Ethics in Evaluating a Sociotechnical Intervention With Socially Isolated Older Adults.

PubMed

Waycott, Jenny; Morgans, Amee; Pedell, Sonja; Ozanne, Elizabeth; Vetere, Frank; Kulik, Lars; Davis, Hilary

2015-11-01

The purpose of this article is to consider how ethical principles can inform the effective design and implementation of technology-based interventions that aim to promote the well-being of socially isolated older adults. We evaluated a new iPad application with small groups of older adults. In this article, we reflect on the ethical issues encountered at each stage of the research process. Drawing on the ethical principles of beneficence, research merit and integrity, justice, and respect, we identify key issues to consider in the future design and implementation of social isolation interventions that use new technologies. Key issues include (a) providing sufficient support to facilitate ongoing social interactions, (b) managing older adults' expectations, (c) providing encouragement without coercion, and (d) responding to individual needs. We conclude that it is important to report on ethical challenges incurred when evaluating social isolation interventions to inform future research in this important area. © The Author(s) 2015.

A strategy for the implementation of a quality indicator system in German primary care.

PubMed

van den Heuvel, Henricus

2011-01-01

The Quality and Outcomes Framework (QOF) has had a major impact on the quality of care in British general practice. It is seen as a major innovation amongst quality indicator systems and as a result various countries are looking at whether such initiatives could be used in their primary care. In Germany also the development of similar schemes has started. To propose a strategy indicating key issues for the implementation of a quality indicator scheme in German primary care. Literature review with a focus on the QOF and German quality indicator literature. There are major differences between the German and British healthcare and primary care systems. The development of quality indicator systems for German general practice is in progress and there is a net force for the implementation of such systems. The following ten key factors are suggested for the successful implementation of such a system in German primary care: involvement of general practitioners (GPs) at all levels of the development, a clear implementation process, investment in practice information technology (IT) systems, an accepted quality indicator set, a quality indicator setting institution and data collection organisation, clear financial and non-financial incentives, a 'practice registration' structure, an exception reporting mechanism, delegation of routine clinical data collection tasks to practice assistants, a stepped implementation approach and adequate evaluation processes. For the successful implementation of a quality indicator system in German primary care a number of key issues, as presented in this article, need to be taken into account.

Curriculum Leadership: Development and Implementation

ERIC Educational Resources Information Center

Glatthorn, Allan A.; Boschee, Floyd; Whitehead, Bruce M.

2005-01-01

This book is a resource written for educational leaders who want to successfully restructure and enhance curriculum in schools today. It provides innovative and successful curriculum ideas, including reflective case studies, "Keys to Leadership" sections, curriculum tips, and "Challenge" sections with key issues and questions in every chapter.…

The Student Issue. Original Articles by Student Gammans.

ERIC Educational Resources Information Center

Neill, Kweethai C., Ed.

1997-01-01

This issue contains eight articles on health education by student members of Eta Sigma Gamma, the National Professional Health Education Honorary. The papers are: (1) "Community Involvement: The Key to Successful Implementation of Comprehensive School Health Education" (Crystal L. Bieterman); (2) "HIV Infection and the Hispanic…

Designing and implementing a balanced scorecard: lessons learned in nonprofit implementation.

PubMed

Gumbus, Andra; Wilson, Tom

2004-01-01

The balanced scorecard has been referred to as the management innovation of the century, and extensive articles have been written using case studies of organizations that use this performance measurement system. This article addresses the key issues of design and implementation with a step-by-step guide to how to design a balanced scorecard and lessons to avoid implementation problems in government and nonprofit settings.

Faculty Perspectives on Programme Curricular Assessment: Individual and Institutional Characteristics That Influence Participation Engagement

ERIC Educational Resources Information Center

Emil, Serap; Cress, Christine

2014-01-01

Driven by issues of accountability, the assessment movement in higher education has gained significant momentum in recent years. However, successful implementation of assessment processes varies radically across institutions. A key issue is faculty engagement. This qualitative inquiry explored factors that impact faculty participation in a…

Observing Teaching. SEDA Paper 79.

ERIC Educational Resources Information Center

Brown, Sally, Ed.; And Others

This publication offers practical support to those in British higher education implementing the Observation of Teaching governmental directives. It provides discussion of key issues as well as a range of materials on how to carry out teaching observation including 23 checklists. The materials are grouped in four main areas: general issues, self…

Issues in Developing the IFSP: A Framework for Establishing Family Outcomes.

ERIC Educational Resources Information Center

Beckman, Paula J.; Bristol, Marie M.

1991-01-01

This paper identifies four key issues in the implementation of Individualized Family Service Plans (IFSPs) to provide services to young handicapped children as required by Public Law 99-457. These include sensitivity to cultural diversity, family assessment, intrusiveness, and establishing family outcomes. A typology of family outcomes which…

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

Not Available

This report contains papers on the following topics: NREN Security Issues: Policies and Technologies; Layer Wars: Protect the Internet with Network Layer Security; Electronic Commission Management; Workflow 2000 - Electronic Document Authorization in Practice; Security Issues of a UNIX PEM Implementation; Implementing Privacy Enhanced Mail on VMS; Distributed Public Key Certificate Management; Protecting the Integrity of Privacy-enhanced Electronic Mail; Practical Authorization in Large Heterogeneous Distributed Systems; Security Issues in the Truffles File System; Issues surrounding the use of Cryptographic Algorithms and Smart Card Applications; Smart Card Augmentation of Kerberos; and An Overview of the Advanced Smart Card Access Control System.more » Selected papers were processed separately for inclusion in the Energy Science and Technology Database.« less

Newborn Survival Case Study in Rwanda - Bottleneck Analysis and Projections in Key Maternal and Child Mortality Rates Using Lives Saved Tool (LiST).

PubMed

Khurmi, Manpreet Singh; Sayinzoga, Felix; Berhe, Atakilt; Bucyana, Tatien; Mwali, Assumpta Kayinamura; Manzi, Emmanuel; Muthu, Maharajan

2017-01-01

The Newborn Survival Case study in Rwanda provides an analysis of the newborn health and survival situation in the country. It reviews evidence-based interventions and coverage levels already implemented in the country; identifies key issues and bottlenecks in service delivery and uptake of services by community/beneficiaries, and provides key recommendations aimed at faster reduction in newborn mortality rate. This study utilized mixed method research including qualitative and quantitative analyses of various maternal and newborn health programs implemented in the country. This included interviewing key stakeholders at each level, field visits and also interviewing beneficiaries for assessment of uptake of services. Monitoring systems such as Health Management Information Systems (HMIS), maternal and newborn death audits were reviewed and data analyzed to aid these analyses. Policies, protocols, various guidelines and tools for monitoring are already in place however, implementation of these remains a challenge e.g. infection control practices to reduce deaths due to sepsis. Although existing staff are quite knowledgeable and are highly motivated, however, shortage of health personnel especially doctors in an issue. New facilities are being operationalized e.g. at Gisenyi, however, the existing facilities needs expansion. It is essential to implement high impact evidence based interventions but coverage levels need to be significantly high in order to achieve higher reduction in newborn mortality rate. Equity approach should be considered in planning so that the services are better implemented and the poor and needy can get the benefits of public health programs.

Secure Cryptographic Key Management System (CKMS) Considerations for Smart Grid Devices

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

Abercrombie, Robert K; Sheldon, Frederick T; Aldridge, Hal

2011-01-01

In this paper, we examine some unique challenges associated with key management in the Smart Grid and concomitant research initiatives: 1) effectively model security requirements and their implementations, and 2) manage keys and key distribution for very large scale deployments such as Smart Meters over a long period of performance. This will set the stage to: 3) develop innovative, low cost methods to protect keying material, and 4) provide high assurance authentication services. We will present our perspective on key management and will discuss some key issues within the life cycle of a cryptographic key designed to achieve the following:more » 1) control systems designed, installed, operated, and maintained to survive an intentional cyber assault with no loss of critical function, and 2) widespread implementation of methods for secure communication between remote access devices and control centers that are scalable and cost-effective to deploy.« less

Health system strengthening: a qualitative evaluation of implementation experience and lessons learned across five African countries.

PubMed

Rwabukwisi, Felix Cyamatare; Bawah, Ayaga A; Gimbel, Sarah; Phillips, James F; Mutale, Wilbroad; Drobac, Peter

2017-12-21

Achieving the United Nations Sustainable Development Goals in sub-Saharan Africa will require substantial improvements in the coverage and performance of primary health care delivery systems. Projects supported by the Doris Duke Charitable Foundation's (DDCF) African Health Initiative (AHI) created public-private-academic and community partnerships in five African countries to implement and evaluate district-level health system strengthening interventions. In this study, we captured common implementation experiences and lessons learned to understand core elements of successful health systems interventions. We used qualitative data from key informant interviews and annual progress reports from the five Population Health Implementation and Training (PHIT) partnership projects funded through AHI in Ghana, Mozambique, Rwanda, Tanzania, and Zambia. Four major overarching lessons were highlighted. First, variety and inclusiveness of concerned key players (public, academic and private) are necessary to address complex health system issues at all levels. Second, a learning culture that promotes evidence creation and ability to efficiently adapt were key in order to meet changing contextual needs. Third, inclusion of strong implementation science tools and strategies allowed informed and measured learning processes and efficient dissemination of best practices. Fourth, five to seven years was the minimum time frame necessary to effectively implement complex health system strengthening interventions and generate the evidence base needed to advocate for sustainable change for the PHIT partnership projects. The AHI experience has raised remaining, if not overlooked, challenges and potential solutions to address complex health systems strengthening intervention designs and implementation issues, while aiming to measurably accomplish sustainable positive change in dynamic, learning, and varied contexts.

Implementation Issues for Departure Planning Systems

NASA Technical Reports Server (NTRS)

Hansman, R. John; Feron, Eric; Clarke, John-Paul; Odoni, Amedeo

1999-01-01

The objective of the proposed effort is to investigate issues associated with the design and implementation of decision aiding tools to assist in improving the departure process at congested airports. This effort follows a preliminary investigation of potential Departure Planning approaches and strategies, which identified potential benefits in departure efficiency, and also in reducing the environmental impact of aircraft in the departure queue. The preliminary study bas based, in large part, on observations and analysis of departure processes at Boston, Logan airport. The objective of this follow-on effort is to address key implementation issues and to expand the observational base to include airports with different constraints and traffic demand. Specifically, the objectives of this research are to: (1) Expand the observational base to include airports with different underlying operational dynamics. (2) Develop prototype decision aiding algorithms/approaches and assess potential benefits. and (3) Investigate Human Machine Integration (HMI) issues associated with decision aids in tower environments.

What does it mean to "employ" the RE-AIM model?

PubMed

Kessler, Rodger S; Purcell, E Peyton; Glasgow, Russell E; Klesges, Lisa M; Benkeser, Rachel M; Peek, C J

2013-03-01

Many grant proposals identify the use of a given evaluation model or framework but offer little about how such models are implemented. The authors discuss what it means to employ a specific model, RE-AIM, and key dimensions from this model for program planning, implementation, evaluation, and reporting. The authors report both conceptual and content specifications for the use of the RE-AIM model and a content review of 42 recent dissemination and implementation grant applications to National Institutes of Health that proposed the use of this model. Outcomes include the extent to which proposals addressed the overall RE-AIM model and specific items within the five dimensions in their methods or evaluation plans. The majority of grants used only some elements of the model (less than 10% contained thorough measures across all RE-AIM dimensions). Few met criteria for "fully developed use" of RE-AIM and the percentage of key issues addressed varied from, on average, 45% to 78% across the RE-AIM dimensions. The results and discussion of key criteria should help investigators in their use of RE-AIM and illuminate the broader issue of comprehensive use of evaluation models.

Employer Supported Child Care: An Idea Whose Time Has Come. A Conference on Child Care as an Employee Benefit (Costs and Benefits, Successful Programs, Company Options, Current Issues). Conference Proceedings.

ERIC Educational Resources Information Center

Haiman, Peter, Ed.; Sud, Gian, Ed.

Many aspects of employer-sponsored child care programs--including key issues, costs and benefits, programmatic options, and implementation strategies--are discussed in these conference proceedings. Public policy issues, legal aspects of child care as an employee benefit, tax incentives for corporate child care, and funding sources for child care…

Clinical Implementation of Pharmacogenomics for Personalized Precision Medicine: Barriers and Solutions.

PubMed

Klein, Michelle E; Parvez, Md Masud; Shin, Jae-Gook

2017-09-01

Clinical implementation of pharmacogenomics (PGx) leads to personalized medicine, which improves the efficacy, safety, and cost-effectiveness of treatments. Although PGx-based research has been conducted for more than a decade, several barriers have slowed down its widespread implementation in clinical practice. Globally, there is an imbalance in programs and solutions required to empower the clinical implementation of PGx between countries. Therefore, we aimed to review these issues comprehensively, determine the major barriers, and find the best solutions. Through an extensive review of ongoing clinical implementation programs, scientific, educational, ethical, legal, and social issues, information technology, and reimbursement were identified as the key barriers. The pace of global implementation of genomic medicine coincided with the resource limitations of each country. The key solutions identified for the earlier mentioned barriers are as follows: building of secure and suitable information technology infrastructure with integrated clinical decision support systems along with increasing PGx evidence, more regulations, reimbursement strategies for stakeholder's acceptance, incorporation of PGx education in all institutions and clinics, and PGx promotion to all health care professionals and patients. In conclusion, this review will be helpful for the better understanding of common barriers and solutions pertaining to the clinical application of PGx. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Elementary and Secondary Education: Flexibility Initiatives Do Not Address Districts' Key Concerns about Federal Requirements. Report to Congressional Requesters.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. Health, Education, and Human Services Div.

The Government Accounting Office (GAO) was asked to: (1) describe major federal requirements that affect school districts; (2) identify key issues school districts face in implementing these requirements; and (3) analyze the impact of the Department of Education's flexibility initiatives on school districts' ability to address these implementation…

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

Putting Adaptive Management into Monitoring: Retrospective and Prospective Views of Northwest Forest Plan Monitoring

Treesearch

David E. Busch; Jon R. Martin

2006-01-01

Based on ten years of Northwest Forest Plan implementation, we focus on key scientifically-oriented questions relating to improving Plan monitoring. The questions, which fall into groups concerning issues of scale, integration, and efficiency, have applicability to monitoring programs being designed and implemented throughout the world. Progress toward answering such...

Online and Social Media Suicide Prevention Interventions for Young People: A Focus on Implementation and Moderation

PubMed Central

Rice, Simon; Robinson, Jo; Bendall, Sarah; Hetrick, Sarah; Cox, Georgina; Bailey, Eleanor; Gleeson, John; Alvarez-Jimenez, Mario

2016-01-01

Objective: Suicide remains a major global public health issue for young people. The reach and accessibility of online and social media-based interventions herald a unique opportunity for suicide prevention. To date, the large body of research into suicide prevention has been undertaken atheoretically. This paper provides a rationale and theoretical framework (based on the interpersonal theory of suicide), and draws on our experiences of developing and testing online and social media-based interventions. Method: The implementation of three distinct online and social media-based intervention studies, undertaken with young people at risk of suicide, are discussed. We highlight the ways that these interventions can serve to bolster social connectedness in young people, and outline key aspects of intervention implementation and moderation. Results: Insights regarding the implementation of these studies include careful protocol development mindful of risk and ethical issues, establishment of suitably qualified teams to oversee development and delivery of the intervention, and utilisation of key aspects of human support (i.e., moderation) to encourage longer-term intervention engagement. Conclusions: Online and social media-based interventions provide an opportunity to enhance feelings of connectedness in young people, a key component of the interpersonal theory of suicide. Our experience has shown that such interventions can be feasibly and safely conducted with young people at risk of suicide. Further studies, with controlled designs, are required to demonstrate intervention efficacy. PMID:27274743

Online and Social Media Suicide Prevention Interventions for Young People: A Focus on Implementation and Moderation.

PubMed

Rice, Simon; Robinson, Jo; Bendall, Sarah; Hetrick, Sarah; Cox, Georgina; Bailey, Eleanor; Gleeson, John; Alvarez-Jimenez, Mario

2016-01-01

Suicide remains a major global public health issue for young people. The reach and accessibility of online and social media-based interventions herald a unique opportunity for suicide prevention. To date, the large body of research into suicide prevention has been undertaken atheoretically. This paper provides a rationale and theoretical framework (based on the interpersonal theory of suicide), and draws on our experiences of developing and testing online and social media-based interventions. The implementation of three distinct online and social media-based intervention studies, undertaken with young people at risk of suicide, are discussed. We highlight the ways that these interventions can serve to bolster social connectedness in young people, and outline key aspects of intervention implementation and moderation. Insights regarding the implementation of these studies include careful protocol development mindful of risk and ethical issues, establishment of suitably qualified teams to oversee development and delivery of the intervention, and utilisation of key aspects of human support (i.e., moderation) to encourage longer-term intervention engagement. Online and social media-based interventions provide an opportunity to enhance feelings of connectedness in young people, a key component of the interpersonal theory of suicide. Our experience has shown that such interventions can be feasibly and safely conducted with young people at risk of suicide. Further studies, with controlled designs, are required to demonstrate intervention efficacy.

Introduction to the special issue: toward implementing physiological measures in clinical child and adolescent assessments.

PubMed

De Los Reyes, Andres; Aldao, Amelia

2015-01-01

The National Institute of Mental Health recently launched the Research Domain Criteria (RDoC). The RDoC is an initiative to improve classification of mental health concerns by promoting research on the brain mechanisms underlying these concerns, with the ultimate goal of developing interventions that target these brain mechanisms. A key focus of RDoC involves opening new lines of research examining patients' responses on biological measures. The RDoC presents unique challenges to mental health professionals who work with children and adolescents. Indeed, mental health professionals rarely integrate biological measures into clinical assessments. Thus, RDoC's ability to improve patient care rests, in part, on the development of strategies for implementing biological measures within mental health assessments. Further, mental health professionals already carry out comprehensive assessments that frequently yield inconsistent findings. These inconsistencies have historically posed challenges to interpreting research findings as well as assessment outcomes in practice settings. In this introductory article, we review key issues that informed the development of a special issue of articles demonstrating methods for implementing low-cost measures of physiological functioning in clinical child and adolescent assessments. We also outline a conceptual framework, informed by theoretical work on using and interpreting multiple informants' clinical reports (De Los Reyes, Thomas, Goodman, & Kundey, 2013 ), to guide hypothesis testing when using physiological measures within clinical child and adolescent assessments. This special issue and the conceptual model described in this article may open up new lines of research testing paradigms for implementing clinically feasible physiological measures in clinical child and adolescent assessments.

Key issues in the quality assurance of the One Number Census.

PubMed

Diamond, Ian; Abbott, Owen; Jackson, Neil

2003-01-01

As part of the 2001 Census, the One Number Census project estimated and adjusted the Census database for underenumeration. As a result of the highly innovative One Number Census and the Quality Assurance process it encompassed, it was also ensured that robust results could be obtained for each local authority area. This article examines some of the issues and analyses that were undertaken as part of that assessment of the 2001 Census population counts for England and Wales. The article firstly highlights the key issues surrounding the implementation of the 2001 Census fieldwork. The article then explores the 2001 Census results through a series of demographic analyses to illustrate the sorts of issues investigated during the One Number Census Quality Assurance process itself. These analyses look at the patterns contained within the results, and comparisons with key alternative sources of population counts. Overall, these in-depth analyses and investigations provide further credence to the plausibility of the One Number Census results.

Economic Incentives: Options for Environmental Protection (1991)

EPA Pesticide Factsheets

Report of EPA Economic Incentives Task Force which develops and evaluates a broad array of economic incentive proposals. Although it does not endorse any particular proposal, it examines some of the key design and implementation issues.

Students' Socioscientific Reasoning and Decision-Making on Energy-Related Issues--Development of a Measurement Instrument

ERIC Educational Resources Information Center

Sakschewski, Mark; Eggert, Sabina; Schneider, Susanne; Bögeholz, Susanne

2014-01-01

The concept of energy is one key component of science education curricula worldwide. While it is still being taught in many science classrooms from a mainly conceptual knowledge perspective, the need to frame the concept of energy as a socioscientific issue and implement it in the context of citizenship education and education for sustainable…

How Northwest Region States Are Supporting Schools in Need of Improvement. Issues & Answers. REL 2007-No. 009

ERIC Educational Resources Information Center

Davis, Deborah; Krasnoff, Basha; Moilanen, Carolyn; Sather, Susan; Kushman, James

2007-01-01

This study examines the systems of technical assistance and support that Northwest Region states implemented during 2005-2006 for schools in need of improvement. By highlighting key characteristics and differences among state systems, the intent is to stimulate an analysis of what states can do and what issues they might address to move schools…

Key issues and challenges in developing a pedagogical intervention in the simulation skills center--an action research study.

PubMed

Reierson, Inger Åse; Hvidsten, Anne; Wighus, Marianne; Brungot, Solvor; Bjørk, Ida Torunn

2013-07-01

Simulation skills centers (SSC) are considered important learning arenas for preparing and qualifying nursing students. Limited clinical placements and claims of diminished learning opportunities raise concerns that newly educated nurses lack proficiency in many psychomotor skills. Accordingly, there is an increased focus on learning in the SSC. However, it has been questioned if the pedagogical underpinning of teaching and learning in the SSC is missing or unclear. At a bachelor nursing education in Norway, there was a desire to change practice and enhance learning in the SSC by systematic use of The Model of Practical Skill Performance (Bjørk and Kirkevold, 2000). A participatory action research design was chosen. A pedagogical intervention was developed and implemented in 2010 in a cohort of eighty-seven first year bachelor nursing students during their basic nursing skill course. The intervention is shortly described. This article reports key issues and challenges that emerged during development of the new intervention. Data to inform the study were collected via thorough meeting minutes and the project leader's logbook, and analyzed using fieldnotes analysis. Six key issues and challenges were identified. These are presented and discussed consecutively in light of their importance for development and implementation of the new intervention. Copyright © 2013 Elsevier Ltd. All rights reserved.

The policy context of patient centered medical homes: perspectives of primary care providers.

PubMed

Alexander, Jeffrey A; Cohen, Genna R; Wise, Christopher G; Green, Lee A

2013-01-01

Interest in the patient centered medical home (PCMH) model has increased significantly in recent years. Despite this attention, information is limited regarding the influence of policy context on implementation of the PCMH model. Using comparative, qualitative data, we identify several key policy impediments to PCMH implementation, and propose practical guidelines for addressing these issues. Qualitative, semi-structured in-person interviews with representatives of physician organizations and primary care practices pursuing PCMH. Practitioners and staff at 16 physician practices in Michigan, as well as key leaders of physician organizations. We identified five primary policy issues cited by physicians and physician organization leaders as most impactful on their efforts to adopt PCMH: misalignment of current reimbursement schemes, administrative burden, conflicting criteria for PCMH designation, workforce policy issues, and uncertainty of health care reform. These policies were largely seen as barriers to their ability to implement PCMH. Providers' motivation to embrace PCMH, and their level of confidence regarding the results of such change, are greatly influenced by their perception of the external environment and the control they believe they have over this environment. Having policies in place that shape the path to PCMH in a manner that makes it as easy as possible for providers to accomplish the desired changes could well make the difference in whether successful transformation is achieved.

A case study detailing key considerations for implementing a telehealth approach to office ergonomics.

PubMed

Ritchie, Catherine L W; Miller, Linda L; Antle, David M

2017-01-01

Telehealth approaches to delivering ergonomics assessment hold great potential to improve service delivery in rural and remote settings. This case study describes a telehealth-based ergonomics service delivery process, and compares in-person and telehealth-based ergonomics approaches at an Alberta-based non-profit advocacy group. This project demonstrates that telehealth approaches to ergonomics do not lead to significantly different scoring outcomes for assessment of ergonomics issues, when compared to in-person assessments. This project also outlines the importance of live real-time video conferencing to improving communication, attaining key assessment information, and demonstrating ergonomic adjustments. However, some key considerations of bandwidth and hardware capabilities need to be taken into account. Key communication strategies are outlined to improve rapport, maintain employee confidentiality, and reduce client anxiety around telehealth ergonomics assessments. This project provides further support for telehealth approaches to office ergonomics, and outlines some key implementation strategies and barriers that should be considered.

Sexuality education in Malaysia: perceived issues and barriers by professionals.

PubMed

Khalaf, Zahra Fazli; Low, Wah Yun; Merghati-Khoei, Effat; Ghorbani, Behzad

2014-07-01

This research explored the perspectives of Malaysian professionals on the issues and barriers affecting the implementation of sexuality education in Malaysia. This qualitative study involved in-depth interviews with 15 key professionals working in the field of sexuality and reproductive health in Malaysia. Thematic analysis was selected to analyze data. Barriers to sexuality education were perceived from 5 aspects: feasibility, acceptability, accountability, strategies, and community unawareness. Respondents believed that implementing national sexuality education is a time-consuming project. They regarded Malaysian multicultural society as a barrier to national sexuality education, and they believed that school-based sexuality education is not easily accomplished in Malaysia; also abstinence-only policy restricts the access of young people to accurate information. Lack of community involvement was perceived as a key concern to sexuality education. Campaigning to promote awareness of families, teachers, community leaders, and policy makers are recommended to help establishing national sexuality education in Malaysia. © 2014 APJPH.

Strategic environmental noise mapping: methodological issues concerning the implementation of the EU Environmental Noise Directive and their policy implications.

PubMed

Murphy, E; King, E A

2010-04-01

This paper explores methodological issues and policy implications concerning the implementation of the EU Environmental Noise Directive (END) across Member States. Methodologically, the paper focuses on two key thematic issues relevant to the Directive: (1) calculation methods and (2) mapping methods. For (1), the paper focuses, in particular, on how differing calculation methods influence noise prediction results as well as the value of the EU noise indicator L(den) and its associated implications for comparability of noise data across EU states. With regard to (2), emphasis is placed on identifying the issues affecting strategic noise mapping, estimating population exposure, noise action planning and dissemination of noise mapping results to the general public. The implication of these issues for future environmental noise policy is also examined. Copyright (c) 2009 Elsevier Ltd. All rights reserved.

A Guide for applying a revised version of the PARIHS framework for implementation

PubMed Central

2011-01-01

Background Based on a critical synthesis of literature on use of the Promoting Action on Research Implementation in Health Services (PARIHS) framework, revisions and a companion Guide were developed by a group of researchers independent of the original PARIHS team. The purpose of the Guide is to enhance and optimize efforts of researchers using PARIHS in implementation trials and evaluations. Methods Authors used a planned, structured process to organize and synthesize critiques, discussions, and potential recommendations for refinements of the PARIHS framework arising from a systematic review. Using a templated form, each author independently recorded key components for each reviewed paper; that is, study definitions, perceived strengths/limitations of PARIHS, other observations regarding key issues and recommendations regarding needed refinements. After reaching consensus on these key components, the authors summarized the information and developed the Guide. Results A number of revisions, perceived as consistent with the PARIHS framework's general nature and intent, are proposed. The related Guide is composed of a set of reference tools, provided in Additional files. Its core content is built upon the basic elements of PARIHS and current implementation science. Conclusions We invite researchers using PARIHS for targeted evidence-based practice (EBP) implementations with a strong task-orientation to use this Guide as a companion and to apply the revised framework prospectively and comprehensively. Researchers also are encouraged to evaluate its use relative to perceived strengths and issues. Such evaluations and critical reflections regarding PARIHS and our Guide could thereby promote the framework's continued evolution. PMID:21878092

Chaos-Based Simultaneous Compression and Encryption for Hadoop.

PubMed

Usama, Muhammad; Zakaria, Nordin

2017-01-01

Data compression and encryption are key components of commonly deployed platforms such as Hadoop. Numerous data compression and encryption tools are presently available on such platforms and the tools are characteristically applied in sequence, i.e., compression followed by encryption or encryption followed by compression. This paper focuses on the open-source Hadoop framework and proposes a data storage method that efficiently couples data compression with encryption. A simultaneous compression and encryption scheme is introduced that addresses an important implementation issue of source coding based on Tent Map and Piece-wise Linear Chaotic Map (PWLM), which is the infinite precision of real numbers that result from their long products. The approach proposed here solves the implementation issue by removing fractional components that are generated by the long products of real numbers. Moreover, it incorporates a stealth key that performs a cyclic shift in PWLM without compromising compression capabilities. In addition, the proposed approach implements a masking pseudorandom keystream that enhances encryption quality. The proposed algorithm demonstrated a congruent fit within the Hadoop framework, providing robust encryption security and compression.

Chaos-Based Simultaneous Compression and Encryption for Hadoop

PubMed Central

Zakaria, Nordin

2017-01-01

Data compression and encryption are key components of commonly deployed platforms such as Hadoop. Numerous data compression and encryption tools are presently available on such platforms and the tools are characteristically applied in sequence, i.e., compression followed by encryption or encryption followed by compression. This paper focuses on the open-source Hadoop framework and proposes a data storage method that efficiently couples data compression with encryption. A simultaneous compression and encryption scheme is introduced that addresses an important implementation issue of source coding based on Tent Map and Piece-wise Linear Chaotic Map (PWLM), which is the infinite precision of real numbers that result from their long products. The approach proposed here solves the implementation issue by removing fractional components that are generated by the long products of real numbers. Moreover, it incorporates a stealth key that performs a cyclic shift in PWLM without compromising compression capabilities. In addition, the proposed approach implements a masking pseudorandom keystream that enhances encryption quality. The proposed algorithm demonstrated a congruent fit within the Hadoop framework, providing robust encryption security and compression. PMID:28072850

Principles to guide sustainable implementation of extended-scope-of-practice physiotherapy workforce redesign initiatives in Australia: stakeholder perspectives, barriers, supports, and incentives

PubMed Central

Morris, Joanne; Grimmer, Karen; Gilmore, Lisa; Perera, Chandima; Waddington, Gordon; Kyle, Greg; Ashman, Bryan; Murphy, Karen

2014-01-01

Sustainable implementation of new workforce redesign initiatives requires strategies that minimize barriers and optimize supports. Such strategies could be provided by a set of guiding principles. A broad understanding of the concerns of all the key stakeholder groups is required before effective strategies and initiatives are developed. Many new workforce redesign initiatives are not underpinned by prior planning, and this threatens their uptake and sustainability. This study reports on a cross-sectional qualitative study that sought the perspectives of representatives of key stakeholders in a new workforce redesign initiative (extended-scope-of-practice physiotherapy) in one Australian tertiary hospital. The key stakeholder groups were those that had been involved in some way in the development, management, training, funding, and/or delivery of the initiative. Data were collected using semistructured questions, answered individually by interview or in writing. Responses were themed collaboratively, using descriptive analysis. Key identified themes comprised: the importance of service marketing; proactively addressing barriers; using readily understood nomenclature; demonstrating service quality and safety, monitoring adverse events, measuring health and cost outcomes; legislative issues; registration; promoting viable career pathways; developing, accrediting, and delivering a curriculum supporting physiotherapists to work outside of the usual scope; and progression from “a good idea” to established service. Health care facilities planning to implement new workforce initiatives that extend scope of usual practice should consider these issues before instigating workforce/model of care changes. PMID:25018637

Principles to guide sustainable implementation of extended-scope-of-practice physiotherapy workforce redesign initiatives in Australia: stakeholder perspectives, barriers, supports, and incentives.

PubMed

Morris, Joanne; Grimmer, Karen; Gilmore, Lisa; Perera, Chandima; Waddington, Gordon; Kyle, Greg; Ashman, Bryan; Murphy, Karen

2014-01-01

Sustainable implementation of new workforce redesign initiatives requires strategies that minimize barriers and optimize supports. Such strategies could be provided by a set of guiding principles. A broad understanding of the concerns of all the key stakeholder groups is required before effective strategies and initiatives are developed. Many new workforce redesign initiatives are not underpinned by prior planning, and this threatens their uptake and sustainability. This study reports on a cross-sectional qualitative study that sought the perspectives of representatives of key stakeholders in a new workforce redesign initiative (extended-scope-of-practice physiotherapy) in one Australian tertiary hospital. The key stakeholder groups were those that had been involved in some way in the development, management, training, funding, and/or delivery of the initiative. Data were collected using semistructured questions, answered individually by interview or in writing. Responses were themed collaboratively, using descriptive analysis. Key identified themes comprised: the importance of service marketing; proactively addressing barriers; using readily understood nomenclature; demonstrating service quality and safety, monitoring adverse events, measuring health and cost outcomes; legislative issues; registration; promoting viable career pathways; developing, accrediting, and delivering a curriculum supporting physiotherapists to work outside of the usual scope; and progression from "a good idea" to established service. Health care facilities planning to implement new workforce initiatives that extend scope of usual practice should consider these issues before instigating workforce/model of care changes.

Legal Challenges and Pitfalls for Start-up Companies - 48 Common Questions and Answers.

PubMed

Staehelin, Matthias

2014-12-01

Transforming a business idea into reality requires a legal implementation plan. The following 48 questions and answers address key issues that typically arise in start-up situations. Early planning can help avoid costly mistakes.

Implementation of Algebra I in Eighth Grade: An "Ex-Post Facto" Study on Student Achievement

ERIC Educational Resources Information Center

Realdine, Dorothy S.

2010-01-01

Only recently have school districts across the nation begun to offer Algebra I to all eighth grade students. Currently, most eighth grade Algebra I curriculum does not have a national consistent focus of topics or level of rigor. A key issue of implementing Algebra I in eighth grade is defining national Algebra I concepts and skills that students…

Dollars and sense: Mitigating budget risk for ICD-10.

PubMed

Newell, Lucy Mancini; DeSilva, Joseph J

2013-02-01

The extended deadline for ICD-10 implementation is time that should not be wasted. Healthcare leaders should keep three things in mind: CFOs should approach the effort knowing the costs of ICD-10 implementation will be high and spread over multiple budget years. Training, productivity, and contractual issues are among key areas that will be challenged by ICD-10 implementation. Healthcare finance leaders should work to improve cash-on-hand and cash reserves prior to the ICD-10 deadline to ensure liquidity post-compliance.

Flood Impact Modelling and Natural Flood Management

NASA Astrophysics Data System (ADS)

Owen, Gareth; Quinn, Paul; ODonnell, Greg

2016-04-01

Local implementation of Natural Flood Management methods are now being proposed in many flood schemes. In principal it offers a cost effective solution to a number of catchment based problem as NFM tackles both flood risk and WFD issues. However within larger catchments there is the issue of which subcatchments to target first and how much NFM to implement. If each catchment has its own configuration of subcatchment and rivers how can the issues of flood synchronisation and strategic investment be addressed? In this study we will show two key aspects to resolving these issues. Firstly, a multi-scale network water level recorder is placed throughout the system to capture the flow concentration and travel time operating in the catchment being studied. The second is a Flood Impact Model (FIM), which is a subcatchment based model that can generate runoff in any location using any hydrological model. The key aspect to the model is that it has a function to represent the impact of NFM in any subcatchment and the ability to route that flood wave to the outfall. This function allows a realistic representation of the synchronisation issues for that catchment. By running the model in interactive mode the user can define an appropriate scheme that minimises or removes the risk of synchornisation and gives confidence that the NFM investment is having a good level of impact downstream in large flood events.

Development and Implementation of Worksite Health and Wellness Programs: A Focus on Non-Communicable Disease.

PubMed

Cahalin, Lawrence P; Kaminsky, Leonard; Lavie, Carl J; Briggs, Paige; Cahalin, Brendan L; Myers, Jonathan; Forman, Daniel E; Patel, Mahesh J; Pinkstaff, Sherry O; Arena, Ross

2015-01-01

The development and implementation of worksite health and wellness programs (WHWPs) in the United States (US) hold promise as a means to improve population health and reverse current trends in non-communicable disease incidence and prevalence. However, WHWPs face organizational, economic, systematic, legal, and logistical challenges which have combined to impact program availability and expansion. Even so, there is a burgeoning body of evidence indicating WHWPs can significantly improve the health profile of participating employees in a cost effective manner. This foundation of scientific knowledge justifies further research inquiry to elucidate optimal WHWP models. It is clear that the development, implementation and operation of WHWPs require a strong commitment from organizational leadership, a pervasive culture of health and availability of necessary resources and infrastructure. Since organizations vary significantly, there is a need to have flexibility in creating a customized, effective health and wellness program. Furthermore, several key legal issues must be addressed to facilitate employer and employee needs and responsibilities; the US Affordable Care Act will play a major role moving forward. The purposes of this review are to: 1) examine currently available health and wellness program models and considerations for the future; 2) highlight key legal issues associated with WHWP development and implementation; and 3) identify challenges and solutions for the development and implementation of as well as adherence to WHWPs. Copyright © 2015 Elsevier Inc. All rights reserved.

Perspectives of key stakeholders and experts in infant feeding on the implementation of the Australian National Breastfeeding Strategy 2010-2015.

PubMed

Hull, Naomi S; Schubert, Lisa C; Smith, Julie P

2017-03-01

Breastfeeding is widely accepted as an important public health issue for babies and their mothers. Yet, despite this, Australia continues to struggle with reaching global targets for breastfeeding indicators. In 2007, the Best Start Parliamentary Inquiry Report was released and set the stage for the Australian National Breastfeeding Strategy [2010-2015), which was announced in November 2009, with the vision to increase Australia's breastfeeding rates of infants at 6 months of age and beyond. The aim of this research project was to explore the perspectives of key stakeholders in the field of infant feeding in Australia on the implementation of the strategy, barriers and enablers to its successful implementation and actions that were still needed. Using qualitative research methods of in-depth, semi-structured interviews and thematic analysis, this study identifies main themes of these perceptions about the strategy implementation and some recommendations for future strategies and further research. The main themes identified were initial opinions of the strategy as a blueprint for action, the strategy as a driver for action, lessons learned and recommendations for the future. For success in improving implementation of national breastfeeding strategies, it is recommended that Australia establish an independent breastfeeding/infant feeding committee, increase the political prioritisation of issues surrounding infant feeding and strengthen the regulation of the marketing of breastmilk substitutes.

Building Better Buildings: Sustainable Building Activities in California Higher Education Systems.

ERIC Educational Resources Information Center

Sowell, Arnold; Eichel, Amanda; Alevantis, Leon; Lovegreen, Maureen

2003-01-01

This article outlines the activities and recommendations of California's sustainable building task force, discusses sustainable building activities in California's higher education systems, and highlights key issues that California is grappling with in its implementation of sustainable building practices. (EV)

Managing Innovation in Academic Libraries.

ERIC Educational Resources Information Center

Drake, Miriam A.

1979-01-01

Explores key issues related to innovation in academic libraries--performance gaps, incentives to innovate, nature of innovation, barriers and constraints, impact of innovation, and implementation of innovative strategies--and concludes that innovation requires a conducive climate, capital investment, and a leadership that is enthusiastic and…

The Practical Implementation of Non-Contacting Laser Strain Measurements Systems

NASA Technical Reports Server (NTRS)

Yunis, Isam; Quinn, roger D.; Kadambi, Jaikrishnan R.

2000-01-01

Measurement of stress and strain in rotating turbomachinery is critical to many industries. The search for a non-contacting, non-interfering, non-degrading measurement system is on going and extensive. While several methods seem promising in theory, implementation has proven troublesome. This work uncovers and quantifies these implementation issues in the context of a laser measurement system. Both a Laser Doppler Velocimeter system and a displacement laser system are utilized. It is found that the key issues are signal to noise ratio, rigid body compensation, measurement location, and conversion of intermittent measurements to a continuous signal. Accounting for these factors leads to successful measurements. These results should lead to better ideas and more practical solutions to the non-contacting, non-degrading, non-interfering strain measurement system problem.

Methods for implementing a medicine outlet survey: lessons from the anti-malarial market.

PubMed

O'Connell, Kathryn A; Poyer, Stephen; Solomon, Tsione; Munroe, Erik; Patouillard, Edith; Njogu, Julius; Evance, Illah; Hanson, Kara; Shewchuk, Tanya; Goodman, Catherine

2013-02-05

In recent years an increasing number of public investments and policy changes have been made to improve the availability, affordability and quality of medicines available to consumers in developing countries, including anti-malarials. It is important to monitor the extent to which these interventions are successful in achieving their aims using quantitative data on the supply side of the market. There are a number of challenges related to studying supply, including outlet sampling, gaining provider cooperation and collecting accurate data on medicines. This paper provides guidance on key steps to address these issues when conducting a medicine outlet survey in a developing country context. While the basic principles of good survey design and implementation are important for all surveys, there are a set of specific issues that should be considered when conducting a medicine outlet survey. This paper draws on the authors' experience of designing and implementing outlet surveys, including the lessons learnt from ACTwatch outlet surveys on anti-malarial retail supply, and other key studies in the field. Key lessons and points of debate are distilled around the following areas: selecting a sample of outlets; techniques for collecting and analysing data on medicine availability, price and sales volumes; and methods for ensuring high quality data in general. The authors first consider the inclusion criteria for outlets, contrasting comprehensive versus more focused approaches. Methods for developing a reliable sampling frame of outlets are then presented, including use of existing lists, key informants and an outlet census. Specific issues in the collection of data on medicine prices and sales volumes are discussed; and approaches for generating comparable price and sales volume data across products using the adult equivalent treatment dose (AETD) are explored. The paper concludes with advice on practical considerations, including questionnaire design, field worker training, and data collection. Survey materials developed by ACTwatch for investigating anti-malarial markets in sub-Saharan Africa and Asia provide a helpful resource for future studies in this area.

Implementing large-scale programmes to optimise the health workforce in low- and middle-income settings: a multicountry case study synthesis.

PubMed

Gopinathan, Unni; Lewin, Simon; Glenton, Claire

2014-12-01

To identify factors affecting the implementation of large-scale programmes to optimise the health workforce in low- and middle-income countries. We conducted a multicountry case study synthesis. Eligible programmes were identified through consultation with experts and using Internet searches. Programmes were selected purposively to match the inclusion criteria. Programme documents were gathered via Google Scholar and PubMed and from key informants. The SURE Framework - a comprehensive list of factors that may influence the implementation of health system interventions - was used to organise the data. Thematic analysis was used to identify the key issues that emerged from the case studies. Programmes from Brazil, Ethiopia, India, Iran, Malawi, Venezuela and Zimbabwe were selected. Key system-level factors affecting the implementation of the programmes were related to health worker training and continuing education, management and programme support structures, the organisation and delivery of services, community participation, and the sociopolitical environment. Existing weaknesses in health systems may undermine the implementation of large-scale programmes to optimise the health workforce. Changes in the roles and responsibilities of cadres may also, in turn, impact the health system throughout. © 2014 John Wiley & Sons Ltd.

Addressing overuse of health services in health systems: a critical interpretive synthesis.

PubMed

Ellen, Moriah E; Wilson, Michael G; Vélez, Marcela; Shach, Ruth; Lavis, John N; Grimshaw, Jeremy M; Moat, Kaelan A

2018-06-15

Health systems are increasingly focusing on the issue of 'overuse' of health services and how to address it. We developed a framework focused on (1) the rationale and context for health systems prioritising addressing overuse, (2) elements of a comprehensive process and approach to reduce overuse and (3) implementation considerations for addressing overuse. We conducted a critical interpretive synthesis informed by a stakeholder-engagement process. The synthesis identified relevant empirical and non-empirical articles about system-level overuse. Two reviewers independently screened records, assessed for inclusion and conceptually mapped included articles. From these, we selected a purposive sample, created structured summaries of key findings and thematically synthesised the results. Our search identified 3545 references, from which we included 251. Most articles (76%; n = 192) were published within 5 years of conducting the review and addressed processes for addressing overuse (63%; n = 158) or political and health system context (60%; n = 151). Besides negative outcomes at the patient, system and global level, there were various contextual factors to addressing service overuse that seem to be key issue drivers. Processes for addressing overuse can be grouped into three elements comprising a comprehensive approach, including (1) approaches to identify overused health services, (2) stakeholder- or patient-led approaches and (3) government-led initiatives. Key implementation considerations include the need to develop 'buy in' from stakeholders and citizens. Health systems want to ensure the use of high-value services to keep citizens healthy and avoid harm. Our synthesis can be used by policy-makers, stakeholders and researchers to understand how the issue has been prioritised, what approaches have been used to address it and implementation considerations. PROSPERO CRD42014013204 .

Exploring the value of mixed methods within the At Home/Chez Soi housing first project: a strategy to evaluate the implementation of a complex population health intervention for people with mental illness who have been homeless.

PubMed

Macnaughton, Eric L; Goering, Paula N; Nelson, Geoffrey B

2012-05-02

This paper is a methodological case study that describes the At Home/Chez Soi (Housing First) Initiative's mixed-methods strategy for implementation evaluation and discusses the value of these methods in evaluating the implementation of such complex population health interventions. The Housing First (HF) model is being implemented in five cities: Vancouver, Winnipeg, Toronto, Montréal and Moncton. At Home/Chez Soi is an intervention trial that aims to address the issue of homelessness in people with mental health issues. The HF model emphasizes choices, hopefulness and connecting people with resources that make a difference to their quality of life. A component of HF is supported housing, which provides a rent subsidy and rapid access to housing of choice in private apartments; a second component is support. Quantitative and qualitative methods were used to evaluate HF implementation. The findings of this case study illustrate how the critical ingredients of complex interventions, such as HF, can be adapted to different contexts while implementation fidelity is maintained at a theoretical level. The findings also illustrate how the project's mixed methods approach helped to facilitate the adaptation process. Another value of this approach is that it identifies systemic and organizational factors (e.g., housing supply, discrimination, housing procurement strategy) that affect implementation of key elements of HF. In general, the approach provides information about both whether and how key aspects of the intervention are implemented effectively across different settings. It thus provides implementation data that are rigorous, contextually relevant and practical.

Research Project Evaluation-Learnings from the PATHWAYS Project Experience.

PubMed

Galas, Aleksander; Pilat, Aleksandra; Leonardi, Matilde; Tobiasz-Adamczyk, Beata

2018-05-25

Every research project faces challenges regarding how to achieve its goals in a timely and effective manner. The purpose of this paper is to present a project evaluation methodology gathered during the implementation of the Participation to Healthy Workplaces and Inclusive Strategies in the Work Sector (the EU PATHWAYS Project). The PATHWAYS project involved multiple countries and multi-cultural aspects of re/integrating chronically ill patients into labor markets in different countries. This paper describes key project's evaluation issues including: (1) purposes, (2) advisability, (3) tools, (4) implementation, and (5) possible benefits and presents the advantages of a continuous monitoring. Project evaluation tool to assess structure and resources, process, management and communication, achievements, and outcomes. The project used a mixed evaluation approach and included Strengths (S), Weaknesses (W), Opportunities (O), and Threats (SWOT) analysis. A methodology for longitudinal EU projects' evaluation is described. The evaluation process allowed to highlight strengths and weaknesses and highlighted good coordination and communication between project partners as well as some key issues such as: the need for a shared glossary covering areas investigated by the project, problematic issues related to the involvement of stakeholders from outside the project, and issues with timing. Numerical SWOT analysis showed improvement in project performance over time. The proportion of participating project partners in the evaluation varied from 100% to 83.3%. There is a need for the implementation of a structured evaluation process in multidisciplinary projects involving different stakeholders in diverse socio-environmental and political conditions. Based on the PATHWAYS experience, a clear monitoring methodology is suggested as essential in every multidisciplinary research projects.

Occupational psychosocial health policies in Hong Kong schools: a review and exploration of key stakeholder perceptions.

PubMed

Tang, Jessica Janice; Leka, Stavroula; Hunt, Nigel; MacLennan, Sara

2011-12-01

It is widely acknowledged that teachers are suffering from work-related health problems. However, the implementation of relevant occupational safety and health (OSH) policies is complex and under-studied. This study reviews key legislation of relevance to psychosocial health and explores stakeholders' perceptions on their implementation in Hong Kong (HK) schools. The content of OSH legislation applicable to psychosocial health was systematically reviewed by the modified WHO checklist on legislation. Semi-structured interviews were then conducted with 38 key stakeholders. These were transcribed and subjected to Framework Analysis. The review showed that there were several ambiguities in the legislation and the interviews found that awareness and understanding in relation to OSH issues and policies differed on the basis of the level of implementation bodies. The importance of management, trust, communication and interpersonal relationships was emphasised. On the basis of the study it is concluded that implementation of psychosocial health policies in HK schools is poor and there appears to be a gap among stakeholder communication. Also, the content of these policies needs to be clarified so that it can be more conducive to implementation in practice. The improvement of OSH climate and social capital could foster a more effective implementation of OSH policies. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

A Blueprint for Success. Operation Rescue.

ERIC Educational Resources Information Center

National Foundation for the Improvement of Education, Washington, DC.

A set of principles that focus on issues concerning implementation of a successful dropout prevention program is presented by a consortium of national educational organizations. The key elements of this "blueprint" consider local adaptations and effective results among various programs. The booklet discusses seven principles for dropout…

The power of VEGF (vascular endothelial growth factor) family molecules.

PubMed

Thomas, Jean-Leon; Eichmann, Anne

2013-05-01

Vascular endothelial growth factors (VEGFs) and their high-affinity tyrosine kinase VEGF receptors (VEGFRs) are key regulators of both angiogenesis and neurogenesis. The current issue of CMLS discusses recent literature and work implementing these signals in nervous system development, maintenance and disease pathology.

Teaching and Testing Early Reading. Focus On

ERIC Educational Resources Information Center

Mraz, Maryann; Kissel, Brian

2007-01-01

This issue of "Focus On" provides an overview of several key early literacy components: phonemic awareness, alphabet knowledge, concepts of print, oral language development, writing, family literacy, and reading aloud. Suggestions for assessing early literacy development are provided, and examples of implementation of effective early literacy…

PREFACE: SPECIAL ISSUE OF ATMOSPHERIC ENVIRONMENT ON FINDINGS FROM EPA'S PARTICULATE MATTER SUPERSITES PROGRAM

EPA Science Inventory

The Supersites Program is a methods development and evaluation, measurements, modeling, and data analysis program designed to provide key stakeholders in the science, regulatory, and policy communities with information to support primarily implementation of National Ambient Air Q...

Twenty questions surrounding unpaid medical leave: Navigating the Bermuda Triangle of employment law.

PubMed

McMahon, B T; Domer, T M

1997-01-01

No federal or state lawmaker could have foreseen the nuances involved in the mutual implementations of the Americans with Disabilities Act, the Family and Medical Leave Act, and state workers compensation statutes. These laws are compared and contrasted on a number of key issues. Readers are provided with a decision matrix to guide them and those they represent in the judicious invocation of the most beneficial statute for each issue.

Diagnosis and predictive molecular analysis of non-small-cell lung cancer in the Africa-Middle East region: challenges and strategies for improvement.

PubMed

Slavik, Tomas; Asselah, Fatima; Fakhruddin, Najla; El Khodary, Ahmed; Torjman, Fairouz; Anis, Elia; Quinn, Martin; Khankan, Azzam; Kerr, Keith M

2014-11-01

The identification of tumor biomarkers provides information on the prognosis and guides the implementation of appropriate treatment in patients with many different cancer types. In non-small cell lung cancer (NSCLC), targeted treatment plans based on biomarker identification have already been used in the clinic. However, such predictive molecular testing is not currently a universally used practice. This is the case, in particular, in developing countries where lung cancer is increasingly prevalent. In September 2012 and November 2013, a committee of 16 lung cancer experts from Africa and the Middle East met to discuss key issues related to diagnosis and biomarker testing in NSCLC and the implementation of personalized medicine in the region. The committee identified current challenges for effective diagnosis and predictive analysis in Africa and the Middle East. Moreover, strategies to encourage the implementation of biomarker testing were discussed. A practical approach for the effective diagnosis and predictive molecular testing of NSCLC in these regions was derived. We present the key issues and recommendations arising from the meetings. Copyright © 2014 Elsevier Inc. All rights reserved.

Considerations to Enhance the Florida Domestic Security Strategic Plan

DTIC Science & Technology

2011-03-01

In his book, Implementing your Strategic Plan How to Turn “Intent” Into Effective Action for Sustainable Change, C. Davis Fogg suggests that...companies that are long-term, strategic winners faithfully practice 18 keys to strategy implementation (1999). Fogg states to begin, a company must have a...this small group of strategic priority issues will lead one toward an envisioned future ( Fogg , 1999, p. 6). Fogg suggests that it is important

Closing the Gap: A Report on the Wingspread Conference "Beyond the Standards Horse Race: Implementation, Assessment, and Accountability--the Keys to Improving Student Achievement" (Racine, Wisconsin, November 2-4, 1999). Special Report.

ERIC Educational Resources Information Center

Duggan, Terri, Ed.; Holmes, Madelyn, Ed.

This report highlights results from the 1999 Wingspread Conference on improving student achievement, a gathering of educators, leaders, and policymakers that opened a dialogue about barriers to full implementation of high standards for all students. Participants discussed five papers that examined these issues from top to bottom--from the…

Design and Implementation of the PALM-3000 Real-Time Control System

NASA Technical Reports Server (NTRS)

Truong, Tuan N.; Bouchez, Antonin H.; Burruss, Rick S.; Dekany, Richard G.; Guiwits, Stephen R.; Roberts, Jennifer E.; Shelton, Jean C.; Troy, Mitchell

2012-01-01

This paper reflects, from a computational perspective, on the experience gathered in designing and implementing realtime control of the PALM-3000 adaptive optics system currently in operation at the Palomar Observatory. We review the algorithms that serve as functional requirements driving the architecture developed, and describe key design issues and solutions that contributed to the system's low compute-latency. Additionally, we describe an implementation of dense matrix-vector-multiplication for wavefront reconstruction that exceeds 95% of the maximum sustained achievable bandwidth on NVIDIA Geforce 8800GTX GPU.

The development of health care data warehouses to support data mining.

PubMed

Lyman, Jason A; Scully, Kenneth; Harrison, James H

2008-03-01

Clinical data warehouses offer tremendous benefits as a foundation for data mining. By serving as a source for comprehensive clinical and demographic information on large patient populations, they streamline knowledge discovery efforts by providing standard and efficient mechanisms to replace time-consuming and expensive original data collection, organization, and processing. Building effective data warehouses requires knowledge of and attention to key issues in database design, data acquisition and processing, and data access and security. In this article, the authors provide an operational and technical definition of data warehouses, present examples of data mining projects enabled by existing data warehouses, and describe key issues and challenges related to warehouse development and implementation.

Barriers to implementation of workplace health interventions: an economic perspective.

PubMed

Cherniack, Martin; Lahiri, Supriya

2010-09-01

To identify insurance related, structural, and workplace cultural barriers to the implementation of effective preventive and upstream clinical interventions in the working age adult population. Analysis of avoided costs from perspective of health economics theory and from empiric observations from large studies; presentation of data from our own cost-plus model on integrating health promotion and ergonomics. We identify key avoided costs issues as a misalignment of interests between employers, insurers, service institutions, and government. Conceptual limitations of neoclassical economics are attributable to work culture and supply-driven nature of health care. Effective valuation of avoided costs is a necessary condition for redirecting allocations and incentives. Key content for valuation models is discussed.

Prototype Training Materials for Acceptance Criteria of Maintenance ASAP Events Occurring Within Social Context

NASA Technical Reports Server (NTRS)

Taylor, J. C.

2004-01-01

The aviation maintenance community is at a crossroads with respect to implementing the Aviation Safety Action Program (ASAP). While there is considerable interest, several key issues have emerged that cast doubt on how to assure a successful implementation, including buy-in from all levels of the company and training for key participants. There are two objectives for the present report. The first is to provide an examination of limits (or more properly, examples) of the degree of acceptability of more problematic events for risk-based decisions within the current ASAP guidelines. The second objective is to apply these limits of community standards to a set of further refined ASAP training scenarios.

Report of IRPA task group on the impact of the eye lens dose limits.

PubMed

Cantone, Marie Claire; Ginjaume, Merce; Miljanic, Saveta; Martin, Colin J; Akahane, Keiichi; Mpete, Louisa; Michelin, Severino C; Flannery, Cynthia M; Dauer, Lawrence T; Balter, Stephen

2017-06-26

In 2012 IRPA established a task group (TG) to identify key issues in the implementation of the revised eye lens dose limit. The TG reported its conclusions in 2013. In January 2015, IRPA asked the TG to review progress with the implementation of the recommendations from the early report and to collate current practitioner experience. This report presents the results of a survey on the view of the IRPA professionals on the new limit to the lens of the eye and on the wider issue of tissue reactions. Recommendations derived from the survey are presented. This report was approved by IRPA Executive Council on 31 January 2017.

Evaluation of interventions on road traffic injuries in Peru: a qualitative approach

PubMed Central

2012-01-01

Background Evaluation of interventions on road traffic injuries (RTI) going beyond the assessment of impact to include factors underlying success or failure is an important complement to standard impact evaluations. We report here how we used a qualitative approach to assess current interventions implemented to reduce RTIs in Peru. Methods We performed in-depth interviews with policymakers and technical officers involved in the implementation of RTI interventions to get their insight on design, implementation and evaluation aspects. We then conducted a workshop with key stakeholders to analyze the results of in-depth interviews, and to further discuss and identify key programmatic considerations when designing and implementing RTI interventions. We finally performed brainstorming sessions to assess potential system-wide effects of a selected intervention (Zero Tolerance), and to identify adaptation and redesign needs for this intervention. Results Key programmatic components were consistently identified that should be considered when designing and implementing RTI interventions. They include effective and sustained political commitment and planning; sufficient and sustained budget allocation; training, supervision, monitoring and evaluation of implemented policies; multisectoral participation; and strong governance and accountability. Brainstorming sessions revealed major negative effects of the selected intervention on various system building blocks. Conclusions Our approach revealed substantial caveats in current RTI interventions in Peru, and fundamental negative effects on several components of the sectors and systems involved. It also highlighted programmatic issues that should be applied to guarantee an effective implementation and evaluation of these policies. The findings from this study were discussed with key stakeholders for consideration in further designing and planning RTI control interventions in Peru. PMID:22269578

Evaluation of interventions on road traffic injuries in Peru: a qualitative approach.

