type (i.e., old and new building constructions, and gas and electric heat). We used the prototypical building characteristics developed earlier for each building type and simulated the impact of HIR strategies on building cooling- and heating-energy use and peak power demand using the DOE-2.1E model. Our simulations included the impact of (1) strategically-placed shade trees near buildings [direct effect], (2) use of high-albedo roofing material on the building [direct effect], (3) urban reforestation with high-albedo pavements and building surfaces [indirect effect] and (4) combined strategies 1, 2, and 3 [direct and indirect effects]. We then estimated the total roof area of air-conditioned buildings in each city using readily obtainable data to calculate the metropolitan-wide impact of HIR strategies. The results show that in Chicago, potential annual energy savings of $30M could be realized by ratepayers from the combined direct and indirect effects of HIR strategies. Additionally, peak power avoidance is estimated at 400 MW and the reduction in annual carbon emissions at 58 ktC. In Houston, the potential annual energy savings are estimated at $82M, with an avoidance of 730 MW in peak power and a reduction in annual carbon emissions of 170 ktC.« less

Glucagon Is a Safe and Inexpensive Initial Strategy in Esophageal Food Bolus Impaction.

PubMed

Haas, Jason; Leo, Julia; Vakil, Nimish

2016-03-01

Controversy exists about the utility of pharmacologic agents and endoscopic technique used for esophageal food bolus impaction. To evaluate the utility of glucagon and the technique used for endoscopic removal, including the rate of success and the adverse events of the techniques. The database of the largest healthcare provider in southeastern Wisconsin was retrospectively reviewed for patients presenting with esophageal food bolus impaction. Data extracted included glucagon administration and its success rate, outcome of radiographic studies, and the endoscopic method of removal and adverse events associated with it, including 30-day mortality. A total of 750 patients were identified with food bolus impaction from 2007 to 2012. Glucagon was administered in 440 patients and was successful in 174 (39.5%). Endoscopic removal was performed in 470 patients and was successful in 469 (99.8%). The push technique was utilized in 209 patients, reduction in the bolus size by piecemeal removal followed by the push technique was utilized in 97 patients, and the pull technique was utilized in 107 patients. There were no perforations with endoscopic removal. Only 4.5% of the X-rays performed reported a possible foreign body within the esophagus. Glucagon was a significantly less-expensive strategy than endoscopic therapy (p < 0.0001). Glucagon is low cost, is moderately effective, and may be considered as an initial strategy. Endoscopic removal regardless of technique is safe and effective. The yield of radiography is poor in the setting of food bolus impaction.

Cost-effectiveness and budget impact of interferon-free direct-acting antiviral-based regimens for hepatitis C treatment: the French case.

PubMed

Deuffic-Burban, S; Obach, D; Canva, V; Pol, S; Roudot-Thoraval, F; Dhumeaux, D; Mathurin, P; Yazdanpanah, Y

2016-10-01

We evaluated the cost-effectiveness and the budget impact of new DAA-based regimen use in France. A Markov model simulated chronic hepatitis C (CHC) treatment interventions with IFN-based and IFN-free regimens at stage of fibrosis ≥F3, ≥F2 or regardless of fibrosis stage, and treatment either with the least or the most expensive combination. It estimated quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). It also assessed the budget impact over 5 years of treating all CHC-screened patients, regardless of fibrosis, assuming ≤20 000 patients treated/year and priority to ≥F3. Sensitivity analyses were also conducted. For genotypes (G) 1-4, the initiation of IFN-free regardless of fibrosis was a cost-effective strategy compared to prior standard of care (SOC) initiated at stage F2: €40 400-88 300/QALY gained in G1; similar results were obtained for patients infected with G4. Considering G2-3, the most cost-effective strategy was IFN-based regimens regardless of fibrosis compared to prior SOC initiated at stage F2: €21 300 and €19 400/QALY gained, respectively; the strategy with IFN-free regimens being more effective but not cost-effective at current costs. The budget impact of treating all CHC-screened patients over 5 years would range between 3.5 and 7.2 billion €, depending on whether one considers the least or the most expensive combination of new DAAs and whether one treats G2-3 with IFN-based or IFN-free new DAAs. In France, treatment initiation with new DDAs regardless of fibrosis stage is cost-effective, but would add 3.5-7.2 billion € to an already overburdened medical care system. © 2016 John Wiley & Sons Ltd.

Promoting Policy, Systems, and Environment Change to Prevent Chronic Disease: Lessons Learned From the King County Communities Putting Prevention to Work Initiative.

PubMed

Cheadle, Allen; Cromp, DeAnn; Krieger, James W; Chan, Nadine; McNees, Molly; Ross-Viles, Sarah; Kellogg, Ryan; Rahimian, Afsaneh; MacDougall, Erin

2016-01-01

Initiatives that convene community stakeholders to implement policy, systems, environment, and infrastructure (PSEI) change have become a standard approach for promoting community health. To assess the PSEI changes brought about by the King County, Washington, Communities Putting Prevention to Work initiative and describe how initiative structures and processes contributed to making changes. The impact evaluation used a logic model design, linking PSEI changes to longer-term behavioral impacts in healthy eating active living and tobacco use and exposure. Qualitative methods, including stakeholder interviews and surveys, were used to identify initiative success factors. Communities Putting Prevention to Work activities occurred throughout King County, with a focus on 7 low-income communities in South Seattle/King County. The focus communities had a combined population of 652 000, or 35% of the county total, with lower incomes and higher rates of physical inactivity, tobacco use, poor diet, and chronic disease. Twenty-four PSEI strategies were pursued by organizations in sectors including schools, local governments, and community organizations, supported by the public health department. There were 17 healthy eating active living strategies (eg, enhancements to school menus, city planning policies) and 7 tobacco strategies (eg, smoke-free policies in schools, housing, and hospitals). PSEI changes made and numbers of residents reached. Twenty-two of the 24 strategies achieved significant progress toward implementing PSEI changes. The most common success factor was a "dyad" consisting of a dedicated technical assistance provider-either an outside consultant or public health department staff-working closely with a champion from the participating organizations to bring about PSEI changes. An initiative structure that creates and supports external consultant/internal organizational champion dyads in key community sectors offers a promising approach that may be adopted by similar community health efforts in the future.

Impact Assessment of a Department-Wide Science Education Initiative Using Students' Perceptions of Teaching and Learning Experiences

ERIC Educational Resources Information Center

Jones, Francis

2017-01-01

Evaluating major post-secondary education improvement projects involves multiple perspectives, including students' perceptions of their experiences. In the final year of a seven-year department-wide science education initiative, we asked students in 48 courses to rate the extent to which each of 39 teaching or learning strategies helped them learn…

A Tale of Two Trails: Exploring Different Paths to Success

PubMed Central

Walker, Jennifer G.; Evenson, Kelly R.; Davis, William J.; Bors, Philip; Rodríguez, Daniel A.

2016-01-01

Background This comparative case study investigates 2 successful community trail initiatives, using the Active Living By Design (ALBD) Community Action Model as an analytical framework. The model includes 5 strategies: preparation, promotion, programs, policy, and physical projects. Methods Key stakeholders at 2 sites participated in in-depth interviews (N = 14). Data were analyzed for content using Atlas Ti and grouped according to the 5 strategies. Results Preparation Securing trail resources was challenging, but shared responsibilities facilitated trail development. Promotions The initiatives demonstrated minimal physical activity encouragement strategies. Programs Community stakeholders did not coordinate programmatic opportunities for routine physical activity. Policy Trails’ inclusion in regional greenway master plans contributed to trail funding and development. Policies that were formally institutionalized and enforced led to more consistent trail construction and safer conditions for users. Physical Projects Consistent standards for way finding signage and design safety features enhanced trail usability and safety. Conclusions Communities with different levels of government support contributed unique lessons to inform best practices of trail initiatives. This study revealed a disparity between trail development and use-encouragement strategies, which may limit trails’ impact on physical activity. The ALBD Community Action Model provided a viable framework to structure cross-disciplinary community trail initiatives. PMID:21597125

The HIV/AIDS epidemic in Indonesia: does primary health care as a prevention and intervention strategy work?

PubMed

Ibrahim, Kusman; Songwathana, Praneed; Boonyasopun, Umaporn; Francis, Karen

2010-04-01

The continuing increase in the number of people living with HIV/AIDS (PLWHA) in Indonesia is impacting on society. Various policies and strategies have been adopted and implemented to tackle this epidemic including primary health-care (PHC) initiatives. This paper describes the current HIV/AIDS epidemic in Indonesia and highlights a range of prevention and intervention initiatives introduced to limit the spread and impact of this disease factors, such as the characteristics of high-risk groups, the decentralization policy in the health sector, and the lack of skilled human resources and supplies in health centres have been identified as influencing access to health-care services among high-risk groups. Revitalization of a PHC approach coupled with adequate fiscal, infrastructure and human resources if addressed will increase of PLWHA and other risk groups to health care.

Impact of atmosphere and land surface initial conditions on seasonal forecast of global surface temperature

NASA Astrophysics Data System (ADS)

Materia, Stefano; Borrelli, Andrea; Bellucci, Alessio; Alessandri, Andrea; Di Pietro, Pierluigi; Athanasiadis, Panagiotis; Navarra, Antonio; Gualdi, Silvio

2014-05-01

The impact of land surface and atmosphere initialization on the forecast skill of a seasonal prediction system is investigated, and an effort to disentangle the role played by the individual components to the global predictability is done, via a hierarchy of seasonal forecast experiments performed under different initialization strategies. A realistic atmospheric initial state allows an improved equilibrium between the ocean and overlying atmosphere, mitigating the coupling shock and possibly increasing the model predictive skill in the ocean. In fact, in a few regions characterized by strong air-sea coupling, the atmosphere initial condition affects the forecast skill for several months. In particular, the ENSO region, the eastern tropical Atlantic and the North Pacific benefit significantly from the atmosphere initialization. On mainland, the impact of atmospheric initial conditions is detected in the early phase of the forecast, while the quality of land surface initialization affects the forecast skill in the following lead seasons. The winter forecast in the high latitude plains of Siberia and Canada benefit from the snow initialization, while the impact of soil moisture initial state is particularly effective in the Mediterranean region, in central Asia and Australia. However, initialization through land surface reanalysis does not systematically guarantee an enhancement of the predictive skill: the quality of the forecast is sometimes higher for the non-constrained model. Overall, the introduction of a realistic initialization of land surface and atmosphere substantially increases skill and accuracy. However, further developments in the operating procedure for land surface initialization are required for more accurate seasonal forecasts.

[Impact of an |A|B|S|-training initiative on |A|B|S|-structural quality of participating hospitals].

PubMed

Christoph, Anna; Ehm, Christine; de With, Katja

2015-01-01

The "ABS-training initiative" was funded by the German Ministry of Health as part of the German Antimicrobial Resistance Strategy (Deutsche Antibiotika-Resistenz-Strategie, DART) from 2009 until early 2014. The initiative was designed for clinicians and clinical pharmacists and contains several training units covering antiinfectives, infectious diseases and ABS strategies including the conduction of a research project at the participants' hospital. Participants who complete the four-weeks training initiative will become a certified "ABS Expert". 281 ABS Experts were asked to take part in a survey (staff for ABS, surveillance data about agents and consumption, ABS activity) to estimate the influence of the ABS-training initiative on the ABS-structural quality. The evaluation was performed using GrafStat (V 4.255), statistical software package for the evaluation of surveys. Ninety-two ABS Experts representing 92 hospitals participated in a questionnaire-based survey before and after completing the training initiative. Forty (44 %) hospitals appointed an ABS representative (+22 %) after completing the training initiative. Antibiotic surveillance data available as a report increased from 34 (40 %) to 54 (60 %) and correct data presentation (DDD or RDD/100 days) from 7 (8 %) to 40 (43 %). Proactive auditing of antiinfective prescribing improved from 54 (60 %) to 71 (78 %) in intensive care units, and from 28 (31 %) to 53 (58 %) on normal wards. Availability of local guidelines increased from 36 (39 %) to 52 (57 %). The "ABS Training Initiative" had a positive impact on ABS-structural quality regarding nomination of ABS-teams, surveillance data of antibiotic consumption, implementation of proactive auditing of antiinfective prescribing and availability of local guidelines. However, there is optimization potential in many sectors. The short time period between pre- and post-assessment and the ongoing personnel or time constraints need to be taken into account. Copyright © 2015. Published by Elsevier GmbH.

Spacecraft formation flying for Earth-crossing object deflections using a power limited laser ablating

NASA Astrophysics Data System (ADS)

Yoo, Sung-Moon; Song, Young-Joo; Park, Sang-Young; Choi, Kyu-Hong

2009-06-01

A formation flying strategy with an Earth-crossing object (ECO) is proposed to avoid the Earth collision. Assuming that a future conceptual spacecraft equipped with a powerful laser ablation tool already rendezvoused with a fictitious Earth collision object, the optimal required laser operating duration and direction histories are accurately derived to miss the Earth. Based on these results, the concept of formation flying between the object and the spacecraft is applied and analyzed as to establish the spacecraft's orbital motion design strategy. A fictitious "Apophis"-like object is established to impact with the Earth and two major deflection scenarios are designed and analyzed. These scenarios include the cases for the both short and long laser operating duration to avoid the Earth impact. Also, requirement of onboard laser tool's for both cases are discussed. As a result, the optimal initial conditions for the spacecraft to maintain its relative trajectory to the object are discovered. Additionally, the discovered optimal initial conditions also satisfied the optimal required laser operating conditions with no additional spacecraft's own fuel expenditure to achieve the spacecraft formation flying with the ECO. The initial conditions founded in the current research can be used as a spacecraft's initial rendezvous points with the ECO when designing the future deflection missions with laser ablation tools. The results with proposed strategy are expected to make more advances in the fields of the conceptual studies, especially for the future deflection missions using powerful laser ablation tools.

Analysis of Strategies for Multiple Emissions from Electric Power SO2, NOX, CO2, Mercury and RPS

EIA Publications

2001-01-01

At the request of the Subcommittee, the Energy Information Administration prepared an initial report that focused on the impacts of reducing power sector NOx, SO2, and CO2 emissions. The current report extends the earlier analysis to add the impacts of reducing power sector mercury emissions and introducing renewable portfolio standard (RPS) requirements.

Improving water quality through California's Clean Beach Initiative: an assessment of 17 projects.

PubMed

Dorsey, John H

2010-07-01

California's Clean Beach Initiative (CBI) funds projects to reduce loads of fecal indicator bacteria (FIB) impacting beaches, thus providing an opportunity to judge the effectiveness of various CBI water pollution control strategies. Seventeen initial projects were selected for assessment to determine their effectiveness on reducing FIB in the receiving waters along beaches nearest to the projects. Control strategies included low-flow diversions, sterilization facilities, sewer improvements, pier best management practices (BMPs), vegetative swales, and enclosed beach BMPs. Assessments were based on statistical changes in pre- and postproject mean densities of FIB at shoreline monitoring stations targeted by the projects. Most low-flow diversions and the wetland swale project were effective in removing all contaminated runoff from beaches. UV sterilization was effective when coupled with pretreatment filtration and where effluent was released within a few hundred meters of the beach to avoid FIB regrowth. Other BMPs were less effective because they treated only a portion of contaminant sources impacting their target beach. These findings should be useful to other coastal states and agencies faced with similar pollution control problems.

A user-friendly, open-source tool to project impact and cost of diagnostic tests for tuberculosis

PubMed Central

Dowdy, David W; Andrews, Jason R; Dodd, Peter J; Gilman, Robert H

2014-01-01

Most models of infectious diseases, including tuberculosis (TB), do not provide results customized to local conditions. We created a dynamic transmission model to project TB incidence, TB mortality, multidrug-resistant (MDR) TB prevalence, and incremental costs over 5 years after scale-up of nine alternative diagnostic strategies. A corresponding web-based interface allows users to specify local costs and epidemiology. In settings with little capacity for up-front investment, same-day microscopy had the greatest impact on TB incidence and became cost-saving within 5 years if delivered at $10/test. With greater initial investment, population-level scale-up of Xpert MTB/RIF or microcolony-based culture often averted 10 times more TB cases than narrowly-targeted strategies, at minimal incremental long-term cost. Xpert for smear-positive TB had reasonable impact on MDR-TB incidence, but at substantial price and little impact on overall TB incidence and mortality. This user-friendly modeling framework improves decision-makers' ability to evaluate the local impact of TB diagnostic strategies. DOI: http://dx.doi.org/10.7554/eLife.02565.001 PMID:24898755

Impact of high resolution land surface initialization in Indian summer monsoon simulation using a regional climate model

NASA Astrophysics Data System (ADS)

Unnikrishnan, C. K.; Rajeevan, M.; Rao, S. Vijaya Bhaskara

2016-06-01

The direct impact of high resolution land surface initialization on the forecast bias in a regional climate model in recent years over Indian summer monsoon region is investigated. Two sets of regional climate model simulations are performed, one with a coarse resolution land surface initial conditions and second one used a high resolution land surface data for initial condition. The results show that all monsoon years respond differently to the high resolution land surface initialization. The drought monsoon year 2009 and extended break periods were more sensitive to the high resolution land surface initialization. These results suggest that the drought monsoon year predictions can be improved with high resolution land surface initialization. Result also shows that there are differences in the response to the land surface initialization within the monsoon season. Case studies of heat wave and a monsoon depression simulation show that, the model biases were also improved with high resolution land surface initialization. These results show the need for a better land surface initialization strategy in high resolution regional models for monsoon forecasting.

Strengthening the evidence and action on multi-sectoral partnerships in public health: an action research initiative

PubMed Central

Willis, C. D.; Greene, J. K.; Abramowicz, A.; Riley, B. L.

2016-01-01

Abstract Introduction: The Public Health Agency of Canada’s Multi-sectoral Partnerships Initiative, administered by the Centre for Chronic Disease Prevention (CCDP), brings together diverse partners to design, implement and advance innovative approaches for improving population health. This article describes the development and initial priorities of an action research project (a learning and improvement strategy) that aims to facilitate continuous improvement of the CCDP’s partnership initiative and contribute to the evidence on multi-sectoral partnerships. Methods: The learning and improvement strategy for the CCDP’s multi-sectoral partnership initiative was informed by (1) consultations with CCDP staff and senior management, and (2) a review of conceptual frameworks to do with multi-sectoral partnerships. Consultations explored the development of the multi-sectoral initiative, barriers and facilitators to success, and markers of effectiveness. Published and grey literature was reviewed using a systematic search strategy with findings synthesized using a narrative approach. Results: Consultations and the review highlighted the importance of understanding partnership impacts, developing a shared vision, implementing a shared measurement system and creating opportunities for knowledge exchange. With that in mind, we propose a six-component learning and improvement strategy that involves (1) prioritizing learning needs, (2) mapping needs to evidence, (3) using relevant data-collection methods, (4) analyzing and synthesizing data, (5) feeding data back to CCDP staff and teams and (6) taking action. Initial learning needs include investigating partnership reach and the unanticipated effects of multi-sectoral partnerships for individuals, groups, organizations or communities. Conclusion: While the CCDP is the primary audience for the learning and improvement strategy, it may prove useful for a range of audiences, including other government departments and external organizations interested in capturing and sharing new knowledge generated from multi-sectoral partnerships. PMID:27284702

The Manchester Fly Facility: Implementing an objective-driven long-term science communication initiative.

PubMed

Patel, Sanjai; Prokop, Andreas

2017-10-01

Science communication is increasingly important for scientists, although research, teaching and administration activities tend to eat up our time already, and budgets for science communication are usually low. It appears impossible to combine all these tasks and, in addition, to develop engagement activities to a quality and impact that would make the efforts worth their while. Here we argue that these challenges are easier addressed when centering science communication initiatives on a long-term vision with a view to eventually forming outreach networks where the load can be shared whilst being driven to higher momentum. As one example, we explain the science communication initiative of the Manchester Fly Facility. It aims to promote public awareness of research using the model organism Drosophila, which is a timely, economic and most efficient experimental strategy to drive discovery processes in the biomedical sciences and must have a firm place in the portfolios of funding organisations. Although this initiative by the Manchester Fly Facility is sustained on a low budget, its long-term vision has allowed gradual development into a multifaceted initiative: (1) targeting university students via resources and strategies for the advanced training in fly genetics; (2) targeting the general public via science fairs, educational YouTube videos, school visits, teacher seminars and the droso4schools project; (3) disseminating and marketing strategies and resources to the public as well as fellow scientists via dedicated websites, blogs, journal articles, conference presentations and workshops - with a view to gradually forming networks of drosophilists that will have a greater potential to drive the science communication objective to momentum and impact. Here we explain the rationales and implementation strategies for our various science communication activities - which are similarly applicable to other model animals and other areas of academic science - and share our experiences and resources to provide ideas and readily available means to those who are actively engaging or intend to do so. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Analysis of strategic plans to assess planning for sustainability of comprehensive community initiatives.

PubMed

Sridharan, Sanjeev; Go, Sodam; Zinzow, Heidi; Gray, Aracelis; Barrett, Melissa Gutierrez

2007-02-01

In order to achieve the intended impact on a community, comprehensive community initiatives must sustain programs once they have been implemented. However, planning for sustainability is challenging and is rarely incorporated in the planning process of an initiative. The current study examined 19 5-year plans developed during the planning phase of the Comprehensive Strategy for Serious, Violent and Chronic Juvenile Offenders. Quantitative and qualitative methods were employed to assess the extent to which the construct of sustainability was incorporated. The plan analysis was supplemented with results from other components of the complex evaluation design implemented as part of the process evaluation of Comprehensive Strategy. Results suggested that sustainability was not accounted for during the planning phase of this initiative. The implications of these findings, including the importance of planning for sustainability in order to achieve sustainability, are discussed.

Analysis of human resources for health strategies and policies in 5 countries in Sub-Saharan Africa, in response to GFATM and PEPFAR-funded HIV-activities.

PubMed

Cailhol, Johann; Craveiro, Isabel; Madede, Tavares; Makoa, Elsie; Mathole, Thubelihle; Parsons, Ann Neo; Van Leemput, Luc; Biesma, Regien; Brugha, Ruairi; Chilundo, Baltazar; Lehmann, Uta; Dussault, Gilles; Van Damme, Wim; Sanders, David

2013-10-25

Global Health Initiatives (GHIs), aiming at reducing the impact of specific diseases such as Human Immunodeficiency Virus (HIV), have flourished since 2000. Amongst these, PEPFAR and GFATM have provided a substantial amount of funding to countries affected by HIV, predominantly for delivery of antiretroviral therapy (ARV) and prevention strategies. Since the need for additional human resources for health (HRH) was not initially considered by GHIs, countries, to allow ARV scale-up, implemented short-term HRH strategies, adapted to GHI-funding conditionality. Such strategies differed from one country to another and slowly evolved to long-term HRH policies. The processes and content of HRH policy shifts in 5 countries in Sub-Saharan Africa were examined. A multi-country study was conducted from 2007 to 2011 in 5 countries (Angola, Burundi, Lesotho, Mozambique and South Africa), to assess the impact of GHIs on the health system, using a mixed methods design. This paper focuses on the impact of GFATM and PEPFAR on HRH policies. Qualitative data consisted of semi-structured interviews undertaken at national and sub-national levels and analysis of secondary data from national reports. Data were analysed in order to extract countries' responses to HRH challenges posed by implementation of HIV-related activities. Common themes across the 5 countries were selected and compared in light of each country context. In all countries successful ARV roll-out was observed, despite HRH shortages. This was a result of mostly short-term emergency response by GHI-funded Non-Governmental Organizations (NGOs) and to a lesser extent by governments, consisting of using and increasing available HRH for HIV tasks. As challenges and limits of short-term HRH strategies were revealed and HIV became a chronic disease, the 5 countries slowly implemented mid to long-term HRH strategies, such as formalisation of pilot initiatives, increase in HRH production and mitigation of internal migration of HRH, sometimes in collaboration with GHIs. Sustainable HRH strengthening is a complex process, depending mostly on HRH production and retention factors, these factors being country-specific. GHIs could assist in these strategies, provided that they are flexible enough to incorporate country-specific needs in terms of funding, that they coordinate at global-level and minimise conditionality for countries.

Analysis of human resources for health strategies and policies in 5 countries in Sub-Saharan Africa, in response to GFATM and PEPFAR-funded HIV-activities

PubMed Central

2013-01-01

Background Global Health Initiatives (GHIs), aiming at reducing the impact of specific diseases such as Human Immunodeficiency Virus (HIV), have flourished since 2000. Amongst these, PEPFAR and GFATM have provided a substantial amount of funding to countries affected by HIV, predominantly for delivery of antiretroviral therapy (ARV) and prevention strategies. Since the need for additional human resources for health (HRH) was not initially considered by GHIs, countries, to allow ARV scale-up, implemented short-term HRH strategies, adapted to GHI-funding conditionality. Such strategies differed from one country to another and slowly evolved to long-term HRH policies. The processes and content of HRH policy shifts in 5 countries in Sub-Saharan Africa were examined. Methods A multi-country study was conducted from 2007 to 2011 in 5 countries (Angola, Burundi, Lesotho, Mozambique and South Africa), to assess the impact of GHIs on the health system, using a mixed methods design. This paper focuses on the impact of GFATM and PEPFAR on HRH policies. Qualitative data consisted of semi-structured interviews undertaken at national and sub-national levels and analysis of secondary data from national reports. Data were analysed in order to extract countries’ responses to HRH challenges posed by implementation of HIV-related activities. Common themes across the 5 countries were selected and compared in light of each country context. Results In all countries successful ARV roll-out was observed, despite HRH shortages. This was a result of mostly short-term emergency response by GHI-funded Non-Governmental Organizations (NGOs) and to a lesser extent by governments, consisting of using and increasing available HRH for HIV tasks. As challenges and limits of short-term HRH strategies were revealed and HIV became a chronic disease, the 5 countries slowly implemented mid to long-term HRH strategies, such as formalisation of pilot initiatives, increase in HRH production and mitigation of internal migration of HRH, sometimes in collaboration with GHIs. Conclusion Sustainable HRH strengthening is a complex process, depending mostly on HRH production and retention factors, these factors being country-specific. GHIs could assist in these strategies, provided that they are flexible enough to incorporate country-specific needs in terms of funding, that they coordinate at global-level and minimise conditionality for countries. PMID:24160182

Quantifying immediate price impact of trades based on the k-shell decomposition of stock trading networks

NASA Astrophysics Data System (ADS)

Xie, Wen-Jie; Li, Ming-Xia; Xu, Hai-Chuan; Chen, Wei; Zhou, Wei-Xing; Stanley, H. Eugene

2016-10-01

Traders in a stock market exchange stock shares and form a stock trading network. Trades at different positions of the stock trading network may contain different information. We construct stock trading networks based on the limit order book data and classify traders into k classes using the k-shell decomposition method. We investigate the influences of trading behaviors on the price impact by comparing a closed national market (A-shares) with an international market (B-shares), individuals and institutions, partially filled and filled trades, buyer-initiated and seller-initiated trades, and trades at different positions of a trading network. Institutional traders professionally use some trading strategies to reduce the price impact and individuals at the same positions in the trading network have a higher price impact than institutions. We also find that trades in the core have higher price impacts than those in the peripheral shell.

Comparing methodologies to assess transportation and air quality impacts of Brownfields and infill development.

DOT National Transportation Integrated Search

2001-08-01

States and communities across the country are actively pursuing smart growth strategies. New transit : lines are opening to higher ridership than expected. States and communities have passed hundreds of : ballot initiatives preserving open space, inc...

'Too scary to think about': first time mothers' perceptions of the usefulness of antenatal breastfeeding education.

PubMed

Craig, Heather J; Dietsch, Elaine

2010-12-01

The purpose of this pilot study was to uncover the perceived usefulness of a contemporary antenatal education strategy for mother's experience of breastfeeding initiation. How useful do first time mothers perceive an antenatal education strategy to be for initiating breastfeeding? This was a simple descriptive pilot study with ten first time mothers as participants; all of whom were booked into an Australian private maternity unit for antenatal breastfeeding education, labour, birth and postpartum care. Semi-structured interviews were transcribed verbatim and thematically analysed. Antenatal education was beneficial for informing first time mothers of the practical skills required to positively initiate breastfeeding. However, this antenatal education strategy was not enough to reduce anxiety and foster the participants sense of self-confidence in their ability to breastfeed their newborns. Recommendations are made to focus antenatal breastfeeding strategies on first, a strength based model that builds confidence in women's ability to successfully breastfeed. Second, in the interests of fully informed consent, women are to be advised about the physiological connection between pregnancy, labour, birth and breastfeeding and the impact that interventions such as synthetic oxytocin, caesarean section and epidural anaesthesia are likely to have on the initiation of breastfeeding. Copyright © 2010 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

The role of evidence, standards and education in rock fishing safety in New South Wales, Australia.

PubMed

Mitchell, Rebecca J; Ware, Lauren; Bambach, Mike R

2014-12-01

To examine rock fishing-related fatalities and hospitalisations, identify initiatives aimed at improving safety and survey key rock fishing stakeholders about the strengths and limitations of each initiative. This research obtained information from mortality and hospitalisation statistics, the published literature and key stakeholders for opinions on the strengths, limitations and improvements for rock fishing safety initiatives. Injury patterns involving rock fishers have largely remained unchanged over time. The literature revealed that many rock fishing safety initiatives focused on awareness raising and engineering initiatives, but ignored the development of guidelines and the use of enforcement strategies. There had been limited evaluations conducted of any of the initiatives reviewed. It is likely that a combination of evidence-based, standard-focused and education initiatives would be useful in improving rock fishing safety in NSW, provided that the impact of these initiatives were routinely evaluated. Information from this research will be used to inform preventive strategies aimed at improving rock fishing safety through better coordination of the role of evidence in informing standards and practices and the continued evaluation of these initiatives. © 2014 Public Health Association of Australia.

Middle manager involvement in strategy development in not-for profit organizations: the director of nursing perspective--how organizational structure impacts on the role.

PubMed

Carney, M

2004-01-01

An attempt was made to link organizational structure and strategic management and, in the process, to identify how organizational structure impacts on the strategic management role of Directors of Nursing working in acute care hospitals in the Republic of Ireland. Directors of Nursing are recognized as holding a pivotal role in health care delivery. The need for their involvement in strategic management is acknowledged, yet it is not clear if this role is influenced by organizational structure. It is recognized that strategic involvement increases the likelihood that middle managers' initiatives will be in line with top management's concept of corporate strategy. The principal thesis is that organizational members will exercise a higher level of strategic consensus if they have been initially involved in the development of strategy. The study was undertaken in not-for-profit health service organizations, through a series of 25 semi-structured interviews with Directors of Nursing. The review of the literature was undertaken simultaneously with grounded theory analysis of the interviews. This research suggests that structure does impact on the role, conferring both positive benefits and negative consequences. Structure is identified in this study, in terms of organizational hierarchy, and the locus of control pertaining in each organization. Two predominating structure models are discussed and analysed.

Stakeholders' participatory diagnosis of climate change impacts on subsistence agriculture in Sikkim, India, for identifying adaptation strategies

NASA Astrophysics Data System (ADS)

Azhoni, A.; Goyal, M. K.

2017-12-01

Narrowing the gap between research, policy making and implementing adaptation remains a challenge in many parts of the world where climate change is likely to severely impact subsistence agriculture. This research aims to narrow this gap by matching the adaptation strategies being framed by policy makers and perspectives of consultants and researchers which are expected to be implemented by development agencies farmers in the state of Sikkim in India. Our case study examined the framing and implementation of State Action Plan on Climate Change through semi-structured interviews carried out with decision makers in the State Government, Scientific Organisations, consultants, local academia, implementing and development agencies, and farmers for whom the adaptation strategies are targeted. Using Social Network and Stakeholder Analysis approach, this research unravels the complexities of perceiving climate change impacts, identifying adaptation strategies, and implementing climate change adaptation strategies. While farmers are less aware about the global phenomenon of climate change impacts for their subsistence livelihood, their knowledge of the local conditions and their close interaction with the State Government Agriculture Department provides them an access to new and high value crops. Although important steps are initiated through the Sikkim State Action Plan on Climate Change it is yet to deliver effective means of adaptation implementation and identifying the networks of close coordination between the various implementing agencies will likely to pay rich dividends. While Sikkim being a small and hilly state with specific contextual challenges of climate change impacts, the results from this study highlights how the internal and external networks between various types of stakeholders informs decision makers in identifying local impacts of climate change and plan adaptation strategies.

Utilizing program evaluation as a strategy to promote community change: evaluation of a comprehensive, community-based, family violence initiative.

PubMed

Kaufman, Joy S; Crusto, Cindy A; Quan, Michael; Ross, Ellen; Friedman, Stacey R; O'Rielly, Kim; Call, Stephanie

2006-12-01

This paper describes the authors' work in a community that received Federal funding for an integrated system of care to reduce the impact and incidence of exposure to violence for children less than six years of age. The paper includes a review of the conceptual framework that guided the work of the authors and provides a brief overview of the issue of family violence, the impact of this violence on young children, and the Federal response to this issue. In addition, a description of the Initiative and the community in which it was based is provided along with some aspects of the evaluation plan. Finally, the authors discuss how their work with this Initiative depicts an approach to facilitating change within communities.

Sustained transfer of knowledge to practice in long-term care: facilitators and barriers of a mental health learning initiative.

PubMed

Stolee, Paul; McAiney, Carrie A; Hillier, Loretta M; Harris, Diane; Hamilton, Pam; Kessler, Linda; Madsen, Victoria; Le Clair, J Kenneth

2009-01-01

This article explores facilitators and barriers to the impact and sustainability of a learning initiative to increase capacity of long-term care (LTC) homes to manage the mental health needs of older persons, through development of in-house Psychogeriatric Resource Persons (PRPs). Twenty interviews were conducted with LTC staff. Management support, particularly designation of time for PRP activities, development of PRP teams, and supportive learning strategies were significant factors affecting sustained knowledge transfer. Continuing education that is provided and evaluated on an ongoing basis, secures management commitment, is integrated within a broader system strategy, and provides on-the-job support has the greatest potential to affect care.

Evaluating a policing strategy intended to disrupt an illicit street-level drug market.

PubMed

Corsaro, Nicholas; Brunson, Rod K; McGarrell, Edmund F

2010-12-01

The authors examined a strategic policing initiative that was implemented in a high crime Nashville, Tennessee neighborhood by utilizing a mixed-methodological evaluation approach in order to provide (a) a descriptive process assessment of program fidelity; (b) an interrupted time-series analysis relying upon generalized linear models; (c) in-depth resident interviews. Results revealed that the initiative corresponded with a statistically significant reduction in drug and narcotics incidents as well as perceived changes in neighborhood disorder within the target community. There was less-clear evidence, however, of a significant impact on other outcomes examined. The implications that an intensive crime prevention strategy corresponded with a reduction in specific forms of neighborhood crime illustrates the complex considerations that law enforcement officials face when deciding to implement this type of crime prevention initiative.

One carbon cycle: Impacts of model integration, ecosystem process detail, model resolution, and initialization data, on projections of future climate mitigation strategies

NASA Astrophysics Data System (ADS)

Fisk, J.; Hurtt, G. C.; le page, Y.; Patel, P. L.; Chini, L. P.; Sahajpal, R.; Dubayah, R.; Thomson, A. M.; Edmonds, J.; Janetos, A. C.

2013-12-01

Integrated assessment models (IAMs) simulate the interactions between human and natural systems at a global scale, representing a broad suite of phenomena across the global economy, energy system, land-use, and carbon cycling. Most proposed climate mitigation strategies rely on maintaining or enhancing the terrestrial carbon sink as a substantial contribution to restrain the concentration of greenhouse gases in the atmosphere, however most IAMs rely on simplified regional representations of terrestrial carbon dynamics. Our research aims to reduce uncertainties associated with forest modeling within integrated assessments, and to quantify the impacts of climate change on forest growth and productivity for integrated assessments of terrestrial carbon management. We developed the new Integrated Ecosystem Demography (iED) to increase terrestrial ecosystem process detail, resolution, and the utilization of remote sensing in integrated assessments. iED brings together state-of-the-art models of human society (GCAM), spatial land-use patterns (GLM) and terrestrial ecosystems (ED) in a fully coupled framework. The major innovative feature of iED is a consistent, process-based representation of ecosystem dynamics and carbon cycle throughout the human, terrestrial, land-use, and atmospheric components. One of the most challenging aspects of ecosystem modeling is to provide accurate initialization of land surface conditions to reflect non-equilibrium conditions, i.e., the actual successional state of the forest. As all plants in ED have an explicit height, it is one of the few ecosystem models that can be initialized directly with vegetation height data. Previous work has demonstrated that ecosystem model resolution and initialization data quality have a large effect on flux predictions at continental scales. Here we use a factorial modeling experiment to quantify the impacts of model integration, process detail, model resolution, and initialization data on projections of future climate mitigation strategies. We find substantial effects on key integrated assessment projections including the magnitude of emissions to mitigate, the economic value of ecosystem carbon storage, future land-use patterns, food prices and energy technology.

Assessing the impact of breeding strategies on inherited disorders and genetic diversity in dogs.

PubMed

Leroy, Grégoire; Rognon, Xavier

2012-12-01

In the context of management of genetic diversity and control of genetic disorders within dog breeds, a method is proposed for assessing the impact of different breeding strategies that takes into account the genealogical information specific to a given breed. Two types of strategies were investigated: (1) eradication of an identified monogenic recessive disorder, taking into account three different mating limitations and various initial allele frequencies; and (2) control of the population sire effect by limiting the number of offspring per reproducer. The method was tested on four dog breeds: Braque Saint Germain, Berger des Pyrénées, Coton de Tulear and Epagneul Breton. Breeding policies, such as the removal of all carriers from the reproduction pool, may have a range of effects on genetic diversity, depending on the breed and the frequency of deleterious alleles. Limiting the number of offspring per reproducer may also have a positive impact on genetic diversity. Copyright © 2012 Elsevier Ltd. All rights reserved.

Discrete homotopy analysis for optimal trading execution with nonlinear transient market impact

NASA Astrophysics Data System (ADS)

Curato, Gianbiagio; Gatheral, Jim; Lillo, Fabrizio

2016-10-01

Optimal execution in financial markets is the problem of how to trade a large quantity of shares incrementally in time in order to minimize the expected cost. In this paper, we study the problem of the optimal execution in the presence of nonlinear transient market impact. Mathematically such problem is equivalent to solve a strongly nonlinear integral equation, which in our model is a weakly singular Urysohn equation of the first kind. We propose an approach based on Homotopy Analysis Method (HAM), whereby a well behaved initial trading strategy is continuously deformed to lower the expected execution cost. Specifically, we propose a discrete version of the HAM, i.e. the DHAM approach, in order to use the method when the integrals to compute have no closed form solution. We find that the optimal solution is front loaded for concave instantaneous impact even when the investor is risk neutral. More important we find that the expected cost of the DHAM strategy is significantly smaller than the cost of conventional strategies.

Green supply chain management strategy selection using analytic network process: case study at PT XYZ

NASA Astrophysics Data System (ADS)

Adelina, W.; Kusumastuti, R. D.

2017-01-01

This study is about business strategy selection for green supply chain management (GSCM) for PT XYZ by using Analytic Network Process (ANP). GSCM is initiated as a response to reduce environmental impacts from industrial activities. The purposes of this study are identifying criteria and sub criteria in selecting GSCM Strategy, and analysing a suitable GSCM strategy for PT XYZ. This study proposes ANP network with 6 criteria and 29 sub criteria, which are obtained from the literature and experts’ judgements. One of the six criteria contains GSCM strategy options, namely risk-based strategy, efficiency-based strategy, innovation-based strategy, and closed loop strategy. ANP solves complex GSCM strategy-selection by using a more structured process and considering green perspectives from experts. The result indicates that innovation-based strategy is the most suitable green supply chain management strategy for PT XYZ.

Eating Disorders among Adolescents and How Educators Can Recognize Symptoms with Possible Strategies for Solutions

ERIC Educational Resources Information Center

Alexander, Kristina; Pohren, Philip

2008-01-01

Eating disorders are a problem that receives too little attention. These disorders have a great impact on student relationships, self-esteem, health, and achievement. Administrators and teacher leaders must take the initiative to think proactively and intervene.

Nursing clinical developments units--A strategy to promote the relationship between practice and academia.

PubMed

Happell, Brenda

2006-05-01

Bridging the theory-practice gap has historically been acknowledged as a priority for the nursing profession. Enhancing nurses' attitudes regarding the relevance of theory to practice has been considered as crucial in order that the relationship between theory and practice becomes strong and complimentary. A review of the literature suggests that strategies such as joint clinical and academic positions have not had a significant impact in this respect. Nursing Clinical Development Units (NCDUs) were introduced in the United Kingdom as an initiative to promote the recognition and utilisation of research findings as an inherent component of nursing practice. However, there is limited literature addressing the impact of NCDUs on relationships between academia and the clinical field. The aim of this paper is to present the findings of a qualitative evaluation conducted with participants (n=14) of an NCDU program in Victoria, Australia. The findings suggest that this initiative can significantly enhance relationships with, and attitudes towards, academia.

A decade of the Clinical Trials Transformation Initiative: What have we accomplished? What have we learned?

PubMed

Tenaerts, P; Madre, L; Landray, M

2018-02-01

The Clinical Trials Transformation Initiative reflects on 10 years of working to improve the quality and efficiency of clinical trials. This article highlights many of the Clinical Trials Transformation Initiative's accomplishments and offers examples of the impact that the Clinical Trials Transformation Initiative has had on the clinical trials enterprise. After conducting more than 25 projects and issuing recommendations for specific strategies to improve the design and execution of clinical trials, some common themes and lessons learned have emerged. Lessons include the importance of engaging many stakeholders, advanced planning to address critical issues, discontinuation of non-value added practices, and new opportunities presented by technology. Through its work, the Clinical Trials Transformation Initiative has also derived some operational best practices for conducting collaborative, multi-stakeholder projects covering project selection, project team dynamics and execution, and multi-stakeholder meetings and team discussions. Through these initiatives, the Clinical Trials Transformation Initiative has helped move the needle toward needed change in the clinical trials enterprise that has directly impacted stakeholders and patients alike.

Community based rehabilitation: a strategy for peace-building

PubMed Central

Boyce, William; Koros, Michael; Hodgson, Jennifer

2002-01-01

Background Certain features of peace-building distinguish it from peacekeeping, and make it an appropriate strategy in dealing with vertical conflict and low intensity conflict. However, some theorists suggest that attempts, through peace-building, to impose liberal values upon non-democratic cultures are misguided and lack an ethical basis. Discussion We have been investigating the peace-building properties of community based approaches to disability in a number of countries. This paper describes the practice and impact of peace-building through Community Based Rehabilitation (CBR) strategies in the context of armed conflict. The ethical basis for peace-building through practical community initiatives is explored. A number of benefits and challenges to using CBR strategies for peace-building purposes are identified. Summary During post-conflict reconstruction, disability is a powerful emotive lever that can be used to mobilize cooperation between factions. We suggest that civil society, in contrast to state-level intervention, has a valuable role in reducing the risks of conflict through community initiatives. PMID:12417012

Costs of Neisseria meningitidis Group A Disease and Economic Impact of Vaccination in Burkina Faso

PubMed Central

Colombini, Anaïs; Trotter, Caroline; Madrid, Yvette; Karachaliou, Andromachi; Preziosi, Marie-Pierre

2015-01-01

Background. Five years since the successful introduction of MenAfriVac in a mass vaccination campaign targeting 1- to 29-year-olds in Burkina Faso, consideration must be given to the optimal strategies for sustaining population protection. This study aims to estimate the economic impact of a range of vaccination strategies in Burkina Faso. Methods. We performed a cost-of-illness study, comparing different vaccination scenarios in terms of costs to both households and health systems over a 26-year time horizon. These scenarios are (1) reactive vaccination campaign (baseline comparator); (2) preventive vaccination campaign; (3) routine immunization at 9 months; and (4) a combination of routine and an initial catchup campaign of children under 5. Costs were estimated from a literature review, which included unpublished programmatic documents and peer-reviewed publications. The future disease burden for each vaccination strategy was predicted using a dynamic transmission model of group A Neisseria meningitidis. Results. From 2010 to 2014, the total costs associated with the preventive campaign targeting 1- to 29-year-olds with MenAfriVac were similar to the estimated costs of the reactive vaccination strategy (approximately 10 million US dollars [USD]). Between 2015 and 2035, routine immunization with or without a catch-up campaign of 1- to 4-year-olds is cost saving compared with the reactive strategy, both with and without discounting costs and cases. Most of the savings are accrued from lower costs of case management and household costs resulting from a lower burden of disease. After the initial investment in the preventive strategy, 1 USD invested in the routine strategy saves an additional 1.3 USD compared to the reactive strategy. Conclusions. Prevention strategies using MenAfriVac will be significantly cost saving in Burkina Faso, both for the health system and for households, compared with the reactive strategy. This will protect households from catastrophic expenditures and increase the development capacity of the population. PMID:26553677

The Evaluation of Post-Exposure Prophylaxis Models for Use in the Event of an Aerosolized Anthrax Attack

DTIC Science & Technology

2014-09-01

exercise conducted in the Chicago metropolitan area revealed that the initiation of PEP on Day 5 after an attack, as opposed to on Day 2, resulted in an...Scale Anthrax Attack on the Chicago Metropolitan Area: Impact of Timing and Surge Capacity,” Biosecurity and Bioterrorism: Biodefense Strategy, Practice... Chicago Metropolitan Area, also concluded that the optimal cost effective response strategy is to provide antibiotic prophylaxis and vaccination for all

Communities Coping with Change: A Conceptual Model

ERIC Educational Resources Information Center

Kelly, Gail J.; Steed, Lyndall G.

2004-01-01

Changing economic, political, environmental, and social conditions continue to have a cumulative impact on Australian regional communities, and in many instances, rural communities are being forced to initiate their own strategies in order to remain economically and socially viable. However, while communities respond in differing ways to similar…

Resource Sharing in Times of Retrenchment.

ERIC Educational Resources Information Center

Sloan, Bernard G.

1992-01-01

Discusses the impact of decreases in revenues on the resource-sharing activities of ILLINET Online and the Illinois Library Computer Systems Organization (ILCSO). Strategies for successfully coping with fiscal crises are suggested, including reducing levels of service and initiating user fees for interlibrary loans and faxing photocopied journal…

CAP--advancing the evaluation of preclinical Alzheimer disease treatments.

PubMed

Reiman, Eric M; Langbaum, Jessica B; Tariot, Pierre N; Lopera, Francisco; Bateman, Randall J; Morris, John C; Sperling, Reisa A; Aisen, Paul S; Roses, Allen D; Welsh-Bohmer, Kathleen A; Carrillo, Maria C; Weninger, Stacie

2016-01-01

If we are to find treatments to postpone, reduce the risk of, or completely prevent the clinical onset of Alzheimer disease (AD), we need faster methods to evaluate promising preclinical AD treatments, new ways to work together in support of common goals, and a determination to expedite the initiation and performance of preclinical AD trials. In this article, we note some of the current challenges, opportunities and emerging strategies in preclinical AD treatment. We describe the Collaboration for Alzheimer's Prevention (CAP)-a convening, harmonizing and consensus-building initiative to help stakeholders advance AD prevention research with rigour, care and maximal impact-and we demonstrate the impact of CAP on the goals and design of new preclinical AD trials.

Integrating patient and worker safety policies.

PubMed

Ormsby, Jason Derek

2013-01-01

Within the United States a number of federal and state legislative efforts, federal agency regulatory initiatives, and public/private policy efforts have attempted to improve patient safety or health care worker safety, but these initiatives have typically not been linked, in either conceptual development or implementation. Recently, policymakers and stakeholders have acknowledged that the two areas are inherently connected and that efforts to improve safety for frontline health care workers have not been adequately coordinated with initiatives addressing patient safety. Experts at prominent organizations recommend that subsequent discussions involve the integration of patient and worker safety advocates and strategies. This article was commissioned to stimulate discussion at a recent workshop in which nationally recognized patient and worker safety advocates participated in an open forum with discussion focused on policies impacting the U.S. hospital sector, resulting in an overall assessment of efforts in both areas and recommendations to integrate future policy strategies.

The Leadership Gap: Preparing Leaders for Urban Schools

ERIC Educational Resources Information Center

Lee, Omaira Z.

2010-01-01

The purpose of this mixed-methods, purposive case study was to investigate the impact of participation in the Metropolitan ISD Principal Coaching Initiative (MPCI) on leadership practice. The MPCI is a district-wide executive leadership capacity building strategy, which combines the District's standards-based leadership curriculum with a…

Student Retention in Higher Education: Some Conceptual and Programmatic Perspectives.

ERIC Educational Resources Information Center

Lang, Marvel

2002-01-01

Provides a review of conceptual perspectives on the salient issues affecting student retention in higher education generally, and minority student retention in particular, over the past few decades. Also summarizes programmatic strategies implemented at institutions as examples of student retention initiatives that have had significant impacts.…

The Impact of "Achievement for All" on School Leadership

ERIC Educational Resources Information Center

Blandford, Sonia

2013-01-01

The "Achievement for All" (AfA) pilot initiative, delivered in partnership by the Department for Education (DfE), (formerly the Department for Children, Schools and Families [DCSF]), National Strategies and the National College (NCSL), aims to increase the attainment and progress of children in schools with special educational needs and…

The Impact of Teacher Responsivity Education on Preschoolers' Language and Literacy Skills

ERIC Educational Resources Information Center

Cabell, Sonia Q.; Justice, Laura M.; Piasta, Shayne B.; Curenton, Stephanie M.; Wiggins, Alice; Turnbull, Khara Pence; Petscher, Yaacov

2011-01-01

Purpose: This study examined the extent to which teacher responsivity education affected preschoolers' language and literacy development over an academic year. Additional aims were to determine whether children's initial language abilities and teachers' use of responsivity strategies were associated with language outcomes, in particular. Method:…

Accommodating Mobile Learning in College Programs

ERIC Educational Resources Information Center

Alden, Jay

2013-01-01

Mobile devices and applications are expected to have a significant impact on teaching and learning in the near future. Yet colleges and universities are currently facing severe budget constraints and discretionary funding is restricted for new initiatives. The question addressed in this paper is: "What strategy should an institution of higher…

Automating the conflict resolution process

NASA Technical Reports Server (NTRS)

Wike, Jeffrey S.

1991-01-01

The purpose is to initiate a discussion of how the conflict resolution process at the Network Control Center can be made more efficient. Described here are how resource conflicts are currently resolved as well as the impacts of automating conflict resolution in the ATDRSS era. A variety of conflict resolution strategies are presented.

Strategies and Challenges in Ipad Initiative

ERIC Educational Resources Information Center

Chou, Chientzu Candace; Block, Lanise; Jesness, Renee

2014-01-01

This study examines the impact of iPad integration on teaching and learning activities in a large school district in Midwest United States. Forty social studies classrooms received iPad carts to engage students in learning. Teachers received professional development opportunities in the forms of workshops, conferences, one-to-one coaching, and…

Childhood Diabesity: International Applications for Health Education and Health Policy

ERIC Educational Resources Information Center

Pinzon-Perez, Helda; Kotkin-Jaszi, Suzanne; Perez, Miguel A.

2010-01-01

Health policy has a direct impact on health education initiatives, health care delivery, resource allocation, and quality of life. Increasing rates in the epidemics of obesity and obesity-dependent diabetes mellitus (aka diabesity) suggest that health policy changes should be included in health education and disease prevention strategies. Health…

Impact of the China Healthy Cities Initiative on Urban Environment.

PubMed

Yue, Dahai; Ruan, Shiman; Xu, Jin; Zhu, Weiming; Zhang, Luyu; Cheng, Gang; Meng, Qingyue

2017-04-01

The China Healthy Cities initiative, a nationwide public health campaign, has been implemented for 25 years. As "Healthy China 2030" becomes the key national strategy for improving population health, this initiative is an important component. However, the effects of the initiative have not been well studied. This paper aims to explore its impact on urban environment using a multiple time series design. We adopted a stratified and systematic sampling method to choose 15 China healthy cities across the country. For the selected healthy cities, 1:1 matched non-healthy cities were selected as the comparison group. We collected longitudinal data from 5 years before cities achieved the healthy city title up to 2012. We used hierarchical models to calculate difference-in-differences estimates for examining the impact of the initiative. We found that the China Healthy Cities initiative was associated with increases in the proportion of urban domestic sewage treated (32 percentage points), the proportion of urban domestic garbage treated (30 percentage points), and the proportion of qualified farmers' markets (40 percentage points), all of which are statistically significant (P < 0.05). No significant change was found for increases in green coverage of urban built-up area (5 percentage points), green space per capita (2 square meter), and days with Air Quality Index/Air Pollution Index ≤ 100 (25 days). In conclusion, the China Healthy Cities initiative was associated with significant improved urban environment in terms of infrastructure construction, yet had little impact on green space and air quality.

Increasing Communities Capacity to Effectively Address Climate Change Through Education, Civic Engagement and Workforce Development

NASA Astrophysics Data System (ADS)

Niepold, F., III; Ledley, T. S.; Stanton, C.; Fraser, J.; Scowcroft, G. A.

2017-12-01

Understanding the causes, effects, risks, and developing the social will and skills for responses to global change is a major challenge of the 21st century that requires coordinated contributions from the sciences, social sciences, humanities, arts, and beyond. There have been many effective efforts to implement climate change education, civic engagement and related workforce development programs focused on a multitude of audiences, topics and in multiple regions. This talk will focus on how comprehensive educational efforts across our communities are needed to support cities and their primary industries as they prepare for, and embrace, a low-carbon economy and develop the related workforce.While challenges still exist in identifying and coordinating all stakeholders, managing and leveraging resources, and resourcing and scaling effective programs to increase impact and reach, climate and energy literacy leaders have developed initiatives with broad input to identify the understandings and structures for climate literacy collective impact and to develop regional/metropolitan strategy that focuses its collective impact efforts on local climate issues, impacts and opportunities. This Climate Literacy initiative envisions education as a central strategy for community's civic actions in the coming decades by key leaders who have the potential to foster the effective and innovative strategies that will enable their communities to seize opportunity and prosperity in a post-carbon and resilient future. This talk discusses the advances and collaborations in the Climate Change Education community over the last decade by U.S. federal and non-profit organization that have been made possible through the partnerships of the Climate Literacy & Energy Awareness Network (CLEAN), U.S. National Science Foundation funded Climate Change Education Partnership (CCEP) Alliance, and the Tri-Agency Climate Change Education Collaborative.

The Impact of Implementation Fidelity on Mortality Under a CD4-Stratified Timing Strategy for Antiretroviral Therapy in Patients With Tuberculosis.

PubMed

Patel, Monita R; Westreich, Daniel; Yotebieng, Marcel; Nana, Mbonze; Eron, Joseph J; Behets, Frieda; Van Rie, Annelies

2015-05-01

Among patients with tuberculosis and human immunodeficiency virus type 1, CD4-stratified initiation of antiretroviral therapy (ART) is recommended, with earlier ART in those with low CD4 counts. However, the impact of implementation fidelity to this recommendation is unknown. We examined a prospective cohort study of 395 adult patients diagnosed with tuberculosis and human immunodeficiency virus between August 2007 and November 2009 in Kinshasa, Democratic Republic of the Congo. ART was to be initiated after 1 month of tuberculosis treatment at a CD4 count of <100 cells/mm(3) or World Health Organization stage 4 (other than extrapulmonary tuberculosis) and after 2 months of tuberculosis treatment at a CD4 count of 100-350 cells/mm(3). We used the parametric g-formula to estimate the impact of implementation fidelity on 6-month mortality. Observed implementation fidelity was low (46%); 54% of patients either experienced delays in ART initiation or did not initiate ART, which could be avoided under perfect implementation fidelity. The observed mortality risk was 12.0% (95% confidence interval (CI): 8.2, 15.7); under complete (counterfactual) implementation fidelity, the mortality risk was 7.8% (95% CI: 2.4, 12.3), corresponding to a risk reduction of 4.2% (95% CI: 0.3, 8.1) and a preventable fraction of 35.1% (95% CI: 2.9, 67.9). Strategies to achieve high implementation fidelity to CD4-stratified ART timing are needed to maximize survival benefit. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Arms control and The President's Strategic Defense Initiative

NASA Astrophysics Data System (ADS)

Bon, J. J.

1985-04-01

The President's Strategic Defense Initiative (SDI) provides the hope for eliminating the threat from ballistic missiles. This study evaluates the impact of SDI on existing and future arms control agreements. Because new or modified space-related treaties are a probable result of the SDI, this study concludes that the best single strategy for arms control negotiations is to preserve overall US interests and maintain open technological options vice severely limiting any space technology that might some day become part of a space-based defensive system.

Cost Minimization Analysis of Different Strategies of Management of Clinically Significant Scorpion Envenomation Among Pediatric Patients.

PubMed

Sinha, Madhumita; Quan, Dan; McDonald, Fred W; Valdez, André

2016-12-01

Scorpion antivenom was recently approved for use in patients with clinically significant scorpion envenomation in the United States; no formal economic analysis on its impact on cost of management has been performed. Three different strategies of management of scorpion envenomation with systemic neurotoxic symptoms in children were compared for cost minimization from a societal perspective. In strategy I, patients were managed with supportive care only without antivenom. In strategy II, an aggressive strategy of full-dose antivenom (initial dose of 3 vials with the use of additional vials administered 1 vial at a time) was considered. In strategy III, a single-vial serial antivenom dosing strategy titrated to clinical response was considered. Clinical probabilities for the different strategies were obtained from retrospective review of medical records of patients with scorpion envenomation over a 10-year period at our institution. Baseline cost values were obtained from patient reimbursement data from our institution. In baseline analysis, strategy I of supportive care only with no antivenom was least costly at US $3466.50/patient. Strategy III of single-vial serial dosing was intermediate but less expensive than strategy II of full-dose antivenom, with an incremental cost of US $3171.08 per patient. In a 1-way sensitivity analysis, at a threshold antivenom cost of US $1577.87, strategy III of single-vial serial dosing became the least costly strategy. For children with scorpion envenomation, use of a management strategy based on serial dosing of antivenom titrated to clinical response is less costly than a strategy of initial use of full-dose antivenom.

An Evidence-Based Review of Impacts, Strategies and Tools to Mitigate Urban Heat Islands

PubMed Central

Leal Filho, Walter; Echevarria Icaza, Leyre; Emanche, Victoria Omeche; Quasem Al-Amin, Abul

2017-01-01

The impacts of climate changes on cities, which are home to over half of the world’s population, are already being felt. In many cases, the intensive speed with which urban centres have been growing means that little attention has been paid to the role played by climatic factors in maintaining quality of life. Among the negative consequences of rapid city growth is the expansion of the problems posed by urban heat islands (UHIs), defined as areas in a city that are much warmer than other sites, especially in comparison with rural areas. This paper analyses the consistency of the UHI-related literature in three stages: first it outlines its characteristics and impacts in a wide variety of cities around the world, which poses pressures to public health in many different countries. Then it introduces strategies which may be employed in order to reduce its effects, and finally it analyses available tools to systematize the initial high level assessment of the phenomenon for multidisciplinary teams involved in the urban planning process. The analysis of literature on the characteristics, impacts, strategies and digital tools to assess on the UHI, reveals the wide variety of parameters, methods, tools and strategies analysed and suggested in the different studies, which does not always allow to compare or standardize the diagnosis or solutions. PMID:29257100

Theory-based evaluation of a comprehensive Latino education initiative: an interactive evaluation approach.

PubMed

Nesman, Teresa M; Batsche, Catherine; Hernandez, Mario

2007-08-01

Latino student access to higher education has received significant national attention in recent years. This article describes a theory-based evaluation approach used with ENLACE of Hillsborough, a 5-year project funded by the W.K. Kellogg Foundation for the purpose of increasing Latino student graduation from high school and college. Theory-based evaluation guided planning, implementation as well as evaluation through the process of developing consensus on the Latino population of focus, adoption of culturally appropriate principles and values to guide the project, and identification of strategies to reach, engage, and impact outcomes for Latino students and their families. The approach included interactive development of logic models that focused the scope of interventions and guided evaluation designs for addressing three stages of the initiative. Challenges and opportunities created by the approach are discussed, as well as ways in which the initiative impacted Latino students and collaborating educational institutions.

Assessing the Validity of Air Force Selection and Training Strategies.

ERIC Educational Resources Information Center

Mumford, Michael D.; And Others

A study was undertaken to develop a system for predicting the impact of adjustments in aptitude requirements on outcomes (performance) in Air Force basic resident technical training. To accomplish this, a multivariate modeling approach was used. Initially, interviews were constructed within a variety of technical training programs to specify the…

School Connectedness: Strategies for Increasing Protective Factors among Youth

ERIC Educational Resources Information Center

Centers for Disease Control and Prevention, 2009

2009-01-01

Efforts to improve child and adolescent health typically have featured interventions designed to address specific health risk behaviors, such as tobacco use, alcohol and drug use, violence, gang involvement, and early sexual initiation. However, results from a growing number of studies suggest that greater health impact might be achieved by also…

School Mental Health: The Impact of State and Local Capacity-Building Training

ERIC Educational Resources Information Center

Stephan, Sharon; Paternite, Carl; Grimm, Lindsey; Hurwitz, Laura

2014-01-01

Despite a growing number of collaborative partnerships between schools and community-based organizations to expand school mental health (SMH) service capacity in the United States, there have been relatively few systematic initiatives focused on key strategies for large-scale SMH capacity building with state and local education systems. Based on a…

Forging New Pathways: The Impact of the Breaking through Initiative in Michigan

ERIC Educational Resources Information Center

Schanker, Jennifer B.; Taylor, Judith C.

2012-01-01

The Michigan Center for Student Success commissioned this study to determine whether strategies employed to improve adult students' success at 41 Breaking Through colleges nationwide have taken root at Michigan's original colleges and spread beyond them. A statewide survey revisited four of the colleges profiled in previous publications, and the…

Monitoring hemlock woolly adelgid and assessing its impacts in the Delaware River Basin

Treesearch

David W. Williams; Michael E. Montgomery; Kathleen S. Shields

2002-01-01

The Collaborative Environmental Monitoring and Research Initiative (CEMRI) was established recently to test strategies for multi-agency collaboration in environmental monitoring (Murdoch and Jenkins 2002). Participating agencies include the U.S. Geological Survey (USGS), USDA Forest Service, National Park Service, National Aeronautics and Space Administration, and U.S...

Success of Underrepresented Nursing Students at Selected Southwest Institutions: Impact of a Nursing Retention Program

ERIC Educational Resources Information Center

Khattab, Ibrahim

2011-01-01

This study examined retention initiatives and strategies provided to underserved students in the nursing programs at three community colleges in the Southwest region. This research addressed nursing student retention, as well as ways to increase retention among underrepresented populations in the three community colleges, representing a unique…

Communication Audits and the Effects of Increased Information: A Follow-up Study.

ERIC Educational Resources Information Center

Hargie, Owen; Tourish, Dennis; Wilson, Noel

2002-01-01

Considers how communication audits are typically presented as one-shot events, whose impact is not measured. Employs a follow-up audit to track the effects of an initial audit upon a major health care organization. Illustrates how the audit can play a useful role in an organization's communication strategy. (SG)

"We Think That's the Future": Curriculum Reform Initiatives in Higher Education

ERIC Educational Resources Information Center

Pegg, Ann

2014-01-01

This international research considered two key questions: (1) What self-scrutiny, strategies, planning and processes do universities with a successfully reformed curriculum undertake?; and (2) How do these universities measure and evaluate the impact of whole curriculum reform in relation to learning and teaching and the student experience?…

Impact Measures for a Marketing Intervention Strategy at a Two-Year College.

ERIC Educational Resources Information Center

Donsky, Aaron P.; And Others

In fall 1983, Dutchess Community College (DCC), Poughkeepsie, New York, implemented a strategic planning process which ultimately resulted in the development of short- and long-range marketing plans. The initial marketing approach began in spring 1985 and was directed toward a pilot project to affect summer 1985 enrollments utilizing a market…

Recent Advances in Chemotherapy and Surgery for Colorectal Liver Metastases

PubMed Central

Passot, Guillaume; Soubrane, Olivier; Giuliante, Felice; Zimmitti, Giuseppe; Goéré, Diane; Yamashita, Suguru; Vauthey, Jean-Nicolas

2016-01-01

Background The liver is the most common site of metastases for colorectal cancer, and combined resection with systemic chemotherapy is the most effective strategy for survival. The aim of this article is to provide a comprehensive summary on four hot topics related to chemotherapy and surgery for colorectal liver metastases (CLM), namely: (1) chemotherapy-related liver injuries: prediction and impact, (2) surgery for initially unresectable CLM, (3) the emerging role of RAS mutations, and (4) the role of hepatic arterial infusion of chemotherapy (HAIC). Summary and Key Messages (1) The use of chemotherapy before liver resection for CLM leads to drug-specific hepatic toxicity, which negatively impacts posthepatectomy outcomes. (2) Curative liver resection of initially unresectable CLM following conversion chemotherapy should be attempted whenever possible, provided that a safe future liver remnant volume is achieved. (3) For CLM, RAS mutation status is needed to guide the use of targeted chemotherapy with anti-epithelial growth factor receptor (EGFR) agents, and is a major prognostic factor that may contribute to optimize surgical strategy. (4) HAIC agents increase the rate of objective response and the rate of complete pathological response. PMID:27995091

Recent Advances in Chemotherapy and Surgery for Colorectal Liver Metastases.

PubMed

Passot, Guillaume; Soubrane, Olivier; Giuliante, Felice; Zimmitti, Giuseppe; Goéré, Diane; Yamashita, Suguru; Vauthey, Jean-Nicolas

2016-11-01

The liver is the most common site of metastases for colorectal cancer, and combined resection with systemic chemotherapy is the most effective strategy for survival. The aim of this article is to provide a comprehensive summary on four hot topics related to chemotherapy and surgery for colorectal liver metastases (CLM), namely: (1) chemotherapy-related liver injuries: prediction and impact, (2) surgery for initially unresectable CLM, (3) the emerging role of RAS mutations, and (4) the role of hepatic arterial infusion of chemotherapy (HAIC). (1) The use of chemotherapy before liver resection for CLM leads to drug-specific hepatic toxicity, which negatively impacts posthepatectomy outcomes. (2) Curative liver resection of initially unresectable CLM following conversion chemotherapy should be attempted whenever possible, provided that a safe future liver remnant volume is achieved. (3) For CLM, RAS mutation status is needed to guide the use of targeted chemotherapy with anti-epithelial growth factor receptor (EGFR) agents, and is a major prognostic factor that may contribute to optimize surgical strategy. (4) HAIC agents increase the rate of objective response and the rate of complete pathological response.

National strategy for suicide prevention in Japan: impact of a national fund on progress of developing systems for suicide prevention and implementing initiatives among local authorities.

PubMed

Nakanishi, Miharu; Yamauchi, Takashi; Takeshima, Tadashi

2015-01-01

In Japan, the Cabinet Office released the 'General Principles of Suicide Prevention Policy' in 2007 and suggested nine initiatives. In 2009, a national fund was launched to help prefectures (the administrative divisions of Japan) and local authorities implement five categories of suicide-prevention programs. This paper examines the impact of the national fund on the establishment of the systems for suicide prevention and the implementation of these initiatives among local authorities. The present study included 1385 local authorities (79.5%) from all 47 prefectures that responded to the cross-sectional questionnaire survey. Improved suicide-prevention systems and the implementation of nine initiatives in April 2013 were observed among 265 local authorities (19.1%) that implemented 'Training of community service providers' and 'Public awareness campaigns'; 178 local authorities (12.9%) that implemented 'Face-to-face counseling', 'Training of community service providers' and 'Public awareness campaigns'; and 324 local authorities (23.4%) that implemented 'Trauma-informed policies and practices'. There was no significant difference in suicide-prevention systems and the implementation of nine initiatives between 203 local authorities (14.7%) that implemented only 'Public awareness campaigns' and 231 local authorities (16.7%) that did not implement any suicide-prevention programs. The results of our study suggest that the national fund promoted the establishment of community systems for suicide prevention and helped implement initiatives among local authorities. The national suicide-prevention strategy in Japan should explore a standard package of programs to guide community suicide-prevention efforts with a sustained workforce among local authorities. © 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.

Evaluating landfill aftercare strategies: A life cycle assessment approach.

PubMed

Turner, David A; Beaven, Richard P; Woodman, Nick D

2017-05-01

This study investigates the potential impacts caused by the loss of active environmental control measures during the aftercare period of landfill management. A combined mechanistic solute flow model and life cycle assessment (LCA) approach was used to evaluate the potential impacts of leachate emissions over a 10,000year time horizon. A continuum of control loss possibilities occurring at different times and for different durations were investigated for four different basic aftercare scenarios, including a typical aftercare scenario involving a low permeability cap and three accelerated aftercare scenarios involving higher initial infiltration rates. Assuming a 'best case' where control is never lost, the largest potential impacts resulted from the typical aftercare scenario. The maximum difference between potential impacts from the 'best case' and the 'worst case', where control fails at the earliest possible point and is never reinstated, was only a fourfold increase. This highlights potential deficiencies in standard life cycle impact assessment practice, which are discussed. Nevertheless, the results show how the influence of active control loss on the potential impacts of landfilling varies considerably depending on the aftercare strategy used and highlight the importance that leachate treatment efficiencies have upon impacts. Copyright © 2016 Elsevier Ltd. All rights reserved.

Assessing the Impact of a Focused Deterrence Strategy to Combat Intimate Partner Domestic Violence.

PubMed

Sechrist, Stacy M; Weil, John D

2018-03-01

The Offender Focused Domestic Violence Initiative (OFDVI) represents for the first time anywhere the application of the evidence-based focused deterrence policing approach to combat intimate partner domestic violence (IPDV). Through holding offenders accountable, the strategy has resulted in 20% reductions each in IPDV-related calls for police service and arrests. Victim injuries have been significantly reduced and the 1-year IPDV offender recidivism rate is about 16-17%. The backbone of the OFDVI strategy is the multidisciplinary collaboration of law enforcement and community partners which has resulted in identification and resolving system issues which have historically allowed offenders to repeat IPDV without consequence.

Implementing Health Impact Assessment Programs in State Health Agencies: Lessons Learned From Pilot Programs, 2009-2011.

PubMed

Goff, Nancy; Wyss, Kerry; Wendel, Arthur; Jarris, Paul

2016-01-01

Health Impact Assessment (HIA) has emerged as a promising tool to integrate health considerations into decision making. The growth and success of HIA practice in the United States will be dependent on building the capacity of practitioners. This article seeks to identify the role of state health agencies (SHAs) in building capacity for conducting HIAs and the key components of initiatives that produced effective HIAs and HIA programs. The authors proposed to answer 3 research questions: (1) What can be the role of the SHA in HIA? (2) What are the characteristics of successful state HIA programs? and (3) What are some effective strategies for building capacity for HIA in SHAs and local health departments? The authors reviewed program reports from the ASTHO's pilot state health agencies (California, Minnesota, Oregon, and Wisconsin) that, between 2009 and 2011, created HIA programs to provide HIA training, conduct HIAs, and build practitioner networks. Program reports were examined for shared themes on the role of SHAs in a statewide HIA initiative, the characteristics of successful programs, and effective strategies for building capacity. Despite differences among the programs, many shared themes existed. These include stressing the importance of a basic, sustained infrastructure for HIA practice; leveraging existing programs and networks; and working in partnership with diverse stakeholders. SHAs can build capacity for HIA, and SHAs can both lead and support the completion of individual HIAs. States and territories interested in starting comprehensive statewide HIA initiatives could consider implementing the strategies identified by the pilot programs.

Space station crew safety alternatives study. Volume 3: Safety impact of human factors

NASA Technical Reports Server (NTRS)

Rockoff, L. A.; Raasch, R. F.; Peercy, R. L., Jr.

1985-01-01

The first 15 years of accumulated space station concepts for Initial Operational Capability (IOC) during the early 1990's was considered. Twenty-five threats to the space station are identified and selected threats addressed as impacting safety criteria, escape and rescue, and human factors safety concerns. Of the 25 threats identified, eight are discussed including strategy options for threat control: fire, biological or toxic contamination, injury/illness, explosion, loss of pressurization, radiation, meteoroid penetration and debris. Of particular interest here is volume three (of five volumes) pertaining to the safety impact of human factors.

Targeted vs. systematic early antiviral treatment against A(H1N1)v influenza with neuraminidase inhibitors in patients with influenza-like symptoms: Clinical and economic impact

PubMed Central

Deuffic-Burban, Sylvie; Lenne, Xavier; Dervaux, Benoit; Julien Poissy; Lemaire, Xavier; Sloan, Caroline; Carrat, Fabrice; Desenclos, Jean-Claude; Delfraissy, Jean-Francois; Yazdanpanah, Yazdan

2009-01-01

Capitalizing on available data, we used a decision model to estimate the clinical and economic outcomes associated with early initiation of treatment with neuraminidase inhibitors in all patients with influenza-like illnesses ( ILI ) (systematic strategy) vs. only those at high risk of complications (targeted strategy). Systematic treatment of ILI during an A(H1N1)v influenza epidemic wave is both effective and cost-effective. Patients who present to care with ILI during an A(H1N1)v influenza epidemic wave should initiate treatment with neuraminidase inhibitors, regardless of risk status. Administering neuraminidase inhibitors between epidemic waves, when the probability of influenza is low, is less effective and cost-effective. PMID:20029659

Emerging Forms of Climate Protection Governance: Urban Initiatives in the European Union

NASA Astrophysics Data System (ADS)

Rosenthal, J. K.; Brunner, E.

2006-12-01

Changes in climate patterns are expected to pose increasing challenges for cities in the following decades, with adverse impacts on urban populations currently stressed by poverty, health and economic inequities. Simultaneously, a strong global trend towards urbanization of poverty exists, with increased challenges for local governments to protect and sustain the well-being of growing cities. In the context of these two overarching trends, interdisciplinary research at the city scale is prioritized for understanding the social impacts of climate change and variability and for the evaluation of strategies in the built environment that might serve as adaptive and mitigative responses to climate change. Urban managers, and transnational networks of municipalities and non-state actors, have taken an increasingly active role in climate protection, through research, policies, programs and agreements on adaptation and mitigation strategies. Concerns for urban impacts of climate change include the potential increase in frequency and intensity of damaging extreme weather events, such as heat waves, hurricanes, heavy rainfall or drought, and coastal flooding and erosion, and potentially adverse impacts on infrastructure, energy systems, and public health. Higher average summertime temperatures in temperate zone cities are also associated with environmental and public health liabilities such as decreased air quality and increased peak electrical demand. We review municipal climate protection programs, generally categorized as approaches based on technological innovation (e.g., new materials); changes in behavior and public education (e.g., use of cooling centers); and improvements in urban design (e.g., zoning for mixed land-use; the use of water, vegetation and plazas to reduce the urban heat island effect). Climate protection initiatives in three European cities are assessed within the context of the global collective efforts enacted by the Kyoto Protocol and United Nations Framework Convention on Climate Change. Initiatives in Stockholm, London and Milan provide evidence that local actions are inevitable and of central importance to mitigate and adapt to the adverse impacts of climate change, the urban heat island effect, and extreme weather events.

Coping Strategies Used by School Staff After a Crisis: A Research Note

PubMed Central

Cole, Rachel; Jones, Dan; Shah, Sonia

2013-01-01

There is much literature on crisis support in schools but little on how school staff are affected. This research had two aims: to begin to explore the coping strategies used by school staff after a crisis event, and to investigate measures that might prove valuable for future research. Seven cases are presented using three measures: the WHO (Five) Wellbeing Index, the Impact of Event Scale–Revised, and the Ways of Coping–Revised. Results from this initial study show great variation in the range of responses reported by teachers. PMID:25170309

Stigmatising feelings and disclosure apprehension among children with epilepsy.

PubMed

Lambert, Veronica; Gallagher, Pamela; O'Toole, Stephanie; Benson, Ailbhe

2014-07-01

Despite worldwide campaigns to enhance public awareness, understanding and acceptability of epilepsy, stigmatising feelings remain among children with epilepsy and their families. Stigma can be internally felt by the child (shame and embarrassment) or enacted by others (discrimination). Many children with epilepsy and their parents fear disclosure of the condition and exercise a variety of disclosure or concealment strategies. Maintaining these strategies can have a negative, stressful impact on the child's social and psychosocial development and quality of life. Continuing dialogue among families, friends, teachers and health professionals should be initiated and supported.

Protocol for project IMPACT (improving millions hearts for provider and community transformation): a quasi-experimental evaluation of an integrated electronic health record and community health worker intervention study to improve hypertension management among South Asian patients.

PubMed

Lopez, Priscilla M; Zanowiak, Jennifer; Goldfeld, Keith; Wyka, Katarzyna; Masoud, Ahmad; Beane, Susan; Kumar, Rashi; Laughlin, Phoebe; Trinh-Shevrin, Chau; Thorpe, Lorna; Islam, Nadia

2017-12-06

The Million Hearts® initiative aims to prevent heart disease and stroke in the United States by mobilizing public and private sectors around a core set of objectives, with particular attention on improving blood pressure control. South Asians in particular have disproportionately high rates of hypertension and face numerous cultural, linguistic, and social barriers to accessing healthcare. Interventions utilizing Health information technology (HIT) and community health worker (CHW)-led patient coaching have each been demonstrated to be effective at advancing Million Hearts® goals, yet few studies have investigated the potential impact of integrating these strategies into a clinical-community linkage initiative. Building upon this initiative, we present the protocol and preliminary results of a research study, Project IMPACT, designed to fill this gap in knowledge. Project IMPACT is a stepped wedge quasi-experimental study designed to test the feasibility, adoption, and impact of integrating CHW-led health coaching with electronic health record (EHR)-based interventions to improve hypertension control among South Asian patients in New York City primary care practices. EHR intervention components include the training and implementation of hypertension-specific registry reports, alerts, and order sets. Fidelity to the EHR intervention is assessed by collecting the type, frequency, and utilization of intervention components for each practice. CHW intervention components consist of health coaching sessions on hypertension and related risk factors for uncontrolled hypertensive patients. The outcome, hypertension control (<140 mmHg systolic blood pressure (BP) and <90 mmHg diastolic BP), is collected at the aggregate- and individual-level for all 16 clinical practices enrolled. Project IMPACT builds upon the evidence base of the effectiveness of CHW and Million Hearts® initiatives and proposes a unique integration of provider-based EHR and community-based CHW interventions. The project informs the effectiveness of these interventions in team-based care approaches, thereby, helping to develop relevant sustainability strategies for improving hypertension control among targeted racial/ethnic minority populations at small primary care practices. This study protocol has been approved and is made available on Clinicaltrials.gov by NCT03159533 as of May 17, 2017.

Using stochastic epidemiological models to evaluate conservation strategies for endangered amphibians

PubMed Central

Griesemer, Marc; Petzold, Linda R.; Briggs, Cheryl J.

2017-01-01

Recent outbreaks of chytridiomycosis, the disease of amphibians caused by the fungal pathogen Batrachochytrium dendrobatidis (Bd), have contributed to population declines of numerous amphibian species worldwide. The devastating impacts of this disease have led researchers to attempt drastic conservation measures to prevent further extinctions and loss of biodiversity. The conservation measures can be labour-intensive or expensive, and in many cases have been unsuccessful. We developed a mathematical model of Bd outbreaks that includes the effects of demographic stochasticity and within-host fungal load dynamics. We investigated the impacts of one-time treatment conservation strategies during the disease outbreak that occurs following the initial arrival of Bd into a previously uninfected frog population. We found that for all versions of the model, for a large fraction of parameter space, none of the one-time treatment strategies are effective at preventing disease-induced extinction of the amphibian population. Of the strategies considered, treating frogs with antifungal agents to reduce their fungal load had the greatest likelihood of a beneficial outcome and the lowest risk of decreasing the persistence of the frog population, suggesting that this disease mitigation strategy should be prioritized over disinfecting the environment or reducing host density. PMID:28855388

A work observation study of nuclear medicine technologists: interruptions, resilience and implications for patient safety

PubMed Central

Larcos, George; Prgomet, Mirela; Georgiou, Andrew; Westbrook, Johanna

2017-01-01

Background Errors by nuclear medicine technologists during the preparation of radiopharmaceuticals or at other times can cause patient harm and may reflect the impact of interruptions, busy work environments and deficient systems or processes. We aimed to: (a) characterise the rate and nature of interruptions technologists experience and (b) identify strategies that support safety. Methods We performed 100 hours of observation of 11 technologists at a major public hospital and measured the proportions of time spent in eight categories of work tasks, location of task, interruption rate and type and multitasking (tasks conducted in parallel). We catalogued specific safety-oriented strategies used by technologists. Results Technologists completed 5227 tasks and experienced 569 interruptions (mean, 4.5 times per hour; 95% CI 4.1 to 4.9). The highest interruption rate occurred when technologists were in transit between rooms (10.3 per hour (95% CI 8.3 to 12.5)). Interruptions during radiopharmaceutical preparation occurred a mean of 4.4 times per hour (95% CI 3.3 to 5.6). Most (n=426) tasks were interrupted once only and all tasks were resumed after interruption. Multitasking occurred 16.6% of the time. At least some interruptions were initiated by other technologists to convey important information and/or to render assistance. Technologists employed a variety of verbal and non-verbal strategies in all work areas (notably in the hot-lab) to minimise the impact of interruptions and optimise the safe conduct of procedures. Although most were due to individual choices, some strategies reflected overt or subliminal departmental policy. Conclusions Some interruptions appear beneficial. Technologists' self-initiated strategies to support safe work practices appear to be an important element in supporting a resilient work environment in nuclear medicine. PMID:27707869

Impact of systematic HIV testing on case finding and retention in care at a primary care clinic in South Africa.

PubMed

Clouse, Kate; Hanrahan, Colleen F; Bassett, Jean; Fox, Matthew P; Sanne, Ian; Van Rie, Annelies

2014-12-01

Systematic, opt-out HIV counselling and testing (HCT) may diagnose individuals at lower levels of immunodeficiency but may impact loss to follow-up (LTFU) if healthier people are less motivated to engage and remain in HIV care. We explored LTFU and patient clinical outcomes under two different HIV testing strategies. We compared patient characteristics and retention in care between adults newly diagnosed with HIV by either voluntary counselling and testing (VCT) plus targeted provider-initiated counselling and testing (PITC) or systematic HCT at a primary care clinic in Johannesburg, South Africa. One thousand one hundred and forty-four adults were newly diagnosed by VCT/PITC and 1124 by systematic HCT. Two-thirds of diagnoses were in women. Median CD4 count at HIV diagnosis (251 vs. 264 cells/μl, P = 0.19) and proportion of individuals eligible for antiretroviral therapy (ART) (67.2% vs. 66.7%, P = 0.80) did not differ by HCT strategy. Within 1 year of HIV diagnosis, half were LTFU: 50.5% under VCT/PITC and 49.6% under systematic HCT (P = 0.64). The overall hazard of LTFU was not affected by testing policy (aHR 0.98, 95%CI: 0.87-1.10). Independent of HCT strategy, males, younger adults and those ineligible for ART were at higher risk of LTFU. Implementation of systematic HCT did not increase baseline CD4 count. Overall retention in the first year after HIV diagnosis was low (37.9%), especially among those ineligible for ART, but did not differ by testing strategy. Expansion of HIV testing should coincide with effective strategies to increase retention in care, especially among those not yet eligible for ART at initial diagnosis. © 2014 John Wiley & Sons Ltd.

Contraceptive care of adolescents: overview, tips, strategies, and implications for school nurses.

PubMed

Gabzdyl, Elizabeth Mary

2010-08-01

The United States has one of the highest unintended pregnancy rates of all industrialized nations in the world, with 13% of those occurring among the adolescent population. In 2005, the adolescent birthrate in the United States was 40.5 per 1,000 women and increased 3% in 2006 (Martin et al., 2009). Unintended pregnancy and motherhood can have a tremendous impact and lifelong implications for adolescents and their children as well as financial and societal costs. Helping make contraception accessible to adolescents is one area where school nurses are able to have an impact. Various contraceptive methods are described. Advantages and disadvantages are summarized along with considerations relative to adolescents. General strategies for counseling and caring for adolescents to encourage successful initiation, use, and continuation of contraception also reviewed.

Maximizing cost-effectiveness by adjusting treatment strategy according to glaucoma severity

PubMed Central

Guedes, Ricardo Augusto Paletta; Guedes, Vanessa Maria Paletta; Gomes, Carlos Eduardo de Mello; Chaoubah, Alfredo

2016-01-01

Abstract Background: The aim of this study is to determine the most cost-effective strategy for the treatment of primary open-angle glaucoma (POAG) in Brazil, from the payer's perspective (Brazilian Public Health System) in the setting of the Glaucoma Referral Centers. Methods: Study design was a cost-effectiveness analysis of different treatment strategies for POAG. We developed 3 Markov models (one for each glaucoma stage: early, moderate and advanced), using a hypothetical cohort of POAG patients, from the perspective of the Brazilian Public Health System (SUS) and a horizon of the average life expectancy of the Brazilian population. Different strategies were tested according to disease severity. For early glaucoma, we compared observation, laser and medications. For moderate glaucoma, medications, laser and surgery. For advanced glaucoma, medications and surgery. Main outcome measures were ICER (incremental cost-effectiveness ratio), medical direct costs and QALY (quality-adjusted life year). Results: In early glaucoma, both laser and medical treatment were cost-effective (ICERs of initial laser and initial medical treatment over observation only, were R$ 2,811.39/QALY and R$ 3,450.47/QALY). Compared to observation strategy, the two alternatives have provided significant gains in quality of life. In moderate glaucoma population, medical treatment presented the highest costs among treatment strategies. Both laser and surgery were highly cost-effective in this group. For advanced glaucoma, both tested strategies were cost-effective. Starting age had a great impact on results in all studied groups. Initiating glaucoma therapy using laser or surgery were more cost-effective, the younger the patient. Conclusion: All tested treatment strategies for glaucoma provided real gains in quality of life and were cost-effective. However, according to the disease severity, not all strategies provided the same cost-effectiveness profile. Based on our findings, there should be a preferred strategy for each glaucoma stage, according to a cost-effectiveness ratio ranking. PMID:28033286

Diagnosing climate change impacts and identifying adaptation strategies by involving key stakeholder organisations and farmers in Sikkim, India: Challenges and opportunities.

PubMed

Azhoni, Adani; Goyal, Manish Kumar

2018-06-01

Narrowing the gap between research, policy making and implementing adaptation remains a challenge in many parts of the world where climate change is likely to severely impact water security. This research aims to narrow this gap by matching the adaptation strategies being framed by policy makers to that of the perspectives of development agencies, researchers and farmers in the Himalayan state of Sikkim in India. Our case study examined the perspectives of various stakeholders for climate change impacts, current adaptation strategies, knowledge gaps and adaptation barriers, particularly in the context of implementing the Sikkim State Action Plan on Climate Change through semi-structured interviews carried out with decision makers in the Sikkim State Government, researchers, consultants, local academia, development agencies and farmers. Using Stakeholders Network Analysis tools, this research unravels the complexities of perceiving climate change impacts, identifying strategies, and implementing adaptation. While farmers are less aware about the global phenomenon of climate change impacts for water security, their knowledge of the local conditions and their close interaction with the State Government Agriculture Department provides them opportunities. Although important steps are being initiated through the Sikkim State Action Plan on Climate Change it is yet to deliver effective means of adaptation implementation and hence, strengthening the networks of close coordination between the various implementing agencies will pay dividends. Knowledge gaps and the need for capacity building identified in this research, based on the understandings of key stakeholders are highly relevant to both the research community and for informing policy. Copyright © 2018 Elsevier B.V. All rights reserved.

Guidebook for analysis of tether applications

NASA Technical Reports Server (NTRS)

Carroll, J. A.

1985-01-01

This guidebook is intended as a tool to facilitate initial analyses of proposed tether applications in space. Topics disscussed include: orbit and orbit transfer equations; orbital perturbations; aerodynamic drag; thermal balance; micrometeoroids; gravity gradient effects; tether control strategies; momentum transfer; orbit transfer by tethered release/rendezvous; impact hazards for tethers; electrodynamic tether principles; and electrodynamic libration control issues.

A Longitudinal Assessment of an Initial Cohort in a Psychology Learning Community

ERIC Educational Resources Information Center

Buch, Kim; Spaulding, Sue

2008-01-01

Discipline-based learning communities have become a popular strategy for improving student performance and satisfaction. This article describes the goals and features of a university-based, first-year psychology learning community (PLC) implemented in Fall 2003. We also report the results of a longitudinal assessment of the impact of the PLC on…

Forging New Pathways: The Impact of the Breaking through Initiative in Michigan. Executive Summary

ERIC Educational Resources Information Center

Schanker, Jennifer B.; Taylor, Judith C.

2012-01-01

The Michigan Center for Student Success commissioned this study to determine whether strategies employed to improve adult students' success at 41 Breaking Through colleges nationwide have taken root at Michigan's original colleges and spread beyond them. A statewide survey revisited four of the colleges profiled in previous publications, and the…

Preliminary Impacts of SECURe PreK on Child- and Classroom-Level Outcomes

ERIC Educational Resources Information Center

Jones, Stephanie M.; Kargman, Marie; Kargman, Max; Bailey, Rebecca

2014-01-01

This paper presents initial results from a pilot evaluation of the pre-K component of a new school-based intervention strategy (Social, Emotional, and Cognitive Understanding and Regulation in education, SECURe) for pre-kindergarten through 3rd grade that is designed to build skills in social-emotional learning (focusing on executive function and…

The power of the drug, nature of support, and their impact on homeless youth.

PubMed

Hudson, Angela L; Nyamathi, Adeline; Slagle, Alexandra; Greengold, Barbara; Griffin, Deborah Koniak; Khalilifard, Farinaz; Gedzoff, Danny; Reid, Courtney

2009-10-01

The purpose of this study was to explore homeless youths' perspectives on the power of drugs in their lives, the preferred type of drugs used, barriers to treatment, and strategies to prevent drug initiation and abuse. This was a descriptive, qualitative study using focus groups with a purposeful sample of 24 drug-using homeless youth. The results provided insight into the lives of drug-using homeless youth. The most commonly used drugs were marijuana and alcohol. Reported reasons for drug use were parental drug use, low self-esteem, and harsh living conditions on the streets. Barriers to treatment were pleasurable enjoyment of the drug, physical dependence, and non-empathetic mental health providers. Strategies to prevent initiation and abuse of drugs were creative activities, such as art, sports, and music, and disdain for parental/family drug use and abuse. Comparative research is needed on specific personal factors that cause initiation and deterrence of drugs use/abuse among homeless youth.

The Power of the Drug, Nature of Support, and their Impact on Homeless Youth

PubMed Central

Hudson, Angela L.; Nyamathi, Adeline; Slagle, Alexandra; Greengold, Barbara; Griffin, Deborah Koniak; Khalilifard, Farinaz; Gedzoff, Danny; Reid, Courtney

2010-01-01

The purpose of this study was to explore homeless youths’ perspectives on the power of drugs in their lives, the preferred type of drugs used, barriers to treatment, and strategies to prevent drug initiation and abuse. This was a descriptive, qualitative study using focus groups with a purposeful sample of 24 homeless drug-using youth. The results provided insight into the lives of drug-using homeless youth. Most commonly-used drugs were marijuana and alcohol. Reported reasons for drug use were parental drug use, low self-esteem, and harsh living conditions on the streets. Barriers to treatment were pleasurable enjoyment of the drug, physical dependence, and non-empathetic mental health providers. Strategies to prevent initiation and abuse of drugs were creative activities, such as art, sports, and music, and disdain for parental/family drug use and abuse. Comparative research is needed on specific personal factors that cause initiation and deterrence of drugs use/abuse among homeless youth. PMID:20155605

Evaluating Niger's experience in strengthening supervision, improving availability of child survival drugs through cost recovery, and initiating training for Integrated Management of Childhood Illness (IMCI)

PubMed Central

Tawfik, Youssef M; Legros, Stephane; Geslin, Colette

2001-01-01

Background WHO and UNICEF have recently developed the "Integrated Management of Childhood Illness" (IMCI) as an efficient strategy to assist developing countries reduce childhood mortality. Early experience with IMCI implementation suggests that clinical training is essential but not sufficient for the success of the strategy. Attention needs to be given to strengthening health systems, such as supervision and drug supply. Results This paper presents results of evaluating an innovative approach for implementing IMCI in Niger. It starts with strengthening district level supervision and improving the availability of child survival drugs through cost recovery well before the beginning of IMCI clinical training. The evaluation documented the effectiveness of the initial IMCI clinical training and referral. Conclusions Strengthening supervision and assuring the availability of essential drugs need to precede the initiation of IMCI Clinical training. Longer term follow up is necessary to confirm the impact of the approach on IMCI preparation and implementation. PMID:11504567

Influencing organisational change in the NHS: lessons learned from workplace wellness initiatives in practice.

PubMed

Blake, Holly; Lloyd, Scott

2008-01-01

This article presents a discussion of the key issues in influencing organisational change in NHS settings, in the development of workplace wellness interventions to improve employee health and wellbeing. To tackle poor public health and associated rising healthcare costs, there must be a focus on the root cause of many preventable diseases - unhealthy lifestyle choices. Workplace wellness initiatives are now an important prevention strategy adopted by socially responsible organisations to target the health and wellbeing of working age adults. Lessons learned from initiatives in secondary care suggest that effective implementation requires change in organisational 'health culture', through a combination of education, behaviour change intervention, needs-based facilities, and services and strategies for developing supportive and health-promoting work environments. Most of all, employers must demonstrate a commitment to health and wellness that is fully integrated with their mission, values and long-term vision, paving the way for sustainable lifestyle changes. Evaluation systems must be in place to measure the impact and outcomes of wellness schemes.

International quality improvement initiatives.

PubMed

Hickey, Patricia A; Connor, Jean A; Cherian, Kotturathu M; Jenkins, Kathy; Doherty, Kaitlin; Zhang, Haibo; Gaies, Michael; Pasquali, Sara; Tabbutt, Sarah; St Louis, James D; Sarris, George E; Kurosawa, Hiromi; Jonas, Richard A; Sandoval, Nestor; Tchervenkov, Christo I; Jacobs, Jeffery P; Stellin, Giovanni; Kirklin, James K; Garg, Rajnish; Vener, David F

2017-12-01

Across the globe, the implementation of quality improvement science and collaborative learning has positively affected the care and outcomes for children born with CHD. These efforts have advanced the collective expertise and performance of inter-professional healthcare teams. In this review, we highlight selected quality improvement initiatives and strategies impacting the field of cardiovascular care and describe implications for future practice and research. The continued leveraging of technology, commitment to data transparency, focus on team-based practice, and recognition of cultural norms and preferences ensure the success of sustainable models of global collaboration.

Review of Strategies to Enhance Outcomes for Patients with Type 2 Diabetes: Payers' Perspective

PubMed Central

Greenapple, Rhonda

2011-01-01

Background Diabetes and its clinical consequences exact a great toll on patients and on society in terms of its effects on morbidity and mortality and its staggering economic impact. Objective To review various programs and strategies that aim at enhancing adherence to antihyperglycemic therapy and suggest the best approach to improving patient outcomes and reducing healthcare costs. Discussion Treatment goals for patients with diabetes have been defined, and multiple safe and effective medications are available. Nevertheless, the majority of patients with diabetes fail to achieve treatment goals, because of difficulty with adherence to medication regimens and lifestyle modifications, and because of economic barriers. This article discusses various initiatives developed to improve patient outcomes, including consumer-driven health plans and wellness and prevention programs. Furthermore, economic incentives to patients, such as value-based insurance design, may increase adherence; nevertheless, evidence suggests that such programs alone provide only modest gains. Primary providers in disease management programs can include nurses, case managers, or pharmacists. Supportive interventions across several modalities have been shown to be effective. Conclusion An approach that uses a combination of strategies designed to impact patients' health-related behaviors across a variety of modalities may help to improve outcomes and reduce costs. Additional novel, innovative interdisciplinary initiatives are necessary to effect meaningful change that can facilitate improved health outcomes for patients with diabetes and maximize cost-effectiveness approaches for payers. PMID:25126364

Spatial and temporal variation in soil and vegetation impacts on campsites: Delaware Water Gap National Recreation Area

USGS Publications Warehouse

Marion, J.L.; Cole, D.N.

1996-01-01

We studied the impacts of camping on soil and vegetation at Delaware Water Gap National Recreation Area. We assessed the magnitude of impact on campsites that varied in amount of use and in topographic position. We also evaluated change over a 5-yr period on long-established, recently opened, and recently closed campsites, as well as on plots subjected to experimental trampling. Campsite impacts were intense and spatially variable. Amount of use and topographic position explained some of this variation. Soil and vegetation conditions changed rapidly when campsites were initially opened to use and when they were closed to use. Changes were less pronounced on the long-established campsites that remained open to use. In the trampling experiments, impact varied greatly with trampling intensity and between vegetation types. An open-canopy grassland vegetation type was much more resistant to trampling than a forb-dominated forest vegetation type. Campsite impacts increased rapidly with initial disturbance, stabilized with ongoing disturbance, and-in contrast to what has been found in most other studies-decreased rapidly once disturbance was terminated. Implications of these results for campsite management strategies, such as use concentration or dispersal, and rotation or closure of campsites, are discussed.

The effects of repetitive drop jumps on impact phase joint kinematics and kinetics.

PubMed

Weinhandl, Joshua T; Smith, Jeremy D; Dugan, Eric L

2011-05-01

The purpose of the study was to investigate the effects of fatigue on lower extremity joint kinematics, and kinetics during repetitive drop jumps. Twelve recreationally active males (n = 6) and females (n = 6) (nine used for analysis) performed repetitive drop jumps until they could no longer reach 80% of their initial drop jump height. Kinematic and kinetic variables were assessed during the impact phase (100 ms) of all jumps. Fatigued landings were performed with increased knee extension, and ankle plantar flexion at initial contact, as well as increased ankle range of motion during the impact phase. Fatigue also resulted in increased peak ankle power absorption and increased energy absorption at the ankle. This was accompanied by an approximately equal reduction in energy absorption at the knee. While the knee extensors were the muscle group primarily responsible for absorbing the impact, individuals compensated for increased knee extension when fatigued by an increased use of the ankle plantar flexors to help absorb the forces during impact. Thus, as fatigue set in and individuals landed with more extended lower extremities, they adopted a landing strategy that shifted a greater burden to the ankle for absorbing the kinetic energy of the impact.

State health care financing strategies for children with intellectual and developmental disabilities.

PubMed

Bachman, Sara S; Comeau, Margaret; Tobias, Carol; Allen, Deborah; Epstein, Susan; Jantz, Kathryn; Honberg, Lynda

2012-06-01

We provide the first descriptive summary of selected programs developed to help expand the scope of coverage, mitigate family financial hardship, and provide health and support services that children with intellectual and developmental disabilities need to maximize their functional status and quality of life. State financing initiatives were identified through interviews with family advocacy, Title V, and Medicaid organizational representatives. Results showed that states use myriad strategies to pay for care and maximize supports, including benefits counseling, consumer- and family-directed care, flexible funding, mandated benefits, Medicaid buy-in programs, and Tax Equity and Fiscal Responsibility Act of 1982 funding. Although health reform may reduce variation among states, its impact on families of children with intellectual and developmental disabilities is not yet clear. As health reform is implemented, state strategies to ameliorate financial hardship among families of children with intellectual and developmental disabilities show promise for immediate use. However, further analysis and evaluation are required to understand their impact on family and child well-being.

The impact of comorbid body dysmorphic disorder on the response to sequential pharmacological trials for obsessive-compulsive disorder.

PubMed

Diniz, Juliana B; Costa, Daniel Lc; Cassab, Raony Cc; Pereira, Carlos Ab; Miguel, Euripedes C; Shavitt, Roseli G

2014-06-01

Our aim was to investigate the impact of comorbid body dysmorphic disorder (BDD) on the response to sequential pharmacological trials in adult obsessive-compulsive disorder (OCD) patients. The sequential trial initially involved fluoxetine monotherapy followed by one of three randomized, add-on strategies: placebo, clomipramine or quetiapine. We included 138 patients in the initial phase of fluoxetine, up to 80 mg or the maximum tolerated dosage, for 12 weeks. We invited 70 non-responders to participate in the add-on trial; as 54 accepted, we allocated 18 to each treatment group and followed them for an additional 12 weeks. To evaluate the combined effects of sex, age, age at onset, initial severity, type of augmentation and BDD on the response to sequential treatments, we constructed a model using generalized estimating equations (GEE). Of the 39 patients who completed the study (OCD-BDD, n = 13; OCD-non-BDD, n = 26), the OCD-BDD patients were less likely to be classified as responders than the OCD-non-BDD patients (Pearson Chi-Square = 4.4; p = 0.036). In the GEE model, BDD was not significantly associated with a worse response to sequential treatments (z-robust = 1.77; p = 0.07). The predictive potential of BDD regarding sequential treatment strategies for OCD did not survive when the analyses were controlled for other clinical characteristics. © The Author(s) 2013.

Broadening Participation in Geosciences with Academic Year and Summer Research Experiences

NASA Astrophysics Data System (ADS)

Austin, S. A.; Howard, A.; Johnson, L. P.; Gutierrez, R.; Chow, Y.

2013-12-01

Medgar Evers College, City University of New York, has initiated a multi-tiered strategy aimed at increasing the number of under-represented minority and female students pursuing careers in the Geosciences, especially Earth and Atmospheric Sciences and related areas. The strategy incorporates research on the persistence of minority and female under-represented students in STEM disciplines. The initiatives include NASA and NSF-funded team-based undergraduate research activities during the summer and academic year as well as academic support (clustering, PTLT workshops for gatekeeper courses), curriculum integration modules, and independent study/special topics courses. In addition, high school students are integrated into summer research activities working with undergraduate and graduate students as well as faculty and other scientist mentors. An important initial component was the building of an infrastructure to support remote sensing, supported by NASA. A range of academic year and summer research experiences are provided to capture student interest in the geosciences. NYC-based research activities include urban impacts of global climate change, the urban heat island, ocean turbulence and general circulation models, and space weather: magnetic rope structure, solar flares and CMEs. Field-based investigations include atmospheric observations using BalloonSat sounding vehicles, observations of tropospheric ozone using ozonesondes, and investigations of the ionosphere using a CubeSat. This presentation provides a description of the programs, student impact, challenges and observations.

Economic and epidemiological impact of early antiretroviral therapy initiation in India

PubMed Central

Maddali, Manoj V; Dowdy, David W; Gupta, Amita; Shah, Maunank

2015-01-01

Introduction Recent WHO guidance advocates for early antiretroviral therapy (ART) initiation at higher CD4 counts to improve survival and reduce HIV transmission. We sought to quantify how the cost-effectiveness and epidemiological impact of early ART strategies in India are affected by attrition throughout the HIV care continuum. Methods We constructed a dynamic compartmental model replicating HIV transmission, disease progression and health system engagement among Indian adults. Our model of the Indian HIV epidemic compared implementation of early ART initiation (i.e. initiation above CD4 ≥350 cells/mm3) with delayed initiation at CD4 ≤350 cells/mm3; primary outcomes were incident cases, deaths, quality-adjusted-life-years (QALYs) and costs over 20 years. We assessed how costs and effects of early ART initiation were impacted by suboptimal engagement at each stage in the HIV care continuum. Results Assuming “idealistic” engagement in HIV care, early ART initiation is highly cost-effective ($442/QALY-gained) compared to delayed initiation at CD4 ≤350 cells/mm3 and could reduce new HIV infections to <15,000 per year within 20 years. However, when accounting for realistic gaps in care, early ART initiation loses nearly half of potential epidemiological benefits and is less cost-effective ($530/QALY-gained). We project 1,285,000 new HIV infections and 973,000 AIDS-related deaths with deferred ART initiation with current levels of care-engagement in India. Early ART initiation in this continuum resulted in 1,050,000 new HIV infections and 883,000 AIDS-related deaths, or 18% and 9% reductions (respectively), compared to current guidelines. Strengthening HIV screening increases benefits of earlier treatment modestly (1,001,000 new infections; 22% reduction), while improving retention in care has a larger modulatory impact (676,000 new infections; 47% reduction). Conclusions Early ART initiation is highly cost-effective in India but only has modest epidemiological benefits at current levels of care-engagement. Improved retention in care is needed to realize the full potential of earlier treatment. PMID:26434780

Impact of the Alzheimer's Disease Neuroimaging Initiative, 2004 to 2014.

PubMed

Weiner, Michael W; Veitch, Dallas P; Aisen, Paul S; Beckett, Laurel A; Cairns, Nigel J; Cedarbaum, Jesse; Donohue, Michael C; Green, Robert C; Harvey, Danielle; Jack, Clifford R; Jagust, William; Morris, John C; Petersen, Ronald C; Saykin, Andrew J; Shaw, Leslie; Thompson, Paul M; Toga, Arthur W; Trojanowski, John Q

2015-07-01

The Alzheimer's Disease Neuroimaging Initiative (ADNI) was established in 2004 to facilitate the development of effective treatments for Alzheimer's disease (AD) by validating biomarkers for AD clinical trials. We searched for ADNI publications using established methods. ADNI has (1) developed standardized biomarkers for use in clinical trial subject selection and as surrogate outcome measures; (2) standardized protocols for use across multiple centers; (3) initiated worldwide ADNI; (4) inspired initiatives investigating traumatic brain injury and post-traumatic stress disorder in military populations, and depression, respectively, as an AD risk factor; (5) acted as a data-sharing model; (6) generated data used in over 600 publications, leading to the identification of novel AD risk alleles, and an understanding of the relationship between biomarkers and AD progression; and (7) inspired other public-private partnerships developing biomarkers for Parkinson's disease and multiple sclerosis. ADNI has made myriad impacts in its first decade. A competitive renewal of the project in 2015 would see the use of newly developed tau imaging ligands, and the continued development of recruitment strategies and outcome measures for clinical trials. Copyright © 2015 The Alzheimer's Association. All rights reserved.

Impact of the Alzheimer’s Disease Neuroimaging Initiative, 2004 to 2014

PubMed Central

Weiner, Michael W.; Veitch, Dallas P.; Aisen, Paul S.; Beckett, Laurel A.; Cairns, Nigel J.; Cedarbaum, Jesse; Donohue, Michael C.; Green, Robert C.; Harvey, Danielle; Jack, Clifford R.; Jagust, William; Morris, John C.; Petersen, Ronald C.; Saykin, Andrew J.; Shaw, Leslie; Thompson, Paul M.; Toga, Arthur W.; Trojanowski, John Q.

2015-01-01

Introduction The Alzheimer’s Disease Neuroimaging Initiative (ADNI) was established in 2004 to facilitate the development of effective treatments for Alzheimer’s disease (AD) by validating biomarkers for AD clinical trials. Methods We searched for ADNI publications using established methods. Results ADNI has (1) developed standardized biomarkers for use in clinical trial subject selection and as surrogate outcome measures; (2) standardized protocols for use across multiple centers; (3) initiated worldwide ADNI; (4) inspired initiatives investigating traumatic brain injury and post-traumatic stress disorder in military populations, and depression, respectively, as an AD risk factor; (5) acted as a data-sharing model; (6) generated data used in over 600 publications, leading to the identification of novel AD risk alleles, and an understanding of the relationship between biomarkers and AD progression; and (7) inspired other public-private partnerships developing biomarkers for Parkinson’s disease and multiple sclerosis. Discussion ADNI has made myriad impacts in its first decade. A competitive renewal of the project in 2015 would see the use of newly developed tau imaging ligands, and the continued development of recruitment strategies and outcome measures for clinical trials. PMID:26194320

An historical document analysis of the introduction of the Baby Friendly Hospital Initiative into the Australian setting.

PubMed

Atchan, Marjorie; Davis, Deborah; Foureur, Maralyn

2017-02-01

Breastfeeding has many known benefits yet its support across Australian health systems was suboptimal throughout the 20th Century. The World Health Organization launched a global health promotion strategy to help create a 'breastfeeding culture'. Research on the programme has revealed multiple barriers since implementation. To analyse the sociopolitical challenges associated with implementing a global programme into a national setting via an examination of the influences on the early period of implementation of the Baby Friendly Hospital Initiative in Australia. A focused historical document analysis was attended as part of an instrumental case study. A purposeful sampling strategy obtained a comprehensive sample of public and private documents related to the introduction of the BFHI in Australia. Analysis was informed by a 'documents as commentary' approach to gain insight into individual and collective social practices not otherwise observable. Four major themes were identified: "a breastfeeding culture"; "resource implications"; "ambivalent support for breastfeeding and the BFHI" and "business versus advocacy". "A breastfeeding culture" included several subthemes. No tangible support for breastfeeding generally, or the Baby Friendly Hospital Initiative specifically, was identified. Australian policy did not follow international recommendations. There were no financial or policy incentives for BFHI implementation. Key stakeholders' decisions negatively impacted on the Baby Friendly Hospital Initiative at a crucial time in its implementation in Australia. The potential impact of the programme was not realised, representing a missed opportunity to establish and provide sustainable standardised breastfeeding support to Australian women and their families. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Encouraging Evidence on a Sector-Focused Advancement Strategy: Two-Year Impacts from the WorkAdvance Demonstration

ERIC Educational Resources Information Center

Hendra, Richard; Greenberg, David H.; Hamilton, Gayle; Oppenheim, Ari; Pennington, Alexandra; Schaberg, Kelsey; Tessler, Betsy L.

2016-01-01

This report summarizes the two-year findings of a rigorous random assignment evaluation of the WorkAdvance model, a sectoral training, and advancement initiative. Launched in 2011, WorkAdvance goes beyond the previous generation of employment programs by introducing demand-driven skills training and a focus on jobs that have career pathways. The…

The Talent Development Middle School Model: Context, Components, and Initial Impacts on Students' Performance and Attendance

ERIC Educational Resources Information Center

Herlihy, Corinne M.; Kemple, James J.

2004-01-01

The Talent Development Middle School model was created to make a difference in struggling urban middle schools. The model is part of a trend in school improvement strategies whereby whole-school reform projects aim to improve performance and attendance outcomes for students through the use of major changes in both the organizational structure and…

Encouraging Evidence on a Sector-Focused Advancement Strategy: Two-Year Impacts from the WorkAdvance Demonstration. Preview Summary

ERIC Educational Resources Information Center

Hendra, Richard; Greenberg, David H.; Hamilton, Gayle; Oppenheim, Ari; Pennington, Alexandra; Schaberg, Kelsey; Tessler, Betsy L.

2016-01-01

This report summarizes the two-year findings of a rigorous random assignment evaluation of the WorkAdvance model, a sectoral training and advancement initiative. Launched in 2011, WorkAdvance goes beyond the previous generation of employment programs by introducing demand-driven skills training and a focus on jobs that have career pathways. The…

Surprising Ripple Effects: How Changing the SAT Score-Sending Policy for Low-Income Students Impacts College Access and Success

ERIC Educational Resources Information Center

Hurwitz, Michael; Mbekeani, Preeya P.; Nipson, Margaret M.; Page, Lindsay C.

2017-01-01

Subtle policy adjustments can induce relatively large "ripple effects." We evaluate a College Board initiative that increased the number of free SAT score reports available to low-income students and changed the time horizon for using these score reports. Using a difference-in-differences analytic strategy, we estimate that targeted…

Modeling the impact of rubella vaccination in Vietnam.

PubMed

Vynnycky, Emilia; Yoshida, Lay Myint; Huyen, Dang Thi Thanh; Trung, Nguyen Dac; Toda, Kohei; Cuong, Nguyen Van; Thi Hong, Duong; Ariyoshi, Koya; Miyakawa, Masami; Moriuchi, Hiroyuki; Tho, Le Huu; Nguyen, Hien Anh; Duc Anh, Dang; Jit, Mark; Hien, Nguyen Tran

2016-01-01

Supported by GAVI Alliance, measles-rubella vaccination was introduced in Vietnam in 2014, involving a mass campaign among 1-14 year olds and routine immunization of children aged 9 months. We explore the impact on the incidence of Congenital Rubella Syndrome (CRS) during 2013-2050 of this strategy and variants involving women aged 15-35 years. We use an age and sex-structured dynamic transmission model, set up using recently-collected seroprevalence data from Central Vietnam, and also consider different levels of transmission and contact patterns. If the serological profile resembles that in Central Vietnam, the planned vaccination strategy could potentially prevent 125,000 CRS cases by 2050 in Vietnam, despite outbreaks predicted in the meantime. Targeting the initial campaign at 15-35 year old women with or without children aged 9 months-14 years led to sustained reductions in incidence, unless levels of ongoing transmission were medium-high before vaccination started. Assumptions about contact greatly influenced predictions if the initial campaign just targeted 15-35 year old women and/or levels of ongoing transmission were medium-high. Given increased interest in rubella vaccination, resulting from GAVI Alliance funding, the findings are relevant for many countries.

Determinants of utilisation of intrapartum obstetric care services in Cambodia, and gaps in coverage.

PubMed

Chomat, Anne Marie; Grundy, John; Oum, Sophal; Bermudez, Odilia I

2011-01-01

Facility delivery and skilled birth attendance are two of the most effective strategies for decreasing maternal mortality. The objectives of this study were to further define utilisation of these services in Cambodia and to uncover socio-economic or location-specific coverage gaps that may exist. We performed a cross-sectional analysis of the 2005 Cambodia Demographic Health Survey (CDHS) to determine prevalence, and determinants, of service utilisation. Out of 6069 women aged 15-49 years, 77% delivered at home, three-fourths without a skilled birth attendant. Poverty, lower education and rural residence were associated with the highest likelihood of poor utilisation of services. Discussion. While there has been an overall increase in facility deliveries and skilled birth attendance since 2000, improvements have been spread unevenly across the population, benefiting mostly urban, wealthier and better educated women. While recent financing initiatives and health system developments appear to have further increased service utilisation since 2005, the extent of their reach to the most vulnerable populations, and their ultimate impact on maternal mortality reduction, remain to be elucidated. Further expanding successful initiatives, particularly among vulnerable populations, is essential. Longitudinal evaluation of ongoing strategies and their impact remains critical.

The Impact of Heterogeneity on Threshold-Limited Social Contagion, and on Crowd Decision-Making

NASA Astrophysics Data System (ADS)

Karampourniotis, Panagiotis Dimitrios

Recent global events and their poor predictability are often attributed to the complexity of the world event dynamics. A key factor generating the turbulence is human diversity. Here, we study the impact of heterogeneity of individuals on opinion formation and emergence of global biases. In the case of opinion formation, we focus on the heterogeneity of individuals' susceptibility to new ideas. In the case of global biases, we focus on the aggregated heterogeneity of individuals in a country. First, to capture the complex nature of social influencing we use a simple but classic model of contagion spreading in complex social systems, namely the threshold model. We investigate numerically and analytically the transition in the behavior of threshold-limited cascades in the presence of multiple initiators as the distribution of thresholds is varied between the two extreme cases of identical thresholds and a uniform distribution. We show that individuals' heterogeneity of susceptibility governs the dynamics, resulting in different sizes of initiators needed for consensus. Furthermore, given the impact of heterogeneity on the cascade dynamics, we investigate selection strategies for accelerating consensus. To this end, we introduce two new selection strategies for Influence Maximization. One of them focuses on finding the balance between targeting nodes which have high resistance to adoptions versus nodes positioned in central spots in networks. The second strategy focuses on the combination of nodes for reaching consensus, by targeting nodes which increase the group's influence. Our strategies outperform other existing strategies regardless of the susceptibility diversity and network degree assortativity. Finally, we study the aggregated biases of humans in a global setting. The emergence of technology and globalization gives raise to the debate on whether the world moves towards becoming flat, a world where preferential attachment does not govern economic growth. By studying the data from a global lending platform we discover that geographical proximity and cultural affinity are highly negatively correlated with levels of flatness of the world. Furthermore, we investigate the robustness of the flatness of the world against sudden catastrophic national events such as political disruptions, by removing countries (nodes) or connections (edges) between them.

From Good Intentions to Proven Interventions: Effectiveness of Actions to Reduce the Health Impacts of Air Pollution

PubMed Central

Giles, Luisa V.; Barn, Prabjit; Künzli, Nino; Romieu, Isabelle; Mittleman, Murray A.; van Eeden, Stephan; Allen, Ryan; Carlsten, Chris; Stieb, Dave; Noonan, Curtis; Smargiassi, Audrey; Kaufman, Joel D.; Hajat, Shakoor; Kosatsky, Tom; Brauer, Michael

2011-01-01

Background Associations between air pollution and a multitude of health effects are now well established. Given ubiquitous exposure to some level of air pollution, the attributable health burden can be high, particularly for susceptible populations. Objectives An international multidisciplinary workshop was convened to discuss evidence of the effectiveness of actions to reduce health impacts of air pollution at both the community and individual level. The overall aim was to summarize current knowledge regarding air pollution exposure and health impacts leading to public health recommendations. Discussion During the workshop, experts reviewed the biological mechanisms of action of air pollution in the initiation and progression of disease, as well as the state of the science regarding community and individual-level interventions. The workshop highlighted strategies to reduce individual baseline risk of conditions associated with increased susceptibility to the effects of air pollution and the need to better understand the role of exposure duration in disease progression, reversal, and adaptation. Conclusion We have identified two promising and largely unexplored strategies to address and mitigate air pollution–related health impacts: reducing individual baseline risk of cardiovascular disease and incorporating air pollution–related health impacts into land-use decisions. PMID:20729178

IMPROVING (SOFTWARE) PATENT QUALITY THROUGH THE ADMINISTRATIVE PROCESS

PubMed Central

Rai, Arti K.

2014-01-01

The available evidence indicates that patent quality, particularly in the area of software, needs improvement. This Article argues that even an agency as institutionally constrained as the U.S. Patent and Trademark Office (“PTO”) could implement a portfolio of pragmatic, cost-effective quality improvement strategies. The argument in favor of these strategies draws upon not only legal theory and doctrine but also new data from a PTO software examination unit with relatively strict practices. Strategies that resolve around Section 112 of the patent statute could usefully be deployed at the initial examination stage. Other strategies could be deployed within the new post-issuance procedures available to the agency under the America Invents Act. Notably, although the strategies the Article discusses have the virtue of being neutral as to technology, they are likely to have a very significant practical impact in the area of software. PMID:25221346

IMPROVING (SOFTWARE) PATENT QUALITY THROUGH THE ADMINISTRATIVE PROCESS.

PubMed

Rai, Arti K

2013-11-24

The available evidence indicates that patent quality, particularly in the area of software, needs improvement. This Article argues that even an agency as institutionally constrained as the U.S. Patent and Trademark Office ("PTO") could implement a portfolio of pragmatic, cost-effective quality improvement strategies. The argument in favor of these strategies draws upon not only legal theory and doctrine but also new data from a PTO software examination unit with relatively strict practices. Strategies that resolve around Section 112 of the patent statute could usefully be deployed at the initial examination stage. Other strategies could be deployed within the new post-issuance procedures available to the agency under the America Invents Act. Notably, although the strategies the Article discusses have the virtue of being neutral as to technology, they are likely to have a very significant practical impact in the area of software.

Structure Damage Simulations Accounting for Inertial Effects and Impact and Optimization of Grid-Stiffened Non-Circular Shells

NASA Technical Reports Server (NTRS)

Mei, Chuh; Jaunky, Navin

1999-01-01

The goal of this research project is to develop modelling and analysis strategy for the penetration of aluminium plates impacted by titanium impactors. Finite element analysis is used to study the penetration of aluminium plates impacted by titanium impactors in order to study the effect of such uncontained engine debris impacts on aircraft-like skin panels. LS-DYNA3D) is used in the simulations to model the impactor, test fixture frame and target barrier plate. The effects of mesh refinement, contact modeling, and impactor initial velocity and orientation were studied. The research project also includes development of a design tool for optimum design of grid-stiffened non-circular shells or panels subjected to buckling.

Non-AUG translation: a new start for protein synthesis in eukaryotes

PubMed Central

Kearse, Michael G.; Wilusz, Jeremy E.

2017-01-01

Although it was long thought that eukaryotic translation almost always initiates at an AUG start codon, recent advancements in ribosome footprint mapping have revealed that non-AUG start codons are used at an astonishing frequency. These non-AUG initiation events are not simply errors but instead are used to generate or regulate proteins with key cellular functions; for example, during development or stress. Misregulation of non-AUG initiation events contributes to multiple human diseases, including cancer and neurodegeneration, and modulation of non-AUG usage may represent a novel therapeutic strategy. It is thus becoming increasingly clear that start codon selection is regulated by many trans-acting initiation factors as well as sequence/structural elements within messenger RNAs and that non-AUG translation has a profound impact on cellular states. PMID:28982758

Projections, plans, policies and politics in Prince George: reflections on five years of climate change adaptation in a northern Canadian community

NASA Astrophysics Data System (ADS)

Picketts, I. M.; Dery, S. J.; Curry, J.

2013-12-01

The City of Prince George, in central British Columbia, Canada, has partnered with academics and collaborators for over five years to address climate change adaptation at the local level. The first phase of research involved conducting a detailed overview of past climate trends and future projections for the region using the outputs of GCMs and downscaled RCMs. This information was communicated to senior local staff and community members, and feedback was applied to create a detailed adaptation strategy for the City, which identified priority impacts and outlined potential strategies to address them at the local level. The top priority impacts for Prince George are forest changes, increased flooding, and impacts to transportation infrastructure. During a second implementation phase of the project, eight local initiatives were completed focusing on: incorporating adaptation into a local sustainability plan and land use plan; exploring impacts related to forests, flooding and transportation infrastructure; and assessing trends and projections in freeze-thaw cycles and heavy rainfall events. This presentation will outline the adaptation initiatives undertaken in the City of Prince George during the second phase of research, and evaluate their effectiveness through reflections from interviews with local planners, engineers, managers, community champions and politicians. The initiatives deemed to be most successful - and most likely to be implemented - focus on topics that: are of high public concern; have clear cost implications; incorporate adaptation into policy; and/or incorporate adaptation into an ongoing project. Outcomes highlight challenges local researchers, practitioners and leaders face as they strive to implement proactive adaptation measures in policy and practice without strong support from policy and professional practices, and with a paucity of successful case study examples to build upon. Outcomes also reveal challenges as municipalities strive to do ';more with less' and work within the reality that adaptation is not generally a high public or political priority. Internal capacity and external support are vital for adaptation success at the local level.

The National Perinatal Depression Initiative: An evaluation of access to general practitioners, psychologists and psychiatrists through the Medicare Benefits Schedule.

PubMed

Chambers, Georgina M; Randall, Sean; Hoang, Van Phuong; Sullivan, Elizabeth A; Highet, Nicole; Croft, Maxine; Mihalopoulos, Cathrine; Morgan, Vera A; Reilly, Nicole; Austin, Marie-Paule

2016-03-01

To evaluate the impact of the National Perinatal Depression Initiative on access to Medicare services for women at risk of perinatal mental illness. Retrospective cohort study using difference-in-difference analytical methods to quantify the impact of the National Perinatal Depression Initiative policies on Medicare Benefits Schedule mental health usage by Australian women giving birth between 2006 and 2010. A random sample of women of reproductive age enrolled in Medicare who had not given birth where used as controls. The main outcome measures were the proportions of women giving birth each month who accessed a Medicare Benefits Schedule mental health items during the perinatal period (pregnancy through to the end of the first postnatal year) before and after the introduction of the National Perinatal Depression Initiative. The proportion of women giving birth who accessed at least one mental health item during the perinatal period increased from 88 to 141 per 1000 between 2007 and 2010. The difference-in-difference analysis showed that while there was an overall increase in Medicare Benefits Schedule mental health item access as a result of the National Perinatal Depression Initiative, this did not reach statistical significance. However, the National Perinatal Depression Initiative was found to significantly increase access in subpopulations of women, particularly those aged under 25 and over 34 years living in major cities. In the 2 years following its introduction, the National Perinatal Depression Initiative was found to have increased access to Medicare funded mental health services in particular groups of women. However, an overall increase across all groups did not reach statistical significance. Further studies are needed to assess the impact of the National Perinatal Depression Initiative on women during childbearing years, including access to tertiary care, the cost-effectiveness of the initiative, and mental health outcomes. It is recommended that new mental health policy initiatives incorporate a planned strategic approach to evaluation, which includes sufficient follow-up to assess the impact of public health strategies. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Results from an audit feedback strategy for chronic obstructive pulmonary disease in-hospital care: a joint analysis from the AUDIPOC and European COPD audit studies.

PubMed

Lopez-Campos, Jose Luis; Asensio-Cruz, M Isabel; Castro-Acosta, Ady; Calero, Carmen; Pozo-Rodriguez, Francisco

2014-01-01

Clinical audits have emerged as a potential tool to summarize the clinical performance of healthcare over a specified period of time. However, the effectiveness of audit and feedback has shown inconsistent results and the impact of audit and feedback on clinical performance has not been evaluated for COPD exacerbations. In the present study, we analyzed the results of two consecutive nationwide clinical audits performed in Spain to evaluate both the in-hospital clinical care provided and the feedback strategy. The present study is an analysis of two clinical audits performed in Spain that evaluated the clinical care provided to COPD patients who were admitted to the hospital for a COPD exacerbation. The first audit was performed from November-December 2008. The feedback strategy consisted of personalized reports for each participant center, the presentation and discussion of the results at regional, national and international meetings and the creation of health-care quality standards for COPD. The second audit was part of a European study during January and February 2011. The impact of the feedback strategy was evaluated in term of clinical care provided and in-hospital survival. A total of 94 centers participated in the two audits, recruiting 8,143 admissions (audit 1∶3,493 and audit 2∶4,650). The initially provided clinical care was reasonably acceptable even though there was considerable variability. Several diagnostic and therapeutic procedures improved in the second audit. Although the differences were significant, the degree of improvement was small to moderate. We found no impact on in-hospital mortality. The present study describes COPD hospital care in Spanish hospitals and evaluates the impact of peer-benchmarked, individually written and group-oral feedback strategy on the clinical outcomes for treating COPD exacerbations. It describes small to moderate improvements in the clinical care provided to COPD patients with no impact on in-hospital mortality.

Complex Network for a Crisis Contagion on AN Interbank System

NASA Astrophysics Data System (ADS)

Tirado, Mariano

2012-09-01

The main focus of this research is the contagion of a financial crisis on an interbank debt network. In order to simulate the crisis propagation a weighted community complex network based on growth strategy has been created. The contagion is described by a new way of disease propagation perspective based on the concept of a financial virus. The model reproduces the existence of TBTF banks and shows the impact that an initial TBTF bank crash produces in the interbank network depending on the magnitude of the initial crash and on the resistance that the network offers against the contagion propagation.

Packaging strategies for printed circuit board components. Volume I, materials & thermal stresses.

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

Neilsen, Michael K.; Austin, Kevin N.; Adolf, Douglas Brian

2011-09-01

Decisions on material selections for electronics packaging can be quite complicated by the need to balance the criteria to withstand severe impacts yet survive deep thermal cycles intact. Many times, material choices are based on historical precedence perhaps ignorant of whether those initial choices were carefully investigated or whether the requirements on the new component match those of previous units. The goal of this program focuses on developing both increased intuition for generic packaging guidelines and computational methodologies for optimizing packaging in specific components. Initial efforts centered on characterization of classes of materials common to packaging strategies and computational analysesmore » of stresses generated during thermal cycling to identify strengths and weaknesses of various material choices. Future studies will analyze the same example problems incorporating the effects of curing stresses as needed and analyzing dynamic loadings to compare trends with the quasi-static conclusions.« less

75 FR 75707 - Request for Public Comment on the Draft National Nanotechnology Initiative Strategy for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-06

... Nanotechnology Initiative Strategy for Nanotechnology-Related Environmental, Health, and Safety Research AGENCY... the public regarding the draft National Nanotechnology Initiative (NNI) Strategy for Nanotechnology... confidential. Overview: The National Nanotechnology Initiative Strategy for Nanotechnology-Related...

To Spray or Not to Spray: A Decision Analysis of Coffee Berry Borer in Hawaii

PubMed Central

2017-01-01

Integrated pest management strategies were adopted to combat the coffee berry borer (CBB) after its arrival in Hawaii in 2010. A decision tree framework is used to model the CBB integrated pest management recommendations, for potential use by growers and to assist in developing and evaluating management strategies and policies. The model focuses on pesticide spraying (spray/no spray) as the most significant pest management decision within each period over the entire crop season. The main result from the analysis suggests the most important parameter to maximize net benefit is to ensure a low initial infestation level. A second result looks at the impact of a subsidy for the cost of pesticides and shows a typical farmer receives a positive net benefit of $947.17. Sensitivity analysis of parameters checks the robustness of the model and further confirms the importance of a low initial infestation level vis-a-vis any level of subsidy. The use of a decision tree is shown to be an effective method for understanding integrated pest management strategies and solutions. PMID:29065464

The Impact Of Optical Storage Technology On Image Processing Systems

NASA Astrophysics Data System (ADS)

Garges, Daniel T.; Durbin, Gerald T.

1984-09-01

The recent announcement of commercially available high density optical storage devices will have a profound impact on the information processing industry. Just as the initial introduction of random access storage created entirely new processing strategies, optical technology will allow dramatic changes in the storage, retrieval, and dissemination of engineering drawings and other pictorial or text-based documents. Storage Technology Corporation has assumed a leading role in this arena with the introduction of the 7600 Optical Storage Subsystem, and the formation of StorageTek Integrated Systems, a subsidiary chartered to incorporate this new technology into deliverable total systems. This paper explores the impact of optical storage technology from the perspective of a leading-edge manufacturer and integrator.

Deaths from Pesticide Poisoning: Are we lacking a global response?

PubMed Central

Bertolote, JM; Fleischmann, A; Eddleston, M; Gunnell, D

2008-01-01

Self-poisoning with pesticides accounts for around a third of all suicides worldwide. To tackle this problem, WHO announced a Global Public Health initiative in 2005. Planned approaches will range from Government regulatory action to the development of new treatments for pesticide poisoning. With broad-based support this strategy will have a major impact on the global burden of suicide. PMID:16946353

The devil that we know: lead (Pb) replacement policies under conditions of scientific uncertainty

NASA Technical Reports Server (NTRS)

Ogunseitan, Dele; Schoenung, Julie; Saphores, Jean-Daniel; Shapiro, Andrew; Bhuie, Amrit; Kang, Hai-Yong; Nixon, Hilary; Stein, Antionette

2003-01-01

Engineering and economic considerations are typical driving forces behind the selection of specific chemicals used in the manufacture of consumer products. Only recently has post-consumer environmental impact become part of the major considerations during the initial phases of product design. Therefore, reactive, rather than proactive strategies have dominated the consideration of environmental and health issues in product design.

Exploring a Cultural Initiative: The Opus College of Business's Mission-Driven Catholic Business Education Seminar

ERIC Educational Resources Information Center

Shoemake, Robert C.

2012-01-01

This article examines and evaluates the development, design, and impact of one strategy for renewing mission and identity in Catholic business education. The Mission-Driven Catholic Business Education (MCBE) Seminar is used by the Opus College of Business at the University of St. Thomas to create and sustain a mission-driven culture. (Contains 1…

Overall Impact of Speed-Related Initiatives and Factors on Crash Outcomes

PubMed Central

D’Elia, A.; Newstead, S.; Cameron, M.

2007-01-01

From December 2000 until July 2002 a package of speed-related initiatives and factors took place in Victoria, Australia. The broad aim of this study was to evaluate the overall impact of the package on crash outcomes. Monthly crash counts and injury severity proportions were assessed using Poisson and logistic regression models respectively. The model measured the overall effect of the package after adjusting as far as possible for non-speed road safety initiatives and socio-economic factors. The speed-related package was associated with statistically significant estimated reductions in casualty crashes and suggested reductions in injury severity with trends towards increased reductions over time. From December 2000 until July 2002, three new speed enforcement initiatives were implemented in Victoria, Australia. These initiatives were introduced in stages and involved the following key components: More covert operations of mobile speed cameras, including flash-less operations; 50% increase in speed camera operating hours; and lowering of cameras’ speed detection threshold. In addition, during the period 2001 to 2002, the 50 km/h General Urban Speed Limit (GUSL) was introduced (January 2001), there was an increase in speed-related advertising including the “Wipe Off 5” campaign, media announcements were made related to the above enforcement initiatives and there was a speeding penalty restructure. The above elements combine to make up a package of speed-related initiatives and factors. The package represents a broad, long term program by Victorian government agencies to reduce speed based on three linked strategies: more intensive Police enforcement of speed limits to deter potential offenders, i.e. the three new speed enforcement initiatives just described - supported by higher penalties; a reduction in the speed limit on local streets throughout Victoria from 60 km/h to 50 km/h; and provision of information using the mass media (television, radio and billboard) to reinforce the benefits of reducing low level speeding - the central message of “Wipe Off 5”. These strategies were implemented across the entire state of Victoria with the intention of covering as many road users as possible. PMID:18184508

Analysis of Envisat Orbit Maintenance Strategies to Improve/Increase Envisat ASAR Interferometry Opportunities

NASA Technical Reports Server (NTRS)

Kuijper, D.; Matatoros, Garcia

2007-01-01

The biggest and most advanced Earth Observation Satellite in-orbit, developed by the European Space Agency (ESA) and its member states, is Envisat. It was launched on March 1, 2002 by an Ariane V from French Guyana and holds a total of 10 multi-disciplinary Earth observation instruments, among which an Advanced Synthetic Aperture Radar (ASAR). The ASAR user community requested the Flight Dynamics division of the European Space Operations Centre (ESOC) to investigate how the orbit control maintenance strategy for Envisat could be changed to optimize ASAR interferometry opportunities overall and in addition support the International Polar Year 2007/2008 initiative. The Polar Regions play a pivotal role in understanding our planet and our impact on it as they are recognized as sensitive barometers of environmental change. One of the main themes of the International Polar Year 2007/2008 is therefore the study of Earth s changing ice and snow, and its impact on our planet and our lives. Naturally, ESA would like to support this very important initiative. This paper presents the investigations that have been conducted to support these requests in the best possible way. It discusses the orbit maintenance strategy that has been in place since its launch, ensuring the actual orbit to be within 1 km of a so-called reference orbit, and presents the new orbit maintenance strategy that is aimed at improving/increasing the opportunities for Envisat ASAR interferometry, while preserving the fuel on board the spacecraft. The hydrazine on-board Envisat happens to be a precious resource as only approximately 300 kg of it was available at launch, like ERS-2. The difference being however that the mass of Envisat is approximately 3.2 times that of ERS-2.

The impact of rural-exposure strategies on the intention of dental students and dental graduates to practice in rural areas: a systematic review and meta-analysis

PubMed Central

Suphanchaimat, Rapeepong; Cetthakrikul, Nisachol; Dalliston, Alexander; Putthasri, Weerasak

2016-01-01

Background and objectives The objective of this study was to assess the impact of strategies on the intention of dental students/graduates to practice in rural areas. The strategies included the recruitment of dental students from rural backgrounds and clinical rotations in rural areas during the training of dental students. Materials and methods The study undertook a systematic review and utilized meta-analysis to assess these strategies. International literature published between 2000 and 2015 was retrieved from three main search engines: Medline, Embase, and Scopus. The selected articles were scanned to extract the main content. The impact of the strategies was quantitatively assessed by meta-analysis, using the random-effect model. The pooled effect was reported in terms of odds ratios (ORs) with 95% confidence intervals. Sensitivity and subgroup analyses were performed. Publication bias was assessed by the Funnel plot and Egger’s test. Results Seven of the initially selected 897 articles were included for the full review. The majority of the selected articles had been published in developed countries. The meta-analysis results revealed that the pooled OR of rural exposure on the intention to practice in rural areas was approximately 4.1, statistically significant. Subgroup analysis showed that clinical rotations in rural areas tended to have a slightly greater influence on rural dental practice than recruiting students from rural backgrounds (OR 4.3 versus 4.2). There was weaker evidence of publication bias, which was derived from small-study effects. Conclusion Enrolling students with rural backgrounds and imposing compulsory clinical rotation in rural areas during their study appeared to be effective strategies in tackling the shortage and maldistribution of dentists in rural areas. PMID:27822134

Overcoming barriers to recruiting ethnic minorities to mental health research: a typology of recruitment strategies.

PubMed

Waheed, Waquas; Hughes-Morley, Adwoa; Woodham, Adrine; Allen, Gill; Bower, Peter

2015-05-02

The ethnic minority population in developed countries is increasing over time. These groups are at higher risk of mental illness and demonstrate lower participation in research. Published evidence suggests that multiple factors like stigma, lack of trust, differences in explanatory models, logistical issues and lack of culturally aware researchers act as barriers to ethnic minority recruitment into mental health research. To reduce inequalities in participation, there is a need to devise innovative and culturally sensitive recruitment strategies. It is important that researchers share their experience of employing these strategies so that ethnic minority participation can be facilitated. We previously published a systematic review of barriers to recruiting ethnic minority participants into mental health research. The nine papers included in our prior review formed the basis for developing a typology of barriers to recruiting ethnic minorities into mental health research. This typology identified 33 barriers, described under five themes. We further extracted data on the strategies used to overcome these recruitment barriers, as described in the included studies. The strategies employed by the authors could be matched to all but two barriers (psychopathology/substance misuse and limited resource availability). There was evidence that multiple strategies were employed, and that these depended upon the population, clinical set-up and resources available. This typology of strategies to overcome barriers to recruiting ethnic minorities provides guidance on achieving higher rates of recruitment. It is important that researchers plan to deploy these strategies well in advance of initiating recruitment. Whilst adopting these strategies, the authors have not been able to quantify the positive impact of these strategies on recruitment. The typology should encourage researchers to employ these strategies in future research, refine them further and quantitatively evaluate their impact.

Cost-effectiveness Analysis of Treatment Sequence Initiating With Etanercept Compared With Leflunomide in Rheumatoid Arthritis: Impact of Reduced Etanercept Cost With Patent Expiration in South Korea.

PubMed

Park, Sun-Kyeong; Park, Seung-Hoo; Lee, Min-Young; Park, Ji-Hyun; Jeong, Jae-Hong; Lee, Eui-Kyung

2016-11-01

In south Korea, the price of biologics has been decreasing owing to patent expiration and the availability of biosimilars. This study evaluated the cost-effectiveness of a treatment strategy initiated with etanercept (ETN) compared with leflunomide (LFN) after a 30% reduction in the medication cost of ETN in patients with active rheumatoid arthritis (RA) with an inadequate response to methotrexate (MTX-IR). A cohort-based Markov model was designed to evaluate the lifetime cost-effectiveness of treatment sequence initiated with ETN (A) compared with 2 sequences initiated with LFN: LFN-ETN sequence (B) and LFN sequence (C). Patients transited through the treatment sequences, which consisted of sequential biologics and palliative therapy, based on American College of Rheumatology (ACR) responses and the probability of discontinuation. A systematic literature review and a network meta-analysis were conducted to estimate ACR responses to ETN and LFN. Utility was estimated by mapping an equation for converting the Health Assessment Questionnaire-Disability Index score to utility weight. The costs comprised medications, outpatient visits, administration, dispensing, monitoring, palliative therapy, and treatment for adverse events. A subanalysis was conducted to identify the influence of the ETN price reduction compared with the unreduced price, and sensitivity analyses explored the uncertainty of model parameters and assumptions. The ETN sequence (A) was associated with higher costs and a gain in quality-adjusted life years (QALYs) compared with both sequences initiated with LFN (B, C) throughout the lifetime of patients with RA and MTX-IR. The incremental cost-effectiveness ratio (ICER) for strategy A versus B was ₩13,965,825 (US$1726) per QALY and that for strategy A versus C was ₩9,587,983 (US$8050) per QALY. The results indicated that strategy A was cost-effective based on the commonly cited ICER threshold of ₩20,000,000 (US$16,793) per QALY in South Korea. The robustness of the base-case analysis was confirmed using sensitivity analyses. When the unreduced medication cost of ETN was applied in a subanalysis, the ICER for strategy A versus B was ₩20,909,572 (US$17,556) per QALY and that for strategy A versus C was ₩22,334,713 (US$18,753) per QALY. This study indicated that a treatment strategy initiated with ETN was more cost-effective in patients with active RA and MTX-IR than 2 sequences initiated with LFN. The results also indicate that the reduced price of ETN affected the cost-effectiveness associated with its earlier use. Copyright © 2016 Elsevier HS Journals, Inc. All rights reserved.

The impact of culture and sociological and psychological issues on Muslim patients with breast cancer in Pakistan.

PubMed

Banning, Maggi; Hafeez, Haroon; Faisal, Saima; Hassan, Mariam; Zafar, Ammarah

2009-01-01

Breast cancer is the most common form of cancer in Muslim women in Pakistan. The impact of the initial diagnosis, culture, religion, and psychosocial and psychological aspects of the disease is not well established. This qualitative study examined the experience and coping strategies used by patients with breast cancer in relation to its impact on their physical, mental health, religious, and family issues. Thirty patients with breast cancer were interviewed. Data were analyzed using thematic analysis. The patient's experience of breast cancer focused on the range of emotions felt throughout the illness trajectory, the importance of religion and family support on coping strategies used to manage the adverse effects of chemotherapy, and also the financial concerns. This is the first study to examine Pakistani Muslim women's views on the lived experience of breast cancer. This article provides clarification of the voiced experiences of women with breast cancer. The data not only highlight the role of religion and family support as essential coping strategies but also emphasize the issues of isolation, aggression, and anger as common responses to chemotherapy. Unique features of this study are women's need to seek spiritual support for their illness and the overriding innate characteristic of maternal responsibility. These cultural features require further analysis and research.

Public policy and risk financing strategies for global catastrophe risk management - the role of global risk initiatives

NASA Astrophysics Data System (ADS)

McSharry, Patrick; Mitchell, Andrew; Anderson, Rebecca

2010-05-01

Decision-makers in both public and private organisations depend on accurate data and scientific understanding to adequately address climate change and the impact of extreme events. The financial impacts of catastrophes on populations and infrastructure can be offset through effective risk transfer mechanisms, structured to reflect the specific perils and levels of exposure to be covered. Optimal strategies depend on the likely socio-econonomic impact, the institutional framework, the overall objectives of the covers placed and the level of both the frequency and severity of loss potential expected. The diversity of approaches across different countries has been documented by the Spanish "Consorcio de Compensación de Seguros". We discuss why international public/private partnerships are necessary for addressing the risk of natural catastrophes. International initiatives such as the Global Earthquake Model (GEM) and the World Forum of Catastrophe Programmes (WFCP) can provide effective guidelines for constructing natural catastrophe schemes. The World Bank has been instrumental in the creation of many of the existing schemes such as the Turkish Catastrophe Insurance Pool, the Caribbean Catastrophe Risk Insurance Facility and the Mongolian Index-Based Livestock Insurance Program. We review existing schemes and report on best practice in relation to providing protection against natural catastrophe perils. The suitability of catastrophe modelling approaches to support schemes across the world are discussed and we identify opportunities to improve risk assessment for such schemes through transparent frameworks for quantifying, pricing, sharing and financing catastrophe risk on a local and global basis.

The impact of innovation intermediary on knowledge transfer

NASA Astrophysics Data System (ADS)

Lin, Min; Wei, Jun

2018-07-01

Many firms have opened up their innovation process and actively transfer knowledge with external partners in the market of technology. To reduce some of the market inefficiencies, more and more firms collaborate with innovation intermediaries. In light of the increasing importance of intermediary in the context of open innovation, we in this paper systematically investigate the effect of innovation intermediary on knowledge transfer and innovation process in networked systems. We find that the existence of innovation intermediary is conducive to the knowledge diffusion and facilitate the knowledge growth at system level. Interestingly, the scale of the innovation intermediary has little effect on the growth of knowledge. We further investigate the selection of intermediary members by comparing four selection strategies: random selection, initial knowledge level based selection, absorptive capability based selection, and innovative ability based selection. It is found that the selection strategy based on innovative ability outperforms all the other strategies in promoting the system knowledge growth. Our study provides a theoretical understanding of the impact of innovation intermediary on knowledge transfer and sheds light on the design and selection of innovation intermediary in open innovation.

A work observation study of nuclear medicine technologists: interruptions, resilience and implications for patient safety.

PubMed

Larcos, George; Prgomet, Mirela; Georgiou, Andrew; Westbrook, Johanna

2017-06-01

Errors by nuclear medicine technologists during the preparation of radiopharmaceuticals or at other times can cause patient harm and may reflect the impact of interruptions, busy work environments and deficient systems or processes. We aimed to: (a) characterise the rate and nature of interruptions technologists experience and (b) identify strategies that support safety. We performed 100 hours of observation of 11 technologists at a major public hospital and measured the proportions of time spent in eight categories of work tasks, location of task, interruption rate and type and multitasking (tasks conducted in parallel). We catalogued specific safety-oriented strategies used by technologists. Technologists completed 5227 tasks and experienced 569 interruptions (mean, 4.5 times per hour; 95% CI 4.1 to 4.9). The highest interruption rate occurred when technologists were in transit between rooms (10.3 per hour (95% CI 8.3 to 12.5)). Interruptions during radiopharmaceutical preparation occurred a mean of 4.4 times per hour (95% CI 3.3 to 5.6). Most (n=426) tasks were interrupted once only and all tasks were resumed after interruption. Multitasking occurred 16.6% of the time. At least some interruptions were initiated by other technologists to convey important information and/or to render assistance. Technologists employed a variety of verbal and non-verbal strategies in all work areas (notably in the hot-lab) to minimise the impact of interruptions and optimise the safe conduct of procedures. Although most were due to individual choices, some strategies reflected overt or subliminal departmental policy. Some interruptions appear beneficial. Technologists' self-initiated strategies to support safe work practices appear to be an important element in supporting a resilient work environment in nuclear medicine. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Developing Teaching Strategies in the EHR Era: A Survey of GME Experts.