PubMed

Huicho, Luis; Adam, Taghreed; Rosales, Edmundo; Paca-Palao, Ada; López, Luis; Luna, Diego; Miranda, J Jaime

2012-01-23

Evaluation of interventions on road traffic injuries (RTI) going beyond the assessment of impact to include factors underlying success or failure is an important complement to standard impact evaluations. We report here how we used a qualitative approach to assess current interventions implemented to reduce RTIs in Peru. We performed in-depth interviews with policymakers and technical officers involved in the implementation of RTI interventions to get their insight on design, implementation and evaluation aspects. We then conducted a workshop with key stakeholders to analyze the results of in-depth interviews, and to further discuss and identify key programmatic considerations when designing and implementing RTI interventions. We finally performed brainstorming sessions to assess potential system-wide effects of a selected intervention (Zero Tolerance), and to identify adaptation and redesign needs for this intervention. Key programmatic components were consistently identified that should be considered when designing and implementing RTI interventions. They include effective and sustained political commitment and planning; sufficient and sustained budget allocation; training, supervision, monitoring and evaluation of implemented policies; multisectoral participation; and strong governance and accountability. Brainstorming sessions revealed major negative effects of the selected intervention on various system building blocks. Our approach revealed substantial caveats in current RTI interventions in Peru, and fundamental negative effects on several components of the sectors and systems involved. It also highlighted programmatic issues that should be applied to guarantee an effective implementation and evaluation of these policies. The findings from this study were discussed with key stakeholders for consideration in further designing and planning RTI control interventions in Peru.

Performance-Based Funding Brief

ERIC Educational Resources Information Center

Washington Higher Education Coordinating Board, 2011

2011-01-01

A number of states have made progress in implementing performance-based funding (PFB) and accountability. This policy brief summarizes main features of performance-based funding systems in three states: Tennessee, Ohio, and Indiana. The brief also identifies key issues that states considering performance-based funding must address, as well as…

Outcomes-Based Funding and Stakeholder Engagement. Lumina Issue Papers

ERIC Educational Resources Information Center

Kadlec, Alison; Shelton, Susan

2015-01-01

This paper examines the key aspects of stakeholder engagement that can strengthen the design, implementation and sustainability of outcomes-based funding policies. We seek to help policymakers understand the prevailing starting-point attitudes of institutional stakeholders, primarily college and university administrators, faculty and staff, and…

The implementation of psychiatric advance directives: experiences from a Dutch crisis card initiative.

PubMed

van der Ham, Alida J; Voskes, Yolande; van Kempen, Nel; Broerse, Jacqueline E W; Widdershoven, Guy A M

2013-06-01

The crisis card is a specific form of psychiatric advance directive, documenting mental clients' treatment preferences in advance of a potential psychiatric crisis. In this paper, we aim to provide insight into implementation issues surrounding the crisis card. A Dutch crisis-card project formed the scope of this study. Data were collected through interviews with 15 participants from six stakeholder groups. Identified implementation issues are: (a) The role of the crisis-card counselor, (b) lack of distribution and familiarity, (c) care professionals' routines, and (d) client readiness. The crisis-card counselor appears to play a key role in fostering benefits of the crisis card by supporting clients' perspectives. More structural integration of the crisis card in care processes may enhance its impact, but should be carefully explored. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Approach to implementing a DICOM network: incorporate both economics and workflow adaptation

NASA Astrophysics Data System (ADS)

Beaver, S. Merritt; Sippel-Schmidt, Teresa M.

1995-05-01

This paper describes an approach to aide in the decision-making process for the justification and design of a digital image and information management system. It identifies key technical and clinical issues that need to be addressed by a healthcare institution during this process. Some issues identified here are very controversial and may take months or years for a department to determine solutions which meet their specific staffing, financial, and technical needs.

Water Infrastructure Needs and Investment: Review and Analysis of Key Issues

DTIC Science & Technology

2008-11-24

the Rural Development Act of 1972, as amended (7 U.S.C. § 1926). The purpose of these USDA programs is to provide basic amenities, alleviate health...nonregulatory costs (e.g., routine replacement of basic infrastructure).12 Wastewater Needs. The most recent wastewater survey, conducted in 2004 and issued...1.6 billion just to implement the most basic steps needed to improve security (such as better controlling access to facilities with fences, locks

Computer-Managed Instruction: Theory, Application, and Some Key Implementation Issues.

DTIC Science & Technology

1984-03-01

who have endorsed computer technology but fail to adopt it . As one educational consultant claims: "Educators appear to have a deep-set skepticism toward...widespread use. i-1 II. BACKGROUND A. HISTORICAL PERSPECTIVE In the mid-1950’s, while still in its infancy, computer technology entered the world of education...to utilize the new technology , and to do it most.. extensively. Implementation of CMI in a standalone configuration using microcomputers has been

ST-segment monitoring: putting standards into practice.

PubMed

Flanders, Sonya A

2007-01-01

ST-segment monitoring is one key reason that continuous electrocardiographic monitoring is performed in hospitals, and can help with early detection of myocardial ischemia for at-risk patients. Although ST-segment monitoring research, guidelines, and expert consensus statements have been published, ST-segment monitoring has not been implemented in all appropriate clinical areas. The purpose of this article is to present relevant research, review the latest practice standards, and discuss issues important to nurses wishing to implement ST-segment monitoring.

Mother Tongue Education in Singapore: Concerns, Issues and Controversies

ERIC Educational Resources Information Center

Ng, Chin Leong Patrick

2014-01-01

In 1966, the Singapore Government implemented the English-knowing bilingual policy which made it mandatory for all Chinese students to study English as a "First Language" and the Chinese language (CL) as a "Mother Tongue Language" in Singapore schools. Using key literature relevant to Singapore's bilingual educational policy…

Associate Degree Education--Current Issues. Publication Number 23-1371.

ERIC Educational Resources Information Center

National League for Nursing, New York, NY. Dept. of Associate Degree Programs.

Papers included in the documents are: (1) "Nursing Education for the Community" by Shirley Chater, (2) "Key Problems in Implementing Associate Degree Nursing Programs" by Elsa L. Brown, (3) "The Allied Health Professions Projects at the University of California" by Mary E. Jensen, (4) "The Profession's…

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

Smith, Jeff

This report discusses the UHSP monitoring program, a radioactive material accounting process and its purpose. The systematic approach to implementing Lean principles, determining key requirements, root causes of variation and disruption that interfere with program efficiency and effectiveness. Preexisting issues within the UHSP are modeled to illustrate the impact that they have on the large and extensive systems.

The First World Congress on the Management of Electronic Commerce: Review and Commentary.

ERIC Educational Resources Information Center

Bontis, Nick; De Castro, Akemi

2000-01-01

Summarizes some key findings of academic papers presented at the First World Congress on the Management of Electronic Commerce (January, 2000, Hamilton, Ontario, Canada). Outlines two meta-management issues that surfaced: taking a strategic approach to Internet ventures and considering infrastructure design during implementation. Highlights…

Enrichment in Massachusetts Expanded Learning Time (ELT) Schools. Issue Brief

ERIC Educational Resources Information Center

Caven, Meghan; Checkoway, Amy; Gamse, Beth; Luck, Rachel; Wu, Sally

2012-01-01

This brief highlights key information about enrichment activities, which represent one of the main components of the Massachusetts Expanded Learning Time (ELT) initiative. Over time, the ELT initiative has supported over two dozen schools across the Commonwealth. A comprehensive evaluation of the ELT initiative found that implementation of the…

Impact Evaluations of Corporate E-Learning.

ERIC Educational Resources Information Center

Ring, Geoff; Reeves, Thomas C.

This paper describes key issues in conducting impact evaluations of corporate eLearning and reports the results of a study that evaluated the impact (including return on investment) of an eLearning implementation by a large telecommunications company. The program was designed to "multi-skill" over 1,000 Customer Service Officers (CSOs)…

Accounting for Contributions. Understanding the Requirements of FASB Statement No. 116.

ERIC Educational Resources Information Center

Ostrom, John S.

Since the Financial Accounting Standards Board (FASB) issued Statement of Financial Accounting Standards No. 116, Accounting for Contributions Received and Contributions Made, in June 1993, guidance has been sought in understanding its impact and implementation. Specific key provisions deal with contributions received and contributions made,…

Identity and Access Management: Technological Implementation of Policy

ERIC Educational Resources Information Center

von Munkwitz-Smith, Jeff; West, Ann

2004-01-01

Navigating the multiple processes for accessing ever-multiplying campus information systems can be a daunting task for students, faculty, and staff. This article provides a brief overview of Identity and Access Management Services. The authors review key characteristics and components of this new information architecture and address the issue of…

School Dropout Indicators, Trends, and Interventions for School Counselors

ERIC Educational Resources Information Center

Dockery, Donna J.

2012-01-01

School counselors are expected to develop programs that promote academic success for all students, including those at risk for dropping out of school. Knowledge of key indicators of potential dropouts and current trends in dropout prevention research may assist school counselors in better understanding this complex issue. Implementing recommended…

Implementing Positive Behavior Support with Chinese American Families: Enhancing Cultural Competence

ERIC Educational Resources Information Center

Wang, Mian; McCart, Amy; Turnbull, Ann P.

2007-01-01

In positive behavior support (PBS) practices, one critical issue involves helping professionals understand and respect the values of families from culturally diverse backgrounds. This article summarizes embedded cultural values of PBS represented in four key features of the PBS process: collaborative partnerships, functional assessment, contextual…

The Logic of Equity Practice in "Queensland State Education"--2010

ERIC Educational Resources Information Center

Taylor, Sandra; Singh, Parlo

2005-01-01

This paper reports on an interview-based study which explored the implementation of a major policy initiative in Queensland, Australia, with particular attention to social justice issues. Interviews were conducted with key policy actors in three sections of the bureaucracy: strategic directions, performance and measurement; curriculum and…

Annual Report To Congress. Department of Energy Activities Relating to the Defense Nuclear Facilities Safety Board, Calendar Year 2003

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

None, None

2004-02-28

The Department of Energy (Department) submits an Annual Report to Congress each year detailing the Department’s activities relating to the Defense Nuclear Facilities Safety Board (Board), which provides advice and recommendations to the Secretary of Energy (Secretary) regarding public health and safety issues at the Department’s defense nuclear facilities. In 2003, the Department continued ongoing activities to resolve issues identified by the Board in formal recommendations and correspondence, staff issue reports pertaining to Department facilities, and public meetings and briefings. Additionally, the Department is implementing several key safety initiatives to address and prevent safety issues: safety culture and review ofmore » the Columbia accident investigation; risk reduction through stabilization of excess nuclear materials; the Facility Representative Program; independent oversight and performance assurance; the Federal Technical Capability Program (FTCP); executive safety initiatives; and quality assurance activities. The following summarizes the key activities addressed in this Annual Report.« less

Delivering digital health and well-being at scale: lessons learned during the implementation of the dallas program in the United Kingdom

PubMed Central

Devlin, Alison M; McGee-Lennon, Marilyn; O’Donnell, Catherine A; Bouamrane, Matt-Mouley; Agbakoba, Ruth; O’Connor, Siobhan; Grieve, Eleanor; Finch, Tracy; Wyke, Sally; Watson, Nicholas; Browne, Susan

2016-01-01

Objective To identify implementation lessons from the United Kingdom Delivering Assisted Living Lifestyles at Scale (dallas) program—a large-scale, national technology program that aims to deliver a broad range of digital services and products to the public to promote health and well-being. Materials and Methods Prospective, longitudinal qualitative research study investigating implementation processes. Qualitative data collected includes semi-structured e-Health Implementation Toolkit–led interviews at baseline/mid-point (n = 38), quarterly evaluation, quarterly technical and barrier and solutions reports, observational logs, quarterly evaluation alignment interviews with project leads, observational data collected during meetings, and ethnographic data from dallas events (n > 200 distinct pieces of qualitative data). Data analysis was guided by Normalization Process Theory, a sociological theory that aids conceptualization of implementation issues in complex healthcare settings. Results Five key challenges were identified: 1) The challenge of establishing and maintaining large heterogeneous, multi-agency partnerships to deliver new models of healthcare; 2) The need for resilience in the face of barriers and set-backs including the backdrop of continually changing external environments; 3) The inherent tension between embracing innovative co-design and achieving delivery at pace and at scale; 4) The effects of branding and marketing issues in consumer healthcare settings; and 5) The challenge of interoperability and information governance, when commercial proprietary models are dominant. Conclusions The magnitude and ambition of the dallas program provides a unique opportunity to investigate the macro level implementation challenges faced when designing and delivering digital health and wellness services at scale. Flexibility, adaptability, and resilience are key implementation facilitators when shifting to new digitally enabled models of care. PMID:26254480

Delivering digital health and well-being at scale: lessons learned during the implementation of the dallas program in the United Kingdom.

PubMed

Devlin, Alison M; McGee-Lennon, Marilyn; O'Donnell, Catherine A; Bouamrane, Matt-Mouley; Agbakoba, Ruth; O'Connor, Siobhan; Grieve, Eleanor; Finch, Tracy; Wyke, Sally; Watson, Nicholas; Browne, Susan; Mair, Frances S

2016-01-01

To identify implementation lessons from the United Kingdom Delivering Assisted Living Lifestyles at Scale (dallas) program-a large-scale, national technology program that aims to deliver a broad range of digital services and products to the public to promote health and well-being. Prospective, longitudinal qualitative research study investigating implementation processes. Qualitative data collected includes semi-structured e-Health Implementation Toolkit-led interviews at baseline/mid-point (n = 38), quarterly evaluation, quarterly technical and barrier and solutions reports, observational logs, quarterly evaluation alignment interviews with project leads, observational data collected during meetings, and ethnographic data from dallas events (n > 200 distinct pieces of qualitative data). Data analysis was guided by Normalization Process Theory, a sociological theory that aids conceptualization of implementation issues in complex healthcare settings. Five key challenges were identified: 1) The challenge of establishing and maintaining large heterogeneous, multi-agency partnerships to deliver new models of healthcare; 2) The need for resilience in the face of barriers and set-backs including the backdrop of continually changing external environments; 3) The inherent tension between embracing innovative co-design and achieving delivery at pace and at scale; 4) The effects of branding and marketing issues in consumer healthcare settings; and 5) The challenge of interoperability and information governance, when commercial proprietary models are dominant. The magnitude and ambition of the dallas program provides a unique opportunity to investigate the macro level implementation challenges faced when designing and delivering digital health and wellness services at scale. Flexibility, adaptability, and resilience are key implementation facilitators when shifting to new digitally enabled models of care. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Hazardous Materials Pharmacies - A Vital Component of a Robust P2 Program

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

McCarter, S.

2006-07-01

Integrating pollution prevention (P2) into the Department of Energy Integrated Safety Management (ISM) - Environmental Management System (EMS) approach, required by DOE Order 450.1, leads to an enhanced ISM program at large and complex installations and facilities. One of the building blocks to integrating P2 into a comprehensive environmental and safety program is the control and tracking of the amounts, types, and flow of hazardous materials used on a facility. Hazardous materials pharmacies (typically called HazMarts) provide a solid approach to resolving this issue through business practice changes that reduce use, avoid excess, and redistribute surplus. If understood from conceptmore » to implementation, the HazMart is a powerful tool for reducing pollution at the source, tracking inventory storage, controlling usage and flow, and summarizing data for reporting requirements. Pharmacy options can range from a strict, single control point for all hazardous materials to a virtual system, where the inventory is user controlled and reported over a common system. Designing and implementing HazMarts on large, diverse installations or facilities present a unique set of issues. This is especially true of research and development (R and D) facilities where the chemical use requirements are extensive and often classified. There are often multiple sources of supply; a wide variety of chemical requirements; a mix of containers ranging from small ampoules to large bulk storage tanks; and a wide range of tools used to track hazardous materials, ranging from simple purchase inventories to sophisticated tracking software. Computer systems are often not uniform in capacity, capability, or operating systems, making it difficult to use a server-based unified tracking system software. Each of these issues has a solution or set of solutions tied to fundamental business practices. Each requires an understanding of the problem at hand, which, in turn, requires good communication among all potential users. A key attribute to a successful HazMart is that everybody must use the same program. That requirement often runs directly into the biggest issue of all... institutional resistance to change. To be successful, the program has to be both a top-down and bottom-up driven process. The installation or facility must set the policy and the requirement, but all of the players have to buy in and participate in building and implementing the program. Dynamac's years of experience assessing hazardous materials programs, providing business case analyses, and recommending and implementing pharmacy approaches for federal agencies has provided us with key insights into the issues, problems, and the array of solutions available. This paper presents the key steps required to implement a HazMart, explores the advantages and pitfalls associated with a HazMart, and presents some options for implementing a pharmacy or HazMart on complex installations and R and D facilities. (authors)« less

PrEP implementation research in Africa: what is new?

PubMed

Cowan, Frances M; Delany-Moretlwe, Sinead; Sanders, Eduard J; Mugo, Nelly R; Guedou, Fernand A; Alary, Michel; Behanzin, Luc; Mugurungi, Owen; Bekker, Linda-Gail

2016-01-01

Of the two million new HIV infections in adults in 2014, 70% occurred in sub-Saharan Africa. Several African countries have already approved guidelines for pre-exposure prophylaxis (PrEP) for individuals at substantial risk of HIV as part of combination HIV prevention but key questions remain about how to identify and deliver PrEP to those at greatest need. Throughout the continent, individuals in sero-discordant relationships, and members of key populations (sex workers, men who have sex with men (MSM), transgender women and injection drug users) are likely to benefit from the availability of PrEP. In addition, adolescent girls and young women (AGYW) are at substantial risk in some parts of the continent. It has been estimated that at least three million individuals in Africa are likely to be eligible for PrEP according to WHO's criteria. Tens of demonstration projects are planned or underway across the continent among a range of countries, populations and delivery settings. In each of the target populations, there are overarching issues related to (i) creating demand for PrEP, (ii) addressing supply-side issues and (iii) providing appropriate and tailored adherence support. Critical for creating demand for PrEP is the normalization of HIV prevention. Community-level interventions which engage opinion leaders as well as empowerment interventions for those at highest risk will be key. Critical to supply of PrEP is that services are accessible for all, including for stigmatized populations. Establishing accessible integrated services provides the opportunity to address other public health priorities including the unmet need for HIV testing, contraception and sexually transmitted infections treatment. National policies need to include minimum standards for training and quality assurance for PrEP implementation and to address supply chain issues. Adherence support needs to recognize that social and structural factors are likely to have an important influence. Combining interventions that build self-efficacy, empowerment and social cohesion, with evidence-based individualized adherence support for PrEP, are most likely to be effective. Efficacy of tenfovir-based PrEP is proven but many issues related to implementation remain unclear. Here, we have summarized some of the important implementation questions that need to be assessed as PrEP is rolled out across Africa.

PrEP implementation research in Africa: what is new?

PubMed Central

Cowan, Frances M; Delany-Moretlwe, Sinead; Sanders, Eduard J; Mugo, Nelly R; Guedou, Fernand A; Alary, Michel; Behanzin, Luc; Mugurungi, Owen; Bekker, Linda-Gail

2016-01-01

Introduction Of the two million new HIV infections in adults in 2014, 70% occurred in sub-Saharan Africa. Several African countries have already approved guidelines for pre-exposure prophylaxis (PrEP) for individuals at substantial risk of HIV as part of combination HIV prevention but key questions remain about how to identify and deliver PrEP to those at greatest need. Throughout the continent, individuals in sero-discordant relationships, and members of key populations (sex workers, men who have sex with men (MSM), transgender women and injection drug users) are likely to benefit from the availability of PrEP. In addition, adolescent girls and young women (AGYW) are at substantial risk in some parts of the continent. It has been estimated that at least three million individuals in Africa are likely to be eligible for PrEP according to WHO's criteria. Tens of demonstration projects are planned or underway across the continent among a range of countries, populations and delivery settings. Discussion In each of the target populations, there are overarching issues related to (i) creating demand for PrEP, (ii) addressing supply-side issues and (iii) providing appropriate and tailored adherence support. Critical for creating demand for PrEP is the normalization of HIV prevention. Community-level interventions which engage opinion leaders as well as empowerment interventions for those at highest risk will be key. Critical to supply of PrEP is that services are accessible for all, including for stigmatized populations. Establishing accessible integrated services provides the opportunity to address other public health priorities including the unmet need for HIV testing, contraception and sexually transmitted infections treatment. National policies need to include minimum standards for training and quality assurance for PrEP implementation and to address supply chain issues. Adherence support needs to recognize that social and structural factors are likely to have an important influence. Combining interventions that build self-efficacy, empowerment and social cohesion, with evidence-based individualized adherence support for PrEP, are most likely to be effective. Conclusions Efficacy of tenfovir-based PrEP is proven but many issues related to implementation remain unclear. Here, we have summarized some of the important implementation questions that need to be assessed as PrEP is rolled out across Africa. PMID:27760680

A Review Study on Cloud Computing Issues

NASA Astrophysics Data System (ADS)

Kanaan Kadhim, Qusay; Yusof, Robiah; Sadeq Mahdi, Hamid; Al-shami, Sayed Samer Ali; Rahayu Selamat, Siti

2018-05-01

Cloud computing is the most promising current implementation of utility computing in the business world, because it provides some key features over classic utility computing, such as elasticity to allow clients dynamically scale-up and scale-down the resources in execution time. Nevertheless, cloud computing is still in its premature stage and experiences lack of standardization. The security issues are the main challenges to cloud computing adoption. Thus, critical industries such as government organizations (ministries) are reluctant to trust cloud computing due to the fear of losing their sensitive data, as it resides on the cloud with no knowledge of data location and lack of transparency of Cloud Service Providers (CSPs) mechanisms used to secure their data and applications which have created a barrier against adopting this agile computing paradigm. This study aims to review and classify the issues that surround the implementation of cloud computing which a hot area that needs to be addressed by future research.

Understanding the economics of succeeding in disease management.

PubMed

Shulkin, D J

1999-04-01

If implemented with the proper resource commitment, disease management can have a significant effect on the health of an organization's patient population. However, it is unlikely that even the noblest of strategic initiatives will survive long without a compelling business imperative. After analyzing the business case, many organizations have committed large amounts of resources to building disease management programs. Yet these issues are still being formulated. The author discusses five issues that are key to understanding the economics of disease management.

Key Informants' Perceptions on the Implementation of a National Program for Improving Nutritional Status of Children in Iran.

PubMed

Ghodsi, Delaram; Omidvar, Nasrin; Rashidian, Arash; Raghfar, Hossein; Eini-Zinab, Hassan; Ebrahimi, Marziyeh

2016-01-01

Childhood malnutrition is a major public health issue. Multidisciplinary approach for Improvement of Nutritional Status of Children in Iran was implemented in order to reduce malnutrition among children. This study aimed to evaluate the implementation aspect of the program and to explore key informants' perceptions and experience regarding the factors affected its implementation. Data were collected through the review of secondary data and semistructured interviews at national, province, and local levels. Four layers of key informants were selected purposefully for interviewing, including policymakers, senior nutrition officers, head of Hygiene, Remedy and Insurance Affairs in Imam Khomeini Relief Foundation, and community health workers. Qualitative content analysis was carried out based on Supporting the Use of Research Evidence framework and Tailored Implementation for Chronic Diseases' checklist to interpret the viewpoints of the study participants. Results showed that the program had successes in improving mother's knowledge on health, nutrition, and child care through health system and increased families' access to food, but there were some aspects that affected program's implementation. Some of these factors are the lack of clarity in the program's protocol and indicators, human shortage and inadequate financial resources, poor facilities, inattention to staff motivation, insufficient commitment among different sections, poor communication and supervision among different executive sections, and program protocols designing regardless of practical condition. Based on the results, top-down approach in policymaking and inadequate financial and human resources were responsible for most of the challenges encountered in the implementation.

Health Sector Reform in the Kurdistan Region - Iraq: Financing Reform, Primary Care, and Patient Safety.

PubMed

Anthony, C Ross; Moore, Melinda; Hilborne, Lee H; Mulcahy, Andrew W

2014-12-30

In 2010, the Kurdistan Regional Government asked the RAND Corporation to help guide reform of the health care system in the Kurdistan Region of Iraq. The overarching goal of reform was to help establish a health system that would provide high-quality services efficiently to everyone to prevent, treat, and manage physical and mental illnesses and injuries. This article summarizes the second phase of RAND's work, when researchers analyzed three distinct but intertwined health policy issue areas: development of financing policy, implementation of early primary care recommendations, and evaluation of quality and patient safety. For health financing, the researchers reviewed the relevant literature, explored the issue in discussions with key stakeholders, developed and assessed various policy options, and developed plans or approaches to overcome barriers and achieve stated policy objectives. In the area of primary care, they developed and helped to implement a new management information system. In the area of quality and patient safety, they reviewed relevant literature, discussed issues and options with health leaders, and recommended an approach toward incremental implementation.

Using qualitative psychology to investigate HACCP implementation barriers.

PubMed

Taylor, Eunice; Taylor, Joanne Zaida

2004-02-01

Hazard Analysis Critical Control Point (HACCP) is a system of food safety management that in the last few decades has become an increasing part of national government and international strategy to reduce the prevalence of food borne disease. Yet despite wide dissemination and scientific support of its principles, successful HACCP implementation has been limited. There has been very little in-depth consideration of the reasons behind this, and qualitative psychological research examining the interplay of factors involved is almost non-existent. For this study therefore, four in-depth narrative interviews were carried out with small business owners attempting to implement HACCP. Non-prescriptive analysis of their interviews was carried out, and this revealed five key themes acting as 'barriers' to successful implementation. These were of HACCP as difficult, burdensome and unnecessary, and hindered by staff and external problems. The analysis showed furthermore the complexity of issues underpinning problems with HACCP implementation and the way in which they operate at knowledge, attitude and behavioural levels. From this, essential issues to be addressed in order for successful HACCP to be achieved are put forward.

Field demonstration of a continuous-variable quantum key distribution network.

PubMed

Huang, Duan; Huang, Peng; Li, Huasheng; Wang, Tao; Zhou, Yingming; Zeng, Guihua

2016-08-01

We report on what we believe is the first field implementation of a continuous-variable quantum key distribution (CV-QKD) network with point-to-point configuration. Four QKD nodes are deployed on standard communication infrastructures connected with commercial telecom optical fiber. Reliable key exchange is achieved in the wavelength-division-multiplexing CV-QKD network. The impact of a complex and volatile field environment on the excess noise is investigated, since excess noise controlling and reduction is arguably the major issue pertaining to distance and the secure key rate. We confirm the applicability and verify the maturity of the CV-QKD network in a metropolitan area, thus paving the way for a next-generation global secure communication network.

Examining sustainability in a hospital setting: case of smoking cessation.

PubMed

Campbell, Sharon; Pieters, Karen; Mullen, Kerri-Anne; Reece, Robin; Reid, Robert D

2011-09-14

The Ottawa Model of Smoking Cessation (OMSC) is a hospital-based smoking cessation program that is expanding across Canada. While the short-term effectiveness of hospital cessation programs has been documented, less is known about long-term sustainability. The purpose of this exploratory study was to understand how hospitals using the OMSC were addressing sustainability and determine if there were critical factors or issues that should be addressed as the program expanded. Six hospitals that differed on OMSC program activities (identify and document smokers, advise quitting, provide medication, and offer follow-up) were intentionally selected, and two key informants per hospital were interviewed using a semi-structured interview guide. Key informants were asked to reflect on the initial decision to implement the OMSC, the current implementation process, and perceived sustainability of the program. Qualitative analysis of the interview transcripts was conducted and themes related to problem definition, stakeholder influence, and program features emerged. Sustainability was operationalized as higher performance of OMSC activities than at baseline. Factors identified in the literature as important for sustainability, such as program design, differences in implementation, organizational characteristics, and the community environment did not explain differences in program sustainability. Instead, key informants identified factors that reflected the interaction between how the health problem was defined by stakeholders, how priorities and concerns were addressed, features of the program itself, and fit within the hospital context and resources as being influential to the sustainability of the program. Applying a sustainability model to a hospital smoking cessation program allowed for an examination of how decisions made during implementation may impact sustainability. Examining these factors during implementation may provide insight into issues affecting program sustainability, and foster development of a sustainability plan. Based on this study, we suggest that sustainability plans should focus on enhancing interactions between the health problem, program features, and stakeholder influence.

Examining sustainability in a hospital setting: Case of smoking cessation

PubMed Central

2011-01-01

Background The Ottawa Model of Smoking Cessation (OMSC) is a hospital-based smoking cessation program that is expanding across Canada. While the short-term effectiveness of hospital cessation programs has been documented, less is known about long-term sustainability. The purpose of this exploratory study was to understand how hospitals using the OMSC were addressing sustainability and determine if there were critical factors or issues that should be addressed as the program expanded. Methods Six hospitals that differed on OMSC program activities (identify and document smokers, advise quitting, provide medication, and offer follow-up) were intentionally selected, and two key informants per hospital were interviewed using a semi-structured interview guide. Key informants were asked to reflect on the initial decision to implement the OMSC, the current implementation process, and perceived sustainability of the program. Qualitative analysis of the interview transcripts was conducted and themes related to problem definition, stakeholder influence, and program features emerged. Results Sustainability was operationalized as higher performance of OMSC activities than at baseline. Factors identified in the literature as important for sustainability, such as program design, differences in implementation, organizational characteristics, and the community environment did not explain differences in program sustainability. Instead, key informants identified factors that reflected the interaction between how the health problem was defined by stakeholders, how priorities and concerns were addressed, features of the program itself, and fit within the hospital context and resources as being influential to the sustainability of the program. Conclusions Applying a sustainability model to a hospital smoking cessation program allowed for an examination of how decisions made during implementation may impact sustainability. Examining these factors during implementation may provide insight into issues affecting program sustainability, and foster development of a sustainability plan. Based on this study, we suggest that sustainability plans should focus on enhancing interactions between the health problem, program features, and stakeholder influence. PMID:21917156

Exploring the Ambiguity: What Faculty Leaders Really Think of Sustainability in Higher Education

ERIC Educational Resources Information Center

Wright, Tarah; Horst, Naomi

2013-01-01

Purpose: The purpose of this paper is to examine how a cohort of university faculty leaders in Canadian universities conceptualize sustainable development, sustainable universities, the role universities play in achieving a sustainable future, key issues facing the university, and the barriers to implementing sustainability initiatives on campus.…

Opening the Door to Coaching Conversations

ERIC Educational Resources Information Center

Cheliotes, Linda Gross; Reilly, Marceta Fleming

2012-01-01

A leader doesn't have to solve every problem personally to be effective. In fact, helping others learn to resolve issues and implement their own solutions is the key to sustainable leadership and an empowered staff. This companion and follow-up book to "Coaching Conversations" brings the coaching style of leadership to life with stories from the…

Flexible Learning, Human Resource and Organisational Development: Putting Theory To Work.

ERIC Educational Resources Information Center

Jakupec, Viktor, Ed.; Garrick, John, Ed.

This book addresses contemporary contexts of flexible learning and its practices and provides insights about directions that education and training providers may be required to follow to implement flexible learning in a variety of settings. Key issues and debates include the following: social and economic dimensions of flexible learning and…

School Counseling Prevention and Intervention for Child Witnesses of Intimate Partner Violence

ERIC Educational Resources Information Center

Buser, Juleen K.; Saponara, Erin

2011-01-01

Children who witness intimate partner violence (IPV) often suffer a range of physical, behavioral, emotional, and familial consequences (Holt, Buckley, & Whelan, 2008). School counselors may be in a key position to implement prevention programs around this issue, identify children who have witnessed IPV, and to engage in intervention efforts.…

Being an Instructional Designer: A Job Requiring Innovation and Trust

ERIC Educational Resources Information Center

Gerin-Lajoie, Serge

2015-01-01

This case study deals with the development and implementation of two online art courses. It outlines the concerns of the faculty member responsible for these courses and those of the instructional designer assisting him. The key design issues deal with the management of copyright material available via the Internet, the difficulty of implementing…

Every Child Matters: Every Challenge Met?

ERIC Educational Resources Information Center

Straker, Katherine; Foster, Rob

2009-01-01

This article explores the impact of the Every Child Matters agenda on a group of multi-agency professionals with regard to a number of key issues--such as leadership, multi-agency collaboration, and individual practice. One of the main challenges concerning the successful implementation of the ECM agenda is to ensure that effective training is…

A Critique of Water Scarcity Discourses in Educational Policy and Textbooks in Jordan

ERIC Educational Resources Information Center

Hussein, Hussam

2018-01-01

This article investigates the representation of water scarcity in Jordanian textbooks to understand its role on improving education on environmental sustainability. People's understanding of an issue guides their actions toward finding and implementing appropriate solutions to what they perceive as a problem. Discourses are key in constructing…

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

Platt, F.N. Jr.

This article examines the treatment of a Superfund site, the Runyon Watershed just outside of Perth Amboy, New Jersey, for volatile organic compounds. The beginning of treatment was the result of a 20-year legal battle begun in 1971 and resolved after the city's consulting engineering firm designed and implemented a specialized approach to identify and develop key critical issues.

More than attendance: the importance of after-school program quality.

PubMed

Hirsch, Barton J; Mekinda, Megan A; Stawicki, Julieann

2010-06-01

A central theme of the articles featured in this issue is the need to improve the quality of after-school programs. In this commentary, we discuss why student engagement, program characteristics and implementation, staff training, and citywide policy are key considerations in the effort to define and achieve high quality programs for youth.

Changes and Challenges: Key Issues for Scottish Rural Schools and Communities

ERIC Educational Resources Information Center

Dowling, Jennie

2009-01-01

Education in rural Scottish schools has changed rapidly over the past 15 years. These changes include the implementation of national curriculum and assessment guidelines, increased parental influence and a shift from local authority based management to more locally based schemes. During the 1990s, research in the field focused largely on learning…

Integration of Computers in Education: A Curriculum Perspective.

ERIC Educational Resources Information Center

Plomp, Tjeerd

This discussion of a major problem area in education--the curricular and implementation aspects of the application of the computer or new information technologies--focuses first on the use and integration of computers in existing courses or subjects in the curriculum, and defines some key terms. The next section considers issues in the…

Teaching and California's Future: California's Teaching Force, 2008. Key Issues and Trends

ERIC Educational Resources Information Center

Guha, R.; Shields, P.; Tiffany-Morales, J.; Bland, J.; Campbell, A.

2008-01-01

This year's report provides an update on California's teacher workforce and state policies that affect the teacher development system. It examines overall trends in the workforce and discusses the demand for teachers, the distribution of underprepared teachers, and the implementation of a statewide data system to improve the quality and accuracy…

Inclusion of Indigenous Peoples in CONFINTEA VI and Follow-Up Processes

ERIC Educational Resources Information Center

Morrison, Sandra L.; Vaioleti, Timote M.

2011-01-01

This paper discusses key issues raised by indigenous peoples during CONFINTEA VI and proposes strategies to enable them to participate in ongoing processes. Indigenous peoples are not involved in the design, implementation and monitoring of adult education programmes, and this often results in a "one-size-fits-all" model. This article…

Railroad system of Texas: A component of the state and national transportation infrastructure. Research report, September 1996--November 1998

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

Roop, S.S.; Warner, J.E.; Rosa, D.

1998-11-01

Railroads continue to play an important role in the Texas transportation system. This study addresses the potential for implementing a rail planning process in the Texas Department of Transportation. The study is documented in three reports, produced in coordinated and parallel efforts by the Center for Transportation Research and the Texas Transportation Institute. This report documents the work performed by TTI, whereby a rail planning framework is presented which formalizes the planning process and presents the key elements as a series of discrete and logical steps. These steps may be used to guide TxDOT in the formation of goals, identificationmore » of issues and affected parties, selection of appropriate analytical methodologies, location of data sources, and implementation of results. The report also presents an in-depth discussion of several key issues facing transportation agencies. These include rail line abandonment, intermodal service planning, and urban rail rationalization. A discussion of the Texas rail system covers the Class 1 railroads, shortline railroads, Amtrak, and the Mexican rail system.« less

Microorganisms: Good or Evil, MIRRI Provides Biosecurity Awareness.

PubMed

Smith, David; Martin, Dunja; Novossiolova, Tatyana

2017-03-01

The life-science community is a key stakeholder in the effort to ensure that the advances in biotechnology are not misused. Unfortunately, to date, the engagement of life scientists with issues of biosecurity has been limited. Microorganisms have been harnessed for the benefit of humankind but in the wrong hands could be used in direct or indirect acts against humans, livestock, crops, food, water infrastructure and other economically valuable entities. The Microbial Resources Research Infrastructure in its preparatory phase has addressed the topic implementing a code of conduct as part of its programme of prevention of malicious use and continues to work with the international community to raise awareness of best practice to avoid misuse of microorganisms. Biosecurity has become a major concern for several countries creating numerous activities to put in place counter measures, risk assessment, legislation and emergency response. The goal is to implement measures to protect us against malicious use of microorganisms, their products, information and technology transfer. Through this paper, we wish to discuss some of the activities that are underway, mention key educational tools and provide scientists with information on addressing biosecurity issues.

Urban Infrastructure Development Works in India: Delay and Difficulties in Implementation with Reference to a Water Supply Project

NASA Astrophysics Data System (ADS)

Aditya, A. K.; Douglass, David Allen; Bhattacharya, Mahua

2017-09-01

A handsome project is undertaken by the Govt. of India with funding under either foreign investments or from their own resources. Though the projects are targeted to be implemented within a certain time frame these are never achieved because of the frequent delay in implementation. This has caused time and cost overruns as well as delay in delivering the benefits to the commuters. An insight into the critical problems and affairs by the experts who are engaged in the process of execution/implementation through various consultants has brought to light some key recurring issues with remedial measures requiring action from the different stakeholders for such projects.

Supporting interoperability of collaborative networks through engineering of a service-based Mediation Information System (MISE 2.0)

NASA Astrophysics Data System (ADS)

Benaben, Frederick; Mu, Wenxin; Boissel-Dallier, Nicolas; Barthe-Delanoe, Anne-Marie; Zribi, Sarah; Pingaud, Herve

2015-08-01

The Mediation Information System Engineering project is currently finishing its second iteration (MISE 2.0). The main objective of this scientific project is to provide any emerging collaborative situation with methods and tools to deploy a Mediation Information System (MIS). MISE 2.0 aims at defining and designing a service-based platform, dedicated to initiating and supporting the interoperability of collaborative situations among potential partners. This MISE 2.0 platform implements a model-driven engineering approach to the design of a service-oriented MIS dedicated to supporting the collaborative situation. This approach is structured in three layers, each providing their own key innovative points: (i) the gathering of individual and collaborative knowledge to provide appropriate collaborative business behaviour (key point: knowledge management, including semantics, exploitation and capitalisation), (ii) deployment of a mediation information system able to computerise the previously deduced collaborative processes (key point: the automatic generation of collaborative workflows, including connection with existing devices or services) (iii) the management of the agility of the obtained collaborative network of organisations (key point: supervision of collaborative situations and relevant exploitation of the gathered data). MISE covers business issues (through BPM), technical issues (through an SOA) and agility issues of collaborative situations (through EDA).

Gutter oil: an overview of Chinese food safety issues and policies.

PubMed

Li, Jia; Cui, Naixue; Liu, Jianghong

2017-09-01

Food safety has become a focus of attention worldwide. In China, one of the top concerns in food safety is gutter oil, known as 'swill-cooked oil'. This Commentary summarizes the key incidents disclosed to the public by the media, and the policies regarding gutter oil at national, regional, and provincial or city levels. Several challenges the country still faces in tackling this issue are identified, including a lack of evaluation of the implementation and effect of the policies, a lack of effective technology to detect and recycle gutter oil, and the overlooking of the hazardous effect of gutter oil on health. This commentary suggests that strengthening policy implementation and evaluation, improving measurement and recycling technologies, and launching public health campaigns would help eliminate gutter oil from dining tables.

Editorial: Challenges and solutions in GW calculations for complex systems

NASA Astrophysics Data System (ADS)

Giustino, F.; Umari, P.; Rubio, A.

2012-09-01

We report key advances in the area of GW calculations, review the available software implementations and define standardization criteria to render the comparison between GW calculations from different codes meaningful, and identify future major challenges in the area of quasiparticle calculations. This Topical Issue should be a reference point for further developments in the field.

Defense Logistics Agency Disposition Services Afghanistan Disposal Process Needed Improvement

DTIC Science & Technology

2013-11-08

audit, and management was proactive in correcting the deficiencies we identified. DLA DS eliminated backlogs, identified and corrected system ...problems, provided additional system training, corrected coding errors, added personnel to key positions, addressed scale issues, submitted debit...Service Automated Information System to the Reutilization Business Integration2 (RBI) solution. The implementation of RBI in Afghanistan occurred in

Key issues in diagnosing and treating hepatitis C infection.

PubMed

Hainsworth, Terry

A strategy and action plan is in place for the management of hepatitis C. However, recent evidence suggests that this is not being implemented and hepatitis C remains a significant public health concern. This article summarises the condition and potential problems, highlights data from the recent audit of practice and outlines the latest recommendations for managing hepatitis C.

Educational Equality in China: Analysing Educational Policies for Migrant Children in Beijing

ERIC Educational Resources Information Center

Liu, Shuiyun; Liu, Fuxing; Yu, Yafeng

2017-01-01

This paper focuses on the education of migrant children in Beijing. As of the late 1990s, the Chinese Government has developed several policies to address educational issues among migrant children. The present study analyses data from interviews with key education personnel in Beijing to explore the outcomes of the implementation of such migrant…

When Is 100% Not 100%? The Use of Safe Harbor to Make Adequate Yearly Progress

ERIC Educational Resources Information Center

Polikoff, Morgan S.; Wrabel, Stephani L.

2013-01-01

Debate over the design of state and federal accountability systems is an important ongoing issue for policy makers. As we move toward next-generation accountability through No Child Left Behind's (NCLB) waivers and reauthorization drafts, it is important to understand the implementation and effects of key elements of prior accountability systems.…

The Development and Implementation of a Teaching and Learning Strategy at a Modern Military Academy

ERIC Educational Resources Information Center

Thain, Richard Holman; McDonough, Ambrose; Priestley, Alan Duncan

2008-01-01

A strategy for teaching and learning was developed at Britannia Royal Naval College during 2006 in order to address several key issues. These included improving professional knowledge and skills retention, enhancing pedagogical practices to increase levels of student motivation, and adapting the training and educational package to an extremely…

Authenticated multi-user quantum key distribution with single particles

NASA Astrophysics Data System (ADS)

Lin, Song; Wang, Hui; Guo, Gong-De; Ye, Guo-Hua; Du, Hong-Zhen; Liu, Xiao-Fen

2016-03-01

Quantum key distribution (QKD) has been growing rapidly in recent years and becomes one of the hottest issues in quantum information science. During the implementation of QKD on a network, identity authentication has been one main problem. In this paper, an efficient authenticated multi-user quantum key distribution (MQKD) protocol with single particles is proposed. In this protocol, any two users on a quantum network can perform mutual authentication and share a secure session key with the assistance of a semi-honest center. Meanwhile, the particles, which are used as quantum information carriers, are not required to be stored, therefore the proposed protocol is feasible with current technology. Finally, security analysis shows that this protocol is secure in theory.

High-κ/Metal Gate Science and Technology

NASA Astrophysics Data System (ADS)

Guha, Supratik; Narayanan, Vijay

2009-08-01

High-κ/metal gate technology is on the verge of replacing conventional oxynitride dielectrics in state-of-the-art transistors for both high-performance and low-power applications. In this review we discuss some of the key materials issues that complicated the introduction of high-κ dielectrics, including reduced electron mobility, oxygen-based thermal instabilities, and the absence of thermally stable dual-metal electrodes. We show that through a combination of materials innovations and engineering ingenuity these issues were successfully overcome, thereby paving the way for high-κ/metal gate implementation.

Effect of culture on acceptance of telemedicine in Middle Eastern countries: case study of Jordan and Syria.

PubMed

Alajlani, Mohannad; Clarke, Malcolm

2013-04-01

We investigated issues that affect the use and adoption of telemedicine in Middle Eastern countries, taking the Hashemite Kingdom of Jordan and the Syrian Arab Republic as case studies. Our study is based on interviews with key stakeholders (including doctors, technicians, engineers, and decision makers) and questionnaires administered to key stakeholders (including patients), ensuring opinion was gained from people from a full range of backgrounds and roles in the healthcare system. We found doctor and patient resistance was a major issue preventing the adoption of telemedicine in both countries, followed by poor infrastructure, lack of funding, and lack of information technology training. Our research identifies that culture is a greater issue than technical matters for the adoption of telemedicine in Middle Eastern countries. Based on our preliminary results we developed a guideline framework for each country that might be applied to telemedicine projects at the pre-implementation phase. The proposed guideline framework was validated through a return visit to the stakeholders and seeking further opinion.

Using Citygml to Deploy Smart-City Services for Urban Ecosystems

NASA Astrophysics Data System (ADS)

Prandi, F.; De Amicis, R.; Piffer, S.; Soave, M.; Cadzow, S.; Gonzalez Boix, E.; D'Hont, E.

2013-05-01

The rapid technological evolution, which is characterizing all the disciplines involved within the wide concept of smart cities, becomes a key factor to trigger true user-driven innovation. In this context 3D city models will play an increasingly important role in our daily lives and become an essential part of the modern city information infrastructure (Spatial Data Infrastructure). The goal of this paper is to introduce the i-SCOPE (interoperable Smart City services through an Open Platform for urban Ecosystems) project methodology and implementations together with key technologies and open standards. Based on interoperable 3D CityGML UIMs, the aim of i-Scope is to deliver an open platform on top of which it possible to develop, within different domains, various "smart city" services. Moreover, in i-SCOPE different issues, transcending the mere technological domain, are being tackled, including aspects dealing with social and environmental issues. Indeed several tasks including citizen awareness, crowd source and voluntary based data collection as well as privacy issue concerning involved people should be considered.

Detector-device-independent quantum key distribution: Security analysis and fast implementation

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

Boaron, Alberto; Korzh, Boris; Houlmann, Raphael

One of the most pressing issues in quantum key distribution (QKD) is the problem of detector side-channel attacks. To overcome this problem, researchers proposed an elegant “time-reversal” QKD protocol called measurement-device-independent QKD (MDI-QKD), which is based on time-reversed entanglement swapping. But, MDI-QKD is more challenging to implement than standard point-to-point QKD. Recently, we proposed an intermediary QKD protocol called detector-device-independent QKD (DDI-QKD) in order to overcome the drawbacks of MDI-QKD, with the hope that it would eventually lead to a more efficient detector side-channel-free QKD system. We analyze the security of DDI-QKD and elucidate its security assumptions. We find thatmore » DDI-QKD is not equivalent to MDI-QKD, but its security can be demonstrated with reasonable assumptions. On the more practical side, we consider the feasibility of DDI-QKD and present a fast experimental demonstration (clocked at 625 MHz), capable of secret key exchange up to more than 90 km.« less

Detector-device-independent quantum key distribution: Security analysis and fast implementation

DOE PAGES

Boaron, Alberto; Korzh, Boris; Houlmann, Raphael; ...

2016-08-09

One of the most pressing issues in quantum key distribution (QKD) is the problem of detector side-channel attacks. To overcome this problem, researchers proposed an elegant “time-reversal” QKD protocol called measurement-device-independent QKD (MDI-QKD), which is based on time-reversed entanglement swapping. But, MDI-QKD is more challenging to implement than standard point-to-point QKD. Recently, we proposed an intermediary QKD protocol called detector-device-independent QKD (DDI-QKD) in order to overcome the drawbacks of MDI-QKD, with the hope that it would eventually lead to a more efficient detector side-channel-free QKD system. We analyze the security of DDI-QKD and elucidate its security assumptions. We find thatmore » DDI-QKD is not equivalent to MDI-QKD, but its security can be demonstrated with reasonable assumptions. On the more practical side, we consider the feasibility of DDI-QKD and present a fast experimental demonstration (clocked at 625 MHz), capable of secret key exchange up to more than 90 km.« less

Local initiatives to access emergency obstetric and neonatal care in Burkina Faso.

PubMed

Yaméogo, Wambi M E; Ouédraogo, Talatou M; Kouanda, Seni

2016-11-01

To describe the various local initiatives to access emergency obstetric and neonatal care in Burkina Faso. An existing framework was used to review the three processes for local initiatives: emergence, formulation, and implementation. Multiple case studies were conducted, followed by literature review and semi-structured interviews with key informants. Sixteen districts had implemented local initiatives, including cost sharing, free care for women and children, and free care for delivery and cesareans. Most districts (n=10) had implemented the cost-sharing intervention. These initiatives were initiated by local actors as well as nongovernmental organizations. The profile of those involved led to different ways of handling the emergence and formulation processes. At implementation, these initiatives faced many issues including late payment of contributions, low involvement of local governments, and equity in participation. There are some issues in the implementation and sustainability of the local initiatives. Although many initiatives exist, these are unable to fully address the financial barriers to care. However, these initiatives highlight context-based financial barriers that must be taken into account to accelerate universal access to health care. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Comprehensive in vitro Proarrhythmia Assay (CiPA): Pending issues for successful validation and implementation.

PubMed

Cavero, Icilio; Guillon, Jean-Michel; Ballet, Veronique; Clements, Mike; Gerbeau, Jean-Frédéric; Holzgrefe, Henry

2016-01-01

The Comprehensive in vitro Proarrhythmia Assay (CiPA) is a nonclinical Safety Pharmacology paradigm for discovering electrophysiological mechanisms that are likely to confer proarrhythmic liability to drug candidates intended for human use. Key talks delivered at the 'CiPA on my mind' session, held during the 2015 Annual Meeting of the Safety Pharmacology Society (SPS), are summarized. Issues and potential solutions relating to crucial constituents [e.g., biological materials (ion channels and pluripotent stem cell-derived cardiomyocytes), study platforms, drug solutions, and data analysis] of CiPA core assays are critically examined. In order to advance the CiPA paradigm from the current testing and validation stages to a research and regulatory drug development strategy, systematic guidance by CiPA stakeholders is necessary to expedite solutions to pending and newly arising issues. Once a study protocol is proved to yield robust and reproducible results within and across laboratories, it can be implemented as qualified regulatory procedure. Copyright © 2016 Elsevier Inc. All rights reserved.

Adaptive management of natural resources-framework and issues

USGS Publications Warehouse

Williams, B.K.

2011-01-01

Adaptive management, an approach for simultaneously managing and learning about natural resources, has been around for several decades. Interest in adaptive decision making has grown steadily over that time, and by now many in natural resources conservation claim that adaptive management is the approach they use in meeting their resource management responsibilities. Yet there remains considerable ambiguity about what adaptive management actually is, and how it is to be implemented by practitioners. The objective of this paper is to present a framework and conditions for adaptive decision making, and discuss some important challenges in its application. Adaptive management is described as a two-phase process of deliberative and iterative phases, which are implemented sequentially over the timeframe of an application. Key elements, processes, and issues in adaptive decision making are highlighted in terms of this framework. Special emphasis is given to the question of geographic scale, the difficulties presented by non-stationarity, and organizational challenges in implementing adaptive management. ?? 2010.

From theory to 'measurement' in complex interventions: methodological lessons from the development of an e-health normalisation instrument.

PubMed

Finch, Tracy L; Mair, Frances S; O'Donnell, Catherine; Murray, Elizabeth; May, Carl R

2012-05-17

Although empirical and theoretical understanding of processes of implementation in health care is advancing, translation of theory into structured measures that capture the complex interplay between interventions, individuals and context remain limited. This paper aimed to (1) describe the process and outcome of a project to develop a theory-based instrument for measuring implementation processes relating to e-health interventions; and (2) identify key issues and methodological challenges for advancing work in this field. A 30-item instrument (Technology Adoption Readiness Scale (TARS)) for measuring normalisation processes in the context of e-health service interventions was developed on the basis on Normalization Process Theory (NPT). NPT focuses on how new practices become routinely embedded within social contexts. The instrument was pre-tested in two health care settings in which e-health (electronic facilitation of healthcare decision-making and practice) was used by health care professionals. The developed instrument was pre-tested in two professional samples (N=46; N=231). Ratings of items representing normalisation 'processes' were significantly related to staff members' perceptions of whether or not e-health had become 'routine'. Key methodological challenges are discussed in relation to: translating multi-component theoretical constructs into simple questions; developing and choosing appropriate outcome measures; conducting multiple-stakeholder assessments; instrument and question framing; and more general issues for instrument development in practice contexts. To develop theory-derived measures of implementation process for progressing research in this field, four key recommendations are made relating to (1) greater attention to underlying theoretical assumptions and extent of translation work required; (2) the need for appropriate but flexible approaches to outcomes measurement; (3) representation of multiple perspectives and collaborative nature of work; and (4) emphasis on generic measurement approaches that can be flexibly tailored to particular contexts of study.

Towards the Development of a New Model for Best Practice and Knowledge Construction in Virtual Campuses

ERIC Educational Resources Information Center

Cartelli, Antonio; Stansfield, Mark; Connolly, Thomas; Jimoyiannis, Athanassios; Magalhaes, Hugo; Maillet, Katherine

2008-01-01

This paper reports on the work of a European Commission DG Education and Culture co-financed project PBP-VC, Promoting Best Practice in Virtual Campuses, which is aimed at providing a deeper understanding of the key issues and critical success factors underlying the implementation of virtual campuses. The paper outlines a tentative model of issues…

Strategies for integrating computer-based activities into your educational environment: a practical guide.

PubMed Central

Miller, J G; Wolf, F M

1996-01-01

Strategies for implementing instructional technology are based on recent experiences at the University of Michigan Medical Center. The issues covered include 1) addressing facilities, hardware, and staffing needs, 2) determining learners' skill requirements and appropriate training activities, and 3) selecting and customizing educational software. Many examples are provided, and nine key points for success are emphasized. PMID:8653447

An Examination of Performance-Based Teacher Evaluation Systems in Five States. Summary. Issues & Answers. REL 2012-No. 129

ERIC Educational Resources Information Center

Shakman, Karen; Riordan, Julie; Sanchez, Maria Teresa; Cook, Kyle DeMeo; Fournier, Richard; Brett, Jessica

2012-01-01

This study reports on performance-based teacher evaluation systems in five states that have implemented such systems. It investigates two primary research questions: (1) What are the key characteristics of state-level performance-based teacher evaluation systems in the study states?; and (2) How do state teacher evaluation measures, the teaching…

Design and Impacts of a Youth-Directed Café Scientifique Program

ERIC Educational Resources Information Center

Hall, Michelle K.; Foutz, Susan; Mayhew, Michael A.

2013-01-01

We have modified the popular Cafe Scientifique model for engaging adults in dialog on issues at the nexus of science and society to address the specific needs and interests of high-school age youth. Key elements of the model are Youth Leadership Teams that guide the program design and assist with implementation; a speaker preparation process to…

Neoliberal Discourses and the Local Policy Implementation of an English Literacy and Civics Education Program

ERIC Educational Resources Information Center

López, Dina

2015-01-01

The issue of language, specifically access to English, has emerged as a key concern for both U.S. policy-makers and immigrant communities alike. Many of these debates are framed by neoliberal and human capital perspectives, which view English as a set of skills and linguistic capital that are inextricably tied to employment opportunities and…

[Science in a crisis. Medical countermeasures in Ebola virus disease, 2016: lessons learned and perspectives].

PubMed

Malvy, D

2016-10-01

In 2013, the world began to witness an unprecedented Ebola epidemic in West Africa that was smoldering by early 2016. Under this urgent circumstance, the global scientific community organized and made progress in identifying potential preventive countermeasures and therapeutics and accelerated the development of those promising interventions. Trials of experimental interventions soon emerged as a key component of the global response. Hence, an interdisciplinary issue ensued concerning how best to assess clinical safety and effectiveness of potential interventions prior to or concurrent with their broad use in humans. Key issues rely on the close collaboration between research and clinical teams involved in care in the field. Indeed, it is of prime importance to consider cultural dimensions when aiming to build trust within communities and flexibility to adapt trial procedures to field constraints. Trials implemented during the outbreak crisis illustrates challenging inputs for producing scientific and ethical gains for the benefits of vulnerable populations in the context of an international emerging or re-emerging infectious disease event. This includes rapid implementation of clinical research studies from the early phase of the next global outbreak on the basis of practical and ready-to-apply innovative methodological framework built during interepidemic periods.

A Survey to Evaluate Facilitators and Barriers to Quality Measurement and Improvement: Adapting Tools for Implementation Research in Palliative Care Programs.

PubMed

Dy, Sydney M; Al Hamayel, Nebras Abu; Hannum, Susan M; Sharma, Ritu; Isenberg, Sarina R; Kuchinad, Kamini; Zhu, Junya; Smith, Katherine; Lorenz, Karl A; Kamal, Arif H; Walling, Anne M; Weaver, Sallie J

2017-12-01

Although critical for improving patient outcomes, palliative care quality indicators are not yet widely used. Better understanding of facilitators and barriers to palliative care quality measurement and improvement might improve their use and program quality. Development of a survey tool to assess palliative care team perspectives on facilitators and barriers to quality measurement and improvement in palliative care programs. We used the adapted Consolidated Framework for Implementation Research to define domains and constructs to select instruments. We assembled a draft survey and assessed content validity through pilot testing and cognitive interviews with experts and frontline practitioners for key items. We analyzed responses using a constant comparative process to assess survey item issues and potential solutions. We developed a final survey using these results. The survey includes five published instruments and two additional item sets. Domains include organizational characteristics, individual and team characteristics, intervention characteristics, and process of implementation. Survey modules include Quality Improvement in Palliative Care, Implementing Quality Improvement in the Palliative Care Program, Teamwork and Communication, Measuring the Quality of Palliative Care, and Palliative Care Quality in Your Program. Key refinements from cognitive interviews included item wording on palliative care team members, programs, and quality issues. This novel, adaptable instrument assesses palliative care team perspectives on barriers and facilitators for quality measurement and improvement in palliative care programs. Next steps include evaluation of the survey's construct validity and how survey results correlate with findings from program quality initiatives. Copyright © 2017 American Academy of Hospice and Palliative Medicine. All rights reserved.