PubMed

Atwater, Amber R; Rudd, Mariah; Brown, Audrey; Wiener, John S; Benjamin, Robert; Lee, W Robert; Rosdahl, Jullia A

2016-10-01

There is limited information on the impact of widespread adoption of the electronic health record (EHR) on graduate medical education (GME). To identify areas of consensus by education experts, where the use of EHR impacts GME, with the goal of developing strategies and tools to enhance GME teaching and learning in the EHR environment. Information was solicited from experienced US physician educators who use EPIC EHR following 3 steps: 2 rounds of online surveys using the Delphi technique, followed by telephone interviews. The survey contained 3 stem questions and 52 items with Likert-scale responses. Consensus was defined by predetermined cutoffs. A second survey reassessed items for which consensus was not initially achieved. Common themes to improve GME in settings with an EHR were compiled from the telephone interviews. The panel included 19 physicians in 15 states in Round 1, 12 in Round 2, and 10 for the interviews. Ten items were found important for teaching and learning: balancing focus on EHR documentation with patient engagement achieved 100% consensus. Other items achieving consensus included adequate learning time, balancing EHR data with verbal history and physical examination, communicating clinical thought processes, hands-on EHR practice, minimizing data repetition, and development of shortcuts and templates. Teaching strategies incorporating both online software and face-to-face solutions were identified during the interviews. New strategies are needed for effective teaching and learning of residents and fellows, capitalizing on the potential of the EHR, while minimizing any unintended negative impact on medical education.

Impact of Soil Moisture Initialization on Seasonal Weather Prediction

NASA Technical Reports Server (NTRS)

Koster, Randal D.; Suarez, Max J.; Houser, Paul (Technical Monitor)

2002-01-01

The potential role of soil moisture initialization in seasonal forecasting is illustrated through ensembles of simulations with the NASA Seasonal-to-Interannual Prediction Project (NSIPP) model. For each boreal summer during 1997-2001, we generated two 16-member ensembles of 3-month simulations. The first, "AMIP-style" ensemble establishes the degree to which a perfect prediction of SSTs would contribute to the seasonal prediction of precipitation and temperature over continents. The second ensemble is identical to the first, except that the land surface is also initialized with "realistic" soil moisture contents through the continuous prior application (within GCM simulations leading up to the start of the forecast period) of a daily observational precipitation data set and the associated avoidance of model drift through the scaling of all surface prognostic variables. A comparison of the two ensembles shows that soil moisture initialization has a statistically significant impact on summertime precipitation and temperature over only a handful of continental regions. These regions agree, to first order, with regions that satisfy three conditions: (1) a tendency toward large initial soil moisture anomalies, (2) a strong sensitivity of evaporation to soil moisture, and (3) a strong sensitivity of precipitation to evaporation. The degree to which the initialization improves forecasts relative to observations is mixed, reflecting a critical need for the continued development of model parameterizations and data analysis strategies.

Risk Scan: A Review of Risk Assessment Capability and Maturity within the Canadian Safety and Security Program

DTIC Science & Technology

2014-06-01

SCADA / ICS Cyber Test Lab initiated in 2013 Psychosocial – academic research exists,; opportunity for sharing and developing impact assessment...ecosystems and species at risk), accidents / system failure (rail; pipelines ; ferries CSSP strategy for the North Focus on regional l(and local) problem...Guidance; business planning; environmental scan; proposal evaluation; and performance measurement Program Risk Management – Guidelines for project

Science and Technology Investment Strategy for Squadron Level Training

DTIC Science & Technology

1993-05-01

be derived from empirically sound and theory -based instructional models. Cmment. The automation of instructional design could favorably impact the...require a significant amount of time to develop and where the underlying theory and/or applications hardware and software is ht flux. Long-term efforts...training or training courses. It does not refer to the initial evaluation of individuals entering Upgrade Training ( UGT ). It Am refer to the evaluation of

WE-H-BRB-02: Where Do We Stand in the Applications of Big Data in Radiation Oncology?

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

Xing, L.

Big Data in Radiation Oncology: (1) Overview of the NIH 2015 Big Data Workshop, (2) Where do we stand in the applications of big data in radiation oncology?, and (3) Learning Health Systems for Radiation Oncology: Needs and Challenges for Future Success The overriding goal of this trio panel of presentations is to improve awareness of the wide ranging opportunities for big data impact on patient quality care and enhancing potential for research and collaboration opportunities with NIH and a host of new big data initiatives. This presentation will also summarize the Big Data workshop that was held at themore » NIH Campus on August 13–14, 2015 and sponsored by AAPM, ASTRO, and NIH. The workshop included discussion of current Big Data cancer registry initiatives, safety and incident reporting systems, and other strategies that will have the greatest impact on radiation oncology research, quality assurance, safety, and outcomes analysis. Learning Objectives: To discuss current and future sources of big data for use in radiation oncology research To optimize our current data collection by adopting new strategies from outside radiation oncology To determine what new knowledge big data can provide for clinical decision support for personalized medicine L. Xing, NIH/NCI Google Inc.« less

WE-H-BRB-00: Big Data in Radiation Oncology

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

NONE

Big Data in Radiation Oncology: (1) Overview of the NIH 2015 Big Data Workshop, (2) Where do we stand in the applications of big data in radiation oncology?, and (3) Learning Health Systems for Radiation Oncology: Needs and Challenges for Future Success The overriding goal of this trio panel of presentations is to improve awareness of the wide ranging opportunities for big data impact on patient quality care and enhancing potential for research and collaboration opportunities with NIH and a host of new big data initiatives. This presentation will also summarize the Big Data workshop that was held at themore » NIH Campus on August 13–14, 2015 and sponsored by AAPM, ASTRO, and NIH. The workshop included discussion of current Big Data cancer registry initiatives, safety and incident reporting systems, and other strategies that will have the greatest impact on radiation oncology research, quality assurance, safety, and outcomes analysis. Learning Objectives: To discuss current and future sources of big data for use in radiation oncology research To optimize our current data collection by adopting new strategies from outside radiation oncology To determine what new knowledge big data can provide for clinical decision support for personalized medicine L. Xing, NIH/NCI Google Inc.« less

WE-H-BRB-03: Learning Health Systems for Radiation Oncology: Needs and Challenges for Future Success

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

McNutt, T.

Big Data in Radiation Oncology: (1) Overview of the NIH 2015 Big Data Workshop, (2) Where do we stand in the applications of big data in radiation oncology?, and (3) Learning Health Systems for Radiation Oncology: Needs and Challenges for Future Success The overriding goal of this trio panel of presentations is to improve awareness of the wide ranging opportunities for big data impact on patient quality care and enhancing potential for research and collaboration opportunities with NIH and a host of new big data initiatives. This presentation will also summarize the Big Data workshop that was held at themore » NIH Campus on August 13–14, 2015 and sponsored by AAPM, ASTRO, and NIH. The workshop included discussion of current Big Data cancer registry initiatives, safety and incident reporting systems, and other strategies that will have the greatest impact on radiation oncology research, quality assurance, safety, and outcomes analysis. Learning Objectives: To discuss current and future sources of big data for use in radiation oncology research To optimize our current data collection by adopting new strategies from outside radiation oncology To determine what new knowledge big data can provide for clinical decision support for personalized medicine L. Xing, NIH/NCI Google Inc.« less

Adapting to Climate Change in the Great Lakes Region: The Wisconsin Initiative on Climate Change Impacts

NASA Astrophysics Data System (ADS)

Vimont, D.; Liebl, D.

2012-12-01

The mission of the Wisconsin Initiative on Climate Change Impacts (WICCI; http://www.wicci.wisc.edu) is to assess the impacts of climate change on Wisconsin's natural, human, and built environments; and to assist in developing, recommending, and implementing climate adaptation strategies in Wisconsin. WICCI originated in 2007 as a partnership between the University of Wisconsin Nelson Institute and the Wisconsin Department of Natural Resources, and has since grown to include numerous other state, public, and private institutions. In 2011, WICCI released its First Assessment Report, which documents the efforts of over 200 individuals around the state in assessing vulnerability and estimating the risk that regional climate change poses to Wisconsin. The success of WICCI as an organization can be traced to its existence as a partnership between academic and state institutions, and as a boundary organization that catalyzes cross-disciplinary efforts between science and policy. WICCI's organizational structure and its past success at assessing climate impacts in Wisconsin will be briefly discussed. As WICCI moves into its second phase, it is increasing its emphasis on the second part of its mission: development, and implementation of adaptation strategies. Towards these goals WICCI has expanded its organizational structure to include a Communications and Outreach Committee that further ensures a necessary two-way communication of information between stakeholders / decision makers, and scientific efforts. WICCI is also increasing its focus on place-based efforts that include climate change information as one part of an integrated effort at sustainable development. The talk will include a discussion of current outreach and education efforts, as well as future directions for WICCI efforts.

Reducing the social gradient in smoking: initiatives in the United Kingdom.

PubMed

Murray, Rachael L; McNeill, Ann

2012-07-01

To describe initiatives aiming to reduce the social gradient of smoking in the UK. A description of government initiatives to support smokers from low socioeconomic and other key groups, including National Health Service Stop Smoking Services and how they are seeking to support smokers to quit. The UK is employing a number of strategies to reduce smoking prevalence and is currently top of the Tobacco Control Scale in Europe but the health gap does not yet appear to be decreasing (in relation to smoking prevalence in deprived and higher income groups). More recently, efforts have been made to target smokers in more deprived groups to draw more of these smokers into the quitting process. While Stop Smoking Services are a key part of the UK's comprehensive tobacco control strategy and are reaching smokers from low socioeconomic groups, wider population strategies, such as ensuring all contacts with health-care professionals include advice to stop and the prohibition of remaining channels of tobacco marketing, are required to maximise the impact on deprived smokers. While smoking prevalence decreases among the general population are important, reducing smoking among disadvantaged groups is imperative to reduce health inequalities. It is too soon to say whether the new measures recently adopted in the UK will help to achieve this. © 2012 Australasian Professional Society on Alcohol and other Drugs.

Dissemination and implementation: INQRI's potential impact.

PubMed

Titler, Marita G; Wilson, Deleise S; Resnick, Barbara; Shever, Leah L

2013-04-01

Application of research evidence in care delivery improves patient outcomes. Large gaps still exist, however, between recommended care and that used in practice. To increase the understanding of implementation studies, and dissemination of research findings, we present the perspective of investigators from seven Interdisciplinary Nursing Quality Research Initiative (INQRI)-funded studies. To describe implementation strategies, challenges, and lessons learned from conducting 5 INQRI-funded implementation studies, and present 2 case examples of other INQRI studies to illustrate dissemination strategies. Potential impact of study findings are set forth. Qualitative descriptive methods were used for the implementation studies. Case examples were set forth by investigators using reflection questions. Four of the 5 implementation studies focused on clinical topics and 1 on professional development of nurse managers, 4 were multisite studies. Common implementation strategies used across studies addressed education, ongoing interaction with sites, use of implementation tools, and visibility of the projects on the study units. Major challenges were the Institutional Review Board approval process and the short length of time allocated for implementation. Successes and lessons learned included creating excitement about research, packaging of study tools and resources for use by other organizations, and understanding the importance of context when conducting this type of research. Case examples revealed that study findings have been disseminated to study sites and to the health care community through publications and presentations. The potential impact of all 7 studies is far reaching. This study captures several nuanced perspectives from 5 Principal Investigators, who were completing INQRI-funded implementation studies. These nuanced perspectives are important lessons for other scientists embarking on implementation studies. The INQRI case examples illustrate important dissemination strategies and impact of findings on quality of care.

Indigenous Mortality (Revealed): The Invisible Illuminated

PubMed Central

Ring, Ian; Arambula Solomon, Teshia G.; Gachupin, Francine C.; Smylie, Janet; Cutler, Tessa Louise; Waldon, John A.

2015-01-01

Inaccuracies in the identification of Indigenous status and the collection of and access to vital statistics data impede the strategic implementation of evidence-based public health initiatives to reduce avoidable deaths. The impact of colonization and subsequent government initiatives has been commonly observed among the Indigenous peoples of Australia, Canada, New Zealand, and the United States. The quality of Indigenous data that informs mortality statistics are similarly connected to these distal processes, which began with colonization. We discuss the methodological and technical challenges in measuring mortality for Indigenous populations within a historical and political context, and identify strategies for the accurate ascertainment and inclusion of Indigenous people in mortality statistics. PMID:25211754

Strengthening the Effectiveness of State-Level Community Health Worker Initiatives Through Ambulatory Care Partnerships

PubMed Central

Allen, Caitlin; Nell Brownstein, J.; Jayapaul-Philip, Bina; Matos, Sergio; Mirambeau, Alberta

2017-01-01

The transformation of the US health care system and the recognition of the effectiveness of community health workers (CHWs) have accelerated national, state, and local efforts to engage CHWs in the support of vulnerable populations. Much can be learned about how to successfully integrate CHWs into health care teams, how to maximize their impact on chronic disease self-management, and how to strengthen their role as emissaries between clinical services and community resources; we share examples of effective strategies. Ambulatory care staff members are key partners in statewide initiatives to build and sustain the CHW workforce and reduce health disparities. PMID:26049655

Initiative for Molecular Profiling and Advanced Cancer Therapy and challenges in the implementation of precision medicine.

PubMed

Tsimberidou, Apostolia-Maria

In the last decade, breakthroughs in technology have improved our understanding of genomic, transcriptional, proteomic, epigenetic aberrations and immune mechanisms in carcinogenesis. Genomics and model systems have enabled the validation of novel therapeutic strategies. Based on these developments, in 2007, we initiated the IMPACT (Initiative for Molecular Profiling and Advanced Cancer Therapy) study, the first personalized medicine program for patients with advanced cancer at The University of Texas MD Anderson Cancer Center. We demonstrated that in patients referred for Phase I clinical trials, the use of tumor molecular profiling and treatment with matched targeted therapy was associated with encouraging rates of response, progression-free survival and overall survival compared to non-matched therapy. We are currently conducting IMPACT2, a randomized study evaluating molecular profiling and targeted agents in patients with metastatic cancer. Optimization of innovative biomarker-driven clinical trials that include targeted therapy and/or immunotherapeutic approaches for carefully selected patients will accelerate the development of novel drugs and the implementation of precision medicine. Copyright © 2017 Elsevier Inc. All rights reserved.

Impact of a surgical site infection reduction strategy after colorectal resection.

PubMed

Connolly, T M; Foppa, C; Kazi, E; Denoya, P I; Bergamaschi, R

2016-09-01

This study was performed to determine the impact of a surgical site infection (SSI) reduction strategy on SSI rates following colorectal resection. American College of Surgeons National Surgical Quality Improvement Program (NSQIP) data from 2006-14 were utilized and supplemented by institutional review board-approved chart review. The primary end-point was superficial and deep incisional SSI. The inclusion criterion was colorectal resection. The SSI reduction strategy consisted of preoperative (blood glucose, bowel preparation, shower, hair removal), intra-operative (prophylactic antibiotics, antimicrobial incisional drape, wound protector, wound closure technique) and postoperative (wound dressing technique) components. The SSI reduction strategy was prospectively implemented and compared with historical controls (pre-SSI strategy arm). Statistical analysis included Pearson's chi-square test, and Student's t-test performed with spss software. Of 1018 patients, 379 were in the pre-SSI strategy arm, 311 in the SSI strategy arm and 328 were included to test durability. The study arms were comparable for all measured parameters. Preoperative wound class, operation time, resection type and stoma creation did not differ significantly. The SSI strategy arm demonstrated a significant decrease in overall SSI rates (32.19% vs 18.97%) and superficial SSI rates (23.48% vs 8.04%). Deep SSI and organ space rates did not differ. A review of patients testing durability demonstrated continued improvement in overall SSI rates (8.23%). The implementation of an SSI reduction strategy resulted in a 41% decrease in SSI rates following colorectal resection over its initial 3 years, and its durability as demonstrated by continuing improvement was seen over an additional 2 years. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

Medical equipment management strategies.

PubMed

Wang, Binseng; Furst, Emanuel; Cohen, Ted; Keil, Ode R; Ridgway, Malcolm; Stiefel, Robert

2006-01-01

Clinical engineering professionals need to continually review and improve their management strategies in order to keep up with improvements in equipment technology, as well as with increasing expectations of health care organizations. In the last 20 years, management strategies have evolved from the initial obsession with electrical safety to flexible criteria that fit the individual institution's needs. Few hospitals, however, are taking full advantage of the paradigm shift offered by the evolution of joint Commission standards. The focus should be on risks caused by equipment failure, rather than on equipment with highest maintenance demands. Furthermore, it is not enough to consider risks posed by individual pieces of equipment to individual patients. It is critical to anticipate the impact of an equipment failure on larger groups of patients, especially when dealing with one of a kind, sophisticated pieces of equipment that are required to provide timely and accurate diagnoses for immediate therapeutic decisions or surgical interventions. A strategy for incorporating multiple criteria to formulate appropriate management strategies is provided in this article.

The long-term outcomes of four alternative treatment strategies for primary open-angle glaucoma.

PubMed

van Gestel, Aukje; Webers, Carroll A; Severens, Johan L; Beckers, Henny J; Jansonius, Nomdo M; Hendrikse, Fred; Schouten, Jan S

2012-02-01

To evaluate the long-term effects and costs of four treatment strategies for primary open-angle glaucoma compared to usual care. Cost-effectiveness analyses with a lifelong horizon were made from a societal perspective. Data were generated with a patient-level model based on discrete event simulation. The model structure and parameter estimates were based on literature, particularly clinical studies on the natural course of glaucoma and the effect of treatment. We simulated heterogeneous cohorts of 3000 patients and explored the impact of uncertainty with sensitivity analyses. The incremental cost-effectiveness ratio (ICER) of initial treatment with a prostaglandin analogue compared with a β-blocker was €12.931 per quality-adjusted life year (QALY) gained. A low initial target pressure (15 mmHg) resulted in 0.115 QALYs gained and €1550 saved compared to a gradual decrease from 21 to 15 mmHg upon progression. Visual field (VF) measurements every 6 rather than 12 months lead to health gains at increased costs (ICER €173,486 per QALY gained), whereas measurements every 24 months lead to health losses at reduced costs (ICER €21,516 per QALY lost). All treatment strategies were dominant over 'withholding treatment'. From a cost-effectiveness point of view, it seems advantageous to aim for a low intraocular pressure in all glaucoma patients. The feasibility of this strategy should therefore be investigated. Additionally, the cost-effectiveness outcomes of initiating monotherapy with a prostaglandin analogue and reducing the frequency of VF testing may be acceptable. © 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.

The Enzyme Function Initiative.

PubMed

Gerlt, John A; Allen, Karen N; Almo, Steven C; Armstrong, Richard N; Babbitt, Patricia C; Cronan, John E; Dunaway-Mariano, Debra; Imker, Heidi J; Jacobson, Matthew P; Minor, Wladek; Poulter, C Dale; Raushel, Frank M; Sali, Andrej; Shoichet, Brian K; Sweedler, Jonathan V

2011-11-22

The Enzyme Function Initiative (EFI) was recently established to address the challenge of assigning reliable functions to enzymes discovered in bacterial genome projects; in this Current Topic, we review the structure and operations of the EFI. The EFI includes the Superfamily/Genome, Protein, Structure, Computation, and Data/Dissemination Cores that provide the infrastructure for reliably predicting the in vitro functions of unknown enzymes. The initial targets for functional assignment are selected from five functionally diverse superfamilies (amidohydrolase, enolase, glutathione transferase, haloalkanoic acid dehalogenase, and isoprenoid synthase), with five superfamily specific Bridging Projects experimentally testing the predicted in vitro enzymatic activities. The EFI also includes the Microbiology Core that evaluates the in vivo context of in vitro enzymatic functions and confirms the functional predictions of the EFI. The deliverables of the EFI to the scientific community include (1) development of a large-scale, multidisciplinary sequence/structure-based strategy for functional assignment of unknown enzymes discovered in genome projects (target selection, protein production, structure determination, computation, experimental enzymology, microbiology, and structure-based annotation), (2) dissemination of the strategy to the community via publications, collaborations, workshops, and symposia, (3) computational and bioinformatic tools for using the strategy, (4) provision of experimental protocols and/or reagents for enzyme production and characterization, and (5) dissemination of data via the EFI's Website, http://enzymefunction.org. The realization of multidisciplinary strategies for functional assignment will begin to define the full metabolic diversity that exists in nature and will impact basic biochemical and evolutionary understanding, as well as a wide range of applications of central importance to industrial, medicinal, and pharmaceutical efforts. © 2011 American Chemical Society

Feasibility of reaching world health organization targets for hepatitis C and the cost-effectiveness of alternative strategies.

PubMed

Wisløff, T; White, R; Dalgard, O; Amundsen, E J; Meijerink, H; Kløvstad, H

2018-04-06

New drugs for treating hepatitis C have considerably increased the probability of being cured. Treatment uptake, however, is still low. The objectives of this study were to analyse the impact of initiatives that may increase the proportion of infected people on treatment and interventions aimed at reducing the incidence of new infection among people who inject drugs. A compartmental model for Norway was used to simulate hepatitis C and related complications. We analysed 2 different screening initiatives aimed to increase the proportion of infected people on treatment. Interventions aiming at reducing the hepatitis C incidence analysed were opioid substitution therapy (OST), a clean needle and syringe programme and a combination of both. The most cost-effective strategy for increasing hepatitis C treatment uptake was screening by general practitioners while simultaneously allowing for all infected people to be treated. We estimated that this intervention reduces the incidence of hepatitis C by 2030 by 63% compared with the current incidence. The 2 harm reduction strategies both reduced the incidence of hepatitis C by about 70%. Combining an increase in the current clean needles and syringe programme with OST was clearly the most cost-effective option. This strategy would reduce the incidence of hepatitis C by 80% compared with the current incidence by 2030. Thus, interventions to reduce the burden and spread of hepatitis C are cost-effective. Reaching the WHO target of a 90% reduction in hepatitis C incidence by 2030 may be difficult without combining different initiatives. © 2018 The Authors. Journal of Viral Hepatitis Published by John Wiley & Sons Ltd.

Montana BioDiesel Initiative

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

Peyton, Brent

This initiative funding helped put Montana State University (MSU) in a position to help lead in the development of biodiesel production strategies. Recent shortages in electrical power and rising gasoline prices have focused much attention on the development of alternative energy sources that will end our dependence on fossil fuels. In addition, as the concern for environmental impact of utilizing fossil fuels increases, effective strategies must be implemented to reduce emissions or the increased regulations imposed on fossil fuel production will cause economic barriers for their use to continue to increase. Biodiesel has been repeatedly promoted as a more environmentallymore » sound and renewable source of fuel and may prove to be a highly viable solution to provide, at the least, a proportion of our energy needs. Currently there are both practical and economic barriers to the implementation of alternative energy however the advent of these technologies is inevitable. Since many of the same strategies for the storage, transport, and utilization of biodiesel are common with that of fossil fuels, the practical barriers for biodiesel are comparatively minimal. Strategies were developed to harness the CO 2 as feedstock to support the growth of biodiesel producing algae. The initiative funding led to the successful funding of highly rated projects in competitive national grant programs in the National Science Foundation and the Department of Energy. This funding put MSU in a key position to develop technologies to utilize the CO 2 rich emissions produced in fossil fuel utilization and assembled world experts concerning the growth characteristics of photosynthetic microorganisms capable of producing biodiesel.« less

Evaluating the Role and Contribution of Innovation to Health and Wealth in the UK: A Review of Innovation, Health and Wealth: Phase 1 Final Report.

PubMed

Bienkowska-Gibbs, Teresa; Exley, Josephine; Saunders, Catherine L; Marjanovic, Sonja; Chataway, Joanna; MacLure, Calum; McDonald, Ruth; Ling, Tom

2016-06-20

The Department of Health's Innovation, Health and Wealth (IHW) strategy aimed to introduce a more strategic approach to the spread of innovation across the NHS. This study represents the first phase of a three-year evaluation and aims to map progress towards the IHW strategy and its component actions. This evaluation used a combination of quantitative and qualitative methods: document review, key informant interviews and stakeholder survey. This study also forms the basis for selecting case studies for phase two of the evaluation. Our findings from the interviews and survey suggest broad stakeholder support for the overarching ambitions of the IHW strategy. However, we found variable progress towards the overarching objectives of the eight IHW themes and an ambiguous relationship between many of the themes' objectives and their actions. It was difficult to assess progress on IHW's actions as commitment to the actions, implementation guidance and expected outcomes of the actions were not clearly articulated. The Academic Health Science Networks (AHSNs) and the Small Business Research Initiative (SBRI) were reported to be working well, which may be attributed to their clear structures of accountability and earmarked budgets. However, survey respondents and interviewees raised concerns that budgetary pressures may limit the impact of both AHSNs and the SBRI. The main challenges identified for ongoing action were the resources available for their implementation (e.g. Medtech Briefings), lack of awareness of the initiative (e.g. the NICE Implementation Collaborative) and the design of the actions (e.g. the Innovation Scorecard, web portal and High Impact Innovations).

Hazard-Rate Analysis and Patterns of Recurrence in Early Stage Melanoma: Moving towards a Rationally Designed Surveillance Strategy

PubMed Central

Scheri, Randall P.; Pruitt, Scott K.; Herndon, James E.; Marcello, Jennifer; Tyler, Douglas S.; Abernethy, Amy P.

2013-01-01

Background While curable at early stages, few treatment options exist for advanced melanoma. Currently, no consensus exists regarding the optimal surveillance strategy for patients after resection. The objectives of this study were to identify patterns of metastatic recurrence, to determine the influence of metastatic site on survival, and to identify high-risk periods for recurrence. Methods A retrospective review of the Duke Melanoma Database from 1970 to 2004 was conducted that focused on patients who were initially diagnosed without metastatic disease. The time to first recurrence was computed from the date of diagnosis, and the associated hazard function was examined to determine the peak risk period of recurrence. Metastatic sites were coded by the American Joint Committee on Cancer (AJCC) system including local skin, distant skin and nodes (M1a), lung (M1b), and other distant (M1c). Results Of 11,615 patients initially diagnosed without metastatic disease, 4616 (40%) had at least one recurrence. Overall the risk of initial recurrence peaked at 12 months. The risk of initial recurrence at the local skin, distant skin, and nodes peaked at 8 months, and the risk at lung and other distant sites peaked at 24 months. Patients with a cutaneous or nodal recurrence had improved survival compared to other recurrence types. Conclusions The risk of developing recurrent melanoma peaked at one year, and the site of first recurrence had a significant impact on survival. Defining the timing and expected patterns of recurrence will be important in creating an optimized surveillance strategy for this patient population. PMID:23516415

Living with constipation--older people's experiences and strategies with constipation before and during hospitalization.

PubMed

Munch, Lene; Tvistholm, Nina; Trosborg, Ingelise; Konradsen, Hanne

2016-01-01

Constipation is a common problem among older people. This study aimed to explore how older patients experience constipation and which strategies they used in handling the condition before and during hospitalization. A qualitative exploratory research design was used. Fourteen semi-structured interviews were conducted with patients (61-91 years of age) during hospitalization. Data were analyzed by using content analysis. Themes concerning experiences were Bodily signs and symptoms of constipation; the participants described severe pain during constipation, as well as pronounced relief after bowel movements, Impact on well-being and social activities; being constipated negatively impacted their mood and limited social activities, Striving for bowel balance; the participants experienced an ongoing strive for balancing between constipation and diarrhea. Themes related to strategies were Struggling to find a solution; they were aware of different strategies to prevent and treat constipation, though the most common solution described was the use of laxatives, Wait and see; the participants were awaiting to take action until they experienced constipation symptoms, Constipation is a private problem being challenged during hospitalization; constipation was considered a private issue rarely discussed with health-care professionals. This study illuminates the need for health-care professionals to be attentive to this issue and initiate the conversation with patients in order to advise on the management of constipation.

Linking Federal, State, and Local Adaptation Strategies in New York (Invited)

NASA Astrophysics Data System (ADS)

Rosenzweig, C.

2010-12-01

New York City and New York State are leaders in adaptation in the U.S. In 2008 Mayor Bloomberg convened the NYC Climate Change Adaptation Task Force and the New York City Panel on Climate Change (NPCC). Also in 2008, the New York State Energy Research and Development Authority (NYSERDA) initiated the Integrated Assessment for Effective Climate Change Adaptation Strategies (ClimAID), to provide New York State decision-makers with cutting-edge information on its vulnerability to climate change and to facilitate the development of adaptation strategies informed by both local experience and scientific knowledge. The two efforts are working together to develop effective adaptation strategies across multiple jurisdictions. The New York Task Force consists of approximate 40 city, state, and federal agencies, regional public authorities, and private companies that operate, maintain, or regulate critical infrastructure in the region. The NPCC consisted of climate change and impacts scientists, and legal, insurance, and risk-management experts and served as the technical advisory body for the Mayor and the Task Force on issues related to climate change, impacts, and adaptation. In its 2010 report, the NPCC recommended adoption of a risk-based approach to climate change; creation of a monitoring program to track and analyze key climate change factors, impacts, and adaptation indicators; review of relevant standards and codes; inclusion of multiple layers of government and a wide range of public and private stakeholder experts to build buy-in; and formation of crucial partnerships for development of coordinated adaptation strategies. The task now is for these partnerships to create pilot programs that move adaptation from the planning phase to implementation; urban areas can provide critical ‘test-beds’ for such efforts.

Communication technologies to improve HPV vaccination initiation and completion: A systematic review.

PubMed

Francis, Diane B; Cates, Joan R; Wagner, Kyla P Garrett; Zola, Tracey; Fitter, Jenny E; Coyne-Beasley, Tamera

2017-07-01

This systematic review examines the effectiveness of communication technology interventions on HPV vaccination initiation and completion. A comprehensive search strategy was used to identify existing randomized controlled trials testing the impact of computer-, mobile- or internet-based interventions on receipt of any dose of the HPV vaccine. Twelve relevant studies were identified with a total of 38,945 participants. The interventions were delivered using several different methods, including electronic health record (i.e. recall/reminder) prompts, text messaging, automated phone calls, interactive computer videos, and email. Vaccine initiation and completion was greater for technology-based studies relative to their control conditions. There is evidence that interventions utilizing communication technologies as their sole or primary mode for HPV vaccination intervention delivery may increase vaccination coverage. Communication technologies hold much promise for the future of HPV vaccination efforts, especially initiatives in practice-based settings. Copyright © 2017 Elsevier B.V. All rights reserved.

Leadership initiatives to disseminate the institute of medicine's future of nursing report.

PubMed

Folan, Patricia; Tarraza, Marianne DeCain; Delaney, Margaret; Fardellone, Christine; Leners, Colleen; Ross, Erin; Fitzpatrick, Joyce J

2012-02-01

This article discusses the critical role professional nurses will play and the tremendous impact nursing education and leadership development will have on the future of health care, as outlined in the recommendations of the Institute of Medicine's report, "The future of nursing: Leading change, and advancing health." Six doctorate of nursing practice students from Case Western Reserve University analyzed the Institute of Medicine (IOM) report and developed projects to disseminate key components to selected organizations. The students developed two primary initiatives. One initiative involved presenting the report to various professional organizations, including a local chapter of an international honor society, a specialty organization, and a health care organization. The second initiative included interviewing several nurse leaders within a large multihospital health system, and a nursing leader in academia to determine (a) the level of awareness about the IOM report and (b) strategies these leaders have implemented or envisioned to address the report recommendations.

Impact of Soil Moisture Assimilation on Land Surface Model Spin-Up and Coupled LandAtmosphere Prediction

NASA Technical Reports Server (NTRS)

Santanello, Joseph A., Jr.; Kumar, Sujay V.; Peters-Lidard, Christa D.; Lawston, P.

2016-01-01

Advances in satellite monitoring of the terrestrial water cycle have led to a concerted effort to assimilate soil moisture observations from various platforms into offline land surface models (LSMs). One principal but still open question is that of the ability of land data assimilation (LDA) to improve LSM initial conditions for coupled short-term weather prediction. In this study, the impact of assimilating Advanced Microwave Scanning Radiometer for EOS (AMSR-E) soil moisture retrievals on coupled WRF Model forecasts is examined during the summers of dry (2006) and wet (2007) surface conditions in the southern Great Plains. LDA is carried out using NASAs Land Information System (LIS) and the Noah LSM through an ensemble Kalman filter (EnKF) approach. The impacts of LDA on the 1) soil moisture and soil temperature initial conditions for WRF, 2) land-atmosphere coupling characteristics, and 3) ambient weather of the coupled LIS-WRF simulations are then assessed. Results show that impacts of soil moisture LDA during the spin-up can significantly modify LSM states and fluxes, depending on regime and season. Results also indicate that the use of seasonal cumulative distribution functions (CDFs) is more advantageous compared to the traditional annual CDF bias correction strategies. LDA performs consistently regardless of atmospheric forcing applied, with greater improvements seen when using coarser, global forcing products. Downstream impacts on coupled simulations vary according to the strength of the LDA impact at the initialization, where significant modifications to the soil moisture flux- PBL-ambient weather process chain are observed. Overall, this study demonstrates potential for future, higher-resolution soil moisture assimilation applications in weather and climate research.

Socio-Economic Impacts of Space Weather and User Needs for Space Weather Information

NASA Astrophysics Data System (ADS)

Worman, S. L.; Taylor, S. M.; Onsager, T. G.; Adkins, J. E.; Baker, D. N.; Forbes, K. F.

2017-12-01

The 2015 National Space Weather Strategy and Space Weather Action Plan (SWAP) details the activities, outcomes, and timelines to build a "Space Weather Ready Nation." NOAA's Space Weather Prediction Center and Abt Associates are working together on two SWAP initiatives: (1) identifying, describing, and quantifying the socio-economic impacts of moderate and severe space weather; and (2) outreach to engineers and operators to better understand user requirements for space weather products and services. Both studies cover four technological sectors (electric power, commercial aviation, satellites, and GNSS users) and rely heavily on industry input. Findings from both studies are essential for decreasing vulnerabilities and enhancing preparedness.

Disruptive technology: new medical advances are troublesome for even the most successful health systems and innovator health companies.

PubMed

Michaelis, Lawrence; Vaul, Joanne; Chumer, Kathleen; Faul, Maureen; Sheehan, Lisa; DeCerce, Jack

2004-01-01

An independent expert panel conducted a multi-year research/education/advocacy initiative on the impact of the new drug-eluting stent technology. They conclude that this technology represents a "tipping point" in a series of transformative drugs and medical devices, often used in combination, and recommend that healthcare decision makers develop careful, data-based strategies to avoid the disruptiveness of these medical advances.

Progressive Care Nurses Improving Patient Safety by Limiting Interruptions During Medication Administration.

PubMed

Flynn, Fran; Evanish, Julie Q; Fernald, Josephine M; Hutchinson, Dawn E; Lefaiver, Cheryl

2016-08-01

Because of the high frequency of interruptions during medication administration, the effectiveness of strategies to limit interruptions during medication administration has been evaluated in numerous quality improvement initiatives in an effort to reduce medication administration errors. To evaluate the effectiveness of evidence-based strategies to limit interruptions during scheduled, peak medication administration times in 3 progressive cardiac care units (PCCUs). A secondary aim of the project was to evaluate the impact of limiting interruptions on medication errors. The percentages of interruptions and medication errors before and after implementation of evidence-based strategies to limit interruptions were measured by using direct observations of nurses on 2 PCCUs. Nurses in a third PCCU served as a comparison group. Interruptions (P < .001) and medication errors (P = .02) decreased significantly in 1 PCCU after implementation of evidence-based strategies to limit interruptions. Avoidable interruptions decreased 83% in PCCU1 and 53% in PCCU2 after implementation of the evidence-based strategies. Implementation of evidence-based strategies to limit interruptions in PCCUs decreases avoidable interruptions and promotes patient safety. ©2016 American Association of Critical-Care Nurses.

Chronic disease in the Caribbean: strategies to respond to the public health challenge in the region. What can we learn from Jamaica's experience?

PubMed

Ferguson, T S; Tulloch-Reid, M K; Cunningham-Myrie, C A; Davidson-Sadler, T; Copeland, S; Lewis-Fuller, E; Wilks, R J

2011-07-01

With the advent of the epidemiological transition, chronic non-communicable diseases (CNCDs) have emerged as the leading cause of death globally. In this paper we present an overview of the burden of CNCDs in the Caribbean region and use Jamaica as a case-study to review the impact of policy initiatives and interventions implemented in response to the CNCD epidemic. The findings show that while Jamaica has implemented several policy initiatives aimed at stemming the tide of the CNCD epidemic, a comparison of data from two national health and lifestyle surveys conducted in Jamaica in 2000/01 and 2007/08 revealed that there was an increase in the prevalence of intermediate CNCD risk factors such as hypertension and obesity. We therefore present recommended strategies which we believe will enhance the current CNCD response and thus reduce, or at least stem, the current epidemic of CNCDs.

Clinical initiatives linking Japanese and Swedish healthcare resources on cancer studies utilizing Biobank Repositories.

PubMed

Nishimura, Toshihide; Kawamura, Takeshi; Sugihara, Yutaka; Bando, Yasuhiko; Sakamoto, Shigeru; Nomura, Masaharu; Ikeda, Norihiko; Ohira, Tatsuo; Fujimoto, Junichiro; Tojo, Hiromasa; Hamakubo, Takao; Kodama, Tatsuhiko; Andersson, Roland; Fehniger, Thomas E; Kato, Harubumi; Marko-Varga, György

2014-12-01

The Tokyo Medical University Hospital in Japan and the Lund University hospital in Sweden have recently initiated a research program with the objective to impact on patient treatment by clinical disease stage characterization (phenotyping), utilizing proteomics sequencing platforms. By sharing clinical experiences, patient treatment principles, and biobank strategies, our respective clinical teams in Japan and Sweden will aid in the development of predictive and drug related protein biomarkers. Data from joint lung cancer studies are presented where protein expression from Neuro- Endocrine lung cancer (LCNEC) phenotype patients can be separated from Small cell- (SCLC) and Large Cell lung cancer (LCC) patients by deep sequencing and spectral counting analysis. LCNEC, a subtype of large cell carcinoma (LCC), is characterized by neuroendocrine differentiation that small cell lung carcinoma (SCLC) shares. Pre-therapeutic histological distinction between LCNEC and SCLC has so far been problematic, leading to adverse clinical outcome. An establishment of protein targets characteristic of LCNEC is quite helpful for decision of optimal therapeutic strategy by diagnosing individual patients. Proteoform annotation and clinical biobanking is part of the HUPO initiative (http://www.hupo.org) within chromosome 10 and chromosome 19 consortia.

Potential deaths averted in USA by replacing cigarettes with e-cigarettes

PubMed Central

Levy, David T; Borland, Ron; Lindblom, Eric N; Goniewicz, Maciej L; Meza, Rafael; Holford, Theodore R; Yuan, Zhe; Luo, Yuying; O’Connor, Richard J; Niaura, Raymond; Abrams, David B

2018-01-01

Introduction US tobacco control policies to reduce cigarette use have been effective, but their impact has been relatively slow. This study considers a strategy of switching cigarette smokers to e-cigarette use (‘vaping’) in the USA to accelerate tobacco control progress. Methods A Status Quo Scenario, developed to project smoking rates and health outcomes in the absence of vaping, is compared with Substitution models, whereby cigarette use is largely replaced by vaping over a 10-year period. We test an Optimistic and a Pessimistic Scenario, differing in terms of the relative harms of e-cigarettes compared with cigarettes and the impact on overall initiation, cessation and switching. Projected mortality outcomes by age and sex under the Status Quo and E-Cigarette Substitution Scenarios are compared from 2016 to 2100 to determine public health impacts. Findings Compared with the Status Quo, replacement of cigarette by e-cigarette use over a 10-year period yields 6.6 million fewer premature deaths with 86.7 million fewer life years lost in the Optimistic Scenario. Under the Pessimistic Scenario, 1.6 million premature deaths are averted with 20.8 million fewer life years lost. The largest gains are among younger cohorts, with a 0.5 gain in average life expectancy projected for the age 15 years cohort in 2016. Conclusions The tobacco control community has been divided regarding the role of e-cigarettes in tobacco control. Our projections show that a strategy of replacing cigarette smoking with vaping would yield substantial life year gains, even under pessimistic assumptions regarding cessation, initiation and relative harm. PMID:28970328

Taking the Initiative: Risk-Reduction Strategies and Decreased Malpractice Costs.

PubMed

Raper, Steven E; Rose, Deborah; Nepps, Mary Ellen; Drebin, Jeffrey A

2017-11-01

To heighten awareness of attending and resident surgeons regarding strategies for defense against malpractice claims, a series of risk reduction initiatives have been carried out in our Department of Surgery. We hypothesized that emphasis on certain aspects of risk might be associated with decreased malpractice costs. The relative impact of Department of Surgery initiatives was assessed when compared with malpractice experience for the rest of the Clinical Practices of the University of Pennsylvania (CPUP). Surgery and CPUP malpractice claims, indemnity, and expenses were obtained from the Office of General Counsel. Malpractice premium data were obtained from CPUP finance. The Department of Surgery was assessed in comparison with all other CPUP departments. Cost data (yearly indemnity and expenses), and malpractice premiums (total and per physician) were expressed as a percentage of the 5-year mean value preceding implementation of the initiative program. Surgery implemented 38 risk reduction initiatives. Faculty participated in 27 initiatives; house staff participated in 10 initiatives; and advanced practitioners in 1 initiative. Department of Surgery claims were significantly less than CPUP (74.07% vs 81.07%; p < 0.05). The mean yearly indemnity paid by the Department of Surgery was significantly less than that of the other CPUP departments (84.08% vs 122.14%; p < 0.05). Department of Surgery-paid expenses were also significantly less (83.17% vs 104.96%; p < 0.05), and surgical malpractice premiums declined from baseline, but remained significantly higher than CPUP premiums. The data suggest that educating surgeons on malpractice and risk reduction may play a role in decreasing malpractice costs. Additional extrinsic factors may also affect cost data. Emphasis on risk reduction appears to be cumulative and should be part of an ongoing program. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Initial therapeutic strategy of invasive candidiasis for intensive care unit patients: a retrospective analysis from the China-SCAN study.

PubMed

Cui, Na; Wang, Hao; Su, Longxiang; Qiu, Haibo; Li, Ruoyu; Liu, Dawei

2017-01-23

To investigate the impact of initial antifungal therapeutic strategies on the prognosis of invasive Candida infections (ICIs) in intensive care units (ICUs) in China. A total of 306 patients with proven ICIs in the China-SCAN study were analyzed retrospectively. Empiric, pre-emptive, and targeted therapy were adopted based on starting criteria including clinical, microbiological, and other conventional prediction rules. The primary outcome was hospital mortality and the secondary endpoints were duration days in ICU and duration days in hospital. The global responses (clinical and microbiological) at the end of the empirical therapy were also assessed. A total of 268/306 (87.6%) ICI patients received antifungal therapy, including 142/268 (53.0%) initial empirical therapy, 53/268 (19.8%) initial pre-emptive therapy, and 73/268 (27.2%) initial targeted therapy. Compared with the initial empirical antifungal therapy and targeted antifungal therapy, patients with initial pre-emptive antifungal therapy had significantly less clinical remission [11/53 (21.2%) vs. 61/142 (43.3%) vs. 22/73 (30.1%), P = 0.009], higher ICU [26/53 (57.8%) vs. 42/142 (32.2%) vs. 27/73 (43.5%), P = 0.008] and hospital mortality [27/53 (60.0%) vs. 43/142 (32.8%) vs. 29/73 (46.8%), P = 0.004] and more microbiological persistence [9/53 (17.0%) vs. 6/142 (4.2%) vs. 9/73 (12.3%), P = 0.011]. Kaplan-Meier survival analysis revealed that ICI patients with initial pre-emptive antifungal therapy and targeted antifungal therapy were associated with reduced hospital duration compared with patients with initial empirical antifungal therapy after confirmation of fungal infection (log-rank test: P = 0.021). Multivariate regression analysis provided evidence that initial empirical antifungal therapy was an independent predictor for DECREASING the hospital mortality in ICI patients on ICU admission and at ICI diagnosis (odds ratio 0.327, 95% confidence interval 0.160-0.667, P = 0.002; odds ratio 0.351, 95% confidence interval 0.168-0.735, P = 0.006). The initial therapeutic strategy for invasive candidiasis was independently associated with hospital mortality. Prompt empirical antifungal therapy could be critical to decrease early hospital mortality. Clinicaltrials.gov NCT01253954 (retrospectively registration date: December 3, 2010).

The impact of the Baby Friendly Health Initiative in the Australian health care system: a critical narrative review of the evidence.

PubMed

Atchan, Marjorie; Davis, Deborah; Foureur, Maralyn

2013-07-01

Studies have identified that the practices of maternity facilities and health professionals are crucial to women's experience of support and breastfeeding 'success'. The Baby Friendly Hospital Initiative (BFHI) was launched globally in 1991 to protect, promote and support breastfeeding. While a direct causal effect has not been established and critics suggest the rhetoric conflicts with women's lived experiences as new mothers, a positive association between the Initiative and breastfeeding prevalence is apparent. Internationally, impact studies have demonstrated that where the Initiative is well integrated, there is an increase in rates of breastfeeding initiation and, to a lesser extent, duration. In consideration of the known health risks associated with the use of artificial baby milks this would suggest that BFHI implementation and accreditation should be a desirable strategy for committed health facilities. However, a variation in both BFHI uptake and breastfeeding prevalence between nations has been reported. This narrative review critically discusses a variety of issues relevant to the uptake and support of breastfeeding and the BFHI, utilising Australia as a case study. Whilst it enjoys 'in principle' policy support, Australia also suffers from a lack of uniformity in uptake and perception of the benefits of BFHI at all levels of the health system. Australian and international studies have identified similar enablers and barriers to implementation.

Overall impact of speed-related initiatives and factors on crash outcomes.

PubMed

D'Elia, A; Newstead, S; Cameron, M

2007-01-01

From December 2000 until July 2002 a package of speed-related initiatives and factors took place in Victoria, Australia. The broad aim of this study was to evaluate the overall impact of the package on crash outcomes. Monthly crash counts and injury severity proportions were assessed using Poisson and logistic regression models respectively. The model measured the overall effect of the package after adjusting as far as possible for non-speed road safety initiatives and socio-economic factors. The speed-related package was associated with statistically significant estimated reductions in casualty crashes and suggested reductions in injury severity with trends towards increased reductions over time. From December 2000 until July 2002, three new speed enforcement initiatives were implemented in Victoria, Australia. These initiatives were introduced in stages and involved the following key components: More covert operations of mobile speed cameras, including flash-less operations; 50% increase in speed camera operating hours; and lowering of cameras' speed detection threshold. In addition, during the period 2001 to 2002, the 50 km/h General Urban Speed Limit (GUSL) was introduced (January 2001), there was an increase in speed-related advertising including the "Wipe Off 5" campaign, media announcements were made related to the above enforcement initiatives and there was a speeding penalty restructure. The above elements combine to make up a package of speed-related initiatives and factors. The package represents a broad, long term program by Victorian government agencies to reduce speed based on three linked strategies: more intensive Police enforcement of speed limits to deter potential offenders, i.e. the three new speed enforcement initiatives just described - supported by higher penalties; a reduction in the speed limit on local streets throughout Victoria from 60 km/h to 50 km/h; and provision of information using the mass media (television, radio and billboard) to reinforce the benefits of reducing low level speeding - the central message of "Wipe Off 5". These strategies were implemented across the entire state of Victoria with the intention of covering as many road users as possible. This study aimed to evaluate the overall effectiveness of the speed-related package. The study objectives were: to document the increased speed camera activity in each speed limit zone and in Melbourne compared with the rest of Victoria; to evaluate the overall effect on crash outcomes of the package; to account as far as possible for the effect on crash outcomes of non-speed road safety initiatives and socio-economic factors, which would otherwise influence the speed-related package evaluation; and to examine speed trends in Melbourne and on Victorian rural highways, especially the proportions of vehicles travelling at excessive speeds. This paper presents the results of the evaluation of the overall impact on crash outcomes associated with the speed-related package, after adjusting as far as possible for the effect of non-speed road safety initiatives and socio-economic factors. D'Elia, Newstead and Cameron (2007) document the study results in full.

Initial foot contact and related kinematics affect impact loading rate in running.

PubMed

Breine, Bastiaan; Malcolm, Philippe; Van Caekenberghe, Ine; Fiers, Pieter; Frederick, Edward C; De Clercq, Dirk

2017-08-01

This study assessed kinematic differences between different foot strike patterns and their relationship with peak vertical instantaneous loading rate (VILR) of the ground reaction force (GRF). Fifty-two runners ran at 3.2 m · s -1 while we recorded GRF and lower limb kinematics and determined foot strike pattern: Typical or Atypical rearfoot strike (RFS), midfoot strike (MFS) of forefoot strike (FFS). Typical RFS had longer contact times and a lower leg stiffness than Atypical RFS and MFS. Typical RFS showed a dorsiflexed ankle (7.2 ± 3.5°) and positive foot angle (20.4 ± 4.8°) at initial contact while MFS showed a plantar flexed ankle (-10.4 ± 6.3°) and more horizontal foot (1.6 ± 3.1°). Atypical RFS showed a plantar flexed ankle (-3.1 ± 4.4°) and a small foot angle (7.0 ± 5.1°) at initial contact and had the highest VILR. For the RFS (Typical and Atypical RFS), foot angle at initial contact showed the highest correlation with VILR (r = -0.68). The observed higher VILR in Atypical RFS could be related to both ankle and foot kinematics and global running style that indicate a limited use of known kinematic impact absorbing "strategies" such as initial ankle dorsiflexion in MFS or initial ankle plantar flexion in Typical RFS.

Impact of community-based support services on antiretroviral treatment programme delivery and outcomes in resource-limited countries: a synthetic review.

PubMed

Wouters, Edwin; Van Damme, Wim; van Rensburg, Dingie; Masquillier, Caroline; Meulemans, Herman

2012-07-09

Task-shifting to lay community health providers is increasingly suggested as a potential strategy to overcome the barriers to sustainable antiretroviral treatment (ART) scale-up in high-HIV-prevalence, resource-limited settings. The dearth of systematic scientific evidence on the contributory role and function of these forms of community mobilisation has rendered a formal evaluation of the published results of existing community support programmes a research priority. We reviewed the relevant published work for the period from November 2003 to December 2011 in accordance with the guidelines for a synthetic review. ISI Web of Knowledge, Science Direct, BioMed Central, OVID Medline, PubMed, Social Services Abstracts, and Sociological Abstracts and a number of relevant websites were searched. The reviewed literature reported an unambiguous positive impact of community support on a wide range of aspects, including access, coverage, adherence, virological and immunological outcomes, patient retention and survival. Looking at the mechanisms through which community support can impact ART programmes, the review indicates that community support initiatives are a promising strategy to address five often cited challenges to ART scale-up, namely (1) the lack of integration of ART services into the general health system; (2) the growing need for comprehensive care, (3) patient empowerment, (4) and defaulter tracing; and (5) the crippling shortage in human resources for health. The literature indicates that by linking HIV/AIDS-care to other primary health care programmes, by providing psychosocial care in addition to the technical-medical care from nurses and doctors, by empowering patients towards self-management and by tracing defaulters, well-organised community support initiatives are a vital part of any sustainable public-sector ART programme. The review demonstrates that community support initiatives are a potentially effective strategy to address the growing shortage of health workers, and to broaden care to accommodate the needs associated with chronic HIV/AIDS. The existing evidence suggests that community support programmes, although not necessarily cheap or easy, remain a good investment to improve coverage of communities with much needed health services, such as ART. For this reason, health policy makers, managers, and providers must acknowledge and strengthen the role of community support in the fight against HIV/AIDS.

Impact of community-based support services on antiretroviral treatment programme delivery and outcomes in resource-limited countries: a synthetic review

PubMed Central

2012-01-01

Background Task-shifting to lay community health providers is increasingly suggested as a potential strategy to overcome the barriers to sustainable antiretroviral treatment (ART) scale-up in high-HIV-prevalence, resource-limited settings. The dearth of systematic scientific evidence on the contributory role and function of these forms of community mobilisation has rendered a formal evaluation of the published results of existing community support programmes a research priority. Methods We reviewed the relevant published work for the period from November 2003 to December 2011 in accordance with the guidelines for a synthetic review. ISI Web of Knowledge, Science Direct, BioMed Central, OVID Medline, PubMed, Social Services Abstracts, and Sociological Abstracts and a number of relevant websites were searched. Results The reviewed literature reported an unambiguous positive impact of community support on a wide range of aspects, including access, coverage, adherence, virological and immunological outcomes, patient retention and survival. Looking at the mechanisms through which community support can impact ART programmes, the review indicates that community support initiatives are a promising strategy to address five often cited challenges to ART scale-up, namely (1) the lack of integration of ART services into the general health system; (2) the growing need for comprehensive care, (3) patient empowerment, (4) and defaulter tracing; and (5) the crippling shortage in human resources for health. The literature indicates that by linking HIV/AIDS-care to other primary health care programmes, by providing psychosocial care in addition to the technical-medical care from nurses and doctors, by empowering patients towards self-management and by tracing defaulters, well-organised community support initiatives are a vital part of any sustainable public-sector ART programme. Conclusions The review demonstrates that community support initiatives are a potentially effective strategy to address the growing shortage of health workers, and to broaden care to accommodate the needs associated with chronic HIV/AIDS. The existing evidence suggests that community support programmes, although not necessarily cheap or easy, remain a good investment to improve coverage of communities with much needed health services, such as ART. For this reason, health policy makers, managers, and providers must acknowledge and strengthen the role of community support in the fight against HIV/AIDS. PMID:22776682

Measuring the impact of the advanced practitioner role: a practical approach.

PubMed

Neville, Lillian; Swift, Juliette

2012-04-01

This paper aims to illuminate difficulties in evaluating the advanced practitioner role and to offer a practical solution. The advanced practice role has been part of the workforce strategy in the Northwest of England since 2005. However capturing hard evidence of the impact of this role has been problematic. Current restrictions on resources require the provision of evidence of the value of roles and services. Critical analysis of literature has identified challenges in evaluating the advanced practice role. The case study design takes account of current policy initiatives, notably QIPP. There is no common approach to evaluating the role of advanced practitioners. The case study has the potential to be a useful tool to organise evidence of the impact of advanced practitioner roles. Advanced practitioners need to have appropriate knowledge and skills to provide evidence of the impact of their role. There is potential for this work to be applied to other roles across the NHS. Managers need to work in partnership with workforce planners and educationalists to support advanced practitioners to utilise their skills in methods of providing evidence that they do work of value. Clear strategic direction for advanced practitioners is advised as part of the workforce strategy. © 2012 Blackwell Publishing Ltd.

The Journal Impact Factor: Moving Toward an Alternative and Combined Scientometric Approach

PubMed Central

Nurmashev, Bekaidar

2017-01-01

The Journal Impact Factor (JIF) is a single citation metric, which is widely employed for ranking journals and choosing target journals, but is also misused as the proxy of the quality of individual articles and academic achievements of authors. This article analyzes Scopus-based publication activity on the JIF and overviews some of the numerous misuses of the JIF, global initiatives to overcome the ‘obsession’ with impact factors, and emerging strategies to revise the concept of the scholarly impact. The growing number of articles on the JIF, most of which are in English, reflects interest of experts in journal editing and scientometrics toward its uses, misuses, and options to overcome related problems. Solely displaying values of the JIFs on the journal websites is criticized by experts as these average metrics do not reflect skewness of citation distribution of individual articles. Emerging strategies suggest to complement the JIFs with citation plots and alternative metrics, reflecting uses of individual articles in terms of downloads and distribution of related information through social media and networking platforms. It is also proposed to revise the original formula of the JIF calculation and embrace the concept of the impact and importance of individual articles. The latter is largely dependent on ethical soundness of the journal instructions, proper editing and structuring of articles, efforts to promote related information through social media, and endorsements of professional societies. PMID:28049225

The Journal Impact Factor: Moving Toward an Alternative and Combined Scientometric Approach.

PubMed

Gasparyan, Armen Yuri; Nurmashev, Bekaidar; Yessirkepov, Marlen; Udovik, Elena E; Baryshnikov, Aleksandr A; Kitas, George D

2017-02-01

The Journal Impact Factor (JIF) is a single citation metric, which is widely employed for ranking journals and choosing target journals, but is also misused as the proxy of the quality of individual articles and academic achievements of authors. This article analyzes Scopus-based publication activity on the JIF and overviews some of the numerous misuses of the JIF, global initiatives to overcome the 'obsession' with impact factors, and emerging strategies to revise the concept of the scholarly impact. The growing number of articles on the JIF, most of which are in English, reflects interest of experts in journal editing and scientometrics toward its uses, misuses, and options to overcome related problems. Solely displaying values of the JIFs on the journal websites is criticized by experts as these average metrics do not reflect skewness of citation distribution of individual articles. Emerging strategies suggest to complement the JIFs with citation plots and alternative metrics, reflecting uses of individual articles in terms of downloads and distribution of related information through social media and networking platforms. It is also proposed to revise the original formula of the JIF calculation and embrace the concept of the impact and importance of individual articles. The latter is largely dependent on ethical soundness of the journal instructions, proper editing and structuring of articles, efforts to promote related information through social media, and endorsements of professional societies.

Economic Analysis of Veterans Affairs Initiative to Prevent Methicillin-Resistant Staphylococcus aureus Infections.

PubMed

Nelson, Richard E; Stevens, Vanessa W; Khader, Karim; Jones, Makoto; Samore, Matthew H; Evans, Martin E; Douglas Scott, R; Slayton, Rachel B; Schweizer, Marin L; Perencevich, Eli L; Rubin, Michael A

2016-05-01

In an effort to reduce methicillin-resistant Staphylococcus aureus (MRSA) transmission through universal screening and isolation, the Department of Veterans Affairs (VA) launched the National MRSA Prevention Initiative in October 2007. The objective of this analysis was to quantify the budget impact and cost effectiveness of this initiative. An economic model was developed using published data on MRSA hospital-acquired infection (HAI) rates in the VA from October 2007 to September 2010; estimates of the costs of MRSA HAIs in the VA; and estimates of the intervention costs, including salaries of staff members hired to support the initiative at each VA facility. To estimate the rate of MRSA HAIs that would have occurred if the initiative had not been implemented, two different assumptions were made: no change and a downward temporal trend. Effectiveness was measured in life-years gained. The initiative resulted in an estimated 1,466-2,176 fewer MRSA HAIs. The initiative itself was estimated to cost $207 million during this 3-year period, while the cost savings from prevented MRSA HAIs ranged from $27 million to $75 million. The incremental cost-effectiveness ratios ranged from $28,048 to $56,944/life-years. The overall impact on the VA's budget was $131-$179 million. Wide-scale implementation of a national MRSA surveillance and prevention strategy in VA inpatient settings may have prevented a substantial number of MRSA HAIs. Although the savings associated with prevented infections helped offset some but not all of the cost of the initiative, this model indicated that the initiative would be considered cost effective. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

A Supervisor-Targeted Implementation Approach to Promote System Change: The R3 Model.

PubMed

Saldana, Lisa; Chamberlain, Patricia; Chapman, Jason

2016-11-01

Opportunities to evaluate strategies to create system-wide change in the child welfare system (CWS) and the resulting public health impact are rare. Leveraging a real-world, system-initiated effort to infuse the use of evidence-based principles throughout a CWS workforce, a pilot of the R 3 model and supervisor-targeted implementation approach is described. The development of R 3 and its associated fidelity monitoring was a collaboration between the CWS and model developers. Outcomes demonstrate implementation feasibility, strong fidelity scale measurement properties, improved supervisor fidelity over time, and the acceptability and perception of positive change by agency leadership. The value of system-initiated collaborations is discussed.

Deflection by kinetic impact: Sensitivity to asteroid properties

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

Bruck Syal, Megan; Michael Owen, J.; Miller, Paul L.

Impacting an asteroid with a spacecraft traveling at high speed delivers an impulsive change in velocity to the body. In certain circumstances, this strategy could be used to deflect a hazardous asteroid, moving its orbital path off of an Earth-impacting course. However, the efficacy of momentum delivery to asteroids by hypervelocity impact is sensitive to both the impact conditions (particularly velocity) and specific characteristics of the target asteroid. We numerically model asteroid response to kinetic impactors under a wide range of initial conditions, using an Adaptive Smoothed Particle Hydrodynamics code. Impact velocities spanning 1–30 km/s were investigated, yielding, for amore » particular set of assumptions about the modeled target material, a power-law dependence consistent with a velocity-scaling exponent of μ = 0.44. Target characteristics including equation of state, strength model, porosity, rotational state, and shape were varied, and corresponding changes in asteroid response were documented. Moreover, the kinetic-impact momentum-multiplication factor, β, decreases with increasing asteroid cohesion and increasing porosity. Although increased porosity lowers β, larger porosities result in greater deflection velocities, as a consequence of reduced target masses for asteroids of fixed size. Porosity also lowers disruption risk for kinetic impacts near the threshold of disruption. Including fast (P = 2.5 h) and very fast (P = 100 s) rotation did not significantly alter β but did affect the risk of disruption by the impact event. Asteroid shape is found to influence the efficiency of momentum delivery, as local slope conditions can change the orientation of the crater ejecta momentum vector. Our results emphasize the need for asteroid characterization studies to bracket the range of target conditions expected at near-Earth asteroids while also highlighting some of the principal uncertainties associated with the kinetic-impact deflection strategy.« less

Deflection by kinetic impact: Sensitivity to asteroid properties

DOE PAGES

Bruck Syal, Megan; Michael Owen, J.; Miller, Paul L.

2016-05-01

Impacting an asteroid with a spacecraft traveling at high speed delivers an impulsive change in velocity to the body. In certain circumstances, this strategy could be used to deflect a hazardous asteroid, moving its orbital path off of an Earth-impacting course. However, the efficacy of momentum delivery to asteroids by hypervelocity impact is sensitive to both the impact conditions (particularly velocity) and specific characteristics of the target asteroid. We numerically model asteroid response to kinetic impactors under a wide range of initial conditions, using an Adaptive Smoothed Particle Hydrodynamics code. Impact velocities spanning 1–30 km/s were investigated, yielding, for amore » particular set of assumptions about the modeled target material, a power-law dependence consistent with a velocity-scaling exponent of μ = 0.44. Target characteristics including equation of state, strength model, porosity, rotational state, and shape were varied, and corresponding changes in asteroid response were documented. Moreover, the kinetic-impact momentum-multiplication factor, β, decreases with increasing asteroid cohesion and increasing porosity. Although increased porosity lowers β, larger porosities result in greater deflection velocities, as a consequence of reduced target masses for asteroids of fixed size. Porosity also lowers disruption risk for kinetic impacts near the threshold of disruption. Including fast (P = 2.5 h) and very fast (P = 100 s) rotation did not significantly alter β but did affect the risk of disruption by the impact event. Asteroid shape is found to influence the efficiency of momentum delivery, as local slope conditions can change the orientation of the crater ejecta momentum vector. Our results emphasize the need for asteroid characterization studies to bracket the range of target conditions expected at near-Earth asteroids while also highlighting some of the principal uncertainties associated with the kinetic-impact deflection strategy.« less

A map of community-based obesity prevention initiatives in Australia following obesity funding 2009–2013

PubMed Central

Whelan, Jillian; Love, Penny; Romanus, Anne; Pettman, Tahna; Bolton, Kristy; Smith, Erin; Gill, Tim; Coveney, John; Waters, Elizabeth; Allender, Steve

2015-01-01

Abstract Objective: Obesity is the single biggest public health threat to developed and developing economies. In concert with healthy public policy, multi-strategy, multi-level community-based initiatives appear promising in preventing obesity, with several countries trialling this approach. In Australia, multiple levels of government have funded and facilitated a range of community-based obesity prevention initiatives (CBI), heterogeneous in their funding, timing, target audience and structure. This paper aims to present a central repository of CBI operating in Australia during 2013, to facilitate knowledge exchange and shared opportunities for learning, and to guide professional development towards best practice for CBI practitioners. Methods: A comprehensive search of government, non-government and community websites was undertaken to identify CBI in Australia in 2013. This was supplemented with data drawn from available reports, personal communication and key informant interviews. The data was translated into an interactive map for use by preventive health practitioners and other parties. Results: We identified 259 CBI; with the majority (84%) having a dual focus on physical activity and healthy eating. Few initiatives, (n=37) adopted a four-pronged multi-strategy approach implementing policy, built environment, social marketing and/or partnership building. Conclusion: This comprehensive overview of Australian CBI has the potential to facilitate engagement and collaboration through knowledge exchange and information sharing amongst CBI practitioners, funders, communities and researchers. Implications: An enhanced understanding of current practice highlights areas of strengths and opportunities for improvement to maximise the impact of obesity prevention initiatives. PMID:25561083

A map of community-based obesity prevention initiatives in Australia following obesity funding 2009-2013.

PubMed

Whelan, Jillian; Love, Penny; Romanus, Anne; Pettman, Tahna; Bolton, Kristy; Smith, Erin; Gill, Tim; Coveney, John; Waters, Elizabeth; Allender, Steve

2015-04-01

Obesity is the single biggest public health threat to developed and developing economies. In concert with healthy public policy, multi-strategy, multi-level community-based initiatives appear promising in preventing obesity, with several countries trialling this approach. In Australia, multiple levels of government have funded and facilitated a range of community-based obesity prevention initiatives (CBI), heterogeneous in their funding, timing, target audience and structure. This paper aims to present a central repository of CBI operating in Australia during 2013, to facilitate knowledge exchange and shared opportunities for learning, and to guide professional development towards best practice for CBI practitioners. A comprehensive search of government, non-government and community websites was undertaken to identify CBI in Australia in 2013. This was supplemented with data drawn from available reports, personal communication and key informant interviews. The data was translated into an interactive map for use by preventive health practitioners and other parties. We identified 259 CBI; with the majority (84%) having a dual focus on physical activity and healthy eating. Few initiatives, (n=37) adopted a four-pronged multi-strategy approach implementing policy, built environment, social marketing and/or partnership building. This comprehensive overview of Australian CBI has the potential to facilitate engagement and collaboration through knowledge exchange and information sharing amongst CBI practitioners, funders, communities and researchers. An enhanced understanding of current practice highlights areas of strengths and opportunities for improvement to maximise the impact of obesity prevention initiatives. © 2015 Public Health Association of Australia.

Space Station crew safety alternatives study. Volume 2: Threat development

NASA Technical Reports Server (NTRS)

Raasch, R. F.; Peercy, R. L., Jr.; Rockoff, L. A.

1985-01-01

The first 15 years of accumulated space station concepts for initial operational capability (IOC) during the early 1990's were considered. Twenty-five threats to the space station are identified and selected threats addressed as impacting safety criteria, escape and rescue, and human factors safety concerns. Of the 25 threats identified, eight are discussed including strategy options for threat control: fire, biological or toxic contamination, injury/illness, explosion, loss of pressurization, radiation, meteoroid penetration, and debris.

Space station crew safety alternatives study, volume 1

NASA Technical Reports Server (NTRS)

Peercy, R. L., Jr.; Raasch, R. F.; Rockoff, L. A.

1985-01-01

The first 15 years of accumulated space station concepts for initial operational capability (IOC) during the early 1990's were considered. Twenty-five threats to the space station are identified and selected threats addressed as impacting safety criteria, escape and rescue, and human factors safety concerns. Of the 25 threats identified, eight are discussed including strategy options for threat control: fire, biological or toxic contamination, injury/illness, explosion, loss of pressurization, radiation, meteoroid penetration and debris.

Software Impact of Selected En Route ATC Computer Replacement Strategies.

DTIC Science & Technology

1979-12-01

Compare 188 SDG Duplicate Flight Plan Search 558 SDU Amendment Output Initiator 3,094 SHA Heading Angle Correction 22 STB Chained -Table Management 278...communications) 1would be required in both systems. However the uses of MK in the two systems to supply information to the two copies of SBB would be...this, all current use of Commniand Chaining -11- and Program Controlled Interrupts will have to be deleted from the existing 9020 programs. For the

Final Environmental Impact Statement Establishment and Operation of an Intelligence, Surveillance, Reconnaissance, and Strike Capability Andersen Air Force Base, Guam

DTIC Science & Technology

2007-01-01

Mariana Fruit Bat Pup Recruitment at Pati Point Colony; • Brown Tree Snake Interdiction and Control; and • Adaptive Management and Ground Track...establishment of a mitigation monitoring plan and adaptive management program. FUTURE ACTIONS As discussed in the Final EIS, the Air Force recognizes that...would initiate modifications to aircraft ground tracks and profiles over sensitive areas through an adaptive management strategy. This adaptive

Central Asia After 2014

DTIC Science & Technology

2013-11-01

initiated , it may look different in 2012 and beyond. Two factors may be brought to illustrate this. First, after the impact of the 2008 economic crisis...Institute’s (SSI) annual conference on Russia in 2012, go far to explain what the agenda for that rivalry is and how it is likely to influence regional...tran- sited or crossed en route to or from Afghanistan. In ac- cordance with the current strategy, when OEF [Opera- tion ENDURING FREEDOM] ends, U.S

Lunar Dust Characterization for Exploration Life Support Systems

NASA Technical Reports Server (NTRS)

Agui, Juan H.

2007-01-01

Lunar dust effects can have a significant impact on the performance and maintenance of future exploration life support systems. Filtration systems will be challenged by the additional loading from lunar dust, and mitigation technology and strategies have to be adapted to protect sensitive equipment. An initial characterization of lunar dust and simulants was undertaken. The data emphasize the irregular morphology of the dust particles and the frequency dependence of lunar dust layer detachment from shaken surfaces.

WE-H-BRB-01: Overview of the ASTRO-NIH-AAPM 2015 Workshop On Exploring Opportunities for Radiation Oncology in the Era of Big Data

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

Benedict, S.

Big Data in Radiation Oncology: (1) Overview of the NIH 2015 Big Data Workshop, (2) Where do we stand in the applications of big data in radiation oncology?, and (3) Learning Health Systems for Radiation Oncology: Needs and Challenges for Future Success The overriding goal of this trio panel of presentations is to improve awareness of the wide ranging opportunities for big data impact on patient quality care and enhancing potential for research and collaboration opportunities with NIH and a host of new big data initiatives. This presentation will also summarize the Big Data workshop that was held at themore » NIH Campus on August 13–14, 2015 and sponsored by AAPM, ASTRO, and NIH. The workshop included discussion of current Big Data cancer registry initiatives, safety and incident reporting systems, and other strategies that will have the greatest impact on radiation oncology research, quality assurance, safety, and outcomes analysis. Learning Objectives: To discuss current and future sources of big data for use in radiation oncology research To optimize our current data collection by adopting new strategies from outside radiation oncology To determine what new knowledge big data can provide for clinical decision support for personalized medicine L. Xing, NIH/NCI Google Inc.« less

Dealing with the white death: avalanche risk management for traffic routes.

PubMed

Rheinberger, Christoph M; Bründl, Michael; Rhyner, Jakob

2009-01-01

This article discusses mitigation strategies to protect traffic routes from snow avalanches. Up to now, mitigation of snow avalanches on many roads and railways in the Alps has relied on avalanche sheds, which require large initial investments resulting in high opportunity costs. Therefore, avalanche risk managers have increasingly adopted organizational mitigation measures such as warning systems and closure policies instead. The effectiveness of these measures is, however, greatly dependent on human decisions. In this article, we present a method for optimizing avalanche mitigation for traffic routes in terms of both their risk reduction impact and their net benefit to society. First, we introduce a generic framework for assessing avalanche risk and for quantifying the impact of mitigation. This allows for sound cost-benefit comparisons between alternative mitigation strategies. Second, we illustrate the framework with a case study from Switzerland. Our findings suggest that site-specific characteristics of avalanche paths, as well as the economic importance of a traffic route, are decisive for the choice of optimal mitigation strategies. On routes endangered by few avalanche paths with frequent avalanche occurrences, structural measures are most efficient, whereas reliance on organizational mitigation is often the most appropriate strategy on routes endangered by many paths with infrequent or fuzzy avalanche risk. Finally, keeping a traffic route open may be very important for tourism or the transport industry. Hence, local economic value may promote the use of a hybrid strategy that combines organizational and structural measures to optimize the resource allocation of avalanche risk mitigation.

Development and evaluation of addiction treatment programs in Latin America.

PubMed

Marín-Navarrete, Rodrigo; Medina-Mora, María Elena; Pérez-López, Alejandro; Horigian, Viviana E

2018-07-01

The aim of this article is to present a state-of-the-art review of the scientific studies that have evaluated healthcare systems, services and programs for addiction treatment in Latin America. As a secondary aim, this article presents a brief description and analysis of the addiction prevention and treatment resources and programs available in Latin America, based on information from the ATLAS on Substance Use (ATLAS-SU) project led by the WHO. Substance use disorders (SUDs) are among the main causes associated with global burden of disease. Around the world, many initiatives have been proposed to promote policies to reduce substance use and reduce the impact of SUD, including integrating treatments into healthcare systems, increasing access to treatment programs and impacting outcome measures. In Latin America, multiple efforts have been implemented to improve addiction services and programs, although little is known about the impact they have generated. International studies report the availability of strategies and public inicitatives on prevention and treatment of addiction in Latin America. These studies also report established networks of public and private services that include prevention and detoxification programs, outpatient and residential treatment, and also social reintegration initiatives. However, despite these advances, information on the evaluation of the progress, results and impact of these programs is limited.

76 FR 2428 - Request for Public Comment on the Draft National Nanotechnology Initiative Strategy for...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-13

... Nanotechnology Initiative Strategy for Nanotechnology-Related Environmental, Health, and Safety Research AGENCY... the public regarding the draft National Nanotechnology Initiative (NNI) Strategy for Nanotechnology... considered proprietary, personal, sensitive, or confidential. Overview: The National Nanotechnology...

A framework for engaging stakeholders on the management of alien species.