Problems and issues in implementing innovative curriculum in the developing countries: the Pakistani experience.

PubMed

Ali, Syeda Kauser; Baig, Lubna A

2012-05-16

The Government of Pakistan identified 4 medical Colleges for introduction of COME, one from each province. Curriculum was prepared by the faculty of these colleges and launched in 2001 and despite concerted efforts could not be implemented. The purpose of this research was to identify the reasons for delay in implementation of the COME curriculum and to assess the understanding of the stakeholders about COME. Mixed methods study design was used for data collection. In-depth interviews, mail-in survey questionnaire, and focus group discussions were held with the representatives of federal and provincial governments, Principals of medical colleges, faculty and students of the designated colleges. Rigor was ensured through independent coding and triangulation of data. The reasons for delay in implementation differed amongst the policy makers and faculty and included thematic issues at the institutional, programmatic and curricular level. Majority (92% of the faculty) felt that COME curriculum couldn't be implemented without adequate infrastructure. The administrators were willing to provide financial assistance, political support and better coordination and felt that COME could improve the overall health system of the country whereas the faculty did not agree to it. The paper discusses the reasons of delay based on findings and identifies the strategies for curriculum change in established institutions. The key issues identified in our study included frequent transfer of faculty of the designated colleges and perceived lack of: Continuation at the policy making level. Communication between the stakeholders. Effective leadership.

Problem-based learning in undergraduate medical education: can we really implement it in the West African subregion?

PubMed

Gukas, I D

2007-01-01

A major global pedagogical shift has occurred in the way medicine is taught over the last half a century. Problem-based learning (PBL) has emerged as one of the most popular, of these learner-centred new methods. To examine the evolution and educational principles of PBL and the feasibility of implementing it in the West African subregion. Key literature detailing the history, educational value and principle behind PBL were reviewed. Issues regarding the implication of implementing PBL to West Africa were deduced and suggestions made for the way forward. Since its introduction in McMaster University in Canada in the 60s, PBL has spread all over world. It is rooted in sound educational theories like the Kolb's experiential learning, adult education, collaborative learning, contextual learning and constructivism. Compared to traditionally trained students, PBL students find learning more enjoyable and develop better relational and professional skills. They show more causal reasoning in diagnosis and become better lifelong learners. Issues that may affect its implementation in West Africa include high start up costs, lack of supporting educational technology and relative lack of medical school managers with appropriate medical education background to assess and evaluate such innovations. The evidence for the need for a change from the traditional method of training is overwhelming. Implementation of PBL as an educational method in medical training in the West African subregion is both desirable and practicable if we address some of the issues outlined above.

The clinical, operational, and financial worlds of neonatal palliative care: A focused ethnography.

PubMed

Williams-Reade, Jackie; Lamson, Angela L; Knight, Sharon M; White, Mark B; Ballard, Sharon M; Desai, Priti P

2015-04-01

Due to multiple issues, integrated interdisciplinary palliative care teams in a neonatal intensive care unit (NICU) may be difficult to access, sometimes fail to be implemented, or provide inconsistent or poorly coordinated care. When implementing an effective institution-specific neonatal palliative care program, it is critical to include stakeholders from the clinical, operational, and financial worlds of healthcare. In this study, researchers sought to gain a multidisciplinary perspective into issues that may impact the implementation of a formal neonatal palliative care program at a tertiary regional academic medical center. In this focused ethnography, the primary researcher conducted semistructured interviews that explored the perspectives of healthcare administrators, finance officers, and clinicians about neonatal palliative care. The perspectives of 39 study participants informed the identification of institutional, financial, and clinical issues that impact the implementation of neonatal palliative care services at the medical center and the planning process for a formal palliative care program on behalf of neonates and their families. Healthcare professionals described experiences that influenced their views on neonatal palliative care. Key themes included: (a) uniqueness of neonatal palliative care, (b) communication and conflict among providers, (c) policy and protocol discrepancies, and (d) lack of administrative support. The present study highlighted several areas that are challenging in the provision of neonatal palliative care. Our findings underscored the importance of recognizing and procuring resources needed simultaneously from the clinical, operational, and financial worlds in order to implement and sustain a successful neonatal palliative care program.

Utility Green-Pricing Programs: What Defines Success? (Topical Issues Brief)

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

Swezey, B.; Bird, L.

2001-09-13

''Green pricing'' is an optional service through which customers can support a greater level of investment by their electric utility in renewable energy technologies. Electric utilities in 29 states are now implementing green-pricing programs. This report examines important elements of green-pricing programs, including the different types of programs offered, the premiums charged, customer response, and additional factors that experience indicates are key to the development of successful programs. The best-performing programs tend to share a number of common attributes related to product design, value creation, product pricing, and program implementation. The report ends with a list of ''best practices'' formore » utilities to follow when developing and implementing programs.« less

Comparison of Various Similarity Measures for Average Image Hash in Mobile Phone Application

NASA Astrophysics Data System (ADS)

Farisa Chaerul Haviana, Sam; Taufik, Muhammad

2017-04-01

One of the main issue in Content Based Image Retrieval (CIBR) is similarity measures for resulting image hashes. The main key challenge is to find the most benefits distance or similarity measures for calculating the similarity in term of speed and computing costs, specially under limited computing capabilities device like mobile phone. This study we utilize twelve most common and popular distance or similarity measures technique implemented in mobile phone application, to be compared and studied. The results show that all similarity measures implemented in this study was perform equally under mobile phone application. This gives more possibilities for method combinations to be implemented for image retrieval.

Stakeholder engagement: a key component of integrating genomic information into electronic health records

PubMed Central

Hartzler, Andrea; McCarty, Catherine A.; Rasmussen, Luke V.; Williams, Marc S.; Brilliant, Murray; Bowton, Erica A.; Clayton, Ellen Wright; Faucett, William A.; Ferryman, Kadija; Field, Julie R.; Fullerton, Stephanie M.; Horowitz, Carol R.; Koenig, Barbara A.; McCormick, Jennifer B.; Ralston, James D.; Sanderson, Saskia C.; Smith, Maureen E.; Trinidad, Susan Brown

2014-01-01

Integrating genomic information into clinical care and the electronic health record can facilitate personalized medicine through genetically guided clinical decision support. Stakeholder involvement is critical to the success of these implementation efforts. Prior work on implementation of clinical information systems provides broad guidance to inform effective engagement strategies. We add to this evidence-based recommendations that are specific to issues at the intersection of genomics and the electronic health record. We describe stakeholder engagement strategies employed by the Electronic Medical Records and Genomics Network, a national consortium of US research institutions funded by the National Human Genome Research Institute to develop, disseminate, and apply approaches that combine genomic and electronic health record data. Through select examples drawn from sites of the Electronic Medical Records and Genomics Network, we illustrate a continuum of engagement strategies to inform genomic integration into commercial and homegrown electronic health records across a range of health-care settings. We frame engagement as activities to consult, involve, and partner with key stakeholder groups throughout specific phases of health information technology implementation. Our aim is to provide insights into engagement strategies to guide genomic integration based on our unique network experiences and lessons learned within the broader context of implementation research in biomedical informatics. On the basis of our collective experience, we describe key stakeholder practices, challenges, and considerations for successful genomic integration to support personalized medicine. PMID:24030437

Community, intervention and provider support influences on implementation: reflections from a South African illustration of safety, peace and health promotion.

PubMed

van Niekerk, Ashley; Seedat, Mohamed; Kramer, Sherianne; Suffla, Shahnaaz; Bulbulia, Samed; Ismail, Ghouwa

2014-01-01

The development, implementation and evaluation of community interventions are important for reducing child violence and injuries in low- to middle-income contexts, with successful implementation critical to effective intervention outcomes. The assessment of implementation processes is required to identify the factors that influence effective implementation. This article draws on a child safety, peace and health initiative to examine key factors that enabled or hindered its implementation, in a context characterised by limited resources. A case study approach was employed. The research team was made up of six researchers and intervention coordinators, who led the development and implementation of the Ukuphepha Child Study in South Africa, and who are also the authors of this article. The study used author observations, reflections and discussions of the factors perceived to influence the implementation of the intervention. The authors engaged in an in-depth and iterative dialogic process aimed at abstracting the experiences of the intervention, with a recursive cycle of reflection and dialogue. Data were analysed utilising inductive content analysis, and categorised using classification frameworks for understanding implementation. The study highlights key factors that enabled or hindered implementation. These included the community context and concomitant community engagement processes; intervention compatibility and adaptability issues; community service provider perceptions of intervention relevance and expectations; and the intervention support system, characterised by training and mentorship support. This evaluation illustrated the complexity of intervention implementation. The study approach sought to support intervention fidelity by fostering and maintaining community endorsement and support, a prerequisite for the unfolding implementation of the intervention.

Community, intervention and provider support influences on implementation: reflections from a South African illustration of safety, peace and health promotion

PubMed Central

2014-01-01

Background The development, implementation and evaluation of community interventions are important for reducing child violence and injuries in low- to middle-income contexts, with successful implementation critical to effective intervention outcomes. The assessment of implementation processes is required to identify the factors that influence effective implementation. This article draws on a child safety, peace and health initiative to examine key factors that enabled or hindered its implementation, in a context characterised by limited resources. Methods A case study approach was employed. The research team was made up of six researchers and intervention coordinators, who led the development and implementation of the Ukuphepha Child Study in South Africa, and who are also the authors of this article. The study used author observations, reflections and discussions of the factors perceived to influence the implementation of the intervention. The authors engaged in an in-depth and iterative dialogic process aimed at abstracting the experiences of the intervention, with a recursive cycle of reflection and dialogue. Data were analysed utilising inductive content analysis, and categorised using classification frameworks for understanding implementation. Results The study highlights key factors that enabled or hindered implementation. These included the community context and concomitant community engagement processes; intervention compatibility and adaptability issues; community service provider perceptions of intervention relevance and expectations; and the intervention support system, characterised by training and mentorship support. Conclusions This evaluation illustrated the complexity of intervention implementation. The study approach sought to support intervention fidelity by fostering and maintaining community endorsement and support, a prerequisite for the unfolding implementation of the intervention. PMID:25081088

Social media interventions to prevent HIV: A review of interventions and methodological considerations.

PubMed

Tso, Lai Sze; Tang, Weiming; Li, Haochu; Yan, H Yanna; Tucker, Joseph D

2016-06-01

Persistent new HIV infections and risky behaviors underscore the need for enhanced HIV prevention. Social media interventions may promote safe sexual behaviors, increase HIV testing uptake, and promote safe injection behaviors. This review discusses how social media interventions tap into the wisdom of crowds through crowdsourcing, build peer-mentored communities, and deliver interventions through social networks. Social media HIV prevention interventions are constrained by ethical issues, low social media usage among some key populations, and implementation issues. Comprehensive measurement of social media interventions to prevent HIV is necessary, but requires further development of metrics.

Social media interventions to prevent HIV: A review of interventions and methodological considerations

PubMed Central

Tso, Lai Sze; Tang, Weiming; Li, Haochu; Yan, H. Yanna; Tucker, Joseph D.

2015-01-01

Persistent new HIV infections and risky behaviors underscore the need for enhanced HIV prevention. Social media interventions may promote safe sexual behaviors, increase HIV testing uptake, and promote safe injection behaviors. This review discusses how social media interventions tap into the wisdom of crowds through crowdsourcing, build peer-mentored communities, and deliver interventions through social networks. Social media HIV prevention interventions are constrained by ethical issues, low social media usage among some key populations, and implementation issues. Comprehensive measurement of social media interventions to prevent HIV is necessary, but requires further development of metrics. PMID:26516632

Gender equality and sustainable human development are key issues.

PubMed

Ando, H

1995-01-01

In a message to the Indochina Women's Parliamentarians Meeting, Hirofumi Ando, Deputy Executive Director of the United Nations Family Planning Association (UNFPA), encouraged participants to link gender equality and development issues. Ando noted that many of the goals of the 1994 International Conference on Population and Development imply recognition of the need to redress gender inequalities and empower women. The Program of Action adopted in Cairo requires countries to achieve universal access to primary education and reproductive health care services. Parliamentarians in attendance were urged to mobilize the financial resources and political will necessary to implement programs in these areas.

Unpacking action research and implementation science: Implications for nursing.

PubMed

Casey, Mary; O' Leary, Denise; Coghlan, David

2018-05-01

The aim of this study was to unpack the key concepts of action research and implementation science thereby enabling appropriate use of these methods in nursing. A key issue in action research is not so much the methodology employed to gather data/evidence but who decides the research agenda and who benefits from it. Implementation science is a way to ensure that evidence is translated into practice. The question arises as to how action research and implementation may be understood in relation to one another in nursing. Discussion Paper DATA SOURCES: This discussion paper is based on our own experiences and offers an exploration of action research and implementation science with the aim of clarifying what each involves and what synergies, if any, exist between them. Using action research to secure the voice of patients in their own care is essential to delivering quality nursing care. Using implementation science frameworks to get research evidence into practice is effective. Familiarity with both these concepts may enable their improved use and have a positive impact on quality of care. There is a tension between action researchers and the protagonists of implementation science related to perceived "trade offs" between what constitutes "science" and the necessity of community participation. Nevertheless, the use of an implementation science framework in an action research approach can reduce the research practice time lag and action research provides sound theoretical and philosophical underpinnings that can be used by those in the implementation science field. © 2017 John Wiley & Sons Ltd.

Resource Integration Strategies for Elder Education Organizations: A Case Study in Taichung, Taiwan

ERIC Educational Resources Information Center

Tien, Chi Hu; Tsai, Wen Chi

2013-01-01

Dealing with the aging problem has been a global issue. One of the keys to help successful aging is to implement elder education. The government in Taiwan has invested a lot of budget in elder education, but in practice, there are two independent and diversified elder education systems in Taiwan, which had led to a lack of resource integration, in…

The Role and Use of E-Materials in Vocational Education and Training: The Case of Slovenia

ERIC Educational Resources Information Center

Mažgon, Jasna; Šebart, Mojca Kovac; Štefanc, Damijan

2015-01-01

In the paper some issues and problems regarding the implementation of ICT in initial vocational education and training in Slovenia are discussed. After the brief analysis of the main theoretical characteristics of ICT and e-materials, the key findings from the recent EU survey on the ICT in schools are presented and some conclusions on the basis…

Improving access to emergent spinal care through knowledge translation: an ethnographic study.

PubMed

Webster, Fiona; Fehlings, Michael G; Rice, Kathleen; Malempati, Harsha; Fawaz, Khaled; Nicholls, Fred; Baldeo, Navindra; Reeves, Scott; Singh, Anoushka; Ahn, Henry; Ginsberg, Howard; Yee, Albert J

2014-04-14

For patients and family members, access to timely specialty medical care for emergent spinal conditions is a significant stressor to an already serious condition. Timing to surgical care for emergent spinal conditions such as spinal trauma is an important predictor of outcome. However, few studies have explored ethnographically the views of surgeons and other key stakeholders on issues related to patient access and care for emergent spine conditions. The primary study objective was to determine the challenges to the provision of timely care as well as to identify areas of opportunities to enhance care delivery. An ethnographic study of key administrative and clinical care providers involved in the triage and care of patients referred through CritiCall Ontario was undertaken utilizing standard methods of qualitative inquiry. This comprised 21 interviews with people involved in varying capacities with the provision of emergent spinal care, as well as qualitative observations on an orthopaedic/neurosurgical ward, in operating theatres, and at CritiCall Ontario's call centre. Several themes were identified and organized into categories that range from inter-professional collaboration through to issues of hospital-level resources and the role of relationships between hospitals and external organizations at the provincial level. Underlying many of these issues is the nature of the medically complex emergent spine patient and the scientific evidentiary base upon which best practice care is delivered. Through the implementation of knowledge translation strategies facilitated from this research, a reduction of patient transfers out of province was observed in the one-year period following program implementation. Our findings suggest that competing priorities at both the hospital and provincial level create challenges in the delivery of spinal care. Key stakeholders recognized spinal care as aligning with multiple priorities such as emergent/critical care, medical through surgical, acute through rehabilitative, disease-based (i.e. trauma, cancer), and wait times initiatives. However, despite newly implemented strategies, there continues to be increasing trends over time in the number of spinal CritiCall Ontario referrals. This reinforces the need for ongoing inter-professional efforts in care delivery that take into account the institutional contexts that may constrain individual or team efforts.

Behavioral medicine and clinical health psychology: introduction to the special issue.

PubMed

Christensen, Alan J; Nezu, Arthur M

2013-04-01

This issue represents the 4th Journal of Consulting and Clinical Psychology special issue on behavioral medicine and clinical health psychology over the past 4 decades. Recent developments in health care policy, as well as in the maturation of the science, make a special issue in this area particularly timely. This collection includes state of the clinical science reviews, reports of clinical trials, and articles addressing theory and methods in behavioral medicine and clinical health psychology. A multilevel, ecological perspective that considers multiple levels of influences (e.g., cultural influences on behavior-health linkages, individual differences) is salient throughout many of the articles. Our hope is that this sampling of this broad field, and coverage of some key issues and areas, will play a role in stimulating the next 10 years of research, practice, and policy implementation in behavioral medicine and clinical health psychology.

The diffusion of telehealth in rural American Indian communities: a retrospective survey of key stakeholders.

PubMed

Brooks, Elizabeth; Manson, Spero M; Bair, Byron; Dailey, Nancy; Shore, Jay H

2012-01-01

Mental health issues are a serious concern for many American Indian Veterans, especially for post-traumatic stress disorder and related psychiatric conditions. Yet, acquiring mental health treatment can be a challenge in Native communities where specialized services are largely unavailable. Consequently, telehealth is increasingly being suggested as a way to expand healthcare access on or near reservation lands. In this study, we wanted to understand the factors affecting the diffusion of telehealth clinics that provided mental health care to rural, American Indian Veterans. We surveyed 39 key personnel and stakeholders who were involved in the decision-making process, technological infrastructure, and implementation of three clinics. Using Roger Everett's Diffusion Theory as a framework, we gathered information about specific tasks, factors hindering progress, and personal reactions to telehealth both before and after implementation. Many participants expressed initial concerns about using telehealth; however, most became positive over time. Factors that influenced participants' viewpoint largely included patient and staff feedback and witnessing the fulfillment of a community health need. The use of outside information to support the implementation of the clinics and personal champions also showed considerable influence in the clinics' success. The findings presented here address critical gaps in our understanding of telehealth diffusion and inform research strategies regarding the cultural issues and outcomes related to telemental health services. Information contained in this report serves as a long overdue guide for developing telemental health programs and policies among American Indians, specifically, and rural populations in general.

Australian blue-collar men's health and well-being: contextual issues for workplace health promotion interventions.

PubMed

Du Plessis, Karin; Cronin, David; Corney, Tim; Green, Emma

2013-09-01

In Australia, blue-collar workers are predominantly male and form a unique and large (approximately 30%) subset of the Australian workforce. They exhibit particular health-related issues and, in comparison to other groups, often a lack of health promoting behavior. This article briefly discusses the Australian context and some of the key health issues blue-collar men face, in particular as it relates to construction workers. It reviews the impact of gender and socioeconomic factors in designing workplace health promotion interventions. This article considers practice strategies for health promoters in a specific workplace setting: it looks at meta-factors and industry-based contextual factors, including barriers to implementation and participation, while addressing common misconceptions about Australian blue-collar workers.

Implementing an intravenous insulin protocol in your practice: practical advice to overcome clinical, administrative, and financial barriers.

PubMed

Kelly, Janet L; Hirsch, Irl B; Furnary, Anthony P

2006-01-01

Diabetes mellitus is the fourth most common comorbid condition among hospitalized patients, and 30% of patients undergoing open-heart surgery have diabetes. The link between hyperglycemia and poor outcome has been well described, and large clinical trials have shown that aggressive control of blood glucose with an insulin infusion can improve these outcomes. The barriers to implementing an insulin infusion protocol are numerous, despite the fact that doing so is paramount to clinical success. Barriers include safety concerns, such as fear of hypoglycemia, insufficient nursing staff to patient ratios, lack of administrative and physician support, various system and procedural issues, and resistance to change. Key steps to overcome the barriers include building support with multidisciplinary champions, involving key staff, educating staff, and administrators of the clinical and economic benefits of improving glycemic control, setting realistic goals, selecting a validated insulin infusion protocol, and internally marketing the success of the protocol.

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

PubMed

Valencia-Palomo, G; Rossiter, J A

2011-01-01

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

DMSK: A practical 2400-bps receiver for the mobile satellite service: An MSAT-X Report

NASA Technical Reports Server (NTRS)

Davarian, F.; Simon, M. K.; Sumida, J.

1985-01-01

The partical aspects of a 2400-bps differential detection minimum-shift-keying (DMSK) receiver are investigated. Fundamental issues relating to hardware precision, Doppler shift, fading, and frequency offset are examined, and it is concluded that the receiver's implementation at baseband is more advantageous both in cost and simplicity than its IF implementation. The DMSK receiver has been fabricated and tested under simulated mobile satellite environment conditions. The measured receiver performance in the presence of anomalies pertinent to the link is presented in this report. Furthermore, the receiver behavior in a band-limited channel (GMSK) is also investigated. The DMSK receiver performs substantially better than a coherent minimum-shift-keying (MSK) receiver in a heavily fading environment. The DMSK radio is simple and robust, and results in a lower error floor than its coherent counterpart. Moreover, this receiver is suitable for burst-type signals, and its recovery from deep fades is fast.

Occupant behavior models: A critical review of implementation and representation approaches in building performance simulation programs

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

Hong, Tianzhen; Chen, Yixing; Belafi, Zsofia

Occupant behavior (OB) in buildings is a leading factor influencing energy use in buildings. Quantifying this influence requires the integration of OB models with building performance simulation (BPS). This study reviews approaches to representing and implementing OB models in today’s popular BPS programs, and discusses weaknesses and strengths of these approaches and key issues in integrating of OB models with BPS programs. Two of the key findings are: (1) a common data model is needed to standardize the representation of OB models, enabling their flexibility and exchange among BPS programs and user applications; the data model can be implemented usingmore » a standard syntax (e.g., in the form of XML schema), and (2) a modular software implementation of OB models, such as functional mock-up units for co-simulation, adopting the common data model, has advantages in providing a robust and interoperable integration with multiple BPS programs. Such common OB model representation and implementation approaches help standardize the input structures of OB models, enable collaborative development of a shared library of OB models, and allow for rapid and widespread integration of OB models with BPS programs to improve the simulation of occupant behavior and quantification of their impact on building performance.« less

Occupant behavior models: A critical review of implementation and representation approaches in building performance simulation programs

DOE PAGES

Hong, Tianzhen; Chen, Yixing; Belafi, Zsofia; ...

2017-07-27

Occupant behavior (OB) in buildings is a leading factor influencing energy use in buildings. Quantifying this influence requires the integration of OB models with building performance simulation (BPS). This study reviews approaches to representing and implementing OB models in today’s popular BPS programs, and discusses weaknesses and strengths of these approaches and key issues in integrating of OB models with BPS programs. Two of the key findings are: (1) a common data model is needed to standardize the representation of OB models, enabling their flexibility and exchange among BPS programs and user applications; the data model can be implemented usingmore » a standard syntax (e.g., in the form of XML schema), and (2) a modular software implementation of OB models, such as functional mock-up units for co-simulation, adopting the common data model, has advantages in providing a robust and interoperable integration with multiple BPS programs. Such common OB model representation and implementation approaches help standardize the input structures of OB models, enable collaborative development of a shared library of OB models, and allow for rapid and widespread integration of OB models with BPS programs to improve the simulation of occupant behavior and quantification of their impact on building performance.« less

Scientific integrity - Recent Department of the Interior policies, codes, and their implementation

USGS Publications Warehouse

Thornhill, Alan D.; Coleman, Richard; Gunderson, Linda C.

2017-01-01

Established on January 28, 2011, the Department of Interior's (DOI’s) Scientific and Scholarly Integrity Policy was the first federal agency policy to respond to the Presidential Memorandum on Scientific Integrity (March 9, 2009) and guidance issued by the Office of Science and Technology Policy Memorandum on Scientific Integrity (December 17, 2010). The increasingly important role of science in DOI decision making and heightened awareness of science integrity issues across the science enterprise provided impetus for making this policy a priority and for incorporating it into the DOI Departmental Manual (Part 305: Chapter 3). This paper discusses the history of scientific integrity in the DOI, the key provisions of the first Department-wide policy and its implementation, and the subsequent revision of the policy. During the first 4 years of implementing the scientific integrity policy, the Department received 35 formal complaints. As of March 31, 2015, only two formal scientific integrity complaints resulted in “warranted determinations,” while the other complaints were closed and dismissed as “not warranted.” Based on the experience of the first three years of implementation (2011-2014), the Department policy was revised on December 16, 2014.

Implementing a continuum of evidence-based psychosocial interventions for people with severe mental illness: part 1-review of major initiatives and implementation strategies.

PubMed

Menear, Matthew; Briand, Catherine

2014-04-01

Providing comprehensive care to people with severe mental illness (SMI) involves moving beyond pharmacological treatment and ensuring access to a wide range of evidence-based psychosocial services. Numerous initiatives carried out in North America and internationally have promoted the widespread adoption of such services. Objectives of this rapid review were 3-fold: to identify these implementation initiatives, to describe the implementation strategies used to promote the uptake of psychosocial services, and to identify key issues related to the implementation of a broad range of services. Part 1 presents findings for objectives 1 and 2 of the review. Searches were carried out in MEDLINE and PsycINFO for reports published between 1990 and 2012 using key words related to SMI, psychosocial practices, and implementation. Contacts with experts and reference list and reverse citation searches were also conducted. Fifty-five articles were retained that identified more than a dozen major North American and international implementation initiatives. Initiative leaders employed diverse strategies at the planning, execution, and evaluation stages of the implementation process. Stakeholder meetings, training, ongoing consultation, and quality or fidelity monitoring were strategies consistently adopted across most initiatives, whereas theory-based approaches and organizational- and system-level strategies were less frequently described. Insights from the initiatives identified in this review can help guide future efforts to implement a broad range of psychosocial services for people with SMI. However, such efforts will also need to be informed by more rigorous, theory-based studies of implementation processes and outcomes.

Foundational Report Series: Advanced Distribution Management Systems for Grid Modernization, Implementation Strategy for a Distribution Management System

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

Singh, Ravindra; Reilly, James T.; Wang, Jianhui

Electric distribution utilities encounter many challenges to successful deployment of Distribution Management Systems (DMSs). The key challenges are documented in this report, along with suggestions for overcoming them. This report offers a recommended list of activities for implementing a DMS. It takes a strategic approach to implementing DMS from a project management perspective. The project management strategy covers DMS planning, procurement, design, building, testing, Installation, commissioning, and system integration issues and solutions. It identifies the risks that are associated with implementation and suggests strategies for utilities to use to mitigate them or avoid them altogether. Attention is given to commonmore » barriers to successful DMS implementation. This report begins with an overview of the implementation strategy for a DMS and proceeds to put forward a basic approach for procuring hardware and software for a DMS; designing the interfaces with external corporate computing systems such as EMS, GIS, OMS, and AMI; and implementing a complete solution.« less

Detector-device-independent quantum key distribution: Security analysis and fast implementation

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

Boaron, Alberto; Korzh, Boris; Boso, Gianluca

One of the most pressing issues in quantum key distribution (QKD) is the problem of detector side-channel attacks. To overcome this problem, researchers proposed an elegant “time-reversal” QKD protocol called measurement-device-independent QKD (MDI-QKD), which is based on time-reversed entanglement swapping. However, MDI-QKD is more challenging to implement than standard point-to-point QKD. Recently, an intermediary QKD protocol called detector-device-independent QKD (DDI-QKD) has been proposed to overcome the drawbacks of MDI-QKD, with the hope that it would eventually lead to a more efficient detector side-channel-free QKD system. Here, we analyze the security of DDI-QKD and elucidate its security assumptions. We find thatmore » DDI-QKD is not equivalent to MDI-QKD, but its security can be demonstrated with reasonable assumptions. On the more practical side, we consider the feasibility of DDI-QKD and present a fast experimental demonstration (clocked at 625 MHz), capable of secret key exchange up to more than 90 km.« less

Enhancing and Adapting Treatment Foster Care: Lessons Learned in Trying to Change Practice.

PubMed

Murray, Maureen M; Southerland, Dannia; Farmer, Elizabeth M; Ballentine, Kess

2010-01-01

Evidence-based practices to improve outcomes for children with severe behavioral and emotional problems have received a great deal of attention in children's mental health. Therapeutic Foster Care (TFC), a residential intervention for youth with emotional or behavioral problems, is one of the few community-based programs that is considered to be evidence-based. However, as for most treatment approaches, the vast majority of existing programs do not deliver the evidence-based version. In an attempt to fill this gap and improve practice across a wide range of TFC agencies, we developed an enhanced model of TFC based on input from both practice and research. It includes elements associated with improved outcomes for youth in "usual care" TFC agencies as well as key elements from Chamberlain's evidence-based model. The current manuscript describes this "hybrid" intervention - Together Facing the Challenge - and discusses key issues in implementation. We describe the sample and settings, highlight key implementation strategies, and provide "lessons learned" to help guide others who may wish to change practice in existing agencies.

Tailored combination prevention packages and PrEP for young key populations

PubMed Central

Pettifor, Audrey; Nguyen, Nadia L; Celum, Connie; Cowan, Frances M; Go, Vivian; Hightow-Weidman, Lisa

2015-01-01

Introduction Young key populations, defined in this article as men who have sex with men, transgender persons, people who sell sex and people who inject drugs, are at particularly high risk for HIV. Due to the often marginalized and sometimes criminalized status of young people who identify as members of key populations, there is a need for HIV prevention packages that account for the unique and challenging circumstances they face. Pre-exposure prophylaxis (PrEP) is likely to become an important element of combination prevention for many young key populations. Objective In this paper, we discuss important challenges to HIV prevention among young key populations, identify key components of a tailored combination prevention package for this population and examine the role of PrEP in these prevention packages. Methods We conducted a comprehensive review of the evidence to date on prevention strategies, challenges to prevention and combination prevention packages for young key populations. We focused specifically on the role of PrEP in these prevention packages and on young people under the age of 24, and 18 in particular. Results and discussion Combination prevention packages that include effective, acceptable and scalable behavioural, structural and biologic interventions are needed for all key populations to prevent new HIV infections. Interventions in these packages should meaningfully involve beneficiaries in the design and implementation of the intervention, and take into account the context in which the intervention is being delivered to thoughtfully address issues of stigma and discrimination. These interventions will likely be most effective if implemented in conjunction with strategies to facilitate an enabling environment, including increasing access to HIV testing and health services for PrEP and other prevention strategies, decriminalizing key populations’ practices, increasing access to prevention and care, reducing stigma and discrimination, and fostering community empowerment. PrEP could offer a highly effective, time-limited primary prevention for young key populations if it is implemented in combination with other programs to increase access to health services and encourage the reliable use of PrEP while at risk of HIV exposure. Conclusions Reductions in HIV incidence will only be achieved through the implementation of combinations of interventions that include biomedical and behavioural interventions, as well as components that address social, economic and other structural factors that influence HIV prevention and transmission. PMID:25724507

Never the twain shall meet? - a comparison of implementation science and policy implementation research

PubMed Central

2013-01-01

Background Many of society’s health problems require research-based knowledge acted on by healthcare practitioners together with implementation of political measures from governmental agencies. However, there has been limited knowledge exchange between implementation science and policy implementation research, which has been conducted since the early 1970s. Based on a narrative review of selective literature on implementation science and policy implementation research, the aim of this paper is to describe the characteristics of policy implementation research, analyze key similarities and differences between this field and implementation science, and discuss how knowledge assembled in policy implementation research could inform implementation science. Discussion Following a brief overview of policy implementation research, several aspects of the two fields were described and compared: the purpose and origins of the research; the characteristics of the research; the development and use of theory; determinants of change (independent variables); and the impact of implementation (dependent variables). The comparative analysis showed that there are many similarities between the two fields, yet there are also profound differences. Still, important learning may be derived from several aspects of policy implementation research, including issues related to the influence of the context of implementation and the values and norms of the implementers (the healthcare practitioners) on implementation processes. Relevant research on various associated policy topics, including The Advocacy Coalition Framework, Governance Theory, and Institutional Theory, may also contribute to improved understanding of the difficulties of implementing evidence in healthcare. Implementation science is at a relatively early stage of development, and advancement of the field would benefit from accounting for knowledge beyond the parameters of the immediate implementation science literature. Summary There are many common issues in policy implementation research and implementation science. Research in both fields deals with the challenges of translating intentions into desired changes. Important learning may be derived from several aspects of policy implementation research. PMID:23758952

Never the twain shall meet?--a comparison of implementation science and policy implementation research.

PubMed

Nilsen, Per; Ståhl, Christian; Roback, Kerstin; Cairney, Paul

2013-06-10

Many of society's health problems require research-based knowledge acted on by healthcare practitioners together with implementation of political measures from governmental agencies. However, there has been limited knowledge exchange between implementation science and policy implementation research, which has been conducted since the early 1970s. Based on a narrative review of selective literature on implementation science and policy implementation research, the aim of this paper is to describe the characteristics of policy implementation research, analyze key similarities and differences between this field and implementation science, and discuss how knowledge assembled in policy implementation research could inform implementation science. Following a brief overview of policy implementation research, several aspects of the two fields were described and compared: the purpose and origins of the research; the characteristics of the research; the development and use of theory; determinants of change (independent variables); and the impact of implementation (dependent variables). The comparative analysis showed that there are many similarities between the two fields, yet there are also profound differences. Still, important learning may be derived from several aspects of policy implementation research, including issues related to the influence of the context of implementation and the values and norms of the implementers (the healthcare practitioners) on implementation processes. Relevant research on various associated policy topics, including The Advocacy Coalition Framework, Governance Theory, and Institutional Theory, may also contribute to improved understanding of the difficulties of implementing evidence in healthcare. Implementation science is at a relatively early stage of development, and advancement of the field would benefit from accounting for knowledge beyond the parameters of the immediate implementation science literature. There are many common issues in policy implementation research and implementation science. Research in both fields deals with the challenges of translating intentions into desired changes. Important learning may be derived from several aspects of policy implementation research.

CMS issues updated rules for the Medicare claims appeal process.

PubMed

Davidson, Nancy J

2003-01-01

BIPA requires extensive changes to Medicare's appeal process. However, due to the lack of funding and adequate resources, CMS has been unable to immediately implement many of BIPA's far-reaching changes. CMS is committed to making a transition to the new process as quickly as possible and intends to implement as many key issues as feasible within budget and resource limits. Once Congress allocates funds for the new changes, CMS will be in a better position to implement all aspects of BIPA. [table: see text] The most significant change that BIPA presents is that Congress will require 12 new contractors to handle Part A and Part B appeals. These entities will be known as qualified independent contractors (QICs). CMS has completed development of the requests for proposals needed to solicit bids for the QIC contracts, including full statements of the scope of work (SOW) for these contracts. CMS released the draft SOW on Oct. 7, 2002. It is anticipated that the addition of the QICs will provide a more uniform and consistent handling of Medicare appeals on a national level.

Applying industrial symbiosis to chemical industry: A literature review

NASA Astrophysics Data System (ADS)

Cui, Hua; Liu, Changhao

2017-08-01

Chemical industry plays an important role in promoting the development of global economy and human society. However, the negative effects caused by chemical production cannot be ignored, which often leads to serious resource consumption and environmental pollution. It is essential for chemical industry to achieve a sustainable development. Industrial symbiosis is one of the key topics in the field of industrial ecology and circular economy, which has been identified as a creative path leading to sustainability. Based on an extensively searching for literatures on linking industrial symbiosis with chemical industry, this paper aims to review the literatures which involves three aspects: (1) economic and environmental benefits achieved by chemical industry through implementing industrial symbiosis, (2) chemical eco-industrial parks, (3) and safety issues for chemical industry. An outlook is also provided. This paper concludes that: (1) chemical industry can achieve both economic and environmental benefits by implementing industrial symbiosis, (2) establishing eco-industrial parks is essential for chemical industry to implement and improve industrial symbiosis, and (3) there is a close relationship between IS and safety issues of chemical industry.

Alternative Paths to Diversity: Exploring and Implementing Effective College Admissions Policies. Policy Information Report and ETS Research Report Series No. RR-17-40

ERIC Educational Resources Information Center

Orfield, Gary

2017-01-01

The Supreme Court has established the parameters within which universities can practice race-conscious affirmative action for college admissions in a series of decisions beginning in l978. The key issues concern the educational impact of campus diversity and whether or not it is necessary to give some consideration to students' race into order to…

Prevention Strategies for Healthy Babies and Healthy Children. Hearing before the Select Committee on Children, Youth, and Families. House of Representatives, Ninety-Eighth Congress, First Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Select Committee on Children, Youth, and Families.

Testimony presented in this document covers (1) current initiatives in the Public Health Service agenda to promote and protect the health of mothers and infants and to implement specific prevention activities in child health; (2) key issues in outcome and prevention along the human growth line; (3) recent neuroscience research having implications…

Galvanising the NHS to Adopt Innovation

PubMed Central

Parris, Stuart; Cochrane, Gavin; Marjanovic, Sonja; Ling, Tom; Chataway, Joanna

2016-01-01

Abstract The Department of Health and the Wellcome Trust, in co-operation with NHS England, asked RAND Europe to conduct a limited consultation with key stakeholders about the practicality of measures and incentives proposed as part of the NHS Accelerated Access Review (AAR), which aims to assess the pathways for the development, assessment, and adoption of innovative medicines and medical technology. Through a focused engagement exercise with key healthcare stakeholders this project explored the implications of selected interim AAR propositions and feasibility of implementation for key actors, in primary and secondary care as well as commissioners and academia. Specifically, the project investigated the feasibility of implementation of three specific propositions including: a new earmarked fund to encourage AHSNs and other key innovation actors to re-design systems to embrace innovation; mobilising the influence of clinical system leaders to champion change; and encouraging secondary care organisations to take on “innovation champion” roles linked to financial incentives and a new emphasis on accountable care organisations. Data was collected on the feasibility of the three AAR propositions from a workshop with AHSN CEOs and Commercial Directors and interviews with senior NHS staff in three AHSN regions (South West, University College London Partners, and North East, North Cumbria). The study concludes with reflections on the feasibility of each recommendation and identifies factors expected to facilitate or challenge their implementation, as well as considering the wider cross cutting issues that may influence the adoption and diffusion of innovation in the NHS. PMID:28083436

Supervised toothbrushing programs in primary schools and early childhood settings: A scoping review.

PubMed

Dickson-Swift, V; Kenny, A; Gussy, M; de Silva, A M; Farmer, J; Bracksley-O'Grady, S

2017-12-01

In this article we report the findings of a scoping review that aimed to identify and summarise the range of programs and guidelines available for toothbrushing programs in schools and early childhood settings. Dental caries is one of the most common preventable diseases affecting children worldwide. Untreated caries can impact on child health and wellbeing, development, socialisation and school attendance. Supervised toothbrushing programs in schools and other early childhood settings can be effective in improving the oral health of young children. There is limited understanding of the salient issues to consider when developing such programs or how they are best implemented in real world settings. A scoping review methodology was utilised to provide a summary of the guidelines and programs available. Key search terms were developed, mapped and utilised to identify guidelines and programs across 6 databases and key search engines. We located 26 programs and guidelines that met the inclusion and exclusion criteria for the review. These were collated and summarised across key countries and critical aspects of program development and implementation were identified. Toothbrush type and storage, toothpaste strength and method of dispensing, toothbrush storage, staff training and parental consent are key considerations that varied widely. Guidelines for supervised toothbrushing programs vary within and across countries due to differences in water fluoridation and availability of low fluoride toothpastes. The results of this review provide critical information to be considered when establishing and implementing toothbrushing programs in these settings. Copyright© 2017 Dennis Barber Ltd.

Benefit-finding intervention for Alzheimer caregivers: conceptual framework, implementation issues, and preliminary efficacy.

PubMed

Cheng, Sheung-Tak; Lau, Rosanna W L; Mak, Emily P M; Ng, Natalie S S; Lam, Linda C W

2014-12-01

To describe an intervention promoting benefit-finding in Alzheimer caregivers, to discuss key issues in implementation and ways to resolve them, and to examine whether the intervention reduced burden and depression in a small randomized trial. Twenty-five caregivers were randomized into benefit-finding and psychoeducation groups. Both groups had eight weekly sessions. Outcome measures including role overload, Zarit Burden Interview, and Hamilton depression scale were collected at baseline and after treatment. Results were analyzed using analysis of covariance. Additionally, the challenges of implementing such interventions, some of which related to cultural issues, were analyzed qualitatively. Controlling for pretest, the benefit-finding group had lower depression than the psychoeducation group at post-test, despite the fact that some caregivers found benefit-finding challenging. The two groups did not differ on overload and burden. However, within-group analysis suggested that both groups showed significant reductions in overload from pretest to post-test. In addition, we discussed participants' difficulties in grasping the technique of thought modification for benefit-finding, recording such exercises at home, and sharing their thoughts and experiences in groups. We described measures undertaken in the main trial to overcome these issues. Cognitive approaches focusing on benefit-finding are feasible among Chinese caregivers, with preliminary evidence suggesting an effect on alleviating depression. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

General practice and the New Zealand health reforms – lessons for Australia?

PubMed Central

McAvoy, Brian R; Coster, Gregor D

2005-01-01

New Zealand's health sector has undergone three significant restructures within 10 years. The most recent has involved a Primary Health Care Strategy, launched in 2001. Primary Health Organisations (PHOs), administered by 21 District Health Boards, are the local structures for implementing the Primary Health Care Strategy. Ninety-three percent of the New Zealand population is now enrolled within 79 PHOs, which pose a challenge to the well-established Independent Practitioner Associations (IPAs). Although there was initial widespread support for the philosophy underlying the Primary Health Care Strategy, there are concerns amongst general practitioners (GPs) and their professional organisations relating to its implementation. These centre around 6 main issues: 1. Loss of autonomy 2. Inadequate management funding and support 3. Inconsistency and variations in contracting processes 4. Lack of publicity and advice around enrolment issues 5. Workforce and workload issues 6. Financial risks On the other hand, many GPs are feeling positive regarding the opportunities for PHOs, particularly for being involved in the provision of a wider range of community health services. Australia has much to learn from New Zealand's latest health sector and primary health care reforms. The key lessons concern: • the need for a national primary health care strategy • active engagement of general practitioners and their professional organisations • recognition of implementation costs • the need for infrastructural support, including information technology and quality systems • robust management and governance arrangements • issues related to critical mass and population/distance trade offs in service delivery models PMID:16262908

Lessons Learned by Community Stakeholders in the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) Project, 2013–2014

PubMed Central

Ganter, Claudia; Aftosmes-Tobio, Alyssa; Chuang, Emmeline; Kwass, Jo-Ann; Land, Thomas

2017-01-01

Introduction Childhood obesity is a multifaceted disease that requires sustainable, multidimensional approaches that support change at the individual, community, and systems levels. The Massachusetts Childhood Obesity Research Demonstration project addressed this need by using clinical and public health evidence-based methods to prevent childhood obesity. To date, little information is known about successes and lessons learned from implementing such large-scale interventions. To address this gap, we examined perspectives of community stakeholders from various sectors on successes achieved and lessons learned during the implementation process. Methods We conducted 39 semistructured interviews with key stakeholders from 6 community sectors in 2 low-income communities from November 2013 through April 2014, during project implementation. Interviews were audio-recorded, transcribed, and analyzed by using the constant comparative method. Data were analyzed by using QSR NVivo 10. Results Successes included increased parental involvement in children’s health and education, increased connections within participating organizations and within the broader community, changes in organizational policies and environments to better support healthy living, and improvements in health behaviors in children, parents, and stakeholders. Lessons learned included the importance of obtaining administrative and leadership support, involving key stakeholders early in the program planning process, creating buffers that allow for unexpected changes, and establishing opportunities for regular communication within and across sectors. Conclusion Study findings indicate that multidisciplinary approaches support health behavior change and provide insight into key issues to consider in developing and implementing such approaches in low-income communities. PMID:28125400

'Do no harm'? Professional regulation of disabled nursing students and nurses in Great Britain.

PubMed

Sin, Chih Hoong; Fong, Janice

2008-06-01

This paper is a report of the findings of a General Formal Investigation launched by the Disability Rights Commission, Great Britain into the impact of regulatory fitness standards on disabled people, and on nursing students and nurses in particular. The potential for systemic discrimination against disabled nursing professionals lies in the existence and nature of regulatory fitness standards, as well as in how these are interpreted and implemented in practice. A review of relevant legislation, regulation and guidance was conducted to explore the interaction of the regulatory framework with the Disability Discrimination Act. A formal call to key national stakeholder organizations solicited information on perceptions of the regulatory framework and the adequacy of guidance issued. Independent research was commissioned on disabled people's disclosure of disability, informal and formal decision-making around fitness within the educational, and employment contexts. An Inquiry Panel examined all evidence sources, solicited further oral evidence from key organizations, and developed recommendations. No mention was found of the Disability Discrimination Act in any regulation and guidance governing nursing prior to 2006. There are particular requirements for 'good health and good character'. Respondents from key national stakeholder organizations, higher educational institutions and employers struggle to interpret the fitness requirements consistently. Implementation is variable, with reliance on ad hoc self-initiated strategies. The variability of interpretation and implementation can lead to discrimination against disabled people. The imprecision of fitness requirements and variability of implementation raise serious doubts about their utility in managing risk.

European consensus conference on faecal microbiota transplantation in clinical practice

PubMed Central

Cammarota, Giovanni; Ianiro, Gianluca; Tilg, Herbert; Rajilić-Stojanović, Mirjana; Kump, Patrizia; Satokari, Reetta; Sokol, Harry; Arkkila, Perttu; Pintus, Cristina; Hart, Ailsa; Segal, Jonathan; Aloi, Marina; Masucci, Luca; Molinaro, Antonio; Scaldaferri, Franco; Gasbarrini, Giovanni; Lopez-Sanroman, Antonio; Link, Alexander; de Groot, Pieter; de Vos, Willem M; Högenauer, Christoph; Malfertheiner, Peter; Mattila, Eero; Milosavljević, Tomica; Nieuwdorp, Max; Sanguinetti, Maurizio; Simren, Magnus; Gasbarrini, Antonio

2017-01-01

Faecal microbiota transplantation (FMT) is an important therapeutic option for Clostridium difficile infection. Promising findings suggest that FMT may play a role also in the management of other disorders associated with the alteration of gut microbiota. Although the health community is assessing FMT with renewed interest and patients are becoming more aware, there are technical and logistical issues in establishing such a non-standardised treatment into the clinical practice with safety and proper governance. In view of this, an evidence-based recommendation is needed to drive the practical implementation of FMT. In this European Consensus Conference, 28 experts from 10 countries collaborated, in separate working groups and through an evidence-based process, to provide statements on the following key issues: FMT indications; donor selection; preparation of faecal material; clinical management and faecal delivery and basic requirements for implementing an FMT centre. Statements developed by each working group were evaluated and voted by all members, first through an electronic Delphi process, and then in a plenary consensus conference. The recommendations were released according to best available evidence, in order to act as guidance for physicians who plan to implement FMT, aiming at supporting the broad availability of the procedure, discussing other issues relevant to FMT and promoting future clinical research in the area of gut microbiota manipulation. This consensus report strongly recommends the implementation of FMT centres for the treatment of C. difficile infection as well as traces the guidelines of technicality, regulatory, administrative and laboratory requirements. PMID:28087657

Community Mobilization and Readiness: Planning Flaws which Challenge Effective Implementation of 'Communities that Care' (CTC) Prevention System.

PubMed

Basic, Josipa

2015-01-01

This article reviews the experience of implementing a community approach to drug use and youth delinquency prevention based on the 'Communities that Care' (CTC) system implemented in one Croatian county consisting of 12 communities, 2002 to 2013 (Hawkins, 1999; Hawkins & Catalano, 2004). This overview explores selected critical issues which are often not considered in substance use(r) community intervention planning, implementation as well as in associated process and outcome assessments. These issues include, among others, the mobilization process of adequate representation of people; the involvement of relevant key individual and organizational stakeholders and being aware of the stakeholders' willingness to participate in the prevention process. In addition, it is important to be aware of the stakeholders' knowledge and perceptions about the 'problems' of drug use and youth delinquency in their communities as well as the characteristics of the targeted population(s). Sometimes there are community members and stakeholders who block needed change and therefore prevention process enablers and 'bridges' should be involved in moving prevention programming forward. Another barrier that is often overlooked in prevention planning is community readiness to change and a realistic assessment of available and accessible resources for initiating the planned change(s) and sustaining them. All of these issues have been found to be potentially related to intervention success. At the end of this article, I summarize perspectives from prevention scientists and practitioners and lessons learned from communities' readiness research and practice in Croatian that has international relevance.

What does voice-processing technology support today?

PubMed Central

Nakatsu, R; Suzuki, Y

1995-01-01

This paper describes the state of the art in applications of voice-processing technologies. In the first part, technologies concerning the implementation of speech recognition and synthesis algorithms are described. Hardware technologies such as microprocessors and DSPs (digital signal processors) are discussed. Software development environment, which is a key technology in developing applications software, ranging from DSP software to support software also is described. In the second part, the state of the art of algorithms from the standpoint of applications is discussed. Several issues concerning evaluation of speech recognition/synthesis algorithms are covered, as well as issues concerning the robustness of algorithms in adverse conditions. Images Fig. 3 PMID:7479720

Ten years (1990--1999) of teacher workshops in Investigating and Evaluating Environmental Issues and Actions (IEEIA) curriculum: Teachers' implementation practices and perceptions

NASA Astrophysics Data System (ADS)

Paul, Regina J.

This study examined the success rate of IEEIA inservice training, and attempted to identify key variables that influenced successful implementation of the IEEIA curriculum. The study used both quantitative and qualitative methods to obtain in-depth data. The total sample consisted of 251 participants; 132 usable surveys were returned resulting in a 53% response rate. The quantitative phase of the study consisted of a nine-page survey. The survey was designed to determine the effectiveness of inservice teacher training for the implementation of IEEIA, teachers' implementation, and their perceptions of the effectiveness of the inservice, the impact using IEEIA had on students and themselves, and barriers that prevented complete implementation. Additional analyses examined the relationships between use of the approach with the variables of length and type of training, and support types teachers received. The second phase analyzed both comments written by the respondents on their surveys, and eight teacher interviews. The research found that teachers perceived their workshops to be between moderately to very effective in helping them develop skills related to IEEIA and for teaching them how to implement it with students. Analyses revealed that teachers who received extended training or attended multiple inservices tended to use IEEIA more than teachers who did not. However, the number of years the teachers had been using the approach had a stronger influence for addressing the action components. Over half of the teachers had used the approach. Support after the inservice was important to implementation. The component of having students conduct an actual issue investigation was addressed the most. Fewer teachers addressed the final component of action by having their students resolve the issues they investigated. However, the teachers who fully implemented IEEIA had students who were active in their communities. Teachers perceived using the approach resulted in positive impacts for students, themselves, and their communities.

Space station needs, attributes and architectural options. Volume 4, task 2 and 3: Mission implementation and cost

NASA Technical Reports Server (NTRS)

1983-01-01

An overview of the basic space station infrastructure is presented. A strong case is made for the evolution of the station using the basic Space Transportation System (STS) to achieve a smooth transition and cost effective implementation. The integrated logistics support (ILS) element of the overall station infrastructure is investigated. The need for an orbital transport system capability that is the key to servicing and spacecraft positioning scenarios and associated mission needs is examined. Communication is also an extremely important element and the basic issue of station autonomy versus ground support effects the system and subsystem architecture.

Time-motion analysis of clinical nursing documentation during implementation of an electronic operating room management system for ophthalmic surgery.

PubMed

Read-Brown, Sarah; Sanders, David S; Brown, Anna S; Yackel, Thomas R; Choi, Dongseok; Tu, Daniel C; Chiang, Michael F

2013-01-01

Efficiency and quality of documentation are critical in surgical settings because operating rooms are a major source of revenue, and because adverse events may have enormous consequences. Electronic health records (EHRs) have potential to impact surgical volume, quality, and documentation time. Ophthalmology is an ideal domain to examine these issues because procedures are high-throughput and demand efficient documentation. This time-motion study examines nursing documentation during implementation of an EHR operating room management system in an ophthalmology department. Key findings are: (1) EHR nursing documentation time was significantly worse during early implementation, but improved to a level near but slightly worse than paper baseline, (2) Mean documentation time varied significantly among nurses during early implementation, and (3) There was no decrease in operating room turnover time or surgical volume after implementation. These findings have important implications for ambulatory surgery departments planning EHR implementation, and for research in system design.

Time-Motion Analysis of Clinical Nursing Documentation During Implementation of an Electronic Operating Room Management System for Ophthalmic Surgery

PubMed Central

Read-Brown, Sarah; Sanders, David S.; Brown, Anna S.; Yackel, Thomas R.; Choi, Dongseok; Tu, Daniel C.; Chiang, Michael F.

2013-01-01

Efficiency and quality of documentation are critical in surgical settings because operating rooms are a major source of revenue, and because adverse events may have enormous consequences. Electronic health records (EHRs) have potential to impact surgical volume, quality, and documentation time. Ophthalmology is an ideal domain to examine these issues because procedures are high-throughput and demand efficient documentation. This time-motion study examines nursing documentation during implementation of an EHR operating room management system in an ophthalmology department. Key findings are: (1) EHR nursing documentation time was significantly worse during early implementation, but improved to a level near but slightly worse than paper baseline, (2) Mean documentation time varied significantly among nurses during early implementation, and (3) There was no decrease in operating room turnover time or surgical volume after implementation. These findings have important implications for ambulatory surgery departments planning EHR implementation, and for research in system design. PMID:24551402

Measurement-Device-Independent Quantum Key Distribution Over a 404 km Optical Fiber.

PubMed

Yin, Hua-Lei; Chen, Teng-Yun; Yu, Zong-Wen; Liu, Hui; You, Li-Xing; Zhou, Yi-Heng; Chen, Si-Jing; Mao, Yingqiu; Huang, Ming-Qi; Zhang, Wei-Jun; Chen, Hao; Li, Ming Jun; Nolan, Daniel; Zhou, Fei; Jiang, Xiao; Wang, Zhen; Zhang, Qiang; Wang, Xiang-Bin; Pan, Jian-Wei

2016-11-04

Measurement-device-independent quantum key distribution (MDIQKD) with the decoy-state method negates security threats of both the imperfect single-photon source and detection losses. Lengthening the distance and improving the key rate of quantum key distribution (QKD) are vital issues in practical applications of QKD. Herein, we report the results of MDIQKD over 404 km of ultralow-loss optical fiber and 311 km of a standard optical fiber while employing an optimized four-intensity decoy-state method. This record-breaking implementation of the MDIQKD method not only provides a new distance record for both MDIQKD and all types of QKD systems but also, more significantly, achieves a distance that the traditional Bennett-Brassard 1984 QKD would not be able to achieve with the same detection devices even with ideal single-photon sources. This work represents a significant step toward proving and developing feasible long-distance QKD.

Integrating evidence into policy and sustainable disability services delivery in western New South Wales, Australia: the 'wobbly hub and double spokes' project.

PubMed

Veitch, Craig; Lincoln, Michelle; Bundy, Anita; Gallego, Gisselle; Dew, Angela; Bulkeley, Kim; Brentnall, Jennie; Griffiths, Scott

2012-03-21

Policy that supports rural allied health service delivery is important given the shortage of services outside of Australian metropolitan centres. The shortage of allied health professionals means that rural clinicians work long hours and have little peer or service support. Service delivery to rural and remote communities is further complicated because relatively small numbers of clients are dispersed over large geographic areas. The aim of this five-year multi-stage project is to generate evidence to confirm and develop evidence-based policies and to evaluate their implementation in procedures that allow a regional allied health workforce to more expeditiously respond to disability service need in regional New South Wales, Australia. The project consists of four inter-related stages that together constitute a full policy cycle. It uses mixed quantitative and qualitative methods, guided by key policy concerns such as: access, complexity, cost, distribution of benefits, timeliness, effectiveness, equity, policy consistency, and community and political acceptability. Stage 1 adopts a policy analysis approach in which existing relevant policies and related documentation will be collected and reviewed. Policy-makers and senior managers within the region and in central offices will be interviewed about issues that influence policy development and implementation. Stage 2 uses a mixed methods approach to collecting information from allied health professionals, clients, and carers. Focus groups and interviews will explore issues related to providing and receiving allied health services. Discrete Choice Experiments will elicit staff and client/carer preferences. Stage 3 synthesises Stage 1 and 2 findings with reference to the key policy issues to develop and implement policies and procedures to establish several innovative regional workforce and service provision projects. Stage 4 uses mixed methods to monitor and evaluate the implementation and impact of new or adapted policies that arise from the preceding stages. The project will provide policy makers with research evidence to support consideration of the complex balance between: (i) the equitable allocation of scarce resources; (ii) the intent of current eligibility and prioritisation policies; (iii) workforce constraints (and strengths); and (iv) the most effective, evidence-based clinical practice.

Averting a pandemic health crisis in Europe by 2020: what physicians need to know regarding cholesterol management.

PubMed

Catapano, Alberico L; Pedersen, Terje R; de Backer, Guy

2007-04-01

Cardiovascular disease (CVD) represents a major cause of premature death, disability, and escalating healthcare costs throughout Europe. According to a recent report by the Stockholm Network (an independent European 'think tank'), major political, economic, social, and medical changes are urgently needed with respect to cholesterol management to help prevent CVD. To identify key cholesterol management issues that practitioners should consider to help prevent an impending European health crisis, our collective experience of policies and practices relating to CVD and cholesterol management in our respective countries was consolidated and used to develop this commentary. Physicians and healthcare workers are uniquely positioned to make immediate and meaningful improvements in preventing and treating CVD if they recognize and address a handful of key clinical issues pertaining to cholesterol management. These issues include utilizing newer combination therapies and realizing the limitations of statins, improving compliance with cholesterol-lowering therapies, promoting a healthy lifestyle and diet, making treatment decisions based on patients' total CVD risk, fostering communication between primary and secondary providers, and soliciting governmental funding to implement disease management programmes. By promptly and effectively addressing these cholesterol management issues, physicians and other healthcare professionals have an unprecedented opportunity to help reduce CVD in Europe to lessen the personal, social, and economic impact of this devastating disease.

The gap between law and ethics in human embryonic stem cell research: overcoming the effect of U.S. federal policy on research advances and public benefit.

PubMed

Taylor, Patrick L

2005-10-01

Key ethical issues arise in association with the conduct of stem cell research by research institutions in the United States. These ethical issues, summarized in detail, receive no adequate translation into federal laws or regulations, also described in this article. U.S. Federal policy takes a passive approach to these ethical issues, translating them simply into limitations on taxpayer funding, and foregoes scientific and ethical leadership while protecting intellectual property interests through a laissez faire approach to stem cell patents and licenses. Those patents and licenses, far from being scientifically and ethically neutral in effect, virtually prohibit commercially sponsored research that could otherwise be a realistic alternative to the federal funding gap. The lack of federal funding and related data-sharing principles, combined with the effect of U.S. patent policy, the lack of key agency guidance, and the proliferation of divergent state laws arising from the lack of Federal leadership, significantly impede ethical stem cell research in the United States, without coherently supporting any consensus ethical vision. Research institutions must themselves implement steps, described in the article, to integrate addressing ethical review with the many legal compliance issues U.S. federal and state laws create.

Universal financial protection through National Health Insurance: a stakeholder analysis of the proposed one-time premium payment policy in Ghana.

PubMed

Abiiro, Gilbert Abotisem; McIntyre, Di

2013-05-01

Extending coverage to the informal sector is a key challenge to achieving universal coverage through contributory health insurance schemes. Ghana introduced a mandatory National Health Insurance system in 2004 to provide financial protection for both the formal and informal sectors through a combination of taxes and annual premium payments. As part of its election promise in 2008, the current government (then in opposition) promised to make the payment of premiums 'one-time'. This has been a very controversial policy issue in Ghana. This study sought to contribute to assessing the feasibility of the proposed policy by exploring the understandings of various stakeholders on the policy, their interests or concerns, potential positions, power and influences on it, as well as the general prospects and challenges for its implementation. Data were gathered from a review of relevant documents in the public domain, 28 key informant interviews and six focus group discussions with key stakeholders in Accra and two other districts. The results show that there is a lot of confusion in stakeholders' understanding of the policy issue, and, because of the uncertainties surrounding it, most powerful stakeholders are yet to take clear positions on it. However, stakeholders raised concerns that revolved around issues such as: the meaning of a one-time premium within an insurance scheme context, the affordability of the one-time premium, financing sources and sustainability of the policy, as well as the likely impact of the policy on equity in access to health care. Policy-makers need to clearly explain the meaning of the one-time premium policy and how it will be funded, and critically consider the concerns raised by stakeholders before proceeding with further attempts to implement it. For other countries planning universal coverage reforms, it is important that the terminology of their reforms clearly reflects policy objectives.

Supporting decision-making processes for evidence-based mental health promotion.

PubMed

Jané-Llopis, Eva; Katschnig, Heinz; McDaid, David; Wahlbeck, Kristian

2011-12-01

The use of evidence is critical in guiding decision-making, but evidence from effect studies will be only one of a number of factors that will need to be taken into account in the decision-making processes. Equally important for policymakers will be the use of different types of evidence including implementation essentials and other decision-making principles such as social justice, political, ethical, equity issues, reflecting public attitudes and the level of resources available, rather than be based on health outcomes alone. This paper, aimed to support decision-makers, highlights the importance of commissioning high-quality evaluations, the key aspects to assess levels of evidence, the importance of supporting evidence-based implementation and what to look out for before, during and after implementation of mental health promotion and mental disorder prevention programmes.

A Framework for Enhancing the Value of Research for Dissemination and Implementation

PubMed Central

Glasgow, Russell E.; Carpenter, Christopher R.; Grimshaw, Jeremy M.; Rabin, Borsika A.; Fernandez, Maria E.; Brownson, Ross C.

2015-01-01

A comprehensive guide that identifies critical evaluation and reporting elements necessary to move research into practice is needed. We propose a framework that highlights the domains required to enhance the value of dissemination and implementation research for end users. We emphasize the importance of transparent reporting on the planning phase of research in addition to delivery, evaluation, and long-term outcomes. We highlight key topics for which well-established reporting and assessment tools are underused (e.g., cost of intervention, implementation strategy, adoption) and where such tools are inadequate or lacking (e.g., context, sustainability, evolution) within the context of existing reporting guidelines. Consistent evaluation of and reporting on these issues with standardized approaches would enhance the value of research for practitioners and decision-makers. PMID:25393182

Considering health equity when moving from evidence-based guideline recommendations to implementation: a case study from an upper-middle income country on the GRADE approach

PubMed Central

Mosquera, Paola; Alzate, Juan Pablo; Pottie, Kevin; Welch, Vivian; Akl, Elie A; Jull, Janet; Lang, Eddy; Katikireddi, Srinivasa Vittal; Morton, Rachel; Thabane, Lehana; Shea, Bev; Stein, Airton T; Singh, Jasvinder; Florez, Ivan D; Guyatt, Gordon; Schünemann, Holger; Tugwell, Peter

2017-01-01

Abstract The availability of evidence-based guidelines does not ensure their implementation and use in clinical practice or policy making. Inequities in health have been defined as those inequalities within or between populations that are avoidable, unnecessary and also unjust and unfair. Evidence-based clinical practice and public health guidelines (‘guidelines’) can be used to target health inequities experienced by disadvantaged populations, although guidelines may unintentionally increase health inequities. For this reason, there is a need for evidence-based clinical practice and public health guidelines to intentionally target health inequities experienced by disadvantaged populations. Current guideline development processes do not include steps for planned implementation of equity-focused guidelines. This article describes nine steps that provide guidance for consideration of equity during guideline implementation. A critical appraisal of the literature followed by a process to build expert consensus was undertaken to define how to include consideration of equity issues during the specific GRADE guideline development process. Using a case study from Colombia we describe nine steps that were used to implement equity-focused GRADE recommendations: (1) identification of disadvantaged groups, (2) quantification of current health inequities, (3) development of equity-sensitive recommendations, (4) identification of key actors for implementation of equity-focused recommendations, (5) identification of barriers and facilitators to the implementation of equity-focused recommendations, (6) development of an equity strategy to be included in the implementation plan, (7) assessment of resources and incentives, (8) development of a communication strategy to support an equity focus and (9) development of monitoring and evaluation strategies. This case study can be used as model for implementing clinical practice guidelines, taking into account equity issues during guideline development and implementation. PMID:29029068

Evaluating the use of key performance indicators to evidence the patient experience.

PubMed

McCance, Tanya; Hastings, Jack; Dowler, Hilda

2015-11-01

To test eight person-centred key performance indicators and the feasibility of an appropriate measurement framework as an approach to evidencing the patient experience. The value of measuring the quality of patient care is undisputed in the international literature, however, the type of measures that can be used to generate data that is meaningful for practice continues to be debated. This paper offers a different perspective to the 'measurement' of the nursing and midwifery contribution to the patient experience. Fourth generation evaluation was the methodological approach used to evaluate the implementation of the key performance indicators and measurement framework across three participating organisations involving nine practice settings. Data were collected by repeated use of claims, concerns and issues with staff working across nine participating sites (n = 18) and the senior executives from the three partner organisations (n = 12). Data were collected during the facilitated sessions with stakeholders and analysed in conjunction with the data generated from the measurement framework. The data reveal the inherent value placed on the evidence generated from the implementation of the key performance indicators as reflected in the following themes: measuring what matters; evidencing the patient experience; engaging staff; a focus for improving practice; and articulating and demonstrating the positive contribution of nursing and midwifery. The implementation of the key performance indicators and the measurement framework has been effective in generating evidence that demonstrates the patient experience. The nature of the data generated not only privileges the patient voice but also offers feedback to nurses and midwives that can inform the development of person-centred cultures. The use of these indicators will produce evidence of patient experience that can be used by nurse and midwives to celebrate and further inform person-centred practice. © 2015 John Wiley & Sons Ltd.

The quest for engaging AmI: Patient engagement and experience design tools to promote effective assisted living.

PubMed

Triberti, Stefano; Barello, Serena

2016-10-01

Recent research highlights that patient engagement, conceived as a patient's behavioral, cognitive and emotional commitment to his own care management, is a key issue while implementing new technologies in the healthcare process. Indeed, eHealth interventions may systematically fail when the patient's subjective experience has not been taken into consideration since the first steps of the technology design. In the present contribution, we argue that such an issue is more and more crucial as regarded to the field of Ambient Intelligence (AmI). Specifically, the exact concept of technologies embedded in the patients' surrounding environment implies a strong impact on their everyday life, which can be perceived as a limitation to autonomy and privacy, and therefore refused or even openly opposed by the final users. The present contribution tackles this issue directly, highlighting: (1) a theoretical framework to include patient engagement in the design of AmI technologies; (2) assessment measures for patient engagement while developing and testing the effectiveness of AmI prototypes for healthcare. Finally (3) this contribution provides an overview of the main issues emerging while implementing AmI technologies and suggests specific design solutions to address them. Copyright © 2016 Elsevier Inc. All rights reserved.

Assessing Community Readiness to Reduce Childhood Diarrheal Disease and Improve Food Security in Dioro, Mali.

PubMed

Borresen, Erica C; Stone, Cordelia; Boré, Abdoulaye; Cissoko, Alima; Maiga, Ababacar; Koita, Ousmane A; Ryan, Elizabeth P

2016-06-08

Diarrhea and malnutrition represent leading causes of death for children in Mali. Understanding a community's needs and ideas are critical to ensure the success of prevention and treatment interventions for diarrheal disease, as well as to improve food security to help reduce malnutrition. The objective of this study was to incorporate the Community Readiness Model (CRM) for the issues of childhood diarrheal disease and food security in Mali to measure baseline community readiness prior to any program implementation. Thirteen key respondents residing in Dioro, Mali were selected based on varied social roles and demographics and completed two questionnaires on these public health issues. The overall readiness score to reduce childhood diarrheal disease was 5.75 ± 1.0 standard deviation (preparation stage). The overall readiness score to improve food security was 5.5 ± 0.5 standard deviation (preparation stage). The preparation stage indicates that at least some of the community have basic knowledge regarding these issues, and want to act locally to reduce childhood diarrhea and improve food security and nutrition. Proposed activities to increase community readiness on these issues are provided and are broad enough to allow opportunities to implement community- and culturally-specific activities by the Dioro community.

Managing Senegalese water resources: Definition and relative importance of information needs

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

Engi, D.

1998-09-01

This report provides an overview of the results of the Vital Issues process as implemented for the Senegal Water Resources Management Initiative, a collaborative effort between the Senegalese Ministry of Water Resources and Sandia National Laboratories. This Initiative is being developed to assist in the development of an efficient and sustainable water resources management system for Senegal. The Vital Issues process was used to provide information for the development of a proposal that will recommend actions to address the key management issues and establish a state-of-the-art decision support system (DSS) for managing Senegal`s water resources. Three Vital Issues panel meetingsmore » were convened to (1) develop a goal statement and criteria for identifying and ranking the issues vital to water resources management in Senegal; (2) define and rank the issues, and (3) identify and prioritize a preliminary list of information needed to address the vital issues. The selection of panelists from the four basic institutional perspectives (government, industry, academe, and citizens` interest groups) ensured a high level of stakeholder representation on the panels.« less

Adapting the Quebecois method for assessing implementation to the French National Alzheimer Plan 2008–2012: lessons for gerontological services integration

PubMed Central

Somme, Dominique; Trouvé, Hélène; Perisset, Catherine; Corvol, Aline; Ankri, Joël; Saint-Jean, Olivier; de Stampa, Matthieu

2014-01-01

Introduction Many countries face ageing-related demographic and epidemiological challenges, notably neurodegenerative disorders, due to the multiple care services they require, thereby pleading for a more integrated system of care. The integrated Quebecois method issued from the Programme of Research to Integrate Services for the Maintenance of Autonomy inspired a French pilot experiment and the National Alzheimer Plan 2008–2012. Programme of Research to Integrate Services for the Maintenance of Autonomy method implementation was rated with an evaluation grid adapted to assess its successive degrees of completion. Discussion The approaching end of the president's term led to the method's institutionalization (2011–2012), before the implementation study ended. When the government changed, the study was interrupted. The results extracted from that ‘lost’ study (presented herein) have, nonetheless, ‘found’ some key lessons. Key lessons/conclusion It was possible to implement a Quebecois integrated-care method in France. We describe the lessons and pitfalls encountered in adapting this evaluation tool. This process is necessarily multidisciplinary and requires a test phase. A simple tool for quantitative assessment of integration was obtained. The first assessment of the tool was unsatisfactory but requires further studies. In the meantime, we recommend using mixed methodologies to assess the services integration level. PMID:24959112

The cognitive nature of action - functional links between cognitive psychology, movement science, and robotics.

PubMed

Schack, Thomas; Ritter, Helge

2009-01-01

This paper examines the cognitive architecture of human action, showing how it is organized over several levels and how it is built up. Basic action concepts (BACs) are identified as major building blocks on a representation level. These BACs are cognitive tools for mastering the functional demands of movement tasks. Results from different lines of research showed that not only the structure formation of mental representations in long-term memory but also chunk formation in working memory are built up on BACs and relate systematically to movement structures. It is concluded that such movement representations might provide the basis for action implementation and action control in skilled voluntary movements in the form of cognitive reference structures. To simulate action implementation we discuss challenges and issues that arise when we try to replicate complex movement abilities in robots. Among the key issues to be addressed is the question how structured representations can arise during skill acquisition and how the underlying processes can be understood sufficiently succinctly to replicate them on robot platforms. Working towards this goal, we translate our findings in studies of motor control in humans into models that can guide the implementation of cognitive robot architectures. Focusing on the issue of manual action control, we illustrate some results in the context of grasping with a five-fingered anthropomorphic robot hand.

[Implementation of precision control to achieve the goal of schistosomiasis elimination in China].

PubMed

Zhou, Xiao-nong

2016-02-01

The integrated strategy for schistosomiasis control with focus on infectious source control, which has been implemented since 2004, accelerated the progress towards schistosomiasis control in China, and achieved transmission control of the disease across the country by the end of 2015, which achieved the overall objective of the Mid- and Long-term National Plan for Prevention and Control of Schistosomiasis (2004-2015) on schedule. Then, the goal of schistosomiasis elimination by 2025 was proposed in China in 2014. To achieve this new goal on schedule, we have to address the key issues, and implement precision control measures with more precise identification of control targets, so that we are able to completely eradicate the potential factors leading to resurgence of schistosomiasis transmission and enable the achievement of schistosomiasis elimination on schedule. Precision schistosomiasis control, a theoretical innovation of precision medicine in schistosomiasis control, will provide new insights into schistosomiasis control based on the conception of precision medicine. This paper describes the definition, interventions and the role of precision schistosomiasis control in the elimination of schistosomiasis in China, and demonstrates that sustainable improvement of professionals and integrated control capability at grass-root level is a prerequisite to the implementation of schistosomiasis control, precision schistosomiasis control is a key to the further implementation of the integrated strategy for schistosomiasis control with focus on infectious source control, and precision schistosomiasis control is a guarantee of curing schistosomiasis patients and implementing schistosomiasis control program and interventions.

Commentary: Pediatric eHealth Interventions: Common Challenges During Development, Implementation, and Dissemination

PubMed Central

Steele, Ric G.; Connelly, Mark A.; Palermo, Tonya M.; Ritterband, Lee M.

2014-01-01

Objective To provide an overview of common challenges that pediatric eHealth researchers may encounter when planning, developing, testing, and disseminating eHealth interventions along with proposed solutions for addressing these challenges. Methods The article draws on the existing eHealth literature and the authors’ collective experience in pediatric eHealth research. Results and conclusions The challenges associated with eHealth interventions and their proposed solutions are multifaceted and cut across a number of areas from eHealth program development through dissemination. Collaboration with a range of individuals (e.g., multidisciplinary colleagues, commercial entities, primary stakeholders) is the key to eHealth intervention success. To ensure adequate resources for design, development, and planning for sustainability, a number of public and private sources of funding are available. A study design that addresses ethical concerns and security issues is critical to ensure scientific integrity and intervention dissemination. Table I summarizes key issues to consider during eHealth intervention development, testing, and dissemination. PMID:24816766

Impact of the Patient-Reported Outcomes Management Information System (PROMIS) upon the design and operation of multi-center clinical trials: a qualitative research study.

PubMed

Eisenstein, Eric L; Diener, Lawrence W; Nahm, Meredith; Weinfurt, Kevin P

2011-12-01

New technologies may be required to integrate the National Institutes of Health's Patient Reported Outcome Management Information System (PROMIS) into multi-center clinical trials. To better understand this need, we identified likely PROMIS reporting formats, developed a multi-center clinical trial process model, and identified gaps between current capabilities and those necessary for PROMIS. These results were evaluated by key trial constituencies. Issues reported by principal investigators fell into two categories: acceptance by key regulators and the scientific community, and usability for researchers and clinicians. Issues reported by the coordinating center, participating sites, and study subjects were those faced when integrating new technologies into existing clinical trial systems. We then defined elements of a PROMIS Tool Kit required for integrating PROMIS into a multi-center clinical trial environment. The requirements identified in this study serve as a framework for future investigators in the design, development, implementation, and operation of PROMIS Tool Kit technologies.

Impact of the Patient-Reported Outcomes Management Information System (PROMIS) upon the Design and Operation of Multi-center Clinical Trials: a Qualitative Research Study

PubMed Central

Diener, Lawrence W.; Nahm, Meredith; Weinfurt, Kevin P.

2013-01-01

New technologies may be required to integrate the National Institutes of Health’s Patient Reported Outcome Management Information System (PROMIS) into multi-center clinical trials. To better understand this need, we identified likely PROMIS reporting formats, developed a multi-center clinical trial process model, and identified gaps between current capabilities and those necessary for PROMIS. These results were evaluated by key trial constituencies. Issues reported by principal investigators fell into two categories: acceptance by key regulators and the scientific community, and usability for researchers and clinicians. Issues reported by the coordinating center, participating sites, and study subjects were those faced when integrating new technologies into existing clinical trial systems. We then defined elements of a PROMIS Tool Kit required for integrating PROMIS into a multi-center clinical trial environment. The requirements identified in this study serve as a framework for future investigators in the design, development, implementation, and operation of PROMIS Tool Kit technologies. PMID:20703765

Measurement-Device-Independent Quantum Cryptography

NASA Astrophysics Data System (ADS)

Tang, Zhiyuan

Quantum key distribution (QKD) enables two legitimate parties to share a secret key even in the presence of an eavesdropper. The unconditional security of QKD is based on the fundamental laws of quantum physics. Original security proofs of QKD are based on a few assumptions, e.g., perfect single photon sources and perfect single-photon detectors. However, practical implementations of QKD systems do not fully comply with such assumptions due to technical limitations. The gap between theory and implementations leads to security loopholes in most QKD systems, and several attacks have been launched on sophisticated QKD systems. Particularly, the detectors have been found to be the most vulnerable part of QKD. Much effort has been put to build side-channel-free QKD systems. Solutions such as security patches and device-independent QKD have been proposed. However, the former are normally ad-hoc, and cannot close unidentified loopholes. The latter, while having the advantages of removing all assumptions on devices, is impractical to implement today. Measurement-device-independent QKD (MDI-QKD) turns out to be a promising solution to the security problem of QKD. In MDI-QKD, all security loopholes, including those yet-to-be discovered, have been removed from the detectors, the most critical part in QKD. In this thesis, we investigate issues related to the practical implementation and security of MDI-QKD. We first present a demonstration of polarization-encoding MDI-QKD. Taking finite key effect into account, we achieve a secret key rate of 0.005 bit per second (bps) over 10 km spooled telecom fiber, and a 1600-bit key is distributed. This work, together with other demonstrations, shows the practicality of MDI-QKD. Next we investigate a critical assumption of MDI-QKD: perfect state preparation. We apply the loss-tolerant QKD protocol and adapt it to MDI-QKD to quantify information leakage due to imperfect state preparation. We then present an experimental demonstration of MDI-QKD over 10 km and 40 km of spooled fiber, which for the first time considers the impact of inaccurate polarization state preparation on the secret key rate. This would not have been possible under previous security proofs, given the same amount of state preparation flaws.

The role of socioscientific issues in biology teaching: from the perspective of teachers

NASA Astrophysics Data System (ADS)

Tidemand, Sofie; Nielsen, Jan Alexis

2017-01-01

Previous research has documented that students who engage with socioscientific issues can acquire some of the complex competences and skills typically related to scientific literacy. But an emerging field of research on science teachers' understanding and use of socioscientific issues, has documented that a range of challenges hinders the uptake of socioscientific issues. In this study, we investigated the interpretation and implementation of socioscientific issues among Danish biology teachers. We conducted five in-depth group interviews and validated the emergent themes from the teachers' talk-in-interaction by distributing a questionnaire. Our findings suggest that the participating teachers generally harbour a content-centred interpretation of socioscientific issues which manifests itself in at least three separate ways. First, the teachers generally use socioscientific issues as a vehicle to teach factual biological content. Second, the teachers emphasised mastery of factual content in their assessment. Third, the teachers tended to reduce socioscientific issues to specific biological contents in a way may preclude students from engaging with the real socioscientific issue. Our findings are particularly significant for science educators, policy-makers and curriculum designers, as we argue that key aspects of this content-centred interpretation may be a coping strategy used to navigate a divided curriculum.

WHO Treatment Guidelines for Drug-Resistant Tuberculosis, 2016 Update: Applicability in South Korea

PubMed Central

2017-01-01

Despite progress made in tuberculosis control worldwide, the disease burden and treatment outcome of multidrug-resistant tuberculosis (MDR-TB) patients have remained virtually unchanged. In 2016, the World Health Organization released new guidelines for the management of MDR-TB. The guidelines are intended to improve detection rate and treatment outcome for MDR-TB through novel, rapid molecular testing and shorter treatment regimens. Key changes include the introduction of a new, shorter MDR-TB treatment regimen, a new classification of medicines and updated recommendations for the conventional MDR-TB regimen. This paper will review these key changes and discuss the potential issues with regard to the implementation of these guidelines in South Korea. PMID:28905529

Satellite mirror systems for providing terrestrial power - System concept

NASA Technical Reports Server (NTRS)

Billman, K. W.; Gilbreath, W. P.; Bowen, S. W.

1978-01-01

A system of orbiting reflectors, SOLARES, has been studied as a possible means of providing terrestrial power with a space system of minimum mass and complexity. The key impact that such a system, providing continuous and slightly concentrated insolation, makes on the economic viability of solar farming is demonstrated. New developments in solar sailing are incorporated to reduce mirror mass and transportation cost. The system is compatible with incremental implementation and continual expansion to produce the world's power needs. Key technology, environmental, and economic issues and payoffs are identified. SOLARES appears to be economically superior to other advanced, and even conventional, energy systems and could be scaled to completely abate our fossil fuel usage for power generation.

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

PubMed Central

Shoup, Jo Ann; Glasgow, Russell E.

2013-01-01

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

A multi-level qualitative analysis of Telehomecare in Ontario: challenges and opportunities.

PubMed

Hunting, Gemma; Shahid, Nida; Sahakyan, Yeva; Fan, Iris; Moneypenny, Crystal R; Stanimirovic, Aleksandra; North, Taylor; Petrosyan, Yelena; Krahn, Murray D; Rac, Valeria E

2015-12-09

Despite research demonstrating the potential effectiveness of Telehomecare for people with Chronic Obstructive Pulmonary Disease and Heart Failure, broad-scale comprehensive evaluations are lacking. This article discusses the qualitative component of a mixed-method program evaluation of Telehomecare in Ontario, Canada. The objective of the qualitative component was to explore the multi-level factors and processes which facilitate or impede the implementation and adoption of the program across three regions where it was first implemented. The study employs a multi-level framework as a conceptual guide to explore the facilitators and barriers to Telehomecare implementation and adoption across five levels: technology, patients, providers, organizations, and structures. In-depth semi-structured interviews and ethnographic observations with program stakeholders, as well as a Telehomecare document review were used to elicit key themes. Study participants (n = 89) included patients and/or informal caregivers (n = 39), health care providers (n = 23), technicians (n = 2), administrators (n = 12), and decision makers (n = 13) across three different Local Health Integration Networks in Ontario. Key facilitators to Telehomecare implementation and adoption at each level of the multi-level framework included: user-friendliness of Telehomecare technology, patient motivation to participate in the program, support for Telehomecare providers, the integration of Telehomecare into broader health service provision, and comprehensive program evaluation. Key barriers included: access-related issues to using the technology, patient language (if not English or French), Telehomecare provider time limitations, gaps in health care provision for patients, and structural barriers to patient participation related to geography and social location. Though Telehomecare has the potential to positively impact patient lives and strengthen models of health care provision, a number of key challenges remain. As such, further implementation and expansion of Telehomecare must involve continuous assessments of what is working and not working with all stakeholders. Increased dialogue, evaluation, and knowledge translation within and across regions to understand the contextual factors influencing Telehomecare implementation and adoption is required. This can inform decision-making that better reflects and addresses the needs of all program stakeholders.

Insurance exchanges under health reform: six design issues for the states.

PubMed

Kingsdale, Jon; Bertko, John

2010-06-01

The Patient Protection and Affordable Care Act depends on new, state-based exchanges to make health insurance readily available to certain segments of the population. One such segment is the lower-income uninsured, who can qualify for subsidized coverage only through an exchange. Other segments are unsubsidized individuals and small employers, who may choose to buy coverage inside or outside of an exchange. Although the law provides some guidance in structuring these new exchanges, it leaves many key decisions to the states. Successfully implementing exchanges will require public-private partnerships, expertise in insurance operations and marketing, and a series of strategic decisions. We review the half-dozen most important design issues.

A Low-Power Instruction Issue Queue for Microprocessors

NASA Astrophysics Data System (ADS)

Watanabe, Shingo; Chiyonobu, Akihiro; Sato, Toshinori

Instruction issue queue is a key component which extracts instruction level parallelism (ILP) in modern out-of-order microprocessors. In order to exploit ILP for improving processor performance, instruction queue size should be increased. However, it is difficult to increase the size, since instruction queue is implemented by a content addressable memory (CAM) whose power and delay are much large. This paper introduces a low power and scalable instruction queue that replaces the CAM with a RAM. In this queue, instructions are explicitly woken up. Evaluation results show that the proposed instruction queue decreases processor performance by only 1.9% on average. Furthermore, the total energy consumption is reduced by 54% on average.

Evidence-based management of ambulatory electronic health record system implementation: an assessment of conceptual support and qualitative evidence.

PubMed

McAlearney, Ann Scheck; Hefner, Jennifer L; Sieck, Cynthia; Rizer, Milisa; Huerta, Timothy R

2014-07-01

While electronic health record (EHR) systems have potential to drive improvements in healthcare, a majority of EHR implementations fall short of expectations. Shortcomings in implementations are often due to organizational issues around the implementation process rather than technological problems. Evidence from both the information technology and healthcare management literature can be applied to improve the likelihood of implementation success, but the translation of this evidence into practice has not been widespread. Our objective was to comprehensively study and synthesize best practices for managing ambulatory EHR system implementation in healthcare organizations, highlighting applicable management theories and successful strategies. We held 45 interviews with key informants in six U.S. healthcare organizations purposively selected based on reported success with ambulatory EHR implementation. We also conducted six focus groups comprised of 37 physicians. Interview and focus group transcripts were analyzed using both deductive and inductive methods to answer research questions and explore emergent themes. We suggest that successful management of ambulatory EHR implementation can be guided by the Plan-Do-Study-Act (PDSA) quality improvement (QI) model. While participants did not acknowledge nor emphasize use of this model, we found evidence that successful implementation practices could be framed using the PDSA model. Additionally, successful sites had three strategies in common: 1) use of evidence from published health information technology (HIT) literature emphasizing implementation facilitators; 2) focusing on workflow; and 3) incorporating critical management factors that facilitate implementation. Organizations seeking to improve ambulatory EHR implementation processes can use frameworks such as the PDSA QI model to guide efforts and provide a means to formally accommodate new evidence over time. Implementing formal management strategies and incorporating new evidence through the PDSA model is a key element of evidence-based management and a crucial way for organizations to position themselves to proactively address implementation and use challenges before they are exacerbated. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Creating an enabling environment for adolescent sexual and reproductive health: a framework and promising approaches.

PubMed

Svanemyr, Joar; Amin, Avni; Robles, Omar J; Greene, Margaret E

2015-01-01

This article provides a conceptual framework and points out the key elements for creating enabling environments for adolescent sexual and reproductive health (ASRH). An ecological framework is applied to organize the key elements of enabling environments for ASRH. At the individual level, strategies that are being implemented and seem promising are those that empower girls, build their individual assets, and create safe spaces. At the relationship level, strategies that are being implemented and seem promising include efforts to build parental support and communication as well as peer support networks. At the community level, strategies to engage men and boys and the wider community to transform gender and other social norms are being tested and may hold promise. Finally, at the broadest societal level, efforts to promote laws and policies that protect and promote human rights and address societal awareness about ASRH issues, including through mass media approaches, need to be considered. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

The Primary Care Behavioral Health (PCBH) Model: An Overview and Operational Definition.

PubMed

Reiter, Jeffrey T; Dobmeyer, Anne C; Hunter, Christopher L

2018-06-01

The Primary Care Behavioral Health (PCBH) model is a prominent approach to the integration of behavioral health services into primary care settings. Implementation of the PCBH model has grown over the past two decades, yet research and training efforts have been slowed by inconsistent terminology and lack of a concise, operationalized definition of the model and its key components. This article provides the first concise operationalized definition of the PCBH model, developed from examination of multiple published resources and consultation with nationally recognized PCBH model experts. The definition frames the model as a team-based approach to managing biopsychosocial issues that present in primary care, with the over-arching goal of improving primary care in general. The article provides a description of the key components and strategies used in the model, the rationale for those strategies, a brief comparison of this model to other integration approaches, a focused summary of PCBH model outcomes, and an overview of common challenges to implementing the model.

YouthAccess to Alcohol: early findings from a community action project to reduce the supply of alcohol to teens.

PubMed

Clark, Sam

2007-01-01

The Youth Access to Alcohol (YATA) project was implemented in 2002 by the Alcohol Advisory Council of New Zealand (ALAC) in thirty communities in New Zealand, with the aim of reducing the harm experienced by young people as a result of alcohol misuse in New Zealand through reducing the supply of alcohol by adults to young people. The communities include a mix of rural and urban from both Islands in New Zealand. The project uses a community action approach, which has included setting up collaborative partnerships of key agencies, the delivery of key strategies, and multimedia awareness raising campaigns. The communities are encouraged to identify unique issues in their community regarding alcohol abuse and young people and to develop action plans incorporating a range of strategies that include tested strategies as well as innovative ideas. Communities are trained to implement several tools to monitor changes in their community over time. The study's limitations are noted and future needed research is suggested.

In acceptance we trust? Conceptualising acceptance as a viable approach to NGO security management.

PubMed

Fast, Larissa A; Freeman, C Faith; O'Neill, Michael; Rowley, Elizabeth

2013-04-01

This paper documents current understanding of acceptance as a security management approach and explores issues and challenges non-governmental organisations (NGOs) confront when implementing an acceptance approach to security management. It argues that the failure of organisations to systematise and clearly articulate acceptance as a distinct security management approach and a lack of organisational policies and procedures concerning acceptance hinder its efficacy as a security management approach. The paper identifies key and cross-cutting components of acceptance that are critical to its effective implementation in order to advance a comprehensive and systematic concept of acceptance. The key components of acceptance illustrate how organisational and staff functions affect positively or negatively an organisation's acceptance, and include: an organisation's principles and mission, communications, negotiation, programming, relationships and networks, stakeholder and context analysis, staffing, and image. The paper contends that acceptance is linked not only to good programming, but also to overall organisational management and structures. © 2013 The Author(s). Journal compilation © Overseas Development Institute, 2013.

Implementation of psychological clinical trials in epilepsy: Review and guide.

PubMed

Modi, Avani C; Wagner, Janelle; Smith, Aimee W; Kellermann, Tanja S; Michaelis, Rosa

2017-09-01

The International League Against Epilepsy (ILAE) Neuropsychiatry commission and United States Institute of Medicine report both identified cognitive and psychological comorbidities as a significant issue for individuals with epilepsy, with rates as high as 60%. However, there is a paucity of evidence-based treatments for many psychological conditions (e.g., learning disorders, cognitive disorders, behavioral disorders). Because of inherent challenges in the implementation of psychological therapy trials and specific considerations for the population with epilepsy, the focus of the current review was to provide guidance and recommendations to conduct psychological trials for individuals with epilepsy. Several key areas will be discussed, including selection of patients, trial design, psychological intervention considerations, outcomes and evaluation of results, publication of trial results, and special issues related to pediatric clinical trials. Rigorously designed psychological therapy trials will set the stage for evidence-based practice in the care of individuals with epilepsy, with the goal of improving seizures, side effects, and HRQOL. Copyright © 2017 Elsevier Inc. All rights reserved.

Management and integration of engineering and construction activities: Lessons learned from the AP1000{sup R} nuclear power plant China project

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

McCullough, M. C.; Ebeling-Koning, D.; Evans, M. C.

2012-07-01

The lessons learned during the early phase of design engineering and construction activities for the AP1000 China Project can be applied to any project involving multiple disciplines and multiple organizations. Implementation of a first-of-a-kind design to directly support construction activities utilizing resources assigned to design development and design delivery creates challenges with prioritization of activities, successful closure of issues, and communication between site organizations and the home office. To ensure successful implementation, teams were assigned and developed to directly support construction activities including prioritization of activities, site communication and ensuring closure of site emergent issues. By developing these teams, themore » organization is better suited to meet the demands of the construction schedule while continuing with design evolution of a standard plant and engineering delivery for multiple projects. For a successful project, proper resource utilization and prioritization are key for overcoming obstacles and ensuring success of the engineering organization. (authors)« less

Ethical and Diversity Challenges in Ecologically Sensitive Systems-Oriented Interventions

PubMed Central

Jason, Leonard A.

2016-01-01

This article discusses ethical and diversity challenges involved in implementing ecologically sensitive, systems-oriented research. These issues are considered with reference to a series of community-based interventions dealing with stigma and chronic illness, recovery from substance-use disorders, and prevention of tobacco use. Each of these ecological interventions incorporates a systems approach, which allows an understanding of how individuals affect and are influenced by their social environments. In addition, issues of diversity with respect to underrepresented and marginalized groups are considered, including overcoming obstacles to gaining access to resources and promoting increased opportunities and empowerment. Throughout, the central importance of developing relationships with key gatekeepers and stakeholders, as well as timely and effective communications with various coalition members, is highlighted. By bringing into the research and policy process diverse citizen/participant suggestions and input regarding the need for, or design and implementation of ecologically and systems-based interventions, researchers can build collaborative relationships that fuel trust and partnerships, leading to more ethically responsible research. PMID:26618968

Enhanced recovery pathways in thoracic surgery from Italian VATS group: nursing care program

PubMed Central

Loizzi, Domenico; Panariti, Silvana; Piccinin, Ivana; Sollitto, Francesco

2018-01-01

Enhanced recovery after surgery (ERAS) is an interprofessional program that can lead to hastened patient recovery and reduced time in hospital. Nursing staff play a key role in the implementation of enhanced recovery protocols. This issue focalizes the role of nurses in ERAS program for patients submitted to Thoracic Surgery, in particular for cases of major lung resection performed by a minimally invasive surgical approach (VATS, video assisted thoracic surgery). PMID:29629199

Progress in Implementing Non-Cr6+ Surface Finishes for U.S. Navy and Marine Corps Aircraft

DTIC Science & Technology

2012-08-01

methods • Only qualified products to date for Class 1A are based on trivalent chromium • Key aspect overlooked: qualified products provide...date are based on trivalent chromium except one non-Cr • Similar passivation issues/potential changes as Class 1A coatings Aluminum Anodizing...including water, nickel, cobalt, trivalent chromium , and duplex Conversion coatings and Anodizing for Magnesium: SAE-AMS-M-3141 • Specification

Team deliberate practice in medicine and related domains: a consideration of the issues.

PubMed

Harris, Kevin R; Eccles, David W; Shatzer, John H

2017-03-01

A better understanding of the factors influencing medical team performance and accounting for expert medical team performance should benefit medical practice. Therefore, the aim here is to highlight key issues with using deliberate practice to improve medical team performance, especially given the success of deliberate practice for developing individual expert performance in medicine and other domains. Highlighting these issues will inform the development of training for medical teams. The authors first describe team coordination and its critical role in medical teams. Presented next are the cognitive mechanisms that allow expert performers to accurately interpret the current situation via the creation of an accurate mental "model" of the current situation, known as a situation model. Following this, the authors propose that effective team performance depends at least in part on team members having similar models of the situation, known as a shared situation model. The authors then propose guiding principles for implementing team deliberate practice in medicine and describe how team deliberate practice can be used in an attempt to reduce barriers inherent in medical teams to the development of shared situation models. The paper concludes with considerations of limitations, and future research directions, concerning the implementation of team deliberate practice within medicine.

Implementing personalisation for people with mental health problems: a comparative case study of four local authorities in England.

PubMed

Larsen, John; Ainsworth, Emily; Harrop, Clare; Patterson, Sue; Hamilton, Sarah; Szymczynska, Paulina; Tew, Jerry; Manthorpe, Jill; Pinfold, Vanessa

2013-04-01

Enhancing choice and control for people using services is a mental health and social-care service priority in England. Personalisation is a new policy and practice for delivery of social-care services where eligible adults are allocated a personal budget to spend to meet their agreed support needs. To describe approaches to introducing personal budgets to people with severe and enduring mental health needs, and to identify facilitators or barriers encountered. Within four English local authority (LA) areas, purposively selected to provide maximum variation, semi-structured interviews were undertaken with 58 participants from LAs, NHS trusts and third-sector organisations. An Interpretive Framework analysis considered within- and across-site insights. Issues arising from the implementation of personalisation for people with mental health needs are presented under two general themes: "responsibility and power" and "vision and leadership". Key challenges identified were complexities of working across NHS and LAs, the importance of effective leadership and engagement with service user representatives. Implementing personal budgets in mental health requires effective engagement of health and social-care systems. Change processes need strong leadership, clear vision and personal commitment, with ownership by all key stakeholders, including front-line practitioners.

Challenges of Implementing ESD in the Education Sector; Experiences in Norway

NASA Astrophysics Data System (ADS)

Sandås, Astrid; Benedict, Faye

This article presents and reflects on Norwegian experiences over a period of about 15 years with implementing the Norwegian national strategy for education for sustainable development (ESD) in the education system. We extract lessons about integration of ESD into education systems. After an introduction to central ideas of sustainable development and ESD, the article discusses the need for appropriate strategies and instruments. Key factors are collaboration to allow pupils and schools to actively contribute to a positive development locally and globally, interdisciplinary approaches to complex sustainability issues, and appropriate use of the ICT and other media. ESD programmes and activities should support school development and build the capacity of schools and teachers for integration of ESD.

Scientific-practical and legal problems of implementation of the personalized medicine.

PubMed

Bezdieniezhnykh, N O; Reznikova, V V; Rossylna, O V

2017-09-01

The article is devoted to the comprehensive analysis of scientific, practical and legal issues of personalized medicine that is a rapidly developing science-driven approach to healthcare. It is concluded that there is lack of general legal framework for the encouragement of scientific researches and practical implementation in this field. The article shows foreign experience and prospects for the introduction of personalized medicine as a key concept of healthcare system, which is based on a selection of diagnostic, therapeutic and preventive measures that would be the most effective for a particular person in view of individual characteristics. The conclusions and proposals to improve the current legislation and development of personalized medicine in Ukraine are suggested.

Effective implementation of health information technologies in U.S. hospitals.

PubMed

Khatri, Naresh; Gupta, Vishal

2016-01-01

Two issues pertaining to the effective implementation of health information technologies (HITs) in U.S. hospitals are examined. First, which information technology (IT) system is better--a homegrown or an outsourced one? In the second issue, the critical role of in-house IT expertise/capabilities in the effective implementation of HITs is investigated. The data on type of HIT system and IT expertise/capabilities were collected from a national sample of senior executives of U.S. hospitals. The data on quality of patient care were gathered from the Hospital Compare Web site. The quality of patient care was significantly higher in hospitals deploying a homegrown HIT system than hospitals deploying an outsourced HIT system. Furthermore, the professional competence and compelling vision of the chief information officer was found to be a major driver of another key IT capability of hospitals-professionalism of IT staff. The positive relationship of professionalism of IT staff with quality of patient care was mediated by proactive employee behavior. A homegrown HIT system achieves better quality of patient care than an outsourced one. The chief information officer's IT vision and the professional expertise and professionalism of IT staff are important IT capabilities in U.S. hospitals.

Enhancing Credibility of Chemical Safety Studies: Emerging Consensus on Key Assessment Criteria

PubMed Central

Conrad, James W.; Becker, Richard A.

2011-01-01

Objectives We examined the extent to which consensus exists on the criteria that should be used for assessing the credibility of a scientific work, regardless of its funding source, and explored how these criteria might be implemented. Data sources Three publications, all presented at a session of the 2009 annual meeting of the Society for Risk Analysis, have proposed a range of criteria for evaluating the credibility of scientific studies. At least two other similar sets of criteria have recently been proposed elsewhere. Data extraction/synthesis In this article we review these criteria, highlight the commonalities among them, and integrate them into a list of 10 criteria. We also discuss issues inherent in any attempt to implement the criteria systematically. Conclusions Recommendations by many scientists and policy experts converge on a finite list of criteria for assessing the credibility of a scientific study without regard to funding source. These criteria should be formalized through a consensus process or a governmental initiative that includes discussion and pilot application of a system for reproducibly implementing them. Formal establishment of such a system should enable the debate regarding chemical studies to move beyond funding issues and focus on scientific merit. PMID:21163723

The use of genetically-engineered animals in science: perspectives of Canadian Animal Care Committee members.

PubMed

Ormandy, Elisabeth H; Dale, Julie; Griffin, Gilly

2013-05-01

The genetic engineering of animals for their use in science challenges the implementation of refinement and reduction in several areas, including the invasiveness of the procedures involved, unanticipated welfare concerns, and the numbers of animals required. Additionally, the creation of genetically-engineered animals raises problems with the Canadian system of reporting animal numbers per Category of Invasiveness, as well as raising issues of whether ethical limits can, or should, be placed on genetic engineering. A workshop was held with the aim of bringing together Canadian animal care committee members to discuss these issues, to reflect on progress that has been made in addressing them, and to propose ways of overcoming any challenges. Although previous literature has made recommendations with regard to refinement and reduction when creating new genetically-engineered animals, the perception of the workshop participants was that some key opportunities are being missed. The participants identified the main roadblocks to the implementation of refinement and reduction alternatives as confidentiality, cost and competition. If the scientific community is to make progress concerning the implementation of refinement and reduction, particularly in the creation and use of genetically-engineered animals, addressing these roadblocks needs to be a priority. 2013 FRAME.

Going digital: a checklist in preparing for hospital-wide electronic medical record implementation and digital transformation.

PubMed

Scott, Ian A; Sullivan, Clair; Staib, Andrew

2018-05-24

Objective In an era of rapid digitisation of Australian hospitals, practical guidance is needed in how to successfully implement electronic medical records (EMRs) as both a technical innovation and a major transformative change in clinical care. The aim of the present study was to develop a checklist that clearly and comprehensively defines the steps that best prepare hospitals for EMR implementation and digital transformation. Methods The checklist was developed using a formal methodological framework comprised of: literature reviews of relevant issues; an interactive workshop involving a multidisciplinary group of digital leads from Queensland hospitals; a draft document based on literature and workshop proceedings; and a review and feedback from senior clinical leads. Results The final checklist comprised 19 questions, 13 related to EMR implementation and six to digital transformation. Questions related to the former included organisational considerations (leadership, governance, change leaders, implementation plan), technical considerations (vendor choice, information technology and project management teams, system and hardware alignment with clinician workflows, interoperability with legacy systems) and training (user training, post-go-live contingency plans, roll-out sequence, staff support at point of care). Questions related to digital transformation included cultural considerations (clinically focused vision statement and communication strategy, readiness for change surveys), management of digital disruption syndromes and plans for further improvement in patient care (post-go-live optimisation of digital system, quality and benefit evaluation, ongoing digital innovation). Conclusion This evidence-based, field-tested checklist provides guidance to hospitals planning EMR implementation and separates readiness for EMR from readiness for digital transformation. What is known about the topic? Many hospitals throughout Australia have implemented, or are planning to implement, hospital wide electronic medical records (EMRs) with varying degrees of functionality. Few hospitals have implemented a complete end-to-end digital system with the ability to bring about major transformation in clinical care. Although the many challenges in implementing EMRs have been well documented, they have not been incorporated into an evidence-based, field-tested checklist that can practically assist hospitals in preparing for EMR implementation as both a technical innovation and a vehicle for major digital transformation of care. What does this paper add? This paper outlines a 19-question checklist that was developed using a formal methodological framework comprising literature review of relevant issues, proceedings from an interactive workshop involving a multidisciplinary group of digital leads from hospitals throughout Queensland, including three hospitals undertaking EMR implementation and one hospital with complete end-to-end EMR, and review of a draft checklist by senior clinical leads within a statewide digital healthcare improvement network. The checklist distinguishes between issues pertaining to EMR as a technical innovation and EMR as a vehicle for digital transformation of patient care. What are the implications for practitioners? Successful implementation of a hospital-wide EMR requires senior managers, clinical leads, information technology teams and project management teams to fully address key operational and strategic issues. Using an issues checklist may help prevent any one issue being inadvertently overlooked or underemphasised in the planning and implementation stages, and ensure the EMR is fully adopted and optimally used by clinician users in an ongoing digital transformation of care.

e-Health preparedness assessment in the context of an influenza pandemic: a qualitative study in China.

PubMed

Li, Junhua; Seale, Holly; Ray, Pradeep; Wang, Quanyi; Yang, Peng; Li, Shuang; Zhang, Yi; Macintyre, C Raina

2013-03-13

To assess the preparedness status of a hospital in Beijing, China for implementation of an e-Health system in the context of a pandemic response. This research project used qualitative methods and involved two phases: (1) group interviews were conducted with key stakeholders to examine how the surveillance system worked with information and communication technology (ICT) support in Beijing, the results of which provided background information for a case study at the second phase and (2) individual interviews were conducted in order to gather a rich data set in relation to e-Health preparedness at the selected hospital. In phase 1, group interviews were conducted at Centres for Disease Prevention and Control (CDC) in Beijing. In phase 2, individual interviews were performed at a secondary hospital selected for the case study. In phase 1, three group interviews were undertaken with 12 key stakeholders (public health/medical practitioners from the Beijing city CDC, two district CDCs and a tertiary hospital) who were involved in the 2009 influenza A (H1N1) pandemic response in Beijing. In phase 2, individual interviews were conducted with 23 participants (including physicians across medical departments, an IT manager and a general administrative officer). PRIMARY AND SECONDARY MEASURES: For the case study, five areas were examined to assess the hospital's preparedness for implementation of an e-Health system in the context of a pandemic response: (1) motivational forces for change; (2) healthcare providers' exposure to e-Health; (3) technological preparedness; (4) organisational non-technical ability to support a clinical ICT innovation and (5) sociocultural issues at the organisation in association with e-Health implementation and a pandemic response. This article reports a small subset of the case study results from which major issues were identified under three main themes in relation to the hospital's preparedness. These issues include a poor sharing of patient health records, prescription errors, unavailability of software tools to assist physicians in answering patient questions, physicians' concerns about the reliability of ICT and the high monetary cost of e-health implementation and uncertainty over return on investment, and their dissatisfaction with the software in use. Prior to the implementation of e-Health, planning must be undertaken to ensure the smooth introduction of the system. The assessment of organisational preparedness is an important step in this planning process. On the basis of a case study, deficient areas of organisational preparedness were identified for the prospective implementation of electronic health records. Accordingly, we suggested possible solutions for the areas in need of improvement to facilitate e-Health implementation's success.

e-Health preparedness assessment in the context of an influenza pandemic: a qualitative study in China

PubMed Central

Li, Junhua; Seale, Holly; Ray, Pradeep; Wang, Quanyi; Yang, Peng; Li, Shuang; Zhang, Yi; MacIntyre, C Raina

2013-01-01

Objective To assess the preparedness status of a hospital in Beijing, China for implementation of an e-Health system in the context of a pandemic response. Design This research project used qualitative methods and involved two phases: (1) group interviews were conducted with key stakeholders to examine how the surveillance system worked with information and communication technology (ICT) support in Beijing, the results of which provided background information for a case study at the second phase and (2) individual interviews were conducted in order to gather a rich data set in relation to e-Health preparedness at the selected hospital. Setting In phase 1, group interviews were conducted at Centres for Disease Prevention and Control (CDC) in Beijing. In phase 2, individual interviews were performed at a secondary hospital selected for the case study. Participants In phase 1, three group interviews were undertaken with 12 key stakeholders (public health/medical practitioners from the Beijing city CDC, two district CDCs and a tertiary hospital) who were involved in the 2009 influenza A (H1N1) pandemic response in Beijing. In phase 2, individual interviews were conducted with 23 participants (including physicians across medical departments, an IT manager and a general administrative officer). Primary and secondary measures For the case study, five areas were examined to assess the hospital's preparedness for implementation of an e-Health system in the context of a pandemic response: (1) motivational forces for change; (2) healthcare providers’ exposure to e-Health; (3) technological preparedness; (4) organisational non-technical ability to support a clinical ICT innovation and (5) sociocultural issues at the organisation in association with e-Health implementation and a pandemic response. Results This article reports a small subset of the case study results from which major issues were identified under three main themes in relation to the hospital's preparedness. These issues include a poor sharing of patient health records, prescription errors, unavailability of software tools to assist physicians in answering patient questions, physicians’ concerns about the reliability of ICT and the high monetary cost of e-health implementation and uncertainty over return on investment, and their dissatisfaction with the software in use. Conclusions Prior to the implementation of e-Health, planning must be undertaken to ensure the smooth introduction of the system. The assessment of organisational preparedness is an important step in this planning process. On the basis of a case study, deficient areas of organisational preparedness were identified for the prospective implementation of electronic health records. Accordingly, we suggested possible solutions for the areas in need of improvement to facilitate e-Health implementation's success. PMID:23485719

Network Computing Infrastructure to Share Tools and Data in Global Nuclear Energy Partnership

NASA Astrophysics Data System (ADS)

Kim, Guehee; Suzuki, Yoshio; Teshima, Naoya

CCSE/JAEA (Center for Computational Science and e-Systems/Japan Atomic Energy Agency) integrated a prototype system of a network computing infrastructure for sharing tools and data to support the U.S. and Japan collaboration in GNEP (Global Nuclear Energy Partnership). We focused on three technical issues to apply our information process infrastructure, which are accessibility, security, and usability. In designing the prototype system, we integrated and improved both network and Web technologies. For the accessibility issue, we adopted SSL-VPN (Security Socket Layer-Virtual Private Network) technology for the access beyond firewalls. For the security issue, we developed an authentication gateway based on the PKI (Public Key Infrastructure) authentication mechanism to strengthen the security. Also, we set fine access control policy to shared tools and data and used shared key based encryption method to protect tools and data against leakage to third parties. For the usability issue, we chose Web browsers as user interface and developed Web application to provide functions to support sharing tools and data. By using WebDAV (Web-based Distributed Authoring and Versioning) function, users can manipulate shared tools and data through the Windows-like folder environment. We implemented the prototype system in Grid infrastructure for atomic energy research: AEGIS (Atomic Energy Grid Infrastructure) developed by CCSE/JAEA. The prototype system was applied for the trial use in the first period of GNEP.

Translating an early childhood obesity prevention program for local community implementation: a case study of the Melbourne InFANT Program.

PubMed

Laws, R; Hesketh, K D; Ball, K; Cooper, C; Vrljic, K; Campbell, K J

2016-08-08

While there is a growing interest in the field of research translation, there are few published examples of public health interventions that have been effectively scaled up and implemented in the community. This paper provides a case study of the community-wide implementation of the Melbourne Infant, Feeding, Activity and Nutrition Trial (InFANT), an obesity prevention program for parents with infants aged 3-18 months. The study explored key factors influencing the translation of the Program into routine practice and the respective role of policy makers, researchers and implementers. Case studies were conducted of five of the eight prevention areas in Victoria, Australia who implemented the Program. Cases were selected on the basis of having implemented the Program for 6 months or more. Data were collected from January to June 2015 and included 18 individual interviews, one focus group and observation of two meetings. A total of 28 individuals, including research staff (n = 4), policy makers (n = 2) and implementers (n = 22), contributed to the data collected. Thematic analysis was conducted using cross case comparisons and key themes were verified through member checking. Key facilitators of implementation included availability of a pre-packaged evidence based program addressing a community need, along with support and training provided by research staff to local implementers. Partnerships between researchers and policy makers facilitated initial program adoption, while local partnerships supported community implementation. Community partnerships were facilitated by local coordinators through alignment of program goals with existing policies and services. Workforce capacity for program delivery and administration was a challenge, largely overcome by embedding the Program into existing roles. Adapting the Program to fit local circumstance was critical for feasible and sustainable delivery, however balancing this with program fidelity was a critical issue. The lack of ongoing funding to support translation activities was a barrier for researchers continued involvement in community implementation. Policy makers, researchers and practitioners have important and complementary roles to play in supporting the translation of effective research interventions into practice. New avenues need to be explored to strengthen partnerships between researchers and end users to support the integration of effective public health research interventions into practice.

Triple symmetric key cryptosystem for data security

NASA Astrophysics Data System (ADS)

Fuzail, C. Md; Norman, Jasmine; Mangayarkarasi, R.

2017-11-01

As the technology is getting spreads in the macro seconds of speed and in which the trend changing era from human to robotics the security issue is also getting increased. By means of using machine attacks it is very easy to break the cryptosystems in very less amount of time. Cryptosystem is a process which provides the security in all sorts of processes, communications and transactions to be done securely with the help of electronical mechanisms. Data is one such thing with the expanded implication and possible scraps over the collection of data to secure predominance and achievement, Information Security is the process where the information is protected from invalid and unverified accessibilities and data from mishandling. So the idea of Information Security has risen. Symmetric key which is also known as private key.Whereas the private key is mostly used to attain the confidentiality of data. It is a dynamic topic which can be implemented over different applications like android, wireless censor networks, etc. In this paper, a new mathematical manipulation algorithm along with Tea cryptosystem has been implemented and it can be used for the purpose of cryptography. The algorithm which we proposed is straightforward and more powerful and it will authenticate in harder way and also it will be very difficult to break by someone without knowing in depth about its internal mechanisms.

Managing IT service management implementation complexity: from the perspective of the Warfield Version of systems science

NASA Astrophysics Data System (ADS)

Wan, Jiangping; Jones, James D.

2013-11-01

The Warfield version of systems science supports a wide variety of application areas, and is useful to practitioners who use the work program of complexity (WPOC) tool. In this article, WPOC is applied to information technology service management (ITSM) for managing the complexity of projects. In discussing the application of WPOC to ITSM, we discuss several steps of WPOC. The discovery step of WPOC consists of a description process and a diagnosis process. During the description process, 52 risk factors are identified, which are then narrowed to 20 key risk factors. All of this is done by interviews and surveys. Root risk factors (the most basic risk factors) consist of 11 kinds of common 'mindbugs' which are selected from an interpretive structural model. This is achieved by empirical analysis of 25 kinds of mindbugs. (A lesser aim of this research is to affirm that these mindbugs developed from a Western mindset have corresponding relevance in a completely different culture: the Peoples Republic of China.) During the diagnosis process, the relationships among the root risk factors in the implementation of the ITSM project are identified. The resolution step of WPOC consists of a design process and an implementation process. During the design process, issues related to the ITSM application are compared to both e-Government operation and maintenance, and software process improvement. The ITSM knowledge support structure is also designed at this time. During the implementation process, 10 keys to the successful implementation of ITSM projects are identified.

Impact Cratering Calculations

NASA Technical Reports Server (NTRS)

Ahrens, Thomas J.

2001-01-01

This research is computational /theoretical and complements the Caltech experimental program. We have developed an understanding of the basic physical processes and produced computational models and implemented these into Eulerian and Lagrangian finite element codes. The key issues we have addressed include the conditions required for: faulting (strain localization), elastic moduli weakening, dynamic weakening (layering elastic instabilities and fluidization), bulking (creation of porosity at zero pressure) and compaction of pores, frictional melting (creation of pseudotachylytes), partial and selective devolatilization of materials (e.g. CaCO3, water/ice mixtures), and debris flows.