PubMed

Novoa, Ana; Shackleton, Ross; Canavan, Susan; Cybèle, Cathleen; Davies, Sarah J; Dehnen-Schmutz, Katharina; Fried, Jana; Gaertner, Mirijam; Geerts, Sjirk; Griffiths, Charles L; Kaplan, Haylee; Kumschick, Sabrina; Le Maitre, David C; Measey, G John; Nunes, Ana L; Richardson, David M; Robinson, Tamara B; Touza, Julia; Wilson, John R U

2018-01-01

Alien species can have major ecological and socioeconomic impacts in their novel ranges and so effective management actions are needed. However, management can be contentious and create conflicts, especially when stakeholders who benefit from alien species are different from those who incur costs. Such conflicts of interests mean that management strategies can often not be implemented. There is, therefore, increasing interest in engaging stakeholders affected by alien species or by their management. Through a facilitated workshop and consultation process including academics and managers working on a variety of organisms and in different areas (urban and rural) and ecosystems (terrestrial and aquatic), we developed a framework for engaging stakeholders in the management of alien species. The proposed framework for stakeholder engagement consists of 12 steps: (1) identify stakeholders; (2) select key stakeholders for engagement; (3) explore key stakeholders' perceptions and develop initial aims for management; (4) engage key stakeholders in the development of a draft management strategy; (5) re-explore key stakeholders' perceptions and revise the aims of the strategy; (6) co-design general aims, management objectives and time frames with key stakeholders; (7) co-design a management strategy; (8) facilitate stakeholders' ownership of the strategy and adapt as required; and (9) implement the strategy and monitor management actions to evaluate the need for additional or future actions. In case additional management is needed after these actions take place, some extra steps should be taken: (10) identify any new stakeholders, benefits, and costs; (11) monitor engagement; and (12) revise management strategy. Overall, we believe that our framework provides an effective approach to minimize the impact of conflicts created by alien species management. Copyright © 2017 Elsevier Ltd. All rights reserved.

Emotion regulation: exploring the impact of stress and sex

PubMed Central

Kinner, Valerie L.; Het, Serkan; Wolf, Oliver T.

2014-01-01

Emotion regulation is a major prerequisite for adaptive behavior. The capacity to regulate emotions is particularly important during and after the encounter of a stressor. However, the impact of acute stress and its associated neuroendocrine alterations on emotion regulation have received little attention so far. This study aimed to explore how stress-induced cortisol increases affect three different emotion regulation strategies. Seventy two healthy men and women were either exposed to a stressor or a control condition. Subsequently participants viewed positive and negative images and were asked to up- or down-regulate their emotional responses or simultaneously required to solve an arithmetic task (distraction). The factors stress, sex, and strategy were operationalized as between group factors (n = 6 per cell). Stress caused an increase in blood pressure and higher subjective stress ratings. An increase in cortisol was observed in male participants only. In contrast to controls, stressed participants were less effective in distracting themselves from the emotional pictures. The results further suggest that in women stress enhances the ability to decrease negative emotions. These findings characterize the impact of stress and sex on emotion regulation and provide initial evidence that these factors may interact. PMID:25431554

American Society of Clinical Oncology Obesity Initiative: Rationale, Progress, and Future Directions.

PubMed

Ligibel, Jennifer A; Wollins, Dana

2016-12-10

Obesity is increasingly being linked to the risk of developing and dying from cancer. In recognition of the growing contribution of obesity to cancer risk and outcomes, ASCO made obesity and cancer one of its core initiatives in 2014. The goals of this initiative included raising awareness of the relationship between obesity and cancer, providing tools and resources to oncology providers and patients to help encourage conversations regarding weight management in cancer survivors, fostering a robust research agenda, and advocating for access to evidence-based weight management programs for cancer survivors. Efforts to date have included developing patient and provider toolkits focused on weight management and physical activity, publishing a policy statement outlining ASCO's initiatives in this area, and hosting a summit focused on obesity research in cancer populations. As ASCO has defined its priorities in the area of obesity and cancer, it has become increasingly clear that obesity is a problem that extends far beyond its impact on cancer risk and outcomes. Many groups, including those focused on heart disease, diabetes, and endocrinology, have been developing, testing, and implementing obesity prevention and treatment strategies for years. As ASCO moves forward with its obesity initiative, the next steps will focus on forging collaboration with groups working on obesity-related initiatives both within and outside of the field of cancer to learn from their efforts and to partner with them on efforts to increase the education of medical professionals; raising awareness in lay populations regarding the negative health consequences of obesity and effective strategies to foster weight loss; developing collaborative research initiatives; and working together to advocate for the societal changes that will be needed to combat the obesity epidemic in the United States and beyond.

An overview of treatments for obesity in a population with mental illness.

PubMed

Taylor, Valerie H; Stonehocker, Brian; Steele, Margot; Sharma, Arya M

2012-01-01

Obesity is associated with early mortality and has overtaken smoking as the health problem with the greatest impact on quality of life, mortality, and morbidity. Despite public health initiatives and numerous commercial enterprises focusing on weight loss, obesity rates continue to rise. In part, this is because obesity is a multifaceted, complex illness, impacted by numerous social, psychological, and behavioural factors that are unrecognized in most current initiatives. One significant factor associated with obesity is mental illness. While having a psychiatric illness does not make weight gain inevitable, it does often require that additional tools be added to lifestyle recommendations around diet and exercise. The following article reviews the common approaches to obesity management and addresses how these strategies can be implemented in psychiatric care. It is important that health professionals involved in the care of people with a mental illness become familiar with the interventions available to control and treat the obesity epidemic, as this will improve treatment compliance and ultimately lead to improved physical and psychological outcomes.

The effectiveness of the mitigation hierarchy in environmental impact studies on marine ecosystems: A case study in France

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

Jacob, Céline, E-mail: celine.jacob@cefe.cnrs.fr; CREOCEAN, Les Belvédères, Bâtiment B, 128, Avenue de Fès, 34080 Montpellier; Pioch, Sylvain, E-mail: sylvain.pioch@gmail.com

While the development of maritime economic activity is increasingly encouraged, the consideration of its impacts constitutes a real challenge. The limitations of the implementation of the mitigation hierarchy have been widely discussed in scientific literature, yet data on marine biodiversity offset practices remains scarce. In this study, we investigated the use of Environmental Impact Assessments (EIAs) as suitable instruments to achieve the No Net Loss objective. Drawing on a French approach developed for the initial assessment of the European Marine Strategy Framework Directive, we examined the pressures and impacts related to various marine development projects and the effectiveness of themore » mitigation hierarchy in limiting these. An analysis of 55 recent French environmental impact studies showed that only 7% of the proposed measures had the aim of offsetting predicted degradation of sites of remarkable biodiversity. This can be partly explained by the lack of a clear definition of ‘significant impact’, which varies greatly depending on what is impacted, in turn allowing socio-economic activities to benefit more easily from offset. Furthermore, offsetting does not always constitute the final step of the mitigation hierarchy, highlighting the need to reinforce avoidance and reduction steps. Although we acknowledge the role of EIA in mitigating the negative impacts of development projects, synergies with other European marine environmental policies such as the Marine Strategy Framework Directive (MSFD) and the Maritime Spatial Planning directive (MSP) should be developed in order to improve current practices. - Highlights: • Avoidance measures were not well represented in the Environmental Impact Assessments studied. • Few significant residual impacts and measures to offset these were described. • Common biodiversity did not benefit from offset measures. • The equivalency of proposed marine offsets is questionable.« less

Living with constipation—older people's experiences and strategies with constipation before and during hospitalization

PubMed Central

Munch, Lene; Tvistholm, Nina; Trosborg, Ingelise; Konradsen, Hanne

2016-01-01

Background Constipation is a common problem among older people. This study aimed to explore how older patients experience constipation and which strategies they used in handling the condition before and during hospitalization. Methods A qualitative exploratory research design was used. Fourteen semi-structured interviews were conducted with patients (61–91 years of age) during hospitalization. Data were analyzed by using content analysis. Results Themes concerning experiences were Bodily signs and symptoms of constipation; the participants described severe pain during constipation, as well as pronounced relief after bowel movements, Impact on well-being and social activities; being constipated negatively impacted their mood and limited social activities, Striving for bowel balance; the participants experienced an ongoing strive for balancing between constipation and diarrhea. Themes related to strategies were Struggling to find a solution; they were aware of different strategies to prevent and treat constipation, though the most common solution described was the use of laxatives, Wait and see; the participants were awaiting to take action until they experienced constipation symptoms, Constipation is a private problem being challenged during hospitalization; constipation was considered a private issue rarely discussed with health-care professionals. Conclusion This study illuminates the need for health-care professionals to be attentive to this issue and initiate the conversation with patients in order to advise on the management of constipation. PMID:27121271

Transportation Energy Futures Series: Effects of Travel Reduction and Efficient Driving on Transportation: Energy Use and Greenhouse Gas Emissions

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

Porter, C. D.; Brown, A.; DeFlorio, J.

2013-03-01

Since the 1970s, numerous transportation strategies have been formulated to change the behavior of drivers or travelers by reducing trips, shifting travel to more efficient modes, or improving the efficiency of existing modes. This report summarizes findings documented in existing literature to identify strategies with the greatest potential impact. The estimated effects of implementing the most significant and aggressive individual driver behavior modification strategies range from less than 1% to a few percent reduction in transportation energy use and GHG emissions. Combined strategies result in reductions of 7% to 15% by 2030. Pricing, ridesharing, eco-driving, and speed limit reduction/enforcement strategiesmore » are widely judged to have the greatest estimated potential effect, but lack the widespread public acceptance needed to accomplish maximum results. This is one of a series of reports produced as a result of the Transportation Energy Futures (TEF) project, a Department of Energy-sponsored multi-agency project initiated to pinpoint underexplored strategies for abating GHGs and reducing petroleum dependence related to transportation.« less

Transportation Energy Futures Series. Effects of Travel Reduction and Efficient Driving on Transportation. Energy Use and Greenhouse Gas Emissions

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

Porter, C. D.; Brown, A.; DeFlorio, J.

2013-03-01

Since the 1970s, numerous transportation strategies have been formulated to change the behavior of drivers or travelers by reducing trips, shifting travel to more efficient modes, or improving the efficiency of existing modes. This report summarizes findings documented in existing literature to identify strategies with the greatest potential impact. The estimated effects of implementing the most significant and aggressive individual driver behavior modification strategies range from less than 1% to a few percent reduction in transportation energy use and GHG emissions. Combined strategies result in reductions of 7% to 15% by 2030. Pricing, ridesharing, eco-driving, and speed limit reduction/enforcement strategiesmore » are widely judged to have the greatest estimated potential effect, but lack the widespread public acceptance needed to accomplish maximum results. This is one of a series of reports produced as a result of the Transportation Energy Futures (TEF) project, a Department of Energy-sponsored multi-agency project initiated to pinpoint underexplored strategies for abating GHGs and reducing petroleum dependence related to transportation.« less

Comparison of tobacco control scenarios: quantifying estimates of long-term health impact using the DYNAMO-HIA modeling tool.

PubMed

Kulik, Margarete C; Nusselder, Wilma J; Boshuizen, Hendriek C; Lhachimi, Stefan K; Fernández, Esteve; Baili, Paolo; Bennett, Kathleen; Mackenbach, Johan P; Smit, H A

2012-01-01

There are several types of tobacco control interventions/policies which can change future smoking exposure. The most basic intervention types are 1) smoking cessation interventions 2) preventing smoking initiation and 3) implementation of a nationwide policy affecting quitters and starters simultaneously. The possibility for dynamic quantification of such different interventions is key for comparing the timing and size of their effects. We developed a software tool, DYNAMO-HIA, which allows for a quantitative comparison of the health impact of different policy scenarios. We illustrate the outcomes of the tool for the three typical types of tobacco control interventions if these were applied in the Netherlands. The tool was used to model the effects of different types of smoking interventions on future smoking prevalence and on health outcomes, comparing these three scenarios with the business-as-usual scenario. The necessary data input was obtained from the DYNAMO-HIA database which was assembled as part of this project. All smoking interventions will be effective in the long run. The population-wide strategy will be most effective in both the short and long term. The smoking cessation scenario will be second-most effective in the short run, though in the long run the smoking initiation scenario will become almost as effective. Interventions aimed at preventing the initiation of smoking need a long time horizon to become manifest in terms of health effects. The outcomes strongly depend on the groups targeted by the intervention. We calculated how much more effective the population-wide strategy is, in both the short and long term, compared to quit smoking interventions and measures aimed at preventing the initiation of smoking. By allowing a great variety of user-specified choices, the DYNAMO-HIA tool is a powerful instrument by which the consequences of different tobacco control policies and interventions can be assessed.

Comparison of Tobacco Control Scenarios: Quantifying Estimates of Long-Term Health Impact Using the DYNAMO-HIA Modeling Tool

PubMed Central

Kulik, Margarete C.; Nusselder, Wilma J.; Boshuizen, Hendriek C.; Lhachimi, Stefan K.; Fernández, Esteve; Baili, Paolo; Bennett, Kathleen; Mackenbach, Johan P.; Smit, H. A.

2012-01-01

Background There are several types of tobacco control interventions/policies which can change future smoking exposure. The most basic intervention types are 1) smoking cessation interventions 2) preventing smoking initiation and 3) implementation of a nationwide policy affecting quitters and starters simultaneously. The possibility for dynamic quantification of such different interventions is key for comparing the timing and size of their effects. Methods and Results We developed a software tool, DYNAMO-HIA, which allows for a quantitative comparison of the health impact of different policy scenarios. We illustrate the outcomes of the tool for the three typical types of tobacco control interventions if these were applied in the Netherlands. The tool was used to model the effects of different types of smoking interventions on future smoking prevalence and on health outcomes, comparing these three scenarios with the business-as-usual scenario. The necessary data input was obtained from the DYNAMO-HIA database which was assembled as part of this project. All smoking interventions will be effective in the long run. The population-wide strategy will be most effective in both the short and long term. The smoking cessation scenario will be second-most effective in the short run, though in the long run the smoking initiation scenario will become almost as effective. Interventions aimed at preventing the initiation of smoking need a long time horizon to become manifest in terms of health effects. The outcomes strongly depend on the groups targeted by the intervention. Conclusion We calculated how much more effective the population-wide strategy is, in both the short and long term, compared to quit smoking interventions and measures aimed at preventing the initiation of smoking. By allowing a great variety of user-specified choices, the DYNAMO-HIA tool is a powerful instrument by which the consequences of different tobacco control policies and interventions can be assessed. PMID:22384230

Humor as a Communication Strategy in Provider-Patient Communication in a Chronic Care Setting.

PubMed

Schöpf, Andrea C; Martin, Gillian S; Keating, Mary A

2017-02-01

Humor is a potential communication strategy to accomplish various and potentially conflicting consultation goals. We investigated humor use and its reception in diabetes consultations by analyzing how and why humor emerges and its impact on the interaction. We did this by using an interactional sociolinguistics approach. We recorded 50 consultations in an Irish diabetes setting. Analysis of the humor events drew on framework analysis and on concepts from Conversation Analysis and pragmatics. The study also comprised interviews using tape-assisted recall. We identified 10 humor functions and two umbrella functions. A key finding is that most humor is relationship-protecting humor initiated by patients, that is, they voice serious messages and deal with emotional issues through humor. Our findings imply that patients' and providers' awareness of indirect communication strategies needs to be increased. We also recommend that researchers employ varied methods to adequately capture the interactive nature of humor.

Establishing sustainable strategies in urban underground engineering.

PubMed

Curiel-Esparza, Jorge; Canto-Perello, Julian; Calvo, Maria A

2004-07-01

Growth of urban areas, the corresponding increased demand for utility services and the possibility of new types of utility systems are overcrowding near surface underground space with urban utilities. Available subsurface space will continue to diminish to the point where utilidors (utility tunnels) may become inevitable. Establishing future sustainable strategies in urban underground engineering consists of the ability to lessen the use of traditional trenching. There is an increasing interest in utility tunnels for urban areas as a sustainable technique to avoid congestion of the subsurface. One of the principal advantages of utility tunnels is the substantially lower environmental impact compared with common trenches. Implementing these underground facilities is retarded most by the initial cost and management procedures. The habitual procedure is to meet problems as they arise in current practice. The moral imperative of sustainable strategies fails to confront the economic and political conflicts of interest. Municipal engineers should act as a key enabler in urban underground sustainable development.

Structural impact detection with vibro-haptic interfaces

NASA Astrophysics Data System (ADS)

Jung, Hwee-Kwon; Park, Gyuhae; Todd, Michael D.

2016-07-01

This paper presents a new sensing paradigm for structural impact detection using vibro-haptic interfaces. The goal of this study is to allow humans to ‘feel’ structural responses (impact, shape changes, and damage) and eventually determine health conditions of a structure. The target applications for this study are aerospace structures, in particular, airplane wings. Both hardware and software components are developed to realize the vibro-haptic-based impact detection system. First, L-shape piezoelectric sensor arrays are deployed to measure the acoustic emission data generated by impacts on a wing. Unique haptic signals are then generated by processing the measured acoustic emission data. These haptic signals are wirelessly transmitted to human arms, and with vibro-haptic interface, human pilots could identify impact location, intensity and possibility of subsequent damage initiation. With the haptic interface, the experimental results demonstrate that human could correctly identify such events, while reducing false indications on structural conditions by capitalizing on human’s classification capability. Several important aspects of this study, including development of haptic interfaces, design of optimal human training strategies, and extension of the haptic capability into structural impact detection are summarized in this paper.

The impact of privacy protections on recruitment in a multicenter stroke genetics study

PubMed Central

Chen, D.T.; Worrall, B.B.; Brown, R.D.; Brott, T.G.; Kissela, B.M.; Olson, T.S.; Rich, S.S.; Meschia, J.F.

2006-01-01

The authors reviewed the recruitment of stroke-affected sibling pairs using a letter-based, proband-initiated contact strategy. The authors randomly sampled 99 proband enrollment forms (Phase 1) and randomly sampled 50 sibling reply cards (Phase 2). The sibling response rate was 30.6%, for a pedigree response rate of 58%. Of the siblings who replied, 96% authorized further contact. Median time from proband enrollment to pedigree DNA banking, which required 3+ probands, was 134 days. PMID:15728301

Space Station crew safety alternatives study. Volume 4: Appendices

NASA Technical Reports Server (NTRS)

Peercy, R. L., Jr.; Raasch, R. F.; Rockoff, L. A.

1985-01-01

The scope of this study considered the first 15 years of accumulated space station concepts for Initial Operational Capability (10C) during the early 1990's. Twenty-five threats to the space station are identified and selected threats addressed as impacting safety criteria, escape and rescue, and human factors safety concerns. Of the 25 threats identified, eight are discussed including strategy options for threat control: fire, biological or toxic contamination, injury/illness, explosion, loss of pressurization, radiation, meteoroid penetration and debris.

"Initiate-build-operate-transfer"--a strategy for establishing sustainable telemedicine programs in developing countries: initial lessons from the balkans.

PubMed

Latifi, Rifat; Merrell, Ronald C; Doarn, Charles R; Hadeed, George J; Bekteshi, Flamur; Lecaj, Ismet; Boucha, Kathe; Hajdari, Fatmir; Hoxha, Astrit; Koshi, Dashurije; de Leonni Stanonik, Mateja; Berisha, Blerim; Novoberdaliu, Kadri; Imeri, Arben; Weinstein, Ronald S

2009-12-01

Establishing sustainable telemedicine has become a goal of many developing countries around the world. Yet, despite initiatives from a select few individuals and on occasion from various governments, often these initiatives never mature to become sustainable programs. The introduction of telemedicine and e-learning in Kosova has been a pivotal step in advancing the quality and availability of medical services in a region whose infrastructure and resources have been decimated by wars, neglect, lack of funding, and poor management. The concept and establishment of the International Virtual e-Hospital (IVeH) has significantly impacted telemedicine and e-health services in the Balkans. The success of the IVeH in Kosova has led to the development of similar programs in other Balkan countries and other developing countries in the hope of modernizing and improving their healthcare infrastructure. A comprehensive, four-pronged strategy, "Initiate-Build-Operate-Transfer" (IBOT), may be a useful approach in establishing telemedicine and e-health educational services in developing countries. The development strategy, IBOT, used by the IVeH to establish and develop telemedicine programs, was discussed. IBOT includes assessment of healthcare needs of each country, the development of a curriculum and education program, the establishment of a nationwide telemedicine network, and the integration of the telemedicine program into the healthcare infrastructure. The endpoint is the transfer of a sustainable telehealth program to the nation involved. By applying IBOT, a sustainable telemedicine program of Kosova has been established as an effective prototype for telemedicine in the Balkans. Once fully matured, the program will be transitioned to the national Ministry of Health, which ensures the sustainability and ownership of the program. Similar programs are being established in Albania, Macedonia, and other countries around the world. The IBOT model has been effective in creating sustainable telemedicine and e-health integrated programs in the Balkans and may be a good model for establishing such programs in developing countries.

Integrated care pathways for airway diseases (AIRWAYS-ICPs).

PubMed

Bousquet, J; Addis, A; Adcock, I; Agache, I; Agusti, A; Alonso, A; Annesi-Maesano, I; Anto, J M; Bachert, C; Baena-Cagnani, C E; Bai, C; Baigenzhin, A; Barbara, C; Barnes, P J; Bateman, E D; Beck, L; Bedbrook, A; Bel, E H; Benezet, O; Bennoor, K S; Benson, M; Bernabeu-Wittel, M; Bewick, M; Bindslev-Jensen, C; Blain, H; Blasi, F; Bonini, M; Bonini, S; Boulet, L P; Bourdin, A; Bourret, R; Bousquet, P J; Brightling, C E; Briggs, A; Brozek, J; Buhl, R; Bush, A; Caimmi, D; Calderon, M; Calverley, P; Camargos, P A; Camuzat, T; Canonica, G W; Carlsen, K H; Casale, T B; Cazzola, M; Cepeda Sarabia, A M; Cesario, A; Chen, Y Z; Chkhartishvili, E; Chavannes, N H; Chiron, R; Chuchalin, A; Chung, K F; Cox, L; Crooks, G; Crooks, M G; Cruz, A A; Custovic, A; Dahl, R; Dahlen, S E; De Blay, F; Dedeu, T; Deleanu, D; Demoly, P; Devillier, P; Didier, A; Dinh-Xuan, A T; Djukanovic, R; Dokic, D; Douagui, H; Dubakiene, R; Eglin, S; Elliot, F; Emuzyte, R; Fabbri, L; Fink Wagner, A; Fletcher, M; Fokkens, W J; Fonseca, J; Franco, A; Frith, P; Furber, A; Gaga, M; Garcés, J; Garcia-Aymerich, J; Gamkrelidze, A; Gonzales-Diaz, S; Gouzi, F; Guzmán, M A; Haahtela, T; Harrison, D; Hayot, M; Heaney, L G; Heinrich, J; Hellings, P W; Hooper, J; Humbert, M; Hyland, M; Iaccarino, G; Jakovenko, D; Jardim, J R; Jeandel, C; Jenkins, C; Johnston, S L; Jonquet, O; Joos, G; Jung, K S; Kalayci, O; Karunanithi, S; Keil, T; Khaltaev, N; Kolek, V; Kowalski, M L; Kull, I; Kuna, P; Kvedariene, V; Le, L T; Lodrup Carlsen, K C; Louis, R; MacNee, W; Mair, A; Majer, I; Manning, P; de Manuel Keenoy, E; Masjedi, M R; Melen, E; Melo-Gomes, E; Menzies-Gow, A; Mercier, G; Mercier, J; Michel, J P; Miculinic, N; Mihaltan, F; Milenkovic, B; Molimard, M; Momas, I; Montilla-Santana, A; Morais-Almeida, M; Morgan, M; N'Diaye, M; Nafti, S; Nekam, K; Neou, A; Nicod, L; O'Hehir, R; Ohta, K; Paggiaro, P; Palkonen, S; Palmer, S; Papadopoulos, N G; Papi, A; Passalacqua, G; Pavord, I; Pigearias, B; Plavec, D; Postma, D S; Price, D; Rabe, K F; Radier Pontal, F; Redon, J; Rennard, S; Roberts, J; Robine, J M; Roca, J; Roche, N; Rodenas, F; Roggeri, A; Rolland, C; Rosado-Pinto, J; Ryan, D; Samolinski, B; Sanchez-Borges, M; Schünemann, H J; Sheikh, A; Shields, M; Siafakas, N; Sibille, Y; Similowski, T; Small, I; Sola-Morales, O; Sooronbaev, T; Stelmach, R; Sterk, P J; Stiris, T; Sud, P; Tellier, V; To, T; Todo-Bom, A; Triggiani, M; Valenta, R; Valero, A L; Valiulis, A; Valovirta, E; Van Ganse, E; Vandenplas, O; Vasankari, T; Vestbo, J; Vezzani, G; Viegi, G; Visier, L; Vogelmeier, C; Vontetsianos, T; Wagstaff, R; Wahn, U; Wallaert, B; Whalley, B; Wickman, M; Williams, D M; Wilson, N; Yawn, B P; Yiallouros, P K; Yorgancioglu, A; Yusuf, O M; Zar, H J; Zhong, N; Zidarn, M; Zuberbier, T

2014-08-01

The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy and will add value to existing public health knowledge by: 1) proposing a common framework of care pathways for chronic respiratory diseases, which will facilitate comparability and trans-national initiatives; 2) informing cost-effective policy development, strengthening in particular those on smoking and environmental exposure; 3) aiding risk stratification in chronic disease patients, using a common strategy; 4) having a significant impact on the health of citizens in the short term (reduction of morbidity, improvement of education in children and of work in adults) and in the long-term (healthy ageing); 5) proposing a common simulation tool to assist physicians; and 6) ultimately reducing the healthcare burden (emergency visits, avoidable hospitalisations, disability and costs) while improving quality of life. In the longer term, the incidence of disease may be reduced by innovative prevention strategies. AIRWAYSICPs was initiated by Area 5 of the Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing. All stakeholders are involved (health and social care, patients, and policy makers).

Cross-promotional alcohol discounting in Australia's grocery sector: a barrier to initiatives to curb excessive alcohol consumption?

PubMed

Wardle, Jonathan L; Chang, Sungwon

2015-04-01

Excessive alcohol consumption is an increasing issue internationally. Pricing strategies, including discount restrictions, have been identified as one of the most effective policy means by which to reduce heavy alcohol consumption. In Australia, cross-promotional alcohol discounts are increasingly used by supermarket chains as a marketing tool. The purpose of the present study is to provide preliminary data on the nature and extent of cross-promotional alcohol discounting in the Australian grocery sector. A purposive sample of 34 supermarkets in Australia's three largest cities was selected and minor grocery purchases made to uncover the prevalence and level of cross-promotional alcohol discounting. Cross-promotional 'bundled' discounts were very common with 33 of the 34 supermarkets offering a 'two for one' discount on bottles of wine. Even with minor purchases (mean purchase $1.35), the mean value of discounts received was substantial ($16.23). These results appear to be consistent with claims that major supermarket chains are using alcohol discounts as loss leaders to entice new consumers. These strategies are antithetical to public health strategies aimed at reducing excessive alcohol consumption. Further examination of the impact of major retailers on public health initiatives is warranted, particularly in light of increasing retailer concentration. © 2014 Public Health Association of Australia.

Systematic review of zinc fortification trials.

PubMed

Das, Jai K; Kumar, Rohail; Salam, Rehana A; Bhutta, Zulfiqar A

2013-01-01

Zinc is one of the essential trace elements required by the human body as it is present in more than a hundred specific enzymes and serves as an important structural ion in transcription factors. Around one third of the world population lives in countries with a high prevalence of zinc deficiency. Food fortification with zinc seems to be an attractive public health strategy and a number of programs have been initiated, especially in developing countries. We conducted a systematic review to assess the efficacy of zinc fortification. A total of 11 studies with 771 participants were included in our analysis. Zinc fortification was associated with significant improvements in plasma zinc concentrations [standard mean difference (SMD) 1.28, 95% CI 0.56, 2.01] which is a functional indicator of zinc status. Significant improvement was observed for height velocity (SMD 0.52, 95% CI 0.01, 1.04); however, this finding was weak and based on a restricted analysis. Further subgroup analysis showed significant improvement in height velocity among very-low-birth-weight infants (SMD 0.70, 95% CI 0.02, 1.37), while for healthy newborns, the impact was insignificant. Zinc fortification had insignificant impacts on serum alkaline levels, serum copper levels, hemoglobin and weight gain. Although the findings highlight that zinc fortification is associated with an increased serum concentration of the micronutrient, overall evidence of the effectiveness of this approach is limited. Data on pregnant and lactating women is scarce. Large-scale fortification programs with robust impact assessment should be initiated to cover larger populations in all age groups. Mass fortification of zinc may be a cost-effective strategy to overcome zinc deficiency. Copyright © 2013 S. Karger AG, Basel.

Different initiatives across Europe to enhance losartan utilization post generics: impact and implications.

PubMed

Moon, James C; Godman, Brian; Petzold, Max; Alvarez-Madrazo, Samantha; Bennett, Kathleen; Bishop, Iain; Bucsics, Anna; Hesse, Ulrik; Martin, Andrew; Simoens, Steven; Zara, Corinne; Malmström, Rickard E

2014-01-01

There is an urgent need for health authorities across Europe to fully realize potential savings from increased use of generics to sustain their healthcare systems. A variety of strategies were used across Europe following the availability of generic losartan, the first angiotensin receptor blocker (ARB) to be approved and marketed, to enhance its prescribing vs. single-sourced drugs in the class. Demand-side strategies ranged from 100% co-payment for single-sourced ARBs in Denmark to no specific measures. We hypothesized this heterogeneity of approaches would provide opportunities to explore prescribing in a class following patent expiry. Contrast the impact of the different approaches among European countries and regions to the availability of generic losartan to provide future guidance. Retrospective segmented regression analyses applying linear random coefficient models with country specific intercepts and slopes were used to assess the impact of the various initiatives across Europe following the availability of generic losartan. Utilization measured in defined daily doses (DDDs). Price reductions for generic losartan were also measured. Utilization of losartan was over 90% of all ARBs in Denmark by the study end. Multiple measures in Sweden and one English primary care group also appreciably enhanced losartan utilization. Losartan utilization actually fell in some countries with no specific demand-side measures. Considerable differences were seen in the prices of generic losartan. Delisting single-sourced ARBs produced the greatest increase in losartan utilization. Overall, multiple demand-side measures are needed to change physician prescribing habits to fully realize savings from generics. There is no apparent "spill over" effect from one class to another to influence future prescribing patterns even if these are closely related.

Different initiatives across Europe to enhance losartan utilization post generics: impact and implications

PubMed Central

Moon, James C.; Godman, Brian; Petzold, Max; Alvarez-Madrazo, Samantha; Bennett, Kathleen; Bishop, Iain; Bucsics, Anna; Hesse, Ulrik; Martin, Andrew; Simoens, Steven; Zara, Corinne; Malmström, Rickard E.

2014-01-01

Introduction: There is an urgent need for health authorities across Europe to fully realize potential savings from increased use of generics to sustain their healthcare systems. A variety of strategies were used across Europe following the availability of generic losartan, the first angiotensin receptor blocker (ARB) to be approved and marketed, to enhance its prescribing vs. single-sourced drugs in the class. Demand-side strategies ranged from 100% co-payment for single-sourced ARBs in Denmark to no specific measures. We hypothesized this heterogeneity of approaches would provide opportunities to explore prescribing in a class following patent expiry. Objective: Contrast the impact of the different approaches among European countries and regions to the availability of generic losartan to provide future guidance. Methodology: Retrospective segmented regression analyses applying linear random coefficient models with country specific intercepts and slopes were used to assess the impact of the various initiatives across Europe following the availability of generic losartan. Utilization measured in defined daily doses (DDDs). Price reductions for generic losartan were also measured. Results: Utilization of losartan was over 90% of all ARBs in Denmark by the study end. Multiple measures in Sweden and one English primary care group also appreciably enhanced losartan utilization. Losartan utilization actually fell in some countries with no specific demand-side measures. Considerable differences were seen in the prices of generic losartan. Conclusion: Delisting single-sourced ARBs produced the greatest increase in losartan utilization. Overall, multiple demand-side measures are needed to change physician prescribing habits to fully realize savings from generics. There is no apparent “spill over” effect from one class to another to influence future prescribing patterns even if these are closely related. PMID:25339902

Potential deaths averted in USA by replacing cigarettes with e-cigarettes.

PubMed

Levy, David T; Borland, Ron; Lindblom, Eric N; Goniewicz, Maciej L; Meza, Rafael; Holford, Theodore R; Yuan, Zhe; Luo, Yuying; O'Connor, Richard J; Niaura, Raymond; Abrams, David B

2018-01-01

US tobacco control policies to reduce cigarette use have been effective, but their impact has been relatively slow. This study considers a strategy of switching cigarette smokers to e-cigarette use ('vaping') in the USA to accelerate tobacco control progress. A Status Quo Scenario, developed to project smoking rates and health outcomes in the absence of vaping, is compared with Substitution models, whereby cigarette use is largely replaced by vaping over a 10-year period. We test an Optimistic and a Pessimistic Scenario, differing in terms of the relative harms of e-cigarettes compared with cigarettes and the impact on overall initiation, cessation and switching. Projected mortality outcomes by age and sex under the Status Quo and E-Cigarette Substitution Scenarios are compared from 2016 to 2100 to determine public health impacts. Compared with the Status Quo, replacement of cigarette by e-cigarette use over a 10-year period yields 6.6 million fewer premature deaths with 86.7 million fewer life years lost in the Optimistic Scenario. Under the Pessimistic Scenario, 1.6 million premature deaths are averted with 20.8 million fewer life years lost. The largest gains are among younger cohorts, with a 0.5 gain in average life expectancy projected for the age 15 years cohort in 2016. The tobacco control community has been divided regarding the role of e-cigarettes in tobacco control. Our projections show that a strategy of replacing cigarette smoking with vaping would yield substantial life year gains, even under pessimistic assumptions regarding cessation, initiation and relative harm. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Landscape and bio- geochemical strategy for monitoring transformation and reclamation of the soil mining sites

NASA Astrophysics Data System (ADS)

Korobova, Elena

2010-05-01

Sites of active or abandoned mining represent areas of considerable technogenic impact and need scientifically ground organization of their monitoring and reclamation. The strategy of monitoring and reclamation depends on the scale and character of the physical, chemical and biological consequences of the disturbances. The geochemical studies for monitoring and rehabilitation of the career-dump complexes should methodically account of formation of the particular new landforms and the changes in circulation of the remobilized elements of the soil cover. However, the general strategy should account of both the initial and transformed landscape geochemical structure of the area with due regard to the natural and new content of chemical elements in the environmental components. For example the tailings and waste rocks present new geochemical fields with specifically different concentration of chemical elements that cause formation of new geochemical barriers and landscapes. The way of colonization of the newly formed landscapes depends upon the new geochemical features of the technogenic environment and the adaptive ability of local and intrusive flora. The newly formed biogeochemical anomalies need organization of permanent monitoring not only within the anomaly itself but also of its impact zones. Spatial landscape geochemical monitoring combined with bio-geochemical criteria of threshold concentrations seems to be a helpful tool for decision making on reclamation and operation of the soil mining sites to provide a long-term ecologically sustainable development of the impact zone as a whole.

Context-specific energy strategies: coupling energy system visions with feasible implementation scenarios.

PubMed

Trutnevyte, Evelina; Stauffacher, Michael; Schlegel, Matthias; Scholz, Roland W

2012-09-04

Conventional energy strategy defines an energy system vision (the goal), energy scenarios with technical choices and an implementation mechanism (such as economic incentives). Due to the lead of a generic vision, when applied in a specific regional context, such a strategy can deviate from the optimal one with, for instance, the lowest environmental impacts. This paper proposes an approach for developing energy strategies by simultaneously, rather than sequentially, combining multiple energy system visions and technically feasible, cost-effective energy scenarios that meet environmental constraints at a given place. The approach is illustrated by developing a residential heat supply strategy for a Swiss region. In the analyzed case, urban municipalities should focus on reducing heat demand, and rural municipalities should focus on harvesting local energy sources, primarily wood. Solar thermal units are cost-competitive in all municipalities, and their deployment should be fostered by information campaigns. Heat pumps and building refurbishment are not competitive; thus, economic incentives are essential, especially for urban municipalities. In rural municipalities, wood is cost-competitive, and community-based initiatives are likely to be most successful. Thus, the paper shows that energy strategies should be spatially differentiated. The suggested approach can be transferred to other regions and spatial scales.

Averting HIV Infections in New York City: A Modeling Approach Estimating the Future Impact of Additional Behavioral and Biomedical HIV Prevention Strategies

PubMed Central

Kessler, Jason; Myers, Julie E.; Nucifora, Kimberly A.; Mensah, Nana; Kowalski, Alexis; Sweeney, Monica; Toohey, Christopher; Khademi, Amin; Shepard, Colin; Cutler, Blayne; Braithwaite, R. Scott

2013-01-01

Background New York City (NYC) remains an epicenter of the HIV epidemic in the United States. Given the variety of evidence-based HIV prevention strategies available and the significant resources required to implement each of them, comparative studies are needed to identify how to maximize the number of HIV cases prevented most economically. Methods A new model of HIV disease transmission was developed integrating information from a previously validated micro-simulation HIV disease progression model. Specification and parameterization of the model and its inputs, including the intervention portfolio, intervention effects and costs were conducted through a collaborative process between the academic modeling team and the NYC Department of Health and Mental Hygiene. The model projects the impact of different prevention strategies, or portfolios of prevention strategies, on the HIV epidemic in NYC. Results Ten unique interventions were able to provide a prevention benefit at an annual program cost of less than $360,000, the threshold for consideration as a cost-saving intervention (because of offsets by future HIV treatment costs averted). An optimized portfolio of these specific interventions could result in up to a 34% reduction in new HIV infections over the next 20 years. The cost-per-infection averted of the portfolio was estimated to be $106,378; the total cost was in excess of $2 billion (over the 20 year period, or approximately $100 million per year, on average). The cost-savings of prevented infections was estimated at more than $5 billion (or approximately $250 million per year, on average). Conclusions Optimal implementation of a portfolio of evidence-based interventions can have a substantial, favorable impact on the ongoing HIV epidemic in NYC and provide future cost-saving despite significant initial costs. PMID:24058465

Modeling the Potential Economic Impact of the Medicare Comprehensive Care for Joint Replacement Episode-Based Payment Model.

PubMed

Maniya, Omar Z; Mather, Richard C; Attarian, David E; Mistry, Bipin; Chopra, Aneesh; Strickland, Matt; Schulman, Kevin A

2017-11-01

The Medicare program has initiated Comprehensive Care for Joint Replacement (CJR), a bundled payment mandate for lower extremity joint replacements. We sought to determine the degree to which hospitals will invest in care redesign in response to CJR, and to project its economic impacts. We defined 4 potential hospital management strategies to address CJR: no action, light care management, heavy care management, and heavy care management with contracting. For each of 798 hospitals included in CJR, we used hospital-specific volume, cost, and quality data to determine the hospital's economically dominant strategy. We aggregated data to assess the percentage of hospitals pursuing each strategy; savings to the health care system; and costs and percentages of CJR-derived revenues gained or lost for Medicare, hospitals, and postacute care facilities. In the model, 83.1% of hospitals (range 55.0%-100.0%) were expected to take no action in response to CJR, and 16.1% of hospitals (range 0.0%-45.0%) were expected to pursue heavy care management with contracting. Overall, CJR is projected to reduce health care expenditures by 0.5% (range 0.0%-4.1%) or $14 million (range $0-$119 million). Medicare is expected to save 2.2% (range 2.2%-2.2%), hospitals are projected to lose 3.7% (range 4.7% loss to 3.8% gain), and postacute care facilities are expected to lose 6.5% (range 0.0%-12.8%). Hospital administrative costs are projected to increase by $63 million (range $0-$148 million). CJR is projected to have a negligible impact on total health care expenditures for lower extremity joint replacements. Further research will be required to assess the actual care management strategies adopted by CJR hospitals. Copyright © 2017 Elsevier Inc. All rights reserved.

Impact of Neurointensivist Co-management on the Clinical Outcomes of Patients Admitted to a Neurosurgical Intensive Care Unit

PubMed Central

2017-01-01

Limited data are available on improved outcomes after initiation of neurointensivist co-management in neurosurgical intensive care units (NSICUs) in Korea. We evaluated the impact of a newly appointed neurointensivist on the outcomes of neurosurgical patients admitted to an intensive care unit (ICU). This retrospective observational study involved neurosurgical patients admitted to the NSICU at Samsung Medical Center between March 2013 and May 2016. Neurointensivist co-management was initiated in October 1 2014. We compared the outcomes of neurosurgical patients before and after neurointensivist co-management. The primary outcome was ICU mortality. A total of 571 patients were admitted to the NSICU during the study period, 291 prior to the initiation of neurointensivist co-management and 280 thereafter. Intracranial hemorrhage (29.6%) and traumatic brain injury (TBI) (26.6%) were the most frequent reasons for ICU admission. TBI was the most common cause of death (39.0%). There were no significant differences in mortality rates and length of ICU stay before and after co-management. However, the rates of ICU and 30-day mortality among the TBI patients were significantly lower after compared to before initiation of neurointensivist co-management (8.5% vs. 22.9%; P = 0.014 and 11.0% vs. 27.1%; P = 0.010, respectively). Although overall outcomes were not different after neurointensivist co-management, initiation of a strategy of routine involvement of a neurointensivist significantly reduced the ICU and 30-day mortality rates of TBI patients. PMID:28480662

Tobacco tax initiatives to prevent tobacco use: a study of eight statewide campaigns.

PubMed

Nicholl, J

1998-12-15

This article reviews the history of successful and unsuccessful tobacco tax initiatives in eight states in the U. S. since 1988. It addresses the common origins of these initiatives and proposes several strategies for the success of citizen-based initiative campaigns attempting to raise the tobacco excise tax. It explores the impact of tobacco tax increases on youth and discusses why youth consumption is increasing even in the face of rising tobacco taxes. Only 50% of the states in the U. S. can pass tobacco tax increases using the initiative process; the other states require legislative action. Four states have succeeded in passing citizen-sponsored tobacco tax initiatives, whereas two others have failed at the ballot. Efforts in two other states foundered when insufficient signatures were submitted to gain a spot on the ballot. Surveys in all six states in which initiatives were placed on the ballot revealed similar high levels of voter support, but the clearest factor separating winning from losing campaigns was the availability of sufficient financial resources. Other important campaign elements included strong leadership, broad coalitions, experienced legal and political consultants, access to public opinion research, and advance planning.

Effect of unilateral and bilateral use of laterally wedged insoles with arch supports on impact loading in medial knee osteoarthritis.

PubMed

Abd El Megeid Abdallah, Amira Abdallah

2016-04-01

Increased impact loading is implicated in knee osteoarthritis development and progression. This study examined the impact ground reaction force (GRF) peak, its loading rate, its relative timing to stance phase timing, and walking speed during unilateral and bilateral use of laterally wedged insoles with arch supports. Within-subject design. Thirty-three female patients with medial knee osteoarthritis were examined with (unilateral 6° and 11°, and bilateral 0°, 6°, and 11°) and without insole use. Repeated measures MANOVA revealed that the impact force increased significantly in bilateral 11° versus unilateral 6° and without-insole conditions. The loading rate decreased significantly in unilateral 11° versus bilateral 6° insoles. The relative timing increased significantly in each of bilateral 6°, bilateral 11°, and unilateral 11° versus bilateral 0° insoles and in each of bilateral 11° and unilateral 11° versus without-insole condition. There were significant positive correlations between the walking speed and each of the force and loading rate. The Chi-square test revealed insignificant association between the insole condition and the presence of impact forces. Unilateral 11° insoles are capable of reducing impact loading possibly through increasing foot pronation. Walking slowly is another possible strategy to reduce loading. Unilaterally applied 11° laterally wedged insoles are capable of reducing and delaying the initial impact ground reaction forces and reducing their loading rates during walking in patients with medial knee osteoarthritis, thus reducing osteoarthritis progression. Walking slowly could also be used as a strategy to reduce impact loading. © The International Society for Prosthetics and Orthotics 2015.

[The World Initiative for the Eradication of Poliomyelitis: a long road full of pitfalls].

PubMed

Kuss, Jean-Jacques

2011-01-01

The World Initiative for the Eradication of Poliomyelitis (IMEP), launched in 1988, is based on two strategies: mass vaccination with oral polio vaccine (OPV) and surveillance of acute flaccid paralysis (AFP). The disease incidence was reduced by 99%, but eradication, originally scheduled for 2000, has still not been reached in 2010, and four countries continue to be endemic (India, Pakistan, Afghanistan and Nigeria). The obstacles to eradication are the difficulty in reaching all children to be vaccinated, especially in areas of insecurity; the imperfections of OPV--irregular efficacy and genetic instability; and the limitations of surveillance in detecting only the paralytic form of the disease, which often remains asymptomatic. The repeated postponements of the ending of the initiative, which greatly increased the cost of IMEP, spark debate about the actual feasibility of eradication and justification to continue funding in a difficult global economic context, so the initiative remains without significant impact on indicators of the Millennium Goals for Development.

Initial programmatic implementation of WHO option B in Botswana associated with increased projected MTCT.

PubMed

Dryden-Peterson, Scott; Lockman, Shahin; Zash, Rebecca; Lei, Quonhong; Chen, Jennifer Y; Souda, Sajini; Petlo, Chipo; Dintwa, Eldah; Lebelonyane, Refeletswe; Mmalane, Mompati; Shapiro, Roger L

2015-03-01

: Botswana was one of the first African countries to transition from WHO Option A to Option B for prevention of mother-to-child HIV transmission (MTCT). We evaluated the impact of this transition on projected MTCT risk through review of 10,681 obstetric records of HIV-infected women delivering at 6 maternity wards. Compared with Option A, women receiving antenatal care under Option B were more likely to receive combination antiretroviral therapy (ART), adjusted odds ratio (aOR): 2.59 (95% confidence interval: 2.25 to 2.98), but they were also more likely to receive no antenatal antiretrovirals, aOR: 2.10 (95% confidence interval: 1.74 to 2.53). Consequently, initial implementation of Option B was associated with increased projected MTCT at 6 months of age, 3.79% under Option A and 4.69% under Option B (P < 0.001). Successful implementation of Option B or B+ may require that ART can be initiated within antenatal clinics, and novel strategies to remove barriers to rapid ART initiation.

Exploring the role of communications in quality improvement: A case study of the 1000 Lives Campaign in NHS Wales

PubMed Central

Cooper, Andrew; Gray, Jonathon; Willson, Alan; Lines, Chris; McCannon, Joe; McHardy, Karina

2015-01-01

Introduction Effective communication is critical to successful large-scale change. Yet, in our experience, communications strategies are not formally incorporated into quality improvement (QI) frameworks. The 1000 Lives Campaign (‘Campaign’) was a large-scale national QI collaborative that aimed to save an additional 1000 lives and prevent 50 000 episodes of harm in Welsh health care over a 2-year period. We use the Campaign as a case study to describe the development, application, and impact of a communications strategy embedded in a large-scale QI initiative. Methods A comprehensive communications strategy guided communications work during the Campaign. The main aims of the communications strategy were to engage the hearts and minds of frontline National Health Service (NHS) staff in the Campaign and promote their awareness and understanding of specific QI interventions and the wider patient safety agenda. We used qualitative and quantitative measures to monitor communications outputs and assess how the communications strategy influenced awareness and knowledge of frontline NHS staff. Results The communications strategy facilitated clear and consistent framing of Campaign messages and allowed dissemination of information related to the range of QI interventions. It reaffirmed the aim and value of the Campaign to frontline staff, thereby promoting sustained engagement with Campaign activities. The communications strategy also built the profile of the Campaign both internally with NHS organizations across Wales and externally with the media, and played a pivotal role in improving awareness and understanding of the patient safety agenda. Ultimately, outcomes from the communications strategy could not be separated from overall Campaign outcomes. Conclusion and recommendations Systematic and structured communications can support and enhance QI initiatives. From our experience, we developed a ‘communications bundle’ consisting of six core components. We recommend that communications bundles be incorporated into existing QI methodology, though details should be tailored to the specific context and available resource. PMID:25878725

Exploring the role of communications in quality improvement: A case study of the 1000 Lives Campaign in NHS Wales.

PubMed

Cooper, Andrew; Gray, Jonathon; Willson, Alan; Lines, Chris; McCannon, Joe; McHardy, Karina

2015-03-01

Effective communication is critical to successful large-scale change. Yet, in our experience, communications strategies are not formally incorporated into quality improvement (QI) frameworks. The 1000 Lives Campaign ('Campaign') was a large-scale national QI collaborative that aimed to save an additional 1000 lives and prevent 50 000 episodes of harm in Welsh health care over a 2-year period. We use the Campaign as a case study to describe the development, application, and impact of a communications strategy embedded in a large-scale QI initiative. A comprehensive communications strategy guided communications work during the Campaign. The main aims of the communications strategy were to engage the hearts and minds of frontline National Health Service (NHS) staff in the Campaign and promote their awareness and understanding of specific QI interventions and the wider patient safety agenda. We used qualitative and quantitative measures to monitor communications outputs and assess how the communications strategy influenced awareness and knowledge of frontline NHS staff. The communications strategy facilitated clear and consistent framing of Campaign messages and allowed dissemination of information related to the range of QI interventions. It reaffirmed the aim and value of the Campaign to frontline staff, thereby promoting sustained engagement with Campaign activities. The communications strategy also built the profile of the Campaign both internally with NHS organizations across Wales and externally with the media, and played a pivotal role in improving awareness and understanding of the patient safety agenda. Ultimately, outcomes from the communications strategy could not be separated from overall Campaign outcomes. Systematic and structured communications can support and enhance QI initiatives. From our experience, we developed a 'communications bundle' consisting of six core components. We recommend that communications bundles be incorporated into existing QI methodology, though details should be tailored to the specific context and available resource.

Understanding Organizational Learning via Knowledge Management in Government-Link Companies in Malaysia

NASA Astrophysics Data System (ADS)

Helmi, Asleena; Ahmad, Zainal Ariffin; Hung, Daisy Kee Mui

The knowledge management or KM discipline conjures a host of understanding and impact upon the global business community albeit commercially or socially. Regardless of the different approach to KM, it has inarguably brought about changes in viewing the knowledge capabilities and capacities of organizations. Peter Drucker (1998) argued that knowledge has become the key economic resource and the only source of competitive advantage. Hence organizational learning is an integral part of KM initiatives and has been widely practiced in many large organizations and across nations such as Europe, North America and Asia Pacific. Thus, this paper explores the KM initiatives of government link companies (GLCs) in Malaysia via synergizing knowledge strategy and capabilities in order to achieve competitive advantage.

CAP—advancing the evaluation of preclinical Alzheimer disease treatments

PubMed Central

Reiman, Eric M.; Langbaum, Jessica B.; Tariot, Pierre N.; Lopera, Francisco; Bateman, Randall J.; Morris, John C.; Sperling, Reisa A.; Aisen, Paul S.; Roses, Allen D.; Welsh-Bohmer, Kathleen A.; Carrillo, Maria C.; Weninger, Stacie

2016-01-01

If we are to find treatments to postpone, reduce the risk of, or completely prevent the clinical onset of Alzheimer disease (AD), we need faster methods to evaluate promising preclinical AD treatments, new ways to work together in support of common goals, and a determination to expedite the initiation and performance of preclinical AD trials. In this article, we note some of the current challenges, opportunities and emerging strategies in preclinical AD treatment. We describe the Collaboration for Alzheimer’s Prevention (CAP)—a convening, harmonizing and consensus-building initiative to help stakeholders advance AD prevention research with rigour, care and maximal impact—and we demonstrate the impact of CAP on the goals and design of new preclinical AD trials. PMID:26416539

Newborn screening for metabolic disorders: parental perceptions of the initial communication of results.

PubMed

Buchbinder, Mara; Timmermans, Stefan

2012-08-01

Positive newborn screening (NBS) results cause significant parental distress, but little is known about how parents find out about children's screening results and what they are told. This qualitative, exploratory study reports on parents' perceptions of the initial communication of NBS results. Participants included the parents of 75 infants referred to a metabolic clinic in California over a 3-year period (2007-2010). Parents provided information about the initial communication of NBS results during audiotaped clinical encounters and open-ended interviews. Transcripts were analyzed inductively using thematic coding. Responses fell into 3 primary themes: sources of news delivery, providing information, and mitigation strategies. The findings suggest that health care providers have access to a range of communicative resources to buffer the impact of positive screening results that may be mobilized in future interventions. Recommendations for improving the communication process and future research directions are discussed.

Strategies to facilitate implementation and sustainability of large system transformations: a case study of a national program for improving quality of care for elderly people.

PubMed

Nyström, Monica Elisabeth; Strehlenert, Helena; Hansson, Johan; Hasson, Henna

2014-09-18

Large-scale change initiatives stimulating change in several organizational systems in the health and social care sector are challenging both to lead and evaluate. There is a lack of systematic research that can enrich our understanding of strategies to facilitate large system transformations in this sector. The purpose of this study was to examine the characteristics of core activities and strategies to facilitate implementation and change of a national program aimed at improving life for the most ill elderly people in Sweden. The program outcomes were also addressed to assess the impact of these strategies. A longitudinal case study design with multiple data collection methods was applied. Archival data (n = 795), interviews with key stakeholders (n = 11) and non-participant observations (n = 23) were analysed using content analysis. Outcome data was obtained from national quality registries. This study presents an approach for implementing a large national change program that is characterized by initial flexibility and dynamism regarding content and facilitation strategies and a growing complexity over time requiring more structure and coordination. The description of activities and strategies show that the program management team engaged a variety of stakeholders and actor groups and accordingly used a palate of different strategies. The main strategies used to influence change in the target organisations were to use regional improvement coaches, regional strategic management teams, national quality registries, financial incentives and annually revised agreements. Interactive learning sessions, intense communication, monitor and measurements, and active involvement of different experts and stakeholders, including elderly people, complemented these strategies. Program outcomes showed steady progress in most of the five target areas, less so for the target of achieving coordinated care. There is no blue-print on how to approach the challenging task of leading large scale change programs in complex contexts, but our conclusion is that more attention has to be given to the multidimensional strategies that program management need to consider. This multidimensionality comprises different strategies depending on types of actors, system levels, contextual factors, program progress over time, program content, types of learning and change processes, and the conditions for sustainability.

Quantifying Impact of Biofeedstock Production on Hydrology/Water Quality in Midwest USA

NASA Astrophysics Data System (ADS)

Chaubey, Indrajeet; Engel, Bernard; Thomas, Mark; Raj, Cibin; Saraswat, Dharmendra

2010-05-01

The production of biofeedstocks for biofuels is likely to impact the hydrology and water quality of watersheds. Communities potentially impacted are increasingly concerned, and at present, little is known regarding the magnitude of impacts of biofeedstock production on hydrology and water quality. We have initiated a national facilitation project to answer the following questions: What are the unintended environmental consequences of increased corn production to meet biofuel demands? What are the environmental impacts of various second generation biofeedstock production systems to meet cellulosic ethanol demands? Would the management of cropping systems involving corn silage meet cellulosic ethanol demands with minimal environmental impact? What are the broad-scale water quality implications of energy crops, such as switchgrass, grown for bioenergy production on highly erodible soils? This presentation will discuss development of multi-regional agricultural land management practices that can be implemented to mitigate potential negative environmental impacts associated with biofeedstock production while meeting the biofuel production demand. Specifically, we will discuss how watershed scale modeling can be utilized to evaluate the environmental impacts of various biofeedstock production strategies. We will also discuss regional differences in alternative biofeedstock production and associated hydrologic/water quality impacts.

High cost sharing and specialty drug initiation under Medicare Part D: a case study in patients with newly diagnosed chronic myeloid leukemia.

PubMed

Doshi, Jalpa A; Li, Pengxiang; Huo, Hairong; Pettit, Amy R; Kumar, Rishab; Weiss, Brenda M; Huntington, Scott F

2016-03-01

Specialty drugs often offer medical advances but are frequently subject to high cost sharing. This is particularly true with Medicare Part D, where after meeting a deductible, patients without low-income subsidies (non-LIS) typically face 25% to 33% coinsurance (initial coverage phase with "specialty tier" cost sharing), followed by ~50% coinsurance (coverage gap phase), and then 5% coinsurance (catastrophic phase). Yet, no studies have examined the impact of such high cost sharing on specialty drug initiation under Part D. Oral tyrosine kinase inhibitors (TKIs) have revolutionized the treatment of chronic myeloid leukemia (CML), making it an apt case study. A retrospective claims-based analysis utilizing 2011 to 2013 100% Medicare claims. TKI initiation rates and time to initiation were compared between fee-for-service non-LIS Part D patients newly diagnosed with CML and their LIS counterparts who faced nominal cost sharing of ≤ $5. The first 30-day TKI fill "straddled" benefit phases, for a mean out-of-pocket cost of $2600 or more for non-LIS patients. Non-LIS patients were less likely than LIS patients to have a TKI claim within 6 months of diagnosis (45.3% vs 66.9%; P < .001) and those initiating a TKI took twice as long to fill it (mean = 50.9 vs 23.7 days; P < .001). Cox regressions controlling for sociodemographic, clinical, and plan characteristics confirmed descriptive findings (hazard ratio, 0.59; 95% CI, 0.45-0.76). Extensive sensitivity analyses confirmed the robustness of our findings. High cost sharing was associated with reduced and/or delayed initiation of TKIs. We discuss policy strategies to reduce current financial barriers that adversely impact access to critical therapies under Medicare Part D.

Translating evidence into policy for cardiovascular disease control in India

PubMed Central

2011-01-01

Cardiovascular diseases (CVD) are leading causes of premature mortality in India. Evidence from developed countries shows that mortality from these can be substantially prevented using population-wide and individual-based strategies. Policy initiatives for control of CVD in India have been suggested but evidence of efficacy has emerged only recently. These initiatives can have immediate impact in reducing morbidity and mortality. Of the prevention strategies, primordial involve improvement in socioeconomic status and literacy, adequate healthcare financing and public health insurance, effective national CVD control programme, smoking control policies, legislative control of saturated fats, trans fats, salt and alcohol, and development of facilities for increasing physical activity through better urban planning and school-based and worksite interventions. Primary prevention entails change in medical educational curriculum and improved healthcare delivery for control of CVD risk factors-smoking, hypertension, dyslipidemia and diabetes. Secondary prevention involves creation of facilities and human resources for optimum acute CVD care and secondary prevention. There is need to integrate various policy makers, develop effective policies and modify healthcare systems for effective delivery of CVD preventive care. PMID:21306620

Raw materials in the manufacture of biotechnology products: regulatory considerations.

PubMed

Cordoba-Rodriguez, Ruth

2010-01-01

The Food and Drug Administration's Pharmaceutical cGMPs for the 21st Century initiative emphasizes science and risk-based approaches in the manufacture of drugs. These approaches are reflected in the International Conference on Harmonization (ICH) guidances ICH Q8, Q9, and Q10 and encourage a comprehensive assessment of the manufacture of a biologic, including all aspects of manufacture that have the potential to affect the finished drug product. Appropriate assessment and management of raw materials are an important part of this initiative. Ideally, a raw materials program should strive to assess and minimize the risk to product quality. With this in mind, risk-assessment concepts and control strategies will be discussed and illustrated by examples, with an emphasis on the impact of raw materials on cell substrates. Finally, the life cycle of the raw material will be considered, including its potential to affect the drug product life cycle. In this framework, the supply chain and the vendor-manufacturer relationship will be explored as important parts of an adequate raw materials control strategy.

Integration of Palliative Care in the Context of Rapid Response

PubMed Central

Nelson, Judith E.; Mathews, Kusum S.; Weissman, David E.; Brasel, Karen J.; Campbell, Margaret; Curtis, J. Randall; Frontera, Jennifer A.; Gabriel, Michelle; Hays, Ross M.; Mosenthal, Anne C.; Mulkerin, Colleen; Puntillo, Kathleen A.; Ray, Daniel E.; Weiss, Stefanie P.; Bassett, Rick; Boss, Renee D.; Lustbader, Dana R.

2015-01-01

Rapid response teams (RRTs) can effectively foster discussions about appropriate goals of care and address other emergent palliative care needs of patients and families facing life-threatening illness on hospital wards. In this article, The Improving Palliative Care in the ICU (IPAL-ICU) Project brings together interdisciplinary expertise and existing data to address the following: special challenges for providing palliative care in the rapid response setting, knowledge and skills needed by RRTs for delivery of high-quality palliative care, and strategies for improving the integration of palliative care with rapid response critical care. We discuss key components of communication with patients, families, and primary clinicians to develop a goal-directed treatment approach during a rapid response event. We also highlight the need for RRT expertise to initiate symptom relief. Strategies including specific clinician training and system initiatives are then recommended for RRT care improvement. We conclude by suggesting that as evaluation of their impact on other outcomes continues, performance by RRTs in meeting palliative care needs of patients and families should also be measured and improved. PMID:25644909

Economic impact of a modification of the treatment trajectories of patients with end-stage renal disease

PubMed Central

Couchoud, Cécile; Couillerot, Anne-Line; Dantony, Emmanuelle; Elsensohn, Mad-Hélénie; Labeeuw, Michel; Villar, Emmanuel; Ecochard, René; Bongiovanni, Isabelle

2015-01-01

Background This study assumed that some patients currently treated at hospital-based haemodialysis centres can be treated with another renal replacement therapy (RRT) modality without any increase in mortality risk and sought to evaluate the monthly cost impact of replacing hospital-based haemodialysis, for which fees are highest, by different proportions of other modalities. Methods We used a deterministic model tool to predict the outcomes and trajectories of hypothetical cohorts of incident adult end-stage renal disease (ESRD) patients for 15 years of RRT (10 different modalities). Our estimates were based on data from 67 258 patients in the REIN registry and 65 662 patients in the French national health insurance information system. Patients were categorized into six subcohorts, stratified for age and diabetes at ESRD onset, and analyses run for each subcohort. We simulated new strategies of care by changing any or all of the following: initial distributions in treatment modalities, transition rates and some costs. Strategies were classified according to their monthly per-patient cost compared to current practices (cost-minimization analysis). Results Simulations of the status quo for the next 15 years predicted a per-patient monthly cost of €2684 for a patient aged 18–45 years without diabetes and €7361 for one older than 70 years with diabetes. All of the strategies we analysed had monthly per-patient costs lower than the status quo, except for daily home HD. None impaired expected survival. Savings varied by strategy. Conclusions Alternative strategies may well be less expensive than current practices. The decision to implement new strategies must nonetheless consider the number of patients concerned, feasibility of renal care reorganization, and investment costs. It must also take into account the role of patients' choice and the availability of professionals. PMID:26268714

GAR Global Risk Assessment

NASA Astrophysics Data System (ADS)

Maskrey, Andrew; Safaie, Sahar

2015-04-01

Disaster risk management strategies, policies and actions need to be based on evidence of current disaster loss and risk patterns, past trends and future projections, and underlying risk factors. Faced with competing demands for resources, at any level it is only possible to priorities a range of disaster risk management strategies and investments with adequate understanding of realised losses, current and future risk levels and impacts on economic growth and social wellbeing as well as cost and impact of the strategy. The mapping and understanding of the global risk landscape has been greatly enhanced by the latest iteration of the GAR Global Risk Assessment and the objective of this submission is to present the GAR global risk assessment which contributed to Global Assessment Report (GAR) 2015. This initiative which has been led by UNISDR, was conducted by a consortium of technical institutions from around the world and has covered earthquake, cyclone, riverine flood, and tsunami probabilistic risk for all countries of the world. In addition, the risks associated with volcanic ash in the Asia-Pacific region, drought in various countries in sub-Saharan Africa and climate change in a number of countries have been calculated. The presentation will share thee results as well as the experience including the challenges faced in technical elements as well as the process and recommendations for the future of such endeavour.

Drug Target Interference in Immunogenicity Assays: Recommendations and Mitigation Strategies.

PubMed

Zhong, Zhandong Don; Clements-Egan, Adrienne; Gorovits, Boris; Maia, Mauricio; Sumner, Giane; Theobald, Valerie; Wu, Yuling; Rajadhyaksha, Manoj

2017-11-01

Sensitive and specific methodology is required for the detection and characterization of anti-drug antibodies (ADAs). High-quality ADA data enables the evaluation of potential impact of ADAs on the drug pharmacokinetic profile, patient safety, and efficacious response to the drug. Immunogenicity assessments are typically initiated at early stages in preclinical studies and continue throughout the drug development program. One of the potential bioanalytical challenges encountered with ADA testing is the need to identify and mitigate the interference mediated by the presence of soluble drug target. A drug target, when present at sufficiently high circulating concentrations, can potentially interfere with the performance of ADA and neutralizing antibody (NAb) assays, leading to either false-positive or, in some cases, false-negative ADA and NAb assay results. This publication describes various mechanisms of assay interference by soluble drug target, as well as strategies to recognize and mitigate such target interference. Pertinent examples are presented to illustrate the impact of target interference on ADA and NAb assays as well as several mitigation strategies, including the use of anti-target antibodies, soluble versions of the receptors, target-binding proteins, lectins, and solid-phase removal of targets. Furthermore, recommendations for detection and mitigation of such interference in different formats of ADA and NAb assays are provided.

Roadmap for an EArth Defense Initiative (READI)

NASA Astrophysics Data System (ADS)

Burke, J. D.; Hussain, A.; Soni, A.; Johnson-Freese, J.; Faull, J.; Schmidt, N.; Wilson, T.; Thangavelu, M.

2015-12-01

During the 2015 Space Studies Program of the International Space University, a team of thirty-four participants from seventeen countries carried out a team project on the subject of planetary defense against near-Earth object impacts. The READI Project presents the components of a complete architecture representing practical future strategies and methods for protecting our planet and life as we know it. The findings and recommendations of the project are as follows: for detection and tracking, add infrared instruments in space and radar in Earth's southern hemisphere, as well as dedicated ground telescopes and a program for spectroscopic and other characterization of asteroids and comets; for deflection, develop and space-qualify kinetic and nuclear interceptors, as well as long-range laser ablators; for education and outreach, develop programs aimed at the cohort of children aged 6-15 and their parents; and for evacuation and recovery, provide distributed shelters and increased emergency planning. The project recognizes that the enactment of any deflection strategy would require significant international collaboration; thus, we recommend the formation of a Mitigation Action Group (MAG) in addition to the existing organizations IAWN and SMPAG. The MAG should be chartered to recommend deflection strategies to the UN Security Council in the event of an imminent NEO impact and, upon approval, to lead international deflection action.

Hydrodynamic Modeling of the Deep Impact Mission into Comet Tempel 1

NASA Astrophysics Data System (ADS)

Sorli, Kya; Remington, Tané; Bruck Syal, Megan

2018-01-01

Kinetic impact is one of the primary strategies to deflect hazardous objects off of an Earth-impacting trajectory. The only test of a small-body impact is the 2005 Deep Impact mission into comet Tempel 1, where a 366-kg mass impactor collided at ~10 km/s into the comet, liberating an enormous amount of vapor and ejecta. Code comparisons with observations of the event represent an important source of new information about the initial conditions of small bodies and an extraordinary opportunity to test our simulation capabilities on a rare, full-scale experiment. Using the Adaptive Smoothed Particle Hydrodynamics (ASPH) code, Spheral, we explore how variations in target material properties such as strength, composition, porosity, and layering affect impact results, in order to best match the observed crater size and ejecta evolution. Benchmarking against this unique small-body experiment provides an enhanced understanding of our ability to simulate asteroid or comet response to future deflection missions. This work was performed under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA27344. LLNL-ABS-739336-DRAFT.

Sexual Behavior, Risk Compensation, and HIV Prevention Strategies Among Participants in the San Francisco PrEP Demonstration Project: A Qualitative Analysis of Counseling Notes.

PubMed

Carlo Hojilla, J; Koester, Kimberly A; Cohen, Stephanie E; Buchbinder, Susan; Ladzekpo, Deawodi; Matheson, Tim; Liu, Albert Y

2016-07-01

Pre-exposure prophylaxis (PrEP) is a viable HIV prevention strategy but risk compensation could undermine potential benefits. There are limited data that examine this phenomenon outside of clinical trials. We conducted a qualitative analysis of counseling notes from the San Francisco site of the US PrEP demonstration project to assess how men who have sex with men used PrEP as a prevention strategy and its impact on their sexual practices. Four major themes emerged from our analysis of 130 distinct notes associated with 26 participants. Prevention strategy decision-making was dynamic, often influenced by the context and perceived risk of a sexual encounter. Counselors noted that participants used PrEP in conjunction with other health promotion strategies like condoms, asking about HIV status of their sex partners, and seroadaptation. With few exceptions, existing risk reduction strategies were not abandoned upon initiation of PrEP. Risk-taking behavior was 'seasonal' and fluctuations were influenced by various personal, psychosocial, and health-related factors. PrEP also helped relieve anxiety regarding sex and HIV, particularly among serodiscordant partners. Understanding sexual decision-making and how PrEP is incorporated into existing prevention strategies can help inform future PrEP implementation efforts.

Sexual Behavior, Risk Compensation, and HIV Prevention Strategies Among Participants in the San Francisco PrEP Demonstration Project: A Qualitative Analysis of Counseling Notes

PubMed Central

Hojilla, J. Carlo; Koester, Kimberly A.; Cohen, Stephanie E.; Buchbinder, Susan; Ladzekpo, Deawodi; Matheson, Tim; Liu, Albert Y

2015-01-01

Pre-exposure prophylaxis (PrEP) is a viable HIV prevention strategy but risk compensation could undermine potential benefits. There are limited data that examine this phenomenon outside of clinical trials. We conducted a qualitative analysis of counseling notes from the San Francisco site of the US PrEP Demonstration Project to assess how men who have sex with men (MSM) used PrEP as a prevention strategy and its impact on their sexual practices. Four major themes emerged from our analysis of 130 distinct notes associated with 26 participants. Prevention strategy decision-making was dynamic, often influenced by the context and perceived risk of a sexual encounter. Counselors noted that participants used PrEP in conjunction with other health promotion strategies like condoms, asking about HIV status of their sex partners, and seroadaptation. With few exceptions, existing risk reduction strategies were not abandoned upon initiation of PrEP. Risk-taking behavior was ‘seasonal’ and fluctuations were influenced by various personal, psychosocial, and health-related factors. PrEP also helped relieve anxiety regarding sex and HIV, particularly among serodiscordant partners. Understanding sexual decision-making and how PrEP is incorporated into existing prevention strategies can help inform future PrEP implementation efforts. PMID:25835463

High- Versus Low-Gradient Severe Aortic Stenosis: Demographics, Clinical Outcomes, and Effects of the Initial Aortic Valve Replacement Strategy on Long-Term Prognosis.

PubMed

Taniguchi, Tomohiko; Morimoto, Takeshi; Shiomi, Hiroki; Ando, Kenji; Kanamori, Norio; Murata, Koichiro; Kitai, Takeshi; Kawase, Yuichi; Izumi, Chisato; Miyake, Makoto; Mitsuoka, Hirokazu; Kato, Masashi; Hirano, Yutaka; Matsuda, Shintaro; Inada, Tsukasa; Nagao, Kazuya; Murakami, Tomoyuki; Takeuchi, Yasuyo; Yamane, Keiichiro; Toyofuku, Mamoru; Ishii, Mitsuru; Minamino-Muta, Eri; Kato, Takao; Inoko, Moriaki; Ikeda, Tomoyuki; Komasa, Akihiro; Ishii, Katsuhisa; Hotta, Kozo; Higashitani, Nobuya; Kato, Yoshihiro; Inuzuka, Yasutaka; Maeda, Chiyo; Jinnai, Toshikazu; Morikami, Yuko; Saito, Naritatsu; Minatoya, Kenji; Kimura, Takeshi

2017-05-01

There is considerable debate on the management of patients with low-gradient severe aortic stenosis (LG-AS), defined as aortic valve area <1 cm 2 with peak aortic jet velocity ≤4.0 m/s, and mean aortic pressure gradient ≤40 mm Hg. In the CURRENT AS registry (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis), there were 2097 patients (initial aortic valve replacement [AVR] strategy: n=977, and conservative strategy: n=1120) with high-gradient severe aortic stenosis (HG-AS) and 1712 patients (initial AVR strategy: n=219, and conservative strategy: n=1493) with LG-AS. AVR was more frequently performed in HG-AS patients than in LG-AS patients (60% versus 28%) during the entire follow-up. In the comparison between the initial AVR and conservative groups, the propensity score-matched cohorts were developed in both HG-AS (n=887 for each group) and LG-AS (n=218 for each group) strata. The initial AVR strategy when compared with the conservative strategy was associated with markedly lower risk for a composite of aortic valve-related death or heart failure hospitalization in both HG-AS and LG-AS strata (hazard ratio, 0.30; 95% confidence interval, 0.25-0.37; P <0.001 and hazard ratio, 0.46; 95% confidence interval, 0.32-0.67; P <0.001, respectively). Among 1358 patients with LG-AS with preserved left ventricular ejection fraction, the initial AVR strategy was associated with a better outcome than the conservative strategy (adjusted hazard ratio, 0.37; 95% confidence interval, 0.23-0.59; P <0.001). The initial AVR strategy was associated with better outcomes than the conservative strategy in both HG-AS and LG-AS patients, although AVR was less frequently performed in LG-AS patients than in HG-AS patients. The favorable effect of initial AVR strategy was also seen in patients with LG-AS with preserved left ventricular ejection fraction. URL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000012140. © 2017 American Heart Association, Inc.