Micromachining technology for thermal ink-jet products

NASA Astrophysics Data System (ADS)

Verdonckt-Vandebroek, Sophie

1997-09-01

This paper reviews recent trends and evolutions in the low- end color printing market which is currently dominated by thermal inkjet (TIJ) based products. Micro electromechanical systems technology has been an enabler for the unprecedented cost/performance ratio of these printing products. The generic TIJ operating principles are based on an intimate blend of thermodynamics, fluid dynamics and LSI electronics. The key principles and design issues are outlined and the fabrication of TIJ printheads illustrated with an implementation by the Xerox Corporation.

Comparative issues in aviation and surgical crew resource management: (1) are we too solution focused?

PubMed

Hunt, Graham J F; Callaghan, Kathleen S N

2008-08-01

Although the published work in health care increasingly promotes aviation as a high-reliability industry to be emulated, there is little empirical research to justify equating the dynamics of health care's operating environment with that of aviation. This article examines some of the potential key areas of difference between the two professional groups with respect to crew resource management. The risks of implementing crew resource management training in health care without an evidential basis are discussed.

An Interactive Ambulatory Nephrology Curriculum for Internal Medicine Interns: Design, Implementation, and Participant Feedback.

PubMed

Gomez, Alexis C; Warburton, Karen M; Miller, Rachel K; Negoianu, Dan; Cohen, Jordana B

2017-09-01

While diminishing nephrology fellow recruitment is a known issue, more work is needed to evaluate possible interventions to reverse this trend. We designed and implemented a curriculum to increase exposure to ambulatory nephrology among internal medicine interns. The curriculum focused on key aspects of outpatient nephrology practice, including supervised clinic visits, formal themed didactic content, and an online interactive forum with assigned evidence-based readings and small-group responses to relevant cases. We obtained postcourse surveys from all participating interns. Of the 43 interns who took part in the first year of the ambulatory nephrology curriculum, 100% reported a positive didactic experience and 91% reported a positive interactive online experience. 77% reported an improvement in their familiarity with clinical nephrology practice (median 2-point increase in familiarity score on a 7-point scale, P<0.001 by signed rank testing). Qualitative feedback included praise for the high-yield topics covered by the lectures and energizing teachers. In conclusion, we successfully implemented an ambulatory nephrology curriculum using a framework that integrated formal didactics, interactive online learning, and key clinical components of outpatient nephrology care. Future investigation will evaluate whether early implementation of this curriculum is associated with increased pursuit of nephrology as a career. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Randomized Controlled Trials in Music Therapy: Guidelines for Design and Implementation.

PubMed

Bradt, Joke

2012-01-01

Evidence from randomized controlled trials (RCTs) plays a powerful role in today's healthcare industry. At the same time, it is important that multiple types of evidence contribute to music therapy's knowledge base and that the dialogue of clinical effectiveness in music therapy is not dominated by the biomedical hierarchical model of evidence-based practice. Whether or not one agrees with the hierarchical model of evidence in the current healthcare climate, RCTs can contribute important knowledge to our field. Therefore, it is important that music therapists are prepared to design trials that meet current methodological standards and, equally important, are able to respond appropriately to those design aspects that may not be feasible in music therapy research. To provide practical guidelines to music therapy researchers for the design and implementation of RCTs as well as to enable music therapists to be well-informed consumers of RCT evidence. This article reviews key design aspects of RCTs and discusses how to best implement these standards in music therapy trials. A systematic presentation of basic randomization methods, allocation concealment strategies, issues related to blinding in music therapy trials and strategies for implementation, the use of treatment manuals, types of control groups, outcome selection, and sample size computation is provided. Despite the challenges of meeting all key design demands typical of an RCT, it is possible to design rigorous music therapy RCTs that accurately estimate music therapy treatment benefits.

Implantable electronics: emerging design issues and an ultra light-weight security solution.

PubMed

Narasimhan, Seetharam; Wang, Xinmu; Bhunia, Swarup

2010-01-01

Implantable systems that monitor biological signals require increasingly complex digital signal processing (DSP) electronics for real-time in-situ analysis and compression of the recorded signals. While it is well-known that such signal processing hardware needs to be implemented under tight area and power constraints, new design requirements emerge with their increasing complexity. Use of nanoscale technology shows tremendous benefits in implementing these advanced circuits due to dramatic improvement in integration density and power dissipation per operation. However, it also brings in new challenges such as reliability and large idle power (due to higher leakage current). Besides, programmability of the device as well as security of the recorded information are rapidly becoming major design considerations of such systems. In this paper, we analyze the emerging issues associated with the design of the DSP unit in an implantable system. Next, we propose a novel ultra light-weight solution to address the information security issue. Unlike the conventional information security approaches like data encryption, which come at large area and power overhead and hence are not amenable for resource-constrained implantable systems, we propose a multilevel key-based scrambling algorithm, which exploits the nature of the biological signal to effectively obfuscate it. Analysis of the proposed algorithm in the context of neural signal processing and its hardware implementation shows that we can achieve high level of security with ∼ 13X lower power and ∼ 5X lower area overhead than conventional cryptographic solutions.

Ethically-based clinical decision-making in physical therapy: process and issues.

PubMed

Finch, Elspeth; Geddes, E Lynne; Larin, Hélène

2005-01-01

The identification and consideration of relevant ethical issues in clinical decision-making, and the education of health care professionals (HCPs) in these skills are key factors in providing quality health care. This qualitative study explores the way in which physical therapists (PTs) integrate ethical issues into clinical practice decisions and identifies ethical themes used by PTs. A purposive sample of eight PTs was asked to describe a recent ethically-based clinical decision. Transcribed interviews were coded and themes identified related to the following categories: 1) the integration of ethical issues in the clinical decision-making process, 2) patient welfare, 3) professional ethos of the PT, and 4) health care economics and business practices. Participants readily described clinical situations involving ethical issues but rarely identified specific conflicting ethical issues in their description. Ethical dilemmas were more frequently resolved when there were fewer emotional sequelae associated with the dilemma, and the PT had a clear understanding of professional ethos, valued patient autonomy, and explored a variety of alternative actions before implementing one. HCP students need to develop a clear professional ethos and an increased understanding of the economic factors that will present ethical issues in practice.

Managerial attitude to the implementation of quality management systems in Lithuanian support treatment and nursing hospitals.

PubMed

Buciuniene, Ilona; Malciankina, Sonata; Lydeka, Zigmas; Kazlauskaite, Ruta

2006-09-20

The regulations of the Quality Management System (QMS) implementation in health care organizations were approved by the Lithuanian Ministry of Health in 1998. Following the above regulations, general managers of health care organizations had to initiate the QMS implementation in hospitals. As no research on the QMS implementation has been carried out in Lithuanian support treatment and nursing hospitals since, the objective of this study is to assess its current stage from a managerial perspective. A questionnaire survey of general managers of Lithuanian support treatment and nursing hospitals was carried out in the period of January through March 2005. Majority of the items included in the questionnaire were measured on a seven-point Likert scale. During the survey, a total of 72 questionnaires was distributed, out of which 58 filled-in ones were returned (response rate 80.6 per cent; standard sampling error 0.029 at 95 per cent level of confidence). Quality Management Systems were found operating in 39.7 per cent of support treatment and nursing hospitals and currently under implementation in 46.6 per cent of hospitals (13.7% still do not have it). The mean of the respondents' perceived QMS significance is 5.8 (on a seven-point scale). The most critical issues related to the QMS implementation include procedure development (5.5), lack of financial resources (5.4) and information (5.1), and development of work guidelines (4.6), while improved responsibility and power sharing (5.2), better service quality (5.1) and higher patient satisfaction (5.1) were perceived by the respondents as the key QMS benefits. The level of satisfaction with the QMS among the management of the surveyed hospitals is mediocre (3.6). However it was found to be higher among respondents who were more competent in quality management, were familiar with ISO 9000 standards, and had higher numbers of employees trained in quality management. QMSs are perceived to be successfully running in one third of the Lithuanian support treatment and nursing hospitals. Its current implementation stage is dependent on the hospital size - the bigger the hospital the more success it meets in the QMS implementation. As to critical Quality Management (QM) issues, hospitals tend to encounter such major problems as lack of financial resources, information and training, as well as difficulties in procedure development. On the other hand, the key factors that assist to the success of the QMS implementation comprise managerial awareness of the QMS significance and the existence of employee training systems and audit groups in hospitals.

Health care financing in Asia: key issues and challenges.

PubMed

Kwon, Soonman

2011-09-01

This article examines the major elements of health care financing such as financial risk protection, resource generation, resource pooling, and purchasing and payment; provides key lessons; and discusses the challenges for health care financing systems of Asian countries. With the exception of Japan, Korea, Taiwan, and Thailand, most health care systems of Asia provide very limited financial risk protection. The role of public prepaid schemes such as tax and social health insurance is minimal, and out-of-pocket payment is a major source of financing. The large informal sector is a major challenge to the extension of population coverage in many low-income countries of Asia, which must seek the optimal mix of tax subsidy and health insurance for universal coverage. Implementation of effective payment systems to control the behavior of health care providers is also a key factor in the success of health care financing reform in Asia.

Planning, implementing, and evaluating a program to address the oral health needs of aboriginal children in port augusta, australia.

PubMed

Parker, E J; Misan, G; Shearer, M; Richards, L; Russell, A; Mills, H; Jamieson, L M

2012-01-01

Aboriginal Australian children experience profound oral health disparities relative to their non-Aboriginal counterparts. In response to community concerns regarding Aboriginal child oral health in the regional town of Port Augusta, South Australia, a child dental health service was established within a Community Controlled Aboriginal Health Service. A partnership approach was employed with the key aims of (1) quantifying rates of dental service utilisation, (2) identifying factors influencing participation, and (3) planning and establishing a program for delivery of Aboriginal children's dental services that would increase participation and adapt to community needs. In planning the program, levels of participation were quantified and key issues identified through semistructured interviews. After 3.5 years, the participation rate for dental care among the target population increased from 53 to 70 percent. Key areas were identified to encourage further improvements and ensure sustainability in Aboriginal child oral health in this regional location.

A Socio-technical Approach for Transient SME Alliances

NASA Astrophysics Data System (ADS)

Rezgui, Yacine

The paper discusses technical requirements to promote the adoption of alliance modes of operation by SMEs in the construction sector. These requirements have provided a basis for specifying a set of functionality to support the collaboration and cooperation needs of SMEs. While service-oriented architectures and semantic web services provide the middleware technology to implement the identified functionality, a number of key technical limitations have been identified, including lack of support for the dynamic and non-functional characteristics of SME alliances distributed business processes, lack of execution monitoring functionality to manage running business processes, and lack of support for semantic reasoning to enable SME business process service composition. The paper examines these issues and provides key directions for supporting SME alliances effectively.

Guidelines for implementing automation in a hospital laboratory setting--part II.

PubMed

Rodriques, Sarina

2007-03-28

Laboratories entering into a discussion regarding automation of their facility have a number of key issues that need to be considered right away. What is the financial impact going to be? How do we know which processes we should automate and which ones we shouldn't? Which vendor is going to best align with the goals of our organization? Developing a thorough and robust plan at the start of the automation process is vital to the overall success of the project. It requires dedicated staff members who are willing to do the research, crunch the numbers, and present the data effectively. In Part II of this manuscript, issues such as cost analyses, business plans, and purchasing decisions are each covered thoroughly.

A Traceability Attack against e-Passports

NASA Astrophysics Data System (ADS)

Chothia, Tom; Smirnov, Vitaliy

Since 2004, many nations have started issuing "e-passports" containing an RFID tag that, when powered, broadcasts information. It is claimed that these passports are more secure and that our data will be protected from any possible unauthorised attempts to read it. In this paper we show that there is a flaw in one of the passport's protocols that makes it possible to trace the movements of a particular passport, without having to break the passport's cryptographic key. All an attacker has to do is to record one session between the passport and a legitimate reader, then by replaying a particular message, the attacker can distinguish that passport from any other. We have implemented our attack and tested it successfully against passports issued by a range of nations.

Key Tasks of Science in Improving Effectiveness of Hard Coal Production in Poland

NASA Astrophysics Data System (ADS)

Dubiński, Józef; Prusek, Stanisław; Turek, Marian

2017-09-01

The article presents an array of specific issues regarding the employed technology and operational efficiency of mining activities, which could and should become the subject of conducted scientific research. Given the circumstances of strong market competition and increasing requirements concerning environmental conditions, both in terms of conducted mining activities and produced coal quality parameters, it is imperative to develop and implement innovative solutions regarding the employed production technology, the safety of work conducted under the conditions of increasing natural hazards, as well as the mining enterprise management systems that enable its effective functioning. The article content pertains to the last group of issues in the most detailed way, particularly in terms of the possibility for rational conducted operation cost reduction.

Decision theory, reinforcement learning, and the brain.

PubMed

Dayan, Peter; Daw, Nathaniel D

2008-12-01

Decision making is a core competence for animals and humans acting and surviving in environments they only partially comprehend, gaining rewards and punishments for their troubles. Decision-theoretic concepts permeate experiments and computational models in ethology, psychology, and neuroscience. Here, we review a well-known, coherent Bayesian approach to decision making, showing how it unifies issues in Markovian decision problems, signal detection psychophysics, sequential sampling, and optimal exploration and discuss paradigmatic psychological and neural examples of each problem. We discuss computational issues concerning what subjects know about their task and how ambitious they are in seeking optimal solutions; we address algorithmic topics concerning model-based and model-free methods for making choices; and we highlight key aspects of the neural implementation of decision making.

Wheelchair transportation safety on school buses: stakeholder recommendations for priority issues and actions.

PubMed

Buning, Mary Ellen; Karg, Patricia E

2011-01-01

This paper presents results from and provides discussion of a state-of-the-science workshop in which highly informed stakeholders in wheelchair transportation safety for students on school buses were participants. The Nominal Group Technique was used to create a process in which the main issues preventing safe transportation of wheelchair-seated students and key strategies to overcome these issues were identified and ranked. These results, along with a synthesis of group discussion and recommendations for action, are presented along with consideration of current policies, regulations, and political realities. Critical safety shortcomings exist in this highly specialized enterprise that varies from state to state. Recommended strategies include implementing wheelchair requirements in federal transportation safety standards, creation of a clearinghouse for wheelchair transportation best practices and education, creation of national standards for training, practices, and monitoring, and increased "buy-in" to voluntary wheelchair standards by wheelchair manufacturers.

Structural-Functional Organization of the Eukaryotic Cell Nucleus and Transcription Regulation: Introduction to This Special Issue of Biochemistry (Moscow).

PubMed

Razin, S V

2018-04-01

This issue of Biochemistry (Moscow) is devoted to the cell nucleus and mechanisms of transcription regulation. Over the years, biochemical processes in the cell nucleus have been studied in isolation, outside the context of their spatial organization. Now it is clear that segregation of functional processes within a compartmentalized cell nucleus is very important for the implementation of basic genetic processes. The functional compartmentalization of the cell nucleus is closely related to the spatial organization of the genome, which in turn plays a key role in the operation of epigenetic mechanisms. In this issue of Biochemistry (Moscow), we present a selection of review articles covering the functional architecture of the eukaryotic cell nucleus, the mechanisms of genome folding, the role of stochastic processes in establishing 3D architecture of the genome, and the impact of genome spatial organization on transcription regulation.

Partnerships for Policy Development: A Case Study From Uganda’s Costed Implementation Plan for Family Planning

PubMed Central

Lipsky, Alyson B; Gribble, James N; Cahaelen, Linda; Sharma, Suneeta

2016-01-01

ABSTRACT In global health, partnerships between practitioners and policy makers facilitate stakeholders in jointly addressing those issues that require multiple perspectives for developing, implementing, and evaluating plans, strategies, and programs. For family planning, costed implementation plans (CIPs) are developed through a strategic government-led consultative process that results in a detailed plan for program activities and an estimate of the funding required to achieve an established set of goals. Since 2009, many countries have developed CIPs. Conventionally, the CIP approach has not been defined with partnerships as a focal point; nevertheless, cooperation between key stakeholders is vital to CIP development and execution. Uganda launched a CIP in November 2014, thus providing an opportunity to examine the process through a partnership lens. This article describes Uganda’s CIP development process in detail, grounded in a framework for assessing partnerships, and provides the findings from 22 key informant interviews. Findings reveal strengths in Uganda’s CIP development process, such as willingness to adapt and strong senior management support. However, the evaluation also highlighted challenges, including district health officers (DHOs), who are a key group of implementers, feeling excluded from the development process. There was also a lack of planning around long-term partnership practices that could help address anticipated execution challenges. The authors recommend that future CIP development efforts use a long-term partnership strategy that fosters accountability by encompassing both the short-term goal of developing the CIP and the longer-term goal of achieving the CIP objectives. Although this study focused on Uganda’s CIP for family planning, its lessons have implications for any policy or strategy development efforts that require multiple stakeholders to ensure successful execution. PMID:27353621

European consensus conference on faecal microbiota transplantation in clinical practice.

PubMed

Cammarota, Giovanni; Ianiro, Gianluca; Tilg, Herbert; Rajilić-Stojanović, Mirjana; Kump, Patrizia; Satokari, Reetta; Sokol, Harry; Arkkila, Perttu; Pintus, Cristina; Hart, Ailsa; Segal, Jonathan; Aloi, Marina; Masucci, Luca; Molinaro, Antonio; Scaldaferri, Franco; Gasbarrini, Giovanni; Lopez-Sanroman, Antonio; Link, Alexander; de Groot, Pieter; de Vos, Willem M; Högenauer, Christoph; Malfertheiner, Peter; Mattila, Eero; Milosavljević, Tomica; Nieuwdorp, Max; Sanguinetti, Maurizio; Simren, Magnus; Gasbarrini, Antonio

2017-04-01

Faecal microbiota transplantation (FMT) is an important therapeutic option for Clostridium difficile infection. Promising findings suggest that FMT may play a role also in the management of other disorders associated with the alteration of gut microbiota. Although the health community is assessing FMT with renewed interest and patients are becoming more aware, there are technical and logistical issues in establishing such a non-standardised treatment into the clinical practice with safety and proper governance. In view of this, an evidence-based recommendation is needed to drive the practical implementation of FMT. In this European Consensus Conference, 28 experts from 10 countries collaborated, in separate working groups and through an evidence-based process, to provide statements on the following key issues: FMT indications; donor selection; preparation of faecal material; clinical management and faecal delivery and basic requirements for implementing an FMT centre. Statements developed by each working group were evaluated and voted by all members, first through an electronic Delphi process, and then in a plenary consensus conference. The recommendations were released according to best available evidence, in order to act as guidance for physicians who plan to implement FMT, aiming at supporting the broad availability of the procedure, discussing other issues relevant to FMT and promoting future clinical research in the area of gut microbiota manipulation. This consensus report strongly recommends the implementation of FMT centres for the treatment of C. difficile infection as well as traces the guidelines of technicality, regulatory, administrative and laboratory requirements. 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/.

Brazilian Federal Police drug chemical profiling - the PeQui project.

PubMed

Zacca, Jorge J; Botelho, Elvio Dias; Vieira, Maurício L; Almeida, Fernanda L A; Ferreira, Luciana S; Maldaner, Adriano O

2014-07-01

Over the past six years the Brazilian Federal Police has undertaken major efforts in order to implement and to develop its own drug chemical profiling program. This paper aims to provide a broad perspective regarding the managerial strategies and some examples of subsequent technical issues involved in the implementation of such a project. Close collaboration with local drug enforcement and investigation teams, establishment of proper worldwide partnerships with well recognized institutions in the field of drug analysis and the attainment of suitable funding and human resources are shown to be key success factors. Some preliminary results concerning the chemical profile of cocaine seizures in Brazil during this process are presented. Copyright © 2014 Forensic Science Society. Published by Elsevier Ireland Ltd. All rights reserved.

Harnessing the language of overdose prevention to advance evidence-based responses to the opioid crisis.

PubMed

Collins, Alexandra B; Bluthenthal, Ricky N; Boyd, Jade; McNeil, Ryan

2018-05-01

Language has significant implications for how we view and respond to public health issues. Conventional moralistic messaging around drug use stigmatizes people who use drugs and inhibits the implementation of evidence-based harm reduction interventions that do not condemn drug use. However, within the context of the unprecedented North American opioid overdose crisis, we argue that shifting conventional moral messaging around overdose prevention and response strategies is key to supporting the rapid roll-out of evidence-based harm reduction interventions. Reframing overdose prevention to highlight the imperative to address the ongoing public health emergency is an important first step in implementing urgently needed response strategies. Copyright © 2018 Elsevier B.V. All rights reserved.

Blood conservation: the CEO perspective.

PubMed

Morgan, Timothy O

2004-08-01

Hospital CEOs are concerned about more than just cost of services to their patients. The advancement of patient car along with maintaining or improving patient safety are also key elements to the CEO, to limit patient risks, hospital liability, and negative public relations. The CEO is accountable to the hospital staff, the patients, and the general public. Establishing programs such as blood management or bloodless medicine can be implemented by using a team approach. A physician champion with a clear business plan that addresses all issues and challenges is critical for successful implementation. As blood and blood product costs rise and supply decreases, alternatives such as cell saving techniques and the use of pharmacologic interventions can have a significant impact on net hospital expenditures.

A flexible CAMAC based data system for Space Shuttle scientific instruments

NASA Technical Reports Server (NTRS)

Ehrmann, C. H.; Baker, R. G.; Smith, R. L.; Kaminski, T. J.

1979-01-01

An effort has been made within NASA to produce a low-cost modular system for implementation of Shuttle payloads based on the CAMAC standards for packaging and data transfer. A key element of such a modular system is a means for controlling the data system, collecting and processing the data for transmission to the ground, and issuing commands to the instrument either from the ground or based on the data collected. A description is presented of such a means based on a network of digital processors and CAMAC crate controllers, which allows for the implementation of instruments ranging from those requiring only a single CAMAC crate of functional modules and no data processing to ones requiring multiple crates and multiple data processors.

Managing the three 'P's to improve patient safety: nursing administration's role in managing information technology.

PubMed

Simpson, Roy L

2004-08-01

The Institute of Medicine's landmark report asserted that medical error is seldom the fault of individuals, but the result of faulty healthcare policy/procedure systems. Numerous studies have shown that information technology (IT) can shore up weak systems. For nursing, IT plays a key role in eliminating nursing mistakes. However, managing IT is a function of managing the people who use it. For nursing administrators, successful IT implementations depend on adroit management of the three 'P's: People, processes and (computer) programs. This paper examines critical issues for managing each entity. It discusses the importance of developing trusting organizations, the requirements of process change, how to implement technology in harmony with the organization and the significance of vision.

Designing an activity-based costing model for a non-admitted prisoner healthcare setting.

PubMed

Cai, Xiao; Moore, Elizabeth; McNamara, Martin

2013-09-01

To design and deliver an activity-based costing model within a non-admitted prisoner healthcare setting. Key phases from the NSW Health clinical redesign methodology were utilised: diagnostic, solution design and implementation. The diagnostic phase utilised a range of strategies to identify issues requiring attention in the development of the costing model. The solution design phase conceptualised distinct 'building blocks' of activity and cost based on the speciality of clinicians providing care. These building blocks enabled the classification of activity and comparisons of costs between similar facilities. The implementation phase validated the model. The project generated an activity-based costing model based on actual activity performed, gained acceptability among clinicians and managers, and provided the basis for ongoing efficiency and benchmarking efforts.

Implementation of QoSS (Quality-of-Security Service) for NoC-Based SoC Protection

NASA Astrophysics Data System (ADS)

Sepúlveda, Johanna; Pires, Ricardo; Strum, Marius; Chau, Wang Jiang

Many of the current electronic systems embedded in a SoC (System-on-Chip) are used to capture, store, manipulate and access critical data, as well as to perform other key functions. In such a scenario, security is considered as an important issue. The Network-on-chip (NoC), as the foreseen communication structure of next-generation SoC devices, can be used to efficiently incorporate security. Our work proposes the implementation of QoSS (Quality of Security Service) to overcome present SoC vulnerabilities. QoSS is a novel concept for data protection that introduces security as a dimension of QoS. In this paper, we present the implementation of two security services (access control and authentication), that may be configured to assume one from several possible levels, the implementation of a technique to avoid denial-of-service (DoS) attacks, evaluate their effectiveness and estimate their impact on NoC performance.

Implementation of a quantum metamaterial using superconducting qubits.

PubMed

Macha, Pascal; Oelsner, Gregor; Reiner, Jan-Michael; Marthaler, Michael; André, Stephan; Schön, Gerd; Hübner, Uwe; Meyer, Hans-Georg; Il'ichev, Evgeni; Ustinov, Alexey V

2014-10-14

The key issue for the implementation of a metamaterial is to demonstrate the existence of collective modes corresponding to coherent oscillations of the meta-atoms. Atoms of natural materials interact with electromagnetic fields as quantum two-level systems. Artificial quantum two-level systems can be made, for example, using superconducting nonlinear resonators cooled down to their ground state. Here we perform an experiment in which 20 of these quantum meta-atoms, so-called flux qubits, are embedded into a microwave resonator. We observe the dispersive shift of the resonator frequency imposed by the qubit metamaterial and the collective resonant coupling of eight qubits. The realized prototype represents a mesoscopic limit of naturally occurring spin ensembles and as such we demonstrate the AC-Zeeman shift of a resonant qubit ensemble. The studied system constitutes the implementation of a basic quantum metamaterial in the sense that many artificial atoms are coupled collectively to the quantized mode of a photon field.

Achieving continuous improvement in laboratory organization through performance measurements: a seven-year experience.

PubMed

Salinas, Maria; López-Garrigós, Maite; Gutiérrez, Mercedes; Lugo, Javier; Sirvent, Jose Vicente; Uris, Joaquin

2010-01-01

Laboratory performance can be measured using a set of model key performance indicators (KPIs). The design and implementation of KPIs are important issues. KPI results from 7 years are reported and their implementation, monitoring, objectives, interventions, result reporting and delivery are analyzed. The KPIs of the entire laboratory process were obtained using Laboratory Information System (LIS) registers. These were collected automatically using a data warehouse application, spreadsheets and external quality program reports. Customer satisfaction was assessed using surveys. Nine model laboratory KPIs were proposed and measured. The results of some examples of KPIs used in our laboratory are reported. Their corrective measurements or the implementation of objectives led to improvement in the associated KPIs results. Measurement of laboratory performance using KPIs and a data warehouse application that continuously collects registers and calculates KPIs confirmed the reliability of indicators, indicator acceptability and usability for users, and continuous process improvement.

Plant mediated green synthesis: modified approaches.

PubMed

Das, Ratul Kumar; Brar, Satinder Kaur

2013-11-07

Plant mediated green synthesis of different metallic nanoparticles has emerged as one of the options for implementation of green chemistry principles, and successfully made an important contribution towards green nanotechnology. However, beyond the synthesis and application aspects, the science of green synthesis has carried some wrong perceptions in an unforeseen fashion. In this review, some of the key issues related to the green synthesis of metallic nanoparticles employing plants as reducing/capping agents have been addressed. Random selection of plants and its overall impact on the different aspects of green synthesis have been discussed. Emphasis is given to the setting of some standard selection criteria to be adopted for selecting a plant for use in green synthesis. How selection of a plant can positively or negatively influence both procedure and products of a green synthesis process is the prime concern of this article. In addition to selection, the key issue of biocompatibility associated with green synthesized metallic nanoparticles has been considered. Both selection of plant and biocompatibility were reconsidered for their minute details in terms of synthesis, analysis and data interpretation in the green synthesis approach. The key factors capable of fine tuning the core meaning of "green" in the synthesis of any metallic nanoparticles were taken into consideration. This article is an effort towards keeping the core meaning of green synthesis.

Legal, ethical, and financial dilemmas in electronic health record adoption and use.

PubMed

Sittig, Dean F; Singh, Hardeep

2011-04-01

Electronic health records (EHRs) facilitate several innovations capable of reforming health care. Despite their promise, many currently unanswered legal, ethical, and financial questions threaten the widespread adoption and use of EHRs. Key legal dilemmas that must be addressed in the near-term pertain to the extent of clinicians' responsibilities for reviewing the entire computer-accessible clinical synopsis from multiple clinicians and institutions, the liabilities posed by overriding clinical decision support warnings and alerts, and mechanisms for clinicians to publically report potential EHR safety issues. Ethical dilemmas that need additional discussion relate to opt-out provisions that exclude patients from electronic record storage, sale of deidentified patient data by EHR vendors, adolescent control of access to their data, and use of electronic data repositories to redesign the nation's health care delivery and payment mechanisms on the basis of statistical analyses. Finally, one overwhelming financial question is who should pay for EHR implementation because most users and current owners of these systems will not receive the majority of benefits. The authors recommend that key stakeholders begin discussing these issues in a national forum. These actions can help identify and prioritize solutions to the key legal, ethical, and financial dilemmas discussed, so that widespread, safe, effective, interoperable EHRs can help transform health care.

HIV Pre-exposure Prophylaxis Program Implementation Using Intervention Mapping.

PubMed

Flash, Charlene A; Frost, Elizabeth L T; Giordano, Thomas P; Amico, K Rivet; Cully, Jeffrey A; Markham, Christine M

2018-04-01

HIV pre-exposure prophylaxis has been proven to be an effective tool in HIV prevention. However, numerous barriers still exist in pre-exposure prophylaxis implementation. The framework of Intervention Mapping was used from August 2016 to October 2017 to describe the process of adoption, implementation, and maintenance of an HIV prevention program from 2012 through 2017 in Houston, Texas, that is nested within a county health system HIV clinic. Using the tasks outlined in the Intervention Mapping framework, potential program implementers were identified, outcomes and performance objectives established, matrices of change objectives created, and methods and practical applications formed. Results include the formation of three matrices that document program outcomes, change agents involved in the process, and the determinants needed to facilitate program adoption, implementation, and maintenance. Key features that facilitated successful program adoption and implementation were obtaining leadership buy-in, leveraging existing resources, systematic evaluation of operations, ongoing education for both clinical and nonclinical staff, and attention to emergent issues during launch. The utilization of Intervention Mapping to delineate the program planning steps can provide a model for pre-exposure prophylaxis implementation in other settings. Copyright © 2018. Published by Elsevier Inc.

Methodology issues in implementation science.

PubMed

Newhouse, Robin; Bobay, Kathleen; Dykes, Patricia C; Stevens, Kathleen R; Titler, Marita

2013-04-01

Putting evidence into practice at the point of care delivery requires an understanding of implementation strategies that work, in what context and how. To identify methodological issues in implementation science using 4 studies as cases and make recommendations for further methods development. Four cases are presented and methodological issues identified. For each issue raised, evidence on the state of the science is described. Issues in implementation science identified include diverse conceptual frameworks, potential weaknesses in pragmatic study designs, and the paucity of standard concepts and measurement. Recommendations to advance methods in implementation include developing a core set of implementation concepts and metrics, generating standards for implementation methods including pragmatic trials, mixed methods designs, complex interventions and measurement, and endorsing reporting standards for implementation studies.

Mapping the existing body of health policy implementation research in lower income settings: what is covered and what are the gaps?

PubMed

Erasmus, E; Orgill, M; Schneider, H; Gilson, L

2014-12-01

This article uses 85 peer-reviewed articles published between 1994 and 2009 to characterize and synthesize aspects of the health policy analysis literature focusing on policy implementation in low- and middle-income countries (LMICs). It seeks to contribute, first, to strengthening the field of LMIC health policy analysis by highlighting gaps in the literature and generating ideas for a future research agenda and, second, to thinking about the value and applicability of qualitative synthesis approaches to the health policy analysis field. Overall, the article considers the disciplinary perspectives from which LMIC health policy implementation is studied and the extent to which the focus is on systems or programme issues. It then works with the more specific themes of the key thrusts of the reviewed articles, the implementation outcomes studied, implementation improvement recommendations made and the theories used in the reviewed articles. With respect to these more specific themes, the article includes explorations of patterns within the themes themselves, the contributions of specific disciplinary perspectives and differences between systems and programme articles. It concludes, among other things, that the literature remains small, fragmented, of limited depth and quite diverse, reflecting a wide spectrum of health system dimensions studied and many different suggestions for improving policy implementation. However, a range of issues beyond traditional 'hardware' health system concerns, such as funding and organizational structure, are understood to influence policy implementation, including many 'software' issues such as the understandings of policy actors and the need for better communication and actor relationships. Looking to the future, there is a need, given the fragmentation in the literature, to consolidate the existing body of work where possible and, given the often broad nature of the work and its limited depth, to draw more explicitly on theoretical frames and concepts to deepen work by sharpening and focusing concerns and questions. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Altruism and Religion: A New Paradigm for Organ Donation.

PubMed

Rabinowich, Aviad; Jotkowitz, Alan

2018-02-01

Activity of NGO's supporting living donor kidney donations can affect the shortage of kidneys. Matnat Chaim is a Jewish orthodox organization active in Israel since 2009. This is a voluntary organization with aims to shorten and eliminate the waiting list for kidneys. Since the beginning of its activity, it has said to play a key role in 379 kidney transplantations. In 2015, out of 174 live donor kidney transplantations that took place in Israel, Matnat Chaim had a key role in 88 of them (50.6%). We found some ethical issues concerning the organization's activity. The donor can restrict his or her donation to specific characteristics of recipient which can result in organs transplanted in a homogeneous group of the population. Another issue is the question of whether nudging people to kidney donation takes place and whether it is valid to do so. We found that Matnat Chaim does a great deal for promotion and intermediation of kidney donations in Israel. This form of promotion can be implemented by other organizations and countries.

Commentary: pediatric eHealth interventions: common challenges during development, implementation, and dissemination.

PubMed

Wu, Yelena P; Steele, Ric G; Connelly, Mark A; Palermo, Tonya M; Ritterband, Lee M

2014-07-01

To provide an overview of common challenges that pediatric eHealth researchers may encounter when planning, developing, testing, and disseminating eHealth interventions along with proposed solutions for addressing these challenges. The article draws on the existing eHealth literature and the authors' collective experience in pediatric eHealth research. The challenges associated with eHealth interventions and their proposed solutions are multifaceted and cut across a number of areas from eHealth program development through dissemination. Collaboration with a range of individuals (e.g., multidisciplinary colleagues, commercial entities, primary stakeholders) is the key to eHealth intervention success. To ensure adequate resources for design, development, and planning for sustainability, a number of public and private sources of funding are available. A study design that addresses ethical concerns and security issues is critical to ensure scientific integrity and intervention dissemination. Table I summarizes key issues to consider during eHealth intervention development, testing, and dissemination. © The Author 2014. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Stakeholder attitudes and needs regarding cell-free fetal DNA testing.

PubMed

Hill, Melissa; Lewis, Celine; Chitty, Lyn S

2016-04-01

To explore stakeholder views on cell-free DNA testing and highlight findings important for successful implementation and the provision of best practice in counseling. Noninvasive tests based on the analysis of cell-free fetal DNA are now widely available in clinical practice and applications are expanding rapidly. It is essential that stakeholder views are considered in order to identify and address any ethical and social issues. We provide an overview of stakeholder viewpoints and then focus on the key issues of informed decision making, test uptake, service delivery and information sources. Stakeholders are positive about the introduction of cell-free fetal DNA testing into clinical practice. They describe both practical and psychological benefits arising from tests that are safe and can potentially be performed earlier in pregnancy. Key concerns, which include the potential for these tests to have a negative impact on informed decision making and increased societal pressure to have testing, can be addressed through careful parent-directed counseling. As applications for these tests expand it is increasingly important to develop innovative approaches to facilitate good understanding for parents who are offered noninvasive prenatal testing.

Policy and administrative issues for large-scale clinical interventions following disasters.

PubMed

Scheeringa, Michael S; Cobham, Vanessa E; McDermott, Brett

2014-02-01

Large, programmatic mental health intervention programs for children and adolescents following disasters have become increasingly common; however, little has been written about the key goals and challenges involved. Using available data and the authors' experiences, this article reviews the factors involved in planning and implementing large-scale treatment programs following disasters. These issues include funding, administration, choice of clinical targets, workforce selection, choice of treatment modalities, training, outcome monitoring, and consumer uptake. Ten factors are suggested for choosing among treatment modalities: 1) reach (providing access to the greatest number), 2) retention of patients, 3) privacy, 4) parental involvement, 5) familiarity of the modality to clinicians, 6) intensity (intervention type matches symptom acuity and impairment of patient), 7) burden to the clinician (in terms of time, travel, and inconvenience), 8) cost, 9) technology needs, and 10) effect size. Traditionally, after every new disaster, local leaders who have never done so before have had to be recruited to design, administer, and implement programs. As expertise in all of these areas represents a gap for most local professionals in disaster-affected areas, we propose that a central, nongovernmental agency with national or international scope be created that can consult flexibly with local leaders following disasters on both overarching and specific issues. We propose recommendations and point out areas in greatest need of innovation.

Acceptance of standardized ultrasound classification, use of albendazole, and long-term follow-up in clinical management of cystic echinococcosis: a systematic review.

PubMed

Tamarozzi, Francesca; Nicoletti, Giovanni J; Neumayr, Andreas; Brunetti, Enrico

2014-10-01

Cystic echinococcosis is a chronic, complex, and neglected disease. The need for a simple classification of cyst morphology that would provide an accepted framework for scientific and clinical work on cystic echinococcosis has been addressed by two documents issued by the WHO Informal Working Group on Echinococcosis in 2003 (cyst classification) and in 2010 (Expert consensus for the diagnosis and treatment of echinococcosis). Here we evaluate the use of the WHO Informal Working Group on Echinococcosis classification of hepatic cystic echinococcosis, the acceptance by clinicians of recommendations regarding the use of albendazole, and the implementation of the long-term follow-up of patients with hepatic cystic echinococcosis in the scientific literature since the WHO Informal Working Group on Echinococcosis recommendations were issued. Of the publications included in our review, 71.2% did not indicate any classification, whereas 14% used the WHO Informal Working Group on Echinococcosis classification. Seventy-four percent reported the administration of peri-interventional albendazole, although less than half reported its modality, and 51% the length of patient follow-up. A joint effort is needed from the scientific community to encourage the acceptance and implementation of these three key issues in the clinical management of cystic echinococcosis.

Experts speak: advice from key informants to small, rural hospitals on implementing the electronic health record system.

PubMed

Craven, Catherine K; Sievert, MaryEllen C; Hicks, Lanis L; Alexander, Gregory L; Hearne, Leonard B; Holmes, John H

2013-01-01

The US government has allocated $30 billion dollars to implement Electronic Health Records (EHRs) in hospitals and provider practices through a policy called Meaningful Use. Small, rural hospitals, particularly those designated as Critical Access Hospitals (CAHs), comprising nearly a quarter of US hospitals, had not implemented EHRs before. Little is known on implementation in this setting. We interviewed a spectrum of 31 experts in the domain. The interviews were then analyzed qualitatively to ascertain the expert recommendations. Nineteen themes emerged. The pool of experts included staff from CAHs that had recently implemented EHRs. We were able to compare their answers with those of other experts and make recommendations for stakeholders. CAH peer experts focused less on issues such as physician buy-in, communication, and the EHR team. None of them indicated concern or focus on clinical decision support systems, leadership, or governance. They were especially concerned with system selection, technology, preparatory work and a need to know more about workflow and optimization. These differences were explained by the size and nature of these small hospitals.

A single competency-based education and training and competency-based career framework for the Australian health workforce: discussing the potential value add.

PubMed

Brownie, Sharon Mary; Thomas, Janelle

2014-09-01

This brief discusses the policy implications of a research study commissioned by Health Workforce Australia (HWA) within its health workforce innovation and reform work program. The project explored conceptually complex and operationally problematic concepts related to developing a whole-of-workforce competency-based education and training and competency-based career framework for the Australian health workforce and culminated with the production of three reports published by HWA. The project raised important queries as to whether such a concept is desirable, feasible or implementable - in short what is the potential value add and is it achievable? In setting the scene for discussion, the foundation of the project's genesis and focus of the study are highlighted. A summary of key definitions related to competency-based education and training frameworks and competency-based career frameworks are provided to further readers' commonality of understanding. The nature of the problem to be solved is explored and the potential value-add for the Australian health workforce and its key constituents proposed. The paper concludes by discussing relevance and feasibility issues within Australia's current and changing healthcare context along with the essential steps and implementation realities that would need to be considered and actioned if whole-of-workforce frameworks were to be developed and implemented.

Remote monitoring of Xpert® MTB/RIF testing in Mozambique: results of programmatic implementation of GxAlert.

PubMed

Cowan, J; Michel, C; Manhiça, I; Mutaquiha, C; Monivo, C; Saize, D; Beste, J; Creswell, J; Codlin, A J; Gloyd, S

2016-03-01

Electronic diagnostic tests, such as the Xpert® MTB/RIF assay, are being implemented in low- and middle-income countries (LMICs). However, timely information from these tests available via remote monitoring is underutilized. The failure to transmit real-time, actionable data to key individuals such as clinicians, patients, and national monitoring and evaluation teams may negatively impact patient care. To describe recently developed applications that allow for real-time, remote monitoring of Xpert results, and initial implementation of one of these products in central Mozambique. In partnership with the Mozambican National Tuberculosis Program, we compared three different remote monitoring tools for Xpert and selected one, GxAlert, to pilot and evaluate at five public health centers in Mozambique. GxAlert software was successfully installed on all five Xpert computers, and test results are now uploaded daily via a USB internet modem to a secure online database. A password-protected web-based interface allows real-time analysis of test results, and 1200 positive tests for tuberculosis generated 8000 SMS result notifications to key individuals. Remote monitoring of diagnostic platforms is feasible in LMICs. While promising, this effort needs to address issues around patient data ownership, confidentiality, interoperability, unique patient identifiers, and data security.

Zoonoses and marginalised infectious diseases of poverty: where do we stand?

PubMed

Molyneux, David; Hallaj, Zuhair; Keusch, Gerald T; McManus, Donald P; Ngowi, Helena; Cleaveland, Sarah; Ramos-Jimenez, Pilar; Gotuzzo, Eduardo; Kar, Kamal; Sanchez, Ana; Garba, Amadou; Carabin, Helene; Bassili, Amal; Chaignat, Claire L; Meslin, Francois-Xavier; Abushama, Hind M; Willingham, Arve L; Kioy, Deborah

2011-06-14

Despite growing awareness of the importance of controlling neglected tropical diseases as a contribution to poverty alleviation and achieving the Millennium Development Goals, there is a need to up-scale programmes to achieve wider public health benefits. This implementation deficit is attributable to several factors but one often overlooked is the specific difficulty in tackling diseases that involve both people and animals - the zoonoses. A Disease Reference Group on Zoonoses and Marginalised Infectious Diseases (DRG6) was convened by the Special Programme for Research and Training in Tropical Diseases (TDR), a programme executed by the World Health Organization and co-sponsored by UNICEF, UNDP, the World Bank and WHO. The key considerations included: (a) the general lack of reliable quantitative data on their public health burden; (b) the need to evaluate livestock production losses and their additional impacts on health and poverty; (c) the relevance of cross-sectoral issues essential to designing and implementing public health interventions for zoonotic diseases; and (d) identifying priority areas for research and interventions to harness resources most effectively. Beyond disease specific research issues, a set of common macro-priorities and interventions were identified which, if implemented through a more integrated approach by countries, would have a significant impact on human health of the most marginalised populations characteristically dependent on livestock.

Zoonoses and marginalised infectious diseases of poverty: Where do we stand?

PubMed Central

2011-01-01

Despite growing awareness of the importance of controlling neglected tropical diseases as a contribution to poverty alleviation and achieving the Millennium Development Goals, there is a need to up-scale programmes to achieve wider public health benefits. This implementation deficit is attributable to several factors but one often overlooked is the specific difficulty in tackling diseases that involve both people and animals - the zoonoses. A Disease Reference Group on Zoonoses and Marginalised Infectious Diseases (DRG6) was convened by the Special Programme for Research and Training in Tropical Diseases (TDR), a programme executed by the World Health Organization and co-sponsored by UNICEF, UNDP, the World Bank and WHO. The key considerations included: (a) the general lack of reliable quantitative data on their public health burden; (b) the need to evaluate livestock production losses and their additional impacts on health and poverty; (c) the relevance of cross-sectoral issues essential to designing and implementing public health interventions for zoonotic diseases; and (d) identifying priority areas for research and interventions to harness resources most effectively. Beyond disease specific research issues, a set of common macro-priorities and interventions were identified which, if implemented through a more integrated approach by countries, would have a significant impact on human health of the most marginalised populations characteristically dependent on livestock. PMID:21672216

Fast and simple high-capacity quantum cryptography with error detection

PubMed Central

Lai, Hong; Luo, Ming-Xing; Pieprzyk, Josef; Zhang, Jun; Pan, Lei; Li, Shudong; Orgun, Mehmet A.

2017-01-01

Quantum cryptography is commonly used to generate fresh secure keys with quantum signal transmission for instant use between two parties. However, research shows that the relatively low key generation rate hinders its practical use where a symmetric cryptography component consumes the shared key. That is, the security of the symmetric cryptography demands frequent rate of key updates, which leads to a higher consumption of the internal one-time-pad communication bandwidth, since it requires the length of the key to be as long as that of the secret. In order to alleviate these issues, we develop a matrix algorithm for fast and simple high-capacity quantum cryptography. Our scheme can achieve secure private communication with fresh keys generated from Fibonacci- and Lucas- valued orbital angular momentum (OAM) states for the seed to construct recursive Fibonacci and Lucas matrices. Moreover, the proposed matrix algorithm for quantum cryptography can ultimately be simplified to matrix multiplication, which is implemented and optimized in modern computers. Most importantly, considerably information capacity can be improved effectively and efficiently by the recursive property of Fibonacci and Lucas matrices, thereby avoiding the restriction of physical conditions, such as the communication bandwidth. PMID:28406240

Fast and simple high-capacity quantum cryptography with error detection.

PubMed

Lai, Hong; Luo, Ming-Xing; Pieprzyk, Josef; Zhang, Jun; Pan, Lei; Li, Shudong; Orgun, Mehmet A

2017-04-13

Quantum cryptography is commonly used to generate fresh secure keys with quantum signal transmission for instant use between two parties. However, research shows that the relatively low key generation rate hinders its practical use where a symmetric cryptography component consumes the shared key. That is, the security of the symmetric cryptography demands frequent rate of key updates, which leads to a higher consumption of the internal one-time-pad communication bandwidth, since it requires the length of the key to be as long as that of the secret. In order to alleviate these issues, we develop a matrix algorithm for fast and simple high-capacity quantum cryptography. Our scheme can achieve secure private communication with fresh keys generated from Fibonacci- and Lucas- valued orbital angular momentum (OAM) states for the seed to construct recursive Fibonacci and Lucas matrices. Moreover, the proposed matrix algorithm for quantum cryptography can ultimately be simplified to matrix multiplication, which is implemented and optimized in modern computers. Most importantly, considerably information capacity can be improved effectively and efficiently by the recursive property of Fibonacci and Lucas matrices, thereby avoiding the restriction of physical conditions, such as the communication bandwidth.

Fast and simple high-capacity quantum cryptography with error detection

NASA Astrophysics Data System (ADS)

Lai, Hong; Luo, Ming-Xing; Pieprzyk, Josef; Zhang, Jun; Pan, Lei; Li, Shudong; Orgun, Mehmet A.

2017-04-01

Quantum cryptography is commonly used to generate fresh secure keys with quantum signal transmission for instant use between two parties. However, research shows that the relatively low key generation rate hinders its practical use where a symmetric cryptography component consumes the shared key. That is, the security of the symmetric cryptography demands frequent rate of key updates, which leads to a higher consumption of the internal one-time-pad communication bandwidth, since it requires the length of the key to be as long as that of the secret. In order to alleviate these issues, we develop a matrix algorithm for fast and simple high-capacity quantum cryptography. Our scheme can achieve secure private communication with fresh keys generated from Fibonacci- and Lucas- valued orbital angular momentum (OAM) states for the seed to construct recursive Fibonacci and Lucas matrices. Moreover, the proposed matrix algorithm for quantum cryptography can ultimately be simplified to matrix multiplication, which is implemented and optimized in modern computers. Most importantly, considerably information capacity can be improved effectively and efficiently by the recursive property of Fibonacci and Lucas matrices, thereby avoiding the restriction of physical conditions, such as the communication bandwidth.

A critical analysis of the implementation of a legal regulated market for new psychoactive substances ("legal highs") in New Zealand.

PubMed

Rychert, Marta; Wilkins, Chris

2018-05-01

In July 2013 New Zealand passed the Psychoactive Substances Act (PSA) to establish the world's first regulated legal market for new psychoactive substances (NPS) ("legal highs"). To critically analyse the implementation of the PSA. Synthesis of findings from interviews with 30 key informants (i.e. politicians, civil servants, legal high industry actors, toxicologists, NGO representatives and drug policy academics), analysis of relevant laws and policy documents, and a review of academic and grey literature on the PSA. Key challenges experienced during the implementation of the PSA included the harmfulness of interim approved products, the slowness in withdrawing products which caused adverse effects, enforcing retail restrictions, price competition by retailers, judicial challenges by the "legal high" industry, and growing opposition to the regime from local communities and key stakeholders (including local councils). The PSA lacks a tax on products and restrictions on retail opening hours which likely contributed to the problems above. The implementation of the PSA also appeared to suffer from a rushed legislative process and resource constraints on the regulatory agency which led to delays in the development of the full regulatory framework, including the product testing requirements, and issues with enforcing retail regulation, such as the minimum age of purchase. The decline in public support for the PSA regime reflected problems with communicating the aims of the policy to the general public. The troubled implementation of the PSA underlines a number of important lessons for consideration when developing a regulated legal drug market, including advanced development of regulatory systems, ensuring the sale of low risk products, adequately resourcing regulatory agencies and related enforcement activity, detailed regulation of retail outlets, establishing price controls, and ongoing engagement with stakeholders and the general public. Copyright © 2018 Elsevier B.V. All rights reserved.

Enhanced primary mental healthcare for Indigenous Australians: service implementation strategies and perspectives of providers.

PubMed

Reifels, Lennart; Nicholas, Angela; Fletcher, Justine; Bassilios, Bridget; King, Kylie; Ewen, Shaun; Pirkis, Jane

2018-01-01

Improving access to culturally appropriate mental healthcare has been recognised as a key strategy to address the often greater burden of mental health issues experienced by Indigenous populations. We present data from the evaluation of a national attempt at improving access to culturally appropriate mental healthcare for Indigenous Australians through a mainstream primary mental healthcare program, the Access to Allied Psychological Services program, whilst specifically focusing on the implementation strategies and perspectives of service providers. We conducted semi-structured interviews with 31 service providers (primary care agency staff, referrers, and mental health professionals) that were analysed thematically and descriptively. Agency-level implementation strategies to enhance service access and cultural appropriateness included: the conduct of local service needs assessments; Indigenous stakeholder consultation and partnership development; establishment of clinical governance frameworks; workforce recruitment, clinical/cultural training and supervision; stakeholder and referrer education; and service co-location at Indigenous health organisations. Dedicated provider-level strategies to ensure the cultural appropriateness of services were primarily aimed at the context and process of delivery (involving, flexible referral pathways, suitable locations, adaptation of client engagement and service feedback processes) and, to a lesser extent, the nature and content of interventions (provision of culturally adapted therapy). This study offers insights into key factors underpinning the successful national service implementation approach. Study findings highlight that concerted national attempts to enhance mainstream primary mental healthcare for Indigenous people are critically dependent on effective local agency- and provider-level strategies to optimise the integration, adaptation and broader utility of these services within local Indigenous community and healthcare service contexts. Despite the explicit provider focus, this study was limited by a lack of Indigenous stakeholder perspectives. Key study findings are of direct relevance to inform the future implementation and delivery of culturally appropriate primary mental healthcare programs for Indigenous populations in Australia and internationally.

Secure and Efficient Key Coordination Algorithm for Line Topology Network Maintenance for Use in Maritime Wireless Sensor Networks.

PubMed

Elgenaidi, Walid; Newe, Thomas; O'Connell, Eoin; Toal, Daniel; Dooly, Gerard

2016-12-21

There has been a significant increase in the proliferation and implementation of Wireless Sensor Networks (WSNs) in different disciplines, including the monitoring of maritime environments, healthcare systems, and industrial sectors. It has now become critical to address the security issues of data communication while considering sensor node constraints. There are many proposed schemes, including the scheme being proposed in this paper, to ensure that there is a high level of security in WSNs. This paper presents a symmetric security scheme for a maritime coastal environment monitoring WSN. The scheme provides security for travelling packets via individually encrypted links between authenticated neighbors, thus avoiding a reiteration of a global rekeying process. Furthermore, this scheme proposes a dynamic update key based on a trusted node configuration, called a leader node, which works as a trusted third party. The technique has been implemented in real time on a Waspmote test bed sensor platform and the results from both field testing and indoor bench testing environments are discussed in this paper.

Secure and Efficient Key Coordination Algorithm for Line Topology Network Maintenance for Use in Maritime Wireless Sensor Networks

PubMed Central

Elgenaidi, Walid; Newe, Thomas; O’Connell, Eoin; Toal, Daniel; Dooly, Gerard

2016-01-01

There has been a significant increase in the proliferation and implementation of Wireless Sensor Networks (WSNs) in different disciplines, including the monitoring of maritime environments, healthcare systems, and industrial sectors. It has now become critical to address the security issues of data communication while considering sensor node constraints. There are many proposed schemes, including the scheme being proposed in this paper, to ensure that there is a high level of security in WSNs. This paper presents a symmetric security scheme for a maritime coastal environment monitoring WSN. The scheme provides security for travelling packets via individually encrypted links between authenticated neighbors, thus avoiding a reiteration of a global rekeying process. Furthermore, this scheme proposes a dynamic update key based on a trusted node configuration, called a leader node, which works as a trusted third party. The technique has been implemented in real time on a Waspmote test bed sensor platform and the results from both field testing and indoor bench testing environments are discussed in this paper. PMID:28009834

Annual report to the Chairman and Ranking Minority Members, House and Senate Committees on Appropriations. Status of open recommendations: Improving operations of federal departments and agencies

NASA Technical Reports Server (NTRS)

1995-01-01

Each year, GAO's work contributes to many legislative and executive branch actions that result in significant financial savings and other improvements in government operations. Some, but not all, are identified through GAO's system for periodically following up to determine the status of actions taken on the recommendations made in its audit and evaluation reports. In fiscal year 1994, GAO made 1,450 recommendations, but, more importantly, about 4,400 GAO recommendations made over the past 5 years have been implemented. This report includes summary information on the status of all GAO recommendations that have not been fully implemented and highlights some of the key ones. This information should help congressional and agency leaders prepare for upcoming appropriations and oversight activities and stimulate further actions to achieve the desired improvements in government operations. In addition to including printed issue area summaries highlighting the ipact of GAO's work and the key open recommendations, this volume includes a set of computer diskettes with details on all open recommendations.

Research on key technology of yacht positioning based on binocular parallax

NASA Astrophysics Data System (ADS)

Wang, Wei; Wei, Ping; Liu, Zengzhi

2016-10-01

Yacht has become a fashionable way for entertainment. However, to obtain the precise location of a yacht docked at a port has become one of the concerns of a yacht manager. To deal with this issue, we adopt a positioning method based on the principle of binocular parallax and background difference in this paper. Binocular parallax uses cameras to get multi-dimensional perspective of the yacht based on geometric principle of imaging. In order to simplify the yacht localization problem, we install LED light indicator as the key point on a yacht. And let it flash at a certain frequency during day time and night time. After getting the distance between the LED and the cameras, locating the yacht is easy. Compared with other traditional positioning methods, this method is simpler and easier to implement. In this paper, we study the yacht positioning method using the LED indicator. Simulation experiment is done for a yacht model in the distance of 3 meters. The experimental result shows that our method is feasible and easy to implement with a small 15% positioning error.

Food commodity pipeline management in transitional settings: challenges and lessons learned from the first USAID food development program in South Sudan

PubMed Central

Tappis, Hannah; Doocy, Shannon; Amoako, Stephen

2013-01-01

ABSTRACT Despite decades of support for international food assistance programs by the U.S. Agency for International Development (USAID) Office of Food for Peace, relatively little is known about the commodity pipeline and management issues these programs face in post-conflict and politically volatile settings. Based on an audit of the program's commodity tracking system and interviews with 13 key program staff, this case study documents the experiences of organizations implementing the first USAID-funded non-emergency (development) food assistance program approved for Sudan and South Sudan. Key challenges and lessons learned in this experience about food commodity procurement, transport, and management may help improve the design and implementation of future development food assistance programs in a variety of complex, food-insecure settings around the world. Specifically, expanding shipping routes in complex political situations may facilitate reliable and timely commodity delivery. In addition, greater flexibility to procure commodities locally, rather than shipping U.S.-procured commodities, may avoid unnecessary shipping delays and reduce costs. PMID:25276532

Linking HIV-Negative Youth to Prevention Services in 12 U.S. Cities: Barriers and Facilitators to Implementing the HIV Prevention Continuum.