The experience of acute leukaemia in adult patients: a qualitative thematic synthesis.

PubMed

Papadopoulou, Constantina; Johnston, Bridget; Themessl-Huber, Markus

2013-10-01

The aim of this review was to systematically identify and synthesise all qualitative evidence on how adult patients diagnosed with acute leukaemia experience living with their illness. A systematic search strategy was developed comprising of two search strings: i) acute leukaemia and ii) qualitative methodology. The search strategy was run in seven electronic databases (Medline, CINAHL, PsychINFO, EMBASE, BNI & Archive, SSCI and ASSIA). Nine qualitative studies in adult patients with acute leukaemia, published in peer reviewed journals between 01/1990 and 01/2013 were included in the final sample. The qualitative thematic synthesis resulted in the development of a conceptual model describing a person's path to build a renewed self. Following the initial blow of diagnosis with the range of initial reactions, patients with acute leukaemia are living in a contracting world; they have to deal with the life in hospital, the several losses and the impact of their illness on their emotions and interpersonal relationships. Several factors take up a buffering role at that stage: coping, support, information and hope. Finally, patients accommodate acute leukaemia in their lives through re-evaluating personal values and assigning new meaning to their experience. Results from this thematic synthesis are indicative of the impact of acute leukaemia on patients' lives and the processes they use to make sense and accommodate the illness in their life. Increasing our understanding of these processes is warranted to improve patient care. Copyright © 2013. Published by Elsevier Ltd.

Compassion in practice-Evaluating the awareness, involvement and perceived impact of a national nursing and midwifery strategy amongst healthcare professionals in NHS Trusts in England.

PubMed

O'Driscoll, Mike; Allan, Helen; Liu, Liang; Corbett, Kevin; Serrant, Laura

2018-03-01

To report the findings from an evaluation of the impact of the Compassion in Practice Vision and Strategy (National Health Service England (NHSE), 2012) on nursing, midwifery and care staff. The Compassion in Practice Vision and Strategy was a programme of work to highlight the importance of compassionate care following the Francis Report in 2013 into the deficits in care in an NHS Hospital Trust. It was launched by NHS England in 2012 at a time when fiscal cuts were introduced by the Department of Health in England. Mixed methods. Inferential statistics were used to test whether there were significant differences between staff at different levels of seniority with regard to awareness and involvement in Compassion in Practice Vision and Strategy and their attitudes to it. Awareness and involvement of staff in Compassion in Practice Vision and Strategy were high amongst middle and senior management but limited at ward level. Staff involvement in Compassion in Practice Vision and Strategy was limited due to a lack of awareness. Ward level staff who were aware and involved, perceived a lack of support and communication from senior leadership to deliver the Compassion in Practice Vision and Strategy. Results reveal professional anger, distress and resistance to the Compassion in Practice Vision and Strategy and a view of the programme as a top-down initiative which did not sufficiently recognise structural constraints on nurses' ability to deliver compassionate care. We discuss the implications of our findings for global nursing. Participants emphasised that compassion for patients is only sustainable where there is compassion for staff and many participants felt that they were not being treated with compassion. National Health Service England should strongly affirm that nurses and midwives in general provide compassionate care. Trust leadership should provide support for ward level staff who deliver compassionate care in difficult circumstances. © 2017 John Wiley & Sons Ltd.

OSSE Assessment of Ocean Observing System Enhancements to Improve Coupled Tropical Cyclone Intensity Prediction

NASA Astrophysics Data System (ADS)

Halliwell, G. R., Jr.; Mehari, M. F.; Dong, J.; Kourafalou, V.; Atlas, R. M.; Kang, H.; Le Henaff, M.

2016-02-01

A new ocean OSSE system validated in the tropical/subtropical Atlantic Ocean is used to evaluate ocean observing strategies during the 2014 hurricane season with the goal of improving coupled tropical cyclone forecasts. Enhancements to the existing operational ocean observing system are evaluated prior to two storms, Edouard and Gonzalo, where ocean measurements were obtained during field experiments supported by the 2013 Disaster Relief Appropriation Act. For Gonzalo, a reference OSSE is performed to evaluate the impact of two ocean gliders deployed north and south of Puerto Rico and two Alamo profiling floats deployed in the same general region during most of the hurricane season. For Edouard, a reference OSSE is performed to evaluate impacts of the pre-storm ocean profile survey conducted by NOAA WP-3D aircraft. For both storms, additional OSSEs are then conducted to evaluate more extensive seasonal and pre-storm ocean observing strategies. These include (1) deploying a larger number of synthetic ocean gliders during the hurricane season, (2) deploying pre-storm synthetic thermistor chains or synthetic profiling floats along one or more "picket fence" lines that cross projected storm tracks, and (3) designing pre-storm airborne profiling surveys to have larger impacts than the actual pre-storm survey conducted for Edouard. Impacts are evaluated based on error reduction in ocean parameters important to SST cooling and hurricane intensity such as ocean heat content and the structure of the ocean eddy field. In all cases, ocean profiles that sample both temperature and salinity down to 1000m provide greater overall error reduction than shallower temperature profiles obtained from AXBTs and thermistor chains. Large spatial coverage with multiple instruments spanning a few degrees of longitude and latitude is necessary to sufficiently reduce ocean initialization errors over a region broad enough to significantly impact predicted surface enthalpy flux into the storm. Error reduction in hurricane intensity forecasts resulting from the additional ocean observations is then assessed by initializing the ocean component of the HYCOM-HWRF coupled prediction system with analyses produced by the OSSE system.

Centres for Leadership: a strategy for academic integration.

PubMed

King, Gillian; Parker, Kathryn; Peacocke, Sean; Curran, C J; McPherson, Amy C; Chau, Tom; Widgett, Elaine; Fehlings, Darcy; Milo-Manson, Golda

2017-05-15

Purpose The purpose of this paper is to describe how an Academic Health Science Centre, providing pediatric rehabilitation services, research, and education, developed a Centres for Leadership (CfL) initiative to integrate its academic functions and embrace the goal of being a learning organization. Design/methodology/approach Historical documents, tracked output information, and staff members' insights were used to describe the ten-year evolution of the initiative, its benefits, and transformational learnings for the organization. Findings The evolutions concerned development of a series of CfLs, and changes over time in leadership and management structure, as well as in operations and targeted activities. Benefits included enhanced clinician engagement in research, practice-based research, and impacts on clinical practice. Transformational learnings concerned the importance of supporting stakeholder engagement, fostering a spirit of inquiry, and fostering leaderful practice. These learnings contributed to three related emergent outcomes reflecting "way stations" on the journey to enhanced evidence-informed decision making and clinical excellence: enhancements in authentic partnerships, greater innovation capacity, and greater understanding and actualization of leadership values. Practical implications Practical information is provided for other organizations interested in understanding how this initiative evolved, its tangible value, and its wider benefits for organizational collaboration, innovation, and leadership values. Challenges encountered and main messages for other organizations are also considered. Originality/value A strategy map is used to present the structures, processes, and outcomes arising from the initiative, with the goal of informing the operations of other organizations desiring to be learning organizations.

Initiation of bladder voiding with epidural stimulation in paralyzed, step trained rats.

PubMed

Gad, Parag N; Roy, Roland R; Zhong, Hui; Lu, Daniel C; Gerasimenko, Yury P; Edgerton, V Reggie

2014-01-01

The inability to control timely bladder emptying is one of the most serious challenges among the several functional deficits that occur after a complete spinal cord injury. Having demonstrated that electrodes placed epidurally on the dorsum of the spinal cord can be used in animals and humans to recover postural and locomotor function after complete paralysis, we hypothesized that a similar approach could be used to recover bladder function after paralysis. Also knowing that posture and locomotion can be initiated immediately with a specific frequency-dependent stimulation pattern and that with repeated stimulation-training sessions these functions can improve even further, we reasoned that the same two strategies could be used to regain bladder function. Recent evidence suggests that rats with severe paralysis can be rehabilitated with a multisystem neuroprosthetic training regime that counteracts the development of neurogenic bladder dysfunction. No data regarding the acute effects of locomotion on bladder function, however, were reported. In this study we show that enabling of locomotor-related spinal neuronal circuits by epidural stimulation also influences neural networks controlling bladder function and can play a vital role in recovering bladder function after complete paralysis. We have identified specific spinal cord stimulation parameters that initiate bladder emptying within seconds of the initiation of epidural stimulation. The clinical implications of these results are substantial in that this strategy could have a major impact in improving the quality of life and longevity of patients while simultaneously dramatically reducing ongoing health maintenance after a spinal cord injury.

Initiation of Bladder Voiding with Epidural Stimulation in Paralyzed, Step Trained Rats

PubMed Central

Gad, Parag N.; Roy, Roland R.; Zhong, Hui; Lu, Daniel C.; Gerasimenko, Yury P.; Edgerton, V. Reggie

2014-01-01

The inability to control timely bladder emptying is one of the most serious challenges among the several functional deficits that occur after a complete spinal cord injury. Having demonstrated that electrodes placed epidurally on the dorsum of the spinal cord can be used in animals and humans to recover postural and locomotor function after complete paralysis, we hypothesized that a similar approach could be used to recover bladder function after paralysis. Also knowing that posture and locomotion can be initiated immediately with a specific frequency-dependent stimulation pattern and that with repeated stimulation-training sessions these functions can improve even further, we reasoned that the same two strategies could be used to regain bladder function. Recent evidence suggests that rats with severe paralysis can be rehabilitated with a multisystem neuroprosthetic training regime that counteracts the development of neurogenic bladder dysfunction. No data regarding the acute effects of locomotion on bladder function, however, were reported. In this study we show that enabling of locomotor-related spinal neuronal circuits by epidural stimulation also influences neural networks controlling bladder function and can play a vital role in recovering bladder function after complete paralysis. We have identified specific spinal cord stimulation parameters that initiate bladder emptying within seconds of the initiation of epidural stimulation. The clinical implications of these results are substantial in that this strategy could have a major impact in improving the quality of life and longevity of patients while simultaneously dramatically reducing ongoing health maintenance after a spinal cord injury. PMID:25264607

Communication: essential strategies for success.

PubMed

O'Connor, Mary

2013-06-01

This department highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. With the goal of presenting practical approaches helpful to nurse leaders advance organizational change, content includes evidence-based projects, tool, and resources that mobilize and sustain organizational change initiatives. In this article, the author discusses strategies for communication for change processes, whether large or small. Intentional planning and development of a communication strategy alongside, not as an afterthought, to change initiatives are essential.

Coping strategies for food insecurity among adolescent girls during the lean season in East Nusa Tenggara, Indonesia: a qualitative study.

PubMed

Fatmaningrum, Dewi; Roshita, Airin; Februhartanty, Judhiastuty

2016-07-01

One in eight people suffer from chronic hunger, leading to an insecure food situation. Chronic hunger mostly occurs in developing countries and includes adolescent girls. Our qualitative study, with data collected in December 2012, provided the results of an exploration of the experiences and strategies implemented by fifteen adolescent girls who tried to cope with their condition of living in food-insecure families. The age of the girls ranged from 10 to 19 years. Their coping strategies were grouped into self-initiated and parent-initiated strategies. Self-initiated coping strategies that were the girls' own initiatives included eating only rice without any vegetables or side dish, eating less-desirable food, reducing portion size, skipping meals, saving pocket money and earning money to buy food. The parent-initiated coping strategies that were initiated by the parents and followed by the girls included selling their own field produce and livestock, asking for food, borrowing food and storing maize for 6 months up to 1 year. These results show that adolescent girls living in food-insecure areas implement several coping strategies in severe conditions, which parents may not be aware of, and such conditions may compromise their growth and health. The acknowledgement of such coping strategies and the girls' food insecurity condition can lead to a useful and suitable food insecurity alleviation programme for the girls and their families.

Relating health and climate impacts to grid-scale emissions using adjoint sensitivity modeling for the Climate and Clean Air Coalition

NASA Astrophysics Data System (ADS)

Henze, D. K.; Lacey, F.; Seltzer, M.; Vallack, H.; Kuylenstierna, J.; Bowman, K. W.; Anenberg, S.; Sasser, E.; Lee, C. J.; Martin, R.

2013-12-01

The Climate and Clean Air Coalition (CCAC) was initiated in 2012 to develop, understand and promote measures to reduce short lived climate forcers such as aerosol, ozone and methane. The Coalition now includes over 30 nations, and as a service to these nations is committed to providing a decision support toolkit that allows member nations to explore the benefits of a range of emissions mitigation measures in terms of the combined impacts on air quality and climate and so help in the development of their National Action Plans. Here we will present recent modeling work to support the development of the CCAC National Action Plans toolkit. Adjoint sensitivity analysis is presented as a means of efficiently relating air quality, climate and crop impacts back to changes in emissions from each species, sector and location at the grid-scale resolution of typical global air quality model applications. The GEOS-Chem adjoint model is used to estimate the damages per ton of emissions of PM2.5 related mortality, the impacts of ozone precursors on crops and ozone-related health effects, and the combined impacts of these species on regional surface temperature changes. We show how the benefits-per-emission vary spatially as a function of the surrounding environment, and how this impacts the overall benefit of sector-specific control strategies. We present initial findings for Bangladesh, as well as Mexico, Ghana and Colombia, some of the first countries to join the CCAC, and discuss general issues related to adjoint-based metrics for quantifying air quality and climate co-benefits.

Migration of Nurses from Sub-Saharan Africa: A Review of Issues and Challenges

PubMed Central

Dovlo, Delanyo

2007-01-01

Objective To assess the impact of out-migration of nurses on the health systems in sub-Saharan Africa (SSA). Setting The countries of SSA. Design and Methods Review of secondary sources: existing publications and country documents on the health workforce; documents prepared for the Joint Learning Initiative Global Human Resources for Health report, the World Health Organization (AFRO) synthesis on migration, and the International Council of Nurses series on the global nursing situation. Analysis of associated data. Principal Findings The state of nursing practice in SSA appears to have been impacted negatively by migration. Available (though inadequate) quantitative data on stocks and flows, qualitative information on migration issues and trends, and on the main strategies being employed in both source and recipient countries indicate that the problem is likely to grow over the next 5–10 years. Conclusions Multiple actions are needed at various policy levels in both source and receiving countries to moderate negative effects of nurse emigration in developing countries in Africa; however, critically, source countries must establish more effective policies and strategies. PMID:17489920

Equilibrium pricing and ordering policies in a two-echelon supply chain in the presence of strategic customers.

PubMed

Sadjadi, Seyed J; Naeij, Jafar; Shavandi, Hasan; Makui, Ahmad

2016-06-07

This paper studying the impact of strategic customer behavior on decentralized supply chain gains and decisions, which includes a supplier, and a monopoly firm as a retailer who sells a single product over a finite two periods of selling season. We consider three types of customers: myopic, strategic and low-value customers. The problem is formulated as a bi-level game where at the second level (e.g. horizontal game), the retailer determines his/her equilibrium pricing strategy in a non-cooperative simultaneous general game with strategic customers who choose equilibrium purchasing strategy to maximize their expected surplus. At the first level (e.g. vertical game), the supplier competes with the retailer as leader and follower in the Stackelberg game. They set the wholesale price and initial stocking capacity to maximize their profits. Finally, a numerical study is presented to demonstrate the impacts of strategic behavior on supply chain gain and decisions; subsequently the effects of market parameters on decision variables and total profitability of supply chain's members is studied through a sensitivity analysis.

Integrating Antiretroviral Strategies for Human Immunodeficiency Virus Prevention: Post- and Pre-Exposure Prophylaxis and Early Treatment.

PubMed

Grant, Robert M; Smith, Dawn K

2015-12-01

Best practices for integrating human immunodeficiency virus (HIV) testing and antiretroviral interventions for prevention and treatment are suggested based on research evidence and existing normative guidance. The goal is to provide high-impact prevention services during periods of substantial risk. Antiretroviral medications are recommended for postexposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP), and treatment of HIV infection. We reviewed research evidence and current normative guidelines to identify best practices for integrating these high-impact prevention strategies. More sensitive HIV tests used for screening enable earlier diagnosis and treatment of HIV infection, more appropriate counseling, and help limit drug resistance. A fully suppressive PEP regimen should be initiated based on exposure history or physical findings when sensitive diagnostic testing is delayed or not available and antibody tests are negative. Transitions from PEP to PrEP are often warranted because HIV exposure events may continue to occur. This algorithmic approach to integrating PEP, PrEP, and early treatment decisions may increase the uptake of these interventions by a greater number and diversity of knowledgeable healthcare providers.

Integrating Antiretroviral Strategies for Human Immunodeficiency Virus Prevention: Post- and Pre-Exposure Prophylaxis and Early Treatment

PubMed Central

Grant, Robert M.; Smith, Dawn K.

2015-01-01

Best practices for integrating human immunodeficiency virus (HIV) testing and antiretroviral interventions for prevention and treatment are suggested based on research evidence and existing normative guidance. The goal is to provide high-impact prevention services during periods of substantial risk. Antiretroviral medications are recommended for postexposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP), and treatment of HIV infection. We reviewed research evidence and current normative guidelines to identify best practices for integrating these high-impact prevention strategies. More sensitive HIV tests used for screening enable earlier diagnosis and treatment of HIV infection, more appropriate counseling, and help limit drug resistance. A fully suppressive PEP regimen should be initiated based on exposure history or physical findings when sensitive diagnostic testing is delayed or not available and antibody tests are negative. Transitions from PEP to PrEP are often warranted because HIV exposure events may continue to occur. This algorithmic approach to integrating PEP, PrEP, and early treatment decisions may increase the uptake of these interventions by a greater number and diversity of knowledgeable healthcare providers. PMID:26512356

Whey acidic proteins (WAPs): novel modulators of innate immunity to HIV infection.

PubMed

Reading, James L; Meyers, Adrienne F A; Vyakarnam, Annapurna

2012-03-01

To discuss how whey acidic proteins (WAPs), a new class of immunomodulatory soluble mediators, impact innate immunity to HIV infection. Innate immunity to HIV infection is increasingly being recognized as critical in determining initial virus transmission and dissemination and may, therefore, be exploited in vaccine and microbicide intervention strategies to combat HIV infection. Several important innate immune mediators have recently been shown to regulate HIV infection in vitro and are, thus, implicated in in vivo immunity to the virus. These include soluble mediators, such as type I interferon, the defensins and more recently WAPs. Recent evidence is discussed, which show that WAPs are pleiotropic soluble mediators that may impact the course of HIV infection in two ways: as regulators of HIV replication and as regulators of innate and adaptive immunity. A better understanding of host factors that regulate HIV transmission is essential in the development of novel therapeutic strategies. This review focuses on recent findings that highlight the HIV regulatory and anti-inflammatory function of WAPs and assesses their potential to be exploited as novel therapeutics.

The impact of systematic landscape conservation planning on ecosystem: Chen Youlan river watershed

NASA Astrophysics Data System (ADS)

Chen, Chi-ju

2017-04-01

Heraclitus said that "no man ever steps in the same river twice." Everything continues to change. Land use change will keep redefine itself and subject the Earth and humankind to collateral changes. Humankind benefits from ecosystem in many ways. The ecosystem provides people with nutrients, enriches soil with sediment, and sustains all living organisms with water; these benefits are known as ecosystem services. In Taiwan, land use change has impacted ecosystem and biodiversity on various levels. Thus, we took six land use scenarios from 1999 to 2005 in Chen Youlan river watershed as our case study, intending to observe the course of ecosystem and biodiversity changes and the cause of it. Systematic Landscape conservation planning (SLCP) framework can be adopted when designing land use policy to safeguard human interests and ecosystem. This study use SLCP to develop ecosystem services and biodiversity protection strategies. Several strategies were designed by using 1999 to 2005 data as provision to protect the intactness of future ecosystem services and biodiversity. This research explores the potential and possible impacts of different land use protection strategies in the future. It is possible to identify the conservation priority of a certain region by using the Zonation meta-algorithm. This study selects the zonation critical protection area (Joint set of Yushan National Park) as strategy A, B and C. Strategy D takes Yushan National Park as a protected area; unstable hot spots in 1999/03 (Joint set of Yushan National Park) are selected as strategy E. Next, we used Kappa statistical method to find the minimal ecosystem services change and biodiversity hotspots change of the five aforementioned strategies and compared with those from 1999/03. By the Kappa statistical method, we further prioritized the important conservation areas by strategy A, B, C, E in the future. The results can not only serve as management reference for government agencies, but also develop an ideal trajectory of policy making as well as human-nature dynamics, leading to a sustainable future. We do not have to be subject to changes passively, instead, we can evolve ourselves and actively initiate the evolutionary path towards sustainable coexistence with nature. Keywords: InVEST , CLUE-s , biodiversity , ecosystem services, ecosystem services hotspots, land use change, SLCP, Systematic Landscape conservation planning, Chen Youlan river

Policy strategies to address sustainability of Alaskan boreal forests in response to a directionally changing climate.

PubMed

Chapin, F Stuart; Lovecraft, Amy L; Zavaleta, Erika S; Nelson, Joanna; Robards, Martin D; Kofinas, Gary P; Trainor, Sarah F; Peterson, Garry D; Huntington, Henry P; Naylor, Rosamond L

2006-11-07

Human activities are altering many factors that determine the fundamental properties of ecological and social systems. Is sustainability a realistic goal in a world in which many key process controls are directionally changing? To address this issue, we integrate several disparate sources of theory to address sustainability in directionally changing social-ecological systems, apply this framework to climate-warming impacts in Interior Alaska, and describe a suite of policy strategies that emerge from these analyses. Climate warming in Interior Alaska has profoundly affected factors that influence landscape processes (climate regulation and disturbance spread) and natural hazards, but has only indirectly influenced ecosystem goods such as food, water, and wood that receive most management attention. Warming has reduced cultural services provided by ecosystems, leading to some of the few institutional responses that directly address the causes of climate warming, e.g., indigenous initiatives to the Arctic Council. Four broad policy strategies emerge: (i) enhancing human adaptability through learning and innovation in the context of changes occurring at multiple scales; (ii) increasing resilience by strengthening negative (stabilizing) feedbacks that buffer the system from change and increasing options for adaptation through biological, cultural, and economic diversity; (iii) reducing vulnerability by strengthening institutions that link the high-latitude impacts of climate warming to their low-latitude causes; and (iv) facilitating transformation to new, potentially more beneficial states by taking advantage of opportunities created by crisis. Each strategy provides societal benefits, and we suggest that all of them be pursued simultaneously.

Global strategies to reduce the price of antiretroviral medicines: evidence from transactional databases.

PubMed

Waning, Brenda; Kaplan, Warren; King, Alexis C; Lawrence, Danielle A; Leufkens, Hubert G; Fox, Matthew P

2009-07-01

To estimate the impact of global strategies, such as pooled procurement arrangements, third-party price negotiation and differential pricing, on reducing the price of antiretrovirals (ARVs), which currently hinders universal access to HIV/AIDS treatment. We estimated the impact of global strategies to reduce ARV prices using data on 7253 procurement transactions (July 2002-October 2007) from databases hosted by WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria. For 19 of 24 ARV dosage forms, we detected no association between price and volume purchased. For the other five ARVs, high-volume purchases were 4-21% less expensive than medium- or low-volume purchases. Nine of 13 generic ARVs were priced 6-36% lower when purchased under the Clinton Foundation HIV/AIDS Initiative (CHAI). Fifteen of 18 branded ARVs were priced 23-498% higher for differentially priced purchases compared with non-CHAI generic purchases. However, two branded, differentially priced ARVs were priced 63% and 73% lower, respectively, than generic non-CHAI equivalents. Large purchase volumes did not necessarily result in lower ARV prices. Although current plans for pooled procurement will further increase purchase volumes, savings are uncertain and should be balanced against programmatic costs. Third-party negotiation by CHAI resulted in lower generic ARV prices. Generics were less expensive than differentially priced branded ARVs, except where little generic competition exists. Alternative strategies for reducing ARV prices, such as streamlining financial management systems, improving demand forecasting and removing barriers to generics, should be explored.

When does a strategy intervention overcome a failure of inhibition? Evidence from two left frontal brain tumour cases.

PubMed

Robinson, Gail A; Walker, David G; Biggs, Vivien; Shallice, Tim

2016-06-01

Initiation and inhibition of responses are crucial for appropriate behaviour across different settings. Initiation and inhibition difficulties are well documented following frontal damage, although task differences have limited our understanding. The Hayling Sentence Completion Test was designed to assess verbal initiation and inhibition within the same task. This study investigates the ability of two patients with left frontal tumours (KI: high grade glioma; PM: meningioma) to use a strategy to overcome profound suppression failures on the Hayling Test. KI and PM completed the Hayling Test and two experimental tasks. The Selection Investigation assessed verbal initiation on a sentence completion task that varied selection demands (high/low). The Suppression and Strategy Investigation assessed ability to implement four strategies aimed to override a suppression failure and facilitate production of an unconnected word. On the Hayling Test, KI and PM initiated responses to complete high constraint sentences, in contrast to impaired suppression. KI benefitted minimally from strategies to overcome suppression failure although one strategy (object naming) was partially successful. KI's errors revealed fast suppression errors, in contrast to slow no responses, and selection ability was also impaired for verbal initiation. PM, however, implemented each strategy 100% to overcome a suppression failure and had no difficulty completing sentences meaningfully, regardless of selection demands. This first investigation of strategy implementation to overcome profound suppression impairments provides insights into verbal initiation, inhibition, selection and strategy mechanisms, which has implications for neurorehabilitation. Specifically, both patients had profound inhibition deficits but KI also presented with a selection deficit and was unable to implement a strategy. By contrast, PM's selection ability was intact but she was unable to generate, rather than implement, a strategy. We suggest that KI has both fast, uncontrolled semantic output and response inhibition difficulty, whereas PM's difficulty is underpinned by motivational factors. Copyright © 2016 Elsevier Ltd. All rights reserved.

Self-efficacy and arthritis disability: An updated synthesis of the evidence base and its relevance to optimal patient care

PubMed Central

2014-01-01

Self-efficacy, denoting the degree of confidence an individual has in carrying out a specific activity, was initially discussed in the 1970s as a potential correlate of disease outcomes. Drawn from 35 years of related research, this review provides an updated understanding of the concept of self-efficacy and its relevance for arthritis management. There is a consistent link between self-efficacy, arthritis pain and disability, and adherence to recommended therapeutic strategies. A wide variety of intervention strategies improve arthritis self-efficacy, as well as outcomes. Steps to assess and intervene thoughtfully to maximize self-efficacy beliefs are likely to impact arthritis disability outcomes quite favorably and significantly, regardless of disease type, duration, or sociodemographic factors. PMID:28070346

Synthetic strategy for preparing chiral double-semicrystalline polyether block copolymers

DOE PAGES

McGrath, Alaina J.; Shi, Weichao; Rodriguez, Christina G.; ...

2014-12-11

Here, we report an effective strategy for the synthesis of semi-crystalline block copolyethers with well-defined architecture and stereochemistry. As an exemplary system, triblock copolymers containing either atactic (racemic) or isotactic ( R or S) poly(propylene oxide) end blocks with a central poly(ethylene oxide) mid-block were prepared by anionic ring-opening procedures. Stereochemical control was achieved by an initial hydrolytic kinetic resolution of racemic terminal epoxides followed by anionic ring-opening polymerization of the enantiopure monomer feedstock. The resultant triblock copolymers were highly isotactic (meso triads [ mm]% ~ 90%) with optical microscopy, differential scanning calorimetry, wide angle x-ray scattering and small anglemore » x-ray scattering being used to probe the impact of the isotacticity on the resultant polymer and hydrogel properties.« less

Recruitment efforts to reduce adverse impact: targeted recruiting for personality, cognitive ability, and diversity.

PubMed

Newman, Daniel A; Lyon, Julie S

2009-03-01

Noting the presumed tradeoff between diversity and performance goals in contemporary selection practice, the authors elaborate on recruiting-based methods for avoiding adverse impact while maintaining aggregate individual productivity. To extend earlier work on the primacy of applicant pool characteristics for resolving adverse impact, they illustrate the advantages of simultaneous cognitive ability- and personality-based recruiting. Results of an algebraic recruiting model support general recruiting for cognitive ability, combined with recruiting for conscientiousness within the underrepresented group. For realistic recruiting effect sizes, this type of recruiting strategy greatly increases average performance of hires and percentage of hires from the underrepresented group. Further results from a policy-capturing study provide initial guidance on how features of organizational image can attract applicants with particular job-related personalities and abilities, in addition to attracting applicants on the basis of demographic background. (c) 2009 APA, all rights reserved.

[Road traffic injuries among youth: measuring the impact of an educational intervention].

PubMed

Hidalgo-Solórzano, Elisa; Híjar, Martha; Mora-Flores, Gerardo; Treviño-Siller, Sandra; Inclán-Valadez, Cristina

2008-01-01

To analyze the impact of an educative intervention intended to increase the knowledge of causes and risk factors associated with road traffic iinjries in the city of Cuernavaca. A quasi-experimental study design was administered to students from 16 to 19 years old in colleges and universities in the city of Cuernavaca. The educative intervention included radio spots, banners, pamphlets, posters and cards. The measure of impact was established as changes in knowledge about speed, alcohol and the use of seat belts, using factor analysis methodologies. A significant change in the level of knowledge (p= 0.000) was observed in 700 students from 16 institutions. Educative interventions represent an initial strategy for changes in knowledge and population behaviours. The present study offers an appropriate methodology to measure short-term changes in knowledge about risk factors associated with a significant problem affecting Mexican youth.

The Dorsolateral Prefrontal Cortex Plays a Role in Self-Initiated Elaborative Cognitive Processing during Episodic Memory Encoding: rTMS Evidence

PubMed Central

Hawco, Colin; Berlim, Marcelo T.; Lepage, Martin

2013-01-01

During episodic memory encoding, elaborative cognitive processing can improve later recall or recognition. While multiple studies examined the neural correlates of encoding strategies, few studies have explicitly focused on the self-initiation of elaborative encoding. Repetitive transcranial magnetic stimulation (rTMS), a method which can transiently disrupt neural activity, was administered during an associative encoding task. rTMS was either applied to the left dorsolateral prefrontal cortex (DLPFC) or to the vertex (a control region not involved in memory encoding) during presentation of pairs of words. Pairs could be semantically related or not related. Two encoding instructions were given, either cueing participants to analyze semantic relationships (cued condition), or to memorize the pair without any specific strategy cues (the self-initiated condition). Participants filled out a questionnaire regarding their use of memory strategies and performed a cued-recall task. We hypothesized that if the DLPFC plays a role in the self-initiation of elaborative encoding we would observe a reduction in memory performance in the self-initiated condition, particularly for related. We found a significant correlation between the effects of rTMS and strategy use, only in the self-initiated condition with related pairs. High strategy users showed reduced performance following DLPFC stimulation, while low strategy users tended to show increased recall following DLPFC stimulation during encoding. These results suggest the left DLPFC may be involved in the self-initiation of memory strategy use, and individuals may utilize different neural networks depending on their use of encoding strategies. PMID:24040072

Enhancing Teachers' Application of Inquiry-Based Strategies Using a Constructivist Sociocultural Professional Development Model

NASA Astrophysics Data System (ADS)

Brand, Brenda R.; Moore, Sandra J.

2011-05-01

This two-year school-wide initiative to improve teachers' pedagogical skills in inquiry-based science instruction using a constructivist sociocultural professional development model involved 30 elementary teachers from one school, three university faculty, and two central office content supervisors. Research was conducted for investigating the impact of the professional development activities on teachers' practices, documenting changes in their philosophies, instruction, and the learning environment. This report includes teachers' accounts of philosophical as well as instructional changes and how these changes shaped the learning environment. For the teachers in this study, examining their teaching practices in learner-centered collaborative group settings encouraged them to critically analyze their instructional practices, challenging their preconceived ideas on inquiry-based strategies. Additionally, other factors affecting teachers' understanding and use of inquiry-based strategies were highlighted, such as self-efficacy beliefs, prior experiences as students in science classrooms, teacher preparation programs, and expectations due to federal, state, and local mandates. These factors were discussed and reconciled, as they constructed new understandings and adapted their strategies to become more student-centered and inquiry-based.

Effect of Promotional Initiatives on Visits to a Dedicated Website for Physical Activity and Non-Communicable Disease in Luxembourg: An Event Study

PubMed Central

Lion, Alexis; Thornton, Jane S.; Vaillant, Michel; Pertuy, Juliette; Besenius, Eric; Hardy, Cyrille; Delagardelle, Charles; Seil, Romain; Urhausen, Axel; Theisen, Daniel

2017-01-01

The Sport-Santé project and its website (www.sport-sante.lu) promote physical activity for individuals with non-communicable diseases (NCDs) in Luxembourg. Our purpose was to perform an event study analysis to evaluate the effects of communication and promotional initiatives on the number of visits to the Sport-Santé website. Between September 2015 and May 2016, the Sport-Santé website was promoted during different initiatives, including participation in health-related events or publication of articles in local journals. The daily number of visits to www.sport-sante.lu website (i.e., our outcome) was recorded using Google Analytics and compared to a counterfactual collected with its benchmarking tool. The counterfactual was defined as the daily number of visits to websites in the same field. A model was created to evaluate the relationship between the number of visits to www.sport-sante.lu website and the number of visits to similar websites during a control period with no promotional initiatives (from July 2015 to September 2015). The effect of promotional initiatives was subsequently tested, by comparing the actual number of visits to our website (up to 2 days after each event) with the theoretical number of visits predicted by the model. Twenty-two initiatives were identified, of which 11 were participations at major health-related events and 11 publications of popular science articles. Of these 22 initiatives, the event study identified 2 popular science articles and 1 interactive workshop that significantly increased the daily number of visits to the www.sport-sante.lu website. One of the two articles was published on the day before the workshop was held, which did not allow us to distinguish its specific impact. The second article was published in the main national newspaper. This is the first time to our knowledge that an event study analysis has been used to evaluate the impact of promotional initiatives on the number of visits to a dedicated website for physical activity and NCDs. Our results indicate that some initiatives can aid in the number of visits, but in general their impact is limited. To observe an increased rate of participation in physical activity, additional promotional and evaluative strategies should be explored. PMID:28611975

Cost-effectiveness of different screening strategies for osteoporosis in postmenopausal women.

PubMed

Nayak, Smita; Roberts, Mark S; Greenspan, Susan L

2011-12-06

The best strategies to screen postmenopausal women for osteoporosis are not clear. To identify the cost-effectiveness of various screening strategies. Individual-level state-transition cost-effectiveness model. Published literature. U.S. women aged 55 years or older. Lifetime. Payer. Screening strategies composed of alternative tests (central dual-energy x-ray absorptiometry [DXA], calcaneal quantitative ultrasonography [QUS], and the Simple Calculated Osteoporosis Risk Estimation [SCORE] tool) initiation ages, treatment thresholds, and rescreening intervals. Oral bisphosphonate treatment was assumed, with a base-case adherence rate of 50% and a 5-year on/off treatment pattern. Incremental cost-effectiveness ratios (2010 U.S. dollars per quality-adjusted life-year [QALY] gained). At all evaluated ages, screening was superior to not screening. In general, quality-adjusted life-days gained with screening tended to increase with age. At all initiation ages, the best strategy with an incremental cost-effectiveness ratio (ICER) of less than $50,000 per QALY was DXA screening with a T-score threshold of -2.5 or less for treatment and with follow-up screening every 5 years. Across screening initiation ages, the best strategy with an ICER less than $50,000 per QALY was initiation of screening at age 55 years by using DXA -2.5 with rescreening every 5 years. The best strategy with an ICER less than $100,000 per QALY was initiation of screening at age 55 years by using DXA with a T-score threshold of -2.0 or less for treatment and then rescreening every 10 years. No other strategy that involved treatment of women with osteopenia had an ICER less than $100,000 per QALY. Many other strategies, including strategies with SCORE or QUS prescreening, were also cost-effective, and in general the differences in effectiveness and costs between evaluated strategies was small. Probabilistic sensitivity analysis did not reveal a consistently superior strategy. Data were primarily from white women. Screening initiation at ages younger than 55 years were not examined. Only osteoporotic fractures of the hip, vertebrae, and wrist were modeled. Many strategies for postmenopausal osteoporosis screening are effective and cost-effective, including strategies involving screening initiation at age 55 years. No strategy substantially outperforms another. National Center for Research Resources.

Does External Funding Help Adaptation? Evidence from Community-Based Water Management in the Colombian Andes

NASA Astrophysics Data System (ADS)

Murtinho, Felipe; Eakin, Hallie; López-Carr, David; Hayes, Tanya M.

2013-11-01

Despite debate regarding whether, and in what form, communities need external support for adaptation to environmental change, few studies have examined how external funding impacts adaptation decisions in rural resource-dependent communities. In this article, we use quantitative and qualitative methods to assess how different funding sources influence the initiative to adapt to water scarcity in the Colombian Andes. We compare efforts to adapt to water scarcity in 111 rural Andean communities with varied dependence on external funding for water management activities. Findings suggest that despite efforts to use their own internal resources, communities often need external support to finance adaptation strategies. However, not all external financial support positively impacts a community’s abilities to adapt. Results show the importance of community-driven requests for external support. In cases where external support was unsolicited, the results show a decline, or “crowding-out,” in community efforts to adapt. In contrast, in cases where communities initiated the request for external support to fund their own projects, findings show that external intervention is more likely to enhance or “crowds-in” community-driven adaptation.

Sample substitution can be an acceptable data-collection strategy: the case of the Belgian Health Interview Survey.

PubMed

Demarest, Stefaan; Molenberghs, Geert; Van der Heyden, Johan; Gisle, Lydia; Van Oyen, Herman; de Waleffe, Sandrine; Van Hal, Guido

2017-11-01

Substitution of non-participating households is used in the Belgian Health Interview Survey (BHIS) as a method to obtain the predefined net sample size. Yet, possible effects of applying substitution on response rates and health estimates remain uncertain. In this article, the process of substitution with its impact on response rates and health estimates is assessed. The response rates (RR)-both at household and individual level-according to the sampling criteria were calculated for each stage of the substitution process, together with the individual accrual rate (AR). Unweighted and weighted health estimates were calculated before and after applying substitution. Of the 10,468 members of 4878 initial households, 5904 members (RRind: 56.4%) of 2707 households (RRhh: 55.5%) participated. For the three successive (matched) substitutes, the RR dropped to 45%. The composition of the net sample resembles the one of the initial samples. Applying substitution did not produce any important distorting effects on the estimates. Applying substitution leads to an increase in non-participation, but does not impact the estimations.

Parental smoking and children’s anxieties: An appropriate strategy for health education?

PubMed Central

Holdsworth, Clare; Robinson, Jude

2016-01-01

While the prevalence of smoking has declined in the UK in recent years, class differentials in smoking behaviour have become more marked and smoking is increasingly recognised as a causal factor in inequalities in health. Health education initiatives to support both smoking cessation and to teach children about the health risks of smoking remain key initiatives in reducing health inequalities. However, teaching children about the risks of smoking and the impact of parental smoking in their health is not straightforward for children from backgrounds who are more likely to encounter smoking at home and in their local communities. These children have to reconcile the key messages taught at school and reinforced in smoking cessation campaigns with the knowledge that their parents and other family members smoke. In this paper we consider how children from smoking homes make sense of these education and health campaigns as observed by their parents, and the impact that this has on both parental smoking and relationships within the home. The paper thus seeks to challenge assumptions about the delivery of health education and the need to acknowledge family diversity. PMID:27695387

7 CFR 1948.81 - State Investment Strategy for Energy Impacted Areas.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 13 2011-01-01 2009-01-01 true State Investment Strategy for Energy Impacted Areas..., DEPARTMENT OF AGRICULTURE (CONTINUED) PROGRAM REGULATIONS (CONTINUED) RURAL DEVELOPMENT Section 601 Energy Impacted Area Development Assistance Program § 1948.81 State Investment Strategy for Energy Impacted Areas...

7 CFR 1948.81 - State Investment Strategy for Energy Impacted Areas.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 13 2013-01-01 2013-01-01 false State Investment Strategy for Energy Impacted Areas..., DEPARTMENT OF AGRICULTURE (CONTINUED) PROGRAM REGULATIONS (CONTINUED) RURAL DEVELOPMENT Section 601 Energy Impacted Area Development Assistance Program § 1948.81 State Investment Strategy for Energy Impacted Areas...

7 CFR 1948.81 - State Investment Strategy for Energy Impacted Areas.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 13 2010-01-01 2009-01-01 true State Investment Strategy for Energy Impacted Areas..., DEPARTMENT OF AGRICULTURE (CONTINUED) PROGRAM REGULATIONS (CONTINUED) RURAL DEVELOPMENT Section 601 Energy Impacted Area Development Assistance Program § 1948.81 State Investment Strategy for Energy Impacted Areas...

Virginia Solar Pathways Project: Economic Study of Utility-Administered Solar Programs: Soft Costs, Community Solar, and Tax Normalization Considerations

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

Reiter, Emerson; Lowder, Travis; Mathur, Shivani

This report presents economic considerations for solar development in support of the Virginia Solar Pathways Project (VSPP), an effort funded by the U.S. Department of Energy (DOE) SunShot Initiative that seeks to develop a collaborative utility-administered solar strategy for the Commonwealth of Virginia. The results presented are intended to be considered alongside the results of other studies conducted under the VSPP that evaluate the impacts of solar energy on the electric distribution, transmission, and generation systems in Virginia.

From Vision to the Implementation of the U.S. National Nanotechnology Initiative

NASA Astrophysics Data System (ADS)

Roco, M. C.

2001-02-01

All natural and living systems are governed by atomic and molecular behavior at the nanoscale. Research is now seeking systematic approaches to create revolutionary new products and technologies by control of matter at the same scale. Fundamental discoveries and potential implications of nanotechnology to wealth, health and peace have captured the imagination of scientists, industry and government experts. The National Nanotechnology Initiative (NNI) has become a top national priority in science and technology in U.S. for fiscal year 2001, with a Federal nanotechnology investment portfolio of 422 million. Nanotechnology is expected to have a profound impact on our economy and society in the earlier 21st century. The vision, research and development strategy, and timeline of NNI are presented by using several recent scientific discoveries and results from industry.

The Worldviews Network: Innovative Strategies for Increasing Climate and Ecological Literacy in Your Community

NASA Astrophysics Data System (ADS)

Connolly, R.; Yu, K.; McConville, D.; Sickler, J.; "Irving, Lindsay", L. S.; Gardiner, N.; Hamilton, H.

2011-12-01

Informal science Institutions (ISI) are in the unique position to convene and support community dialogues surrounding local ecological impacts of global change. The Worldviews Network-a collaboration between museums, scientists, and community-based organizations-is developing and testing innovative approaches for promoting and encouraging ecological literacy with the American public. In this session, we will share strategies for sparking and sustaining dialogue and action in local communities through high-impact visual presentations and real-world examples of successful projects that are increasing the healthy functioning of regional and global ecosystems. Educating the public about interconnected global change issues can be a daunting task. ISIs can help communities by facilitating dialogues about realistic and regionally relevant approaches for systemically addressing global challenges. Managing the complexity of these challenges requires going far beyond the standard prescriptions for behavior change; it requires inspiring participants with positive examples of system-wide solutions as well as actively involving the audience in scientifically informed design processes. This session will demonstrate how you can implement and sustain these community dialogues, using real-world examples from our partners' national events. We present visualization story templates and a model for facilitating dialogues that can be adapted at your institution. Based on video and written assessment feedback from visitors of our first Worldviews events, we will present initial evaluation findings about the impact that these strategies are having on our audiences and ISI partners. These findings show that engaging the public and NGO partners in sustainability and design dialogues is a powerful way to maintain the relevance of ISIs within their communities.

Learning strategies of first year nursing and medical students: a comparative study.

PubMed

Salamonson, Yenna; Everett, Bronwyn; Koch, Jane; Wilson, Ian; Davidson, Patricia M

2009-12-01

Interprofessional education (IPE), where two or more professions learn with, from, and about each other to improve collaboration and the quality of care, has been proposed as a curriculum strategy to promote mutual understanding between professions, thus helping to prepare health professionals to work in challenging contemporary health systems. Although there is support for IPE initiatives within health professional education, differences in student motivation and learning strategies are likely to contribute to the success of these initiatives. To explore self-regulated learning strategies used by first year medical and nursing students, and to determine if these strategies were different among nursing students who were high achievers. A comparative survey design. Nursing and medical nursing schools in a large university in the western region of Sydney, Australia. Six hundred and sixty-five first year nursing (n=565) and medical (n=100) students in a large university in the western region of Sydney were surveyed to assess motivational and learning strategies using The Motivated Strategies for Learning Questionnaire (MSLQ). Data relating to sociodemographic characteristics and academic performance were also collected. Nursing students were significantly older than medical students (mean age: 24.4 years versus 19.4 years; p<0.001), and there were also more females in the nursing student group (82% versus 56%; p<0.001). Although nursing students had a higher mean score for extrinsic goal orientation compared to medical students (p<0.001), medical students had higher mean scores for the other four learning strategies measured: peer learning (p=0.003), help seeking (p=0.008), critical thinking (p=0.058), and time and study environment management (p<0.001). Similarly, the grade point average (GPA) of medical students at the end of their first year was significantly higher (4.5, S.D. 1.4 versus 3.6, S.D. 1.3; p<0.001) compared to that of nursing students. While interprofessional education is seen to have many benefits for students, this study demonstrates differences in motivational and learning strategies between nursing and medical students that may impact on the success of interprofessional programs.

Georgia's breastfeeding promotion program for low-income women.

PubMed

Ahluwalia, I B; Tessaro, I; Grummer-Strawn, L M; MacGowan, C; Benton-Davis, S

2000-06-01

Beginning in 1990, Georgia's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) initiated 5 new strategies to promote breastfeeding among its pregnant and postpartum clients. These strategies were implemented in 1991, each to be provided as an addition to its standard program of counseling on breastfeeding and distributing appropriate literature: 1) enhanced breastfeeding education, 2) breast pump loans, 3) hospital-based programs, 4) peer counseling, and 5) community coalitions. The enhanced breastfeeding education strategy provides access to a hotline as well as periodic training of staff, and the breast pump loan provides free breast pumps to mothers who want to use them. The hospital-based strategy provides bedside support and counseling to women who have just given birth and includes staff training, as well as a hotline number for women to call after they leave the hospital. The peer-counseling strategy focuses on identifying former WIC participants who have successfully breastfed their infants; these women are recruited to provide support and encouragement to current WIC participants. Finally, the community coalitions approach is designed to identify existing community attitudes about breastfeeding, establish plans to address gaps in breastfeeding services, to develop resource guides on breastfeeding for the community, and to advocate at the community level to support breastfeeding women. The objective of our research was to evaluate the impact of breastfeeding promotion strategies on breastfeeding initiation among WIC participants in Georgia. Using data from the Pregnancy Nutrition Surveillance System (PNSS) for 1992-1996, we examined breastfeeding initiation rate during this period and compared rates among 6 different intervention strategies. Also, we used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) to assess breastfeeding initiation and duration among WIC enrollees. We conducted 13 focus groups to understand the experiences of program participants. Ten focus groups were conducted with women who were breastfeeding their infants, 3 each with women from the community coalitions, hospital-based programs, and standard education programs, and 1 with women from the breast pump loan program. Three focus groups were conducted with women who were feeding their infants formula. PNSS data show that breastfeeding initiation increased in the Georgia WIC program from 31.6% in 1992 to 39.5% in 1996. PRAMS data confirmed the increase in breastfeeding initiation from 33.6% (standard error [SE]: 2.2) in 1993 to 42.1% (SE: 2.4) in 1996 among WIC participants. Both datasets (PRAMS and PNSS) showed breastfeeding initiation to be well below the year 2000 goal of 75%. Overall, PRAMS data show a high breastfeeding initiation among non-WIC participants (range: 64.7% [SE: 2.2]) for 1994 to 70.1% (SE: 2.2) in 1996. The percent change between 1993 and 1996 was 8% for non-WIC participants, and it was 25% for the WIC participants among those responding to the PRAMS questionnaire. Data from PRAMS indicated no statistical change in the percentage of WIC enrollees who breastfed their infants for 8 weeks or more; this estimate was 18.3% (95% confidence interval (CI): 14.9-21.8) in 1993 and 19.4% (95% CI: 15.7-23.2) in 1996, well below the Healthy People 2000 objective of 50% at 6 months. According to PNSS data, the largest increases in breastfeeding initiation for 1992 to 1996 were among younger women (

Pertussis control in the Asia-Pacific region: a report from the Global Pertussis Initiative.

PubMed

Forsyth, Kevin; Thisyakorn, Usa; von König, Carl Heinz Wirsing; Tan, Tina; Plotkin, Stanley

2012-05-01

The Global Pertussis Initiative (GPI) is an expert, scientific forum that seeks to address the worldwide burden of pertussis. To reduce the global incidence of pertussis, the GPI recommends reinforcing and/or improving current infant and toddler immunization strategies, universal booster dosing of pre-school children, universal booster dosing of adolescents and adults (where appropriate), and cocooning to protect infants. To tailor these global recommendations to local needs, the GPI has hosted two meetings in Asia-Pacific. Pertussis vaccination practices differ across Asia-Pacific, with only some countries recommending booster dosing. Given the limited use of laboratory diagnostics, disease surveillance was considered inadequate. To make informed health policy decisions on pertussis prevention, more robust epidemiological data are needed. Because of its unique clinical presentation, adolescent and adult pertussis is under-recognized by lay and medical communities. Consequently, adolescent and adult disease likely exists even in Asian-Pacific countries where epidemiological data are presently lacking. In Asia-Pacific, there exist issues with health care access and costs. Fragmented health care will negatively impact the effectiveness of any proposed immunization strategies. The GPI recommends-in Asia-Pacific and elsewhere-that countries first educate lay and medical communities on pertussis, while simultaneously implementing robust surveillance practices. Once armed with sufficient epidemiological evidence, the prevention strategies recommended by the GPI can then be appropriately (and more effectively) introduced.

Scaling up strategies of the chronic respiratory disease programme of the European Innovation Partnership on Active and Healthy Ageing (Action Plan B3: Area 5).

PubMed

Bousquet, J; Farrell, J; Crooks, G; Hellings, P; Bel, E H; Bewick, M; Chavannes, N H; de Sousa, J Correia; Cruz, A A; Haahtela, T; Joos, G; Khaltaev, N; Malva, J; Muraro, A; Nogues, M; Palkonen, S; Pedersen, S; Robalo-Cordeiro, C; Samolinski, B; Strandberg, T; Valiulis, A; Yorgancioglu, A; Zuberbier, T; Bedbrook, A; Aberer, W; Adachi, M; Agusti, A; Akdis, C A; Akdis, M; Ankri, J; Alonso, A; Annesi-Maesano, I; Ansotegui, I J; Anto, J M; Arnavielhe, S; Arshad, H; Bai, C; Baiardini, I; Bachert, C; Baigenzhin, A K; Barbara, C; Bateman, E D; Beghé, B; Kheder, A Ben; Bennoor, K S; Benson, M; Bergmann, K C; Bieber, T; Bindslev-Jensen, C; Bjermer, L; Blain, H; Blasi, F; Boner, A L; Bonini, M; Bonini, S; Bosnic-Anticevitch, S; Boulet, L P; Bourret, R; Bousquet, P J; Braido, F; Briggs, A H; Brightling, C E; Brozek, J; Buhl, R; Burney, P G; Bush, A; Caballero-Fonseca, F; Caimmi, D; Calderon, M A; Calverley, P M; Camargos, P A M; Canonica, G W; Camuzat, T; Carlsen, K H; Carr, W; Carriazo, A; Casale, T; Cepeda Sarabia, A M; Chatzi, L; Chen, Y Z; Chiron, R; Chkhartishvili, E; Chuchalin, A G; Chung, K F; Ciprandi, G; Cirule, I; Cox, L; Costa, D J; Custovic, A; Dahl, R; Dahlen, S E; Darsow, U; De Carlo, G; De Blay, F; Dedeu, T; Deleanu, D; De Manuel Keenoy, E; Demoly, P; Denburg, J A; Devillier, P; Didier, A; Dinh-Xuan, A T; Djukanovic, R; Dokic, D; Douagui, H; Dray, G; Dubakiene, R; Durham, S R; Dykewicz, M S; El-Gamal, Y; Emuzyte, R; Fabbri, L M; Fletcher, M; Fiocchi, A; Fink Wagner, A; Fonseca, J; Fokkens, W J; Forastiere, F; Frith, P; Gaga, M; Gamkrelidze, A; Garces, J; Garcia-Aymerich, J; Gemicioğlu, B; Gereda, J E; González Diaz, S; Gotua, M; Grisle, I; Grouse, L; Gutter, Z; Guzmán, M A; Heaney, L G; Hellquist-Dahl, B; Henderson, D; Hendry, A; Heinrich, J; Heve, D; Horak, F; Hourihane, J O' B; Howarth, P; Humbert, M; Hyland, M E; Illario, M; Ivancevich, J C; Jardim, J R; Jares, E J; Jeandel, C; Jenkins, C; Johnston, S L; Jonquet, O; Julge, K; Jung, K S; Just, J; Kaidashev, I; Kaitov, M R; Kalayci, O; Kalyoncu, A F; Keil, T; Keith, P K; Klimek, L; Koffi N'Goran, B; Kolek, V; Koppelman, G H; Kowalski, M L; Kull, I; Kuna, P; Kvedariene, V; Lambrecht, B; Lau, S; Larenas-Linnemann, D; Laune, D; Le, L T T; Lieberman, P; Lipworth, B; Li, J; Lodrup Carlsen, K; Louis, R; MacNee, W; Magard, Y; Magnan, A; Mahboub, B; Mair, A; Majer, I; Makela, M J; Manning, P; Mara, S; Marshall, G D; Masjedi, M R; Matignon, P; Maurer, M; Mavale-Manuel, S; Melén, E; Melo-Gomes, E; Meltzer, E O; Menzies-Gow, A; Merk, H; Michel, J P; Miculinic, N; Mihaltan, F; Milenkovic, B; Mohammad, G M Y; Molimard, M; Momas, I; Montilla-Santana, A; Morais-Almeida, M; Morgan, M; Mösges, R; Mullol, J; Nafti, S; Namazova-Baranova, L; Naclerio, R; Neou, A; Neffen, H; Nekam, K; Niggemann, B; Ninot, G; Nyembue, T D; O'Hehir, R E; Ohta, K; Okamoto, Y; Okubo, K; Ouedraogo, S; Paggiaro, P; Pali-Schöll, I; Panzner, P; Papadopoulos, N; Papi, A; Park, H S; Passalacqua, G; Pavord, I; Pawankar, R; Pengelly, R; Pfaar, O; Picard, R; Pigearias, B; Pin, I; Plavec, D; Poethig, D; Pohl, W; Popov, T A; Portejoie, F; Potter, P; Postma, D; Price, D; Rabe, K F; Raciborski, F; Radier Pontal, F; Repka-Ramirez, S; Reitamo, S; Rennard, S; Rodenas, F; Roberts, J; Roca, J; Rodriguez Mañas, L; Rolland, C; Roman Rodriguez, M; Romano, A; Rosado-Pinto, J; Rosario, N; Rosenwasser, L; Rottem, M; Ryan, D; Sanchez-Borges, M; Scadding, G K; Schunemann, H J; Serrano, E; Schmid-Grendelmeier, P; Schulz, H; Sheikh, A; Shields, M; Siafakas, N; Sibille, Y; Similowski, T; Simons, F E R; Sisul, J C; Skrindo, I; Smit, H A; Solé, D; Sooronbaev, T; Spranger, O; Stelmach, R; Sterk, P J; Sunyer, J; Thijs, C; To, T; Todo-Bom, A; Triggiani, M; Valenta, R; Valero, A L; Valia, E; Valovirta, E; Van Ganse, E; van Hage, M; Vandenplas, O; Vasankari, T; Vellas, B; Vestbo, J; Vezzani, G; Vichyanond, P; Viegi, G; Vogelmeier, C; Vontetsianos, T; Wagenmann, M; Wallaert, B; Walker, S; Wang, D Y; Wahn, U; Wickman, M; Williams, D M; Williams, S; Wright, J; Yawn, B P; Yiallouros, P K; Yusuf, O M; Zaidi, A; Zar, H J; Zernotti, M E; Zhang, L; Zhong, N; Zidarn, M; Mercier, J

2016-01-01

Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) focuses on the integrated care of chronic diseases. Area 5 (Care Pathways) was initiated using chronic respiratory diseases as a model. The chronic respiratory disease action plan includes (1) AIRWAYS integrated care pathways (ICPs), (2) the joint initiative between the Reference site MACVIA-LR (Contre les MAladies Chroniques pour un VIeillissement Actif) and ARIA (Allergic Rhinitis and its Impact on Asthma), (3) Commitments for Action to the European Innovation Partnership on Active and Healthy Ageing and the AIRWAYS ICPs network. It is deployed in collaboration with the World Health Organization Global Alliance against Chronic Respiratory Diseases (GARD). The European Innovation Partnership on Active and Healthy Ageing has proposed a 5-step framework for developing an individual scaling up strategy: (1) what to scale up: (1-a) databases of good practices, (1-b) assessment of viability of the scaling up of good practices, (1-c) classification of good practices for local replication and (2) how to scale up: (2-a) facilitating partnerships for scaling up, (2-b) implementation of key success factors and lessons learnt, including emerging technologies for individualised and predictive medicine. This strategy has already been applied to the chronic respiratory disease action plan of the European Innovation Partnership on Active and Healthy Ageing.

Early versus late initiation of rehabilitation after lumbar spinal fusion: economic evaluation alongside a randomized controlled trial.

PubMed

Oestergaard, Lisa G; Christensen, Finn B; Nielsen, Claus V; Bünger, Cody E; Fruensgaard, Soeren; Sogaard, Rikke

2013-11-01

Economic evaluation conducted alongside a randomized controlled trial with 1-year follow-up. To examine the cost-effectiveness of initiating rehabilitation 6 weeks after surgery as opposed to 12 weeks after surgery. In a previously reported randomized controlled trial, we assessed the impact of timing of rehabilitation after a lumbar spinal fusion and found that a fast-track strategy led to poorer functional ability. Before making recommendations, it seems relevant to address the societal perspective including return to work, quality of life, and costs. A cost-effectiveness analysis and a cost-utility analysis were conducted. Eighty-two patients undergoing instrumented lumbar spinal fusion due to degenerative disc disease or spondylolisthesis (grade I or II) were randomized to an identical protocol of 4 sessions of group-based rehabilitation and were instructed in home exercises focusing on active stability training. Outcome parameters included functional disability (Oswestry Disability Index) and quality-adjusted life years. Health care and productivity costs were estimated from national registries and reported in euros. Costs and effects were transformed into net benefit. Bootstrapping was used to estimate 95% confidence intervals (95% CI). The fast-track strategy tended to be costlier by €6869 (95% CI, -4640 to 18,378) while at the same time leading to significantly poorer outcomes of functional disability by -9 points (95% CI, -18 to -3) and a tendency for a reduced gain in quality-adjusted life years by -0.04 (95% CI, -0.13 to 0.01). The overall probability for the fast-track strategy being cost-effective does not reach 10% at conventional thresholds for cost-effectiveness. Initiating rehabilitation at 6 weeks as opposed to 12 weeks after surgery is on average more costly and less effective. The uncertainty of this result did not seem to be sensitive to methodological issues, and clinical managements who have already adapted fast-track rehabilitation strategies have reason to reconsider their choice. .

Summer in the City - Assessing and Communicating the Richmond, VA Urban Heat Island to the Public and Policymakers

NASA Astrophysics Data System (ADS)

Hoffman, J. S.; Maurakis, E. G.; Shandas, V.

2017-12-01

The local impacts of global climate change are generally underestimated or misunderstood by the public and policymakers as far-off, future problems. However, differential and regional surface warming trends are exacerbated in urban areas due to the radiative properties of impervious surfaces like buildings and roads relative to natural landscapes. Decades of research illustrate that this unnatural radiative imbalance in the built environment gives rise to the well-studied urban heat island effect, whereby air temperatures in urban areas are several degrees warmer than in surrounding non-urbanized areas. In this way, the urban heat island effect presents a unique opportunity to highlight the human influence on Earth systems and at the same time mobilize local community-scale action to mitigate and become resilient to climate change impacts on tangible, experiential time scales. However, public stakeholders, city planners, and policymakers may view the urban heat island effect and its mitigation strategies through varying degrees of climatological, public health, and urban development knowledge and interest. This variation in stakeholder engagement highlights the need for individualized science communication strategies for each audience in order to maximize understanding of the scientific outcomes and tactics for mitigating the urban heat island effect. The City of Richmond, Virginia is currently developing a climate action plan as part of their greenhouse gas emission reduction initiative, RVAgreen 2050, and its recently announced "Richmond 300," a 20-year city development master plan. These initiatives provide the policy backdrop for a public and stakeholder education campaign centered on communicating urban heat island effects and resilience strategies. As such, the Science Museum of Virginia led the city's first urban heat island assessment using citizen science and leveraging a network of local university, non-profit, and city government stakeholders. Here, we will share our tactics for public- and policymaker-centered dissemination of urban heat island science, findings, and mitigation strategies using a variety of techniques including local news stations, 3D visualization technology, NOAA-funded museum media pieces, and policymaker/stakeholder engagement opportunities.

Novel mobbing strategies of a fish population against a sessile annelid predator.

PubMed

Lachat, Jose; Haag-Wackernagel, Daniel

2016-09-12

When searching for food, foraging fishes expose themselves to hidden predators. The strategies that maximize the survival of foraging fishes are not well understood. Here, we describe a novel type of mobbing behaviour displayed by foraging Scolopsis affinis. The fish direct sharp water jets towards the hidden sessile annelid predator Eunice aphroditois (Bobbit worm). We recognized two different behavioural roles for mobbers (i.e., initiator and subsequent participants). The first individual to exhibit behaviour indicating the discovery of the Bobbit directed, absolutely and per time unit, more water jets than the subsequent individuals that joined the mobbing. We found evidence that the mobbing impacted the behaviour of the Bobbit, e.g., by inducing retraction. S. affinis individuals either mob alone or form mobbing groups. We speculate that this behaviour may provide social benefits for its conspecifics by securing foraging territories for S. affinis. Our results reveal a sophisticated and complex behavioural strategy to protect against a hidden predator.

Designing Effective Persuasive Systems Utilizing the Power of Entanglement: Communication Channel, Strategy and Affect

NASA Astrophysics Data System (ADS)

Li, Haiqing; Chatterjee, Samir

With rapid advances in information and communication technology, computer-mediated communication (CMC) technologies are utilizing multiple IT platforms such as email, websites, cell-phones/PDAs, social networking sites, and gaming environments. However, no studies have compared the effectiveness of a persuasive system using such alternative channels and various persuasive techniques. Moreover, how affective computing impacts the effectiveness of persuasive systems is not clear. This study proposes (1) persuasive technology channels in combination with persuasive strategies will have different persuasive effectiveness; (2) Adding positive emotion to a message that leads to a better overall user experience could increase persuasive effectiveness. The affective computing or emotion information was added to the experiment using emoticons. The initial results of a pilot study show that computer-mediated communication channels along with various persuasive strategies can affect the persuasive effectiveness to varying degrees. These results also shows that adding a positive emoticon to a message leads to a better user experience which increases the overall persuasive effectiveness of a system.

Novel mobbing strategies of a fish population against a sessile annelid predator

PubMed Central

Lachat, Jose; Haag-Wackernagel, Daniel

2016-01-01

When searching for food, foraging fishes expose themselves to hidden predators. The strategies that maximize the survival of foraging fishes are not well understood. Here, we describe a novel type of mobbing behaviour displayed by foraging Scolopsis affinis. The fish direct sharp water jets towards the hidden sessile annelid predator Eunice aphroditois (Bobbit worm). We recognized two different behavioural roles for mobbers (i.e., initiator and subsequent participants). The first individual to exhibit behaviour indicating the discovery of the Bobbit directed, absolutely and per time unit, more water jets than the subsequent individuals that joined the mobbing. We found evidence that the mobbing impacted the behaviour of the Bobbit, e.g., by inducing retraction. S. affinis individuals either mob alone or form mobbing groups. We speculate that this behaviour may provide social benefits for its conspecifics by securing foraging territories for S. affinis. Our results reveal a sophisticated and complex behavioural strategy to protect against a hidden predator. PMID:27615670

Reducing the Impact of Stereotype Threat on Women's Math Performance: Are Two Strategies Better Than One?

PubMed Central

Jones, Paul R.

2012-01-01

Introduction Two studies examined whether stereotype threat impairs women's math performance and whether concurrent threat reduction strategies can be used to offset this effect. Method In Study 1, collegiate men and women (N = 100) watched a video purporting that males and females performed equally well (gender-fair) or males outperformed females (gender differences) on an imminent math test. In Study 2, (N = 44) women viewed the gender differences video, followed by misattribution (cue present, absent) and self-affirmation (present, absent) manipulations, before taking the aforesaid test. Results In the initial study, women underperformed men on the test after receiving the gender differences video, whereas no gender differences emerged in the gender-fair condition. In Study 2, affirming the self led to better performance than not doing so. Planned contrasts indicated, however, that only women receiving a misattribution cue and self-affirmation opportunity outperformed their counterparts not given these reduction strategies. Discussion These findings are discussed relative to Stereotype Threat Theory and educational implications are provided. PMID:22545058

Biological effects-based tools for monitoring impacted surface waters in the Great Lakes: a multiagency program in support of the Great Lakes Restoration Initiative

USGS Publications Warehouse

Ekman, Drew R.; Ankley, Gerald T.; Blazer, Vicki; Collette, Timothy W.; Garcia-Reyero, Natàlia; Iwanowicz, Luke R.; Jorgensen, Zachary G.; Lee, Kathy E.; Mazik, Pat M.; Miller, David H.; Perkins, Edward J.; Smith, Edwin T.; Tietge, Joseph E.; Villeneuve, Daniel L.

2013-01-01

There is increasing demand for the implementation of effects-based monitoring and surveillance (EBMS) approaches in the Great Lakes Basin to complement traditional chemical monitoring. Herein, we describe an ongoing multiagency effort to develop and implement EBMS tools, particularly with regard to monitoring potentially toxic chemicals and assessing Areas of Concern (AOCs), as envisioned by the Great Lakes Restoration Initiative (GLRI). Our strategy includes use of both targeted and open-ended/discovery techniques, as appropriate to the amount of information available, to guide a priori end point and/or assay selection. Specifically, a combination of in vivo and in vitro tools is employed by using both wild and caged fish (in vivo), and a variety of receptor- and cell-based assays (in vitro). We employ a work flow that progressively emphasizes in vitro tools for long-term or high-intensity monitoring because of their greater practicality (e.g., lower cost, labor) and relying on in vivo assays for initial surveillance and verification. Our strategy takes advantage of the strengths of a diversity of tools, balancing the depth, breadth, and specificity of information they provide against their costs, transferability, and practicality. Finally, a series of illustrative scenarios is examined that align EBMS options with management goals to illustrate the adaptability and scaling of EBMS approaches and how they can be used in management decisions.

Bladder Preservation for Localized Muscle-Invasive Bladder Cancer: The Survival Impact of Local Utilization Rates of Definitive Radiotherapy

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

Kozak, Kevin R.; Hamidi, Maryam; Manning, Matthew

2012-06-01

Purpose: This study examines the management and outcomes of muscle-invasive bladder cancer in the United States. Methods and Materials: Patients with muscle-invasive bladder cancer diagnosed between 1988 and 2006 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Patients were classified according to three mutually exclusive treatment categories based on the primary initial treatment: no local management, radiotherapy, or surgery. Overall survival was assessed with Kaplan-Meier analysis and Cox models based on multiple factors including treatment utilization patterns. Results: The study population consisted of 26,851 patients. Age, sex, race, tumor grade, histology, and geographic location were associated withmore » differences in treatment (all p < 0.01). Patients receiving definitive radiotherapy tended to be older and have less differentiated tumors than patients undergoing surgery (RT, median age 78 years old and 90.6% grade 3/4 tumors; surgery, median age 71 years old and 77.1% grade 3/4 tumors). No large shifts in treatment were seen over time, with most patients managed with surgical resection (86.3% for overall study population). Significant survival differences were observed according to initial treatment: median survival, 14 months with no definitive local treatment; 17 months with radiotherapy; and 43 months for surgery. On multivariate analysis, differences in local utilization rates of definitive radiotherapy did not demonstrate a significant effect on overall survival (hazard ratio, 1.002; 95% confidence interval, 0.999-1.005). Conclusions: Multiple factors influence the initial treatment strategy for muscle-invasive bladder cancer, but definitive radiotherapy continues to be used infrequently. Although patients who undergo surgery fare better, a multivariable model that accounted for patient and tumor characteristics found no survival detriment to the utilization of definitive radiotherapy. These results support continued research into bladder preservation strategies and suggest that definitive radiotherapy represents a viable initial treatment strategy for those who wish to attempt to preserve their native bladder.« less

Determinants of successful clinical networks: the conceptual framework and study protocol.

PubMed

Haines, Mary; Brown, Bernadette; Craig, Jonathan; D'Este, Catherine; Elliott, Elizabeth; Klineberg, Emily; McInnes, Elizabeth; Middleton, Sandy; Paul, Christine; Redman, Sally; Yano, Elizabeth M

2012-03-13

Clinical networks are increasingly being viewed as an important strategy for increasing evidence-based practice and improving models of care, but success is variable and characteristics of networks with high impact are uncertain. This study takes advantage of the variability in the functioning and outcomes of networks supported by the Australian New South Wales (NSW) Agency for Clinical Innovation's non-mandatory model of clinical networks to investigate the factors that contribute to the success of clinical networks. The objective of this retrospective study is to examine the association between external support, organisational and program factors, and indicators of success among 19 clinical networks over a three-year period (2006-2008). The outcomes (health impact, system impact, programs implemented, engagement, user perception, and financial leverage) and explanatory factors will be collected using a web-based survey, interviews, and record review. An independent expert panel will provide judgements about the impact or extent of each network's initiatives on health and system impacts. The ratings of the expert panel will be the outcome used in multivariable analyses. Following the rating of network success, a qualitative study will be conducted to provide a more in-depth examination of the most successful networks. This is the first study to combine quantitative and qualitative methods to examine the factors that contribute to the success of clinical networks and, more generally, is the largest study of clinical networks undertaken. The adaptation of expert panel methods to rate the impacts of networks is the methodological innovation of this study. The proposed project will identify the conditions that should be established or encouraged by agencies developing clinical networks and will be of immediate use in forming strategies and programs to maximise the effectiveness of such networks.

Autonomous safety and reliability features of the K-1 avionics system

NASA Astrophysics Data System (ADS)

Mueller, George E.; Kohrs, Dick; Bailey, Richard; Lai, Gary

2004-03-01

Kistler Aerospace Corporation is developing the K-1, a fully reusable, two-stage-to-orbit launch vehicle. Both stages return to the launch site using parachutes and airbags. Initial flight operations will occur from Woomera, Australia. K-1 guidance is performed autonomously. Each stage of the K-1 employs a triplex, fault tolerant avionics architecture, including three fault tolerant computers and three radiation hardened Embedded GPS/INS units with a hardware voter. The K-1 has an Integrated Vehicle Health Management (IVHM) system on each stage residing in the three vehicle computers based on similar systems in commercial aircraft. During first-stage ascent, the IVHM system performs an Instantaneous Impact Prediction (IIP) calculation 25 times per second, initiating an abort in the event the vehicle is outside a predetermined safety corridor for at least 3 consecutive calculations. In this event, commands are issued to terminate thrust, separate the stages, dump all propellant in the first-stage, and initiate a normal landing sequence. The second-stage flight computer calculates its ability to reach orbit along its state vector, initiating an abort sequence similar to the first stage if it cannot. On a nominal mission, following separation, the second-stage also performs calculations to assure its impact point is within a safety corridor. The K-1's guidance and control design is being tested through simulation with hardware-in-the-loop at Draper Laboratory. Kistler's verification strategy assures reliable and safe operation of the K-1.

The Enzyme Function Initiative†

PubMed Central

Gerlt, John A.; Allen, Karen N.; Almo, Steven C.; Armstrong, Richard N.; Babbitt, Patricia C.; Cronan, John E.; Dunaway-Mariano, Debra; Imker, Heidi J.; Jacobson, Matthew P.; Minor, Wladek; Poulter, C. Dale; Raushel, Frank M.; Sali, Andrej; Shoichet, Brian K.; Sweedler, Jonathan V.

2011-01-01

The Enzyme Function Initiative (EFI) was recently established to address the challenge of assigning reliable functions to enzymes discovered in bacterial genome projects; in this Current Topic we review the structure and operations of the EFI. The EFI includes the Superfamily/Genome, Protein, Structure, Computation, and Data/Dissemination Cores that provide the infrastructure for reliably predicting the in vitro functions of unknown enzymes. The initial targets for functional assignment are selected from five functionally diverse superfamilies (amidohydrolase, enolase, glutathione transferase, haloalkanoic acid dehalogenase, and isoprenoid synthase), with five superfamily-specific Bridging Projects experimentally testing the predicted in vitro enzymatic activities. The EFI also includes the Microbiology Core that evaluates the in vivo context of in vitro enzymatic functions and confirms the functional predictions of the EFI. The deliverables of the EFI to the scientific community include: 1) development of a large-scale, multidisciplinary sequence/structure-based strategy for functional assignment of unknown enzymes discovered in genome projects (target selection, protein production, structure determination, computation, experimental enzymology, microbiology, and structure-based annotation); 2) dissemination of the strategy to the community via publications, collaborations, workshops, and symposia; 3) computational and bioinformatic tools for using the strategy; 4) provision of experimental protocols and/or reagents for enzyme production and characterization; and 5) dissemination of data via the EFI’s website, enzymefunction.org. The realization of multidisciplinary strategies for functional assignment will begin to define the full metabolic diversity that exists in nature and will impact basic biochemical and evolutionary understanding, as well as a wide range of applications of central importance to industrial, medicinal and pharmaceutical efforts. PMID:21999478

The Pain Associates' International Network Initiative: a novel practical approach to the challenge of chronic pain management in Europe.

PubMed

Morlion, Bart; Walch, Heribert; Yihune, Gabriel; Vielvoye-Kerkmeer, Ans; de Jong, Zuzana; Castro-Lopes, José; Stanton-Hicks, Michael

2008-01-01

Chronic pain is a debilitating condition with a multidimensional impact on the lives of patients, their families and communities. The public health burden of chronic pain is gathering recognition as a major healthcare problem in its own right and deserves closer attention. The challenge in treating chronic pain is to provide effective clinical management of a complex, multifaceted set of conditions that require a coordinated strategy of care. Epidemiological data and patient surveys have highlighted the areas of pain management that might be improved. These include a need for better understanding and documentation of the symptoms of chronic pain, standardized levels of care, improved communication among clinical personnel and with patients, and an updated education program for clinicians. For these reasons, new strategies aimed at improving the standards of pain management are needed. The Pain Associates' International Network (P.A.I.N.) Initiative was set up to devise practical methods for improving the quality of pain management for patients. These strategies have recently been put into practice through a number of activities: P.A.I.N. Workshops are meetings of international pain management professionals dedicated to discussing current management strategies and producing consensus recommendations for improving standards of care; P.A.I.N. Quality is a unique software program designed to help treating clinicians to document patient data and derive effective treatment plans; P.A.I.N. Online provides a web site forum for discussion of pain management topics; and P.A.I.N. Management is a clinician education program providing up-to-date training in pain management.

Leadership and organizational change for implementation (LOCI): a randomized mixed method pilot study of a leadership and organization development intervention for evidence-based practice implementation.

PubMed

Aarons, Gregory A; Ehrhart, Mark G; Farahnak, Lauren R; Hurlburt, Michael S

2015-01-16

Leadership is important in the implementation of innovation in business, health, and allied health care settings. Yet there is a need for empirically validated organizational interventions for coordinated leadership and organizational development strategies to facilitate effective evidence-based practice (EBP) implementation. This paper describes the initial feasibility, acceptability, and perceived utility of the Leadership and Organizational Change for Implementation (LOCI) intervention. A transdisciplinary team of investigators and community stakeholders worked together to develop and test a leadership and organizational strategy to promote effective leadership for implementing EBPs. Participants were 12 mental health service team leaders and their staff (n = 100) from three different agencies that provide mental health services to children and families in California, USA. Supervisors were randomly assigned to the 6-month LOCI intervention or to a two-session leadership webinar control condition provided by a well-known leadership training organization. We utilized mixed methods with quantitative surveys and qualitative data collected via surveys and a focus group with LOCI trainees. Quantitative and qualitative analyses support the LOCI training and organizational strategy intervention in regard to feasibility, acceptability, and perceived utility, as well as impact on leader and supervisee-rated outcomes. The LOCI leadership and organizational change for implementation intervention is a feasible and acceptable strategy that has utility to improve staff-rated leadership for EBP implementation. Further studies are needed to conduct rigorous tests of the proximal and distal impacts of LOCI on leader behaviors, implementation leadership, organizational context, and implementation outcomes. The results of this study suggest that LOCI may be a viable strategy to support organizations in preparing for the implementation and sustainment of EBP.

Negotiating with interactive scenarios and strategies.

PubMed

Savage, G T; Blair, J D; Sorenson, R; Buesseler, J

1991-01-01

Physician executives need to negotiate effectively with a wide range of parties. In those negotiations, they should consider the relative importance of both substantive and relationship outcomes in selecting initial negotiation strategies. Of course, these strategies may or may not be successful, depending on the strategies used by the other party. Hence, the physician executive must consider the other party's strategy and how it and his or her initial strategy are likely to interact both before and during negotiations.

Early ART initiation among HIV-positive pregnant women in central Mozambique: a stepped wedge randomized controlled trial of an optimized Option B+ approach.

PubMed

Cowan, James F; Micek, Mark; Cowan, Jessica F Greenberg; Napúa, Manuel; Hoek, Roxanne; Gimbel, Sarah; Gloyd, Stephen; Sherr, Kenneth; Pfeiffer, James T; Chapman, Rachel R

2015-04-30

Despite effective prevention strategies and increasing investments in global health, maternal to child transmission (MTCT) of HIV remains a significant problem globally, especially in sub-Saharan Africa. In 2012, there were 94,000 HIV-positive pregnant women in Mozambique. Approximately 15% of these women transmitted HIV to their newborn infants, resulting in nearly 14,000 new pediatric HIV infections that year. To address this issue, in 2013, the Mozambican Ministry of Health implemented the World Health Organization-recommended "Option B+" strategy in which all newly diagnosed HIV-positive pregnant women are counseled to initiate combination anti-retroviral therapy (ART) immediately upon diagnosis regardless of CD4 count and to continue treatment for life. Given the limited experience with Option B+ in sub-Saharan Africa, few rigorous pragmatic trials have studied this new treatment strategy. This study utilizes an initial formative research process involving patient and health care provider interviews and focus groups, workforce assessments, value stream mapping, and commodity utilization assessments to understand the strengths and weaknesses in the current Option B+ care cascade. The formative research is intended to guide identification and prioritization of key workflow modifications and the development of an enhanced adherence and retention package. These two components are bundled into a defined intervention implemented and evaluated across six health facilities utilizing a stepped wedge randomized controlled trial study design. The overall objective of this trial is to develop and test a pilot intervention in central Mozambique to implement the new Option B+ guidelines with high fidelity and increase the proportion of HIV-positive pregnant women in target antenatal clinics (ANC) who start ART prior to delivery and are retained in care. This pragmatic study utilizes research strategies that have the potential to meaningfully improve the Option B+ care cascade in central Mozambique and to decrease the MTCT of HIV. This trial is designed to identify critical low-cost improvement strategies that can be bundled into a defined intervention. If this intervention has a measurable impact, it can be rapidly scaled up to other ANC in Mozambique and sub-Saharan Africa. ClinicalTrials.gov: NCT02371265.

Exploring Alcohol Policy Approaches to Prevent Sexual Violence Perpetration

PubMed Central

Lippy, Caroline; DeGue, Sarah

2018-01-01

Sexual violence continues to be a significant public health problem worldwide with serious consequences for individuals and communities. The implementation of prevention strategies that address risk and protective factors for sexual violence at the community level are important components of a comprehensive approach, but few such strategies have been identified or evaluated. The current review explores one potential opportunity for preventing sexual violence perpetration at the community level: alcohol policy. Alcohol policy has the potential to impact sexual violence perpetration through the direct effects of excessive alcohol consumption on behavior or through the impact of alcohol and alcohol outlets on social organization within communities. Policies affecting alcohol pricing, sale time, outlet density, drinking environment, marketing, and college environment are reviewed to identify existing evidence of impact on rates of sexual violence or related outcomes, including risk factors and related health behaviors. Several policy areas with initial evidence of an association with sexual violence outcomes were identified, including policies affecting alcohol pricing, alcohol outlet density, barroom management, sexist content in alcohol marketing, and policies banning alcohol on campus and in substance-free dorms. We identify other policy areas with evidence of an impact on related outcomes and risk factors that may also hold potential as a preventative approach for sexual violence perpetration. Evidence from the current review suggests that alcohol policy may represent one promising avenue for the prevention of sexual violence perpetration at the community level, but additional research is needed to directly examine effects on sexual violence outcomes. PMID:25403447

Exploring Alcohol Policy Approaches to Prevent Sexual Violence Perpetration.

PubMed

Lippy, Caroline; DeGue, Sarah

2016-01-01

Sexual violence continues to be a significant public health problem worldwide with serious consequences for individuals and communities. The implementation of prevention strategies that address risk and protective factors for sexual violence at the community level are important components of a comprehensive approach, but few such strategies have been identified or evaluated. The current review explores one potential opportunity for preventing sexual violence perpetration at the community level: alcohol policy. Alcohol policy has the potential to impact sexual violence perpetration through the direct effects of excessive alcohol consumption on behavior or through the impact of alcohol and alcohol outlets on social organization within communities. Policies affecting alcohol pricing, sale time, outlet density, drinking environment, marketing, and college environment are reviewed to identify existing evidence of impact on rates of sexual violence or related outcomes, including risk factors and related health behaviors. Several policy areas with initial evidence of an association with sexual violence outcomes were identified, including policies affecting alcohol pricing, alcohol outlet density, barroom management, sexist content in alcohol marketing, and policies banning alcohol on campus and in substance-free dorms. We identify other policy areas with evidence of an impact on related outcomes and risk factors that may also hold potential as a preventative approach for sexual violence perpetration. Evidence from the current review suggests that alcohol policy may represent one promising avenue for the prevention of sexual violence perpetration at the community level, but additional research is needed to directly examine effects on sexual violence outcomes. © The Author(s) 2014.

Role of healthcare workers in early epidemic spread of Ebola: policy implications of prophylactic compared to reactive vaccination policy in outbreak prevention and control.

PubMed

Coltart, Cordelia E M; Johnson, Anne M; Whitty, Christopher J M

2015-10-19

Ebola causes severe illness in humans and has epidemic potential. How to deploy vaccines most effectively is a central policy question since different strategies have implications for ideal vaccine profile. More than one vaccine may be needed. A vaccine optimised for prophylactic vaccination in high-risk areas but when the virus is not actively circulating should be safe, well tolerated, and provide long-lasting protection; a two- or three-dose strategy would be realistic. Conversely, a reactive vaccine deployed in an outbreak context for ring-vaccination strategies should have rapid onset of protection with one dose, but longevity of protection is less important. In initial cases, before an outbreak is recognised, healthcare workers (HCWs) are at particular risk of acquiring and transmitting infection, thus potentially augmenting early epidemics. We hypothesise that many early outbreak cases could be averted, or epidemics aborted, by prophylactic vaccination of HCWs. This paper explores the potential impact of prophylactic versus reactive vaccination strategies of HCWs in preventing early epidemic transmissions. To do this, we use the limited data available from Ebola epidemics (current and historic) to reconstruct transmission trees and illustrate the theoretical impact of these vaccination strategies. Our data suggest a substantial potential benefit of prophylactic versus reactive vaccination of HCWs in preventing early transmissions. We estimate that prophylactic vaccination with a coverage >99% and theoretical 100% efficacy could avert nearly two-thirds of cases studied; 75% coverage would still confer clear benefit (40% cases averted), but reactive vaccination would be of less value in the early epidemic. A prophylactic vaccination campaign for front-line HCWs is not a trivial undertaking; whether to prioritise long-lasting vaccines and provide prophylaxis to HCWs is a live policy question. Prophylactic vaccination is likely to have a greater impact on the mitigation of future epidemics than reactive strategies and, in some cases, might prevent them. However, in a confirmed outbreak, reactive vaccination would be an essential humanitarian priority. The value of HCW Ebola vaccination is often only seen in terms of personal protection of the HCW workforce. A prophylactic vaccination strategy is likely to bring substantial additional benefit by preventing early transmission and might abort some epidemics. This has implications both for policy and for the optimum product profile for vaccines currently in development.

Future methods in pharmacy practice research.

PubMed

Almarsdottir, A B; Babar, Z U D

2016-06-01

This article describes the current and future practice of pharmacy scenario underpinning and guiding this research and then suggests future directions and strategies for such research. First, it sets the scene by discussing the key drivers which could influence the change in pharmacy practice research. These are demographics, technology and professional standards. Second, deriving from this, it seeks to predict and forecast the future shifts in use of methodologies. Third, new research areas and availability of data impacting on future methods are discussed. These include the impact of aging information technology users on healthcare, understanding and responding to cultural and social disparities, implementing multidisciplinary initiatives to improve health care, medicines optimization and predictive risk analysis, and pharmacy as business and health care institution. Finally, implications of the trends for pharmacy practice research methods are discussed.

The Impact of Incentives on Exercise Behavior: A Systematic Review of Randomized Controlled Trials

PubMed Central

Strohacker, Kelley; Galarraga, Omar; Williams, David M.

2015-01-01

Background The effectiveness of reinforcing exercise behavior with material incentives is unclear. Purpose Conduct a systematic review of existing research on material incentives for exercise, organized by incentive strategy. Methods Ten studies conducted between January 1965 and June 2013 assessed the impact of incentivizing exercise compared to a non-incentivized control. Results There was significant heterogeneity between studies regarding reinforcement procedures and outcomes. Incentives tended to improve behavior during the intervention while findings were mixed regarding sustained behavior after incentives were removed. Conclusions The most effective incentive procedure is unclear given the limitations of existing research. The effectiveness of various incentive procedures in promoting initial behavior change and habit formation, as well as the use of sustainable incentive procedures should be explored in future research. PMID:24307474

Perceived medication use challenges and coping strategies among medical outpatients in Nigeria.

PubMed

Yusuff, Kazeem B

2013-02-01

The use of medicines is an action that involves a change in behaviour and it is a complex construct involving reciprocal interactions between social, environmental and cognitive factors. This is particularly true when a patient uses medicines for asymptomatic chronic conditions, requiring life-long use. To identify patient-perceived medication use challenges, determine the coping strategies used and investigate the relationship between patient-perceived challenges and self-initiation of coping strategies. A premier 900-bed tertiary/teaching hospital located in Ibadan, Nigeria. Ten pharmacists conducted cross-sectional medication use interviews for a random sample of 324 medical outpatients in 4 weeks (25th October-19th November 2006). Patient-perceived challenges with prescribed medications, self-initiated coping strategies used and relationship between patient-perceived challenges and self-initiation of coping strategies Eighty-one percent (324) of the random sample of 400 patients consented and completed the interview. Of these, 50.3 % were males while 49.7 % were females with mean age (SD) of 51.5 (17.6) and 52.1 (17.4) years respectively. The most frequent diagnoses were hypertension (53 %) and type-2 diabetes + hypertension (14.5 %). Two hundred and twenty-four patients reported one or more perceived challenges. Of these, 43.8 % were 65 years or older and about half reported at least 3 challenges. The majority (95.6 %) of patients who reported perceived challenges initiated one or more coping strategies without the knowledge of their physicians or pharmacists. Of 100 patients who did not report any perceived challenge, 43 % admitted initiating strategies to maintain perceived "cure" of their medical conditions. Self-initiation and use of coping strategies was far more likely among patients who reported perceived challenges (OR: 28.4, 95 % CI 26.1-30.5). The number of coping strategies reported appeared strongly related to the number of perceived challenges (r = 0.91, p < 0.001). Perceived challenges associated with the use of prescribed medications and self-initiation of coping strategies appeared considerable among medical outpatients at a major teaching hospital in Nigeria. The risk of unauthorised initiation and use of varieties of coping strategies without the knowledge of clinicians was very high among patients who reported at least one perceived challenge.

Learning a locomotor task: with or without errors?

PubMed

Marchal-Crespo, Laura; Schneider, Jasmin; Jaeger, Lukas; Riener, Robert

2014-03-04

Robotic haptic guidance is the most commonly used robotic training strategy to reduce performance errors while training. However, research on motor learning has emphasized that errors are a fundamental neural signal that drive motor adaptation. Thus, researchers have proposed robotic therapy algorithms that amplify movement errors rather than decrease them. However, to date, no study has analyzed with precision which training strategy is the most appropriate to learn an especially simple task. In this study, the impact of robotic training strategies that amplify or reduce errors on muscle activation and motor learning of a simple locomotor task was investigated in twenty two healthy subjects. The experiment was conducted with the MAgnetic Resonance COmpatible Stepper (MARCOS) a special robotic device developed for investigations in the MR scanner. The robot moved the dominant leg passively and the subject was requested to actively synchronize the non-dominant leg to achieve an alternating stepping-like movement. Learning with four different training strategies that reduce or amplify errors was evaluated: (i) Haptic guidance: errors were eliminated by passively moving the limbs, (ii) No guidance: no robot disturbances were presented, (iii) Error amplification: existing errors were amplified with repulsive forces, (iv) Noise disturbance: errors were evoked intentionally with a randomly-varying force disturbance on top of the no guidance strategy. Additionally, the activation of four lower limb muscles was measured by the means of surface electromyography (EMG). Strategies that reduce or do not amplify errors limit muscle activation during training and result in poor learning gains. Adding random disturbing forces during training seems to increase attention, and therefore improve motor learning. Error amplification seems to be the most suitable strategy for initially less skilled subjects, perhaps because subjects could better detect their errors and correct them. Error strategies have a great potential to evoke higher muscle activation and provoke better motor learning of simple tasks. Neuroimaging evaluation of brain regions involved in learning can provide valuable information on observed behavioral outcomes related to learning processes. The impacts of these strategies on neurological patients need further investigations.

[Impact of a national treatment program in overweight adults women in primary care centers].

PubMed

Echenique Sarah, J; Rodríguez Osiac, L; Pizarro Quevedo, T; Martín, Ma A; Atalah Samur, E

2011-01-01

Chile has a high prevalence of overweight and obesity and is important to implement and evaluate treatment and control strategies that are effective. To evaluate changes in nutritional status and fasting glucose in overweight women, pre-diabetic and/or pre-hypertension in primary care centers of public health sector. A retrospective cohort of the universe of women admitted to the program in the participating primary care centers for 18 months was studied. Intervention includes consultations and workshops with doctors, nutritionists, psychologists and physical therapists for 4 months, in primary heath center, promoting healthy eating and increased physical activity, not using drugs. Analysis of causes of admission, dropout, participation in scheduled activities and changes in baseline nutritional status and fasting glucose after 4 months of intervention. 1,528 women 18 to 65 years old, with initial BMI between 25 and 40 were studied and 1,222 completed treatment (71.6%). The median weight change was -3.9% (CI -4.1 to 3.7) of initial weight and -2.0 mg/dl (CI -2.0 to 1.0) of blood glucose. 36.8% of patient decreased ≥ 5% of initial weight, 12.5% of overweight and about one third of obese partly improved or normalized their nutritional status. There was significant reduction in the prevalence of pre-diabetes (16.6 to 8.8%, p < 0.001). The intervention was effective for good adhesion and impact in reducing cardiovascular risk factors as BMI, waist circumference and high fasting glucose. One challenge is to keep track of this population to ascertain the impact in the medium and long term.

Cost-Effectiveness of Osteoporosis Screening Strategies for Men

PubMed Central

Nayak, Smita; Greenspan, Susan L.

2016-01-01

Osteoporosis affects many men, with significant morbidity and mortality. However, the best osteoporosis screening strategies for men are unknown. We developed an individual-level state-transition cost-effectiveness model with a lifetime time horizon to identify the cost-effectiveness of different osteoporosis screening strategies for U.S. men involving various screening tests (dual-energy x-ray absorptiometry (DXA); the Osteoporosis Self-Assessment Tool (OST); or a fracture risk assessment strategy using age, femoral neck bone mineral density (BMD), and Vertebral Fracture Assessment (VFA)); screening initiation ages (50, 60, 70, or 80); and repeat screening intervals (5 years or 10 years). In base-case analysis, no screening was a less effective option than all other strategies evaluated; furthermore, no screening was more expensive than all strategies that involved screening with DXA or the OST risk assessment instrument, and thus no screening was “dominated” by screening with DXA or OST at all evaluated screening initiation ages and repeat screening intervals. Screening strategies that most frequently appeared as most cost-effective in base-case analysis and one-way sensitivity analyses when assuming willingness-to-pay of $50,000/QALY or $100,000/QALY included screening initiation at age 50 with the fracture risk assessment strategy and repeat screening every 10 years; screening initiation at age 50 with fracture risk assessment and repeat screening every 5 years; and screening initiation at age 50 with DXA and repeat screening every 5 years. In conclusion, expansion of osteoporosis screening for U.S. men to initiate routine screening at age 50 or 60 would be expected to be effective and of good value for improving health outcomes. A fracture risk assessment strategy using variables of age, femoral neck BMD, and VFA is likely to be the most effective of the evaluated strategies within accepted cost-effectiveness parameters. DXA and OST are also reasonable screening options, albeit likely slightly less effective than the evaluated fracture risk assessment strategy. PMID:26751984

Efficiency enhancement of optimized Latin hypercube sampling strategies: Application to Monte Carlo uncertainty analysis and meta-modeling

NASA Astrophysics Data System (ADS)

Rajabi, Mohammad Mahdi; Ataie-Ashtiani, Behzad; Janssen, Hans

2015-02-01

The majority of literature regarding optimized Latin hypercube sampling (OLHS) is devoted to increasing the efficiency of these sampling strategies through the development of new algorithms based on the combination of innovative space-filling criteria and specialized optimization schemes. However, little attention has been given to the impact of the initial design that is fed into the optimization algorithm, on the efficiency of OLHS strategies. Previous studies, as well as codes developed for OLHS, have relied on one of the following two approaches for the selection of the initial design in OLHS: (1) the use of random points in the hypercube intervals (random LHS), and (2) the use of midpoints in the hypercube intervals (midpoint LHS). Both approaches have been extensively used, but no attempt has been previously made to compare the efficiency and robustness of their resulting sample designs. In this study we compare the two approaches and show that the space-filling characteristics of OLHS designs are sensitive to the initial design that is fed into the optimization algorithm. It is also illustrated that the space-filling characteristics of OLHS designs based on midpoint LHS are significantly better those based on random LHS. The two approaches are compared by incorporating their resulting sample designs in Monte Carlo simulation (MCS) for uncertainty propagation analysis, and then, by employing the sample designs in the selection of the training set for constructing non-intrusive polynomial chaos expansion (NIPCE) meta-models which subsequently replace the original full model in MCSs. The analysis is based on two case studies involving numerical simulation of density dependent flow and solute transport in porous media within the context of seawater intrusion in coastal aquifers. We show that the use of midpoint LHS as the initial design increases the efficiency and robustness of the resulting MCSs and NIPCE meta-models. The study also illustrates that this relative improvement decreases with increasing number of sample points and input parameter dimensions. Since the computational time and efforts for generating the sample designs in the two approaches are identical, the use of midpoint LHS as the initial design in OLHS is thus recommended.

Child and youth participatory interventions for addressing lifestyle-related childhood obesity: a systematic review.

PubMed

Frerichs, L; Ataga, O; Corbie-Smith, G; Tessler Lindau, S

2016-12-01

A growing number of childhood obesity interventions involve children and youth in participatory roles, but these types of interventions have not been systematically reviewed. We aimed to identify child and youth participatory interventions in the peer-reviewed literature in order to characterize the approaches and examine their impact on obesity and obesity-related lifestyle behaviours. We searched PubMed/Medline, psychINFO and ERIC for quasi-experimental and randomized trials conducted from date of database initiation through May 2015 that engaged children or youth in implementing healthy eating, physical activity or weight management strategies. Eighteen studies met our eligibility criteria. Most (n = 14) trained youth to implement pre-defined strategies targeting their peers. A few (n = 4) assisted youth to plan and implement interventions that addressed environmental changes. Thirteen studies reported at least one statistically significant weight, physical activity or dietary change outcome. Participatory approaches have potential, but variation in strategies and outcomes leave questions unanswered about the mechanisms through which child and youth engagement impact childhood obesity. Future research should compare child-delivered or youth-delivered to adult-delivered health promotion interventions and more rigorously evaluate natural experiments that engage youth to implement environmental changes. With careful attention to theoretical frameworks, process and outcome measures, these studies could strengthen the effectiveness of child and youth participatory approaches. © 2016 World Obesity Federation.

Prefrontal activity and impaired memory encoding strategies in schizophrenia.

PubMed

Guimond, Synthia; Hawco, Colin; Lepage, Martin

2017-08-01

Schizophrenia patients have significant memory difficulties that have far-reaching implications in their daily life. These impairments are partly attributed to an inability to self-initiate effective memory encoding strategies, but its core neurobiological correlates remain unknown. The current study addresses this critical gap in our knowledge of episodic memory impairments in schizophrenia. Schizophrenia patients (n = 35) and healthy controls (n = 23) underwent a Semantic Encoding Memory Task (SEMT) during an fMRI scan. Brain activity was examined for conditions where participants were a) prompted to use semantic encoding strategies, or b) not prompted but required to self-initiate such strategies. When prompted to use semantic encoding strategies, schizophrenia patients exhibited similar recognition performance and brain activity as healthy controls. However, when required to self-initiate these strategies, patients had significant reduced recognition performance and brain activity in the left dorsolateral prefrontal cortex, as well as in the left temporal gyrus, left superior parietal lobule, and cerebellum. When patients were divided based on performance on the SEMT, the subgroup with more severe deficits in self-initiation also showed greater reduction in left dorsolateral prefrontal activity. These results suggest that impaired self-initiation of elaborative encoding strategies is a driving feature of memory deficits in schizophrenia. We also identified the neural correlates of impaired self-initiation of semantic encoding strategies, in which a failure to activate the left dorsolateral prefrontal cortex plays a key role. These findings provide important new targets in the development of novel treatments aiming to improve memory and ultimately patients' outcome. Copyright © 2017. Published by Elsevier Ltd.

Research of information classification and strategy intelligence extract algorithm based on military strategy hall

NASA Astrophysics Data System (ADS)

Chen, Lei; Li, Dehua; Yang, Jie

2007-12-01

Constructing virtual international strategy environment needs many kinds of information, such as economy, politic, military, diploma, culture, science, etc. So it is very important to build an information auto-extract, classification, recombination and analysis management system with high efficiency as the foundation and component of military strategy hall. This paper firstly use improved Boost algorithm to classify obtained initial information, then use a strategy intelligence extract algorithm to extract strategy intelligence from initial information to help strategist to analysis information.

Recovery in soccer : part ii-recovery strategies.

PubMed

Nédélec, Mathieu; McCall, Alan; Carling, Chris; Legall, Franck; Berthoin, Serge; Dupont, Gregory

2013-01-01

In the formerly published part I of this two-part review, we examined fatigue after soccer matchplay and recovery kinetics of physical performance, and cognitive, subjective and biological markers. To reduce the magnitude of fatigue and to accelerate the time to fully recover after completion, several recovery strategies are now used in professional soccer teams. During congested fixture schedules, recovery strategies are highly required to alleviate post-match fatigue, and then to regain performance faster and reduce the risk of injury. Fatigue following competition is multifactorial and mainly related to dehydration, glycogen depletion, muscle damage and mental fatigue. Recovery strategies should consequently be targeted against the major causes of fatigue. Strategies reviewed in part II of this article were nutritional intake, cold water immersion, sleeping, active recovery, stretching, compression garments, massage and electrical stimulation. Some strategies such as hydration, diet and sleep are effective in their ability to counteract the fatigue mechanisms. Providing milk drinks to players at the end of competition and a meal containing high-glycaemic index carbohydrate and protein within the hour following the match are effective in replenishing substrate stores and optimizing muscle-damage repair. Sleep is an essential part of recovery management. Sleep disturbance after a match is common and can negatively impact on the recovery process. Cold water immersion is effective during acute periods of match congestion in order to regain performance levels faster and repress the acute inflammatory process. Scientific evidence for other strategies reviewed in their ability to accelerate the return to the initial level of performance is still lacking. These include active recovery, stretching, compression garments, massage and electrical stimulation. While this does not mean that these strategies do not aid the recovery process, the protocols implemented up until now do not significantly accelerate the return to initial levels of performance in comparison with a control condition. In conclusion, scientific evidence to support the use of strategies commonly used during recovery is lacking. Additional research is required in this area in order to help practitioners establish an efficient recovery protocol immediately after matchplay, but also for the following days. Future studies could focus on the chronic effects of recovery strategies, on combinations of recovery protocols and on the effects of recovery strategies inducing an anti-inflammatory or a pro-inflammatory response.

Strategies for promoting equity: experience with community financing in three African countries.

PubMed

Gilson, L; Kalyalya, D; Kuchler, F; Lake, S; Oranga, H; Ouendo, M

2001-10-01

Although the need for a pro-poor health reform agenda in low and middle income countries is increasingly clear, implementing such policy change is always difficult. This paper seeks to contribute to thinking about how to take forward such an agenda by reflection on the community financing activities of the UNICEF/WHO Bamako Initiative. It presents findings from a three-country study, undertaken in Benin, Kenya and Zambia in 1994/95, which was initiated in order to better understand the nature of the equity impact of community financing activities as well as the factors underlying this impact. The sustained relative affordability gains achieved in Benin emphasise the importance of ensuring that financing change is used as a policy lever for strengthening health service management in support of quality of care improvements. All countries, however, failed in protecting the most poor from the burden of payment, benefiting this group preferentially and ensuring that their views were heard in decision-making. Tackling these problems requires, amongst other things, an appropriate balance between central and local-level decision-making as well as the creation of local decision-making structures which have representation from civil society groups that can voice the needs of the most poor. Leadership, strategy and tactics are also always important in securing any kind of equity gain-such as establishing equity goals to drive implementation. In the experiences examined, the dominance of the goal of financial sustainability contributed to their equity failures. Further research is required to understand what equity goals communities themselves would prefer to guide financing policy.

Influence of tibial shock feedback training on impact loading and running economy.

PubMed

Clansey, Adam Charles; Hanlon, Michael; Wallace, Eric S; Nevill, Alan; Lake, Mark J

2014-01-01

The purpose of this study was to determine whether real-time feedback (RTF) training would reduce impact loading variables previously linked with tibial stress fracture risk and whether these adaptations would influence running economy. Twenty-two male runners were randomly assigned to RTF (n = 12) and control (n = 10) groups. The RTF group received feedback based on their peak tibial axial accelerations (PTA) during six 20-min treadmill runs for 3 wk, whereas the control group adhered to the same training but without feedback. Unilateral three-dimensional kinematic and kinetic analysis and running economy measurements were conducted before, after, and at 1 month posttraining. The RTF group had significant reductions (P < 0.01) in PTA and average and instantaneous vertical force loading rates after training as compared with no changes in the control group. These modifications in impact loads were only maintained in PTA 1 month after the training. A significant increase (P = 0.0033) in ankle plantarflexion at initial contact and a significant change (P = 0.030) in foot strike pattern from a rearfoot to midfoot strike pattern and a significant decrease (P = 0.008) in heel vertical velocity at initial contact appeared to be the primary mechanical strategies adopted by runners to reduce impact loading after RTF training. Despite these gait adaptations, running economy was unaffected. The results of this study suggest that gait retraining using RTF is an effective means of eliciting reductions in impact loading without negatively affecting running economy. However, with loading rate reductions not being maintained 1 month posttraining, further research is required to determine how these reductions in impact severity can be retained long term.

The Cellie Coping Kit for Children with Injury: Initial feasibility, acceptability, and outcomes.

PubMed

Marsac, M L; Weiss, D; Kohser, K L; Van Allen, J; Seegan, P; Ostrowski-Delahanty, S; McGar, A; Winston, F K; Kassam-Adams, N

2018-04-15

Physical and psychological challenges can arise from paediatric injury, which can impact child health outcomes. Evidence-based resources to promote recovery are limited. The low cost, portable Cellie Coping Kit for Children with Injury provides evidence-based strategies to help children manage injury-related challenges. This study aimed to describe intervention feasibility and explore initial outcomes (learning, quality of life [QOL], and trauma symptoms). Three independent pilot studies were conducted. Child-parent dyads (n = 61) participated in the intervention; ~36% completed a 4-week follow-up assessment. Results suggested that the intervention was feasible (e.g., 95% of parents would recommend the intervention; >85% reported that it was easy to use). Over 70% of participants reported learning new skills. No statistically significant differences were detected for children's QOL or trauma symptoms preintervention to postintervention. Preliminary research suggests that the Cellie Coping Kit for Children with Injuries is a feasible, low-cost, preventive intervention, which may provide families with strategies to promote recovery from paediatric injury. Future research, including a randomized controlled trial, ought to further examine targeted long-term intervention outcomes. © 2018 John Wiley & Sons Ltd.

[Current strategies to diminish the impact of cardiovascular diseases in women].

PubMed

Stramba Badiale, Marco; Priori, Silvia G

2006-11-01

The European Society of Cardiology (ESC) has recently promoted the "Women at Heart" program in order to organize initiatives targeted at promoting research and education in the field of cardiovascular diseases in women. Comparisons of the gender differences in specific disease and treatment trends across Europe are provided by analyzing data from the Euro Heart Surveys. A Policy Conference has been organized with the objective to summarize the state of the art from an European perspective, to identify the scientific gaps and to delineate the strategies for changing the misperception of cardiovascular diseases in women, improving risk stratification, diagnosis, and therapy from a gender perspective and increasing women representation in clinical trials. A Statement from the Policy Conference has been provided and published in the European Heart Journal. Synergic activities should be undertaken at European level with the support of national scientific societies, European institutions, national health care authorities, patients' associations, and foundations. The commitment of the Board of the ESC is that these initiatives contribute to increase the awareness across Europe that cardiovascular disease is the primary cause of death in women and to improve the knowledge of risk factors, presentation and treatment of cardiovascular diseases in women.

Soft regulations in pharmaceutical policy making: an overview of current approaches and their consequences.

PubMed

Wettermark, Björn; Godman, Brian; Jacobsson, Bengt; Haaijer-Ruskamp, Flora M

2009-01-01

It is a challenge to improve public health within limited resources. Pharmaceutical policy making is a greater challenge due to conflicting interests between key stakeholder groups. This paper reviews current and future strategies to help improve the quality and efficiency of care, with special emphasis on demand-side controls for pharmaceutical prescribing. A large number of different educational, organizational, financial and regulatory strategies have been applied in pharmaceutical policy making. However, the effectiveness of most strategies has not been thoroughly evaluated and there is evidence that the behaviour of healthcare professionals is difficult to influence with traditional methods. During the last decades, new modes of governing and new governing constellations have also appeared in healthcare. However, relationships between those who regulate and those regulated are often unclear. New approaches have recently been introduced, including extensive dissemination strategies for guidelines and extensive quality assessment programmes where physicians' performances are measured against agreed standards or against each other. The main components of these 'soft regulations' are standardization, monitoring and agenda setting. However, the impact of these new modes on health provision and overall costs is often unknown, and the increased focus on monitoring may result in a higher conformity and uniformity that may not always benefit all key stakeholders. Alongside this, a substantial growth of auditing associations controlling a diminishing minority of people actually performing the tasks may be costly and counter-productive. As a result, new effective strategies are urgently needed to help maintain comprehensive healthcare without prohibitively raising taxes or insurance premiums. This is especially important where countries are faced with extreme financial problems. Healthcare researchers may benefit from researching other areas of society. However, any potential strategies initiated must be adequately researched, debated and evaluated to enhance implementation. We hope this opinion paper is the first step in the process to develop and implement new demand-side initiatives building on existing 'soft regulations'.

Quantifying patient preferences for symptomatic breast clinic referral: a decision analysis study.

PubMed

Quinlan, Aisling; O'Brien, Kirsty K; Galvin, Rose; Hardy, Colin; McDonnell, Ronan; Joyce, Doireann; McDowell, Ronald D; Aherne, Emma; Keogh, Claire; O'Sullivan, Katriona; Fahey, Tom

2018-05-31

Decision analysis study that incorporates patient preferences and probability estimates to investigate the impact of women's preferences for referral or an alternative strategy of watchful waiting if faced with symptoms that could be due to breast cancer. Community-based study. Asymptomatic women aged 30-60 years. Participants were presented with 11 health scenarios that represent the possible consequences of symptomatic breast problems. Participants were asked the risk of death that they were willing to take in order to avoid the health scenario using the standard gamble utility method. This process was repeated for all 11 health scenarios. Formal decision analysis for the preferred individual decision was then estimated for each participant. The preferred diagnostic strategy was either watchful waiting or referral to a breast clinic. Sensitivity analysis was used to examine how each varied according to changes in the probabilities of the health scenarios. A total of 35 participants completed the interviews, with a median age 41 years (IQR 35-47 years). The majority of the study sample was employed (n=32, 91.4%), with a third-level (university) education (n=32, 91.4%) and with knowledge of someone with breast cancer (n=30, 85.7%). When individual preferences were accounted for, 25 (71.4%) patients preferred watchful waiting to referral for triple assessment as their preferred initial diagnostic strategy. Sensitivity analysis shows that referral for triple assessment becomes the dominant strategy at the upper probability estimate (18%) of breast cancer in the community. Watchful waiting is an acceptable strategy for most women who present to their general practitioner (GP) with breast symptoms. These findings suggest that current referral guidelines should take more explicit account of women's preferences in relation to their GPs initial management strategy. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Patented drug extension strategies on healthcare spending: a cost-evaluation analysis.

PubMed

Vernaz, Nathalie; Haller, Guy; Girardin, François; Huttner, Benedikt; Combescure, Christophe; Dayer, Pierre; Muscionico, Daniel; Salomon, Jean-Luc; Bonnabry, Pascal

2013-01-01

Drug manufacturers have developed "evergreening" strategies to compete with generic medication after patent termination. These include marketing of slightly modified follow-on drugs. We aimed to estimate the financial impact of these drugs on overall healthcare costs and also to examine the impact of listing these drugs in hospital restrictive drug formularies (RDFs) on the healthcare system as a whole ("spillover effect"). We used hospital and community pharmacy invoice office data in the Swiss canton of Geneva to calculate utilisation of eight follow-on drugs in defined daily doses between 2000 and 2008. "Extra costs" were calculated for three different scenarios assuming replacement with the corresponding generic equivalent for prescriptions of (1) all brand (i.e., initially patented) drugs, (2) all follow-on drugs, or (3) brand and follow-on drugs. To examine the financial spillover effect we calculated a monthly follow-on drug market share in defined daily doses for medications prescribed by hospital physicians but dispensed in community pharmacies, in comparison to drugs prescribed by non-hospital physicians in the community. Estimated "extra costs" over the study period were €15.9 (95% CI 15.5; 16.2) million for scenario 1, €14.4 (95% CI 14.1; 14.7) million for scenario 2, and €30.3 (95% CI 29.8; 30.8) million for scenario 3. The impact of strictly switching all patients using proton-pump inhibitors to esomeprazole at admission resulted in a spillover "extra cost" of €330,300 (95% CI 276,100; 383,800), whereas strictly switching to generic cetirizine resulted in savings of €7,700 (95% CI 4,100; 11,100). Overall we estimated that the RDF resulted in "extra costs" of €503,600 (95% CI 444,500; 563,100). Evergreening strategies have been successful in maintaining market share in Geneva, offsetting competition by generics and cost containment policies. Hospitals may be contributing to increased overall healthcare costs by listing follow-on drugs in their RDF. Therefore, healthcare providers and policy makers should be aware of the impact of evergreening strategies.

Spatial strategies for managing visitor impacts in National Parks

USGS Publications Warehouse

Leung, Y.-F.; Marion, J.L.

1999-01-01

Resource and social impacts caused by recreationists and tourists have become a management concern in national parks and equivalent protected areas. The need to contain visitor impacts within acceptable limits has prompted park and protected area managers to implement a wide variety of strategies and actions, many of which are spatial in nature. This paper classifies and illustrates the basic spatial strategies for managing visitor impacts in parks and protected areas. A typology of four spatial strategies was proposed based on the recreation and park management literature. Spatial segregation is a common strategy for shielding sensitive resources from visitor impacts or for separating potentially conflicting types of use. Two forms of spatial segregation are zoning and closure. A spatial containment strategy is intended to minimize the aggregate extent of visitor impacts by confining use to limited designated or established Iocations. In contrast, a spatial dispersal strategy seeks to spread visitor use, reducing the frequency of use to levels that avoid or minimize permanent resource impacts or visitor crowding and conflict. Finally, a spatial configuration strategy minimizes impacting visitor behavior though the judicious spatial arrangement of facilities. These four spatial strategics can be implemented separately or in combination at varying spatial scales within a single park. A survey of national park managers provides an empirical example of the diversity of implemented spatial strategies in managing visitor impacts. Spatial segregation is frequently applied in the form of camping restrictions or closures to protect sensitive natural or cultural resources and to separate incompatible visitor activities. Spatial containment is the most widely applied strategy for minimizing the areal extent of resource impacts. Spatial dispersal is commonly applied to reduce visitor crowding or conflicts in popular destination areas but is less frequently applied or effective in minimizing resource impacts. Spatial configuration was only minimally evaluated, as it was not included in the survey. The proposed typology of spatial strategies offers a useful means of organizing and understanding the wide variety of management strategies and actions applied in managing visitor impacts in parks and protected areas. Examples from U.S. national parks demonstrate the diversity of these basic strategies and their flexibility in implementation at various spatial scales. Documentation of these examples helps illustrate their application and inform managers of the multitude of options. Further analysis from the spatial perspective is needed Io extend the applicability of this typology to other recreational activities and management issues.

Reduction of initial shock in decadal predictions using a new initialization strategy

NASA Astrophysics Data System (ADS)

He, Yujun; Wang, Bin

2017-04-01

Initial shock is a well-known problem occurring in the early years of a decadal prediction when assimilating full-field observations into a coupled model, which directly affects the prediction skill. For the purpose to alleviate this problem, we propose a novel full-field initialization method based on dimension-reduced projection four-dimensional variational data assimilation (DRP-4DVar). Different from the available solution strategies including anomaly assimilation and bias correction, it substantially reduces the initial shock through generating more consistent initial conditions for the coupled model, which, along with the model trajectory in one-month windows, best fit the monthly mean analysis data of oceanic temperature and salinity. We evaluate the performance of initialized hindcast experiments according to three proposed indices to measure the intensity of the initial shock. The results indicate that this strategy can obviously reduce the initial shock in decadal predictions by FGOALS-g2 (the Flexible Global Ocean-Atmosphere-Land System model, Grid-point Version 2) compared with the commonly-used nudging full-field initialization for the same model as well as the different full-field initialization strategies for other CMIP5 (the fifth phase of the Coupled Model Intercomparison Project) models whose decadal prediction results are available. It is also comparable to or even better than the anomaly initialization methods. Better hindcasts of global mean surface air temperature anomaly are obtained due to the reduction of initial shock by the new initialization scheme.

Rural and remote young people's health career decision making within a health workforce development program: a qualitative exploration.

PubMed

Kumar, Koshila; Jones, Debra; Naden, Kathryn; Roberts, Chris

2015-01-01

One strategy aimed at resolving ongoing health workforce shortages in rural and remote settings has been to implement workforce development initiatives involving the early activation and development of health career aspirations and intentions among young people in these settings. This strategy aligns with the considerable evidence showing that rural background is a strong predictor of rural practice intentions and preferences. The Broken Hill Regional Health Career Academy Program (BHRHCAP) is an initiative aimed at addressing local health workforce challenges by helping young people in the region develop and further their health career aspirations and goals. This article reports the factors impacting on rural and remote youths' health career decision-making within the context of a health workforce development program. Data were collected using interviews and focus groups with a range of stakeholders involved in the BHRHCAP including local secondary school students, secondary school teachers, career advisors, school principals, parents, and pre-graduate health students undertaking a clinical placement in Broken Hill, and local clinicians. Data interpretation was informed by the theoretical constructs articulated within socio cognitive career theory. Young people's career decision-making in the context of a local health workforce development program was influenced by a range of personal, contextual and experiential factors. These included personal factors related to young people's career goals and motivations and their confidence to engage in career decision-making, contextual factors related to BHRHCAP program design and structure as well as the visibility and accessibility of health career pathways in a rural setting, and experiential factors related to the interaction and engagement between young people and role models or influential others in the health and education sectors. This study provided theoretical insight into the broader range of interrelating and complex personal, contextual and experiential factors impacting on rural and remote youths' career decision-making within a health workforce development initiative.

Cognitive and Neural Effects of Semantic Encoding Strategy Training in Older Adults

PubMed Central

Anderson, B. A.; Barch, D. M.; Jacoby, L. L.

2012-01-01

Prior research suggests that older adults are less likely than young adults to use effective learning strategies during intentional encoding. This functional magnetic resonance imaging (fMRI) study investigated whether training older adults to use semantic encoding strategies can increase their self-initiated use of these strategies and improve their recognition memory. The effects of training on older adults' brain activity during intentional encoding were also examined. Training increased older adults' self-initiated semantic encoding strategy use and eliminated pretraining age differences in recognition memory following intentional encoding. Training also increased older adults' brain activity in the medial superior frontal gyrus, right precentral gyrus, and left caudate during intentional encoding. In addition, older adults' training-related changes in recognition memory were strongly correlated with training-related changes in brain activity in prefrontal and left lateral temporal regions associated with semantic processing and self-initiated verbal encoding strategy use in young adults. These neuroimaging results demonstrate that semantic encoding strategy training can alter older adults' brain activity patterns during intentional encoding and suggest that young and older adults may use the same network of brain regions to support self-initiated use of verbal encoding strategies. PMID:21709173

Patients' perception of chemotherapy side effects: Expectations, doctor-patient communication and impact on quality of life - An Italian survey.

PubMed

Lorusso, Domenica; Bria, Emilio; Costantini, Anna; Di Maio, Massimo; Rosti, Giovanni; Mancuso, Annamaria

2017-03-01

Chemotherapy side effects (CSE) have a strong impact on patients' quality of life (QOL). To assess patient perceptions of CSE, their impact on QOL and doctor-patient communication regarding these aspects, a survey was conducted among Italian cancer patients. Patients at least 18 years of age, who received chemotherapy, were administered a dedicated questionnaire to assess their point of view on five domains: expectations about CSE and impact on QOL; doctor-patient communication about CSE; treatments to reduce the impact of CSE; sexual life; family relationships/activities and employment. A total of 761 patients participated. CSE had a considerable impact on patient QOL. Nausea/vomiting was the most feared adverse effect before initiating chemotherapy and the one most commonly experienced during treatment. Patients generally reported good doctor-patient communication regarding information about CSE. In almost all cases, the oncologists prescribed an antiemetic treatment, but the incidence of nausea/vomiting was high. Cancer and CSE severely affected sexual life, daily activities and employment. CSE had a strong negative impact on QOL. Good doctor-patient communication is essential. Improving antiemetic strategies may improve QOL. Doctors' ability to inform patients about delicate issues, such as the impact of CSE on sexual life, needs to be improved. © 2016 John Wiley & Sons Ltd.

Global initiatives in maternal and newborn health

PubMed Central

Tunçalp, Özge

2017-01-01

In 2015, 17 sustainable development goals were established for 2030. These global goals aim to ensure healthy lives and promote wellbeing for all. In support of the sustainable development goals, the World Health Organization proposed a new global strategy for women’s, children’s, and adolescents’ health in 2016 with three overarching objectives: to survive, to thrive, and to transform. We are now globally seeking not only to end preventable deaths but also to ensure health and wellbeing, and expand enabling environments. This strategy builds on several prior initiatives in maternal and newborn health, such as the Every Woman, Every Child initiative, and the strategy to end preventable maternal mortality and implementation of an action plan to end preventable newborn death. This confluence of initiatives, strategies, and novel financing mechanisms under the umbrella of the sustainable development goals and the global strategy pave the way for a global agenda in which securing women’s health is critical. PMID:28491127

Conservation planning as an adaptive strategy for climate change and groundwater depletion in Wadi El Natrun, Egypt

NASA Astrophysics Data System (ADS)

Switzman, Harris; Salem, Boshra; Gad, Mohamed; Adeel, Zafar; Coulibaly, Paulin

2018-05-01

In drylands, groundwater is often the sole source of freshwater for industrial, domestic and agricultural uses, while concurrently supporting ecosystems. Many dryland aquifers are becoming depleted due to over-pumping and a lack of natural recharge, resulting in loss of storage and future water supplies, water-level declines that reduce access to freshwater, water quality problems, and, in extreme cases, geologic hazards. Conservation is often proposed as a strategy for managing groundwater to reduce or reverse the depletion, although there is a need to better understand its potential effectiveness and benefits at the local scale. This study assesses the impact of water-conservation planning strategies on groundwater resources in the Wadi El Natrun (WEN) area of northern Egypt. WEN has been subjected to groundwater depletion and quality degradation since the 1990s, attributed to agricultural and industrial groundwater usage. Initiatives have been proposed to increase the sustainability of the groundwater resource in the study area, but they have yet to be evaluated. Simultaneously, there are also proposals to increase the extent of arable land and thus demand for freshwater. In this study, three water management scenarios are developed and assessed to the 2060s for their impact on groundwater resources using a hydrogeologic model. Results demonstrate that demand management implemented through an optimized irrigation and crop rotation strategy has the greatest potential to significantly reduce risk of groundwater depletion compared to the other two scenarios—"business as usual" and "30% water-use reduction"—that were evaluated.

Iron in the Ross Sea: 2. Impact of discrete iron addition strategies

NASA Astrophysics Data System (ADS)

Arrigo, Kevin R.; Tagliabue, Alessandro

2005-03-01

Presented are results of a regional-scale numerical investigation into the effectiveness of Fe fertilization as a means to increase the efficiency of the biological pump in Fe-limited waters of the Ross Sea, Antarctica. This investigation was conducted using a modified version of the Coupled Ice And Ocean (CIAO) ecosystem model of the Ross Sea sector of the Southern Ocean. Four sets of experiments were performed, investigating the impacts of differences in (1) timing of fertilization, (2) duration of fertilization, (3) amount of Fe added, and (4) size of the fertilized patch. Results show that the stimulation of air-sea CO2 exchange (FCO2) depends primarily on the timing of fertilization, regardless of the amount of Fe added. When Fe was added at the optimal time of year, FCO2 from the atmosphere into the Ross Sea was increased by 3-22%, depending on fertilization strategy. Increasing patch size produced the largest response, and increasing initial Fe concentration produced the smallest. In all cases, as the intensity of Fe fertilization increased, the fertilization efficiency (increase in CO2 uptake per unit added Fe) dropped. Strategies that maximized the fertilization efficiency resulted in relatively little additional CO2 being drawn out of the atmosphere. To markedly increase oceanic uptake of atmospheric CO2 would require the addition of large amounts of Fe due to the low fertilization efficiencies associated with maximum air-sea CO2 exchange. Our results also show that differences in the fertilization strategy should be kept in mind when comparing the results of different Fe fertilization experiments.

Improving skills in pediatric rheumatology in Colombia: a combined educational strategy supported by ILAR.

PubMed

Pino, Sally; Mora, Claudia; Diaz, Adriana; Guarnizo, Pilar; Jaimes, Diego

2017-07-01

Colombia is a densely populated country with a small number of pediatric rheumatology specialists, including 14 specialists for a population of 1,927,000 children in 2014. The objective of the study was to improve the skills required for early identification, timely referral, and management of musculoskeletal diseases, especially juvenile idiopathic arthritis (JIA), in a group of pediatricians and pediatric residents in a remote region of Colombia. Supported by grant programs developed by the International League of Associations for Rheumatology (ILAR), a combined educational strategy (blended learning) was implemented based on two classroom educational activities and four online modules. The students' acquired knowledge and perception of the strategy were evaluated. Scores were reported as median values and interquartile ranges (IQR), and the differences between scores were estimated using the Wilcoxon test for equal medians. Forty-one students were enrolled, 37 completed the online modules, and 33 attended the final in-person session. The results of the written tests demonstrated an improved ability to solve clinical problems compared with the results of the tests before the course (the median initial vs. final test scores 3 (IQR = 1) vs. 5 (IQR = 0), p = 0.000). The students reported high levels of satisfaction related to compliance with the proposed objectives, the relevance of the contents and activities performed, and the impact on everyday practice. These types of strategies are useful as tools for continuing medical education. However, the results pertain only to short-term learning. It is necessary to evaluate their impact on "lifelong learning."

Global strategies to reduce the price of antiretroviral medicines: evidence from transactional databases

PubMed Central

Kaplan, Warren; King, Alexis C; Lawrence, Danielle A; Leufkens, Hubert G; Fox, Matthew P

2009-01-01

Abstract Objective To estimate the impact of global strategies, such as pooled procurement arrangements, third-party price negotiation and differential pricing, on reducing the price of antiretrovirals (ARVs), which currently hinders universal access to HIV/AIDS treatment. Methods We estimated the impact of global strategies to reduce ARV prices using data on 7253 procurement transactions (July 2002–October 2007) from databases hosted by WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Findings For 19 of 24 ARV dosage forms, we detected no association between price and volume purchased. For the other five ARVs, high-volume purchases were 4–21% less expensive than medium- or low-volume purchases. Nine of 13 generic ARVs were priced 6–36% lower when purchased under the Clinton Foundation HIV/AIDS Initiative (CHAI). Fifteen of 18 branded ARVs were priced 23–498% higher for differentially priced purchases compared with non-CHAI generic purchases. However, two branded, differentially priced ARVs were priced 63% and 73% lower, respectively, than generic non-CHAI equivalents. Conclusion Large purchase volumes did not necessarily result in lower ARV prices. Although current plans for pooled procurement will further increase purchase volumes, savings are uncertain and should be balanced against programmatic costs. Third-party negotiation by CHAI resulted in lower generic ARV prices. Generics were less expensive than differentially priced branded ARVs, except where little generic competition exists. Alternative strategies for reducing ARV prices, such as streamlining financial management systems, improving demand forecasting and removing barriers to generics, should be explored. PMID:19649366

Influence of magnetic field strength and image registration strategy on voxel-based morphometry in a study of Alzheimer's disease.

PubMed

Marchewka, Artur; Kherif, Ferath; Krueger, Gunnar; Grabowska, Anna; Frackowiak, Richard; Draganski, Bogdan

2014-05-01

Multi-centre data repositories like the Alzheimer's Disease Neuroimaging Initiative (ADNI) offer a unique research platform, but pose questions concerning comparability of results when using a range of imaging protocols and data processing algorithms. The variability is mainly due to the non-quantitative character of the widely used structural T1-weighted magnetic resonance (MR) images. Although the stability of the main effect of Alzheimer's disease (AD) on brain structure across platforms and field strength has been addressed in previous studies using multi-site MR images, there are only sparse empirically-based recommendations for processing and analysis of pooled multi-centre structural MR data acquired at different magnetic field strengths (MFS). Aiming to minimise potential systematic bias when using ADNI data we investigate the specific contributions of spatial registration strategies and the impact of MFS on voxel-based morphometry in AD. We perform a whole-brain analysis within the framework of Statistical Parametric Mapping, testing for main effects of various diffeomorphic spatial registration strategies, of MFS and their interaction with disease status. Beyond the confirmation of medial temporal lobe volume loss in AD, we detect a significant impact of spatial registration strategy on estimation of AD related atrophy. Additionally, we report a significant effect of MFS on the assessment of brain anatomy (i) in the cerebellum, (ii) the precentral gyrus and (iii) the thalamus bilaterally, showing no interaction with the disease status. We provide empirical evidence in support of pooling data in multi-centre VBM studies irrespective of disease status or MFS. Copyright © 2013 Wiley Periodicals, Inc.

A CLEAN Network Initiative - Accelerating Transition to Post Carbon and Resilient Communities through Education and Engagement

NASA Astrophysics Data System (ADS)

Ledley, T. S.; Niepold, F., III; Bozuwa, J.; Davis, A.; Fraser, J.; Kretser, J.; Poppleton, K. L. I.; Qusba, L.; Ruggiero, K.; Spitzer, W.; Stylinski, C.

2016-12-01

The Climate Literacy and Energy Awareness Network (CLEAN) was formed in 2008 to help climate and energy literacy stakeholders implement the Climate and Energy Literacy Essential Principles to enable effective and responsible decisions with regard to actions that may affect climate. The ongoing conversations of the CLEAN Network have cultivated a culture of shared resources and expertise and allowed for the development of collective impact strategies. However, it has become clear that to accelerate and scale change, effective mitigation, adaptation, and resilience strategies must be developed by a diverse network of stakeholders at the community level to deal with the local impacts of climate change and move toward decarbonized and resilient economies. A group of CLEAN Network members, experienced in establishing effective networks and representing mature climate change education programs, came together to discuss at the community level 1) how we can collectively enable larger scale efforts to 2) develop effective strategies, 3) identify gaps in the system that limit action, and 4) coordinate possible vectors for interceding to advance community level decisions related to climate. We will describe our Theory of Change, based on both the power of communities and increasing climate literacy as a key requirement for sustained progress on the crisis climate change presents. From our Theory of Change, we have begun to outline a national monitoring strategy that can provide communities a measured way to understand their local readiness to respond to the impacts of climate change and understand the magnitude of those impacts in relation to their political and ecological economies. The scale would help describe the robustness of their programs and partnerships to address those impacts, the political climate for working in advance of pending change, and the degree of citizen engagement in resilience planning and action. The goal is to provide a common tool equivalent to GDP that communities could use to see their strengths and leverage points, and where they have the local resources to build solutions or co-develop solutions with others. Though this new tool, communities may be better able to focus on mitigation, adaptation, and the building of resilience that will put into practice the identified Theory of Change.

Impacts of the creation, expansion and management of English wetlands on mosquito presence and abundance - developing strategies for future disease mitigation.

PubMed

Medlock, Jolyon M; Vaux, Alexander G C

2015-03-03

The incidence of mosquito-borne diseases is increasing in Europe, partly due to the incursion of a number of invasive species known to be vectors of dengue and chikungunya viruses, but also due to the involvement of native species in the transmission of West Nile virus and malaria. For some of these pathogens, there is a risk of the re-emergence of vector-borne diseases that were once widespread in Europe, but declined partly due to large-scale land-drainage projects. Some mosquito species exploit container habitats as breeding sites in urban areas; an adaptation to human-made micro-habitats resulting from increased urbanisation. However, many species thrive in natural wetland ecosystems. Owing to the impacts of climate change there is an urgent need for environmental adaptation, such as the creation of new wetlands to mitigate coastal and inland flooding. In some cases, these initiatives can be coupled with environmental change strategies to protect a range of endangered flora and fauna species by enhancing and extending wetland landscapes, which may by driven by European legislation, particularly in urban areas. This paper reviews field studies conducted in England to assess the impact of newly created wetlands on mosquito colonisation in a) coastal, b) urban and c) arable reversion habitats. It also considers the impact of wetland management on mosquito populations and explores the implications of various water and vegetation management options on the range of British mosquito species. Understanding the impact of wetland creation and management strategies on mosquito prevalence and the potential risk of increasing the levels of nuisance or disease vector species will be crucial in informing health and well-being risk assessments, guiding targeted control, and anticipating the social effects of extreme weather and climate change. Although new wetlands will certainly extend aquatic habitats for mosquitoes, not all species will become a major nuisance or a vector concern as a result. Understanding how the design and management of wetlands might exacerbate mosquito densities is crucial if we are to manage nuisance mosquitoes and control vector species in the event of a disease outbreak. This entomological evidence-base will ensure that control strategies achieve optimal efficacy at minimal cost.

Self-reinforcing feedback loop in financial markets with coupling of market impact and momentum traders

NASA Astrophysics Data System (ADS)

Zhong, Li-Xin; Xu, Wen-Juan; Chen, Rong-Da; Zhong, Chen-Yang; Qiu, Tian; Ren, Fei; He, Yun-Xing

2018-03-01

By incorporating market impact and momentum traders into an agent-based model, we investigate the conditions for the occurrence of self-reinforcing feedback loops and the coevolutionary mechanism of prices and strategies. For low market impact, the price fluctuations are originally large. The existence of momentum traders has little impact on the change of price fluctuations but destroys the equilibrium between the trend-following and trend-rejecting strategies. The trend-following herd behaviors become dominant. A self-reinforcing feedback loop exists. For high market impact, the existence of momentum traders leads to an increase in price fluctuations. The trend-following strategies of rational individuals are suppressed while the trend-following strategies of momentum traders are promoted. The crowd-anticrowd behaviors become dominant. A negative feedback loop exists. A theoretical analysis indicates that, for low market impact, the majority effect is beneficial for the trend-followers to earn more, which in turn promotes the trend-following strategies. For high market impact, the minority effect causes the trend-followers to suffer great losses, which in turn suppresses the trend-following strategies.

The outcomes of health-promoting communities: being active eating well initiative-a community-based obesity prevention intervention in Victoria, Australia.

PubMed

Bolton, K A; Kremer, P; Gibbs, L; Waters, E; Swinburn, B; de Silva, A

2017-07-01

The aim of this study is to evaluate the impact of the Health-Promoting Communities: Being Active Eating Well (HPC:BAEW, 2007-2010) initiative, which comprised community-based multi-component interventions adapted to community context in five separate communities. The intervention aimed to promote healthy eating, physical activity and stronger, healthier communities. A mixed method and multilevel quasi-experimental evaluation of the HPC:BAEW initiative captured process, impact and outcome data. The evaluation involved both cross-sectional (children and adolescents) and longitudinal designs (adults) with data collected pre- and post-intervention in intervention (n=2408 children and adolescents from 18 schools, n=501 adults from 22 workplaces) and comparison groups (n=3163 children and adolescents from 33 schools, n=318 adults from seven workplaces). Anthropometry, obesity-related behavioural and environmental data, information regarding community context and implementation factors were collected. The primary outcomes were differences in anthropometry (weight, waist, body mass index (BMI) and standardised BMI (BMI z-score)) over time compared with comparison communities. Baseline data was collected 2008/2009 and post-intervention collected in 2010 with an average intervention time frame of approximately 12 months. The strategies most commonly implemented were related to social marketing, stakeholder engagement, network and partnership development, community-directed needs assessment and capacity building. Analysis of post-intervention data showed gains in community capacity, but few impacts on environments, policy or individual knowledge, skills, beliefs and perceptions. Relative to the comparison group, one community achieved a lower prevalence of overweight/obesity, lower weight, waist circumference and BMI (P<0.005). One community achieved a higher level of healthy eating policy implementation in schools; two communities achieved improved healthy eating-related behaviours (P<0.03); one community achieved lower sedentary behaviours; and one community achieved higher levels of physical activity in schools (P<0.05). All effect sizes were in the small-to-moderate range. This was a complex and ambitious initiative, which attempted to expand a previously successful community-based intervention in Victoria into five new contexts and communities. Overall, project success was quite inconsistent, and some significant differences were in the unanticipated direction. However, there are many important learnings that should inform future health-promotion activities. The heterogeneity of outcomes of HPC:BAEW communities reflects the reality of life whereby effectiveness of intervention strategies is dependent on individual and community factors. Future health promotion should consider a systems approach whereby existing systems are modified rather than relying heavily on the addition of new activities, with longer time frames for implementation.

Peers as clinicians: Examining the impact of Stay Play Talk on social communication in young preschoolers with autism.

PubMed

Barber, Angela B; Saffo, Rachel W; Gilpin, Ansley T; Craft, Lydia D; Goldstein, Howard

2016-01-01

Peer Mediated Interventions (PMIs) can be incorporated into integrated early childhood and preschool settings to address socialization impairments observed in children with ASD (Katz & Girolametto, 2013). However, research examining specific PMI strategies with young preschoolers remains limited. The current study examines the efficacy of the Stay, Play, Talk PMI (English, Shafer, Goldstein, & Kaczmerek, 1997) on the social communication skills of young preschool children diagnosed with an Autism Spectrum Disorder (ASD). Each of 3 typically developing children (ages 3-5 years) was paired with a child with an ASD (ages 3-4 years). Typically developing peers were taught to Stay with their friend, Play with their friend, and Talk to their friend. The child dyads played together during two, 20-min weekly sessions for 6-8 weeks. A multiple baseline design across participants was implemented to measure the impact of the Stay Play Talk strategies on social initiations and responses characterized by non-coordinated gestures, gestures, and words. Simulation Modeling Analysis was also conducted to confirm visual analysis. All 3 typical peer buddies and all 3 target children with ASD demonstrated increases in the frequency of their responses, reaching levels that greatly exceeded baseline levels. Further, social reciprocations increased among each dyad above baseline. Social initiations remained variable across dyads. Gains were not maintained two months post intervention. Results of this study corroborated previous findings that support the usefulness of PMIs to improve social communication of young children with ASD (Chan et al., 2009) and suggest an economical, naturally occurring approach to improve social communication during early childhood. Readers will gain knowledge regarding the social communication profile of children with ASD and how this profile can negatively impact language development and peer relationships. In addition, readers will be able to identify the basic components of the Stay Play Talk intervention. Finally, this paper will explain the impacts of the Stay Play Talk intervention on the social communication skills of young children with ASD. Copyright © 2015 Elsevier Inc. All rights reserved.

Educating men about prostate cancer in the workplace.

PubMed

Ilic, Dragan

2013-07-01

Prostate cancer is a common cancer affecting men worldwide. Few men access health services with respect to early detection. Workplace health education initiatives can promote behavior change in men. A total of 12 in-depth interviews with men were conducted in this study to examine how a workplace-based educational campaign on prostate cancer influences the knowledge, awareness, and beliefs of male workers on screening for prostate cancer. Analyses of interview transcripts identified that men had a poor overall knowledge about prostate cancer, its screening, and treatment. Participants were receptive to the introduction of workplace-based health education initiatives to promote men's health issues but recommended an integrated health approach that incorporated information delivered by medical professionals, cancer survivors, supplemented with existing patient education materials. Further research is required to formally evaluate the impact of workplace-based education strategies on men's health.

Strategies for Reforming Initial Vocational Education and Training in Europe. Final Report of the Project. Leonardo da Vinci/Transnational Pilot Projects: Multiplier Effect, Strand III.3.a. Sharpening Post-16 Education Strategies by Horizontal and Vertical Networking (1997-2000).

ERIC Educational Resources Information Center

Stenstrom, Marja-Leena, Ed.; Lasonen, Johanna, Ed.

This document contains 24 papers examining strategies for reforming initial vocational education and training (VET) in Europe. The following papers are included: "Reassessing VET Reform Strategies in a New Context: Implementation of the SPES-NET (Sharpening Post-16 Education Strategies by Horizontal and Vertical Networking) Project"…

Learning before leaping: integration of an adaptive study design process prior to initiation of BetterBirth, a large-scale randomized controlled trial in Uttar Pradesh, India.

PubMed

Hirschhorn, Lisa Ruth; Semrau, Katherine; Kodkany, Bhala; Churchill, Robyn; Kapoor, Atul; Spector, Jonathan; Ringer, Steve; Firestone, Rebecca; Kumar, Vishwajeet; Gawande, Atul

2015-08-14

Pragmatic and adaptive trial designs are increasingly used in quality improvement (QI) interventions to provide the strongest evidence for effective implementation and impact prior to broader scale-up. We previously showed that an on-site coaching intervention focused on the World Health Organization Safe Childbirth Checklist (SCC) improved performance of essential birth practices (EBPs) in one facility in Karnataka, India. We report on the process and outcomes of adapting the intervention prior to larger-scale implementation in a randomized controlled trial in Uttar Pradesh (UP), India. Initially, we trained a local team of physicians and nurses to coach birth attendants in SCC use at two public facilities for 4-6 weeks. Trained observers evaluated adherence to EBPs before and after coaching. Using mixed methods and a systematic adaptation process, we modified and strengthened the intervention. The modified intervention was implemented in three additional facilities. Pre/post-change in EBP prevalence aggregated across facilities was analyzed. In the first two facilities, limited improvement was seen in EBPs with the exception of post-partum oxytocin. Checklists were used <25 % of observations. We identified challenges in physicians coaching nurses, need to engage district and facility leadership to address system gaps, and inadequate strategy for motivating SCC uptake. Revisions included change to peer-to-peer coaching (nurse to nurse, physician to physician); strengthened coach training on behavior and system change; adapted strategy for effective leadership engagement; and an explicit motivation strategy to enhance professional pride and effectiveness. These modifications resulted in improvement in multiple EBPs from baseline including taking maternal blood pressure (0 to 16 %), post-partum oxytocin (36 to 97 %), early breastfeeding initiation (3 to 64 %), as well as checklist use (range 32 to 88 %), all p < 0.01. Further adaptations were implemented to increase the effectiveness prior to full trial launch. The adaptive study design of implementation, evaluation, and feedback drove iterative redesign and successfully developed a SCC-focused coaching intervention that improved EBPs in UP facilities. This work was critical to develop a replicable BetterBirth package tailored to the local context. The multi-center pragmatic trial is underway measuring impact of the BetterBirth program on EBP and maternal-neonatal morbidity and mortality. NCT02148952 .

Health and climate related ecosystem services provided by street trees in the urban environment.

PubMed

Salmond, Jennifer A; Tadaki, Marc; Vardoulakis, Sotiris; Arbuthnott, Katherine; Coutts, Andrew; Demuzere, Matthias; Dirks, Kim N; Heaviside, Clare; Lim, Shanon; Macintyre, Helen; McInnes, Rachel N; Wheeler, Benedict W

2016-03-08

Urban tree planting initiatives are being actively promoted as a planning tool to enable urban areas to adapt to and mitigate against climate change, enhance urban sustainability and improve human health and well-being. However, opportunities for creating new areas of green space within cities are often limited and tree planting initiatives may be constrained to kerbside locations. At this scale, the net impact of trees on human health and the local environment is less clear, and generalised approaches for evaluating their impact are not well developed.In this review, we use an urban ecosystems services framework to evaluate the direct, and locally-generated, ecosystems services and disservices provided by street trees. We focus our review on the services of major importance to human health and well-being which include 'climate regulation', 'air quality regulation' and 'aesthetics and cultural services'. These are themes that are commonly used to justify new street tree or street tree retention initiatives. We argue that current scientific understanding of the impact of street trees on human health and the urban environment has been limited by predominantly regional-scale reductionist approaches which consider vegetation generally and/or single out individual services or impacts without considering the wider synergistic impacts of street trees on urban ecosystems. This can lead planners and policymakers towards decision making based on single parameter optimisation strategies which may be problematic when a single intervention offers different outcomes and has multiple effects and potential trade-offs in different places.We suggest that a holistic approach is required to evaluate the services and disservices provided by street trees at different scales. We provide information to guide decision makers and planners in their attempts to evaluate the value of vegetation in their local setting. We show that by ensuring that the specific aim of the intervention, the scale of the desired biophysical effect and an awareness of a range of impacts guide the choice of i) tree species, ii) location and iii) density of tree placement, street trees can be an important tool for urban planners and designers in developing resilient and resourceful cities in an era of climatic change.

Impact of Simulation Training on Time to Initiation of Cardiopulmonary Resuscitation for First-Year Pediatrics Residents

PubMed Central

Ross, Joshua C.; Trainor, Jennifer L.; Eppich, Walter J.; Adler, Mark D.

2013-01-01

Background Pediatrics residents have few opportunities to perform cardiopulmonary resuscitation (CPR). Enhancing the quality of CPR is a key factor to improving outcomes for cardiopulmonary arrest in children and requires effective training strategies. Objective To evaluate the effectiveness of a simulation-based intervention to reduce first-year pediatrics residents' time for 3 critical actions in CPR: (1) call for help, (2) initiate bag-mask ventilation, and (3) initiate chest compressions. Methods A prospective study involving 31 first-year pediatrics residents at a children's hospital assigned to an early or late (control) intervention group. Residents underwent baseline assessment followed by repeat evaluations at 3 and 6 months. Time to critical actions was scored by video review. A 90-minute educational intervention focused on skill practice was conducted following baseline evaluation for the early-intervention group and following 3-month evaluation for the late-intervention group. Primary outcome was change in time to initiating the 3 critical actions. Change in time was analyzed by comparison of Kaplan-Meier curves, using the log-rank test. A 10% sample was timed by a second rater. Agreement was assessed using intraclass correlation (ICC). Results There was a statistically significant reduction in time for all 3 critical actions between baseline and 3-month evaluation in the early intervention group; this was not observed in the late (control) group. Rater agreement was excellent (ICC ≥ 0.99). Conclusions A simulation-based educational intervention significantly reduced time to initiation of CPR for first-year pediatrics residents. Simulation training facilitated acquisition of critical CPR skills that have the potential to impact patient outcome. PMID:24455010

Combating Rhino Horn Trafficking: The Need to Disrupt Criminal Networks.

PubMed

Haas, Timothy C; Ferreira, Sam M

2016-01-01

The onslaught on the World's wildlife continues despite numerous initiatives aimed at curbing it. We build a model that integrates rhino horn trade with rhino population dynamics in order to evaluate the impact of various management policies on rhino sustainability. In our model, an agent-based sub-model of horn trade from the poaching event up through a purchase of rhino horn in Asia impacts rhino abundance. A data-validated, individual-based sub-model of the rhino population of South Africa provides these abundance values. We evaluate policies that consist of different combinations of legal trade initiatives, demand reduction marketing campaigns, increased anti-poaching measures within protected areas, and transnational policing initiatives aimed at disrupting those criminal syndicates engaged in horn trafficking. Simulation runs of our model over the next 35 years produces a sustainable rhino population under only one management policy. This policy includes both a transnational policing effort aimed at dismantling those criminal networks engaged in rhino horn trafficking-coupled with increases in legal economic opportunities for people living next to protected areas where rhinos live. This multi-faceted approach should be the focus of the international debate on strategies to combat the current slaughter of rhino rather than the binary debate about whether rhino horn trade should be legalized. This approach to the evaluation of wildlife management policies may be useful to apply to other species threatened by wildlife trafficking.