PubMed

Doll, Mimi; Fortenberry, J Dennis; Roseland, Denise; McAuliff, Kathleen; Wilson, Craig M; Boyer, Cherrie B

2018-04-01

Linkage of HIV-negative youth to prevention services is increasingly important with the development of effective pre-exposure prophylaxis that complements behavioral and other prevention-focused interventions. However, effective infrastructure for delivery of prevention services does not exist, leaving many programs to address HIV prevention without data to guide program development/implementation. The objective of this study was to provide a qualitative description of barriers and facilitators of linkage to prevention services among high-risk, HIV-negative youth. Thematic analysis of structured interviews with staff implementing linkage to prevention services programs for youth aged 12-24 years. Twelve adolescent medicine HIV primary care programs as part of larger testing research program focused on young sexual minority men of color. The study included staff implementing linkage to prevention services programs along with community-based HIV testing programs. The main outcomes of the study were key barriers/facilitators to linkage to prevention services. Eight themes summarized perspectives on linkage to prevention services: (1) relationships with community partners, (2) trust between providers and youth, (3) youth capacity to navigate prevention services, (4) pre-exposure prophylaxis specific issues, (5) privacy issues, (6) gaps in health records preventing tailored services, (7) confidentiality of care for youth accessing services through parents'/caretakers' insurance, and (8) need for health-care institutions to keep pace with models that prioritize HIV prevention among at-risk youth. Themes are discussed in the context of factors that facilitated/challenged linkage to prevention services. Several evidence-based HIV prevention tools are available; infrastructures for coordinated service delivery to high-risk youth have not been developed. Implementation of such infrastructures requires attention to community-, provider-, and youth-related issues. Copyright © 2017 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Identification of Crew-Systems Interactions and Decision Related Trends

NASA Technical Reports Server (NTRS)

Jones, Sharon Monica; Evans, Joni K.; Reveley, Mary S.; Withrow, Colleen A.; Ancel, Ersin; Barr, Lawrence

2013-01-01

NASA Vehicle System Safety Technology (VSST) project management uses systems analysis to identify key issues and maintain a portfolio of research leading to potential solutions to its three identified technical challenges. Statistical data and published safety priority lists from academic, industry and other government agencies were reviewed and analyzed by NASA Aviation Safety Program (AvSP) systems analysis personnel to identify issues and future research needs related to one of VSST's technical challenges, Crew Decision Making (CDM). The data examined in the study were obtained from the National Transportation Safety Board (NTSB) Aviation Accident and Incident Data System, Federal Aviation Administration (FAA) Accident/Incident Data System and the NASA Aviation Safety Reporting System (ASRS). In addition, this report contains the results of a review of safety priority lists, information databases and other documented references pertaining to aviation crew systems issues and future research needs. The specific sources examined were: Commercial Aviation Safety Team (CAST) Safety Enhancements Reserved for Future Implementation (SERFIs), Flight Deck Automation Issues (FDAI) and NTSB Most Wanted List and Open Recommendations. Various automation issues taxonomies and priority lists pertaining to human factors, automation and flight design were combined to create a list of automation issues related to CDM.

Knowledge translation at the macro level: legal and ethical considerations.

PubMed

Larkin, Gregory Luke; Hamann, Cara J; Monico, Edward P; Degutis, Linda; Schuur, Jeremiah; Kantor, Walter; Graffeo, Charles S

2007-11-01

Macro-level legal and ethical issues play a significant role in the successful translation of knowledge into practice. The medicolegal milieu, in particular, can promote clinical inertia and stifle innovation. Embracing new clinical practice guidelines and best practice models has not protected physicians from superfluous torts; in some cases, emerging evidence has been used as the dagger of trial lawyers rather than the scalpel of physicians. Beyond the legal challenges are overarching justice issues that frame the broad goals of knowledge translation (KT) and technology diffusion. Optimal implementation of the latest evidence requires attention to be paid to the context of the candidate community and the key opinion leaders therein, characterized by the "8Ps" (public, patients, press, physicians, policy makers, private sector, payers, and public health). Ethical and equitable KT also accounts for the global burdens and benefits of implementing innovation such that disparities and gaps in health experienced by the least advantaged are prioritized. Researchers and thought leaders must attend to questions of fairness, economics, and legal risk when investigating ways to promote equity-oriented KT.

Implementing standard setting into the Conjoint MAFP/FRACGP Part 1 examination - Process and issues.

PubMed

Chan, S C; Mohd Amin, S; Lee, T W

2016-01-01

The College of General Practitioners of Malaysia and the Royal Australian College of General Practitioners held the first Conjoint Member of the College of General Practitioners (MCGP)/Fellow of Royal Australian College of General Practitioners (FRACGP) examination in 1982, later renamed the Conjoint MAFP/FRACGP examinations. The examination assesses competency for safe independent general practice and as family medicine specialists in Malaysia. Therefore, a defensible standard set pass mark is imperative to separate the competent from the incompetent. This paper discusses the process and issues encountered in implementing standard setting to the Conjoint Part 1 examination. Critical to success in standard setting were judges' understanding of the process of the modified Angoff method, defining the borderline candidate's characteristics and the composition of judges. These were overcome by repeated hands-on training, provision of detailed guidelines and careful selection of judges. In December 2013, 16 judges successfully standard set the Part 1 Conjoint examinations, with high inter-rater reliability: Cronbach's alpha coefficient 0.926 (Applied Knowledge Test), 0.921 (Key Feature Problems).

The Impact of Minimum Energy Performance Standards (MEPS) Regulation on Electricity Saving in Malaysia

NASA Astrophysics Data System (ADS)

Fatihah Salleh, Siti; Eqwan Roslan, Mohd; Isa, Aishah Mohd; Faizal Basri Nair, Mohd; Syafiqah Salleh, Siti

2018-03-01

One of Malaysia’s key strategies to promote efficient energy use in the country is to implement the minimum energy performance standards (MEPS) through the Electricity Regulations (Amendment) 2013. Five selected electrical appliances (refrigerator, air conditioner, television, domestic fans and lamp fittings) must comply with MEPS requirement in order to be sold in Malaysian market. Manufacturers, importers or distributors are issued Certificate of Approval (COA) if products are MEPS-compliant. In 2015, 1,215 COAs were issued but the number of MEPS products in the market is unknown. This work collects sales data from major manufacturers to estimate the annual sales of MEPS appliances and the cumulative electricity consumption and electricity saving. It was found that most products sold have 3-star rating and above. By year 2015, total cumulative electricity savings gained from MEPS implementation is 3,645 GWh, with air conditioner being the highest contributor (30%). In the future, it is recommended that more MEPS products and related incentives be introduced to further improve efficiency of energy use in Malaysia.

Data quality through a web-based QA/QC system: implementation for atmospheric mercury data from the global mercury observation system.

PubMed

D'Amore, Francesco; Bencardino, Mariantonia; Cinnirella, Sergio; Sprovieri, Francesca; Pirrone, Nicola

2015-08-01

The overall goal of the on-going Global Mercury Observation System (GMOS) project is to develop a coordinated global monitoring network for mercury, including ground-based, high altitude and sea level stations. In order to ensure data reliability and comparability, a significant effort has been made to implement a centralized system, which is designed to quality assure and quality control atmospheric mercury datasets. This system, GMOS-Data Quality Management (G-DQM), uses a web-based approach with real-time adaptive monitoring procedures aimed at preventing the production of poor-quality data. G-DQM is plugged on a cyberinfrastructure and deployed as a service. Atmospheric mercury datasets, produced during the first-three years of the GMOS project, are used as the input to demonstrate the application of the G-DQM and how it identifies a number of key issues concerning data quality. The major issues influencing data quality are presented and discussed for the GMOS stations under study. Atmospheric mercury data collected at the Longobucco (Italy) station is used as a detailed case study.

Recent progress of the JT-60SA project

NASA Astrophysics Data System (ADS)

Shirai, H.; Barabaschi, P.; Kamada, Y.; the JT-60SA Team

2017-10-01

The JT-60SA project has been implemented for the purpose of an early realization of fusion energy. With a powerful and versatile NBI and ECRF system, a flexible plasma-shaping capability, and various kinds of in-vessel coils to suppress MHD instabilities, JT-60SA plays an essential role in addressing the key physics and engineering issues of ITER and DEMO. It aims to achieve the long sustainment of high integrated performance plasmas under the high β N condition required in DEMO. The fabrication and installation of components and systems of JT-60SA procured by the EU and Japan are steadily progressing. The installation of toroidal field (TF) coils around the vacuum vessel started in December 2016. The commissioning of the cryogenic system and power supply system has been implemented in the Naka site, and JT-60SA will start operation in 2019. The JT-60SA research plan covers a wide area of issues in ITER and DEMO relevant operation regimes, and has been regularly updated on the basis of intensive discussion among European and Japanese researchers.

Perceived benefits and barriers of implementing nursing residency programs in Jordan.

PubMed

AbuAlRub, R F; Abu Alhaija'a, M G

2018-03-02

To explore the challenges that face Jordanian nurses in the first year of employment; and understand the benefits and barriers of implementing a Nursing Residency Program from the perspectives of nurses and key informants. Many researchers reported that novice nurses do not have an adequate level of competence needed in the real clinical practice to meet the increasing demands of healthcare systems. A descriptive qualitative approach using individual interviews and focus group discussions was utilized. The sample was a purposive one that consisted of 30 Jordanian nurses and six key informants. Data were recorded and then transcribed. Content analysis was used to analyze the data. The results revealed several challenges that face nurses in their first year of experience such as reality shock, lack of self-confidence, and burnout and intent to leave. Some of the perceived barriers of implementing the Program were issues concerned with the responsible regulatory body, payment, and monitoring and evaluation. The findings asserted that the implementation of the Nursing Residency Program for new practicing nurses would enhance their competencies and self- confidence; and decrease the rate of reality shock and turnover within the first year of employment. Policy makers, nurse educators, and nurse administrators and clinical nurses need to collaborate to develop a formal system with binding policies and regulations concerning the implementation of Nursing Residency Program. There is also a need to address and modify current orientation programmes offered by hospitals for novice nurses to enhance their transition into clinical practice. © 2018 International Council of Nurses.

Evaluating the implementation of a national disclosure policy for large-scale adverse events in an integrated health care system: identification of gaps and successes.

PubMed

Maguire, Elizabeth M; Bokhour, Barbara G; Wagner, Todd H; Asch, Steven M; Gifford, Allen L; Gallagher, Thomas H; Durfee, Janet M; Martinello, Richard A; Elwy, A Rani

2016-11-11

Many healthcare organizations have developed disclosure policies for large-scale adverse events, including the Veterans Health Administration (VA). This study evaluated VA's national large-scale disclosure policy and identifies gaps and successes in its implementation. Semi-structured qualitative interviews were conducted with leaders, hospital employees, and patients at nine sites to elicit their perceptions of recent large-scale adverse events notifications and the national disclosure policy. Data were coded using the constructs of the Consolidated Framework for Implementation Research (CFIR). We conducted 97 interviews. Insights included how to handle the communication of large-scale disclosures through multiple levels of a large healthcare organization and manage ongoing communications about the event with employees. Of the 5 CFIR constructs and 26 sub-constructs assessed, seven were prominent in interviews. Leaders and employees specifically mentioned key problem areas involving 1) networks and communications during disclosure, 2) organizational culture, 3) engagement of external change agents during disclosure, and 4) a need for reflecting on and evaluating the policy implementation and disclosure itself. Patients shared 5) preferences for personal outreach by phone in place of the current use of certified letters. All interviewees discussed 6) issues with execution and 7) costs of the disclosure. CFIR analysis reveals key problem areas that need to be addresses during disclosure, including: timely communication patterns throughout the organization, establishing a supportive culture prior to implementation, using patient-approved, effective communications strategies during disclosures; providing follow-up support for employees and patients, and sharing lessons learned.

The challenge of benchmarking health systems: is ICT innovation capacity more systemic than organizational dependent?

PubMed

Lapão, Luís Velez

2015-01-01

The article by Catan et al. presents a benchmarking exercise comparing Israel and Portugal on the implementation of Information and Communication Technologies in the healthcare sector. Special attention was given to e-Health and m-Health. The authors collected information via a set of interviews with key stakeholders. They compared two different cultures and societies, which have reached slightly different implementation outcomes. Although the comparison is very enlightening, it is also challenging. Benchmarking exercises present a set of challenges, such as the choice of methodologies and the assessment of the impact on organizational strategy. Precise benchmarking methodology is a valid tool for eliciting information about alternatives for improving health systems. However, many beneficial interventions, which benchmark as effective, fail to translate into meaningful healthcare outcomes across contexts. There is a relationship between results and the innovational and competitive environments. Differences in healthcare governance and financing models are well known; but little is known about their impact on Information and Communication Technology implementation. The article by Catan et al. provides interesting clues about this issue. Public systems (such as those of Portugal, UK, Sweden, Spain, etc.) present specific advantages and disadvantages concerning Information and Communication Technology development and implementation. Meanwhile, private systems based fundamentally on insurance packages, (such as Israel, Germany, Netherlands or USA) present a different set of advantages and disadvantages - especially a more open context for innovation. Challenging issues from both the Portuguese and Israeli cases will be addressed. Clearly, more research is needed on both benchmarking methodologies and on ICT implementation strategies.

[Principles and methodology for ecological rehabilitation and security pattern design in key project construction].

PubMed

Chen, Li-Ding; Lu, Yi-He; Tian, Hui-Ying; Shi, Qian

2007-03-01

Global ecological security becomes increasingly important with the intensive human activities. The function of ecological security is influenced by human activities, and in return, the efficiency of human activities will also be affected by the patterns of regional ecological security. Since the 1990s, China has initiated the construction of key projects "Yangtze Three Gorges Dam", "Qinghai-Tibet Railway", "West-to-East Gas Pipeline", "West-to-East Electricity Transmission" and "South-to-North Water Transfer" , etc. The interaction between these projects and regional ecological security has particularly attracted the attention of Chinese government. It is not only important for the regional environmental protection, but also of significance for the smoothly implementation of various projects aimed to develop an ecological rehabilitation system and to design a regional ecological security pattern. This paper made a systematic analysis on the types and characteristics of key project construction and their effects on the environment, and on the basis of this, brought forward the basic principles and methodology for ecological rehabilitation and security pattern design in this construction. It was considered that the following issues should be addressed in the implementation of a key project: 1) analysis and evaluation of current regional ecological environment, 2) evaluation of anthropogenic disturbances and their ecological risk, 3) regional ecological rehabilitation and security pattern design, 4) scenario analysis of environmental benefits of regional ecological security pattern, 5) re-optimization of regional ecological system framework, and 6) establishment of regional ecosystem management plan.

Using object-oriented analysis to design a multi-mission ground data system

NASA Technical Reports Server (NTRS)

Shames, Peter

1995-01-01

This paper describes an analytical approach and descriptive methodology that is adapted from Object-Oriented Analysis (OOA) techniques. The technique is described and then used to communicate key issues of system logical architecture. The essence of the approach is to limit the analysis to only service objects, with the idea of providing a direct mapping from the design to a client-server implementation. Key perspectives on the system, such as user interaction, data flow and management, service interfaces, hardware configuration, and system and data integrity are covered. A significant advantage of this service-oriented approach is that it permits mapping all of these different perspectives on the system onto a single common substrate. This services substrate is readily represented diagramatically, thus making details of the overall design much more accessible.

Design and implementation of PKI-based certification authority

NASA Astrophysics Data System (ADS)

Zheng, Ying; Bai, Qinghai; Zhao, Linna; Chun, Hua; Chen, Jing

2015-12-01

PKI achieves the management of public key by certificates. It combines the user's public key and his or her identification formation through a trusted third-party organization CA, in order to authenticate the user's identity on the Internet, thus ensuring the authenticity, integrity, confidentiality, and non- repudiation of the information transmitted on the Internet. CA is the most critical agency in the PKI system, mainly responsible for issuing and managing certificates. On the basis of the actual needs of an enterprise, in this paper the author designs and develops a small-sized PKI-based Certification Authority equipped with the functions of root CA initialization, certificate application, certificate issuance, certificate revocation, and the generation of certificate revocation list. The author also points out the problems that need to be mentioned in the design and development.

OCCUPATIONAL SAFETY AND HEALTH EDUCATION AND TRAINING FOR UNDERSERVED POPULATIONS

PubMed Central

O’CONNOR, TOM; FLYNN, MICHAEL; WEINSTOCK, DEBORAH; ZANONI, JOSEPH

2015-01-01

This article presents an analysis of the essential elements of effective occupational safety and health education and training programs targeting under-served communities. While not an exhaustive review of the literature on occupational safety and health training, the paper provides a guide for practitioners and researchers to the key factors they should consider in the design and implementation of training programs for underserved communities. It also addresses issues of evaluation of such programs, with specific emphasis on considerations for programs involving low-literacy and limited-English-speaking workers. PMID:25053607

Strategies for the nurse executive to keep the rural hospitals open.

PubMed

Shride, S E

1997-01-01

Rural hospitals are confronted with multiple challenges to survive in the competitive health care environment of today's world. Declining population, corporate mergers and downsizing, transportation, cost of technology, and health manpower shortages are only a few of the issues rural hospitals must be prepared to address in order to survive. Federal- and state-administered programs are available that can contribute to the survival of the rural hospital. The nurse executive has a key role in contributing to the planning, development, and implementation of survival strategies.

Policy model for space economy infrastructure

NASA Astrophysics Data System (ADS)

Komerath, Narayanan; Nally, James; Zilin Tang, Elizabeth

2007-12-01

Extraterrestrial infrastructure is key to the development of a space economy. Means for accelerating transition from today's isolated projects to a broad-based economy are considered. A large system integration approach is proposed. The beginnings of an economic simulation model are presented, along with examples of how interactions and coordination bring down costs. A global organization focused on space infrastructure and economic expansion is proposed to plan, coordinate, fund and implement infrastructure construction. This entity also opens a way to raise low-cost capital and solve the legal and public policy issues of access to extraterrestrial resources.

New developments in the management of speech and language disorders.

PubMed

Harding, Celia; Gourlay, Sara

2008-05-01

Speech and language disorders, which include swallowing difficulties, are usually managed by speech and language therapists. Such a diverse, complex and challenging clinical group of symptoms requires practitioners with detailed knowledge and understanding of research within those areas, as well as the ability to implement appropriate therapy strategies within many environments. These environments range from neonatal units, acute paediatric wards and health centres through to nurseries, schools and children's homes. This paper summarises the key issues that are fundamental to our understanding of this client group.

Formal Modeling and Analysis of a Preliminary Small Aircraft Transportation System (SATS)Concept

NASA Technical Reports Server (NTRS)

Carrreno, Victor A.; Gottliebsen, Hanne; Butler, Ricky; Kalvala, Sara

2004-01-01

New concepts for automating air traffic management functions at small non-towered airports raise serious safety issues associated with the software implementations and their underlying key algorithms. The criticality of such software systems necessitates that strong guarantees of the safety be developed for them. In this paper we present a formal method for modeling and verifying such systems using the PVS theorem proving system. The method is demonstrated on a preliminary concept of operation for the Small Aircraft Transportation System (SATS) project at NASA Langley.

Counterfactual quantum cryptography network with untrusted relay

NASA Astrophysics Data System (ADS)

Chen, Yuanyuan; Gu, Xuemei; Jiang, Dong; Xie, Ling; Chen, Lijun

2015-07-01

Counterfactual quantum cryptography allows two remote parties to share a secret key even though a physical particle is not in fact transmitted through the quantum channel. In order to extend the scope of counterfactual quantum cryptography, we use an untrusted relay to construct a multi-user network. The implementation issues are discussed to show that the scheme can be realized with current technologies. We also prove the practical security advantages of the scheme by eliminating the probability that an eavesdropper can directly access the signal or an untrusted relay can perform false operations.

Improvement of Selected Logistics Processes Using Quality Engineering Tools

NASA Astrophysics Data System (ADS)

Zasadzień, Michał; Žarnovský, Jozef

2018-03-01

Increase in the number of orders, the increasing quality requirements and the speed of order preparation require implementation of new solutions and improvement of logistics processes. Any disruption that occurs during execution of an order often leads to customer dissatisfaction, as well as loss of his/her confidence. The article presents a case study of the use of quality engineering methods and tools to improve the e-commerce logistic process. This made it possible to identify and prioritize key issues, identify their causes, and formulate improvement and prevention measures.

Occupational safety and health education and training for underserved populations.

PubMed

O'Connor, Tom; Flynn, Michael; Weinstock, Deborah; Zanoni, Joseph

2014-01-01

This article presents an analysis of the essential elements of effective occupational safety and health education and training programs targeting underserved communities. While not an exhaustive review of the literature on occupational safety and health training, the paper provides a guide for practitioners and researchers to the key factors they should consider in the design and implementation of training programs for underserved communities. It also addresses issues of evaluation of such programs, with specific emphasis on considerations for programs involving low-literacy and limited-English-speaking workers.

Declarative Programming with Temporal Constraints, in the Language CG.

PubMed

Negreanu, Lorina

2015-01-01

Specifying and interpreting temporal constraints are key elements of knowledge representation and reasoning, with applications in temporal databases, agent programming, and ambient intelligence. We present and formally characterize the language CG, which tackles this issue. In CG, users are able to develop time-dependent programs, in a flexible and straightforward manner. Such programs can, in turn, be coupled with evolving environments, thus empowering users to control the environment's evolution. CG relies on a structure for storing temporal information, together with a dedicated query mechanism. Hence, we explore the computational complexity of our query satisfaction problem. We discuss previous implementation attempts of CG and introduce a novel prototype which relies on logic programming. Finally, we address the issue of consistency and correctness of CG program execution, using the Event-B modeling approach.

Development of a Prototype Automation Simulation Scenario Generator for Air Traffic Management Software Simulations

NASA Technical Reports Server (NTRS)

Khambatta, Cyrus F.

2007-01-01

A technique for automated development of scenarios for use in the Multi-Center Traffic Management Advisor (McTMA) software simulations is described. The resulting software is designed and implemented to automate the generation of simulation scenarios with the intent of reducing the time it currently takes using an observational approach. The software program is effective in achieving this goal. The scenarios created for use in the McTMA simulations are based on data taken from data files from the McTMA system, and were manually edited before incorporation into the simulations to ensure accuracy. Despite the software s overall favorable performance, several key software issues are identified. Proposed solutions to these issues are discussed. Future enhancements to the scenario generator software may address the limitations identified in this paper.

Eliminating extravasation events: a multidisciplinary approach.

PubMed

Coyle, Christine E; Griffie, Julie; Czaplewski, Lynn M

2014-01-01

Administration of chemotherapy agents can give rise to many safety issues. Extravasation of a vesicant agent causes tissue blistering and necrosis. This complication of chemotherapy administration causes additional pain and suffering in patients who are already suffering with a diagnosis of cancer. Nurses hold key responsibilities for educating patients about administration issues and following practice standards to minimize the risk of extravasation. Defining a path of shared responsibilities among team members is a critical step in assuring the safe administration of drugs classified as vesicants. This article describes a clinical practice change that is used at a large midwestern academic medical cancer center. This practice and policy change has resulted in a 90% reduction in the administration of vesicant agents peripherally, with no occurrence of extravasations in the first 6 months of implementation.

Eliminating Extravasation Events: A Multidisciplinary Approach.

PubMed

Coyle, Christine E; Griffie, Julie; Czaplewski, Lynn M

2015-01-01

Administration of chemotherapy agents can give rise to many safety issues. Extravasation of a vesicant agent causes tissue blistering and necrosis. This complication of chemotherapy administration causes additional pain and suffering in patients who are already suffering with a diagnosis of cancer. Nurses hold key responsibilities for educating patients about administration issues and following practice standards to minimize the risk of extravasation. Defining a path of shared responsibilities among team members is a critical step in assuring the safe administration of drugs classified as vesicants. This article describes a clinical practice change that is used at a large midwestern academic medical cancer center. This practice and policy change has resulted in a 90% reduction in the administration of vesicant agents peripherally, with no occurrence of extravasations in the first 6 months of implementation.

Microgravity science experiment integration - When the PI and the PED differ

NASA Technical Reports Server (NTRS)

Baer-Peckham, M. S.; Mccarley, K. S.

1991-01-01

This paper addresses issues related to the integration of principal investigators (PIs) and payload-element developers (PEDs) for conducting effective microgravity experiments. The Crystal Growth Furnace (CGF) is used as an example to demonstrate the key issues related to the integration of a PI's sample into a facility run by a different organization. Attention is given to the typical preflight timeline, documentation required for experimental implementation, and hardware deliverables. A flow chart delineates the payload-integration process flow, and PI inputs required for an experiment include equipment and procedure definitions, detailed design and fabrication of the experiment-specific equipment, and specifications of the contract-end item. The present analysis is of interest to the coordination of effective microgravity experiments on the Space Station Freedom that incorporate PIs and PEDs from different organizations.

[Project design and implementation of the fourth national survey Chinese matiera medica resources].

PubMed

Huang, Lu-Qi; Lu, Jian-Wei; Guo, Lan-Ping; Zhang, Xiao-Bo; Zhao, Run-Huai; Zhang, Ben-Gang; Li, Yu; Su, Gang-Qiang; Li, Da-Ning

2013-03-01

The planning of the fourth national survey on Chinese materia medica resources shall follow the requirement of "carrying out the national survey on Chinese materia medica resources, strengthening the construction of Chinese materia medica resources monitoring and information network" which is according to the document issued by the State Council. Based on the responsibilities of State Administration of Traditional Chinese Medicine which is "organizing the survey, promoting the resource-protection, keeping development and rational utilization", combined with the key problems that need to be solved in current medicinal industry, the related instructions issued by central leadership and the recommendations from NPC delegates, CPPCC members and experts, the planning shall make overall plans and top-level design for the new round of national survey on Chinese materia medica resources.

Guidelines for Creating, Implementing, and Evaluating Mind-Body Programs in a Military Healthcare Setting.

PubMed

Smith, Katherine; Firth, Kimberly; Smeeding, Sandra; Wolever, Ruth; Kaufman, Joanna; Delgado, Roxana; Bellanti, Dawn; Xenakis, Lea

2016-01-01

Research suggests that the development of mind-body skills can improve individual and family resilience, particularly related to the stresses of illness, trauma, and caregiving. To operationalize the research evidence that mind-body skills help with health and recovery, Samueli Institute, in partnership with experts in mind-body programming, created a set of guidelines for developing and evaluating mind-body programs for service members, veterans, and their families. The Guidelines for Creating, Implementing, and Evaluating Mind-Body Programs in a Military Healthcare Setting outline key strategies and issues to consider when developing, implementing, and evaluating a mind-body focused family empowerment approach in a military healthcare setting. Although these guidelines were developed specifically for a military setting, most of the same principles can be applied to the development of programs in the civilian setting as well. The guidelines particularly address issues unique to mind-body programs, such as choosing evidence-based modalities, licensure and credentialing, safety and contraindications, and choosing evaluation measures that capture the holistic nature of these types of programs. The guidelines are practical, practice-based guidelines, developed by experts in the fields of program development and evaluation, mind-body therapies, patient- and family-centered care, as well as, experts in military and veteran's health systems. They provide a flexible framework to create mind-body family empowerment programs and describe important issues that program developers and evaluators are encouraged to address to ensure the development of the most impactful, successful, evidence-supported programs possible. Copyright © 2016 Elsevier Inc. All rights reserved.

MO-D-BRB-02: SBRT Treatment Planning and Delivery

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

Yang, Y.

2016-06-15

Increased use of SBRT and hypofractionation in radiation oncology practice has posted a number of challenges to medical physicist, ranging from planning, image-guided patient setup and on-treatment monitoring, to quality assurance (QA) and dose delivery. This symposium is designed to provide current knowledge necessary for the safe and efficient implementation of SBRT in various linac platforms, including the emerging digital linacs equipped with high dose rate FFF beams. Issues related to 4D CT, PET and MRI simulations, 3D/4D CBCT guided patient setup, real-time image guidance during SBRT dose delivery using gated/un-gated VMAT/IMRT, and technical advancements in QA of SBRT (inmore » particular, strategies dealing with high dose rate FFF beams) will be addressed. The symposium will help the attendees to gain a comprehensive understanding of the SBRT workflow and facilitate their clinical implementation of the state-of-art imaging and planning techniques. Learning Objectives: Present background knowledge of SBRT, describe essential requirements for safe implementation of SBRT, and discuss issues specific to SBRT treatment planning and QA. Update on the use of multi-dimensional and multi-modality imaging for reliable guidance of SBRT. Discuss treatment planning and QA issues specific to SBRT. Provide a comprehensive overview of emerging digital linacs and summarize the key geometric and dosimetric features of the new generation of linacs for substantially improved SBRT. NIH/NCI; Varian Medical Systems; F. Yin, Duke University has a research agreement with Varian Medical Systems. In addition to research grant, I had a technology license agreement with Varian Medical Systems.« less

'Important… but of low status': male education leaders' views on gender in medicine.

PubMed

Risberg, Gunilla; Johansson, Eva E; Hamberg, Katarina

2011-06-01

The implementation of and communication about matters associated with gender in medical education have been predominantly perceived as women's issues. This study aimed to explore attitudes towards and experiences of gender-related issues among key male members of faculties of medicine. We conducted semi-structured interviews with 20 male education leaders from the six medical schools in Sweden. The interviews were analysed qualitatively using a modified grounded theory approach. The core category--'important… but of low status'--reflects ambivalent attitudes towards gender-related issues in medicine among male education leaders. All informants were able to articulate why gender matters. As doctors, they saw gender as a determinant of health and, as bystanders, they had witnessed inequalities and the wasting of women's competence. However, they had doubts about gender-related issues and found them to be overemphasised. Gender education was seen as a threat to medical school curricula as a consequence of the time and space it requires. Gender-related issues were considered to be unscientifically presented, to mostly concern women's issues and to tend to involve 'male bashing' (i.e. gender issues were often labelled as ideological and political). Interviewees asked for facts and knowledge, but questioned specific lessons and gender theory. Experiences of structural constraints, such as prejudice, hierarchies and homosociality, were presented, making gender education difficult and downgrading it. The results indicate that male faculty leaders embrace the importance of gender-related issues, but do not necessarily recognise or defend their impact on an area of significant knowledge and competence in medicine. To change this and to engage more men in gender education, faculty measures are needed to counteract prejudice and to upgrade the time allocation, merits and status of gender implementation work. Based on our findings, we present and discuss possible ways to interest more men and to improve gender education in medicine. © Blackwell Publishing Ltd 2011.

Assessing the ecological status in the context of the European Water Framework Directive: where do we go now?

PubMed

Reyjol, Yorick; Argillier, Christine; Bonne, Wendy; Borja, Angel; Buijse, Anthonie D; Cardoso, Ana Cristina; Daufresne, Martin; Kernan, Martin; Ferreira, Maria Teresa; Poikane, Sandra; Prat, Narcís; Solheim, Anne-Lyche; Stroffek, Stéphane; Usseglio-Polatera, Philippe; Villeneuve, Bertrand; van de Bund, Wouter

2014-11-01

The Water Framework Directive (WFD) is now well established as the key management imperative in river basins across Europe. However, there remain significant concerns with the way WFD is implemented and there is now a need for water managers and scientists to communicate better in order to find solutions to these concerns. To address this, a Science-Policy Interface (SPI) activity was launched in 2010 led by Directorate-General for Research and Innovation and Onema (the French national agency for water and aquatic ecosystems), which provided an interactive forum to connect scientists and WFD end-users. One major aim of the SPI activity was to establish a list of the most crucial research and development needs for enhancing WFD implementation. This paper synthesises the recommendations from this event highlighting 10 priority issues relating to ecological status. For lakes, temporary streams and transitional and coastal waters, WFD implementation still suffers from a lack of WFD-compliant bioassessment methods. For rivers, special attention is required to assess the ecological impacts of hydromorphological alterations on biological communities, notably those affecting river continuity and riparian covering. Spatial extrapolation tools are needed in order to evaluate ecological status for water bodies for which no data are available. The need for more functional bioassessment tools as complements to usual WFD-compliant tools, and to connect clearly good ecological state, biodiversity and ecosystem services when implementing WFD were also identified as crucial issues. Copyright © 2014 Elsevier B.V. All rights reserved.

Technical issues affecting the implementation of US Environmental Protection Agency's proposed fish tissue-based aquatic criterion for selenium.

PubMed

Lemly, A Dennis; Skorupa, Joseph P

2007-10-01

The US Environmental Protection Agency is developing a national water quality criterion for selenium that is based on concentrations of the element in fish tissue. Although this approach offers advantages over the current water-based regulations, it also presents new challenges with respect to implementation. A comprehensive protocol that answers the "what, where, and when" is essential with the new tissue-based approach in order to ensure proper acquisition of data that apply to the criterion. Dischargers will need to understand selenium transport, cycling, and bioaccumulation in order to effectively monitor for the criterion and, if necessary, develop site-specific standards. This paper discusses 11 key issues that affect the implementation of a tissue-based criterion, ranging from the selection of fish species to the importance of hydrological units in the sampling design. It also outlines a strategy that incorporates both water column and tissue-based approaches. A national generic safety-net water criterion could be combined with a fish tissue-based criterion for site-specific implementation. For the majority of waters nationwide, National Pollution Discharge Elimination System permitting and other activities associated with the Clean Water Act could continue without the increased expense of sampling and interpreting biological materials. Dischargers would do biotic sampling intermittently (not a routine monitoring burden) on fish tissue relative to the fish tissue criterion. Only when the fish tissue criterion is exceeded would a full site-specific analysis including development of intermedia translation factors be necessary.

The transcatheter aortic valve implementation (TAVI)--a qualitative approach to the implementation and diffusion of a minimally invasive surgical procedure.

PubMed

Merkel, Sebastian; Eikermann, Michaela; Neugebauer, Edmund A; von Bandemer, Stephan

2015-10-06

The transcatheter aortic valve implantation (TAVI), a minimally invasive surgical procedure to treat patients with severe symptomatic aortic stenosis, showed a rapid diffusion in Germany compared to the international level. The aim of this study is to identify and analyze factors affecting the implementation and diffusion of the procedure in hospitals using a qualitative application of the diffusion of innovations theory. We conducted problem-centered interviews with cardiologists and cardiac surgeons working in German hospitals. The multi-level model "diffusion of innovations in health services organizations" developed by Greenhalgh et al. was used to guide the research. Data was analyzed using content and a thematic analysis. Among the ten participants who were interviewed, we found both barriers and facilitators related to the innovation itself, system readiness and antecedents, communication and influence, and the outer context. Key issues were the collaboration between cardiologists and cardiac surgeons, reimbursement policies, requirements needed to conduct the procedure, and medical advantages of the method. The findings show that there are multiple factors influencing the diffusion of TAVI that go beyond the reimbursement and cost issues. The diffusion of innovations model proved to be helpful in understanding the different aspects of the uptake of the procedure. A central theme that affected the implementation of TAVI was the collaboration and competition between involved medical departments: cardiology and cardiac surgery. Against this background, it seems especially important to moderate and coordinate the cooperation of the different medical disciplines.

A sustainable dietetics bridging program: development and implementation in Atlantic Canada.

PubMed

Lordly, Daphne; Guy, Jennifer; Barry, Paula; Garus, Jennifer

2014-01-01

A provincial focus on immigration and improved foreign credential recognition has led to an investigation of best practices and subsequent recommendations for the development and implementation of a sustainable university-based bridging program for internationally educated dietitians in Atlantic Canada. Data were collected from various sources and used to inform program decisions and direction. An advisory framework was established through a core group representing dietetics education and regulation and internationalization. Subsequently, a key stakeholder group was formed. As a result of this collaboration and research, a dietetics bridging framework was developed and a program pilot tested. Lessons learned may inform similar endeavours and highlight the importance of collaborative leadership and collaboration among multiple stakeholders, and of creatively addressing program sustainability issues while keeping learners (internationally educated dietitians) at the centre.

A mobile network-based multimedia teleconference system for homecare services.

PubMed

Zhang, Zhaomin; He, Aiguo; Wei, Daming

2008-03-01

Because most research and development for homecare services have focused on providing connections between home and service centers, the goal of the present work is to develop techniques and create realtime communications to connect service centers and homecare workers in mobile environments. A key technical issue for this research is how to overcome the limitation of bandwidth in mobile media and networks. An effort has been made to balance performance of communication and basic demands in telehealth through optimized system design and technical implementation. Implementations using third generation (3G) Freedom Of Mobile multimedia Access (FOMA) and Personal Handyphone System (PHS) were developed and evaluated. We conclude that the system we developed based on 3G FOMA provides sufficient and satisfactory functions for use in homecare services.

Study of China green supply chain management policies and standard

NASA Astrophysics Data System (ADS)

Zhang, Xiaoxin; Huang, Jin; Lin, Ling

2017-11-01

With the highlight of the environment issues, manufacturing industry needs to be environmentally managed with integrated methods in system aspect. Green supply chain management, integrating the environment aspect into each step of the implement of supply chain management, is the key measure to improve the efficiency of environmental management and to remit the pollution. It also helps to make best use and configuration of the resources and has been attracting much attention from our government, enterprises and academia in recent years. This paper introduced the definition and content of green supply chain management, concluded the research progress of green supply chain management by domestic scholars, stated the characteristic and achievement of the implement of green supply chain management in China as well as analyzed the current existing problems and suggestions in the future.

Guiding Principles for Data Architecture to Support the Pathways Community HUB Model.

PubMed

Zeigler, Bernard P; Redding, Sarah; Leath, Brenda A; Carter, Ernest L; Russell, Cynthia

2016-01-01

The Pathways Community HUB Model provides a unique strategy to effectively supplement health care services with social services needed to overcome barriers for those most at risk of poor health outcomes. Pathways are standardized measurement tools used to define and track health and social issues from identification through to a measurable completion point. The HUB use Pathways to coordinate agencies and service providers in the community to eliminate the inefficiencies and duplication that exist among them. Experience with the Model has brought out the need for better information technology solutions to support implementation of the Pathways themselves through decision-support tools for care coordinators and other users to track activities and outcomes, and to facilitate reporting. Here we provide a basis for discussing recommendations for such a data infrastructure by developing a conceptual model that formalizes the Pathway concept underlying current implementations. The main contribution is a set of core recommendations as a framework for developing and implementing a data architecture to support implementation of the Pathways Community HUB Model. The objective is to present a tool for communities interested in adopting the Model to learn from and to adapt in their own development and implementation efforts. Experience with the Community Health Access Project (CHAP) data base system (the core implementation of the Model) has identified several issues and remedies that have been developed to address these issues. Based on analysis of issues and remedies, we present several key features for a data architecture meeting the just mentioned recommendations. Presentation of features is followed by a practical guide to their implementation allowing an organization to consider either tailoring off-the-shelf generic systems to meet the requirements or offerings that are specialized for community-based care coordination. Looking to future extensions, we discuss the utility and prospects for an ontology to include care coordination in the Unified Medical Language System (UMLS) of the National Library of Medicine and other existing medical and nursing taxonomies. Pathways structures are an important principle, not only for organizing the care coordination activities, but also for structuring the data stored in electronic form in the conduct of such care. We showed how the proposed architecture encourages design of effective decision support systems for coordinated care and suggested how interested organizations can set about acquiring such systems. Although the presentation focuses on the Pathways Community HUB Model, the principles for data architecture are stated in generic form and are applicable to any health information system for improving care coordination services and population health.

Teacher Perceptions of the Integration of Laptop Computers in Their High School Biology Classrooms

NASA Astrophysics Data System (ADS)

Gundy, Morag S.

2011-12-01

Studies indicate that teachers, and in particular science teachers in the senior high school grades, do not integrate laptop computers into their instruction to the extent anticipated by researchers. This technology has not spread easily to other teachers even with improved access to hardware and software, increased support, and a paradigm shift from teacher-centred to student-centred education. Although a number of studies have focused on the issues and problems related to the integration of laptops in classroom instruction, these studies, largely quantitative in nature, have tended to bypass the role teachers play in integrating laptop computers into their instruction. This thesis documents and describes the role of Ontario high school science teachers in the integration of laptop computers in the classroom. Ten teachers who have successfully integrated laptop computers into their biology courses participated in this descriptive study. Their perceptions of implementing laptops into their biology courses, key factors about the implementation process, and how the implementation was accomplished are examined. The study also identifies the conditions which they feel would allow this innovation to be implemented by other teachers. Key findings of the study indicate that teachers must initiate, implement and sustain an emergent and still evolving innovation; teacher perceptions change and continue to change with increased experience using laptops in the science classroom; changes in teaching approaches are significant as a result of the introduction of laptop technology; and, the teachers considered the acquisition and use of new teaching materials to be an important aspect of integrating laptop computers into instruction. Ongoing challenges for appropriate professional development, sharing of knowledge, skills and teaching materials are identified. The study provides a body of practical knowledge for biology teachers who are considering the integration of laptops into their instruction. The results are of interest to science teachers, those whose decisions affect the meaningful integration of technology in science education, those researching the teaching of science in secondary schools and those who prepare science graduates to teach at this level. Key Words: innovation, laptop, computer, biology, science, secondary, implementation, perceptions, instruction, professional development, qualitative, descriptive.

Multi-level factors influence the implementation and use of complex innovations in cancer care: a multiple case study of synoptic reporting.

PubMed

Urquhart, Robin; Porter, Geoffrey A; Sargeant, Joan; Jackson, Lois; Grunfeld, Eva

2014-09-16

The implementation of innovations (i.e., new tools and practices) in healthcare organizations remains a significant challenge. The objective of this study was to examine the key interpersonal, organizational, and system level factors that influenced the implementation and use of synoptic reporting tools in three specific areas of cancer care. Using case study methodology, we studied three cases in Nova Scotia, Canada, wherein synoptic reporting tools were implemented within clinical departments/programs. Synoptic reporting tools capture and present information about a medical or surgical procedure in a structured, checklist-like format and typically report only items critical for understanding the disease and subsequent impacts on patient care. Data were collected through semi-structured interviews with key informants, document analysis, nonparticipant observation, and tool use/examination. Analysis involved production of case histories, in-depth analysis of each case, and a cross-case analysis. Numerous techniques were used during the research design, data collection, and data analysis stages to increase the rigour of this study. The analysis revealed five common factors that were particularly influential to implementation and use of synoptic reporting tools across the three cases: stakeholder involvement, managing the change process (e.g., building demand, communication, training and support), champions and respected colleagues, administrative and managerial support, and innovation attributes (e.g., complexity, compatibility with interests and values). The direction of influence (facilitating or impeding) of each of these factors differed across and within cases. The findings demonstrate the importance of a multi-level contextual analysis to gaining both breadth and depth to our understanding of innovation implementation and use in health care. They also provide new insights into several important issues under-reported in the literature on moving innovations into healthcare practice, including the role of middle managers in implementation efforts and the importance of attending to the interpersonal aspects of implementation.

Managerial attitude to the implementation of quality management systems in Lithuanian support treatment and nursing hospitals

PubMed Central

Buciuniene, Ilona; Malciankina, Sonata; Lydeka, Zigmas; Kazlauskaite, Ruta

2006-01-01

Background The regulations of the Quality Management System (QMS) implementation in health care organizations were approved by the Lithuanian Ministry of Health in 1998. Following the above regulations, general managers of health care organizations had to initiate the QMS implementation in hospitals. As no research on the QMS implementation has been carried out in Lithuanian support treatment and nursing hospitals since, the objective of this study is to assess its current stage from a managerial perspective. Methods A questionnaire survey of general managers of Lithuanian support treatment and nursing hospitals was carried out in the period of January through March 2005. Majority of the items included in the questionnaire were measured on a seven-point Likert scale. During the survey, a total of 72 questionnaires was distributed, out of which 58 filled-in ones were returned (response rate 80.6 per cent; standard sampling error 0.029 at 95 per cent level of confidence). Results Quality Management Systems were found operating in 39.7 per cent of support treatment and nursing hospitals and currently under implementation in 46.6 per cent of hospitals (13.7% still do not have it). The mean of the respondents' perceived QMS significance is 5.8 (on a seven-point scale). The most critical issues related to the QMS implementation include procedure development (5.5), lack of financial resources (5.4) and information (5.1), and development of work guidelines (4.6), while improved responsibility and power sharing (5.2), better service quality (5.1) and higher patient satisfaction (5.1) were perceived by the respondents as the key QMS benefits. The level of satisfaction with the QMS among the management of the surveyed hospitals is mediocre (3.6). However it was found to be higher among respondents who were more competent in quality management, were familiar with ISO 9000 standards, and had higher numbers of employees trained in quality management. Conclusion QMSs are perceived to be successfully running in one third of the Lithuanian support treatment and nursing hospitals. Its current implementation stage is dependent on the hospital size – the bigger the hospital the more success it meets in the QMS implementation. As to critical Quality Management (QM) issues, hospitals tend to encounter such major problems as lack of financial resources, information and training, as well as difficulties in procedure development. On the other hand, the key factors that assist to the success of the QMS implementation comprise managerial awareness of the QMS significance and the existence of employee training systems and audit groups in hospitals. PMID:16987416

Dating Violence among College Students: Key Issues for College Counselors

ERIC Educational Resources Information Center

Murray, Christine E.; Kardatzke, Kerrie N.

2007-01-01

The authors present a review of literature examining dating violence among college students. They describe 6 key issues related to dating violence among college students that affect college counselors' work. These key issues relate to the incidence and prevalence of physical, sexual, and psychological violence in college students' dating…

The implementation of mindfulness in healthcare systems: a theoretical analysis.

PubMed

Demarzo, M M P; Cebolla, A; Garcia-Campayo, J

2015-01-01

Evidence regarding the efficacy of mindfulness-based interventions (MBIs) is increasing exponentially; however, there are still challenges to their integration in healthcare systems. Our goal is to provide a conceptual framework that addresses these challenges in order to bring about scholarly dialog and support health managers and practitioners with the implementation of MBIs in healthcare. This is an opinative narrative review based on theoretical and empirical data that address key issues in the implementation of mindfulness in healthcare systems, such as the training of professionals, funding and costs of interventions, cost effectiveness and innovative delivery models. We show that even in the United Kingdom, where mindfulness has a high level of implementation, there is a high variability in the access to MBIs. In addition, we discuss innovative approaches based on "complex interventions," "stepped-care" and "low intensity-high volume" concepts that may prove fruitful in the development and implementation of MBIs in national healthcare systems, particularly in Primary Care. In order to better understand barriers and opportunities for mindfulness implementation in healthcare systems, it is necessary to be aware that MBIs are "complex interventions," which require innovative approaches and delivery models to implement these interventions in a cost-effective and accessible way. Copyright © 2015 Elsevier Inc. All rights reserved.

Parents' views on childhood obesity: qualitative analysis of discussion board postings.

PubMed

Appleton, Jessica; Fowler, Cathrine; Brown, Nicola

2017-08-01

Childhood obesity is an increasing concern for parents and health professionals alike. Parents' perception of obesity as a current health issue for their children is important for the everyday parenting and health choices parents make. As parents are frequently going online to seek and exchange information about parenting and child health, asynchronous online discussion forums provide an opportunity to investigate their perceptions and concerns. Understanding parents' perceptions, beliefs and attitudes is important in any childhood obesity prevention and intervention. To explore parents' perceptions, perspectives and concerns regarding childhood obesity expressed on asynchronous online discussion forums. A qualitative descriptive approach using template analysis to analyse a novel data collection strategy of 34 purposefully sampled threads from two Australian-based asynchronous online discussion forums. Parents on the discussion forum displayed an understanding of childhood obesity as a public health concern, the discussion incorporated issues such as providing a healthy diet and lifestyle for children. Parents shared their own opinions and experiences that challenged or conceded to the status quo of the discussion. Parents discussed the role of health professionals in obesity prevention. There were varied opinions on the relevance of health professionals, particularly nurses, monitoring of growth and risk of obesity. This exploratory study highlights that parents perceive childhood obesity as an important public health concern, and that they understand the key public health messages of prevention and intervention. Yet, for many it is difficult to successfully implement these messages into their everyday lives. Health professionals need to play a key role in providing non-judgemental, innovative support and advice to parents to successfully implement prevention and intervention strategies.

Human factors for capacity building: lessons learned from the OpenMRS implementers network.

PubMed

Seebregts, C J; Mamlin, B W; Biondich, P G; Fraser, H S F; Wolfe, B A; Jazayeri, D; Miranda, J; Blaya, J; Sinha, C; Bailey, C T; Kanter, A S

2010-01-01

The overall objective of this project was to investigate ways to strengthen the OpenMRS community by (i) developing capacity and implementing a network focusing specifically on the needs of OpenMRS implementers, (ii) strengthening community-driven aspects of OpenMRS and providing a dedicated forum for implementation-specific issues, and; (iii) providing regional support for OpenMRS implementations as well as mentorship and training. The methods used included (i) face-to-face networking using meetings and workshops; (ii) online collaboration tools, peer support and mentorship programmes; (iii) capacity and community development programmes, and; (iv) community outreach programmes. The community-driven approach, combined with a few simple interventions, has been a key factor in the growth and success of the OpenMRS Implementers Network. It has contributed to implementations in at least twenty-three different countries using basic online tools; and provided mentorship and peer support through an annual meeting, workshops and an internship program. The OpenMRS Implementers Network has formed collaborations with several other open source networks and is evolving regional OpenMRS Centres of Excellence to provide localized support for OpenMRS development and implementation. These initiatives are increasing the range of functionality and sustainability of open source software in the health domain, resulting in improved adoption and enterprise-readiness. Social organization and capacity development activities are important in growing a successful community-driven open source software model.

User involvement in the implementation of clinical guidelines for common mental health disorders: a review and compilation of strategies and resources.

PubMed

Moreno, Eliana M; Moriana, Juan Antonio

2016-08-09

There is now broad consensus regarding the importance of involving users in the process of implementing guidelines. Few studies, however, have addressed this issue, let alone the implementation of guidelines for common mental health disorders. The aim of this study is to compile and describe implementation strategies and resources related to common clinical mental health disorders targeted at service users. The literature was reviewed and resources for the implementation of clinical guidelines were compiled using the PRISMA model. A mixed qualitative and quantitative analysis was performed based on a series of categories developed ad hoc. A total of 263 items were included in the preliminary analysis and 64 implementation resources aimed at users were analysed in depth. A wide variety of types, sources and formats were identified, including guides (40%), websites (29%), videos and leaflets, as well as instruments for the implementation of strategies regarding information and education (64%), self-care, or users' assessment of service quality. The results reveal the need to establish clear criteria for assessing the quality of implementation materials in general and standardising systems to classify user-targeted strategies. The compilation and description of key elements of strategies and resources for users can be of interest in designing materials and specific actions for this target audience, as well as improving the implementation of clinical guidelines.

Planning, Implementing, and Evaluating a Program to Address the Oral Health Needs of Aboriginal Children in Port Augusta, Australia

PubMed Central

Parker, E. J.; Misan, G.; Shearer, M.; Richards, L.; Russell, A.; Mills, H.; Jamieson, L. M.

2012-01-01

Aboriginal Australian children experience profound oral health disparities relative to their non-Aboriginal counterparts. In response to community concerns regarding Aboriginal child oral health in the regional town of Port Augusta, South Australia, a child dental health service was established within a Community Controlled Aboriginal Health Service. A partnership approach was employed with the key aims of (1) quantifying rates of dental service utilisation, (2) identifying factors influencing participation, and (3) planning and establishing a program for delivery of Aboriginal children's dental services that would increase participation and adapt to community needs. In planning the program, levels of participation were quantified and key issues identified through semistructured interviews. After 3.5 years, the participation rate for dental care among the target population increased from 53 to 70 percent. Key areas were identified to encourage further improvements and ensure sustainability in Aboriginal child oral health in this regional location. PMID:22577401

Country watch: Zimbabwe.

PubMed

Laver, S

1999-01-01

Tsungirirai is a counseling and information service developed during 1994 in response to the growing problem of HIV/AIDS in the small town of Norton, southwest of Harare, Zimbabwe. The objectives of the project include identification of key leaders in the area, determination of the setting in which HIV was spreading, and community consultation in program design and implementation. Tsungirirai's initial activities included a series of workshops on participatory techniques particularly the LADA (Listening-Appraisal-Dialogue-Action) method for key leaders, community men, women, and adolescents. Workshop participants demonstrated different views concerning HIV/AIDS problems. Key leaders viewed the HIV/AIDS problem within the context of existing laws that contradict traditional mores, while the youth linked the problem of HIV to the issue of unemployment and lack of recreation. Lessons learned include the following: 1) stop talking and listen; 2) start where people are at instead of telling them what they already know; 3) let the people decide; 4) turn a dream into reality; and 5) facilitate awareness process instead of leading it.

Service delivery innovation for hospital emergency management using rich organizational modelling.

PubMed

Dhakal, Yogit; Bhuiyan, Moshiur; Prasad, Pwc; Krishna, Aneesh

2018-04-01

The purpose of this article is to identify and assess service delivery issues within a hospital emergency department and propose an improved model to address them. Possible solutions and options to these issues are explored to determine the one that best fits the context. In this article, we have analysed the emergency department's organizational models through i* strategic dependency and rational modelling technique before proposing updated models that could potentially drive business process efficiencies. The results produced by the models, framework and improved patient journey in the emergency department were evaluated against the statistical data revealed from a reputed government organization related to health, to ensure that the key elements of the issues such as wait time, stay time/throughput, workload and human resource are resolved. The result of the evaluation was taken as a basis to determine the success of the project. Based on these results, the article recommends implementing the concept on actual scenario, where a positive result is achievable.

Trauma is a public health issue.

PubMed

Magruder, Kathryn M; McLaughlin, Katie A; Elmore Borbon, Diane L

2017-01-01

Exposure to trauma is pervasive in societies worldwide and is associated with substantial costs to the individual and society, making it a significant global public health concern. We present evidence for trauma as a public health issue by highlighting the role of characteristics operating at multiple levels of influence - individual, relationship, community, and society - as explanatory factors in both the occurrence of trauma and its sequelae. Within the context of this multi-level framework, we highlight targets for prevention of trauma and its downstream consequences and provide examples of where public health approaches to prevention have met with success. Finally, we describe the essential role of public health policies in addressing trauma as a global public health issue, including key challenges for global mental health and next steps for developing and implementing a trauma-informed public health policy agenda. A public health framework is critical for understanding risk and protective factors for trauma and its aftermath operating at multiple levels of influence and generating opportunities for prevention.

Social network approaches to recruitment, HIV prevention, medical care, and medication adherence.

PubMed

Latkin, Carl A; Davey-Rothwell, Melissa A; Knowlton, Amy R; Alexander, Kamila A; Williams, Chyvette T; Boodram, Basmattee

2013-06-01

This article reviews the current issues and advancements in social network approaches to HIV prevention and care. Social network analysis can provide a method to understand health disparities in HIV rates, treatment access, and outcomes. Social network analysis is a valuable tool to link social structural factors to individual behaviors. Social networks provide an avenue for low-cost and sustainable HIV prevention interventions that can be adapted and translated into diverse populations. Social networks can be utilized as a viable approach to recruitment for HIV testing and counseling, HIV prevention interventions, optimizing HIV medical care, and medication adherence. Social network interventions may be face-to-face or through social media. Key issues in designing social network interventions are contamination due to social diffusion, network stability, density, and the choice and training of network members. There are also ethical issues involved in the development and implementation of social network interventions. Social network analyses can also be used to understand HIV transmission dynamics.

Bridging the Gap between Health and Social Care for Rare Diseases: Key Issues and Innovative Solutions.

PubMed

Castro, Raquel; Senecat, Juliette; de Chalendar, Myriam; Vajda, Ildikó; Dan, Dorica; Boncz, Béata

2017-01-01

Bridging the gaps between health and social care for rare diseases is not only necessary but crucial to increase the life expectancy, quality of life and autonomy of people living with a rare disease, supporting them in the full realisation of their fundamental human rights.The complexity of rare diseases, their strong relation to disability and the current unmet social and daily life needs of people living with a rare disease must not be underestimated and require urgent attention from all stakeholders involved in care provision, from healthcare to social and community services.The Commission Expert Group Recommendations to Support the Incorporation of Rare Diseases into Social Services and Policies, adopted unanimously in April 2016, by the representatives of European Member States and the other rare disease stakeholders, clearly set the tone for the need to promote measures that facilitate multidisciplinary, holistic, continuous, person-centred and participative care provision to people living with rare diseases.These recommendations, sided by other recent policy developments at European and national levels, represent an important policy step into approaching rare diseases' complex challenges in regards to holistic care provision.Innovative approaches aiming at bridging the gap between health, social and community service and support providers are currently being developed and tested in different European countries: standards of care, networks of expertise, case management services, one-stop-shop services, amongst others.These ongoing pilot approaches, presented in this chapter, have the power to inspire future policies and the effective and efficient implementation of holistic care pathways for people living with a rare disease, bringing about significant changes for patients, carers, care providers, competent authorities and the society at large.Nonetheless, the challenges to fully address this issue remain numerous and other key issues will also need to be taken into account when moving forward with the implementation of measures that aim at bridging the gaps between care providers and providing holistic care to people living with a rare disease.

Are Key Principles for improved health technology assessment supported and used by health technology assessment organizations?

PubMed

Neumann, Peter J; Drummond, Michael F; Jönsson, Bengt; Luce, Bryan R; Schwartz, J Sanford; Siebert, Uwe; Sullivan, Sean D

2010-01-01

Previously, our group-the International Working Group for HTA Advancement-proposed a set of fifteen Key Principles that could be applied to health technology assessment (HTA) programs in different jurisdictions and across a range of organizations and perspectives. In this commentary, we investigate the extent to which these principles are supported and used by fourteen selected HTA organizations worldwide. We find that some principles are broadly supported: examples include being explicit about HTA goals and scope; considering a wide range of evidence and outcomes; and being unbiased and transparent. Other principles receive less widespread support: examples are addressing issues of generalizability and transferability; being transparent on the link between HTA findings and decision-making processes; considering a full societal perspective; and monitoring the implementation of HTA findings. The analysis also suggests a lack of consensus in the field about some principles--for example, considering a societal perspective. Our study highlights differences in the uptake of key principles for HTA and indicates considerable room for improvement for HTA organizations to adopt principles identified to reflect good HTA practices. Most HTA organizations espouse certain general concepts of good practice--for example, assessments should be unbiased and transparent. However, principles that require more intensive follow-up--for example, monitoring the implementation of HTA findings--have received little support and execution.

Scientific governance and the process for exposure scenario development in REACH.