Combating Rhino Horn Trafficking: The Need to Disrupt Criminal Networks

PubMed Central

Haas, Timothy C.; Ferreira, Sam M.

2016-01-01

The onslaught on the World’s wildlife continues despite numerous initiatives aimed at curbing it. We build a model that integrates rhino horn trade with rhino population dynamics in order to evaluate the impact of various management policies on rhino sustainability. In our model, an agent-based sub-model of horn trade from the poaching event up through a purchase of rhino horn in Asia impacts rhino abundance. A data-validated, individual-based sub-model of the rhino population of South Africa provides these abundance values. We evaluate policies that consist of different combinations of legal trade initiatives, demand reduction marketing campaigns, increased anti-poaching measures within protected areas, and transnational policing initiatives aimed at disrupting those criminal syndicates engaged in horn trafficking. Simulation runs of our model over the next 35 years produces a sustainable rhino population under only one management policy. This policy includes both a transnational policing effort aimed at dismantling those criminal networks engaged in rhino horn trafficking—coupled with increases in legal economic opportunities for people living next to protected areas where rhinos live. This multi-faceted approach should be the focus of the international debate on strategies to combat the current slaughter of rhino rather than the binary debate about whether rhino horn trade should be legalized. This approach to the evaluation of wildlife management policies may be useful to apply to other species threatened by wildlife trafficking. PMID:27870917

The Impact of Teaching Communication Strategies on English Speaking of Engineering Undergraduates

ERIC Educational Resources Information Center

Kongsom, Tiwaporn

2016-01-01

This study investigates the impact of teaching communication strategies on Thai engineering undergraduate students' communication strategy use and strategic competence. Fifty-seven engineering undergraduate students were taught ten communication strategies for ten weeks and responded to a self-report communication strategy questionnaire before and…

Leadership Strategies of Performance Measures Impacts in Public Sector Management: A National Content Analysis.

ERIC Educational Resources Information Center

Kubala, James Joseph

A quantitative and qualitative study examined three leadership strategies found in performance-based management (human resource, scientific management and political strategies used in public sector management); a framework by which performance measurement (PM) supports leadership strategies; and how the strategies impact PM. It examined leadership…

Impact of methodological "shortcuts" in conducting public health surveys: Results from a vaccination coverage survey

PubMed Central

Luman, Elizabeth T; Sablan, Mariana; Stokley, Shannon; McCauley, Mary M; Shaw, Kate M

2008-01-01

Background Lack of methodological rigor can cause survey error, leading to biased results and suboptimal public health response. This study focused on the potential impact of 3 methodological "shortcuts" pertaining to field surveys: relying on a single source for critical data, failing to repeatedly visit households to improve response rates, and excluding remote areas. Methods In a vaccination coverage survey of young children conducted in the Commonwealth of the Northern Mariana Islands in July 2005, 3 sources of vaccination information were used, multiple follow-up visits were made, and all inhabited areas were included in the sampling frame. Results are calculated with and without these strategies. Results Most children had at least 2 sources of data; vaccination coverage estimated from any single source was substantially lower than from all sources combined. Eligibility was ascertained for 79% of households after the initial visit and for 94% of households after follow-up visits; vaccination coverage rates were similar with and without follow-up. Coverage among children on remote islands differed substantially from that of their counterparts on the main island indicating a programmatic need for locality-specific information; excluding remote islands from the survey would have had little effect on overall estimates due to small populations and divergent results. Conclusion Strategies to reduce sources of survey error should be maximized in public health surveys. The impact of the 3 strategies illustrated here will vary depending on the primary outcomes of interest and local situations. Survey limitations such as potential for error should be well-documented, and the likely direction and magnitude of bias should be considered. PMID:18371195

Literacy Initiative For Empowerment (LIFE), 2005-2015. Vision and Strategy Paper. Second Edition

ERIC Educational Resources Information Center

UNESCO International Bureau of Education, 2006

2006-01-01

This document describes the rationale and the strategy of the new United Nations Educational, Scientific, and Cultural Organization (UNESCO) Initiative for literacy: LIFE. The Literacy Initiative for Empowerment (LIFE) is designed as a global strategic framework through which national governments, non-governmental organizations (NGOs), civil…

Using Win-Win Strategies to Implement Health in All Policies: A Cross-Case Analysis

PubMed Central

Molnar, Agnes; Renahy, Emilie; O’Campo, Patricia; Muntaner, Carles; Freiler, Alix; Shankardass, Ketan

2016-01-01

Background In spite of increasing research into intersections of public policy and health, little evidence shows how policy processes impact the implementation of Health in All Policies (HiAP) initiatives. Our research sought to understand how and why strategies for engaging partners from diverse policy sectors in the implementation of HiAP succeed or fail in order to uncover the underlying social mechanisms contributing to sustainable implementation of HiAP. Methods In this explanatory multiple case study, we analyzed grey and peer-review literature and key informant interviews to identify mechanisms leading to implementation successes and failures in relation to different strategies for engagement across three case studies (Sweden, Quebec and South Australia), after accounting for the role of different contextual conditions. Findings Our results yielded no support for the use of awareness-raising or directive strategies as standalone approaches for engaging partners to implement HiAP. However, we found strong evidence that mechanisms related to “win-win” strategies facilitated implementation by increasing perceived acceptability (or buy-in) and feasibility of HiAP implementation across sectors. Win-win strategies were facilitated by mechanisms related to several activities, including: the development of a shared language to facilitate communication between actors from different sectors; integrating health into other policy agendas (eg., sustainability) and use of dual outcomes to appeal to the interests of diverse policy sectors; use of scientific evidence to demonstrate the effectiveness of HiAP; and using health impact assessment to make policy coordination for public health outcomes more feasible and to give credibility to policies being developed by diverse policy sectors. Conclusion Our findings enrich theoretical understanding in an under-unexplored area of intersectoral action. They also provide policy makers with examples of HiAP across wealthy welfare regimes, and improve understanding of successful HiAP implementation practices, including the win-win approach. PMID:26845574

Small-body deflection techniques using spacecraft: Techniques in simulating the fate of ejecta

NASA Astrophysics Data System (ADS)

Schwartz, Stephen R.; Yu, Yang; Michel, Patrick; Jutzi, Martin

2016-04-01

We define a set of procedures to numerically study the fate of ejecta produced by the impact of an artificial projectile with the aim of deflecting an asteroid. Here we develop a simplified, idealized model of impact conditions that can be adapted to fit the details of specific deflection-test scenarios, such as what is being proposed for the AIDA project. Ongoing studies based upon the methodology described here can be used to inform observational strategies and safety conditions for an observing spacecraft. To account for ejecta evolution, the numerical strategies we are employing are varied and include a large N-Body component, a smoothed-particle hydrodynamics (SPH) component, and an application of impactor scaling laws. Simulations that use SPH-derived initial conditions show high-speed ejecta escaping at low angles of inclination, and very slowly moving ejecta lofting off the surface at higher inclination angles, some of which reimpacts the small-body surface. We are currently investigating the realism of this and other models' behaviors. Next steps will include the addition of solar perturbations to the model and applying the protocol developed here directly to specific potential mission concepts such as the proposed AIDA scenario.

Ecosystem change and human health: implementation economics and policy

PubMed Central

Kramer, R. A.; Vincent, J. R.

2017-01-01

Several recent initiatives such as Planetary Health, EcoHealth and One Health claim that human health depends on flourishing natural ecosystems. However, little has been said about the operational and implementation challenges of health-oriented conservation actions on the ground. We contend that ecological–epidemiological research must be complemented by a form of implementation science that examines: (i) the links between specific conservation actions and the resulting ecological changes, and (ii) how this ecological change impacts human health and well-being, when human behaviours are considered. Drawing on the policy evaluation tradition in public economics, first, we present three examples of recent social science research on conservation interventions that affect human health. These examples are from low- and middle-income countries in the tropics and subtropics. Second, drawing on these examples, we present three propositions related to impact evaluation and non-market valuation that can help guide future multidisciplinary research on conservation and human health. Research guided by these propositions will allow stakeholders to determine how ecosystem-mediated strategies for health promotion compare with more conventional biomedical prevention and treatment strategies for safeguarding health. This article is part of the themed issue ‘Conservation, biodiversity and infectious disease: scientific evidence and policy implications’. PMID:28438919

Ecosystem change and human health: implementation economics and policy.

PubMed

Pattanayak, S K; Kramer, R A; Vincent, J R

2017-06-05

Several recent initiatives such as Planetary Health , EcoHealth and One Health claim that human health depends on flourishing natural ecosystems. However, little has been said about the operational and implementation challenges of health-oriented conservation actions on the ground. We contend that ecological-epidemiological research must be complemented by a form of implementation science that examines: (i) the links between specific conservation actions and the resulting ecological changes, and (ii) how this ecological change impacts human health and well-being, when human behaviours are considered. Drawing on the policy evaluation tradition in public economics, first, we present three examples of recent social science research on conservation interventions that affect human health. These examples are from low- and middle-income countries in the tropics and subtropics. Second, drawing on these examples, we present three propositions related to impact evaluation and non-market valuation that can help guide future multidisciplinary research on conservation and human health. Research guided by these propositions will allow stakeholders to determine how ecosystem-mediated strategies for health promotion compare with more conventional biomedical prevention and treatment strategies for safeguarding health.This article is part of the themed issue 'Conservation, biodiversity and infectious disease: scientific evidence and policy implications'. © 2017 The Authors.

How The Australian National University's emergency management and continuity plans responded to a large-scale fire.

PubMed

Meehan, Bart

2008-01-01

On 18th January, 2003, one of the worst bushfires in the history of Australia hit the capital city, Canberra. By the time it was under control, four people were dead and more than 500 homes were destroyed. The fire also destroyed the Mount Stromlo campus of the Australian National University, the location of the Research School of Astronomy and Astrophysics. In response to the fires, the University initiated its emergency management strategy and business continuity plans. These allowed the School to recommence limited operations within two weeks of the disaster. This paper details a case study of the impact of the fire (in part using personal recollections of staff and students), and the emergency response implemented by the University. It describes the development of the University's emergency management strategy, with its emphasis on the key elements of clear chain of command and flexibility in developing an incident-specific response. The paper also provides an assessment of how the plan worked during an actual incident and some of the lessons learned, including the importance of the early response, managing the impact on people, media management, insurance and communications.

Tracking linkage to HIV care for former prisoners

PubMed Central

Montague, Brian T.; Rosen, David L.; Solomon, Liza; Nunn, Amy; Green, Traci; Costa, Michael; Baillargeon, Jacques; Wohl, David A.; Paar, David P.; Rich, Josiah D.; Study Group, on behalf of the LINCS

2012-01-01

Improving testing and uptake to care among highly impacted populations is a critical element of Seek, Test, Treat and Retain strategies for reducing HIV incidence in the community. HIV disproportionately impacts prisoners. Though, incarceration provides an opportunity to diagnose and initiate therapy, treatment is frequently disrupted after release. Though model programs exist to support linkage to care on release, there is a lack of scalable metrics with which to assess adequacy of linkage to care after release. The linking data from Ryan White program Client Level Data (CLD) files reported to HRSA with corrections release data offers an attractive means of generating these metrics. Identified only by use of a confidential encrypted Unique Client Identifier (eUCI) these CLD files allow collection of key clinical indicators across the system of Ryan White funded providers. Using eUCIs generated from corrections release data sets as a linkage tool, the time to the first service at community providers along with key clinical indicators of patient status at entry into care can be determined as measures of linkage adequacy. Using this strategy, high and low performing sites can be identified and best practices can be identified to reproduce these successes in other settings. PMID:22561157

What evidence exists for initiatives to reduce risk and incidence of sexual violence in armed conflict and other humanitarian crises? A systematic review.

PubMed

Spangaro, Jo; Adogu, Chinelo; Ranmuthugala, Geetha; Powell Davies, Gawaine; Steinacker, Léa; Zwi, Anthony

2013-01-01

Sexual violence is highly prevalent in armed conflict and other humanitarian crises and attracting increasing policy and practice attention. This systematic review aimed to canvas the extent and impact of initiatives to reduce incidence, risk and harm from sexual violence in conflict, post-conflict and other humanitarian crises, in low and middle income countries. Twenty three bibliographic databases and 26 websites were searched, covering publications from 1990 to September 2011 using database-specific keywords for sexual violence and conflict or humanitarian crisis. The 40 included studies reported on seven strategy types: i) survivor care; ii) livelihood initiatives; iii) community mobilisation; iv) personnel initiatives; v) systems and security responses; vi) legal interventions and vii) multiple component interventions. Conducted in 26 countries, the majority of interventions were offered in African countries. Despite the extensive literature on sexual violence by combatants, most interventions addressed opportunistic forms of sexual violence committed in post-conflict settings. Only one study specifically addressed the disaster setting. Actual implementation of initiatives appeared to be limited as was the quality of outcome studies. No studies prospectively measured incidence of sexual violence, although three studies provided some evidence of reductions in association with firewood distribution to reduce women's exposure, as did one program to prevent sexual exploitation and abuse by peacekeeping forces. Apparent increases to risk resulted from lack of protection, stigma and retaliation associated with interventions. Multiple-component interventions and sensitive community engagement appeared to contribute to positive outcomes. Significant obstacles prevent women seeking help following sexual violence, pointing to the need to protect anonymity and preventive strategies. This review contributes a conceptual framework for understanding the forms, settings, and interventions for conflict and crisis-related sexual violence. It points to the need for thorough implementation of initiatives that build on local capacity, while avoiding increased risk and re-traumatisation to survivors of sexual violence.

What Evidence Exists for Initiatives to Reduce Risk and Incidence of Sexual Violence in Armed Conflict and Other Humanitarian Crises? A Systematic Review

PubMed Central

Spangaro, Jo; Adogu, Chinelo; Ranmuthugala, Geetha; Powell Davies, Gawaine; Steinacker, Léa; Zwi, Anthony

2013-01-01

Sexual violence is highly prevalent in armed conflict and other humanitarian crises and attracting increasing policy and practice attention. This systematic review aimed to canvas the extent and impact of initiatives to reduce incidence, risk and harm from sexual violence in conflict, post-conflict and other humanitarian crises, in low and middle income countries. Twenty three bibliographic databases and 26 websites were searched, covering publications from 1990 to September 2011 using database-specific keywords for sexual violence and conflict or humanitarian crisis. The 40 included studies reported on seven strategy types: i) survivor care; ii) livelihood initiatives; iii) community mobilisation; iv) personnel initiatives; v) systems and security responses; vi) legal interventions and vii) multiple component interventions. Conducted in 26 countries, the majority of interventions were offered in African countries. Despite the extensive literature on sexual violence by combatants, most interventions addressed opportunistic forms of sexual violence committed in post-conflict settings. Only one study specifically addressed the disaster setting. Actual implementation of initiatives appeared to be limited as was the quality of outcome studies. No studies prospectively measured incidence of sexual violence, although three studies provided some evidence of reductions in association with firewood distribution to reduce women's exposure, as did one program to prevent sexual exploitation and abuse by peacekeeping forces. Apparent increases to risk resulted from lack of protection, stigma and retaliation associated with interventions. Multiple-component interventions and sensitive community engagement appeared to contribute to positive outcomes. Significant obstacles prevent women seeking help following sexual violence, pointing to the need to protect anonymity and preventive strategies. This review contributes a conceptual framework for understanding the forms, settings, and interventions for conflict and crisis-related sexual violence. It points to the need for thorough implementation of initiatives that build on local capacity, while avoiding increased risk and re-traumatisation to survivors of sexual violence. PMID:23690945

What is heartburn worth? A cost-utility analysis of management strategies.

PubMed

Heudebert, G R; Centor, R M; Klapow, J C; Marks, R; Johnson, L; Wilcox, C M

2000-03-01

To determine the best treatment strategy for the management of patients presenting with symptoms consistent with uncomplicated heartburn. We performed a cost-utility analysis of 4 alternatives: empirical proton pump inhibitor, empirical histamine2-receptor antagonist, and diagnostic strategies consisting of either esophagogastroduodenoscopy (EGD) or an upper gastrointestinal series before treatment. The time horizon of the model was 1 year. The base case analysis assumed a cohort of otherwise healthy 45-year-old individuals in a primary care practice. Empirical treatment with a proton pump inhibitor was projected to provide the greatest quality-adjusted survival for the cohort. Empirical treatment with a histamine2 receptor antagonist was projected to be the least costly of the alternatives. The marginal cost-effectiveness of using a proton pump inhibitor over a histamine2-receptor antagonist was approximately $10,400 per quality-adjusted life year (QALY) gained in the base case analysis and was less than $50,000 per QALY as long as the utility for heartburn was less than 0.95. Both diagnostic strategies were dominated by proton pump inhibitor alternative. Empirical treatment seems to be the optimal initial management strategy for patients with heartburn, but the choice between a proton pump inhibitor or histamine2-receptor antagonist depends on the impact of heartburn on quality of life.

Organizational strategies mediate nonverbal memory impairment in obsessive-compulsive disorder.

PubMed

Savage, C R; Baer, L; Keuthen, N J; Brown, H D; Rauch, S L; Jenike, M A

1999-04-01

Previous neuropsychological studies of obsessive-compulsive disorder (OCD) have indicated impaired executive functioning and nonverbal memory. The extent to which impaired executive functioning impacts nonverbal memory has not been established. The current study investigated the mediating effects of organizational strategies used when copying a figure on subsequent nonverbal memory for that figure. We examined neuropsychological performance in 20 unmedicated subjects with OCD and 20 matched normal control subjects. Subjects were administered the Rey-Osterrieth Complex Figure Test (RCFT) and neuropsychological tests assessing various aspects of executive function. OCD subjects differed significantly from healthy control subjects in the organizational strategies used to copy the RCFT figure, and they recalled significantly less information on both immediate and delayed testing. Multiple regression analyses indicated that group differences in immediate percent recall were significantly mediated by copy organizational strategies. Further exploratory analyses indicated that organizational problems in OCD may be related to difficulties shifting mental and/or spatial set. Immediate nonverbal memory problems in OCD subjects were mediated by impaired organizational strategies used during the initial copy of the RCFT figure. Thus, the primary deficit was one affecting executive function, which then had a secondary effect on immediate memory. These findings are consistent with current theories proposing frontal-striatal system dysfunction in OCD.

Simulated impact of RTS,S/AS01 vaccination programs in the context of changing malaria transmission.

PubMed

Brooks, Alan; Briët, Olivier J T; Hardy, Diggory; Steketee, Richard; Smith, Thomas A

2012-01-01

The RTS,S/AS01 pre-erythrocytic malaria vaccine is in phase III clinical trials. It is critical to anticipate where and how it should be implemented if trials are successful. Such planning may be complicated by changing levels of malaria transmission. Computer simulations were used to examine RTS,S/AS01 impact, using a vaccine profile based on phase II trial results, and assuming that protection decays only slowly. Settings were simulated in which baseline transmission (in the absence of vaccine) was fixed or varied between 2 and 20 infectious mosquito bites per person per annum (ibpa) over ten years. Four delivery strategies were studied: routine infant immunization (EPI), EPI plus infant catch-up, EPI plus school-based campaigns, and EPI plus mass campaigns. Impacts in changing transmission settings were similar to those in fixed settings. Assuming a persistent effect of vaccination, at 2 ibpa, the vaccine averted approximately 5-7 deaths per 1000 doses of vaccine when delivered via mass campaigns, but the benefit was less at higher transmission levels. EPI, catch-up and school-based strategies averted 2-3 deaths per 1000 doses in settings with 2 ibpa. In settings where transmission was decreasing or increasing, EPI, catch-up and school-based strategies averted approximately 3-4 deaths per 1000 doses. Where transmission is changing, it appears to be sufficient to consider simulations of pre-erythrocytic vaccine impact at a range of initial transmission levels. At 2 ibpa, mass campaigns averted the most deaths and reduced transmission, but this requires further study. If delivered via EPI, RTS,S/AS01 could avert approximately 6-11 deaths per 1000 vaccinees in all examined settings, similar to estimates for pneumococcal conjugate vaccine in African infants. These results support RTS,S/AS01 implementation via EPI, for example alongside vector control interventions, providing that the phase III trials provide support for our assumptions about efficacy.

[Whooping cough in Spain. Current epidemiology, prevention and control strategies. Recommendations by the Pertussis Working Group].

PubMed

Campins, Magda; Moreno-Pérez, David; Gil-de Miguel, Angel; González-Romo, Fernando; Moraga-Llop, Fernando A; Arístegui-Fernández, Javier; Goncé-Mellgren, Anna; Bayas, José M; Salleras-Sanmartí, Lluís

2013-04-01

A large increase of pertussis incidence has been observed in recent years in countries with high vaccination coverage. Outbreaks of pertussis are increasingly being reported. The age presentation has a bipolar distribution: infants younger 6months that have not initiated or completed a vaccination schedule, and adolescents and adults, due to the lost of natural or vaccine immunity over time. These epidemiological changes justify the need to adopt new vaccination strategies in order to protect young infants and to reduce pertussis incidence in all age groups. Adolescents and adults immunization must be a priority. In the first group, strategy is easy to implement, and with a very low additional cost (to replace dT vaccine by dTap one). Adult vaccination may be more difficult to implement; dT vaccine decennial booster should be replaced by dTap. The immunization of household contacts of newborn infants (cocooning) is the strategy that has a most important impact on infant pertussis. Recently, pregnant women vaccination (after 20weeks of gestation) has been recommended in some countries as the most effective way to protect the newborn. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Rankings in Institutional Strategies and Processes: Impact or Illusion?

ERIC Educational Resources Information Center

Hazelkorn, Ellen; Loukkola, Tia; Zhang, Thérèse

2014-01-01

The "Rankings in Institutional Strategies and Processes" (RISP) project is the first pan-European study of the impact and influence of rankings on European higher education institutions. The project has sought to build understanding of how rankings impact and influence the development of institutional strategies and processes and its…

Emerging biomedical applications of synthetic biology.

PubMed

Weber, Wilfried; Fussenegger, Martin

2011-11-29

Synthetic biology aims to create functional devices, systems and organisms with novel and useful functions on the basis of catalogued and standardized biological building blocks. Although they were initially constructed to elucidate the dynamics of simple processes, designed devices now contribute to the understanding of disease mechanisms, provide novel diagnostic tools, enable economic production of therapeutics and allow the design of novel strategies for the treatment of cancer, immune diseases and metabolic disorders, such as diabetes and gout, as well as a range of infectious diseases. In this Review, we cover the impact and potential of synthetic biology for biomedical applications.

ARPA-E: Accelerating U.S. Energy Innovation

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

Manser, Joseph S.; Rollin, Joseph A.; Brown, Kristen E.

With aggressive commitments to mitigate the impacts of climate change and emphasis on maintaining an advantage in technological development in an increasingly globalized marketplace, the U.S. government is actively taking measures to ensure the nation’s environmental and economic health and sustainability. As part of its broader strategy, with motivation from the National Academies,(1) the United States established the Advanced Research Project Agency-Energy (ARPA-E) within the Department of Energy (DOE) through the America Competes Act in 2007.(2) The agency was allotted an initial appropriation of $400 million in 2009 as part of the American Recovery and Reinvestment Act.

Progress toward understanding the contribution of alkali generation in dental biofilms to inhibition of dental caries

PubMed Central

Liu, Ya-Ling; Nascimento, Marcelle; Burne, Robert A

2012-01-01

Alkali production by oral bacteria is believed to have a major impact on oral microbial ecology and to be inibitory to the initiation and progression of dental caries. A substantial body of evidence is beginning to accumulate that indicates the modulation of the alkalinogenic potential of dental biofilms may be a promising strategy for caries control. This brief review highlights recent progress toward understanding molecular genetic and physiologic aspects of important alkali-generating pathways in oral bacteria, and the role of alkali production in the ecology of dental biofilms in health and disease. PMID:22996271

A gradient based algorithm to solve inverse plane bimodular problems of identification

NASA Astrophysics Data System (ADS)

Ran, Chunjiang; Yang, Haitian; Zhang, Guoqing

2018-02-01

This paper presents a gradient based algorithm to solve inverse plane bimodular problems of identifying constitutive parameters, including tensile/compressive moduli and tensile/compressive Poisson's ratios. For the forward bimodular problem, a FE tangent stiffness matrix is derived facilitating the implementation of gradient based algorithms, for the inverse bimodular problem of identification, a two-level sensitivity analysis based strategy is proposed. Numerical verification in term of accuracy and efficiency is provided, and the impacts of initial guess, number of measurement points, regional inhomogeneity, and noisy data on the identification are taken into accounts.

Vulvodynia.

PubMed

Shah, Mitul; Hoffstetter, Susan

2014-09-01

Vulvar pain and discomfort (vulvodynia) are common conditions that can have a significant impact on a patient's quality of life. Vulvodynia is a difficult condition to evaluate and treat. This article gives the primary gynecologist a basic framework with which to identify, diagnose, and begin treatment for these patients and refer if necessary. Initial evaluation and physical examination are discussed in detail. Treatments ranging from self-management strategies to nonpharmacologic and pharmacologic therapies will be explored. Because vulvodynia is a chronic pain disorder, diagnosis is the key to beginning treatment and support for this patient population. Copyright © 2014 Elsevier Inc. All rights reserved.

Impact on a Person's Daily Life During Episodes of Supraventricular Tachycardia.

PubMed

Nordblom, Ann-Katrin; Broström, Anders; Fridlund, Bengt

2017-03-01

To describe the impact of episodes of supraventricular tachycardia (SVT) on a person's daily life from a holistic perspective. A deductive descriptive design was used. Twenty semistructured interviews (12 women and 8 men) were conducted before planned ablation of SVT and were analyzed using qualitative content analysis. Living with SVT had a complex impact on daily life. Initially, the patients described an inhibited existence due to demands to give up things that they had previously been doing, in case the unpredictable episodes of SVT would occur. The episodes caused fatigue and worry, which together created a barrier for living life to the full by making the person give up undertakings. The patients constantly needed to find short-term and long-term strategies to prevent new episodes from happening. Episodes of SVT entail a complex life situation as the person's entire existence is affected in daily life. To understand the impact of SVT on daily life, nurses and other health care professionals need increased knowledge and understanding to be able to provide support through relevant information and take optimal care measures.

When Women with Cystic Fibrosis Become Mothers: Psychosocial Impact and Adjustments

PubMed Central

Duff, Alistair J. A.; Etherington, Christine

2016-01-01

Advances in the treatment and life expectancy of cystic fibrosis (CF) patients mean that motherhood is now a realistic option for many women with CF. This qualitative study explored the psychosocial impact and adjustments made when women with CF become mothers. Women with CF (n = 11) were recruited via an online forum and participated in semistructured telephone interviews about their experiences of becoming a mother. Transcriptions were analysed using Grounded Theory. Analysis revealed three core categories: (i) “Living with CF”: how becoming a mother impacted on health and treatment adherence, requiring a change in support from the CF team, (ii) “Becoming a Mother”: balancing issues common to new mothers with their CF, and (iii) “Pooling Personal Resources”: coping strategies in managing the dual demands of child and CF care. Participants experienced a variety of complex psychosocial processes. Most participants acknowledged an initial negative impact on CF care; however over time they reported successful adaptation to managing dual commitments and that adherence and motivation to stay well had improved. This study highlights the need for preconceptual psychosocial counselling and postpartum adjustment to CF care. PMID:27999682

The impact of Nursing Rounds on the practice environment and nurse satisfaction in intensive care: pre-test post-test comparative study.

PubMed

Aitken, Leanne M; Burmeister, Elizabeth; Clayton, Samantha; Dalais, Christine; Gardner, Glenn

2011-08-01

Factors previously shown to influence patient care include effective decision making, team work, evidence based practice, staffing and job satisfaction. Clinical rounds have the potential to optimise these factors and impact on patient outcomes, but use of this strategy by intensive care nurses has not been reported. To determine the effect of implementing Nursing Rounds in the intensive care environment on patient care planning and nurses' perceptions of the practice environment and work satisfaction. Pre-test post-test 2 group comparative design. Two intensive care units in tertiary teaching hospitals in Australia. A convenience sample of registered nurses (n=244) working full time or part time in the participating intensive care units. Nurses in participating intensive care units were asked to complete the Practice Environment Scale-Nursing Work Index (PES-NWI) and the Nursing Worklife Satisfaction Scale (NWSS) prior to and after a 12 month period during which regular Nursing Rounds were conducted in the intervention unit. Issues raised during Nursing Rounds were described and categorised. The characteristics of the sample and scale scores were summarised with differences between pre and post scores analysed using t-tests for continuous variables and chi-square tests for categorical variables. Independent predictors of the PES-NWI were determined using multivariate linear regression. Nursing Rounds resulted in 577 changes being initiated for 171 patients reviewed; these changes related to the physical, psychological--individual, psychological--family, or professional practice aspects of care. Total PES-NWI and NWSS scores were similar before and after the study period in both participating units. The NWSS sub-scale of interaction between nurses improved in the intervention unit during the study period (pre--4.85±0.93; post--5.36±0.89, p=0.002) with no significant increase in the control group. Factors independently related to higher PES-NWI included intervention site and less years in critical care (p<0.05). Implementation of Nursing Rounds within the intensive care environment is feasible and is an effective strategy for initiating change to patient care. Application and testing of this strategy, including identification of the most appropriate methods of measuring impact, in other settings is needed to determine generalisability. Copyright © 2010 Elsevier Ltd. All rights reserved.

The cost-effectiveness and budgetary impact of a dolutegravir-based regimen as first-line treatment of HIV infection in India.

PubMed

Zheng, Amy; Kumarasamy, Nagalingeswaran; Huang, Mingshu; Paltiel, A David; Mayer, Kenneth H; Rewari, Bharat B; Walensky, Rochelle P; Freedberg, Kenneth A

2018-03-01

Dolutegravir (DTG)-based antiretroviral therapy (ART) is recommended for first-line HIV treatment in the US and Europe. Efavirenz (EFV)-based regimens remain the standard of care (SOC) in India. We examined the clinical and economic impact of DTG-based first-line ART in the setting of India's recent guidelines change to treating all patients with HIV infection regardless of CD4 count. We used a microsimulation of HIV disease, the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-International model, to project outcomes in ART-naive patients under two strategies: (1) SOC: EFV/tenofovir disoproxil fumarate (TDF)/lamivudine (3TC); and (2) DTG: DTG + TDF/3TC. Regimen-specific inputs, including virologic suppression at 48 weeks (SOC: 82% vs. DTG: 90%) and annual costs ($98 vs. $102), were informed by clinical trial data and other sources and varied widely in sensitivity analysis. We compared incremental cost-effectiveness ratios (ICERs), measured in $/year of life saved (YLS), to India's per capita gross domestic product ($1600 in 2015). We compared the budget impact and HIV transmission effects of the two strategies for the estimated 444,000 and 916,000 patients likely to initiate ART in India over the next 2 and 5 years. Compared to SOC, DTG improved 5-year survival from 76.7% to 83.0%, increased life expectancy from 22.0 to 24.8 years (14.0 to 15.5 years, discounted), averted 13,000 transmitted HIV infections over 5 years, increased discounted lifetime care costs from $3040 to $3240, and resulted in a lifetime ICER of $130/YLS, less than 10% of India's per capita GDP in 2015. DTG maintained an ICER below 50% of India's per capita GDP as long as the annual three-drug regimen cost was ≤$180/year. Over a 2- or 5-year horizon, total undiscounted outlays for HIV-related care were virtually the same for both strategies. A generic DTG-based regimen is likely to be cost-effective and should be recommended for initial therapy of HIV infection in India. © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

Identifying Synergies in Multilevel Interventions.

PubMed

Lewis, Megan A; Fitzgerald, Tania M; Zulkiewicz, Brittany; Peinado, Susana; Williams, Pamela A

2017-04-01

Social ecological models of health often describe multiple levels of influence that interact to influence health. However, it is still common for interventions to target only one or two of these levels, perhaps owing in part to a lack of guidance on how to design multilevel interventions to achieve optimal impact. The convergence strategy emphasizes that interventions at different levels mutually reinforce each other by changing patterns of interaction among two or more intervention audiences; this strategy is one approach for combining interventions at different levels to produce synergistic effects. We used semistructured interviews with 65 representatives in a cross-site national initiative that enhanced health and outcomes for patients with diabetes to examine whether the convergence strategy was a useful conceptual model for multilevel interventions. Using a framework analysis approach to analyze qualitative interview data, we found three synergistic themes that match the convergence strategy and support how multilevel interventions can be successful. These three themes were (1) enhancing engagement between patient and provider and access to quality care; (2) supporting communication, information sharing, and coordination among providers, community stakeholders, and systems; and (3) building relationships and fostering alignment among providers, community stakeholders, and systems. These results support the convergence strategy as a testable conceptual model and provide examples of successful intervention strategies for combining multilevel interventions to produce synergies across levels and promote diabetes self-management and that may extend to management of other chronic illnesses as well.

Alcohol industry corporate social responsibility initiatives and harmful drinking: a systematic review.

PubMed

Mialon, Melissa; McCambridge, Jim

2018-04-25

There is growing awareness of the detrimental effects of alcohol industry commercial activities, and concern about possible adverse impacts of its corporate social responsibility (CSR) initiatives, on public health. The aims of this systematic review were to summarize and examine what is known about CSR initiatives undertaken by alcohol industry actors in respect of harmful drinking globally. We searched for peer-reviewed studies published since 1980 of alcohol industry CSR initiatives in seven electronic databases. The basic search strategy was organized around the three constructs of 'alcohol', 'industry' and 'corporate social responsibility'. We performed the searches on 21 July 2017. Data from included studies were analyzed inductively, according to the extent to which they addressed specified research objectives. A total of 21 studies were included. We identified five types of CSR initiatives relevant to the reduction of harmful drinking: alcohol information and education provision; drink driving prevention; research involvement; policy involvement and the creation of social aspects organizations. Individual companies appear to undertake different CSR initiatives than do industry-funded social aspects organizations. There is no robust evidence that alcohol industry CSR initiatives reduce harmful drinking. There is good evidence, however, that CSR initiatives are used to influence the framing of the nature of alcohol-related issues in line with industry interests. This research literature is at an early stage of development. Alcohol policy measures to reduce harmful drinking are needed, and the alcohol industry CSR initiatives studied so far do not contribute to the attainment of this goal.

Getting men in the room: perceptions of effective strategies to initiate men's involvement in gender-based violence prevention in a global sample.

PubMed

Casey, Erin A; Leek, Cliff; Tolman, Richard M; Allen, Christopher T; Carlson, Juliana M

2017-09-01

As engaging men in gender-based violence prevention efforts becomes an increasingly institutionalised component of gender equity work globally, clarity is needed about the strategies that best initiate male-identified individuals' involvement in these efforts. The purpose of this study was to examine the perceived relevance and effectiveness of men's engagement strategies from the perspective of men around the world who have organised or attended gender-based violence prevention events. Participants responded to an online survey (available in English, French and Spanish) and rated the effectiveness of 15 discrete engagement strategies derived from earlier qualitative work. Participants also provided suggestions regarding strategies in open-ended comments. Listed strategies cut across the social ecological spectrum and represented both venues in which to reach men, and the content of violence prevention messaging. Results suggest that all strategies, on average, were perceived as effective across regions of the world, with strategies that tailor messaging to topics of particular concern to men (such as fatherhood and healthy relationships) rated most highly. Open-ended comments also surfaced tensions, particularly related to the role of a gender analysis in initial men's engagement efforts. Findings suggest the promise of cross-regional adaptation and information sharing regarding successful approaches to initiating men's anti-violence involvement.

Global and local concerns: what attitudes and beliefs motivate farmers to mitigate and adapt to climate change?

PubMed

Haden, Van R; Niles, Meredith T; Lubell, Mark; Perlman, Joshua; Jackson, Louise E

2012-01-01

In response to agriculture's vulnerability and contribution to climate change, many governments are developing initiatives that promote the adoption of mitigation and adaptation practices among farmers. Since most climate policies affecting agriculture rely on voluntary efforts by individual farmers, success requires a sound understanding of the factors that motivate farmers to change practices. Recent evidence suggests that past experience with the effects of climate change and the psychological distance associated with people's concern for global and local impacts can influence environmental behavior. Here we surveyed farmers in a representative rural county in California's Central Valley to examine how their intention to adopt mitigation and adaptation practices is influenced by previous climate experiences and their global and local concerns about climate change. Perceived changes in water availability had significant effects on farmers' intention to adopt mitigation and adaptation strategies, which were mediated through global and local concerns respectively. This suggests that mitigation is largely motivated by psychologically distant concerns and beliefs about climate change, while adaptation is driven by psychologically proximate concerns for local impacts. This match between attitudes and behaviors according to the psychological distance at which they are cognitively construed indicates that policy and outreach initiatives may benefit by framing climate impacts and behavioral goals concordantly; either in a global context for mitigation or a local context for adaptation.

Strategies for Selecting Routes through Real-World Environments: Relative Topography, Initial Route Straightness, and Cardinal Direction

PubMed Central

Brunyé, Tad T.; Collier, Zachary A.; Cantelon, Julie; Holmes, Amanda; Wood, Matthew D.; Linkov, Igor; Taylor, Holly A.

2015-01-01

Previous research has demonstrated that route planners use several reliable strategies for selecting between alternate routes. Strategies include selecting straight rather than winding routes leaving an origin, selecting generally south- rather than north-going routes, and selecting routes that avoid traversal of complex topography. The contribution of this paper is characterizing the relative influence and potential interactions of these strategies. We also examine whether individual differences would predict any strategy reliance. Results showed evidence for independent and additive influences of all three strategies, with a strong influence of topography and initial segment straightness, and relatively weak influence of cardinal direction. Additively, routes were also disproportionately selected when they traversed relatively flat regions, had relatively straight initial segments, and went generally south rather than north. Two individual differences, extraversion and sense of direction, predicted the extent of some effects. Under real-world conditions navigators indeed consider a route’s initial straightness, cardinal direction, and topography, but these cues differ in relative influence and vary in their application across individuals. PMID:25992685

Air quality impacts of transit improvement, preferential lane, and carpool programs: an annotated bibliography of demonstration and analytical experience. Final report

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

DiRenzo, J.F.; Rubin, R.B.

1978-03-01

In accordance with the Clean Air Act Amendments of 1977, the Environmental Protection Agency is evaluating the use and cost-effectiveness of alternative short-range transit fare and service improvement strategies, carpool and vanpool strategies, and strategies involving the preferential treatment of high occupancy vehicles to improve air quality in urban areas. The evaluation of individual strategies and combinations of the above strategies includes their emission and air quality impacts and their related energy, noise, and economic impacts. A comprehensive literature review was also conducted, as part of this evaluation, to identify both observed and projected travel, emission, air quality, energy, noise,more » and economic impacts of the short-range low-cost strategies of interest.« less

Evacuation dynamics with smoking diffusion in three dimension based on an extended Floor-Field model

NASA Astrophysics Data System (ADS)

Zheng, Ying; Li, Xingang; Zhu, Nuo; Jia, Bin; Jiang, Rui

2018-10-01

This paper proposes an extended Floor-Field (FF) model to study the pedestrian evacuation dynamics under the influence of smoke diffusing in three-dimension (3D). In addition to static and dynamic fields, the extended model adopts the smoke and herding fields to reflect pedestrian's smoke-avoiding behavior and herding behavior. The impact of smoke on pedestrians' health is also considered. The smoke will reduce the pedestrians' health point and finally impact their moving ability. Numerical simulations were carried out to study the evacuation dynamics. The influence of the smoke particles producing rate, the initial health point, the critical smoke concentration value, and the herding field on evacuation dynamics were analyzed in detail. Those results could bring some guidance to make the evacuation strategy in the smoke diffusing environment.

The Quebec Rural Emergency Department Project: A Cross-Sectional Study of a Potential Two-Pronged Strategy in the Knowledge Transfer Process

PubMed Central

Poitras, Julien; Chauny, Jean-Marc; Lévesque, Jean-Frédéric; Ouimet, Mathieu; Dupuis, Gilles; Tanguay, Alain; Simard-Racine, Geneviève

2015-01-01

Introduction Health services research generates useful knowledge. Promotion of implementation of this knowledge in medical practice is essential. Prior to initiation of a major study on rural emergency departments (EDs), we deployed two knowledge transfer strategies designed to generate interest and engagement from potential knowledge users. The objective of this paper was to review: 1) a combined project launch and media press release strategy, and 2) a pre-study survey designed to survey potential knowledge users’ opinions on the proposed study variables. Materials and Methods We evaluated the impact of the project launch (presentation at two conferences hosted by key stakeholders) and media press release via a survey of participants/stakeholders and by calculating the number of media interview requests and reports generated. We used a pre-study survey to collect potential key stakeholder’ opinions on the study variables. Results Twenty-one of Quebec’s 26 rural EDs participated in the pre-study survey (81% participation rate). The press release about the study generated 51 press articles and 20 media request for interviews, and contributed to public awareness of a major rural research initiative. In the pre-study survey, thirteen participants (46%) mentioned prior knowledge of the research project. Results from the pre-study survey revealed that all of the potential study variables were considered to be relevant for inclusion in the research project. Respondents also proposed additional variables of interest, including factors promoting retention of human resources. Conclusions The present study demonstrated the potential utility of a two-pronged knowledge transfer strategy, including a combined formal launch and press release, and a pre-study survey designed to ensure that the included variables were of interest to participants and stakeholders. PMID:25849328

A Knowledge Management Approach to Support Software Process Improvement Implementation Initiatives

NASA Astrophysics Data System (ADS)

Montoni, Mariano Angel; Cerdeiral, Cristina; Zanetti, David; Cavalcanti da Rocha, Ana Regina

The success of software process improvement (SPI) implementation initiatives depends fundamentally of the strategies adopted to support the execution of such initiatives. Therefore, it is essential to define adequate SPI implementation strategies aiming to facilitate the achievement of organizational business goals and to increase the benefits of process improvements. The objective of this work is to present an approach to support the execution of SPI implementation initiatives. We also describe a methodology applied to capture knowledge related to critical success factors that influence SPI initiatives. This knowledge was used to define effective SPI strategies aiming to increase the success of SPI initiatives coordinated by a specific SPI consultancy organization. This work also presents the functionalities of a set of tools integrated in a process-centered knowledge management environment, named CORE-KM, customized to support the presented approach.

Reduction of initial shock in decadal predictions using a new initialization strategy

NASA Astrophysics Data System (ADS)

He, Yujun; Wang, Bin; Liu, Mimi; Liu, Li; Yu, Yongqiang; Liu, Juanjuan; Li, Ruizhe; Zhang, Cheng; Xu, Shiming; Huang, Wenyu; Liu, Qun; Wang, Yong; Li, Feifei

2017-08-01

A novel full-field initialization strategy based on the dimension-reduced projection four-dimensional variational data assimilation (DRP-4DVar) is proposed to alleviate the well-known initial shock occurring in the early years of decadal predictions. It generates consistent initial conditions, which best fit the monthly mean oceanic analysis data along the coupled model trajectory in 1 month windows. Three indices to measure the initial shock intensity are also proposed. Results indicate that this method does reduce the initial shock in decadal predictions by Flexible Global Ocean-Atmosphere-Land System model, Grid-point version 2 (FGOALS-g2) compared with the three-dimensional variational data assimilation-based nudging full-field initialization for the same model and is comparable to or even better than the different initialization strategies for other fifth phase of the Coupled Model Intercomparison Project (CMIP5) models. Better hindcasts of global mean surface air temperature anomalies can be obtained than in other FGOALS-g2 experiments. Due to the good model response to external forcing and the reduction of initial shock, higher decadal prediction skill is achieved than in other CMIP5 models.

The Ponseti method in Latin America: initial impact and barriers to its diffusion and implementation.

PubMed

Boardman, Allison; Jayawardena, Asitha; Oprescu, Florin; Cook, Thomas; Morcuende, Jose A

2011-01-01

The Ponseti method for correcting clubfoot is a safe, effective, and minimally invasive treatment that has recently been implemented in Latin America. This study evaluates the initial impact and unique barriers to the diffusion of the Ponseti method throughout this region. Structured interviews were conducted with 30 physicians practicing the Ponseti method in three socioeconomically diverse countries: Chile, Peru and Guatemala. Since learning the Ponseti method, these physicians have treated approximately 1,740 clubfoot patients, with an estimated 1,705 (98%) patients treated using the Ponseti method, and 35 (2%) patients treated using surgical techniques. The barriers were classified into the following themes: physician education, health care system of the country, culture and beliefs of patients, physical distance and transport, financial barriers for patients, and parental compliance with the method. The results yielded several common barriers throughout Latin America including lack of physician education, physical distance to the treatment centers, and financial barriers for patients. Information from this study can be used to inform, and to implement and evaluate specific strategies to improve the diffusion of the Ponseti method for treating clubfoot throughout Latin America.

The Impact of Forest Thinning on the Reliability of Water Supply in Central Arizona

PubMed Central

Simonit, Silvio; Connors, John P.; Yoo, James; Kinzig, Ann; Perrings, Charles

2015-01-01

Economic growth in Central Arizona, as in other semiarid systems characterized by low and variable rainfall, has historically depended on the effectiveness of strategies to manage water supply risks. Traditionally, the management of supply risks includes three elements: hard infrastructures, landscape management within the watershed, and a supporting set of institutions of which water markets are frequently the most important. In this paper we model the interactions between these elements. A forest restoration initiative in Central Arizona (the Four Forest Restoration Initiative, or 4FRI) will result in thinning of ponderosa pine forests in the upper watershed, with potential implications for both sedimentation rates and water delivery to reservoirs. Specifically, we model the net effect of ponderosa pine forest thinning across the Salt and Verde River watersheds on the reliability and cost of water supply to the Phoenix metropolitan area. We conclude that the sediment impacts of forest thinning (up to 50% of canopy cover) are unlikely to compromise the reliability of the reservoir system while thinning has the potential to increase annual water supply by 8%. This represents an estimated net present value of surface water storage of $104 million, considering both water consumption and hydropower generation. PMID:25835003

Adaptation strategies to climate change in the Arctic: a global patchwork of reactive community-scale initiatives

NASA Astrophysics Data System (ADS)

Loboda, Tatiana V.

2014-11-01

Arctic regions have experienced and will continue to experience the greatest rates of warming compared to any other region of the world. The people living in the Arctic are considered among most vulnerable to the impacts of environmental change ranging from decline in natural resources to increasing mental health concerns (IPCC 2014 Climate Change 2014: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change (Cambridge: Cambridge University Press)). A meta-analysis study by Ford et al (2014 Environ. Res. Lett. 9 104005) has assessed the volume, scope and geographic distribution of reported in the English language peer-reviewed literature initiatives for adaptation to climate change in the Arctic. Their analysis highlights the reactive nature of the adopted policies with a strong emphasis on local and community-level policies mostly targeting indigenous population in Canada and Alaska. The study raises concerns about the lack of monitoring and evaluation mechanism to track the success rate of the existing policies and the need for long-term strategic planning in adaption policies spanning international boundaries and including all groups of population.

Supporting Knowledge Mobilization and Research Impact Strategies in Grant Applications

ERIC Educational Resources Information Center

Phipps, David; Jensen, Krista E.; Johnny, Michael; Poetz, Anneliese

2016-01-01

Each application to the National Science Foundation (NSF) must contain a Broader Impact (BI) strategy. Similarly, grant applications for most research funders in Canada and the UK require strategies to support the translation of research into impacts on society; however, the guidance provided to researchers is too general to inform the specific…

Introduction: the Interdisciplinary Nursing Quality Research Initiative.

PubMed

Naylor, Mary D; Lustig, Adam; Kelley, Heather J; Volpe, Ellen M; Melichar, Lori; Pauly, Mark V

2013-04-01

The Robert Wood Johnson Foundation launched the Interdisciplinary Nursing Quality Research Initiative (INQRI) program in 2005 to generate, disseminate, and translate research to understand how nurses contribute to and can improve patient care quality. This special edition of Medical Care provides an overview of the program's strategy, goals, and impact, highlighting cross-cutting issues addressed by the initiative. INQRI's leadership and select grantees discuss the implications of a collection of studies on the following: advances in the science of nursing's contribution to quality, measurement of quality, interdisciplinary collaboration, implementation methodology, dissemination and translation of findings, and the business case for nursing. A comprehensive review of the scholarly literature published in 2004 and 2009 found that the evidence linking nursing to quality of care has grown. The second paper discusses INQRI's work on measurement of quality of care, revealing the need for additional comprehensive measures. The third paper examines INQRI's focus on interdisciplinary collaboration, finding that it can enhance methodological approaches and result in substantive changes in health delivery systems. The fourth paper presents methodological challenges faced in health care implementation, emphasizing the need for standardized terms and research designs. The fifth paper addresses INQRI's commitment to translating research into practice, illustrating dissemination strategies and lessons learned. The final paper discusses how the INQRI program has contributed to the current evidence regarding the business case for nursing. This supplement describes the accomplishments of the INQRI program, discusses current issues in research design and implementation, and places INQRI research within the larger context regarding advances in nursing science.

SimPhy: a simulation game to lessen the impact of phytosanitaries on health and the environment--the case of Merja Zerga in Morocco.

PubMed

Ayadi, H; Le Bars, M; Le Grusse, Ph; Mandart, E; Fabre, J; Bouaziz, A; Bord, J P

2014-04-01

Diffuse phytosanitary pollution is a complex phenomenon to manage. Reducing this type of pollution is one of today's key socio-economic and environmental challenges. At the regional level, few approaches enable the actors concerned to implement agricultural management strategies to reduce the use and impact of phytosanitary products. Our research problem focused on the consequences of intensive agriculture and, in particular, how to evaluate the impact of phytosanitary products on human health and the environment. In this article, we present the SimPhy simulation game which places the actors from a given region directly into a situation in which they manage farms whilst under pressure to reduce phytosanitaries (quantity and toxicity). The application focused on the Merja Zerga catchment area in Morocco. The region is dominated by intensive agriculture which is located upstream from a Ramsar-classified wetland area. The SimPhy simulation game is based on a decision support system-type tool. It allows us to anticipate the impact of regulations on farming systems. It also enables us to analyse the consequences of the actors' strategies on farm economies, human health and the quality of ecosystems. Initial results from the SimPhy simulation game enabled the technicians from Agricultural Development Center (CDA) themselves to learn about managing agricultural production systems in a dynamic and interactive fashion. With the simulation game, it was possible to learn about the farmer's ability to adapt to new regulatory constraints, and the involved consequences for toxicity risks for human health and the environment.

The Promise of Antiretrovirals for HIV Prevention

PubMed Central

Flash, Charlene; Krakower, Douglas; Mayer, Kenneth H.

2013-01-01

With an estimated 2.6 million new HIV infections diagnosed annually, the world needs new prevention strategies to partner with condom use, harm reduction approaches for injection drug users, and male circumcision. Antiretrovirals can reduce the risk of mother-to-child HIV transmission and limit HIV acquisition after occupational exposure. Macaque models and clinical trials demonstrate efficacy of oral or topical antiretrovirals used prior to HIV exposure to prevent HIV transmission, ie pre-exposure prophylaxis (PrEP). Early initiation of effective HIV treatment in serodiscordant couples results in a 96% decrease in HIV transmission. HIV testing to determine serostatus and identify undiagnosed persons is foundational to these approaches. The relative efficacy of different approaches, adherence, cost and long-term safety will affect uptake and impact of these strategies. Ongoing research will help characterize the role for oral and topical formulations and help quantify potential benefits in sub-populations at risk for HIV acquisition. PMID:22351302

Psychological contracts: a new strategy for retaining reduced-hour physicians.

PubMed

Hartwell, Jennifer K

2010-01-01

As a retention strategy, healthcare organizations offer reduced-hour schedules to physicians seeking better work-family balance. However, this quantitative study of 94 full-time and reduced-hour female physicians in the Boston area found that working fewer hours helps physicians achieve better balance but does not improve their burnout or career satisfaction, or impact their intention to quit or leave the field of medicine. Instead, the findings demonstrate that psychological contract fulfillment, which reflects the subjective nature of the employment relationship, is more important than work hours, an objective job condition, in predicting intention to quit and these other outcomes. A fine-grained analysis is initiated uncovering the multidimensionality of the psychological contract construct. To integrate successful reduced-hour arrangements for physicians, medical managers are directed to the importance of understanding the composition of reduced-hour physicians' psychological contracts, specifically, their need to do challenging work, receive high levels of supervisor support, and promotion opportunities.

The evolution of policy and actions to tackle obesity in England.

PubMed

Jebb, S A; Aveyard, P N; Hawkes, C

2013-11-01

Tackling obesity has been a policy priority in England for more than 20 years. Two formal government strategies on obesity in 2008 and 2011 drew together a range of actions and developed new initiatives to fill perceived gaps. Today, a wide range of policies are in place, including support for breastfeeding and healthy weaning practices, nutritional standards in schools, restrictions on marketing foods high in fat, sugar and salt to children, schemes to boost participation in sport, active travel plans, and weight management services. Data from annual surveys show that the rate of increase in obesity has attenuated in recent years, but has not yet been reversed. This paper considers the actions taken and what is known about the impact of individual policies and the overarching strategy to tackle obesity in England. © 2013 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of the International Association for the Study of Obesity.

Improving Communication Skills of Pharmacy Students Through Effective Precepting

PubMed Central

McDonough, Randy P.; Bennett, Marialice S.

2006-01-01

Pharmacy students should be given opportunities to learn and practice interpersonal communication skills during their community advanced pharmacy practice experience (APPE). Preceptors have the responsibility of setting the stage for the pharmacy students during their initial encounter. During this orientation to the site, students should become familiar with the history of the practice, the types of services provided, and the staff members. Once the orientation is completed, preceptors can develop strategies for incorporating the students into the practice's patient care activities. Students should participate in patient counseling, interviewing, and educational sessions. Also, students should participate in collaborative work with other health care providers. To ensure the development of communication skills in pharmacy students, preceptors can incorporate the teaching process “see one, do one, teach one” into their teaching activities. By following these strategies, preceptors can effectively and positively impact the communication skills of their students. PMID:17136179

Communities putting prevention to work: Local evaluation of community-based strategies designed to make healthy living easier☆,☆☆

PubMed Central

Soler, Robin E.; Whitten, Kathleen L.; Ottley, Phyllis G.

2015-01-01

This introduction is an overview of the articles presented in this supplement that describe implementation and evaluation activities conducted as part of the Centers for Disease Control and Prevention’s (CDC’s) Communities Putting Prevention to Work (CPPW) initiative. CPPW was one of the largest federal investments ever to combat chronic diseases in the United States. CPPW supported high-impact, jurisdiction-wide policy, systems, and environmental changes to improve health by increasing access to physical activity and healthy foods, and by decreasing tobacco use and exposure to secondhand smoke. The articles included in this supplement describe implementation and evaluation efforts of strategies implemented as part of CPPW by local awardees. This supplement is intended to guide the evidence base for public health interventions on the basis of jurisdiction-wide policy and environmental-level improvements and to encourage rigorous evaluation of the public health interventions. PMID:25150384

Opioid Addiction and Implications for Employers.

PubMed

Kuhn, Sandra

2017-01-01

Although the prevalence and destruction of opioid addiction have touched individuals and families across all social groups and geographies, until recently, federal and state-level efforts to confront this growing problem have lacked focus and rigor. With several legislative actions already underway and the recent enactment of the Comprehensive Addiction and Recovery Act (CARA), we will continue to see a focus on program development and treatment strategies. Employers can contribute toward curbing the opioid addiction epidemic in a number of ways and should play an instrumental role in facilitating increased awareness of and access to needed programming. These efforts will improve quality of life for employees and their dependents, as well as have a positive impact on productivity (including reduced absenteeism and decreased presenteeism). This article will explore the size and prevalence of the opioid epidemic, reflect on its implications for employers-including public policy initiatives-and suggest specific strategies for employer interventions.

Managing physical and mental health conditions: Consumer perspectives on integrated care.

PubMed

Rollins, Angela L; Wright-Berryman, Jennifer; Henry, Nancy H; Quash, Alicia M; Benbow, Kyle; Bonfils, Kelsey A; Hedrick, Heidi; Miller, Alex P; Firmin, Ruthie; Salyers, Michelle P

2017-01-01

Despite the growing trend of integrating primary care and mental health services, little research has documented how consumers with severe mental illnesses manage comorbid conditions or view integrated services. We sought to better understand how consumers perceive and manage both mental and physical health conditions and their views of integrated services. We conducted semi-structured interviews with consumers receiving primary care services integrated in a community mental health setting. Consumers described a range of strategies to deal with physical health conditions and generally viewed mental and physical health conditions as impacting one another. Consumers viewed integration of primary care and mental health services favorably, specifically its convenience, friendliness and knowledge of providers, and collaboration between providers. Although integration was viewed positively, consumers with SMI may need a myriad of strategies and supports to both initiate and sustain lifestyle changes that address common physical health problems.

[Impact of quality measurement, transparency and peer review on in-hospital mortality - retrospective before-after study with 63 hospitals].

PubMed

Nimptsch, Ulrike; Peschke, Dirk; Mansky, Thomas

2016-10-01

In 2008 the 'Initiative Qualitätsmedizin' (initiative for quality in medical care, IQM) was established as a voluntary non-profit association of hospital providers of all kinds of ownership. Currently, about 350 hospitals from Germany and Switzerland participate in IQM. Member hospitals are committed to a quality strategy based on measuring outcome indicators using administrative data, peer review procedures to improve medical quality, and transparency by public reporting. This study aims to investigate whether voluntary implementation of this approach is associated with improvements in medical outcome. Within a retrospective before-after study 63 hospitals, which started to participate in IQM between 2009 and 2011, were monitored. In-hospital mortality in these hospitals was studied for 14 selected inpatient services in comparison to the German national average. The analyses examine whether in-hospital mortality declined after participation of the studied hospitals in IQM, independently of secular trends or deviations in case mix when compared to the national average, and whether such findings were associated with initial hospital performance or peer review procedures. Declining in-hospital mortality was observed in hospitals with initially subpar performance. These declines were statistically significant for treatment of myocardial infarction, heart failure, pneumonia, and septicemia. Similar, but statistically non-significant trends were observed for nine further treatments. Following peer-review procedures significant declines in in-hospital mortality were observed for treatments of myocardial infarction, heart failure, and pneumonia. Mortality declines after peer reviews regarding stroke, hip fracture and colorectal resection were not significant, and after peer reviews regarding mechanically ventilated patients no changes were observed. The results point to a positive impact of the quality approach applied by IQM on clinical outcomes. A more targeted selection of hospitals to be peer-reviewed might further enhance the impact of this approach. Copyright © 2016. Published by Elsevier GmbH.

[Optimizing carbon/energy metabolism to enhance monellin production by Pichia pastoris].

PubMed

Huai, Qiangqiang; Jia, Luqiang; Ding, Jian; Chen, Shanshan; Sun, Jiaowen; Shi, Zhongping

2018-02-25

In heterologous protein productions by Pichia pastoris, methanol induction is generally initiated when cell density reaches very high level. However, this traditional strategy suffers with the problems of difficulty in DO control, toxic by-metabolites accumulation and low targeted protein titer. Therefore, initiating methanol induction at lower cell concentration is considered as an alternative strategy to overcome those problems. However, the methanol/energy regulation mechanisms of initiating induction at lower concentration are not clear and seldom reported. In this article, with monellin production as a prototype, we analyzed the methanol/energy metabolism in protein expression process using the strategies of initiating induction at both higher/lower cells concentrations. We attempted to interpret the advantages of the "alternative" strategy, via online measurements of methanol consumption, CO₂ production and O₂ uptake rates. When adopting this "alternative" strategy and maintaining temperature at 30 °C, carbon flux ratio directing into monellin precursors synthesis reached the highest level of 65%. In addition, monellin synthesis was completely associated with cell growth.

LC-MS/MS strategies for therapeutic antibodies and investigation into the quantitative impact of antidrug-antibodies.

PubMed

Ewles, Matthew; Mannu, Ranbir; Fox, Chris; Stanta, Johannes; Evans, Graeme; Goodwin, Lee; Duffy, James; Bell, Len; Estdale, Sian; Firth, David

2016-12-01

We aimed to establish novel, high-throughput LC-MS/MS strategies for quantification of monoclonal antibodies in human serum and examine the potential impact of antidrug antibodies. We present two strategies using a thermally stable immobilized trypsin. The first strategy uses whole serum digestion and the second introduces Protein G enrichment to improve the selectivity. The impact of anti-trastuzumab antibodies on the methods was tested. Whole serum digestion has been validated for trastuzumab (LLOQ 0.25 µg/ml). Protein G enrichment has been validated for trastuzumab (LLOQ 0.1 µg/ml), bevacizumab (LLOQ 0.1 µg/ml) and adalimumab (LLOQ 0.25 µg/ml). We have shown the potential for anti-drug antibodies to impact on the quantification and we have subsequently established a strategy to overcome this impact where total quantification is desired.

Methodology for environmental assessments of oil and hazardous substance spills

NASA Astrophysics Data System (ADS)

Davis, W. P.; Scott, G. I.; Getter, C. D.; Hayes, M. O.; Gundlach, E. R.

1980-03-01

Scientific assessment of the complex environmental consequences of large spills of oil or other hazardous substances has stimulated development of improved strategies for rapid and valid collection and processing of ecological data. The combination of coastal processes and geological measurements developed by Hayes & Gundlach (1978), together with selected field biological and chemical observations/measurements, provide an ecosystem impact assessment approach which is termed “integrated zonal method of ecological impact assessment.” Ecological assessment of oil and hazardous material spills has been divided into three distinct phases: (1) first-order response studies — conducted at the time of the initial spill event, which gather data to document acute impacts and assist decision-makers in prioritization of cleanup efforts and protection of ecologically sensitive habitats, (2) second-order response studies — conducted two months to one year post-spill, which document any delayed mortality and attempt to identify potential sublethal impacts in sensitive species, and (3) third-order response studies — conducted one to three years post-spill, to document chronic impacts (both lethal and sublethal) to specific indicator species. Data collected during first-order response studies are gathered in a quantitative manner so that the initial assessment may become a baseline for later, more detailed, post-spill scientific efforts. First- and second-order response studies of the “Peck Slip” oil spill in Puerto Rico illustrate the usefulness of this method. The need for contingency planning before a spill has been discussed along with the use of the Vulnerability Index, a method in which coastal environments are classified on a scale of 1 10, based upon their potential susceptibility to oiling. A study of the lower Cook Inlet section of the Alaskan coast illustrates the practical application of this method.

Designing, implementing and monitoring social impact mitigation strategies: Lessons from Forest Industry Structural Adjustment Packages

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

Loxton, Edwina A., E-mail: Edwina.Loxton@anu.edu.au; Schirmer, Jacki, E-mail: Jacki.Schirmer@canberra.edu.au; Cooperative Research Centre for Forestry, Hobart, 7001

2013-09-15

Social impact mitigation strategies are implemented by the proponents of policies and projects with the intent of reducing the negative, and increasing the positive social impacts of their activities, and facilitating the achievement of policy/project goals. Evaluation of mitigation strategies is critical to improving their future success and cost-effectiveness. This paper evaluates two Forest Industry Structural Adjustment Packages (FISAP) implemented in Australia in the 1990s to 2000s as part of broader policy changes that reduced access to timber from publicly owned native forests. It assesses the effectiveness of the structure, design, implementation and monitoring of the FISAPs, and highlights themore » interactions between these four elements and their influence on social impacts. The two FISAPs were found to be effective in terms of reducing negative impacts, encouraging positive impacts and contributing towards policy goals, although they did not mitigate negative impacts in all cases, and sometimes interacted with external factors and additional policy changes to contribute to significant short and long term negative impacts. -- Highlights: ► Mitigation strategies aim to reduce negative and enhance positive social impacts ► Mitigation strategy design, implementation, and monitoring are critical to success ► Effective mitigation enhanced the capacity of recipients to respond to change ► Mitigation strategies influenced multiple interacting positive and negative impacts ► Success required good communication, transparency, support, resources and timing.« less

Impact Initiation of Rods of Pressed Polytetrafluoroethylene (PTFE) and Aluminum Powders

NASA Astrophysics Data System (ADS)

Mock, Willis, Jr.; Drotar, Jason T.

2007-06-01

A gas gun has been used to investigate the impact initiation of rods consisting of a mixture of 72 wt% PTFE (28 μm particle size) and 28 wt% aluminum (95 micron particle size) powders. The rods were 7.6 mm in diameter by 51 mm long, and were fabricated from material that had been pressed and sintered to a full density of 2.27 gm/cm^ 3. They were sabot-launched into steel anvils at impact velocities ranging from 468 to 970 m/sec. This corresponds to calculated initial impact stresses of 25 to 64 kbar, respectively. A framing camera was used to observe the time sequence of events. These include change in rod shape, fracture, and the initiation and evolution of the reaction phenomena. The time of observation of first light after impact was taken as the initiation time. Initiation occurred at discrete locations in the impacted material. At the lowest impact stress of 25 kbar no light was observed; this value was taken as the initiation threshold stress for this material. Above the initiation threshold, the initiation time dropped abruptly from 74 μs just above threshold to 14 μs at the highest impact velocity of 970 m/s. These results are compared with rod impact experiments for a similar material [1] in which the only major difference is a smaller aluminum particle size (9 micron). [1] W. Mock, Jr. and W. H. Holt, in Proc. APS Shock Compression of Condensed Matter--2005, p.1097.

The Moving Target of Climate Mitigation: Examples from the Energy Sector in California

NASA Astrophysics Data System (ADS)

Tarroja, B.; AghaKouchak, A.; Forrest, K.; Chiang, F.; Samuelsen, S.

2016-12-01

In response to the concerns of climate change-induced impacts on human health, environmental integrity, and the secure operation of resource supply infrastructures, strategies to reduce greenhouse gas (GHG) emissions of major societal sectors have been in development. In the energy sector, these strategies are based in low carbon primary energy deployment, increased energy efficiency, and implementing complementary technologies for operational resilience. While these strategies are aimed at climate mitigation, a degree of climate change-induced impacts will occur by the time of their deployment, and many of these impacts can compromise the effectiveness of these climate mitigation strategies. In order to develop climate mitigation strategies that will achieve their GHG reduction and other goals, the impact that climate change-induced conditions can have on different components of climate mitigation strategies must be understood. This presentation will highlight three examples of how climate change-induced conditions affect components of climate mitigation strategies in California: through impacts on 1) hydropower generation, 2) renewable potential for geothermal and solar thermal resources to form part of the renewable resource portfolio, and 3) the magnitudes and shapes of the electric load demand that must be met sustainably. These studies are part of a larger, overarching project to understand how climate change impacts the energy system and how to develop a sustainable energy infrastructure that is resilient against these impacts.

Stakeholder Education for Community-Wide Health Initiatives: A Focus on Teen Pregnancy Prevention.

PubMed

Finley, Cara; Suellentrop, Katherine; Griesse, Rebecca; House, Lawrence Duane; Brittain, Anna

2018-01-01

Teen pregnancies and births continue to decline due in part to implementation of evidence-based interventions and clinical strategies. While local stakeholder education is also thought to be critical to this success, little is known about what types of strategies work best to engage stakeholders. With the goal of identifying and describing evidence-based or best practice strategies for stakeholder education in community-based public health initiatives, we conducted a systematic literature review of strategies used for effective stakeholder education. Over 400 articles were initially retrieved; 59 articles met inclusion criteria. Strategies were grouped into four steps that communities can use to support stakeholder education efforts: identify stakeholder needs and resources, develop a plan, develop tailored and compelling messaging, and use implementation strategies. These strategies lay a framework for high-quality stakeholder education. In future research, it is important to prioritize evaluating specific activities taken to raise awareness, educate, and engage a community in community-wide public health efforts.

Evaluative reports on medical malpractice policies in obstetrics: a rapid scoping review.

PubMed

Cardoso, Roberta; Zarin, Wasifa; Nincic, Vera; Barber, Sarah Louise; Gulmezoglu, Ahmet Metin; Wilson, Charlotte; Wilson, Katherine; McDonald, Heather; Kenny, Meghan; Warren, Rachel; Straus, Sharon E; Tricco, Andrea C

2017-09-06

The clinical specialty of obstetrics is under particular scrutiny with increasing litigation costs and unnecessary tests and procedures done in attempts to prevent litigation. We aimed to identify reports evaluating or comparing the effectiveness of medical liability reforms and quality improvement strategies in improving litigation-related outcomes in obstetrics. We conducted a rapid scoping review with a 6-week timeline. MEDLINE, EMBASE, LexisNexis Academic, the Legal Scholarship Network, Justis, LegalTrac, QuickLaw, and HeinOnline were searched for publications in English from 2004 until June 2015. The selection criteria for screening were established a priori and pilot-tested. We included reports comparing or evaluating the impact of obstetrics-related medical liability reforms and quality improvement strategies on cost containment and litigation settlement across all countries. All levels of screening were done by two reviewers independently, and discrepancies were resolved by a third reviewer. In addition, two reviewers independently extracted relevant data using a pre-tested form, and discrepancies were resolved by a third reviewer. The results were summarized descriptively. The search resulted in 2729 citations, of which 14 reports met our eligibility criteria. Several initiatives for improving the medical malpractice litigation system were found, including no-fault approaches, patient safety policy initiatives, communication and resolution, caps on compensation and attorney fees, alternative payment system and liabilities, and limitations on litigation. Only a few litigation policies in obstetrics were evaluated or compared. Included documents showed that initiatives to reduce medical malpractice litigation could be associated with a decrease in adverse and malpractice events. However, due to heterogeneous settings (e.g., economic structure, healthcare system) and variation in the outcomes reported, the advantages and disadvantages of initiatives may vary.

Shifting Resources and Focus to Meet the Goals of the National HIV/AIDS Strategy: The Enhanced Comprehensive HIV Prevention Planning Project, 2010–2013

PubMed Central

Purcell, David W.; Fisher, Holly H.; Belcher, Lisa; Carey, James W.; Courtenay-Quirk, Cari; Dunbar, Erica; Eke, Agatha N.; Galindo, Carla A.; Glassman, Marlene; Margolis, Andrew D.; Neumann, Mary Spink; Prather, Cynthia; Stratford, Dale; Taylor, Raekiela D.; Mermin, Jonathan

2016-01-01

In September 2010, CDC launched the Enhanced Comprehensive HIV Prevention Planning (ECHPP) project to shift HIV-related activities to meet goals of the 2010 National HIV/AIDS Strategy (NHAS). Twelve health departments in cities with high AIDS burden participated. These 12 grantees submitted plans detailing jurisdiction-level goals, strategies, and objectives for HIV prevention and care activities. We reviewed plans to identify themes in the planning process and initial implementation. Planning themes included data integration, broad engagement of partners, and resource allocation modeling. Implementation themes included organizational change, building partnerships, enhancing data use, developing protocols and policies, and providing training and technical assistance for new and expanded activities. Pilot programs also allowed grantees to assess the feasibility of large-scale implementation. These findings indicate that health departments in areas hardest hit by HIV are shifting their HIV prevention and care programs to increase local impact. Examples from ECHPP will be of interest to other health departments as they work toward meeting the NHAS goals. PMID:26843670

The Client's Perspective on Voluntary Stuttering.

PubMed

Byrd, Courtney T; Gkalitsiou, Zoi; Donaher, Joe; Stergiou, Erin

2016-08-01

Voluntary stuttering is a strategy that has been suggested for use in the clinical literature but has minimal empirical data regarding treatment outcomes. The purpose of the present study is to explore client perspectives regarding the impact of the use of this strategy on the affective, behavioral, and cognitive components of stuttering. The present study used an original survey designed to explore the intended purpose. A total of 206 adults who stutter were included in the final data corpus. Responses were considered with respect to the type of voluntary stuttering the participants reportedly produced and the location of use. A client perceives significantly greater affective, behavioral, and cognitive benefits from voluntary stuttering when the production is closely matched to the client's actual stutter and when it is used outside the clinical environment. To enhance client perception of associated benefits, clinicians should encourage use of voluntary stuttering that closely matches the client's own stuttering. Clinicians should also facilitate practice of voluntary stuttering outside of the therapy room. Finally, clinicians should be aware that clients, at least initially, may not perceive any benefits from the use of this strategy.

Using Copernicus earth observation services to monitor climate change impacts and adaptations

NASA Astrophysics Data System (ADS)

Becker, Daniel; Zebisch, Marc; Sonnenschein, Ruth; Schönthaler, Konstanze; von Andrian-Werburg, Stefan

2016-04-01

In the last years, earth observation made a big leap towards an operational monitoring of the state of environment. Remote sensing provides for instance information on the dynamics, trends and anomalies of snow and glaciers, vegetation, soil moisture or water temperature. In particular, the European Copernicus initiative offers new opportunities through new satellites with a higher temporal and spatial resolution, operational services for environmental monitoring and an open data access policy. With the Copernicus climate change service and the ESA climate change initiative, specific earth observation programs are in place to address the impacts of climate change. However, such products and services are until now rarely picked up in the field of policy or decision making oriented climate impact or climate risk assessments. In this talk, we will present results of a study, which focus on the question, if and how remote sensing approaches could be integrated into operational monitoring activities of climate impacts and response measures on a national and subnational scale. We assessed all existing and planned Copernicus services regarding their relevance for climate impact monitoring by comparing them against the indication fields from an indicator system for climate impact and response monitoring in Germany, which has lately been developed in the framework of the German national adaptation strategy. For several climate impact or response indicators, an immediate integration of remote sensing data could be identified and been recommended. For these cases, we will show practical examples on the benefit of remote sensing data. For other indication fields, promising approaches were found, which need further development. We argue that remote sensing is a very valuable complement to the existing indicator schemes by contributing with spatial explicit, timely information but not always easy to integrate with classical approaches, which are oriented towards consistent long term monitoring. Furthermore, we provide specific recommendations for the Copernicus services to ensure a consistent climate change monitoring in future and we indicate options and limitations for integrating service products into practical assessment and monitoring activities.