PubMed

Money, Chris D; Van Hemmen, Joop J; Vermeire, Theo G

2007-12-01

The primary process established by the European Commission to address the science needed to define key REACH concepts and to help rationally implement REACH's ambitions is enshrined in a series of activities known as the REACH Implementation Projects (RIPs). These are projects that aim to define the methodology that could be used, and present the basis for guidance on the actual principles and procedures that may be (are proposed to be) followed in the development of the required documentation that ensures the safe use of chemicals. In order to develop soundly based and equitable regulation, it is necessary that science governance using established and accepted scientific principles must take a leading role. The extent to which such governance is embraced will be determined by many factors, but notably the process adopted to enable scientific discussion to take place. This article addresses the issues of science as they have impacted on the exemplification of the Exposure Scenario concept under REACH. The current RIP activities have created a non-adversarial process in which the key stakeholders are able to discuss the key REACH challenges. But the RIP activities will be finalised before REACH comes into force. A suitable mechanism should perhaps now be identified to ensure that this positive spirit of scientific discussion and collaboration can continue to benefit REACH and those that it serves well into the future.

Stakeholder views on pharmacogenomic testing.

PubMed

Patel, Haridarshan N; Ursan, Iulia D; Zueger, Patrick M; Cavallari, Larisa H; Pickard, A Simon

2014-02-01

Pharmacogenomics has an important role in the evolution of personalized medicine, and its widespread uptake may ultimately depend on the interests and perspectives of key players in health care. Our aim was to summarize studies on stakeholder perspectives and attitudes toward pharmacogenomic testing. Thus, we conducted a review of original research studies that reported stakeholder views on pharmacogenomic testing using a structured approach in PubMed, International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and EMBASE. A standardized data abstraction form was developed that included stakeholder group of interest-patients, general public, providers, and payers. Stakeholder views regarding barriers to pharmacogenetic implementation were organized into the following themes: ancillary information-related, clinical, economic, educational, ethical or legal, medical mistrust, and practicality. Of 34 studies that met our inclusion criteria, 37 perspectives were reported (15 on providers, 9 on the general public, 9 on patients, and 4 on payers). The most common topics that arose in studies of providers related to clinical usefulness of genetic data (n=11) and educational needs (n=11). Among the general public, the most common concerns were medical mistrust (n=5), insufficient education (n=5), and practicality (n=5). The most prevalent issues from the patient perspective were ethical or legal (n=6) and economic (n=5) issues. Among payers, leading issues were practicality (n=4) and clinical usefulness (n=3). There was overlap in the topics and concerns across stakeholder perspectives, including lack of knowledge about pharmacogenomic testing. Views on issues related to privacy, cost, and test result dissemination varied by stakeholder perspective. Limited research had been conducted in underrepresented groups. Efforts to address the issues raised by stakeholders may facilitate the implementation of pharmacogenomic testing into clinical practice. © 2013 American College of Clinical Pharmacy.

Policy and Administrative Issues for Large-Scale Clinical Interventions Following Disasters

PubMed Central

Cobham, Vanessa E.; McDermott, Brett

2014-01-01

Abstract Objective: Large, programmatic mental health intervention programs for children and adolescents following disasters have become increasingly common; however, little has been written about the key goals and challenges involved. Methods: Using available data and the authors' experiences, this article reviews the factors involved in planning and implementing large-scale treatment programs following disasters. Results: These issues include funding, administration, choice of clinical targets, workforce selection, choice of treatment modalities, training, outcome monitoring, and consumer uptake. Ten factors are suggested for choosing among treatment modalities: 1) reach (providing access to the greatest number), 2) retention of patients, 3) privacy, 4) parental involvement, 5) familiarity of the modality to clinicians, 6) intensity (intervention type matches symptom acuity and impairment of patient), 7) burden to the clinician (in terms of time, travel, and inconvenience), 8) cost, 9) technology needs, and 10) effect size. Traditionally, after every new disaster, local leaders who have never done so before have had to be recruited to design, administer, and implement programs. Conclusion: As expertise in all of these areas represents a gap for most local professionals in disaster-affected areas, we propose that a central, nongovernmental agency with national or international scope be created that can consult flexibly with local leaders following disasters on both overarching and specific issues. We propose recommendations and point out areas in greatest need of innovation. PMID:24521227

Evaluation of workforce and organizational issues in establishing primary angioplasty in England.

PubMed

Carter, Angela; Wood, Stephen; Goodacre, Steve; Sampson, Fiona; Stables, Rod

2010-01-01

To assess workforce and organizational issues in establishing a primary angioplasty service in England. Staff associated with the heart attack pathway at seven acute hospitals participating in the National Infarct Angioplasty Project (NIAP) completed a questionnaire, participated in focus groups and interviews, and observations were undertaken in catheter laboratories. All seven hospitals implemented primary angioplasty though not all provided a 24-hour service. Hospitals varied in size, number of staff involved in the delivery of angioplasty and the volume of cases. Hospitals that developed the service by incremental expansion encountered more problems than hospitals that planned for a full service at the outset. Simple, direct access to a catheter laboratory reduced delays and could be facilitated by an angioplasty gatekeeper. Little attention was paid to later cardiac rehabilitation. Multiskilling and the ability to work across traditional professional boundaries appeared to provide substantial advantages. Building relationships with key staff and auditing the heart attack pathway were critical to successful service development. Differences in remuneration and rest for staff undertaking out-of-hours working threatened sustainability. Primary angioplasty was feasible in varied settings and generally supported by staff. However, the participating hospitals were selected enthusiasts, only some implemented a 24-hour service and activity levels were relatively low. Organizational and workforce issues need to be addressed to achieve an efficient and sustainable service.

Guiding Principles for Data Architecture to Support the Pathways Community HUB Model

PubMed Central

Zeigler, Bernard P.; Redding, Sarah; Leath, Brenda A.; Carter, Ernest L.; Russell, Cynthia

2016-01-01

Introduction: The Pathways Community HUB Model provides a unique strategy to effectively supplement health care services with social services needed to overcome barriers for those most at risk of poor health outcomes. Pathways are standardized measurement tools used to define and track health and social issues from identification through to a measurable completion point. The HUB use Pathways to coordinate agencies and service providers in the community to eliminate the inefficiencies and duplication that exist among them. Pathways Community HUB Model and Formalization: Experience with the Model has brought out the need for better information technology solutions to support implementation of the Pathways themselves through decision-support tools for care coordinators and other users to track activities and outcomes, and to facilitate reporting. Here we provide a basis for discussing recommendations for such a data infrastructure by developing a conceptual model that formalizes the Pathway concept underlying current implementations. Requirements for Data Architecture to Support the Pathways Community HUB Model: The main contribution is a set of core recommendations as a framework for developing and implementing a data architecture to support implementation of the Pathways Community HUB Model. The objective is to present a tool for communities interested in adopting the Model to learn from and to adapt in their own development and implementation efforts. Problems with Quality of Data Extracted from the CHAP Database: Experience with the Community Health Access Project (CHAP) data base system (the core implementation of the Model) has identified several issues and remedies that have been developed to address these issues. Based on analysis of issues and remedies, we present several key features for a data architecture meeting the just mentioned recommendations. Implementation of Features: Presentation of features is followed by a practical guide to their implementation allowing an organization to consider either tailoring off-the-shelf generic systems to meet the requirements or offerings that are specialized for community-based care coordination. Discussion: Looking to future extensions, we discuss the utility and prospects for an ontology to include care coordination in the Unified Medical Language System (UMLS) of the National Library of Medicine and other existing medical and nursing taxonomies. Conclusions and Recommendations: Pathways structures are an important principle, not only for organizing the care coordination activities, but also for structuring the data stored in electronic form in the conduct of such care. We showed how the proposed architecture encourages design of effective decision support systems for coordinated care and suggested how interested organizations can set about acquiring such systems. Although the presentation focuses on the Pathways Community HUB Model, the principles for data architecture are stated in generic form and are applicable to any health information system for improving care coordination services and population health. PMID:26870743

A recommended epidemiological study design for examining the adverse health effects among emergency workers who experienced the TEPCO fukushima daiichi NPP accident in 2011.

PubMed

Yasui, Shojiro

2016-01-01

Results from medical examinations conducted in 2012 of workers who were engaged in radiation work in 2012 as a result of the 2011 Fukushima Daiichi Nuclear Power Plant (NPP) accident showed that the prevalence of abnormal findings was 4.21%, 3.23 points higher than the 0.98% that was found prior to the accident in the jurisdiction area of the labor inspection office which holds jurisdiction over the NPP. The Ministry of Health, Labour and Welfare (MHLW) concluded that the 2010 and 2012 data cannot be easily compared because 70% of the enterprises within the jurisdiction of the office that reported the 2012 results were different from those that did so in 2010. In addition, although the radiation workers' estimated average dose weighted by number of workers was 3.66 times higher than decontamination workers' dose, the prevalence among radiation workers was only 1.14 times higher than that among decontamination workers. Based on the results of the medical examinations, however, the MHLW decided to implement an epidemiological study on the health effects of radiation exposure on all emergency workers. This article explains key issues of the basic design of the study recommended by the expert meeting established in the MHLW and also identifies challenges that could not be resolved and thus required further consideration by the study researchers. The major issues included: (a) study methods and target group; (b) evaluation of cumulative doses; (c) health effects (end points); (d) control of confounding factors; and (e) study implementation framework. Identified key challenges that required further deliberation were: (a) preventing arbitrary partisan analysis; (b) ensuring a high participation rate; (c) inquiry about the medical radiation doses; and (d) the preparedness of new analytical technology. The study team formulated and implemented the pilot study in 2014 and started the full-scale study in April 2015 with funding from a research grant from the MHLW.

Improving hearing health for farming families.

PubMed

Lower, Tony; Fragar, Lyn; Depcynzksi, Julie; Challinor, Kathy; Mills, Jan; Williams, Warwick

2010-01-01

Occupational noise injury and hearing loss are common features of agricultural workforces internationally. Farmsafe Australia has identified hearing health as one of its 4 key priority goals and targets. Currently, approximately 60-70% of Australian farmers have measurable hearing loss, compared with 27% of those in the general Australian community. This article describes the findings of a community based demonstration project to address hearing health issues conducted in the Australian state of New South Wales. This program sought to implement local demonstration projects in 3 communities to identify what works well in hearing health promotion with farmers and what could be applied more broadly throughout Australia. Local advisory groups were established in each community to guide project development and implementation. Project implementation focused on 3 major aspects: (1) increasing awareness of priority noise injury prevention and hearing health practices; (2) improving access to hearing health services; and (3) networking services in local communities. Area-specific training was undertaken for stakeholders to maximize local information links. Service utilization data were monitored and analysed. There was variability among sites; however in general there was an increased awareness of hearing health issues by farming families and expanded opportunities for farmers to access screening services. Utilization rates of hearing services also increased markedly in one community. Local hearing health networks were strengthened by linkages to key stakeholders outside the health sector. Previously unidentified methods of promoting hearing health (eg using agricultural retail outlets that supply hearing protection equipment and are accepted by farmers as an information source) were identified and utilized. Hearing health promotion with farmers in local communities can be enhanced through utilization and strengthening of local networks. Integration of hearing health initiatives with other agencies already working with farming families will be important in developing and enhancing long-term sustainable outcomes. Continued work at a national level to assist in stimulating local action will be required to build on the potential gains in reducing noise injury in the farming community.

A single competency-based education and training and competency-based career framework for the Australian health workforce: discussing the potential value add

PubMed Central

Brownie, Sharon Mary; Thomas, Janelle

2014-01-01

This brief discusses the policy implications of a research study commissioned by Health Workforce Australia (HWA) within its health workforce innovation and reform work program. The project explored conceptually complex and operationally problematic concepts related to developing a whole-of-workforce competency-based education and training and competency-based career framework for the Australian health workforce and culminated with the production of three reports published by HWA. The project raised important queries as to whether such a concept is desirable, feasible or implementable – in short what is the potential value add and is it achievable? In setting the scene for discussion, the foundation of the project’s genesis and focus of the study are highlighted. A summary of key definitions related to competency-based education and training frameworks and competency-based career frameworks are provided to further readers’ commonality of understanding. The nature of the problem to be solved is explored and the potential value-add for the Australian health workforce and its key constituents proposed. The paper concludes by discussing relevance and feasibility issues within Australia’s current and changing healthcare context along with the essential steps and implementation realities that would need to be considered and actioned if whole-of-workforce frameworks were to be developed and implemented. PMID:25279384

How to implement live video recording in the clinical environment: A practical guide for clinical services.

PubMed

Lloyd, Adam; Dewar, Alistair; Edgar, Simon; Caesar, Dave; Gowens, Paul; Clegg, Gareth

2017-06-01

The use of video in healthcare is becoming more common, particularly in simulation and educational settings. However, video recording live episodes of clinical care is far less routine. To provide a practical guide for clinical services to embed live video recording. Using Kotter's 8-step process for leading change, we provide a 'how to' guide to navigate the challenges required to implement a continuous video-audit system based on our experience of video recording in our emergency department resuscitation rooms. The most significant hurdles in installing continuous video audit in a busy clinical area involve change management rather than equipment. Clinicians are faced with considerable ethical, legal and data protection challenges which are the primary barriers for services that pursue video recording of patient care. Existing accounts of video use rarely acknowledge the organisational and cultural dimensions that are key to the success of establishing a video system. This article outlines core implementation issues that need to be addressed if video is to become part of routine care delivery. By focussing on issues such as staff acceptability, departmental culture and organisational readiness, we provide a roadmap that can be pragmatically adapted by all clinical environments, locally and internationally, that seek to utilise video recording as an approach to improving clinical care. © 2017 John Wiley & Sons Ltd.

Implementing biosecurity education: approaches, resources and programmes.

PubMed

Minehata, Masamichi; Sture, Judi; Shinomiya, Nariyoshi; Whitby, Simon

2013-12-01

This paper aims to present possible approaches, resources and programmes to introduce the topic of biosecurity to life scientists and engineers at the higher education level. Firstly, we summarise key findings from a number of international surveys on biosecurity education that have been carried out in the United States, Europe, Israel and the Asia-Pacific region. Secondly, we describe the development of our openly-accessible education resource, illustrating the scope and content of these materials. Thirdly, we report on actual cases of biosecurity education that have been implemented. These include achievements in and lessons derived from the implementation of biosecurity education at the National Defense Medical College in Japan. These experiences are followed by presentation of the expert-level "Train-the-Trainer" programmes subsequently launched by the University of Bradford in the United Kingdom. These examples will help readers to understand how educators can enhance their own understanding about biosecurity issues and how they can then disseminate their knowledge through development of their own customised, relevantly-targeted and stage-tailored education programmes within their own life science communities. By providing these examples, we argue that education for life scientists, policy-makers and other stakeholders about social responsibility on dual-use issues is easily achievable and need not be expensive, time-consuming or over-burdening. We suggest that recurring classes or courses be held at appropriate times during educational programmes to accommodate the developing expertise and advancing learning stages of students.

An end-users oriented methodology for enhancing the integration of knowledge on soil-water-sediment systems in River Basin Management: an illustration from the AquaTerra project.

PubMed

Merly, Corinne; Chapman, Antony; Mouvet, Christophe

2012-01-01

Research results in environmental and socio-economic sciences are often under-used by stakeholders involved in the management of natural resources. To minimise this gap, the FP6 EU interdisciplinary project AquaTerra (AT) developed an end-users' integration methodology in order to ensure that the data, knowledge and tools related to the soil-water-sediment system that were generated by the project were delivered in a meaningful way for end-users, thus improving their uptake. The methodology and examples of its application are presented in this paper. From the 408 project deliverables, 96 key findings were identified, 53 related to data and knowledge, and 43 describing advanced tools. River Basin Management (RBM) stakeholders workshops identified 8 main RBM issues and 25 specific stakeholders' questions related to RBM which were classified into seven groups of cross-cutting issues, namely scale, climate change, non-climatic change, the need for systemic approaches, communication and participation, international and inter-basin coordination and collaboration, and the implementation of the Water Framework Directive. The integration methodology enabled an assessment of how AT key findings meet stakeholders' demands, and for each main RBM issue and for each specific question, described the added-value of the AT project in terms of knowledge and tools generated, key parameters to consider, and recommendations that can be made to stakeholders and the wider scientific community. Added value and limitations of the integration methodology and its outcomes are discussed and recommendations are provided to further improve integration methodology and bridge the gaps between scientific research data and their potential uptake by end-users.

Defining Long Term Goals and Setting Priorities for Education and Outreach, 2003 to 2013 - Panel Report

NASA Astrophysics Data System (ADS)

Grier, J. A.; Atkinson, D. H.; Barlow, N.; Griffin, I.; Hoffman, J.; Kelly-Serrato, B.; Kesthelyi, L.; Klein, M.; Klug, S.; Kolvoord, B.; Lanagan, P.; Lebofsky, L. A.; Lindstrom, M.; Lopes, R.; Lowes, L.; Manifold, J.; Mastrapa, R.; Milazzo, M.; Miner, E.; Morris, P.; Runyon, C.; Sohus, A.; Urquhart, M.; Warasila, R. L.; Withers, P.; Wood, Chuck

2001-11-01

Education and Public Outreach (E/PO) activities are an integral part of NASA's mandated mission and detailed in its Strategic Plan. The Office of Space Science Solar System Exploration (OSS SSE) E/PO program has made great strides in defining priorities and achieving its goals in the last five years. The Education and Public Outreach panel for NASA's Decadal Survey has generated a list of key issues to be addressed for the years 2003-2013 to assist the OSS SSE in future prioritization and planning. Key issues under discussion include: improving the involvement of planetary science professionals in E/PO activities; combating scientific elitism; examining the association between E/PO programs and public relations; re-examining funding E/PO activities from an audience perspective as opposed to a mission-centered perspective; improving access to resources for scientists, educators, students and partner organizations; promoting communication between educational programs at NASA; and reaching traditionally underrepresented groups, women, minorities and the disabled with science education programs. The panel is developing a list of specific recommendations to be implemented to improve OSS SSE E/PO activities in the next decade. These recommendations deal with topics such as: the production of evaluated resource web sites for scientists and educators; the development of a policy of long-term funding for the maintenance of web sites and other tools after they are created; methods for reaching those who do not have computer access through television and public programs; and the development of a reward system to recognize and encourage scientist involvement in E/PO activities. Such key issues and recommendations will be presented, along with materials from current programs and initiatives for E/PO in the OSS SSE.

A strategic approach for Water Safety Plans implementation in Portugal.

PubMed

Vieira, Jose M P

2011-03-01

Effective risk assessment and risk management approaches in public drinking water systems can benefit from a systematic process for hazards identification and effective management control based on the Water Safety Plan (WSP) concept. Good results from WSP development and implementation in a small number of Portuguese water utilities have shown that a more ambitious nationwide strategic approach to disseminate this methodology is needed. However, the establishment of strategic frameworks for systematic and organic scaling-up of WSP implementation at a national level requires major constraints to be overcome: lack of legislation and policies and the need for appropriate monitoring tools. This study presents a framework to inform future policy making by understanding the key constraints and needs related to institutional, organizational and research issues for WSP development and implementation in Portugal. This methodological contribution for WSP implementation can be replicated at a global scale. National health authorities and the Regulator may promote changes in legislation and policies. Independent global monitoring and benchmarking are adequate tools for measuring the progress over time and for comparing the performance of water utilities. Water utilities self-assessment must include performance improvement, operational monitoring and verification. Research and education and resources dissemination ensure knowledge acquisition and transfer.

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

PubMed

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

2013-06-01

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

Tailoring International Pressure Ulcer Prevention Guidelines for Nigeria: A Knowledge Translation Study Protocol.

PubMed

Ilesanmi, Rose Ekama; Gillespie, Brigid M; Adejumo, Prisca Olabisi; Chaboyer, Wendy

2015-07-28

The 2014 International Pressure Ulcer Prevention (PUP) Clinical Practice Guidelines (CPG) provides the most current evidence based strategies to prevent Pressure Ulcer (PU). The evidence upon which these guidelines have been developed has predominantly been generated from research conducted in developed countries. Some of these guidelines may not be feasible in developing countries due to structural and resource issues; therefore there is a need to adapt these guidelines to the context thus making it culturally acceptable. To present a protocol detailing the tailoring of international PUPCPG into a care bundle for the Nigerian context. Guided by the Knowledge to Action (KTA) framework, a two phased study will be undertaken. In Phase 1, the Delphi technique with stakeholder leaders will be used to review the current PUPCPG, identifying core strategies that are feasible to be adopted in Nigeria. These core strategies will become components of a PUP care bundle. In Phase 2, key stakeholder interviews will be used to identify the barriers, facilitators and potential implementation strategies to promote uptake of the PUP care bundle. A PUP care bundle, with three to eight components is expected to be developed from Phase 1. Implementation strategies to promote adoption of the PUP care bundle into clinical practice in selected Nigerian hospitals, is expected to result from Phase 2. Engagement of key stakeholders and consumers in the project should promote successful implementation and translate into better patient care. Using KTA, a knowledge translation framework, to guide the implementation of PUPCPG will enhance the likelihood of successful adoption in clinical practice. In implementing a PUP care bundle, developing countries face a number of challenges such as the feasibility of its components and the required resources.

Planning for pre-exposure prophylaxis to prevent HIV transmission: challenges and opportunities

PubMed Central

2010-01-01

There are currently several ongoing or planned trials evaluating the efficacy of pre-exposure prophylaxis (PrEP) as a preventative approach to reducing the transmission of HIV. PrEP may prove ineffective, demonstrate partial efficacy, or show high efficacy and have the potential to reduce HIV infection in a significant way. However, in addition to the trial results, it is important that issues related to delivery, implementation and further research are also discussed. As a part of the ongoing discussion, in June 2009, the Bill & Melinda Gates Foundation sponsored a Planning for PrEP conference with stakeholders to review expected trial results, outline responsible educational approaches, and develop potential delivery and implementation strategies. The conference reinforced the need for continued and sustained dialogue to identify where PrEP implementation may fit best within an integrated HIV prevention package. This paper identifies the key action points that emerged from the Planning for PrEP meeting. PMID:20624303

Early phase clinical trials with human immunodeficiency virus-1 and malaria vectored vaccines in The Gambia: frontline challenges in study design and implementation.

PubMed

Afolabi, Muhammed O; Adetifa, Jane U; Imoukhuede, Egeruan B; Viebig, Nicola K; Kampmann, Beate; Bojang, Kalifa

2014-05-01

Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and malaria are among the most important infectious diseases in developing countries. Existing control strategies are unlikely to curtail these diseases in the absence of efficacious vaccines. Testing of HIV and malaria vaccines candidates start with early phase trials that are increasingly being conducted in developing countries where the burden of the diseases is high. Unique challenges, which affect planning and implementation of vaccine trials according to internationally accepted standards have thus been identified. In this review, we highlight specific challenges encountered during two early phase trials of novel HIV-1 and malaria vectored vaccine candidates conducted in The Gambia and how some of these issues were pragmatically addressed. We hope our experience will be useful for key study personnel involved in day-to-day running of similar clinical trials. It may also guide future design and implementation of vaccine trials in resource-constrained settings.

Qualitative analysis of vendor discussions on the procurement of Computerised Physician Order Entry and Clinical Decision Support systems in hospitals

PubMed Central

Cresswell, Kathrin M; Lee, Lisa; Slee, Ann; Coleman, Jamie; Bates, David W; Sheikh, Aziz

2015-01-01

Objectives We studied vendor perspectives about potentially transferable lessons for implementing organisations and national strategies surrounding the procurement of Computerised Physician Order Entry (CPOE)/Clinical Decision Support (CDS) systems in English hospitals. Setting Data were collected from digitally audio-recorded discussions from a series of CPOE/CDS vendor round-table discussions held in September 2014 in the UK. Participants Nine participants, representing 6 key vendors operating in the UK, attended. The discussions were transcribed verbatim and thematically analysed. Results Vendors reported a range of challenges surrounding the procurement and contracting processes of CPOE/CDS systems, including hospitals’ inability to adequately assess their own needs and then select a suitable product, rushed procurement and implementation processes that resulted in difficulties in meaningfully engaging with vendors, as well as challenges relating to contracting leading to ambiguities in implementation roles. Consequently, relationships between system vendors and hospitals were often strained, the vendors attributing this to a lack of hospital management's appreciation of the complexities associated with implementation efforts. Future anticipated challenges included issues surrounding the standardisation of data to enable their aggregation across systems for effective secondary uses, and implementation of data exchange with providers outside the hospital. Conclusions Our results indicate that there are significant issues surrounding capacity to procure and optimise CPOE/CDS systems among UK hospitals. There is an urgent need to encourage more synergistic and collaborative working between providers and vendors and for a more centralised support for National Health Service hospitals, which draws on a wider body of experience, including a formalised procurement framework with value-based product specifications. PMID:26503385

Implementing the United Kingdom Government's 10-Year Teenage Pregnancy Strategy for England (1999-2010): Applicable Lessons for Other Countries.

PubMed

Hadley, Alison; Chandra-Mouli, Venkatraman; Ingham, Roger

2016-07-01

Teenage pregnancy is an issue of inequality affecting the health, well-being, and life chances of young women, young men, and their children. Consequently, high levels of teenage pregnancy are of concern to an increasing number of developing and developed countries. The UK Labour Government's Teenage Pregnancy Strategy for England was one of the very few examples of a nationally led, locally implemented evidence-based strategy, resourced over a long duration, with an associated reduction of 51% in the under-18 conception rate. This article seeks to identify the lessons applicable to other countries. The article focuses on the prevention program. Drawing on the detailed documentation of the 10-year strategy, it analyzes the factors that helped and hindered implementation against the World Health Organization (WHO) ExpandNet Framework. The Framework strives to improve the planning and management of the process of scaling-up of successful pilot programs with a focus on sexual and reproductive health, making it particularly suited for an analysis of England's teenage pregnancy strategy. The development and implementation of the strategy matches the Framework's key attributes for successful planning and scaling up of sexual and reproductive health programs. It also matched the attributes identified by the Centre for Global Development for scaled up approaches to complex public health issues. Although the strategy was implemented in a high-income country, analysis against the WHO-ExpandNet Framework identifies many lessons which are transferable to low- and medium-income countries seeking to address high teenage pregnancy rates. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Toward an understanding of global change: Initial priorities for US contributions to the International Geosphere-Biosphere Program

NASA Technical Reports Server (NTRS)

1988-01-01

A limited number of high-priority research initiatives are recommended for early implementation as part of the U.S. contribution to the preparatory phase of the International Geosphere-Biosphere Program. The recommendations are based on the committee's analysis of the most critical gaps in the scientific knowledge needed to understand the changes that are occurring in the earth system not being addressed by existing programs. The report articulates a number of important key issues and interactions that characterize global change in the geosphere-biosphere system on time scales of decades to centuries; identifies the knowledge that is the most urgently needed to improve understanding of those issues and interactions; and formulates initial priorities for initial U.S. contributions to the IGBP, recognizing the contributions of other ongoing and proposed programs.

Direct-to-Consumer Marketing: A Complementary Approach to Traditional Dissemination and implementation Efforts for Mental Health and Substance Abuse Interventions.

PubMed

Becker, Sara J

2015-03-01

The overall chasm between those who need treatment for mental health and substance abuse (M/SU) and those who receive effective treatment consists of two, interrelated gaps: the research-to-practice gap and the treatment gap. Prior efforts to disseminate evidence-based practice (EBP) for M/SU have predominantly targeted the research-to-practice gap, by focusing efforts toward treatment providers. This article introduces direct-to-consumer (DTC) marketing that targets patients and caregivers as a complementary approach to existing dissemination efforts. Specific issues discussed include: rationale for DTC marketing based on the concept of push versus pull marketing; overview of key stakeholders involved in DTC marketing; and description of the Marketing Mix planning framework. The applicability of these issues to the dissemination of EBP for M/SU is discussed.

Accounting for Parcel-Allocation Variability in Practice: Combining Sources of Uncertainty and Choosing the Number of Allocations.

PubMed

Sterba, Sonya K; Rights, Jason D

2016-01-01

Item parceling remains widely used under conditions that can lead to parcel-allocation variability in results. Hence, researchers may be interested in quantifying and accounting for parcel-allocation variability within sample. To do so in practice, three key issues need to be addressed. First, how can we combine sources of uncertainty arising from sampling variability and parcel-allocation variability when drawing inferences about parameters in structural equation models? Second, on what basis can we choose the number of repeated item-to-parcel allocations within sample? Third, how can we diagnose and report proportions of total variability per estimate arising due to parcel-allocation variability versus sampling variability? This article addresses these three methodological issues. Developments are illustrated using simulated and empirical examples, and software for implementing them is provided.

Faculty and student perceptions of academic integrity at U.S. and Canadian dental schools.

PubMed

Andrews, Kenneth G; Smith, Linda A; Henzi, David; Demps, Elaine

2007-08-01

The issues of cheating and plagiarism in educational settings have received a large amount of attention in recent years. The purpose of this study was to assess the degree to which academic integrity issues currently exist in the dental schools throughout the United States and Canada. An online survey was developed to gather data pertaining to this topic from two key groups in dental education: faculty and students. Responses were obtained from 1,153 students and 423 faculty members. The results of the survey clearly reveal that cheating is a significant problem in dental schools and that significant differences exist between students' and faculty members' perceptions of academic integrity. The challenge for dental schools is to identify effective strategies to prevent cheating opportunities and to implement and enforce effective means of dealing with specific examples of cheating.

Advancing drug availability-experiences from Africa.

PubMed

Powell, Richard A; Kaye, Richard Mugula; Ddungu, Henry; Mwangi-Powell, Faith

2010-07-01

International health and drug regulatory authorities acknowledge that analgesics (especially opioids) are insufficiently available for pain management in many countries. In Africa, reported morphine consumption is far below the global mean, with multiple factors hampering opioid supply. Since 2006, the African Palliative Care Association has hosted three regional drug availability workshops across the continent to address this issue. Using an interactive format, the workshops have identified country-specific barriers to opioid and other essential medication accessibility before supporting participants to develop action plans to address recognized impediments. Despite multiple challenges, a number of successes have arisen from the implementation of the plans. However, key issues remain, including the introduction of supportive policy environments, effective educational initiatives, and measures to address supply-chain obstacles impeding drug availability. Copyright 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Case Study in Ethics of Research: The Bucharest Early Intervention Project

PubMed Central

Zeanah, Charles H.; Fox, Nathan A.; Nelson, Charles A.

2014-01-01

The Bucharest Early Intervention Project is the first ever randomized controlled trial of foster care as an alternative to institutional care for young abandoned children. This paper examines ethical issues in the conceptualization and implementation of the study, which involved American investigators conducting research in another country, as well as vulnerable participants. We organize discussion of ethical questions about the study around several key issues. These include the nature and location of the vulnerable study population, the social value of conducting the study, risks and benefits of participating in the study to participants, and the post-trial obligations of the investigators. In discussing how these questions were addressed as the study was designed and after it was initiated, we describe our attempts to wed sound scientific practices with meaningful ethical protections for participants. PMID:22373763

[Sustainable Implementation of Evidence-Based Programmes in Health Promotion: A Theoretical Framework and Concept of Interactive Knowledge to Action].

PubMed

Rütten, A; Wolff, A; Streber, A

2016-03-01

This article discusses 2 current issues in the field of public health research: (i) transfer of scientific knowledge into practice and (ii) sustainable implementation of good practice projects. It also supports integration of scientific and practice-based evidence production. Furthermore, it supports utilisation of interactive models that transcend deductive approaches to the process of knowledge transfer. Existing theoretical approaches, pilot studies and thoughtful conceptual considerations are incorporated into a framework showing the interplay of science, politics and prevention practice, which fosters a more sustainable implementation of health promotion programmes. The framework depicts 4 key processes of interaction between science and prevention practice: interactive knowledge to action, capacity building, programme adaptation and adaptation of the implementation context. Ensuring sustainability of health promotion programmes requires a concentrated process of integrating scientific and practice-based evidence production in the context of implementation. Central to the integration process is the approach of interactive knowledge to action, which especially benefits from capacity building processes that facilitate participation and systematic interaction between relevant stakeholders. Intense cooperation also induces a dynamic interaction between multiple actors and components such as health promotion programmes, target groups, relevant organisations and social, cultural and political contexts. The reciprocal adaptation of programmes and key components of the implementation context can foster effectiveness and sustainability of programmes. Sustainable implementation of evidence-based health promotion programmes requires alternatives to recent deductive models of knowledge transfer. Interactive approaches prove to be promising alternatives. Simultaneously, they change the responsibilities of science, policy and public health practice. Existing boundaries within disciplines and sectors are overcome by arranging transdisciplinary teams as well as by developing common agendas and procedures. Such approaches also require adaptations of the structure of research projects such as extending the length of funding. © Georg Thieme Verlag KG Stuttgart · New York.

Status Report on Efforts to Enhance Instrumentation to Support Advanced Test Reactor Irradiations

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

J. Rempe; D. Knudson; J. Daw

2014-01-01

The Department of Energy (DOE) designated the Advanced Test Reactor (ATR) as a National Scientific User Facility (NSUF) in April 2007 to support the growth of nuclear science and technology in the United States (US). By attracting new research users - universities, laboratories, and industry - the ATR NSUF facilitates basic and applied nuclear research and development, further advancing the nation's energy security needs. A key component of the ATR NSUF effort at the Idaho National Laboratory (INL) is to design, develop, and deploy new in-pile instrumentation techniques that are capable of providing real-time measurements of key parameters during irradiation.more » To address this need, an assessment of instrumentation available and under-development at other test reactors was completed. Based on this initial review, recommendations were made with respect to what instrumentation is needed at the ATR, and a strategy was developed for obtaining these sensors. In 2009, a report was issued documenting this program’s strategy and initial progress toward accomplishing program objectives. Since 2009, annual reports have been issued to provide updates on the program strategy and the progress made on implementing the strategy. This report provides an update reflecting progress as of January 2014.« less

Of taps and toilets: quasi-experimental protocol for evaluating community-demand-driven projects.

PubMed

Pattanayak, Subhrendu K; Poulos, Christine; Yang, Jui-Chen; Patil, Sumeet R; Wendland, Kelly J

2009-09-01

Sustainable and equitable access to safe water and adequate sanitation are widely acknowledged as vital, yet neglected, development goals. Water supply and sanitation (WSS) policies are justified because of the usual efficiency criteria, but also major equity concerns. Yet, to date there are few scientific impact evaluations showing that WSS policies are effective in delivering social welfare outcomes. This lack of an evaluation culture is partly because WSS policies are characterized by diverse mechanisms, broad goals and the increasing importance of decentralized delivery, and partly because programme administrators are unaware of appropriate methods. We describe a protocol for a quasi-experimental evaluation of a community-demand-driven programme for water and sanitation in rural India, which addresses several evaluation challenges. After briefly reviewing policy and implementation issues in the sector, we describe key features of our protocol, including control group identification, pre-post measurement, programme theory, sample sufficiency and robust indicators. At its core, our protocol proposes to combine propensity score matching and difference-in-difference estimation. We conclude by briefly summarizing how quasi-experimental impact evaluations can address key issues in WSS policy design and when such evaluations are needed.

Privacy and Security within Biobanking: The Role of Information Technology.

PubMed

Heatherly, Raymond

2016-03-01

Along with technical issues, biobanking frequently raises important privacy and security issues that must be resolved as biobanks continue to grow in scale and scope. Consent mechanisms currently in use range from fine-grained to very broad, and in some cases participants are offered very few privacy protections. However, developments in information technology are bringing improvements. New programs and systems are being developed to allow researchers to conduct analyses without distributing the data itself offsite, either by allowing the investigator to communicate with a central computer, or by having each site participate in meta-analysis that results in a shared statistic or final significance result. The implementation of security protocols into the research biobanking setting requires three key elements: authentication, authorization, and auditing. Authentication is the process of making sure individuals are who they claim to be, frequently through the use of a password, a key fob, or a physical (i.e., retinal or fingerprint) scan. Authorization involves ensuring that every individual who attempts an action has permission to do that action. Finally, auditing allows for actions to be logged so that inappropriate or unethical actions can later be traced back to their source. © 2016 American Society of Law, Medicine & Ethics.

Patient-Centred Care in Canada: Key Components and the Path Forward.

PubMed

Montague, Terrence; Gogovor, Amédé; Aylen, John; Ashley, Lisa; Ahmed, Sara; Martin, Lesli; Cochrane, Bonnie; Adams, Owen; Nemis-White, Joanna

2017-01-01

Canadians' health and its care continue to evolve. Chronic diseases affect more than 50% of our aging population, but the majority of public and professional stakeholders retain a sense of care quality. An emergent issue, however, is generating an increasingly wide debate. It is the concept of patient-centred care, including its definition of key components, and efficacy. To advance the evidence base, the 2013-2014 and 2016 Health Care in Canada (HCIC) surveys measured pan-stakeholder levels of support and implementation priorities for frequently proposed components of patient centricity in healthcare. The public's highest rated component was timely access to care, followed by perceived respect and caring in its delivery, with decisions made in partnership among patients and professional providers, and within a basic belief that care should be based on patients' needs versus their ability to pay. Health professionals' levels of support for key components largely overlapped the public's levels of support for key components, with an additional accent on care influenced by an evidence base and expert opinion. In terms of priority to actually implement enhanced patient-centred care options, timely access was universally dominant among all stakeholders. Caring, respectful care, also retained high implementation priority among both the public and professionals, as did care decisions made in partnership, and, among professionals, care driven by research and expert opinion. Low priorities, for both the public and professionals, were the actual measurements of patient-centred care delivery and its impact on outcomes. In summary, there is remarkable concordance among all stakeholders in terms of favoured interventions to enhance patient-centred care, namely, timely access, caring, partnering and communicative delivery of evidence-based care. Unfortunately, the lack of contemporary imperative around the value of measuring and reporting actual use and outcomes of favoured interventions means uncertainty of their efficacy will persist for the foreseeable future. Things can be better.

76 FR 26290 - Science Advisory Board Staff Office; Notification of a Public Teleconference of the Chartered...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-06

... report entitled ``SAB Review of EPA's Reanalysis of Key Issues Related to Dioxin Toxicity and Response to... of EPA's Reanalysis of Key Issues Related to Dioxin Toxicity and Response to NAS Comments.'' The SAB... Reanalysis of Key Issues Related to Dioxin Toxicity and Response to NAS Comments.'' To conduct this review...

The World Summit on Sustainable Development: reaffirming the centrality of health

PubMed Central

von Schirnding, Yasmin

2005-01-01

The World Summit on Sustainable Development (WSSD) was held in Johannesburg in 2002 to review progress since the Rio conference in 1992, and to agree a new global deal on sustainable development. Unlike its predecessor, it was primarily concerned with implementation rather than with new treaties and targets, although a number of new targets were agreed, for example one on sanitation. Failure to agree a target on renewable energy was regarded as a major disappointment of the conference. While relatively modest in its achievements, and with difficulties in achieving consensus in key areas such as energy, trade, finance and globalisation, WSSD nevertheless succeeded in placing sustainable development back on the political agenda, giving new impetus, in particular to the environment and development needs of Africa, with a strong focus on local issues like household energy, water and sanitation. Health was singled out as one of five priority areas, along with water, energy, agriculture and biodiversity, and was devoted a separate chapter in the resulting Plan of Implementation, which highlighted a range of environmental health issues as well as issues relating to health services, communicable and non-communicable diseases. A number of new partnerships were formed at WSSD, including the Healthy Environments for Children Alliance (HECA) launched by WHO, which will form an important platform for implementation. The Commission on Sustainable Development has been designated main responsibility for monitoring and follow up, with its programme of work reorganised to focus on thematic clusters of issues. From the perspective of health, WSSD must be seen as a reaffirmation of the central place of health on the sustainable development agenda, and in the broader context of a process which began in Rio and was given added impetus with the Monterrey Financing for Development conference and the World Trade Organisation meeting held in Doha. Translating policies into action at all levels- global to local – remains the single biggest challenge in the years that lie ahead. PMID:15953397

The World Summit on Sustainable Development: reaffirming the centrality of health.

PubMed

von Schirnding, Yasmin

2005-05-10

The World Summit on Sustainable Development (WSSD) was held in Johannesburg in 2002 to review progress since the Rio conference in 1992, and to agree a new global deal on sustainable development. Unlike its predecessor, it was primarily concerned with implementation rather than with new treaties and targets, although a number of new targets were agreed, for example one on sanitation. Failure to agree a target on renewable energy was regarded as a major disappointment of the conference. While relatively modest in its achievements, and with difficulties in achieving consensus in key areas such as energy, trade, finance and globalisation, WSSD nevertheless succeeded in placing sustainable development back on the political agenda, giving new impetus, in particular to the environment and development needs of Africa, with a strong focus on local issues like household energy, water and sanitation. Health was singled out as one of five priority areas, along with water, energy, agriculture and biodiversity, and was devoted a separate chapter in the resulting Plan of Implementation, which highlighted a range of environmental health issues as well as issues relating to health services, communicable and non-communicable diseases. A number of new partnerships were formed at WSSD, including the Healthy Environments for Children Alliance (HECA) launched by WHO, which will form an important platform for implementation. The Commission on Sustainable Development has been designated main responsibility for monitoring and follow up, with its programme of work reorganised to focus on thematic clusters of issues. From the perspective of health, WSSD must be seen as a reaffirmation of the central place of health on the sustainable development agenda, and in the broader context of a process which began in Rio and was given added impetus with the Monterrey Financing for Development conference and the World Trade Organisation meeting held in Doha. Translating policies into action at all levels- global to local - remains the single biggest challenge in the years that lie ahead.

Blue and green infrastructures implementation to solve stormwater management issues in a new urban development project - a modelling approach

NASA Astrophysics Data System (ADS)

Versini, Pierre-Antoine; Tchiguirinskaia, Ioulia; Schertzer, Daniel

2016-04-01

Concentrating buildings and socio-economic activities, urban areas are particularly vulnerable to hydrological risks. Modification in climate may intensify already existing issues concerning stormwater management (due to impervious area) and water supply (due to the increase of the population). In this context, water use efficiency and best water management practices are key-issues in the urban environment already stressed. Blue and green infrastructures are nature-based solutions that provide synergy of the blue and green systems to provide multifunctional solutions and multiple benefits: increased amenity, urban heat island improvement, biodiversity, reduced energy requirements... They are particularly efficient to reduce the potential impact of new and existing developments with respect to stormwater and/or water supply issues. The Multi-Hydro distributed rainfall-runoff model represents an adapted tool to manage the impacts of such infrastructures at the urban basin scale. It is a numerical platform that makes several models interact, each of them representing a specific portion of the water cycle in an urban environment: surface runoff and infiltration depending on a land use classification, sub-surface processes and sewer network drainage. Multi-Hydro is still being developed at the Ecole des Ponts (open access from https://hmco.enpc.fr/Tools-Training/Tools/Multi-Hydro.php) to take into account the wide complexity of urban environments. The latest advancements have made possible the representation of several blue and green infrastructures (green roof, basin, swale). Applied in a new urban development project located in the Paris region, Multi-Hydro has been used to simulate the impact of blue and green infrastructures implementation. It was particularly focused on their ability to fulfil regulation rules established by local stormwater managers in order to connect the parcel to the sewer network. The results show that a combination of several blue and green infrastructures, if they are widely implemented, could represent an efficient tool to ensure regulation rules at the parcel scale.

Community Member and Stakeholder Perspectives on a Healthy Environment Initiative in North Carolina.

PubMed

Carter-Edwards, Lori; Lowe-Wilson, Abby; Mouw, Mary Sherwyn; Jeon, Janet Yewon; Baber, Ceola Ross; Vu, Maihan B; Bethell, Monique

2015-08-13

The North Carolina Community Transformation Grant Project (NC-CTG) aimed to implement policy, system, and environmental strategies to promote healthy eating, active living, tobacco-free living, and clinical and community preventive services to advance health equity and reduce health disparities for the state's most vulnerable communities. This article presents findings from the Health Equity Collaborative Evaluation and Implementation Project, which assessed community and stakeholder perceptions of health equity for 3 NC-CTG strategies: farmers markets, shared use, and smoke-free multiunit housing. In a triangulated qualitative evaluation, 6 photo elicitation (PE) sessions among 45 community members in 1 urban and 3 rural counties and key informant interviews among 22 stakeholders were conducted. Nine participants from the PE sessions and key informant interviews in the urban county subsequently participated in a stakeholder power analysis and mapping session (SPA) to discuss and identify people and organizations in their community perceived to be influential in addressing health equity-related issues. Evaluations of the PE sessions and key informant interviews indicated that access (convenience, cost, safety, and awareness of products and services) and community fit (community-defined quality, safety, values, and norms) were important constructs across the strategies. The SPA identified specific community- and faith-based organizations, health care organizations, and local government agencies as key stakeholders for future efforts. Both community fit and access are essential constructs for promoting health equity. Findings demonstrate the feasibility of and need for formative research that engages community members and local stakeholders to shape context-specific, culturally relevant health promotion strategies.

Community Member and Stakeholder Perspectives on a Healthy Environment Initiative in North Carolina

PubMed Central

Lowe-Wilson, Abby; Mouw, Mary Sherwyn; Jeon, Janet Yewon; Baber, Ceola Ross; Vu, Maihan B.; Bethell, Monique

2015-01-01

Introduction The North Carolina Community Transformation Grant Project (NC-CTG) aimed to implement policy, system, and environmental strategies to promote healthy eating, active living, tobacco-free living, and clinical and community preventive services to advance health equity and reduce health disparities for the state’s most vulnerable communities. This article presents findings from the Health Equity Collaborative Evaluation and Implementation Project, which assessed community and stakeholder perceptions of health equity for 3 NC-CTG strategies: farmers markets, shared use, and smoke-free multiunit housing. Methods In a triangulated qualitative evaluation, 6 photo elicitation (PE) sessions among 45 community members in 1 urban and 3 rural counties and key informant interviews among 22 stakeholders were conducted. Nine participants from the PE sessions and key informant interviews in the urban county subsequently participated in a stakeholder power analysis and mapping session (SPA) to discuss and identify people and organizations in their community perceived to be influential in addressing health equity–related issues. Results Evaluations of the PE sessions and key informant interviews indicated that access (convenience, cost, safety, and awareness of products and services) and community fit (community-defined quality, safety, values, and norms) were important constructs across the strategies. The SPA identified specific community- and faith-based organizations, health care organizations, and local government agencies as key stakeholders for future efforts. Conclusions Both community fit and access are essential constructs for promoting health equity. Findings demonstrate the feasibility of and need for formative research that engages community members and local stakeholders to shape context-specific, culturally relevant health promotion strategies. PMID:26270741

Data warehousing in disease management programs.

PubMed

Ramick, D C

2001-01-01

Disease management programs offer the benefits of lower disease occurrence, improved patient care, and lower healthcare costs. In such programs, the key mechanism used to identify individuals at risk for targeted diseases is the data warehouse. This article surveys recent warehousing techniques from HMOs to map out critical issues relating to the preparation, design, and implementation of a successful data warehouse. Discussions of scope, data cleansing, and storage management are included in depicting warehouse preparation and design; data implementation options are contrasted. Examples are provided of data warehouse execution in disease management programs that identify members with preexisting illnesses, as well as those exhibiting high-risk conditions. The proper deployment of successful data warehouses in disease management programs benefits both the organization and the member. Organizations benefit from decreased medical costs; members benefit through an improved quality of life through disease-specific care.

Local implementation of the Essence of Care benchmarks.

PubMed

Jones, Sue

To understand clinical practice benchmarking from the perspective of nurses working in a large acute NHS trust and to determine whether the nurses perceived that their commitment to Essence of Care led to improvements in care, the factors that influenced their role in the process and the organisational factors that influenced benchmarking. An ethnographic case study approach was adopted. Six themes emerged from the data. Two organisational issues emerged: leadership and the values and/or culture of the organisation. The findings suggested that the leadership ability of the Essence of Care link nurses and the value placed on this work by the organisation were key to the success of benchmarking. A model for successful implementation of the Essence of Care is proposed based on the findings of this study, which lends itself to testing by other organisations.

Barriers and Facilitators to Implementing Functional Family Therapy in a Community Setting: Client and Practitioner Perspectives.

PubMed

McPherson, Kerri E; Kerr, Susan; Casey, Beth; Marshall, John

2017-10-01

While Functional Family Therapy (FFT) is known to be effective in addressing adolescent behavioral problems, there has been little exploration of issues relevant to its transport from the tightly controlled setting of clinical trials into routine service delivery. This study sought the views of key stakeholders, clients, and practitioners, on barriers and facilitators to the successful implementation of FFT. Undertaken in a community setting in Scotland, interviews were carried out with 12 adolescents, 14 parents/caregivers, and 6 practitioners. Results focus on: Referral process and pre-intervention contact; Engagement of families; Structure and delivery; Organizational factors. Although barriers to engagement were identified, FFT was viewed as an acceptable, appropriate and feasible intervention with the potential to improve adolescent wellbeing in 'real-world' settings. © 2017 American Association for Marriage and Family Therapy.

Teaching dental students about patient communication following an adverse event: a pilot educational module.

PubMed

Raja, Sheela; Rajagopalan, Chelsea F; Patel, Janki; Van Kanegan, Kevin

2014-05-01

Adverse events are an important but understudied area in dentistry. Most dentists will face the issue of an adverse event several times in their clinical careers. The authors implemented a six-hour pilot educational module at one dental school to improve fourth-year dental students' knowledge and confidence in communicating with patients about adverse events. Based on results from the twenty-nine students who completed both the pre- and posttests, the module significantly increased the students' knowledge of the key concepts involved in adverse events. However, the module did not improve the students' confidence that they would be able to implement these communication skills in clinical situations. Based on these results, this article discusses how future educational efforts can be modified to better prepare students for the communication challenges associated with adverse events.

Telemedicine: Pediatric Applications

PubMed Central

Burke, Bryan L.; Hall, R. W.

2017-01-01

Telemedicine is a technological tool that is improving the health of children around the world. This report chronicles the use of telemedicine by pediatricians and pediatric medical and surgical specialists to deliver inpatient and outpatient care, educate physicians and patients, and conduct medical research. It also describes the importance of telemedicine in responding to emergencies and disasters and providing access to pediatric care to remote and underserved populations. Barriers to telemedicine expansion are explained, such as legal issues, inadequate payment for services, technology costs and sustainability, and the lack of technology infrastructure on a national scale. Although certain challenges have constrained more widespread implementation, telemedicine’s current use bears testimony to its effectiveness and potential. Telemedicine’s widespread adoption will be influenced by the implementation of key provisions of the Patient Protection and Affordable Care Act, technological advances, and growing patient demand for virtual visits. PMID:26122813

Barriers to breastfeeding in Lebanon: A policy analysis.

PubMed

Akik, Chaza; Ghattas, Hala; Filteau, Suzanne; Knai, Cecile

2017-08-01

Although the issue of breastfeeding in Lebanon has risen on the political agenda, the country does not meet international recommendations for early breastfeeding practices. This study analysed barriers to dissemination, implementation, and enforcement of key policies to improve early breastfeeding practices. We conducted interviews with stakeholders in breastfeeding policy in Lebanon and used a framework approach for analysing data. We found a disconnect between policy endorsement and translation on the ground, weak engagement of professional associations and governmental institutions, undue influence by the breast milk substitute industry, and competing priorities-most notably the current refugee crisis. This study highlights the potential policy opportunities to counter these barriers and points to the role of international organisations and grassroots advocacy in pushing, monitoring, and implementing policies that protect breastfeeding, where government capacity is limited, and the private sector is strong.

CLAHRCs in practice: combined knowledge transfer and exchange strategies, cultural change, and experimentation.

PubMed

Soper, Bryony; Yaqub, Ohid; Hinrichs, Saba; Marjanovich, Sonja; Drabble, Samuel; Hanney, Stephen; Nolte, Ellen

2013-10-01

The nine NIHR CLAHRCs are collaborations between universities and local NHS organizations that seek to improve patient outcomes through the conduct and application of applied health research. The theoretical and practical context within which the CLAHRCs were set up was characterized by a considerable degree of uncertainty, and the CLAHRCs were established as a natural experiment. We adopted a formative and emergent evaluation approach. Drawing on in-depth, multi-method case studies of two CLAHRCs we explored how they pursued their remit by supporting efforts to increase the relevance and use of health research, and building relationships. Both CLAHRCs: strengthened local networks and relationships; built capacity in their local academic and NHS communities to undertake and use research that meets the needs of the service; developed research and implementation methodologies; and added to understanding of the complex relation between research and implementation. There was evidence of impact of CLAHRC projects on health and social care services. Informed by the literature on implementing collaborative research initiatives, knowledge transfer and exchange and cultural change, some key lessons can be drawn. The CLAHRCs pursued a strategy that can be categorized as one of flexible comprehensiveness; i.e. their programmes have been flexible and responsive and they have used a range of approaches that seek to match the diverse aspects of the complex issues they face. Key features include their work on combining a range of knowledge transfer and exchange strategies, their efforts to promote cultural change, and the freedom to experiment, learn and adapt. Although the CLAHRCs do not, by themselves, have the remit or resources to bring about wholesale service improvement in health care, they do have features that would allow them to play a key role in some of the wider initiatives that encourage innovation.

Results from levels 2/3 fusion implementations: issues, challenges, retrospectives, and perspectives for the future an annotated perspective

NASA Astrophysics Data System (ADS)

Kadar, Ivan; Bosse, Eloi; Salerno, John; Lambert, Dale A.; Das, Subrata; Ruspini, Enrique H.; Rhodes, Bradley J.; Biermann, Joachim

2008-04-01

Even though the definition of the Joint Director of Laboratories (JDL) "fusion levels" were established in 1987, published 1991, revised in 1999 and 2004, the meaning, effects, control and optimization of interactions among the fusion levels have not as yet been fully explored and understood. Specifically, this is apparent from the abstract JDL definitions of "Levels 2/3 Fusion" - situation and threat assessment (SA/TA), which involve deriving relations among entities, e.g., the aggregation of object states (i.e., classification and location) in SA, while TA uses SA products to estimate/predict the impact of actions/interactions effects on situations taken by the participant entities involved. Given all the existing knowledge in the information fusion and human factors literature, (both prior to and after the introduction of "fusion levels" in 1987) there are still open questions remaining in regard to implementation of knowledge representation and reasoning methods under uncertainty to afford SA/TA. Therefore, to promote exchange of ideas and to illuminate the historical, current and future issues associated with Levels 2/3 implementations, leading experts were invited to present their respective views on various facets of this complex problem. This paper is a retrospective annotated view of the invited panel discussion organized by Ivan Kadar (first author), supported by John Salerno, in order to provide both a historical perspective of the evolution of the state-of-the-art (SOA) in higher-level "Levels 2/3" information fusion implementations by looking back over the past ten or more years (before JDL), and based upon the lessons learned to forecast where focus should be placed to further enhance and advance the SOA by addressing key issues and challenges. In order to convey the panel discussion to audiences not present at the panel, annotated position papers summarizing the panel presentation are included.

Scalable Metadata Management for a Large Multi-Source Seismic Data Repository

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

Gaylord, J. M.; Dodge, D. A.; Magana-Zook, S. A.

In this work, we implemented the key metadata management components of a scalable seismic data ingestion framework to address limitations in our existing system, and to position it for anticipated growth in volume and complexity. We began the effort with an assessment of open source data flow tools from the Hadoop ecosystem. We then began the construction of a layered architecture that is specifically designed to address many of the scalability and data quality issues we experience with our current pipeline. This included implementing basic functionality in each of the layers, such as establishing a data lake, designing a unifiedmore » metadata schema, tracking provenance, and calculating data quality metrics. Our original intent was to test and validate the new ingestion framework with data from a large-scale field deployment in a temporary network. This delivered somewhat unsatisfying results, since the new system immediately identified fatal flaws in the data relatively early in the pipeline. Although this is a correct result it did not allow us to sufficiently exercise the whole framework. We then widened our scope to process all available metadata from over a dozen online seismic data sources to further test the implementation and validate the design. This experiment also uncovered a higher than expected frequency of certain types of metadata issues that challenged us to further tune our data management strategy to handle them. Our result from this project is a greatly improved understanding of real world data issues, a validated design, and prototype implementations of major components of an eventual production framework. This successfully forms the basis of future development for the Geophysical Monitoring Program data pipeline, which is a critical asset supporting multiple programs. It also positions us very well to deliver valuable metadata management expertise to our sponsors, and has already resulted in an NNSA Office of Defense Nuclear Nonproliferation commitment to a multi-year project for follow-on work.« less

The municipalities of the Northwest region of the Czech Republic adapt to climate change: overview of barriers and challenges

NASA Astrophysics Data System (ADS)

Emmer, Adam; Krkoška Lorencová, Eliška; Vačkář, David

2017-04-01

The municipalities of the Czech Republic have been facing negative impacts of changing climate in the past decades - especially floods (1997, 2002, 2010, 2013), droughts and heat waves (2013, 2015), claiming lives, material damages and economic losses up to several % of GDP. Reflecting these events, climate change adaptation should represent major issue in strategical planning on all administrative levels, which is actually not fully met nowadays. Sectoral National Adaptation Strategy (NAS) was approved by the Government of the Czech Republic in autumn 2015 and the implementation action plan is currently being approved. Adaptation strategies on lower administrative level (adaptation strategies of individual municipalities) are, however, still quite rare. In this contribution, we analyse barriers and challenges for: (i) the development of climate change adaptation strategies on administrative level of individual municipalities in the Northwest region, Czech Republic; and (ii) implementation of adaptation measures into the decision-making processes. Based on participatory seminars with key stakeholders organised in pilot municipalities, it was shown that municipalities are (at least partly) able to cope with existing risks such as floods, but are not well-prepared for expected regionally "new" risks such as long lasting heat waves, insufficient water retention and flash floods. Linking the goals of adaptation strategy with urban planning seems to be challenging task but also potentially powerfull tool to implement specific adaptation measures. It emerged, that complicated ownership relations often cause obstacles for implementation of adaptation measures, highlighting the potential of stimulation and motivation tools from the side of the municipality. On the other hand, it was also shown that despite experiencing its negative impacts, climate change is often neglected or percepted as a marginal issue by some municipalities and developing adaptation strategy is considered needless, referring to another burning issues such as socioeconomic situation. The role of information campaigns and education of stakeholders as well as public regarding climate change and possible future climate change impacts is, therefore, considered highly important task.