Strategies Utilized by Superintendents and Mathematics District Personnel That Impact Minority Student Outcomes in Algebra

ERIC Educational Resources Information Center

DuPree, Jared Bernard

2013-01-01

This study applies the constructs from effective instruction from the literature on teacher education to understand the impact of school district strategies on algebra outcomes for minority students. The purpose of this study was to examine the strategies utilized by superintendents and district personnel and the impact of these identified…

Risk evaluation and mitigation strategies: a focus on the mycophenolic acid preparations.

PubMed

Rostas, Sara; Kim, Miae; Gabardi, Steven

2014-03-01

To review risks associated with mycophenolic acid (MPA) preparations and evaluate their required risk evaluation and mitigation strategies (REMS) elements. Articles were identified through a non-date-limited MEDLINE and EMBASE search using the terms fetal toxicity, teratogenicity, risk evaluation and mitigation strategies, REMS, MPA, mycophenolate mofetil, entericcoated MPA, and organ transplant. Information from the Food and Drug Administration (FDA) and the manufacturers of the MPA preparations was also evaluated. The MPA preparations are associated with several potential risks, including gastrointestinal disturbances and myelosuppression; however, their impact on the fetus in pregnant patients taking 1 of these agents poses the greatest risk. The FDA approved REMS programs for all MPA products, both innovator and generic preparations, in September 2012. With evidence of increased risk of miscarriage and birth defects associated with MPA use, the FDA instituted a REMS program that contains both a medication guide and elements to assure safe use (ETASU). The medication guides for the MPA products, which were previously FDA approved, should continue to be distributed to patients who get either an initial prescription filled or a refill. The ETASU requires prescribers to complete training and obtain patient signatures on the Patient-Prescriber Acknowledgment Form. A single, national, voluntary pregnancy registry specific to this medication has been established, and pregnant patients should be encouraged to participate. Although the impact of the MPA REMS on clinical practice is not clear, it is a step toward increasing the understanding of fetal risks with MPA.

Modeling the Impact of Spatial Structure on Growth Dynamics of Invasive Plant Species

NASA Astrophysics Data System (ADS)

Murphy, James T.; Johnson, Mark P.; Walshe, Ray

2013-07-01

Invasive nonindigenous plant species can have potentially serious detrimental effects on local ecosystems and, as a result, costly control efforts often have to be put in place to protect habitats. An example of an invasive problem on a global scale involves the salt marsh grass species from the genus Spartina. The spread of Spartina anglica in Europe and Asia has drawn much concern due to its ability to convert coastal habitats into cord-grass monocultures and to alter the native food webs. However, the patterns of invasion of Spartina species are amenable to spatially-explicit modeling strategies that take into account both temporal and spatio-temporal processes. In this study, an agent-based model of Spartina growth on a simulated mud flat environment was developed in order to study the effects of spatial pattern and initial seedling placement on the invasion dynamics of the population. The spatial pattern of an invasion plays a key role in the rate of spread of the species and understanding this can lead to significant cost savings when designing efficient control strategies. We present here a model framework that can be used to explicitly represent complex spatial and temporal patterns of invasion in order to be able to predict quantitatively the impact of these factors on invasion dynamics. This would be a useful tool for assessing eradication strategies and choosing optimal control solutions in order to be able to minimize future control costs.

Cost-effectiveness of gefitinib, icotinib, and pemetrexed-based chemotherapy as first-line treatments for advanced non-small cell lung cancer in China

PubMed Central

Lu, Shun; Ye, Ming; Ding, Lieming; Tan, Fenlai; Fu, Jie; Wu, Bin

2017-01-01

Tyrosine kinase inhibitors of the epidermal growth factor receptor (EGFR) are becoming the standard treatment option for patients with advanced non-small cell lung cancer (NSCLC) harboring an EGFR mutation, but the economic impact of this practice is unclear, especially in a health resource-limited setting. A decision-analytic model was developed to simulate 21-day patient transitions in a 10-year time horizon. The health and economic outcomes of four first-line strategies (pemetrexed plus cisplatin [PC] alone, PC followed by maintenance with pemetrexed, or initial treatment with gefitinib or icotinib) among patients harboring EGFR mutations were estimated and assessed via indirect comparisons. Costs in the Chinese setting were estimated. The primary outcome was the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed. The icotinib strategy resulted in greater health benefits than the other three strategies in NSCLC patients harboring EGFR mutations. Relative to PC alone, PC followed by pemetrexed maintenance, gefitinib and icotinib resulted in ICERs of $104,657, $28,485 and $19,809 per quality-adjusted life-year gained, respectively. The cost of pemetrexed, the EGFR mutation prevalence and the utility of progression-free survival were factors that had a considerable impact on the model outcomes. When the icotinib Patient Assistance Program was available, the economic outcome of icotinib was more favorable. These results indicate that gene-guided therapy with icotinib might be a more cost-effective treatment option than traditional chemotherapy. PMID:28036283

Cost-effectiveness of gefitinib, icotinib, and pemetrexed-based chemotherapy as first-line treatments for advanced non-small cell lung cancer in China.

PubMed

Lu, Shun; Ye, Ming; Ding, Lieming; Tan, Fenlai; Fu, Jie; Wu, Bin

2017-02-07

Tyrosine kinase inhibitors of the epidermal growth factor receptor (EGFR) are becoming the standard treatment option for patients with advanced non-small cell lung cancer (NSCLC) harboring an EGFR mutation, but the economic impact of this practice is unclear, especially in a health resource-limited setting. A decision-analytic model was developed to simulate 21-day patient transitions in a 10-year time horizon. The health and economic outcomes of four first-line strategies (pemetrexed plus cisplatin [PC] alone, PC followed by maintenance with pemetrexed, or initial treatment with gefitinib or icotinib) among patients harboring EGFR mutations were estimated and assessed via indirect comparisons. Costs in the Chinese setting were estimated. The primary outcome was the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed. The icotinib strategy resulted in greater health benefits than the other three strategies in NSCLC patients harboring EGFR mutations. Relative to PC alone, PC followed by pemetrexed maintenance, gefitinib and icotinib resulted in ICERs of $104,657, $28,485 and $19,809 per quality-adjusted life-year gained, respectively. The cost of pemetrexed, the EGFR mutation prevalence and the utility of progression-free survival were factors that had a considerable impact on the model outcomes. When the icotinib Patient Assistance Program was available, the economic outcome of icotinib was more favorable. These results indicate that gene-guided therapy with icotinib might be a more cost-effective treatment option than traditional chemotherapy.

Adaptive use of research aircraft data sets for hurricane forecasts

NASA Astrophysics Data System (ADS)

Biswas, M. K.; Krishnamurti, T. N.

2008-02-01

This study uses an adaptive observational strategy for hurricane forecasting. It shows the impacts of Lidar Atmospheric Sensing Experiment (LASE) and dropsonde data sets from Convection and Moisture Experiment (CAMEX) field campaigns on hurricane track and intensity forecasts. The following cases are used in this study: Bonnie, Danielle and Georges of 1998 and Erin, Gabrielle and Humberto of 2001. A single model run for each storm is carried out using the Florida State University Global Spectral Model (FSUGSM) with the European Center for Medium Range Weather Forecasts (ECMWF) analysis as initial conditions, in addition to 50 other model runs where the analysis is randomly perturbed for each storm. The centers of maximum variance of the DLM heights are located from the forecast error variance fields at the 84-hr forecast. Back correlations are then performed using the centers of these maximum variances and the fields at the 36-hr forecast. The regions having the highest correlations in the vicinity of the hurricanes are indicative of regions from where the error growth emanates and suggests the need for additional observations. Data sets are next assimilated in those areas that contain high correlations. Forecasts are computed using the new initial conditions for the storm cases, and track and intensity skills are then examined with respect to the control forecast. The adaptive strategy is capable of identifying sensitive areas where additional observations can help in reducing the hurricane track forecast errors. A reduction of position error by approximately 52% for day 3 of forecast (averaged over 7 storm cases) over the control runs is observed. The intensity forecast shows only a slight positive impact due to the model’s coarse resolution.

Test and treat DC: forecasting the impact of a comprehensive HIV strategy in Washington DC.

PubMed

Walensky, Rochelle P; Paltiel, A David; Losina, Elena; Morris, Bethany L; Scott, Callie A; Rhode, Erin R; Seage, George R; Freedberg, Kenneth A

2010-08-15

The United States and international agencies have signaled their commitment to containing the human immunodeficiency virus (HIV) epidemic via early case identification and linkage to antiretroviral therapy (ART) immediately at diagnosis. We forecast outcomes of this approach if implemented in Washington DC. Using a mathematical model of HIV case detection and treatment, we evaluated combinations of HIV screening and ART initiation strategies. We define current practice as no regular screening program and ART at CD4 counts < or = 350 cells/microL, and we define test and treat as annual screening and administration of ART at diagnosis. Outcomes include life expectancy of HIV-infected persons and changes in the population time with transmissible HIV RNA levels. Data, largely from Washington DC, include undiagnosed HIV prevalence of 0.6%, annual incidence of 0.13%, 31% rate of test offer, 60% rate of acceptance, and 50% linkage to care. Input parameters, including optimized ART efficacy, are varied in sensitivity analyses. Projected life expectancies, from an initial mean age of 41 years, are 23.9, 25.0, and 25.6 years for current practice, test and treat, and test and treat with optimized ART, respectively. Compared with current practice, test and treat leads to a 14.7% reduction in time spent with transmissible HIV RNA level in the next 5 years; test and treat with optimized ART results in a 27.3% reduction. An expanded HIV test and treat program in Washington DC will increase life expectancy of HIV-infected patients but will have a modest impact on HIV transmission over the next 5 years and is unlikely to halt the HIV epidemic.

Duration of untreated psychosis: Impact of the definition of treatment onset on its predictive value over three years of treatment.

PubMed

Golay, Philippe; Alameda, Luis; Baumann, Philipp; Elowe, Julien; Progin, Pierre; Polari, Andrea; Conus, Philippe

2016-06-01

While reduction of DUP (Duration of Untreated Psychosis) is a key goal in early intervention strategies, the predictive value of DUP on outcome has been questioned. We planned this study in order to explore the impact of three different definition of "treatment initiation" on the predictive value of DUP on outcome in an early psychosis sample. 221 early psychosis patients aged 18-35 were followed-up prospectively over 36 months. DUP was measured using three definitions for treatment onset: Initiation of antipsychotic medication (DUP1); engagement in a specialized programme (DUP2) and combination of engagement in a specialized programme and adherence to medication (DUP3). 10% of patients never reached criteria for DUP3 and therefore were never adequately treated over the 36-month period of care. While DUP1 and DUP2 had a limited predictive value on outcome, DUP3, based on a more restrictive definition for treatment onset, was a better predictor of positive and negative symptoms, as well as functional outcome at 12, 24 and 36 months. Globally, DUP3 explained 2 to 5 times more of the variance than DUP1 and DUP2, with effect sizes falling in the medium range according to Cohen. The limited predictive value of DUP on outcome in previous studies may be linked to problems of definitions that do not take adherence to treatment into account. While they need replication, our results suggest effort to reduce DUP should continue and aim both at early detection and development of engagement strategies. Copyright © 2016 Elsevier Ltd. All rights reserved.

Early initiation of beta blockade in heart failure: issues and evidence.

PubMed

Williams, Randall E

2005-09-01

Despite clinical trials demonstrating that inhibitors of the renin-angiotensin and sympathetic nervous systems can reduce the mortality and morbidity risk associated with heart failure, these drugs have remained underutilized in general clinical practice. In particular, many patients with heart failure due to left ventricular systolic dysfunction fail to receive beta blockers, although this class of drugs, as well as other antihypertensive agents such as angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, are recommended as part of routine heart failure therapy by national expert consensus guidelines. In-hospital initiation of beta-blocker therapy may improve long-term utilization by physicians and compliance by patients through obviating many of the misperceived dangers associated with beta blockade. The following review of the clinical trial data from the Randomized Evaluation of Strategies for Left Ventricular Dysfunction (RESOLVD) trial, the Metoprolol Controlled-Release Randomized Intervention Trial in Heart Failure (MERIT-HF), the Cardiac Insufficiency Bisoprolol Study II (CIBIS-II), the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) trial, and the Initiation Management Predischarge Process for Assessment of Carvedilol Therapy for Heart Failure (IMPACT-HF) trial on the efficacy, safety, and tolerability of beta blockers indicates that early initiation can be safely achieved and can improve patient outcomes.

Vaccine strategies: Optimising outcomes.

PubMed

Hardt, Karin; Bonanni, Paolo; King, Susan; Santos, Jose Ignacio; El-Hodhod, Mostafa; Zimet, Gregory D; Preiss, Scott

2016-12-20

Successful immunisation programmes generally result from high vaccine effectiveness and adequate uptake of vaccines. In the development of new vaccination strategies, the structure and strength of the local healthcare system is a key consideration. In high income countries, existing infrastructures are usually used, while in less developed countries, the capacity for introducing new vaccines may need to be strengthened, particularly for vaccines administered beyond early childhood, such as the measles or human papillomavirus (HPV) vaccine. Reliable immunisation service funding is another important factor and low income countries often need external supplementary sources of finance. Many regions also obtain support in generating an evidence base for vaccination via initiatives created by organisations including World Health Organization (WHO), the Pan American Health Organization (PAHO), the Agence de Médecine Préventive and the Sabin Vaccine Institute. Strong monitoring and surveillance mechanisms are also required. An example is the efficient and low-cost approaches for measuring the impact of the hepatitis B control initiative and evaluating achievement of goals that have been established in the WHO Western Pacific region. A review of implementation strategies reveals differing degrees of success. For example, in the Americas, PAHO advanced a measles-mumps-rubella vaccine strategy, targeting different population groups in mass, catch-up and follow-up vaccination campaigns. This has had much success but coverage data from some parts of the region suggest that children are still not receiving all appropriate vaccines, highlighting problems with local service infrastructures. Stark differences in coverage levels are also observed among high income countries, as is the case with HPV vaccine implementation in the USA versus the UK and Australia, reflecting differences in delivery settings. Experience and research have shown which vaccine strategies work well and the factors that encourage success, which often include strong support from government and healthcare organisations, as well as tailored, culturally-appropriate local approaches to optimise outcomes. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Being baby friendly: evidence-based breastfeeding support.

PubMed

Cleminson, J; Oddie, S; Renfrew, M J; McGuire, W

2015-03-01

Breast feeding improves important outcomes for mothers and infants. In the UK, breastfeeding rates have historically been low, particularly among socially disadvantaged young women. Although there have been gradual increases in breastfeeding initiation rates since 2000, rates of exclusive breast feeding and continuation until 6 months remain lower than those in similar countries. This review summarises the evidence for effective and cost-effective strategies to help women, particularly those in low income groups, make informed choices, overcome barriers and establish and maintain breast feeding. We describe the development and impact of the Unicef Baby Friendly Initiative, and the roles and responsibilities, and challenges and opportunities that clinicians have in promoting breast feeding and maintaining a baby-friendly culture and environment. 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.

A Research Agenda for Humanitarian Health Ethics

PubMed Central

Hunt, Matthew; Schwartz, Lisa; Pringle, John; Boulanger, Renaud; Nouvet, Elysée; O'Mathúna, Dónal; Arya, Neil; Bernard, Carrie; Beukeboom, Carolyn; Calain, Philippe; de Laat, Sonya; Eckenwiler, Lisa; Elit, Laurie; Fraser, Veronique; Gillespie, Leigh-Anne; Johnson, Kirsten; Meagher, Rachel; Nixon, Stephanie; Olivier, Catherine; Pakes, Barry; Redwood-Campbell, Lynda; Reis, Andreas; Renaldi, Teuku; Singh, Jerome; Smith, Maxwell; Von Schreeb, Johan

2014-01-01

This paper maps key research questions for humanitarian health ethics: the ethical dimensions of healthcare provision and public health activities during international responses to situations of humanitarian crisis. Development of this research agenda was initiated at the Humanitarian Health Ethics Forum (HHE Forum) convened in Hamilton, Canada in November 2012. The HHE Forum identified priority avenues for advancing policy and practice for ethics in humanitarian health action. The main topic areas examined were: experiences and perceptions of humanitarian health ethics; training and professional development initiatives for humanitarian health ethics; ethics support for humanitarian health workers; impact of policies and project structures on humanitarian health ethics; and theoretical frameworks and ethics lenses. Key research questions for each topic area are presented, as well as proposed strategies for advancing this research agenda. Pursuing the research agenda will help strengthen the ethical foundations of humanitarian health action. PMID:25687273

Evaluating the benefits of risk prevention initiatives

NASA Astrophysics Data System (ADS)

Di Baldassarre, G.

2012-04-01

The likelihood and adverse impacts of water-related disasters, such as floods and landslides, are increasing in many countries because of changes in climate and land-use. This presentation illustrates some preliminary results of a comprehensive demonstration of the benefits of risk prevention measures, carried out within the European FP7 KULTURisk project. The study is performed by using a variety of case studies characterised by diverse socio-economic contexts, different types of water-related hazards (floods, debris flows and landslides, storm surges) and space-time scales. In particular, the benefits of state-of-the-art prevention initiatives, such as early warning systems, non-structural options (e.g. mapping and planning), risk transfer strategies (e.g. insurance policy), and structural measures, are showed. Lastly, the importance of homogenising criteria to create hazard inventories and build memory, efficient risk communication and warning methods as well as active dialogue with and between public and private stakeholders, is highlighted.

Long-term Cost-Effectiveness of Diagnostic Tests for Assessing Stable Chest Pain: Modeled Analysis of Anatomical and Functional Strategies.

PubMed

Bertoldi, Eduardo G; Stella, Steffan F; Rohde, Luis E; Polanczyk, Carisi A

2016-05-01

Several tests exist for diagnosing coronary artery disease, with varying accuracy and cost. We sought to provide cost-effectiveness information to aid physicians and decision-makers in selecting the most appropriate testing strategy. We used the state-transitions (Markov) model from the Brazilian public health system perspective with a lifetime horizon. Diagnostic strategies were based on exercise electrocardiography (Ex-ECG), stress echocardiography (ECHO), single-photon emission computed tomography (SPECT), computed tomography coronary angiography (CTA), or stress cardiac magnetic resonance imaging (C-MRI) as the initial test. Systematic review provided input data for test accuracy and long-term prognosis. Cost data were derived from the Brazilian public health system. Diagnostic test strategy had a small but measurable impact in quality-adjusted life-years gained. Switching from Ex-ECG to CTA-based strategies improved outcomes at an incremental cost-effectiveness ratio of 3100 international dollars per quality-adjusted life-year. ECHO-based strategies resulted in cost and effectiveness almost identical to CTA, and SPECT-based strategies were dominated because of their much higher cost. Strategies based on stress C-MRI were most effective, but the incremental cost-effectiveness ratio vs CTA was higher than the proposed willingness-to-pay threshold. Invasive strategies were dominant in the high pretest probability setting. Sensitivity analysis showed that results were sensitive to costs of CTA, ECHO, and C-MRI. Coronary CT is cost-effective for the diagnosis of coronary artery disease and should be included in the Brazilian public health system. Stress ECHO has a similar performance and is an acceptable alternative for most patients, but invasive strategies should be reserved for patients at high risk. © 2016 Wiley Periodicals, Inc.

7 CFR 1948.82 - Plan and State Investment Strategy approval procedure.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 13 2010-01-01 2009-01-01 true Plan and State Investment Strategy approval procedure... Impacted Area Development Assistance Program § 1948.82 Plan and State Investment Strategy approval... the State Investment Strategy for Energy Impacted Areas. (c) Appropriate growth management and/or...

Clinical impact of an inter-hospital transfer strategy in patients with ST-elevation myocardial infarction undergoing primary angioplasty: the Emilia-Romagna ST-segment elevation acute myocardial infarction network.

PubMed

Manari, Antonio; Ortolani, Paolo; Guastaroba, Paolo; Casella, Gianni; Vignali, Luigi; Varani, Elisabetta; Piovaccari, Giancarlo; Guiducci, Vincenzo; Percoco, Gianfranco; Tondi, Stefano; Passerini, Francesco; Santarelli, Andrea; Marzocchi, Antonio

2008-08-01

This study sought to evaluate the impact of an inter-hospital transfer strategy on treatment times and in-hospital and 1 year cardiac mortality of patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous intervention (p-PCI) in the Italian region of Emilia-Romagna, where an efficient region-wide system for reperfusion has been established. 3296 patients with STEMI, undergoing on-site p-PCI (2444 patients) (OS group) or p-PCI after inter-hospital transfer (852 patients) (T group) between 1 January 2004 and 30 June 2006 in the Italian region of Emilia-Romagna, were considered. During the study period, the number of patients undergoing p-PCI increased both for patients admitted to interventional centres and for those admitted to peripheral hospitals. At the same time, the proportion of patients with STEMI initially admitted to peripheral hospitals and not transferred and the door-to-balloon time delays of transfer patients decreased. In spite of longer door-to-balloon delay in the transfer group [112 min (86-147) vs. 71 min (46-104)], in-hospital cardiac mortality (OS 7.0 vs. T 5.4%, P = 0.10) did not significantly differ between the two groups. After multivariable adjustment, the transfer strategy was not associated with increased risk of in-hospital [odds ratio 0.956; 95% confidence interval (CI) 0.633-1.442] and 1 year (hazard ratio 0.817; 95% CI 0.617-1.085) cardiac mortality. This study, concerning an established STEMI regional network, suggests that a strategy of inter-hospital transfer for p-PCI, when supported by an organized system of care, may be applied with rapid reperfusion times and favourable short- and long-term clinical outcomes.

Integrated Research on the Development of Global Climate Risk Management Strategies - Framework and Initial Results of the Research Project ICA-RUS

NASA Astrophysics Data System (ADS)

Emori, Seita; Takahashi, Kiyoshi; Yamagata, Yoshiki; Oki, Taikan; Mori, Shunsuke; Fujigaki, Yuko

2013-04-01

With the aim of proposing strategies of global climate risk management, we have launched a five-year research project called ICA-RUS (Integrated Climate Assessment - Risks, Uncertainties and Society). In this project with the phrase "risk management" in its title, we aspire for a comprehensive assessment of climate change risks, explicit consideration of uncertainties, utilization of best available information, and consideration of every possible conditions and options. We also regard the problem as one of decision-making at the human level, which involves social value judgments and adapts to future changes in circumstances. The ICA-RUS project consists of the following five themes: 1) Synthesis of global climate risk management strategies, 2) Optimization of land, water and ecosystem uses for climate risk management, 3) Identification and analysis of critical climate risks, 4) Evaluation of climate risk management options under technological, social and economic uncertainties and 5) Interactions between scientific and social rationalities in climate risk management (see also: http://www.nies.go.jp/ica-rus/en/). For the integration of quantitative knowledge of climate change risks and responses, we apply a tool named AIM/Impact [Policy], which consists of an energy-economic model, a simplified climate model and impact projection modules. At the same time, in order to make use of qualitative knowledge as well, we hold monthly project meetings for the discussion of risk management strategies and publish annual reports based on the quantitative and qualitative information. To enhance the comprehensiveness of the analyses, we maintain an inventory of risks and risk management options. The inventory is revised iteratively through interactive meetings with stakeholders such as policymakers, government officials and industrial representatives.

Adolescents' responses to peer smoking offers: the role of sensation seeking and self-esteem.

PubMed

Greene, Kathryn; Banerjee, Smita C

2008-01-01

This article deals with an important topic (youth smoking) and makes a contribution to the literature by validating existing research and extending our understanding of smoking resistance strategies. This study classified adolescent reports of their responses to cigarette smoking offers utilizing four drug refusal strategies of refuse, explain, avoid, and leave (REAL) and explored how personality factors explain adolescents' use of cigarette refusal strategies. Participants were predominantly Hispanic junior high students (6th-8th grades) from schools in the Northeast United States who participated in a survey design (N = 260). The strategy of explain was reported most frequently for initial and follow-up smoking offers. Adolescents with a greater number of friends who smoked were more likely to use the avoid strategy for initial smoking offers. Sensation seeking was positively related to the use of leave and avoid strategies for initial smoking offers and leave strategy for follow-up smoking offers. No association was found between self-esteem and use of smoking refusal strategies. Implications and directions for future research are discussed.

The Impact of Cross-Age Peer Tutoring on Third and Sixth Graders' Reading Strategy Awareness, Reading Strategy Use, and Reading Comprehension

ERIC Educational Resources Information Center

Van Keer, Hilde; Vanderlinde, Ruben

2010-01-01

The present study explores the impact of an experimental reading intervention focusing on explicit reading strategy instruction and cross-age peer tutoring on third and sixth graders' reading strategy awareness, cognitive and metacognitive reading strategy use, and reading comprehension achievement. A quasi-experimental pretest-posttest design was…

Evaluating the effectiveness of impact assessment instruments: Theorising the nature and implications of their political constitution

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

Cashmore, Matthew, E-mail: m.cashmore@uea.ac.u; Richardson, Tim; Hilding-Ryedvik, Tuija

2010-11-15

The central role of impact assessment instruments globally in policy integration initiatives has been cemented in recent years. Associated with this trend, but also reflecting political emphasis on greater accountability in certain policy sectors and a renewed focus on economic competitiveness in Western countries, demand has increased for evidence that these instruments are effective (however defined). Resurgent interest in evaluation has not, however, been accompanied by the conceptual developments required to redress longstanding theoretical problems associated with such activities. In order to sharpen effectiveness evaluation theory for impact assessment instruments this article critically examines the neglected issue of their politicalmore » constitution. Analytical examples are used to concretely explore the nature and significance of the politicisation of impact assessment. It is argued that raising awareness about the political character of impact assessment instruments, in itself, is a vital step in advancing effectiveness evaluation theory. Broader theoretical lessons on the framing of evaluation research are also drawn from the political analysis. We conclude that, at least within the contemporary research context, learning derived from analysing the meaning and implications of plural interpretations of effectiveness represents the most constructive strategy for advancing impact assessment and policy integration theory.« less

The place of physical activity in the WHO Global Strategy on Diet and Physical Activity.

PubMed

Bauman, Adrian; Craig, Cora L

2005-08-24

In an effort to reduce the global burden of non-communicable disease, the World Health Organization released a Global Strategy for Diet and Physical Activity in May 2004. This commentary reports on the development of the strategy and its importance specifically for physical activity-related work of NGOs and researchers interested in increasing global physical activity participation. Sparked by its work on global efforts to target non-communicable disease prevention in 2000, the World Health Organization commissioned a global strategy on diet and physical activity. The physical activity interest followed efforts that had led to the initial global "Move for Health Day" in 2002. WHO assembled a reference group for the global strategy, and a regional consultation process with countries was undertaken. Underpinning the responses was the need for more physical activity advocacy; partnerships outside of health including urban planning; development of national activity guidelines; and monitoring of the implementation of the strategy. The consultation process was an important mechanism to confirm the importance and elevate the profile of physical activity within the global strategy. It is suggested that separate implementation strategies for diet and physical activity may be needed to work with partner agencies in disparate sectors (e.g. urban planning for physical activity, agriculture for diet). International professional societies are well situated to make an important contribution to global public health by advocating for the importance of physical activity among risk factors; developing international measures of physical activity and global impacts of inactivity; and developing a global research and intervention agenda.

Measuring the impact of outreach and enrollment strategies for public health insurance in California.

PubMed

Cousineau, Michael R; Stevens, Gregory D; Farias, Albert

2011-02-01

OBJECTIVE AND STUDY SETTING: To evaluate the effectiveness of different approaches to outreach on public health insurance enrollment in 25 California counties with a Children's Health Initiative. Administrative enrollment databases. The use of eight enrollment strategies were identified in each quarter from 2001 to 2007 for each of 25 counties (county quarter). Strategies were categorized as either technology or nontechnology. New enrollments were obtained for Medi-Cal, Healthy Families, and Healthy Kids. Bivariate and multivariate analyses assessed the link between each strategy and new enrollments rates of children. Methods Surveys of key informants determined whether a specific outreach strategy was used in each quarter. These were linked to new enrollments in each county quarter. Between 2001 and 2007, enrollment grew in all three children's health programs. We controlled for the effects of counties, seasons, and county-specific child poverty rates. There was an increase in enrollment rates of 11 percent in periods when technology-based systems were in use compared with when these approaches were inactive. Non-technology-based approaches, including school-linked approaches, yielded a 12 percent increase in new enrollments rates. Deploying seven to eight strategies yielded 54 percent more new enrollments per 10,000 children compared with periods with none of the specific strategies. National health care reform provides new opportunities to expand coverage to millions of Americans. An investment in technology-based enrollment systems will maximize new enrollments, particularly into Medicaid; nontechnological approaches may help identify harder-to-reach populations. Moreover, incorporating several strategies, whether phased in or implemented simultaneously, will enhance enrollments. © Health Research and Educational Trust.

The Gars Programme And The Integrated Global Observing Strategy For Geohazards

NASA Astrophysics Data System (ADS)

Marsh, S.; Paganini, M.; Missotten, R.; Palazzo, F.

UNESCO and the IUGS have funded the Geological Applications of Remote Sensing Programme (GARS) since 1984. Its aim is to assess the value and utility of remotely sensed data for geoscience, whilst at the same time building capacity in developing countries. It has run projects in Africa on geological mapping, in Latin America on landslide hazards and in Asia on volcanic hazards. It is a main sponsor of the Integrated Global Observing Strategy (IGOS) for Geohazards. The societal impact of geological and related geophysical hazards is enormous. Every year volcanoes, earthquakes, landslides and subsidence claim thousands of lives, injure thousands more, devastate homes and destroy livelihoods. Damaged infrastructure and insurance premiums increase these costs. As population increases, more people live in hazardous areas and the impact grows. The World Summit on Sustainable Development recognised that systematic, joint international observations under initiatives like the Integrated Global Observing Strategy form the basis for an integrated approach to hazard mitigation and preparedness. In this context, the IGOS Partners developed this geohazards theme. Its goal is to integrate disparate, multidisciplinary, applied research into global, operational systems by filling gaps in organisation, observation and knowledge. It has four strategic objectives; building global capacity to mitigate geohazards; improving mapping, monitoring and forecasting, based on satellite and ground-based observations; increasing preparedness, using integrated geohazards information products and improved geohazards models; and promoting global take-up of local best practice in geohazards management. Gaps remain between what is known and the knowledge required to answer citizen's questions, what is observed and what must be observed to provide the necessary information for hazard mitigation and current data integration and the integration needed to make useful geohazard information products. An action plan is proposed that is designed to close these gaps. Priority actions are to: begin networking within the geohazards community; improve topographic data provision using existing observations and secure continuity of C- and L-Band radar interferometry with the space agencies; assess the potential for existing data to be integrated into geohazard products and services; evaluate ways to improve databases with their managing agencies; and initiate research that increases geohazards knowledge. This paper presents the strategy and describes the action plan that will implement it over the next decade, as a key part of the GARS Programme.

Landing strategies focusing on the control of tibial rotation in the initial contact period of one-leg forward hops.

PubMed

Chen, W-L; Chen, Y-T; Huang, S-Y; Yang, C-Y; Wu, C-D; Chang, C-W

2017-08-01

Anterior cruciate ligament (ACL) reconstruction (ACLR) surgeries successfully restore anterior tibial translation but not tibial rotation. This study aimed to explore landing strategies focusing on the control of tibial rotation at landing when the ACL is most vulnerable. Three groups of male subjects (50 ACLRs, 26 basketball players, and 31 controls) participated in one-leg forward hop tests for determining the tibial rotatory landing strategies adopted during the initial landing phase. The differences in knee kinematics and muscle activities between internal and external tibial rotatory (ITR, ETR) landing strategies were examined. A higher proportion of basketball players (34.6%) were found to adopt ITR strategies (controls: 6.5%), exhibiting significantly greater hopping distance and knee strength. After adjusting for hopping distance, subjects adopting ITR strategies were found to hop faster with straighter knees at foot contact and with greater ITR and less knee adduction angular displacement during the initial landing phase. However, significantly greater angular displacement in knee flexion, greater medial hamstring activities, and greater co-contraction index of hamstrings and medial knee muscles were also found during initial landing. Our results support the importance of the recruitments of medial hamstrings or the local co-contraction in assisting the rotatory control of the knee during initial landing for avoiding ACL injuries. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A goal and strategy for human exploration of the moon and Mars

NASA Technical Reports Server (NTRS)

Pivirotto, Donna Shirley

1990-01-01

Eventual settlement of the solar system, beginning with the moon and Mars, is proposed, and a strategy for the exploration of and initial settlement of the moon and Mars, based on the model of European settlement of the Americas, is discussed. Strategies suggest an allocation of functions between humans and telerobots to conduct the exploration and initial settlement.

Evaluation of the Healthy Lifestyles Initiative for Improving Community Capacity for Childhood Obesity Prevention.

PubMed

Berman, Marcie; Bozsik, Frances; Shook, Robin P; Meissen-Sebelius, Emily; Markenson, Deborah; Summar, Shelly; DeWit, Emily; Carlson, Jordan A

2018-02-22

Policy, systems, and environmental approaches are recommended for preventing childhood obesity. The objective of our study was to evaluate the Healthy Lifestyles Initiative, which aimed to strengthen community capacity for policy, systems, and environmental approaches to healthy eating and active living among children and families. The Healthy Lifestyles Initiative was developed through a collaborative process and facilitated by community organizers at a local children's hospital. The initiative supported 218 partners from 170 community organizations through training, action planning, coalition support, one-on-one support, and the dissemination of materials and sharing of resources. Eighty initiative partners completed a brief online survey on implementation strategies engaged in, materials used, and policy, systems, and environmental activities implemented. In accordance with frameworks for implementation science, we assessed associations among the constructs by using linear regression to identify whether and which of the implementation strategies were associated with materials used and implementation of policy, systems, and environmental activities targeted by the initiative. Each implementation strategy was engaged in by 30% to 35% of the 80 survey respondents. The most frequently used materials were educational handouts (76.3%) and posters (66.3%). The most frequently implemented activities were developing or continuing partnerships (57.5%) and reviewing organizational wellness policies (46.3%). Completing an action plan and the number of implementation strategies engaged in were positively associated with implementation of targeted activities (action plan, effect size = 0.82; number of strategies, effect size = 0.51) and materials use (action plan, effect size = 0.59; number of strategies, effect size = 0.52). Materials use was positively associated with implementation of targeted activities (effect size = 0.35). Community-capacity-building efforts can be effective in supporting community organizations to engage in policy, systems, and environmental activities for healthy eating and active living. Multiple implementation strategies are likely needed, particularly strategies that involve a high level of engagement, such as training community organizations and working with them on structured action plans.

A mixed-methods impact evaluation of the feasibility of an initiative in small rural stores to improve access to fruit and vegetables.

PubMed

Palermo, Claire; Gardiner, Breeana; Gee, Carena; Charaktis, Stella; Blake, Miranda

2016-02-01

Retail stores are a promising setting for improving access to nutritious food. This study opportunistically evaluated an initiative that supported stores in small rural Victorian towns to sell fresh fruit and vegetables. It aimed to measure whether the initiative showed a trend towards improved access to fruit and vegetables in these rural communities. A mixed-methods, pre-post evaluation was employed to measure the range and price of 39 fruits and 45 vegetables, together with 15 interviews with stakeholders 2.5 years after the commencement of the initiative. Twenty-one of 35 eligible stores took up the initiative. Analysis of qualitative and quantitative data showed that the initiative improved the availability of and access to fruit and vegetables, and that stores have a role in improving access to fruit and vegetables. The overall range of fruit and vegetables increased over 18 months from a median of 10 varieties (n=10) to 17 varieties (n=15) (P=0.028) and the prices decreased over 12 months in five out of seven stores where data was available. The capacity to influence availability of fruit and vegetables was affected by time, human resources and community support. Sustaining change to fruit and vegetables access is challenging. Using stores for health promotion may be an effective strategy for improving rural populations' fruit and vegetable intake.

Biomedical Simulation: Evolution, Concepts, Challenges and Future Trends.

PubMed

Sá-Couto, Carla; Patrão, Luís; Maio-Matos, Francisco; Pêgo, José Miguel

2016-12-30

Biomedical simulation is an effective educational complement for healthcare training, both at undergraduate and postgraduate level. It enables knowledge, skills and attitudes to be acquired in a safe, educationally orientated and efficient manner. In this context, simulation provides skills and experience that facilitate the transfer of cognitive, psychomotor and proper communication competences, thus changing behavior and attitudes, and ultimately improving patient safety. Beyond the impact on individual and team performance, simulation provides an opportunity to study organizational failures and improve system performance. Over the last decades, simulation in healthcare had a slow but steady growth, with a visible maturation in the last ten years. The simulation community must continue to provide the core leadership in developing standards. There is a need for strategies and policy development to ensure its coordinated and cost-effective implementation, applied to patient safety. This paper reviews the evolutionary movements of biomedical simulation, including a review of the Portuguese initiatives and nationwide programs. For leveling knowledge and standardize terminology, basic but essential concepts in clinical simulation, together with some considerations on assessment, validation and reliability are presented. The final sections discuss the current challenges and future initiatives and strategies, crucial for the integration of simulation programs in the greater movement toward patient safety.

On the primary variable switching technique for simulating unsaturated-saturated flows

NASA Astrophysics Data System (ADS)

Diersch, H.-J. G.; Perrochet, P.

Primary variable switching appears as a promising numerical technique for variably saturated flows. While the standard pressure-based form of the Richards equation can suffer from poor mass balance accuracy, the mixed form with its improved conservative properties can possess convergence difficulties for dry initial conditions. On the other hand, variable switching can overcome most of the stated numerical problems. The paper deals with variable switching for finite elements in two and three dimensions. The technique is incorporated in both an adaptive error-controlled predictor-corrector one-step Newton (PCOSN) iteration strategy and a target-based full Newton (TBFN) iteration scheme. Both schemes provide different behaviors with respect to accuracy and solution effort. Additionally, a simplified upstream weighting technique is used. Compared with conventional approaches the primary variable switching technique represents a fast and robust strategy for unsaturated problems with dry initial conditions. The impact of the primary variable switching technique is studied over a wide range of mostly 2D and partly difficult-to-solve problems (infiltration, drainage, perched water table, capillary barrier), where comparable results are available. It is shown that the TBFN iteration is an effective but error-prone procedure. TBFN sacrifices temporal accuracy in favor of accelerated convergence if aggressive time step sizes are chosen.

Investigation of the Impact of User Gaming in the Next Generation National Airspace System

NASA Technical Reports Server (NTRS)

Hunter, George C.; Gao, Huina

2011-01-01

Over the past three decades, growth in the demand for air transportation has exceeded the growth in the national airspace system (NAS) capacity. Systems operating near capacity inevitably have delays and NAS d elays have increased in recent years. The desire to minimize delay costs has placed attention on the NAS air traffic management (ATM) syste m.One initiative that has helped to provide user representation in the ATM solution is the collaborative decision making (CDM) process. CDM addresses this issue by bringing users (referred to here as airline operation centers [AOCs]) and ATM providers together for information e xchange and cooperative planning. Such cooperative planning has been instituted, for instance, for the purpose of planning airport slot control strategies and rerouting strategies. While the CDM initiatives ha ve met with much success, they have also introduced the potential for AOCs to manipulate the system in unforeseen, unintended, and perhaps undesirable ways, from a system-wide, synoptic perspective. This type of manipulation is sometimes referred to as "gaming" the system. This study uses a high-fidelity simulation tool to investigate several models of user decision making behavior which could be considered to be gaming behavior and the emergent system dynamics and interactions between AOCs and traffic management.

Implementation of E-Government in Mexico: The Case of Infonavit

NASA Astrophysics Data System (ADS)

Herrera, Lizbeth; Gil-Garcia, J. Ramon

The implementation of information and communication technologies (ICTs) in the public sector is a strategy for administrative reform that has grown in ­importance in recent years. The use of ICT in government can help to improve the ­efficiency, quality, and transparency of public services and reduce the operating costs of bureaucracy. ICTs have also opened a new communication channel for government to provide public services to citizens without intermediaries. However, the ­implementation of an ICT initiative is not a simple process. Organizations ­frequently invest a great amount of resources into ICT initiatives, but the results they obtain often do not meet expectations. This observation is particularly true in some developing countries. Based on a case study of a Mexican federal agency, this ­chapter analyzes a successful strategy involving three ICT projects, taking into consideration institutional, organizational, and managerial aspects. Overall, the results of this study show that having a strategic plan that aligns the ICT project objectives with the overarching organizational goals leads to successful implementation because the technical, organizational, and institutional resources are ­managed in an integrated fashion. The chapter also reports on specific factors that had an impact on the characteristics and success of the three ICT projects.

Skipping Strategy (SS) for Initial Population of Job-Shop Scheduling Problem

NASA Astrophysics Data System (ADS)

Abdolrazzagh-Nezhad, M.; Nababan, E. B.; Sarim, H. M.

2018-03-01

Initial population in job-shop scheduling problem (JSSP) is an essential step to obtain near optimal solution. Techniques used to solve JSSP are computationally demanding. Skipping strategy (SS) is employed to acquire initial population after sequence of job on machine and sequence of operations (expressed in Plates-jobs and mPlates-jobs) are determined. The proposed technique is applied to benchmark datasets and the results are compared to that of other initialization techniques. It is shown that the initial population obtained from the SS approach could generate optimal solution.

"Initiate-build-operate-transfer" - a strategy for establishing sustainable telemedicine programs not only in the developing countries.

PubMed

Latifi, Rifat

2011-01-01

Establishing sustainable telemedicine has become a goal of many developing countries around the world. Yet, despite initiatives from a select few individuals and on occasion from various governments, often these initiatives never mature to become sustainable programs. The introduction of telemedicine and e-learning in the Balkans has been a pivotal step in advancing the quality and availability of medical services in a region whose infrastructure and resources have been decimated by wars, neglect, lack of funding, and poor management. The concept and establishment of the International Virtual e-Hospital (IVeH) has significantly impacted telemedicine and e-health services in Kosova. The success of the IVeH in Kosova has led to the development of similar programs in other Balkan countries and other developing countries in the hope of modernizing and improving their healthcare infrastructure. A comprehensive, four-pronged strategy developed by IVeH "Initiate-Build-Operate-Transfer" (IBOT), may be a useful approach in establishing telemedicine and e-health educational services not only in developing countries, but in developed countries. The development strategy, IBOT, used by the IVeH to establish and develop telemedicine programs is described. IBOT includes assessment of healthcare needs of each country, the development of a curriculum and education program, the establishment of a nationwide telemedicine network, and the integration of the telemedicine program into the very core of healthcare infrastructure. The end point is the transfer of a sustainable telehealth program to the nation involved. By applying IBOT, a sustainable telemedicine program of Kosova and Albania has been established as an effective prototype for telemedicine in the Balkans. Once fully matured, the program is transitioned to the Ministry of Health, which ensures the sustainability and ownership of the program. Similar programs are being established in Macedonia, Montenegro and other countries around the world. The IBOT model has been effective in creating sustainable telemedicine and e-health integrated programs in the Balkans and may be a good model for establishing such programs in developing countries.

Healthy Weight: Community Outreach Initiative. Strategy Development Workshop Report (Bethesda, Maryland, February 17-18, 2004)

ERIC Educational Resources Information Center

National Heart, Lung, and Blood Institute, 2005

2005-01-01

The National Heart, Lung, and Blood Institute (NHLBI) Obesity Education Initiative (OEI) convened a two-day meeting to help develop a national public education outreach initiative to help reduce and prevent overweight and obesity in the United States. This Strategy Development Workshop, held on February 17-18, 2004, convened more that 70 public…

The Wisconsin Early Childhood Obesity Prevention Initiative: An Example of Statewide Collective Impact.

PubMed

Meinen, Amy; Hilgendorf, Amy; Korth, Amy L; Christens, Brian D; Breuer, Catherine; Joyner, Hilary; Polzin, Molle; Adams, Alexandra; Wolfe, Daithi; Braun, Abbe; Hoiting, Jill; Paulson, Jeanette; Cullen, Bridget; Stader, Kelli

2016-11-01

The Wisconsin Early Childhood Obesity Prevention Initiative (Initiative), established in 2007, seeks to address and prevent obesity in the early care and education system through nutrition and physical activity environmental and policy changes. The collaborative includes professionals from 3 state of Wisconsin Departments, the University of Wisconsin-Extension, the University of Wisconsin-Madison, and public health and early care and education organizations. This paper explores the efforts of the Initiative to advance our understanding of collective impact in practice and its value to health promotion efforts. Evaluators conducted a mixed methods case study to evaluate the application of collective impact principles by the Initiative. This included a survey of Initiative partners, review of archival documents, and qualitative interviews with Initiative leaders. Initiative partners noted progress in establishing the conditions for collective impact. Archival documents and interviews describe both formal and informal practices that helped set a common agenda, align and coordinate partner activities, and promote communication among Initiative leaders. Results also detail the important current and potential roles of “backbone” staff from healthTIDE to support the Initiative. Additionally, results suggest particularly challenging aspects of the Initiative’s impact model related to shared measurement and broader stakeholder communication. While the Initiative is still setting in place the conditions for collective impact, it has achieved significant policy, systems, and environment changes since its formation. Inclusion of nutrition and physical activity criteria in the state’s quality rating improvement system for child care centers is one of its outcomes. This case study offers several important insights about the application of collective impact in health promotion efforts, particularly in relation to the transition from previous collaborative activities, the value of establishing a clear common agenda among partners, the roles of backbone staff, and time and partner relationships in collective impact.

On the Path to SunShot - Utility Regulatory Business Model Reforms forAddressing the Financial Impacts of Distributed Solar on Utilities

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

None, None

Net-energy metering (NEM) with volumetric retail electricity pricing has enabled rapid proliferation of distributed photovoltaics (DPV) in the United States. However, this transformation is raising concerns about the potential for higher electricity rates and cost-shifting to non-solar customers, reduced utility shareholder profitability, reduced utility earnings opportunities, and inefficient resource allocation. Although DPV deployment in most utility territories remains too low to produce significant impacts, these concerns have motivated real and proposed reforms to utility regulatory and business models, with profound implications for future DPV deployment. This report explores the challenges and opportunities associated with such reforms in the context ofmore » the U.S. Department of Energy’s SunShot Initiative. As such, the report focuses on a subset of a broader range of reforms underway in the electric utility sector. Drawing on original analysis and existing literature, we analyze the significance of DPV’s financial impacts on utilities and non-solar ratepayers under current NEM rules and rate designs, the projected effects of proposed NEM and rate reforms on DPV deployment, and alternative reforms that could address utility and ratepayer concerns while supporting continued DPV growth. We categorize reforms into one or more of four conceptual strategies. Understanding how specific reforms map onto these general strategies can help decision makers identify and prioritize options for addressing specific DPV concerns that balance stakeholder interests.« less

Simulations of defense strategies for Bennu: Material characterization and impulse delivery

DOE PAGES

Herbold, E. B.; Owen, J. M.; Swift, D. C.; ...

2015-05-19

Assessments of asteroid deflection strategies depend on material characterization to reduce the uncertainty in predictions of the deflection velocity resulting from impulsive loading. In addition to strength, equation of state, the initial state of the material including its competency (i.e. fractured or monolithic) and the amount of micro- or macroscopic porosity are important considerations to predict the thermomechanical response. There is recent interest in observing near-Earth asteroid (101955) Bennu due to its classification of being potentially hazardous with close approaches occurring every 6 years. Bennu is relatively large with a nominal diameter of 492 m, density estimates ranging from 0.9-1.26more » g/cm³ and is composed mainly of carbonaceous chondrite. There is a lack of data for highly porous carbonaceous chondrite at very large pressures and temperatures. In the absence of the specific material composition and state (e.g. layering, porosity as a function of depth) on Bennu we introduce a continuum constitutive model based on the response of granular materials and provide impact and standoff explosion simulations to investigate the response of highly porous materials to these types of impulsive loading scenarios. Simulations with impact speeds of 5 km/s show that the shock wave emanating from the impact site is highly dispersive and that a 10% porous material has a larger compacted volume compared with a 40% porous material with the same bulk density due to differences in compaction response.« less

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

PubMed Central

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

2014-01-01

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

Surviving pregnancy and childbirth is a human right: the silent tragedy of maternal mortality

PubMed Central

Baraté, P.; Temmerman, M.

2010-01-01

More than two decades after the launch of the Safe Motherhood Initiative (Nairobi 1987) , maternal health in many developing countries has shown little or no improvement. Year after year, more than half a million mothers continue to die in silence. The specificities of the complex cross-cutting issue only partly explain why tireless efforts have led to insufficient progress so far. While some success stories prove that results can be obtained quickly, the dissensions and deficiencies the Initiative has encountered have strongly weakened its impact. However, recent developments over the past 3 years allow to foresee the silence will soon be broken. While advocacy begins to subsequently raise awareness, more financial means are mobilized. As a consensus on priority interventions has finally been reached, more coordinated actions and initiatives are being developed. The strive for achieving the Millennium Development Goals helps to create the political momentum strongly needed to generate new leadership, and to develop and implement adequate strategies. Sensible focus on resources and structures as well as innovative management will be crucial in that process. PMID:25206963

Understanding the Potential Impact of a Combination HIV Prevention Intervention in a Hyper-Endemic Community

PubMed Central

Alsallaq, Ramzi A.; Baeten, Jared M.; Celum, Connie L.; Hughes, James P.; Abu-Raddad, Laith J.; Barnabas, Ruanne V.; Hallett, Timothy B.

2013-01-01

Objectives Despite demonstrating only partial efficacy in preventing new infections, available HIV prevention interventions could offer a powerful strategy when combined. In anticipation of combination HIV prevention programs and research studies we estimated the population-level impact of combining effective scalable interventions at high population coverage, determined the factors that influence this impact, and estimated the synergy between the components. Methods We used a mathematical model to investigate the effect on HIV incidence of a combination HIV prevention intervention comprised of high coverage of HIV testing and counselling, risk reduction following HIV diagnosis, male circumcision for HIV-uninfected men, and antiretroviral therapy (ART) for HIV-infected persons. The model was calibrated to data for KwaZulu-Natal, South Africa, where adult HIV prevalence is approximately 23%. Results Compared to current levels of HIV testing, circumcision, and ART, the combined intervention with ART initiation according to current guidelines could reduce HIV incidence by 47%, from 2.3 new infections per 100 person-years (pyar) to 1.2 per 100 pyar within 4 years and by almost 60%, to 1 per 100 pyar, after 25 years. Short-term impact is driven primarily by uptake of testing and reductions in risk behaviour following testing while long-term effects are driven by periodic HIV testing and retention in ART programs. If the combination prevention program incorporated HIV treatment upon diagnosis, incidence could be reduced by 63% after 4 years and by 76% (to about 0.5 per 100 pyar) after 15 years. The full impact of the combination interventions accrues over 10–15 years. Synergy is demonstrated between the intervention components. Conclusion High coverage combination of evidence-based strategies could generate substantial reductions in population HIV incidence in an African generalized HIV epidemic setting. The full impact could be underestimated by the short assessment duration of typical evaluations. PMID:23372738

Impact of Euro-Canadian agrarian practices: in search of sustainable import-substitution strategies to enhance food security in subarctic Ontario, Canada.

PubMed

Spiegelaar, Nicole F; Tsuji, Leonard J S

2013-01-01

In Canada, food insecurity exists among Aboriginal (Inuit, Metis and First Nations) people living in remote northern communities, in part, because of their reliance on the industrialized, import-based food system. Local food production as a substitute to imports would be an adaptive response, but enhancement of food security via food localization requires reflection on previous failings of conventional agricultural strategies so that informed decisions can be made. In light of potential reintroduction of local food production in remote First Nations communities, we investigated the cultural, social and ecological effects of a 20th century, Euro-Canadian agrarian settlement on the food system of a subarctic First Nation; this will act as the first step in developing a more sustainable local food program and enhancing food security in this community. To investigate the socio-cultural impacts of the Euro-Canadian agrarian initiative on the food system of Fort Albany First Nation, purposive, semi-directive interviews were conducted with elders and other knowledgeable community members. Interview data were placed into themes using inductive analyses. To determine the biophysical impact of the agrarian initiative, soil samples were taken from one site within the cultivated area and from one site in an undisturbed forest area. Soil properties associated with agricultural use and productivity were assessed. To compare the means of a given soil property between the sites, one-tailed t-tests were employed. Vegetative analysis was conducted in both sites to assess disturbance. According to the interviewees, prior to the agrarian initiative, First Nation families harvested wild game and fish, and gathered berries as well as other forms of vegetation for sustenance. With the introduction of the residential school and agrarian initiative, traditional food practices were deemed inadequate, families were forced to work and live in the settlement (becoming less reliant on traditional foods), and yet little knowledge sharing of agricultural practices occurred. When the residential school and agrarian movement came to an end in the 1970s, First Nation community members were left to become reliant on an import food system. The mission's agrarian techniques resulted in overall degradation of soil quality and ecological integrity: compared the natural boreal forest, the cultivated area had been colonized by invasive species and had significantly lower soil levels of nitrogen, magnesium and organic carbon, and significantly higher levels of phosphorus and bulk density. Because the agrarian initiative was not a viable long-term approach to food security in Fort Albany, the people became more reliant on imported goods. Taking into account climate change, there exists an opportunity whereby fruits and vegetables, historically stunted-in-growth or outside the distributional range of subarctic Canada, could now grow in the north. Together, agroecosystem stewardship practices and community-based, autonomous food security programs have the potential to increase locally grown food availability in a sustainable manner.

Health impact assessment as an agent of policy change: improving the health impacts of the mayor of London's draft transport strategy.

PubMed

Mindell, J; Sheridan, L; Joffe, M; Samson-Barry, H; Atkinson, S

2004-03-01

To increase the positive and mitigate the negative health impacts of the mayor's draft transport strategy for London. A rapid prospective health impact assessment (HIA) of the penultimate draft of the strategy, using a review commissioned by the regional director of public health; an appraisal of congestion charging; and a participatory workshop. Two audits of changes were performed to assess the impact on policy of the HIA process. Regional government policy development. Recommendations from the rapid HIA were fed back into the drafting process. Changes (a) between the penultimate draft and the draft for public consultation and (b) between that and the final mayoral strategy. The draft transport strategy published for consultation differed in a number of respects from the previous version. Almost all the recommendations from the HIA were incorporated into the final strategy. Significant changes included promoting sustainable travel plans for workplaces and schools; giving priority to infrastructure and services that benefit London's deprived communities; increased emphasis on promoting walking and cycling and reducing reliance on private cars; and a commitment to track the health impacts of the final strategy and its implementation. Specific additions included re-allocating road space. HIA was successful in influencing the transport strategy for London, resulting in several improvements from a health viewpoint. HIA is an effective method both for bringing about significant change in policy proposals and in increasing policy makers' understanding of determinants of health and hence in changing attitudes of policy makers.

International nursing students and what impacts their clinical learning: literature review.

PubMed

Edgecombe, Kay; Jennings, Michele; Bowden, Margaret

2013-02-01

This paper reviews the sparse literature about international nursing students' clinical learning experiences, and also draws on the literature about international higher education students' learning experiences across disciplines as well as nursing students' experiences when undertaking international clinical placements. The paper aims to identify factors that may impact international nursing students' clinical learning with a view to initiating further research into these students' attributes and how to work with these to enhance the students' clinical learning. Issues commonly cited as affecting international students are socialisation, communication, culture, relationships, and unmet expectations and aspirations. International student attributes tend to be included by implication rather than as part of the literature's focus. The review concludes that recognition and valuing of international nursing students' attributes in academic and clinical contexts are needed to facilitate effective strategies to support their clinical practice in new environments. Copyright © 2012. Published by Elsevier Ltd.

Asteroid Impacts and Modern Civilization: Can We Prevent a Catastrophe?

NASA Astrophysics Data System (ADS)

Harris, A. W.; Boslough, M.; Chapman, C. R.; Drube, L.; Michel, P.; Harris, A. W.

We are now approaching the level of technical expertise necessary to deflect a near-Earth asteroid (NEA) capable of destroying a large urban area, if not a small country. The current level of activity in the field, including search programs, physical characterization, and international initiatives to assess mitigation strategies, is unprecedented. However, we have only just started to explore the relevant properties of the small end of the NEA population (diameter <300 m), of which the next major impactor is most likely to be a member. The Chelyabinsk event has reminded us that objects as small as 20 m, about which we know very little, impact frequently and are a serious threat to life and property. Political awareness and international response efforts are still at a very primitive stage. For a global guarantee of protection, advances in scientific and technical competence must be matched by improvements in international coordination, as well as preparedness at the political level.

Goal setting: an integral component of effective diabetes care.

PubMed

Miller, Carla K; Bauman, Jennifer

2014-08-01

Goal setting is a widely used behavior change tool in diabetes education and training. Prior research found specific relatively difficult but attainable goals set within a specific timeframe improved performance in sports and at the workplace. However, the impact of goal setting in diabetes self-care has not received extensive attention. This review examined the mechanisms underlying behavioral change according to goal setting theory and evaluated the impact of goal setting in diabetes intervention studies. Eight studies were identified, which incorporated goal setting as the primary strategy to promote behavioral change in individual, group-based, and primary care settings among patients with type 2 diabetes. Improvements in diabetes-related self-efficacy, dietary intake, physical activity, and A1c were observed in some but not all studies. More systematic research is needed to determine the conditions and behaviors for which goal setting is most effective. Initial recommendations for using goal setting in diabetes patient encounters are offered.

The impact of nurse turnover on patient, nurse, and system outcomes: a pilot study and focus for a multicenter international study.

PubMed

O'Brien-Pallas, Linda; Griffin, Pat; Shamian, Judith; Buchan, James; Duffield, Christine; Hughes, Frances; Spence Laschinger, Heather K; North, Nicola; Stone, Patricia W

2006-08-01

Research about the economic impact of nurse turnover has been compromised by a lack of consistent definitions and measurement. This article describes a study that was designed to refine a methodology to examine the costs associated with nurse turnover. Nursing unit managers responded to a survey that contained items relating to budgeted full-time equivalents, new hires, and turnover, as well as direct and indirect costs. The highest mean direct cost was incurred through temporary replacements, whereas the highest indirect cost was decreased initial productivity of the new hire. The study allowed the identification of the availability of data and where further refinement of data definition of variables is needed. The results provided significant evidence to justify increased emphasis on nurse retention strategies and the creation of healthy work environments for nurses.

Initial evaluation of a student-run fruit and vegetable business in urban high schools.

PubMed

Sikic, Nicholas I; Erbstein, Nancy; Welch, Kearnan; Grundberg, Ethan; Miller, Elizabeth

2012-11-01

This study examined the acceptability and feasibility of Fresh Producers, a student-run fruit and vegetable distribution program at three urban high schools located in low-income neighborhoods, and its potential impact on the nutrition and professional development of participating students. Thirteen focus groups conducted with 72 students explored the program's impact on their dietary habits and professional skill development, and discussed program challenges. Responses were coded for common themes by multiple investigators. Participants reported increased fruit and vegetable consumption, and improved interpersonal, team-building, and organizational skills. Challenges included integration into the school schedule and environment and limited faculty support for business activities. This program is acceptable and feasible for secondary school students in a variety of school settings. Students reported positive changes in professional skills and nutrition. Training and support for students and faculty, including strategies to improve program integration into the school context, could increase participation.

Eosinophilic esophagitis: dilate or medicate? A cost analysis model of the choice of initial therapy.

PubMed

Kavitt, R T; Penson, D F; Vaezi, M F

2014-07-01

Eosinophilic esophagitis (EoE) is an increasingly recognized clinical entity. The optimal initial treatment strategy in adults with EoE remains controversial. The aim of this study was to employ a decision analysis model to determine the less costly option between the two most commonly employed treatment strategies in EoE. We constructed a model for an index case of a patient with biopsy-proven EoE who continues to be symptomatic despite proton-pump inhibitor therapy. The following treatment strategies were included: (i) swallowed fluticasone inhaler (followed by esophagogastroduodenoscopy [EGD] with dilation if ineffective); and (ii) EGD with dilation (followed by swallowed fluticasone inhaler if ineffective). The time horizon was 1 year. The model focused on cost analysis of initial treatment strategies. The perspective of the healthcare payer was used. Sensitivity analyses were performed to assess the robustness of the model. For every patient whose symptoms improved or resolved with the strategy of fluticasone first followed by EGD, if necessary, it cost an average of $1078. Similarly, it cost an average of $1171 per patient if EGD with dilation was employed first. Sensitivity analyses indicated that initial treatment with fluticasone was the less costly strategy to improve dysphagia symptoms as long as the effectiveness of fluticasone remains at or above 0.62. Swallowed fluticasone inhaler (followed by EGD with dilation if necessary) is the more economical initial strategy when compared with EGD with dilation first. © 2012 Copyright the Authors. Journal compilation © 2012, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

The Cost-effectiveness and Budget Impact of 2-Drug Dolutegravir-Lamivudine Regimens for the Treatment of HIV Infection in the United States

PubMed Central

Girouard, Michael P.; Sax, Paul E.; Parker, Robert A.; Taiwo, Babafemi; Freedberg, Kenneth A.; Gulick, Roy M.; Weinstein, Milton C.; Paltiel, A. David; Walensky, Rochelle P.

2016-01-01

Background. Recommended human immunodeficiency virus (HIV) treatment regimens in the United States contain 3 antiretroviral agents, costing >$30 000/person/year. Pilot studies are evaluating the efficacy of dual therapy with dolutegravir (DTG) and lamivudine (3TC). We examined the potential cost-effectiveness and budget impact of DTG + 3TC regimens in the United States. Methods. Using a mathematical model, we projected the clinical and economic outcomes of antiretroviral therapy (ART)–naive patients under 4 strategies: (1) no ART (for modeling comparison); (2) 2-drug: initial regimen of DTG + 3TC; (3) induction-maintenance: 48-week induction regimen of 3 drugs (DTG/abacavir [ABC]/3TC), followed by DTG + 3TC maintenance if virologically suppressed; and (4) standard of care: 3-drug regimen of DTG/ABC/3TC. Strategy-dependent model inputs, varied widely in sensitivity analyses, included 48-week virologic suppression (88%–93%), subsequent virologic failure (0.1%–0.6%/month), and Medicaid-discounted ART costs ($15 200–$39 600/year). A strategy was considered cost-effective if its incremental cost-effectiveness ratio (ICER) was <$100 000/quality-adjusted life-year (QALY). Results. The 3 ART strategies had the same 5-year survival rates (90%). The ICER was $22 500/QALY for induction-maintenance and >$500 000/QALY for standard of care. Two-drug was the preferred strategy only when DTG + 3TC 48-week virologic suppression rate exceeded 90%. With 50% uptake of either induction-maintenance or 2-drug for ART-naive patients, cost savings totaled $550 million and $800 million, respectively, within 5 years; savings reached >$3 billion if 25% of currently suppressed patients were switched to DTG + 3TC maintenance. Conclusions. Should DTG + 3TC demonstrate high rates of virologic suppression, this regimen will be cost-effective and would save >$500 million in ART costs in the United States over 5 years. PMID:26658053

Identifying Effective Strategies for Climate Change Education: The Coastal Areas Climate Change Education (CACCE) Partnership Audiences and Activities

NASA Astrophysics Data System (ADS)

Ryan, J. G.; Feldman, A.; Muller-Karger, F. E.; Gilbes, F.; Stone, D.; Plank, L.; Reynolds, C. J.

2011-12-01

Many past educational initiatives focused on global climate change have foundered on public skepticism and disbelief. Some key reasons for these past failures can be drawn directly from recognized best practices in STEM education - specifically, the necessity to help learners connect new knowledge with their own experiences and perspectives, and the need to create linkages with issues or concerns that are both important for and relevant to the audiences to be educated. The Coastal Areas Climate Change Education (CACCE) partnership has sought to follow these tenets as guiding principles in identifying critical audiences and developing new strategies for educating the public living in the low-lying coastal areas of Florida and the Caribbean on the realities, risks, and adaptation and mitigation strategies for dealing with the regional impacts of global climate change. CACCE is currently focused on three key learner audiences: a) The formal education spectrum, targeting K-12 curricula through middle school marine science courses, and student and educator audiences through coursework and participatory research strategies engaging participants in a range of climate-related investigations. b) Informal science educators and outlets, in particular aquaria and nature centers, as an avenue toward K-12 teacher professional development as well as for public education. c) Regional planning, regulatory and business professionals focused on the built environment along the coasts, many of whom require continuing education to maintain licensing and/or other professional certifications. Our current activities are focused on bringing together an effective set of educational, public- and private-sector partners to target the varied needs of these audiences in Florida and the U.S. Caribbean, and tailoring an educational plan aimed at these stakeholder audiences that starts with the regionally and topically relevant impacts of climate change, and strategies for effective adaptation and mitigation.

Supporting local planning and budgeting for maternal, neonatal and child health in the Philippines

PubMed Central

2013-01-01

Background Responsibility for planning and delivery of health services in the Philippines is devolved to the local government level. Given the recognised need to strengthen capacity for local planning and budgeting, we implemented Investment Cases (IC) for Maternal, Neonatal and Child Health (MNCH) in three selected sub-national units: two poor, rural provinces and one highly-urbanised city. The IC combines structured problem-solving by local policymakers and planners to identify key health system constraints and strategies to scale-up critical MNCH interventions with a decision-support model to estimate the cost and impact of different scaling-up scenarios. Methods We outline how the initiative was implemented, the aspects that worked well, and the key limitations identified in the sub-national application of this approach. Results Local officials found the structured analysis of health system constraints helpful to identify problems and select locally appropriate strategies. In particular the process was an improvement on standard approaches that focused only on supply-side issues. However, the lack of data available at the local level is a major impediment to planning. While the majority of the strategies recommended by the IC were incorporated into the 2011 plans and budgets in the three study sites, one key strategy in the participating city was subsequently reversed in 2012. Higher level systemic issues are likely to have influenced use of evidence in plans and budgets and implementation of strategies. Conclusions Efforts should be made to improve locally-representative data through routine information systems for planning and monitoring purposes. Even with sound plans and budgets, evidence is only one factor influencing investments in health. Political considerations at a local level and issues related to decentralisation, influence prioritisation and implementation of plans. In addition to the strengthening of capacity at local level, a parallel process at a higher level of government to relieve fund channelling and coordination issues is critical for any evidence-based planning approach to have a significant impact on health service delivery. PMID:23343218

Physicians' accounts of frontline tensions when implementing pilot projects to improve primary care.

PubMed

Mansfield, Elizabeth; Bhattacharyya, Onil; Christian, Jennifer; Naglie, Gary; Steriopoulos, Vicky; Webster, Fiona

2018-03-19

Purpose Canada's primary care system has been described as "a culture of pilot projects" with little evidence of converting successful initiatives into funded, permanent programs or sharing project outcomes and insights across jurisdictions. Health services pilot projects are advocated as an effective strategy for identifying promising models of care and building integrated care partnerships in local settings. In the qualitative study reported here, the purpose of this paper is to investigate the strengths and challenges of this approach. Design/methodology/approach Semi-structured interviews were conducted with 34 primary care physicians who discussed their experiences as pilot project leads. Following thematic analysis methods, broad system issues were captured as well as individual project information. Findings While participants often portrayed themselves as advocates for vulnerable patients, mobilizing healthcare organizations and providers to support new models of care was discussed as challenging. Competition between local healthcare providers and initiatives could impact pilot project success. Participants also reported tensions between their clinical, project management and research roles with additional time demands and skill requirements interfering with the work of implementing and evaluating service innovations. Originality/value Study findings highlight the complexity of pilot project implementation, which encompasses physician commitment to addressing care for vulnerable populations through to the need for additional skill set requirements and the impact of local project environments. The current pilot project approach could be strengthened by including more multidisciplinary collaboration and providing infrastructure supports to enhance the design, implementation and evaluation of health services improvement initiatives.

Targeting practitioners: A review of guidelines, training, and policy in pain management

PubMed Central

Barth, Kelly S.; Guille, Constance; McCauley, Jenna; Brady, Kathleen T.

2017-01-01

This paper reviews the current literature on clinical guidelines, practitioner training, and government/payer policies that have come forth in response to the national rise in prescription opioid overdoses. A review of clinical opioid prescribing guidelines highlights the need for more research on safe and effective treatment options for chronic pain, improved guidance for the best management of post-operative pain, and evaluation of the implementation and impact of guideline recommendations on patient risk and outcomes. Although there is increasing attention to training in pain management in medical schools and medical residency programs, educational opportunities remain highly variable, and the need for additional clinician training in the recognition and treatment of pain as well as opioid use disorder has been recognized. Mandated use of private, federal and state educational and clinical initiatives such as Risk Evaluation and Mitigation Strategies (REMS) and Prescription Drug Monitoring Programs (PDMPs) generally increase utilization of these initiatives, but more research is needed to determine the impact of these initiatives on provider behaviors, treatment access, and patient outcomes. Finally, there is an acute need for more research on safe and effective treatments for chronic pain as well as an increased multi-level focus on improving training and access to evidence-based treatment for opioid use disorder as well as non-pharmacologic and non-interventional chronic pain treatments, so that these guideline-recommended interventions can become mainstream, accessible, first-line interventions for chronic pain and/or opioid use disorders. PMID:28363316

Global health impacts of policies: lessons from the UK

PubMed Central

2014-01-01

Background The UK government committed to undertaking impact assessments of its policies on the health of populations in low and middle-income countries in its cross-government strategy “Health is Global”. To facilitate this process, the Department of Health, in collaboration with the National Heart Forum, initiated a project to pilot the use of a global health impact assessment guidance framework and toolkit for policy-makers. This paper aims to stimulate debate about the desirability and feasibility of global health impact assessments by describing and drawing lessons from the first stage of the project. Discussion Despite the attraction of being able to assess and address potential global health impacts of policies, there is a dearth of existing information and experience. A literature review was followed by discussions with policy-makers and an online survey about potential barriers, preferred support mechanisms and potential policies on which to pilot the toolkit. Although policy-makers were willing to engage in hypothetical discussions about the methodology, difficulties in identifying potential pilots suggest a wider problem in encouraging take up without legislative imperatives. This is reinforced by the findings of the survey that barriers to uptake included lack of time, resources and expertise. We identified three lessons for future efforts to mainstream global health impact assessments: 1) Identify a lead government department and champion – to some extent, this role was fulfilled by the Department of Health, however, it lacked a high-level cross-government mechanism to support implementation. 2) Ensure adequate resources and consider embedding the goals and principles of global health impact assessments into existing processes to maximise those resources. 3) Develop an effective delivery mechanism involving both state actors, and non-state actors who can ensure a “voice” for constituencies who are affected by government policies and also provide the “demand” for the assessments. Summary This paper uses the initial stages of a study on global health impact assessments to pose the wider question of incentives for policy-makers to improve global health. It highlights three lessons for successful development and implementation of global health impact assessments in relation to stewardship, resources, and delivery mechanisms. PMID:24612523

Global health impacts of policies: lessons from the UK.

PubMed

Mwatsama, Modi K; Wong, Sidney; Ettehad, Dena; Watt, Nicola F

2014-03-10

The UK government committed to undertaking impact assessments of its policies on the health of populations in low and middle-income countries in its cross-government strategy "Health is Global". To facilitate this process, the Department of Health, in collaboration with the National Heart Forum, initiated a project to pilot the use of a global health impact assessment guidance framework and toolkit for policy-makers. This paper aims to stimulate debate about the desirability and feasibility of global health impact assessments by describing and drawing lessons from the first stage of the project. Despite the attraction of being able to assess and address potential global health impacts of policies, there is a dearth of existing information and experience. A literature review was followed by discussions with policy-makers and an online survey about potential barriers, preferred support mechanisms and potential policies on which to pilot the toolkit. Although policy-makers were willing to engage in hypothetical discussions about the methodology, difficulties in identifying potential pilots suggest a wider problem in encouraging take up without legislative imperatives. This is reinforced by the findings of the survey that barriers to uptake included lack of time, resources and expertise. We identified three lessons for future efforts to mainstream global health impact assessments: 1) Identify a lead government department and champion--to some extent, this role was fulfilled by the Department of Health, however, it lacked a high-level cross-government mechanism to support implementation. 2) Ensure adequate resources and consider embedding the goals and principles of global health impact assessments into existing processes to maximise those resources. 3) Develop an effective delivery mechanism involving both state actors, and non-state actors who can ensure a "voice" for constituencies who are affected by government policies and also provide the "demand" for the assessments. This paper uses the initial stages of a study on global health impact assessments to pose the wider question of incentives for policy-makers to improve global health. It highlights three lessons for successful development and implementation of global health impact assessments in relation to stewardship, resources, and delivery mechanisms.