Evaluation Guidelines for the Clinical and Translational Science Awards (CTSAs)

PubMed Central

Rubio, Doris M.; Thomas, Veronica G.

2013-01-01

Abstract The National Center for Advancing Translational Sciences (NCATS), a part of the National Institutes of Health, currently funds the Clinical and Translational Science Awards (CTSAs), a national consortium of 61 medical research institutions in 30 states and the District of Columbia. The program seeks to transform the way biomedical research is conducted, speed the translation of laboratory discoveries into treatments for patients, engage communities in clinical research efforts, and train a new generation of clinical and translational researchers. An endeavor as ambitious and complex as the CTSA program requires high‐quality evaluations in order to show that the program is well implemented, efficiently managed, and demonstrably effective. In this paper, the Evaluation Key Function Committee of the CTSA Consortium presents an overall framework for evaluating the CTSA program and offers policies to guide the evaluation work. The guidelines set forth are designed to serve as a tool for education within the CTSA community by illuminating key issues and practices that should be considered during evaluation planning, implementation, and utilization. Additionally, these guidelines can provide a basis for ongoing discussions about how the principles articulated in this paper can most effectively be translated into operational reality. PMID:23919366

Algorithm Engineering: Concepts and Practice

NASA Astrophysics Data System (ADS)

Chimani, Markus; Klein, Karsten

Over the last years the term algorithm engineering has become wide spread synonym for experimental evaluation in the context of algorithm development. Yet it implies even more. We discuss the major weaknesses of traditional "pen and paper" algorithmics and the ever-growing gap between theory and practice in the context of modern computer hardware and real-world problem instances. We present the key ideas and concepts of the central algorithm engineering cycle that is based on a full feedback loop: It starts with the design of the algorithm, followed by the analysis, implementation, and experimental evaluation. The results of the latter can then be reused for modifications to the algorithmic design, stronger or input-specific theoretic performance guarantees, etc. We describe the individual steps of the cycle, explaining the rationale behind them and giving examples of how to conduct these steps thoughtfully. Thereby we give an introduction to current algorithmic key issues like I/O-efficient or parallel algorithms, succinct data structures, hardware-aware implementations, and others. We conclude with two especially insightful success stories—shortest path problems and text search—where the application of algorithm engineering techniques led to tremendous performance improvements compared with previous state-of-the-art approaches.

Quality by design for herbal drugs: a feedforward control strategy and an approach to define the acceptable ranges of critical quality attributes.

PubMed

Yan, Binjun; Li, Yao; Guo, Zhengtai; Qu, Haibin

2014-01-01

The concept of quality by design (QbD) has been widely accepted and applied in the pharmaceutical manufacturing industry. There are still two key issues to be addressed in the implementation of QbD for herbal drugs. The first issue is the quality variation of herbal raw materials and the second issue is the difficulty in defining the acceptable ranges of critical quality attributes (CQAs). To propose a feedforward control strategy and a method for defining the acceptable ranges of CQAs for the two issues. In the case study of the ethanol precipitation process of Danshen (Radix Salvia miltiorrhiza) injection, regression models linking input material attributes and process parameters to CQAs were built first and an optimisation model for calculating the best process parameters according to the input materials was established. Then, the feasible material space was defined and the acceptable ranges of CQAs for the previous process were determined. In the case study, satisfactory regression models were built with cross-validated regression coefficients (Q(2) ) all above 91 %. The feedforward control strategy was applied successfully to compensate the quality variation of the input materials, which was able to control the CQAs in the 90-110 % ranges of the desired values. In addition, the feasible material space for the ethanol precipitation process was built successfully, which showed the acceptable ranges of the CQAs for the concentration process. The proposed methodology can help to promote the implementation of QbD for herbal drugs. Copyright © 2013 John Wiley & Sons, Ltd.

Why gender matters in the solution towards safe sanitation? Reflections from rural India.

PubMed

Khanna, Tina; Das, Madhumita

2016-12-01

While the topic of women and water, sanitation and hygiene is a widely accepted concern among academics and activists, it continues to be an issue in developing countries with serious consequences. Based on a qualitative research conducted in rural Uttar Pradesh, India, the paper affirms that sanitation issues for women and girls are compounded by inequitable gender norms that put them at greater risk of experiencing violence and multiple health vulnerabilities. Women, despite having a high demand for safe toilet facilities, continue to practise unsafe sanitation. The findings highlight the role of three structural constraints as the key factors influencing toilet construction and use: poverty, inadequate sanitation policy and its implementation and gender-based power dynamics at the household level. The paper concludes by emphasising the relevance of engendering sanitation programmes and policies by involving women and girls in the planning process to ensure that dignified and gender-sensitive sanitation solutions are developed. The paper also stresses the need to have measures for strengthening and effectively implementing a sanitation policy for the poor and for programmes to work with both men and women to address gender power relations which influence toilet adoption and use.

An electronic dashboard to improve nursing care.

PubMed

Tan, Yung-Ming; Hii, Joshua; Chan, Katherine; Sardual, Robert; Mah, Benjamin

2013-01-01

With the introduction of CPOE systems, nurses in a Singapore hospital were facing difficulties monitoring key patient information such as critical tasks and alerts. Issues include unfriendly user interfaces of clinical systems, information overload, and the loss of visual cues for action due to paperless workflows. The hospital decided to implement an interactive electronic dashboard on top of their CPOE system to improve visibility of vital patient data. A post-implementation survey was performed to gather end-user feedback and evaluate factors that influence user satisfaction of the dashboard. Questionnaires were sent to all nurses of five pilot wards. 106 valid responses were received. User adoption was good with 86% of nurses using the dashboard every shift. Mean satisfaction score was 3.6 out of 5. User satisfaction was strongly and positively correlated to the system's perceived impact on work efficiency and care quality. From qualitative feedback, nurses generally agreed that the dashboard had improved their awareness of critical patient issues without the hassle of navigating a CPOE system. This study shows that an interactive clinical dashboard when properly integrated with a CPOE system could be a useful tool to improve daily patient care.

Farmers' markets' uptake of food assistance programmes in East Tennessee, USA.

PubMed

Russomanno, Jennifer; Jabson, Jennifer M

2016-10-01

Limited acceptance of government food assistance programmes such as the US Department of Agriculture's (USDA) Supplemental Nutrition Assistance Program (SNAP) is a barrier that produces unequal access to market products for SNAP beneficiaries. There is a dearth of published evidence to explain the limited SNAP acceptance at farmers' markets. The current project aimed to fill this gap; to identify and describe the barriers to markets' acceptance of SNAP. Cross-sectional, semi-structured interviews were conducted. All interviews were conducted via telephone. Twelve East Tennessee area market managers, vendors and other key stakeholders. Multiple barriers exist for SNAP implementation at markets including administrative and time limitations, prejudice from market vendors against SNAP beneficiaries, and resistance to invasive and burdensome requirements of the USDA SNAP application required for farmers' markets. SNAP acceptance at farmers' markets is a complex issue, especially for small, rural markets. If farmers' markets are to serve as sustainable resources to increase food access, these issues must be addressed so that SNAP can be accepted. Successful implementation of SNAP at rural markets requires increased administrative support and vendor education about SNAP and its beneficiaries. A revised USDA SNAP application process for farmers' markets should also be considered.

Identification of Increasing Green Behaviour in Citraland Bagya City, Medan

NASA Astrophysics Data System (ADS)

Aulia, D. N.; Marpaung, B. O. Y.; Suryani, L.

2017-03-01

This present time, Indonesia just began applying the concept of Green Architecture. The actions require community participation as residents and the users of the building. The built environment is designed around the idea of Green Architecture but inhabited and managed improperly; the goal of sustainable built environment is not achieved. The aspect of behaviour is the key factor in the implementation of Green Architecture’s concept. This research is a descriptive exploratory which is to identify the problems to the implementation of Green Architecture’s concept in planned housing. Then the study will explore the components causes of the problems used as a problem solver. The study conducted on the living behaviour in Citraland Bagya City’s resident. The estate is designed and built with the concept of Green Architecture in Medan city. The research was carried out by the four aspects of housing are the physical, social and cultural, policy, and management issue. These three components will indirectly relate to the economic issues that are the efficiency and effectiveness of living behaviour. The results showed that the increasing of green behavior is still small and the occupant requires motivation and socialization of living green.

Issues with monitoring the safety of psychoactive products under a legal regulated market for new psychoactive substances ('legal highs') in New Zealand.

PubMed

Rychert, Marta; Wilkins, Chris; Witten, Karen

2017-09-01

New Zealand's Psychoactive Substances Act (2013) established the world's first regulated market for 'low risk' psychoactive products ('legal highs'). Under an interim PSA regime, 47 existing products were permitted to be continued to be sold. To explore issues with the implementation of regulatory systems to monitor the safety of products on the legal market under the interim Psychoactive Substances Act regime. Semi-structured interviews with 30 key stakeholders, including industry, government agency, health and drug service professionals were conducted, transcribed and analysed thematically. In retrospect stakeholders questioned the decision to approve strong synthetic cannabinoid smoking products, noting their health risks because of product formulation, inconsistent manufacturing practices and smoking as the means of administration. Industry actors claimed the decision to approve synthetic cannabinoid smokeable products prevented potentially safer products from gaining market share. The system for withdrawing approved products which were subsequently found to be harmful was criticised for the poor quality of data available, limited engagement with health professionals and the slowness of product withdrawal. Many of the problems with the regime were attributed to the urgency under which the legal market under the interim Psychoactive Substances Act was established and implemented. The selection of 'safer' products, implementation of the product monitoring system, and engagement with health professionals may have benefited from more time and resources. An incremental approach to establishing the new market may have made the regulatory management of the new regime more workable. [Rychert M, Wilkins C, Witten K. Issues with monitoring the safety of psychoactive products under a legal regulated market for new psychoactive substances ('legal highs') in New Zealand. Drug Alcohol Rev 2017;00:000-000]. © 2017 Australasian Professional Society on Alcohol and other Drugs.

A four-country comparison of healthcare systems, implementation of diagnostic criteria, and treatment availability for functional gastrointestinal disorders: a report of the Rome Foundation Working Team on cross-cultural, multinational research.

PubMed

Schmulson, M; Corazziari, E; Ghoshal, U C; Myung, S-J; Gerson, C D; Quigley, E M M; Gwee, K-A; Sperber, A D

2014-10-01

Variations in healthcare provision around the world may impact how patients with functional gastrointestinal disorder (FGIDs) are investigated, diagnosed, and treated. However, these differences have not been reviewed. The Multinational Working Team of the Rome Foundation, established to make recommendations on the conduct of multinational, cross-cultural research in FGIDs, identified seven key issues that are analyzed herein: (i) coverage afforded by different healthcare systems/providers; (ii) level of the healthcare system where patients with FGIDs are treated; (iii) extent/types of diagnostic procedures typically undertaken to diagnose FGIDs; (iv) physicians' familiarity with and implementation of the Rome diagnostic criteria in clinical practice; (v) range of medications approved for FGIDs and approval process for new agents; (vi) costs involved in treating FGIDs; and (vii) prevalence and role of complementary/alternative medicine (CAM) for FGIDs. Because it was not feasible to survey all countries around the world, we compared a selected number of countries based on their geographical and ethno-cultural diversity. Thus, we included Italy and South Korea as representative of nations with broad-based coverage of healthcare in the population and India and Mexico as newly industrialized countries where there may be limited provision of healthcare for substantial segments of the population. In light of the paucity of formal publications on these issues, we included additional sources from the medical literature as well as perspectives provided by local experts and the media. Finally, we provide future directions on healthcare issues that should be taken into account and implemented when conducting cross-cultural and multinational research in FGIDs. © 2014 John Wiley & Sons Ltd.

A look at statin cost-effectiveness in view of the 2013 ACC/AHA cholesterol management guidelines.

PubMed

Deaño, Roderick C; Pandya, Ankur; Jones, Erica C; Borden, William B

2014-09-01

The 2013 cholesterol management guidelines presented a major shift in recommendations on which patients at risk of cardiovascular disease should be treated and how to treat them. Implementation of the guidelines is estimated to increase substantially the number of people who would be eligible for statin therapy. As the medical community considers the broad population impact of the new cholesterol guidelines, the issue of cost-effectiveness plays a role. This review covers the basic fundamentals of cost-effectiveness analysis and summarizes the key cost-effectiveness studies that relate to the new cholesterol guidelines.

Case Study: The Role of eLearning in Midwifery Pre-Service Education in Ghana.

PubMed

Appiagyei, Martha; Trump, Alison; Danso, Evans; Yeboah, Alex; Searle, Sarah; Carr, Catherine

The issues and challenges of implementing eLearning in pre-service health education were explored through a pilot study conducted in six nurse-midwifery education programs in Ghana. Case-based, interactive computer mediated eLearning modules, targeted to basic emergency and obstetrical signal functions, were delivered both online and offline using a free-for-use eLearning platform, skoool HE(®). Key success factors included broad stakeholder support, an established curriculum and student and tutor interest. Challenges included infrastructure limitations, large class sizes and added workloads for tutors and information technology staff. National scale up is planned.

Improving care and efficiency: appointment times in a haemodialysis unit.

PubMed

Lunts, P

2002-01-01

Shortage of nurses and dialysis spaces and the desire to improve patient care are the two main driving forces in the dialysis field today. This paper suggests that these issues can be addressed by organisational change. We describe a simple, dramatically effective but rarely used example - the effect on a haemodialysis unit of the introduction of patient appointment times. This paper will demonstrate that appointment times can be highly effective in reducing waiting times for patients and in utilizing staff and resources more efficiently, as long as there is commitment from key staff to implement and maintain them effectively

Geographic variation in premiums in health insurance marketplaces.

PubMed

Barker, Abigail R; McBride, Timothy D; Kemper, Leah M; Mueller, Keith

2014-08-01

This policy brief analyzes the 2014 premiums associated with qualified health plans (QHPs) made available through new health insurance marketplaces (HIMs), an implementation of the Patient Protection and Affordable Care Act (ACA) of 2010. We report differences in premiums by insurance rating areas while controlling for other important factors such as the actuarial value of the plan (metal level), cost-of-living differences, and state-level decisions over type of rating area. While market equilibrium, based on experience and understanding of the characteristics of the new market, should not be expected this soon, preliminary results give policymakers key issues to monitor.

Workshop 8 (synthesis): challenges of expanding ecological sanitation into urban areas.

PubMed

Milburn, A; Matsui, S; Malmqvist, P A

2002-01-01

After seven papers discussing specific examples of ecological sanitation projects, the workshop considered the background, motivation and feasibility of this technology. It was agreed that ecological sanitation could help tackle water scarcity, health protection and, by recycling water and nutrients into agriculture, food scarcity. Dense cities are probably unsuitable for its implementation, but rural, town and peri-urban areas are promising. Key issues that remains are: the microbiological and chemical risks associated with the technology; the need for major information, education and support programmes; effective linking to reuse schemes; tailoring systems to meet local physical, socio-economic and cultural circumstances.

Precision medicine in the age of big data: The present and future role of large-scale unbiased sequencing in drug discovery and development.

PubMed

Vicini, P; Fields, O; Lai, E; Litwack, E D; Martin, A-M; Morgan, T M; Pacanowski, M A; Papaluca, M; Perez, O D; Ringel, M S; Robson, M; Sakul, H; Vockley, J; Zaks, T; Dolsten, M; Søgaard, M

2016-02-01

High throughput molecular and functional profiling of patients is a key driver of precision medicine. DNA and RNA characterization has been enabled at unprecedented cost and scale through rapid, disruptive progress in sequencing technology, but challenges persist in data management and interpretation. We analyze the state-of-the-art of large-scale unbiased sequencing in drug discovery and development, including technology, application, ethical, regulatory, policy and commercial considerations, and discuss issues of LUS implementation in clinical and regulatory practice. © 2015 American Society for Clinical Pharmacology and Therapeutics.

The Journey through Grief: Insights from a Qualitative Study of Electronic Health Record Implementation

PubMed Central

McAlearney, Ann Scheck; Hefner, Jennifer L; Sieck, Cynthia J; Huerta, Timothy R

2015-01-01

Objective To improve understanding of facilitators of EHR system implementation, paying particular attention to opportunities to maximize physician adoption and effective deployment. Data Sources/Study Setting Primary data collected from 47 physician and 35 administrative key informants from six U.S. health care organizations identified because of purported success with EHR implementation. Study Design We conducted interviews and focus groups in an extensive qualitative study. Data Collection/Extraction Methods Verbatim transcripts were analyzed both deductively and inductively using the constant comparative method. Principal Findings Conceptualizing EHR adoption as loss through the lens of Kübler-Ross's five stages of grief model may help individuals and organizations more effectively orient to the challenge of change. Coupled with Kotter's eight-step change management framework, we offer a structure to facilitate organizations' movement through the EHR implementation journey. Combining insights from these frameworks, we identify 10 EHR strategies that can help address EHR implementation barriers. Conclusions Loss is one part of change often overlooked. Addressing it directly and compassionately can potentially facilitate the EHR implementation journey. We offer a summarized list of deployment strategies that are sensitive to these issues to support physician transition to new technologies that will bring value to clinical practice. PMID:25219627

Critical success factors in implementing an e-rostering system in a healthcare organisation.

PubMed

Soomro, Zahoor A; Ahmed, Javed; Muhammad, Raza; Hayes, Dawn; Shah, Mahmood H

2017-01-01

Effective and efficient staff scheduling has always been a challenging issue, especially in health service organisations. Both the extremes of staff shortage and overage have an adverse impact on the performance of healthcare organisations. In this case, an electronic and systematic staff scheduling (e-rostering) system is the often seen as the best solution. Unless an organisation has an effective implementation of such a system, possible cost savings, efficiency, and benefits could be minimal. This study is aimed to research key success factors for the successful effective implementation of an electronic rostering system, especially at healthcare organisations. A case study research method was used to evaluate critical success factors for effectively implementing an e-rostering system. The data were collected through interviews and observations. The findings indicate that technical support, an effective policy, leadership, clear goals and objectives, gradual change, evidence of the advantages of the new system, senior management support, and effective communication are the critical success factors in implementing an e-rostering system in healthcare organisations. Prior to this study, no such factors were grounded in the current context, so this research would help in bridging the gap towards effective implementation of an e-rostering system in the healthcare sector. This research also suggests future studies in different cultures and contexts.

Added value of involving patients in the first step of multidisciplinary guideline development: a qualitative interview study among infertile patients.

PubMed

den Breejen, Elvira M E; Hermens, Rosella P M G; Galama, Wienke H; Willemsen, Wim N P; Kremer, Jan A M; Nelen, Willianne L D M

2016-06-01

Patient involvement in scoping the guideline is emphasized, but published initiatives actively involving patients are generally limited to the writing and reviewing phase. To assess patients' added value to the scoping phase of a multidisciplinary guideline on infertility. Qualitative interview study. We conducted interviews among 12 infertile couples and 17 professionals. We listed and compared the couples' and professionals' key clinical issues (=care aspects that need improvement) to be addressed in the guideline according to four domains: current guidelines, professionals, patients and organization of care. Main key clinical issues suggested by more than three quarters of the infertile couples and/or at least two professionals were identified and compared. Overall, we identified 32 key clinical issues among infertile couples and 23 among professionals. Of the defined main key clinical issues, infertile couples mentioned eight issues that were not mentioned by the professionals. These main key clinical issues mainly concerned patient-centred (e.g. poor information provision and poor alignment of care) aspects of care on the professional and organizational domain. Both groups mentioned two main key clinical issues collectively that were interpreted differently: the lack of emotional support and respect for patients' values. Including patients from the first phase of the guideline development process leads to valuable additional main key clinical issues for the next step of a multidisciplinary guideline development process and broadens the scope of the guideline, particularly regarding patient-centredness and organizational issues from a patients' perspective. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Preventing alcohol misuse in young people aged 9-11 years through promoting family communication: an exploratory evaluation of the Kids, Adults Together (KAT) Programme

PubMed Central

2011-01-01

Background Alcohol misuse by young people is an important public health issue, and has led to the development of a range of prevention interventions. Evidence concerning the most effective approaches to intervention design and implementation is limited. Parental involvement in school-based interventions is important, but many programmes fail to recruit large numbers of parents. This paper reports findings from an exploratory evaluation of a new alcohol misuse prevention programme - Kids, Adults Together (KAT), which comprised a classroom component, engagement with parents through a fun evening for families with children aged 9-11 years, and a DVD. The evaluation aimed to establish the programme's theoretical basis, explore implementation processes and acceptability, and identify plausible precursors of the intended long-term outcomes. Methods Documentary analysis and interviews with key personnel examined the programme's development. Classroom preparation and KAT family events in two schools were observed. Focus groups with children, and interviews with parents who attended KAT family events were held immediately after programme delivery, and again after three months. Interviews with head teachers and with teachers who delivered the classroom preparation were conducted. Follow-up interviews with programme personnel were undertaken. Questionnaires were sent to parents of all children involved in classroom preparation. Results KAT achieved high levels of acceptability and involvement among both children and parents. Main perceived impacts of the programme were increased pro-social communication within families (including discussions about harmful parental alcohol consumption), heightened knowledge and awareness of the effects of alcohol consumption and key legal and health issues, and changes in parental drinking behaviours. Conclusions KAT demonstrated promise as a prevention intervention, primarily through its impact on knowledge and communication processes within families, and its ability to engage with large numbers of parents. A key programme mechanism was the classroom preparation's facilitation of parental involvement in the family fun evening. The programme also incorporated features identified in the literature as likely to increase effectiveness, including a focus on harm reduction, interactive delivery, and targeting primary-school-age children. Further research is needed to test and develop programme theory through implementation in different school contexts, and to examine potential longer-term impacts, and the feasibility of large scale delivery. PMID:22004185

Evaluation of existing district health management information systems a case study of the district health systems in Kenya.

PubMed

Odhiambo-Otieno, George W

2005-09-01

This paper discusses some of the issues and challenges of implementing appropriate and coordinated District Health Management Information System (DHMIS) in environments dependent on external support especially when insufficient attention has been given to the sustainability of systems. It also discusses fundamental issues which affect the usability of DHMIS to support District Health System (DHS), including meeting user needs and user education in the use of information for management; and the need for integration of data from all health-providing and related organizations in the district. This descriptive cross-sectional study was carried out in three DHSs in Kenya. Data was collected through use of questionnaires, focus group discussions and review of relevant literature, reports and operational manuals of the studied DHMISs. Key personnel at the DHS level were not involved in the development and implementation of the established systems. The DHMISs were fragmented to the extent that their information products were bypassing the very levels they were created to serve. None of the DHMISs was computerized. Key resources for DHMIS operation were inadequate. The adequacy of personnel was 47%, working space 40%, storage space 34%, stationery 20%, 73% of DHMIS staff were not trained, management support was 13%. Information produced was 30% accurate, 19% complete, 26% timely, 72% relevant; the level of confidentiality and use of information at the point of collection stood at 32% and 22% respectively and information security at 48%. Basic DHMIS equipment for information processing was not available. This inhibited effective and efficient provision of information services. An effective DHMIS is essential for DHS planning, implementation, monitoring and evaluation activities. Without accurate, timely, relevant and complete information the existing information systems are not capable of facilitating the DHS managers in their day-today operational management. The existing DHMISs were found not supportive of the DHS managers' strategic and operational management functions. Consequently DHMISs were found to be plagued by numerous designs, operational, resources and managerial problems. There is an urgent need to explore the possibilities of computerizing the existing manual systems to take advantage of the potential uses of microcomputers for DHMIS operations within the DHS. Information system designers must also address issues of cooperative partnership in information activities, systems compatibility and sustainability.

Developing a rapid-response program for health system decision-makers in Canada: findings from an issue brief and stakeholder dialogue.

PubMed

Wilson, Michael G; Lavis, John N; Gauvin, Francois-Pierre

2015-03-11

There is currently no mechanism in place outside of government to provide rapid syntheses of the best available research evidence about problems, options and/or implementation considerations related to a specific health system challenge that Canadian health system decision-makers need to address in a timely manner. A 'rapid-response' program could address this gap by providing access to optimally packaged, relevant and high-quality research evidence over short periods of time (i.e. days or weeks). We prepared an issue brief that describes the best available research evidence related to the problem, three broad features of a program that addresses the problem and implementation considerations. We identified systematic reviews by searching for organization-targeted implementation strategies in Health Systems Evidence ( www.healthsystemsevidence.org ) and drew on an existing analytical framework for how knowledge-brokering organizations can organize themselves to operationalize the program features. The issue brief was then used to inform a half-day stakeholder dialogue about whether and how to develop a rapid-response program for health system decision-makers in Canada. We thematically synthesized the deliberations. We found very few relevant systematic reviews but used frameworks and examples from existing programs to 1) outline key considerations for organizing a rapid-response program,, 2) determine what can be done in timelines ranging from 3 to 10 and 30 business days, and 3) define success and measure it. The 11 dialogue participants from across Canada largely agreed with the content presented in the brief, but noted two key challenges to consider: securing stable, long-term funding and finding a way to effectively and equitably manage the expected demand. Recommendations and suggestions for next steps from dialogue participants included taking an 'organic' approach to developing a pan-Canadian network and including jurisdictional scans as a type of product to deliver through the program (rather than only syntheses of research evidence). Dialogue participants clearly signalled that there is an appetite for a rapid-response program for health system decision-makers in Canada. To 'organically' build such a program, we are currently engaging in efforts to build partnerships and secure funding to support the creation of a pan-Canadian network for conducting rapid syntheses for health system decision-makers in Canada.

A view of software management issues

NASA Technical Reports Server (NTRS)

Manley, J. H.

1985-01-01

The Software Development Environment (SDE) Panel addressed key programmatic, scope, and structural issues raised by its members and the general audience regarding the proposed software development environment for the Space Station program. The general team approach taken by this group led to a consensus on 18 recommendations to NASA mangament regarding the acquisition and definition of the SDE. This approach was keyed by the initial issues presentation given to the general audience. Additional issues (for a total of 23) were developed by the panelists in their first closed session from which key areas were selected and discussed in open session. These discussions led to key recommendations which are summarized and described.

African leaders' views on critical human resource issues for the implementation of family medicine in Africa.

PubMed

Moosa, Shabir; Downing, Raymond; Essuman, Akye; Pentz, Stephen; Reid, Stephen; Mash, Robert

2014-01-17

The World Health Organisation has advocated for comprehensive primary care teams, which include family physicians. However, despite (or because of) severe doctor shortages in Africa, there is insufficient clarity on the role of the family physician in the primary health care team. Instead there is a trend towards task shifting without thought for teamwork, which runs the risk of dangerous oversimplification. It is not clear how African leaders understand the challenges of implementing family medicine, especially in human resource terms. This study, therefore, sought to explore the views of academic and government leaders on critical human resource issues for implementation of family medicine in Africa. In this qualitative study, key academic and government leaders were purposively selected from sixteen African countries. In-depth interviews were conducted using an interview guide. All interviews were audio-recorded, transcribed and thematically analysed. There were 27 interviews conducted with 16 government and 11 academic leaders in nine Sub-Saharan African countries: Botswana, Democratic Republic of Congo, Ghana, Kenya, Malawi, Nigeria, Rwanda, South Africa and Uganda. Respondents spoke about: educating doctors in family medicine suited to Africa, including procedural skills and holistic care, to address the difficulty of recruiting and retaining doctors in rural and underserved areas; planning for primary health care teams, including family physicians; new supervisory models in primary health care; and general human resource management issues. Important milestones in African health care fail to specifically address the human resource issues of integrated primary health care teamwork that includes family physicians. Leaders interviewed in this study, however, proposed organising the district health system with a strong embrace of family medicine in Africa, especially with regard to providing clinical leadership in team-based primary health care. Whilst these leaders focussed positively on entry and workforce issues, in terms of the 2006 World Health Report on human resources for health, they did not substantially address retention of family physicians. Family physicians need to respond to the challenge by respondents to articulate human resource policies appropriate to Africa, including the organisational development of the primary health care team with more sophisticated skills and teamwork.

In and across bureaucracy: structural and administrative issues for the tobacco endgame.

PubMed

Isett, Kimberley R

2013-05-01

This article assesses the structural choices for the proposed tobacco endgame strategies. I focus on the issues associated with particular structural choices for the location of the implementation. Specifically, I discuss issues related to implementation of the endgame within a specific single agency, and issues related to a more widespread, broad implementation involving several agencies. Where appropriate, I provide examples of how the dynamics discussed would apply to particular endgame strategies. Issues related to design, administration, authority and finances are raised.

In and across bureaucracy: structural and administrative issues for the tobacco endgame

PubMed Central

Isett, Kimberley R

2013-01-01

This article assesses the structural choices for the proposed tobacco endgame strategies. I focus on the issues associated with particular structural choices for the location of the implementation. Specifically, I discuss issues related to implementation of the endgame within a specific single agency, and issues related to a more widespread, broad implementation involving several agencies. Where appropriate, I provide examples of how the dynamics discussed would apply to particular endgame strategies. Issues related to design, administration, authority and finances are raised. PMID:23591514

Providers' perceptions of the implementation of a performance measurement system for substance abuse treatment: A process evaluation of the Service Quality Measures initiative.

PubMed

Myers, Bronwyn; Williams, Petal Petersen; Johnson, Kim; Govender, Rajen; Manderscheid, Ron; Koch, J Randy

2016-02-22

In South Africa, concerns exist about the quality of substance abuse treatment. We developed a performance measurement system, known as the Service Quality Measures (SQM) initiative, to monitor the quality of treatment and assess efforts to improve quality of care. In 2014, the SQM system was implemented at six treatment sites to evaluate how implementation protocols could be improved in preparation for wider roll-out. To describe providers' perceptions of the feasibility and acceptability of implementing the SQM system, including barriers to and facilitators of implementation. We conducted 15 in-depth interviews (IDIs) with treatment providers from six treatment sites (two sites in KwaZulu-Natal and four in the Western Cape). Providers were asked about their experiences in implementing the system, the perceived feasibility of the system, and barriers to implementation. All IDIs were audio-recorded and transcribed verbatim. A framework approach was used to analyse the data. Providers reported that the SQM system was feasible to implement and acceptable to patients and providers. Issues identified through the IDIs included a perceived lack of clarity about sequencing of key elements in the implementation of the SQM system, questions on integration of the system into clinical care pathways, difficulties in tracking patients through the system, and concerns about maximising patient participation in the process. Findings suggest that the SQM system is feasible to implement and acceptable to providers, but that some refinements to the implementation protocols are needed to maximise patient participation and the likelihood of sustained implementation.

Education Studies: Issues & Critical Perspectives

ERIC Educational Resources Information Center

Kassem, Derek; Mufti, Emmanuel; Robinson, John

2006-01-01

This major text for Education Studies students provides a critical account of key issues in education today. The text features: (1) A critical analysis of key issues in Education Studies to encourage students' thinking about education in the broadest terms; (2) Themed sections with introductions to link the issues discussed in each chapter; (3)…

Implementation issues for consumer-directed programs: comparing views of policy experts, consumers, and representatives.

PubMed

Simon-Rusinowitz, Lori; Marks, Lori N; Loughlin, Dawn M; Desmond, Sharon M; Mahoney, Kevin J; Zacharias, B Lee; Squillace, Marie R; Allison, Ann Marie

2002-01-01

An increasing number of aging community providers and consumers support consumer-direction (CD) in long-term care services. In regard to devolution, consumer-direction goes beyond the usual approach of shifting responsibilities from the federal government to state governments to bring programs "closer to the people." Consumer-direction goes even further by placing resources directly in the hands of consumers. Yet, many questions remain unanswered regarding how to implement CD personal assistance services in general, and especially for older persons. This article describes the importance of examining views from multiple key stakeholders involved in implementing CD programs. We report on three background studies that have informed the Cash and Counseling Demonstration and Evaluation (CCDE) design and implementation-policy expert interviews as well as surveys and focus groups with consumers and representatives. As a fourth data source, we drew upon experiences in designing the CCDE and initial results from the first year of implementation. Each of the three studies on its own provided essential information for planning the CCDE. However, when we examined the studies together, and added CCDE design and implementation experiences, views expressed by the different stakeholders formed a type of multi-perspective "dialogue" that expanded our knowledge about implementing CD services. We hope this increased knowledge will help expand the availability of such services for consumers of any age who want to direct their own care.

HIV epidemic among key populations in west Africa.

PubMed

Djomand, Gaston; Quaye, Silas; Sullivan, Patrick S

2014-09-01

Globally, HIV infection remains a significant issue for key populations such as men who have sex with men (MSM) and female sex workers. A review of recent articles was conducted for west African countries to assess the burden of disease among female sex workers and MSM, access to services and identify barriers to implementation of services for key populations. In west Africa, key populations engage in high-risk practices for the acquisition of HIV and other sexually transmitted infections. Available HIV prevalence data fluctuate across and within countries for both MSM and female sex workers and may be five to ten times as high as that of the general population. HIV prevalence varied from 15.9% in The Gambia to 68% in Benin among female sex workers, whereas it ranged from 9.8% in The Gambia to 34.9% in Nigeria for MSM. Yet, important data gaps exist, including key populations size estimations in several countries as well as HIV prevalence, incidence and other biomarkers of HIV risk. Because of sociocultural, legal, political and economic challenges, exacerbated by a poor health system infrastructure, the HIV response is not strategically directed toward programs for key populations in countries with concentrated epidemics. Noteworthy is the low coverage of prevention care and treatment interventions offered to key populations. Sufficient planning and political will with legal and structural frameworks that reconcile public health and human rights are needed to prioritize HIV prevention, care and treatment programming for key populations programs in west Africa.

Implementation of continuous-variable quantum key distribution with composable and one-sided-device-independent security against coherent attacks.

PubMed

Gehring, Tobias; Händchen, Vitus; Duhme, Jörg; Furrer, Fabian; Franz, Torsten; Pacher, Christoph; Werner, Reinhard F; Schnabel, Roman

2015-10-30

Secret communication over public channels is one of the central pillars of a modern information society. Using quantum key distribution this is achieved without relying on the hardness of mathematical problems, which might be compromised by improved algorithms or by future quantum computers. State-of-the-art quantum key distribution requires composable security against coherent attacks for a finite number of distributed quantum states as well as robustness against implementation side channels. Here we present an implementation of continuous-variable quantum key distribution satisfying these requirements. Our implementation is based on the distribution of continuous-variable Einstein-Podolsky-Rosen entangled light. It is one-sided device independent, which means the security of the generated key is independent of any memoryfree attacks on the remote detector. Since continuous-variable encoding is compatible with conventional optical communication technology, our work is a step towards practical implementations of quantum key distribution with state-of-the-art security based solely on telecom components.

Implementation of continuous-variable quantum key distribution with composable and one-sided-device-independent security against coherent attacks

PubMed Central

Gehring, Tobias; Händchen, Vitus; Duhme, Jörg; Furrer, Fabian; Franz, Torsten; Pacher, Christoph; Werner, Reinhard F.; Schnabel, Roman

2015-01-01

Secret communication over public channels is one of the central pillars of a modern information society. Using quantum key distribution this is achieved without relying on the hardness of mathematical problems, which might be compromised by improved algorithms or by future quantum computers. State-of-the-art quantum key distribution requires composable security against coherent attacks for a finite number of distributed quantum states as well as robustness against implementation side channels. Here we present an implementation of continuous-variable quantum key distribution satisfying these requirements. Our implementation is based on the distribution of continuous-variable Einstein–Podolsky–Rosen entangled light. It is one-sided device independent, which means the security of the generated key is independent of any memoryfree attacks on the remote detector. Since continuous-variable encoding is compatible with conventional optical communication technology, our work is a step towards practical implementations of quantum key distribution with state-of-the-art security based solely on telecom components. PMID:26514280

Multi-user quantum key distribution with entangled photons from an AlGaAs chip

NASA Astrophysics Data System (ADS)

Autebert, C.; Trapateau, J.; Orieux, A.; Lemaître, A.; Gomez-Carbonell, C.; Diamanti, E.; Zaquine, I.; Ducci, S.

2016-12-01

In view of real-world applications of quantum information technologies, the combination of miniature quantum resources with existing fibre networks is a crucial issue. Among such resources, on-chip entangled photon sources play a central role for applications spanning quantum communications, computing and metrology. Here, we use a semiconductor source of entangled photons operating at room temperature in conjunction with standard telecom components to demonstrate multi-user quantum key distribution, a core protocol for securing communications in quantum networks. The source consists of an AlGaAs chip-emitting polarisation entangled photon pairs over a large bandwidth in the main telecom band around 1550 nm without the use of any off-chip compensation or interferometric scheme; the photon pairs are directly launched into a dense wavelength division multiplexer (DWDM) and secret keys are distributed between several pairs of users communicating through different channels. We achieve a visibility measured after the DWDM of 87% and show long-distance key distribution using a 50-km standard telecom fibre link between two network users. These results illustrate a promising route to practical, resource-efficient implementations adapted to quantum network infrastructures.

Staff awareness of food and fluid care needs for older people with dementia in residential care: A qualitative study.

PubMed

Lea, Emma J; Goldberg, Lynette R; Price, Andrea D; Tierney, Laura T; McInerney, Fran

2017-12-01

To examine awareness of aged care home staff regarding daily food and fluid care needs of older people with dementia. Older people in residential care frequently are malnourished, and many have dementia. Staff knowledge of the food and fluid needs of people with dementia is limited. Qualitative research on this topic is scarce but can provide insight into how nutrition and hydration care may be improved. Qualitative, interview-based study. Eleven staff in a range of positions at one care home were interviewed regarding their perceptions of current and potential food/fluid care practices. Transcripts were coded and analysed thematically. Key food and fluid issues reported by these staff members were weight loss and malnutrition, chewing and swallowing difficulties (dysphagia), and inadequate hydration. Staff identified a number of current care practices that they felt to be effective in facilitating older people's food and fluid intake, including responsiveness to their needs. Staff suggestions to facilitate food and fluid intake centred on improved composition and timing of meals, enhanced physical and social eating environment, and increased hydration opportunities. Staff commented on factors that may prevent changes to care practices, particularly the part-time workforce, and proposed changes to overcome such barriers. Staff were aware of key food and fluid issues experienced by the older people in their care and of a range of beneficial care practices, but lacked knowledge of many promising care practices and/or how to implement such practices. Staff need to be supported to build on their existing knowledge around effective food and fluid care practices. The numerous ideas staff expressed for changing care practices can be leveraged by facilitating staff networking to work and learn together to implement evidence-based change. © 2017 John Wiley & Sons Ltd.

Achieving development goals for HIV, tuberculosis and malaria in sub-Saharan Africa through integrated antenatal care: barriers and challenges.

PubMed

Fowkes, Freya J I; Draper, Bridget L; Hellard, Margaret; Stoové, Mark

2016-12-12

The global health community is currently transitioning from the Millennium Development Goals (MDGs) to the Sustainable Development Goals (SDGs). Unfortunately, progress towards maternal, newborn and infant health MDGs has lagged significantly behind other key health goals, demanding a renewed global effort in this key health area. The World Health Organization and other institutions heralded integrated antenatal care (ANC) as the best way to address the inter-related health issues of HIV, tuberculosis (TB) and malaria in the high risk groups of pregnant women and infants; integrated ANC services also offer a mechanism to address slow progress towards improved maternal health. There is remarkably limited evidence on best practice approaches of program implementation, acceptability and effectiveness for integrated ANC models targeting multiple diseases. Here, we discuss current integrated ANC global guidelines and the limited literature describing integrated ANC implementation and evidence for their role in addressing HIV, malaria and TB during pregnancy in sub-Saharan Africa. We highlight the paucity of data on the effectiveness of integrated ANC models and identify significant structural barriers in the health system (funding, infrastructure, distribution, human resources), the adoption system (limited buy-in from implementers, leadership, governance) and, in the broader context, patient-centred barriers (fear, stigma, personal burdens) and barriers in funding structures. We highlight recommendations for action and discuss avenues for the global health community to develop systems to integrate multiple disease programs into ANC models of care that better address these three priority infectious diseases. With the current transition to the SDGs and concerns regarding the failure to meet maternal health MDGs, the global health community, researchers, implementers and funding bodies must work together to ensure the establishment of quality operational and implementation research to inform integrated ANC models. It is imperative that the global health community engages in a timely discussion about such implementation innovations and instigates appropriate actions to ensure advances in maternal health are sufficient to meet applicable SDGs.

Strategies of Educational Decentralization: Key Questions and Core Issues.

ERIC Educational Resources Information Center

Hanson, E. Mark

1998-01-01

Explains key issues and forces that shape organization and management strategies of educational decentralization, using examples from Colombia, Venezuela, Argentina, Nicaragua, and Spain. Core decentralization issues include national and regional goals, planning, political stress, resource distribution, infrastructure development, and job…

Neutrality and Robustness in Evo-Devo: Emergence of Lateral Inhibition

PubMed Central

Munteanu, Andreea; Solé, Ricard V.

2008-01-01

Embryonic development is defined by the hierarchical dynamical process that translates genetic information (genotype) into a spatial gene expression pattern (phenotype) providing the positional information for the correct unfolding of the organism. The nature and evolutionary implications of genotype–phenotype mapping still remain key topics in evolutionary developmental biology (evo-devo). We have explored here issues of neutrality, robustness, and diversity in evo-devo by means of a simple model of gene regulatory networks. The small size of the system allowed an exhaustive analysis of the entire fitness landscape and the extent of its neutrality. This analysis shows that evolution leads to a class of robust genetic networks with an expression pattern characteristic of lateral inhibition. This class is a repertoire of distinct implementations of this key developmental process, the diversity of which provides valuable clues about its underlying causal principles. PMID:19023404

The differing perspectives of workers and occupational medicine physicians on the ethical, legal and social issues of genetic testing in the workplace.

PubMed

Brandt-Rauf, Sherry I; Brandt-Rauf, Elka; Gershon, Robyn; Brandt-Rauf, Paul W

2011-01-01

Genetic testing in the workplace holds the promise of improving worker health but also raises ethical, legal, and social issues. In considering such testing, it is critical to understand the perspectives of workers, who are most directly affected by it, and occupational health professionals, who are often directly involved in its implementation. Therefore, a series of focus groups of unionized workers (n=25) and occupational medicine physicians (n=23) was conducted. The results demonstrated strikingly different perspectives of workers and physicians in several key areas, including the goals and appropriateness of genetic testing, and methods to minimize its risks. In general, workers were guided by a profound mistrust of the employer, physician, and government, while physicians were guided primarily by scientific and medical concerns, and, in many cases, by the business concerns distrusted by the workers.

Advanced software development workstation. Comparison of two object-oriented development methodologies

NASA Technical Reports Server (NTRS)

Izygon, Michel E.

1992-01-01

This report is an attempt to clarify some of the concerns raised about the OMT method, specifically that OMT is weaker than the Booch method in a few key areas. This interim report specifically addresses the following issues: (1) is OMT object-oriented or only data-driven?; (2) can OMT be used as a front-end to implementation in C++?; (3) the inheritance concept in OMT is in contradiction with the 'pure and real' inheritance concept found in object-oriented (OO) design; (4) low support for software life-cycle issues, for project and risk management; (5) uselessness of functional modeling for the ROSE project; and (6) problems with event-driven and simulation systems. The conclusion of this report is that both Booch's method and Rumbaugh's method are good OO methods, each with strengths and weaknesses in different areas of the development process.

Direct-to-Consumer Marketing: A Complementary Approach to Traditional Dissemination and implementation Efforts for Mental Health and Substance Abuse Interventions

PubMed Central

Becker, Sara J.

2014-01-01

The overall chasm between those who need treatment for mental health and substance abuse (M/SU) and those who receive effective treatment consists of two, interrelated gaps: the research-to-practice gap and the treatment gap. Prior efforts to disseminate evidence-based practice (EBP) for M/SU have predominantly targeted the research-to-practice gap, by focusing efforts toward treatment providers. This article introduces direct-to-consumer (DTC) marketing that targets patients and caregivers as a complementary approach to existing dissemination efforts. Specific issues discussed include: rationale for DTC marketing based on the concept of push versus pull marketing; overview of key stakeholders involved in DTC marketing; and description of the Marketing Mix planning framework. The applicability of these issues to the dissemination of EBP for M/SU is discussed. PMID:25937710

Cutting to the chase: what physician executives need to know about HIPAA.

PubMed

Fitzmaurice, J M; Rose, J S

2000-01-01

All health care providers, plans, and clearinghouses will be affected by the federally mandated uniform standards for administrative transactions. This article presents distilled core information about the Health Insurance Portability and Accountability Act (HIPAA) legislation--the standards, penalties for violations, and status of final rules. It also raises several key unsolved issues of which clinicians, executives, and health care providers must be aware so they can prepare and plan for the upcoming changes. HIPAA is intended to improve the efficiency and effectiveness of the health care system, as well as to increase the protection and confidentiality of individually identifiable health information. The costs of making the transition to the legislated standards and processes remain a worrisome factor. Although there are two years before these standards must be implemented, and cost and compliance issues resolved, work has already begun in many health institutions to identify and address them.

Solid Waste Management in Nigeria: Problems and Issues.

PubMed

AGUNWAMBA

1998-11-01

/ This paper is a presentation of the problems of solid waste management in Nigeria and certain important issues that must be addressed in order to achieve success. At the core of the problems of solid waste management are the absence of adequate policies, enabling legislation, and an environmentally stimulated and enlightened public. Government policies on the environment are piecemeal where they exist and are poorly implemented. Public enlightenment programs lacked the needed coverage, intensity, and continuity to correct the apathetic public attitude towards the environment. Up to now the activities of the state environmental agencies have been hampered by poor funding, inadequate facilities and human resources, inappropriate technology, and an inequitable taxation system. Successful solid waste management in Nigeria will require a holistic program that will integrate all the technical, economic, social, cultural, and psychological factors that are often ignored in solid waste programs.KEY WORDS: Solid waste; Management; Problems; Solutions; Nigeria

Mathematics lecturing in the digital age

NASA Astrophysics Data System (ADS)

Trenholm, Sven; Alcock, Lara; Robinson, Carol L.

2012-09-01

In this article, we consider the transformation of tertiary mathematics lecture practice. We undertake a focused examination of the related research with two goals in mind. First, we document this research, reviewing the findings of key studies and noting that reflective pieces on individual practice as well as surveys are more prevalent than empirical studies. Second, we investigate issues related to the transformation of lecture practice by the emergence of e-lectures. We discuss the latter in terms of claims about the efficiencies offered by new technologies and contrast these with possible disadvantages in terms of student engagement in a learning community. Overall findings indicate that while survey results appear to trumpet the value of e-lecture provision, empirical study results appear to call that value into question. Two explanatory theoretical frameworks are presented. Issues concerning the instructional context (e.g. the nature of mathematical thinking), inherent complexities and recommendations for implementation are discussed.

Financial barriers to implementing combination vaccines: perspectives from pediatricians and policy makers.

PubMed

Gidengil, Courtney A; Rusinak, Donna; Allred, Norma J; Luff, Donna; Lee, Grace M; Lieu, Tracy A

2009-06-01

To describe the factors that affect the use of new combination vaccines, the authors conducted qualitative interviews with pediatricians (n = 7), state immunization program managers (n = 7), and health insurance plan representatives (n = 6 plans). Respondents from each group identified reduction in pain and potentially increased immunization coverage as key benefits of new combination vaccines. For several pediatricians, low reimbursement for cost of vaccine doses and potential loss of fees for vaccine administration were barriers to using combination vaccines. For most state immunization programs, the higher cost of combination vaccines relative to separate vaccines was an important consideration but not a barrier to adoption. Most insurers were not aware of the financial issues for providers, but some had changed or were willing to change reimbursement to support the use of new combination vaccines. Financial issues for pediatric practices that purchase and provide vaccines for children may be an important barrier to offering combination vaccines.

Integrating biomedical and herbal medicine in Ghana - experiences from the Kumasi South Hospital: a qualitative study.

PubMed

Boateng, Millicent Addai; Danso-Appiah, Anthony; Turkson, Bernard Kofi; Tersbøl, Britt Pinkowski

2016-07-07

Over the past decade there has been growing interest in the use of herbal medicine both in developed and developing countries. Given the high proportion of patients using herbal medicine in Ghana, some health facilities have initiated implementation of herbal medicine as a component of their healthcare delivery. However, the extent to which herbal medicine has been integrated in Ghanaian health facilities, how integration is implemented and perceived by different stakeholders has not been documented. The study sought to explore these critical issues at the Kumasi South Hospital (KSH) and outline the challenges and motivations of the integration process. Qualitative phenomenological exploratory study design involving fieldwork observations, focus group discussion, in-depth interviews and key informants' interviews was employed to collect data. Policies and protocols outlining the definition, process and goals of integration were lacking, with respondents sharing different views about the purpose and value of integration of herbal medicine within public health facilities. Key informants were supportive of the initiative. Whilst biomedical health workers perceived the system to be parallel than integrated, health personnel providing herbal medicine perceived the system as integrated. Most patients were not aware of the herbal clinic in the hospital but those who had utilized services of the herbal clinic viewed the clinic as part of the hospital. The lack of a regulatory policy and protocol for the integration seemed to have led to the different perception of the integration. Policy and protocol to guide the integration are key recommendations.

Hydrothermal impacts on trace element and isotope ocean biogeochemistry.

PubMed

German, C R; Casciotti, K A; Dutay, J-C; Heimbürger, L E; Jenkins, W J; Measures, C I; Mills, R A; Obata, H; Schlitzer, R; Tagliabue, A; Turner, D R; Whitby, H

2016-11-28

Hydrothermal activity occurs in all ocean basins, releasing high concentrations of key trace elements and isotopes (TEIs) into the oceans. Importantly, the calculated rate of entrainment of the entire ocean volume through turbulently mixing buoyant hydrothermal plumes is so vigorous as to be comparable to that of deep-ocean thermohaline circulation. Consequently, biogeochemical processes active within deep-ocean hydrothermal plumes have long been known to have the potential to impact global-scale biogeochemical cycles. More recently, new results from GEOTRACES have revealed that plumes rich in dissolved Fe, an important micronutrient that is limiting to productivity in some areas, are widespread above mid-ocean ridges and extend out into the deep-ocean interior. While Fe is only one element among the full suite of TEIs of interest to GEOTRACES, these preliminary results are important because they illustrate how inputs from seafloor venting might impact the global biogeochemical budgets of many other TEIs. To determine the global impact of seafloor venting, however, requires two key questions to be addressed: (i) What processes are active close to vent sites that regulate the initial high-temperature hydrothermal fluxes for the full suite of TEIs that are dispersed through non-buoyant hydrothermal plumes? (ii) How do those processes vary, globally, in response to changing geologic settings at the seafloor and/or the geochemistry of the overlying ocean water? In this paper, we review key findings from recent work in this realm, highlight a series of key hypotheses arising from that research and propose a series of new GEOTRACES modelling, section and process studies that could be implemented, nationally and internationally, to address these issues.This article is part of the themed issue 'Biological and climatic impacts of ocean trace element chemistry'. © 2015 The Authors.

Hydrothermal impacts on trace element and isotope ocean biogeochemistry

PubMed Central

Dutay, J.-C.; Heimbürger, L. E.; Jenkins, W. J.; Measures, C. I.; Mills, R. A.; Obata, H.; Turner, D. R.; Whitby, H.

2016-01-01

Hydrothermal activity occurs in all ocean basins, releasing high concentrations of key trace elements and isotopes (TEIs) into the oceans. Importantly, the calculated rate of entrainment of the entire ocean volume through turbulently mixing buoyant hydrothermal plumes is so vigorous as to be comparable to that of deep-ocean thermohaline circulation. Consequently, biogeochemical processes active within deep-ocean hydrothermal plumes have long been known to have the potential to impact global-scale biogeochemical cycles. More recently, new results from GEOTRACES have revealed that plumes rich in dissolved Fe, an important micronutrient that is limiting to productivity in some areas, are widespread above mid-ocean ridges and extend out into the deep-ocean interior. While Fe is only one element among the full suite of TEIs of interest to GEOTRACES, these preliminary results are important because they illustrate how inputs from seafloor venting might impact the global biogeochemical budgets of many other TEIs. To determine the global impact of seafloor venting, however, requires two key questions to be addressed: (i) What processes are active close to vent sites that regulate the initial high-temperature hydrothermal fluxes for the full suite of TEIs that are dispersed through non-buoyant hydrothermal plumes? (ii) How do those processes vary, globally, in response to changing geologic settings at the seafloor and/or the geochemistry of the overlying ocean water? In this paper, we review key findings from recent work in this realm, highlight a series of key hypotheses arising from that research and propose a series of new GEOTRACES modelling, section and process studies that could be implemented, nationally and internationally, to address these issues. This article is part of the themed issue ‘Biological and climatic impacts of ocean trace element chemistry’. PMID:29035265

Digital tanlock loop architecture with no delay

NASA Astrophysics Data System (ADS)

Al-Kharji AL-Ali, Omar; Anani, Nader; Al-Araji, Saleh; Al-Qutayri, Mahmoud; Ponnapalli, Prasad

2012-02-01

This article proposes a new architecture for a digital tanlock loop which eliminates the time-delay block. The ? (rad) phase shift relationship between the two channels, which is generated by the delay block in the conventional time-delay digital tanlock loop (TDTL), is preserved using two quadrature sampling signals for the loop channels. The proposed system outperformed the original TDTL architecture, when both systems were tested with frequency shift keying input signal. The new system demonstrated better linearity and acquisition speed as well as improved noise performance compared with the original TDTL architecture. Furthermore, the removal of the time-delay block enables all processing to be digitally performed, which reduces the implementation complexity. Both the original TDTL and the new architecture without the delay block were modelled and simulated using MATLAB/Simulink. Implementation issues, including complexity and relation to simulation of both architectures, are also addressed.

Occupational safety and health in Europe: lessons from the past, challenges and opportunities for the future.

PubMed

Gagliardi, Diana; Marinaccio, Alessandro; Valenti, Antonio; Iavicoli, Sergio

2012-01-01

Europe has always played a key role in the field of Occupational Health and Safety (OHS) and can be considered the cradle of Occupational Health. The European policy framework has been set since the establishment of the European Union, but its strength lies in the enactment of the Framework Directive on Occupational Health and Safety (89/391/EC), which has had a strong positive impact on the assessment and management of occupational risk factors and has promoted the quick diffusion of common standards across Europe. Yet, some implementation issues still remain to be addressed, due to changes in the world of work, fragmentation, economic crisis and, more generally, to the impact of globalization. Therefore, actions need to be reviewed with respect to research plans and policy implementation so as to support the OHS social dimension fostering a broader concept of wellbeing at work.

Setting Housing Standards to Improve Global Health

PubMed Central

Howden-Chapman, Philippa; Roebbel, Nathalie

2017-01-01

Developing World Health Organization international guidelines is a highly formal process. Yet the resulting guidelines, which Member States are encouraged, but not required to adopt, are a powerful way of developing rigorous policy and fostering implementation. Using the example of the housing and health guidelines, which are currently being finalised, this paper outlines the process for developing WHO guidelines. This includes: forming a Guidelines Review Group that represents all regions of the world, and ensures gender balance and technical expertise; identifying key health outcomes of interest; commissioning systematic reviews of the evidence; assessing the evidence; and formulating recommendations. The strength of each recommendation is assessed based on the quality of the evidence, along with consideration of issues such as equity, acceptability, and feasibility of the implementation of the recommendation. The proposed housing guidelines will address: cold and hot indoor temperatures, home injuries, household crowding, accessibility and access to active travel infrastructure. PMID:29232827

Achieving Integrated Care for Older People: Shuffling the Deckchairs or Making the System Watertight For the Future?

PubMed Central

Harvey, Gill; Dollard, Joanne; Marshall, Amy; Mittinty, Manasi Murthy

2018-01-01

Integrated care has been recognised as a key initiative to resolve the issues surrounding care for older people living with multi-morbidity. Multiple strategies and policies have been implemented to increase coordination of care globally however, evidence of effectiveness remains mixed. The reasons for this are complex and multifactorial, yet many strategies deal with parts of the problem rather than taking a whole systems view with the older person clearly at the centre. This approach of fixing parts of the system may be akin to shuffling the deckchairs on the Titanic, rather than dealing with the fundamental reasons why the ship is sinking. Attempts to make the ship more watertight need to be firmly centred on the older person, pay close attention to implementation and embrace approaches that promote collaborative working between all the stakeholders involved. PMID:29626395

Reflections on the Implementation of Low-Dose Computed Tomography Screening in Individuals at High Risk of Lung Cancer in Spain.

PubMed

Garrido, Pilar; Sánchez, Marcelo; Belda Sanchis, José; Moreno Mata, Nicolás; Artal, Ángel; Gayete, Ángel; Matilla González, José María; Galbis Caravajal, José Marcelo; Isla, Dolores; Paz-Ares, Luis; Seijo, Luis M

2017-10-01

Lung cancer (LC) is a major public health issue. Despite recent advances in treatment, primary prevention and early diagnosis are key to reducing the incidence and mortality of this disease. A recent clinical trial demonstrated the efficacy of selective screening by low-dose computed tomography (LDCT) in reducing the risk of both lung cancer mortality and all-cause mortality in high-risk individuals. This article contains the reflections of an expert group on the use of LDCT for early diagnosis of LC in high-risk individuals, and how to evaluate its implementation in Spain. The expert group was set up by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), the Spanish Society of Thoracic Surgery (SECT), the Spanish Society of Radiology (SERAM) and the Spanish Society of Medical Oncology (SEOM). Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

Low-level rf control of Spallation Neutron Source: System and characterization

NASA Astrophysics Data System (ADS)

Ma, Hengjie; Champion, Mark; Crofford, Mark; Kasemir, Kay-Uwe; Piller, Maurice; Doolittle, Lawrence; Ratti, Alex

2006-03-01

The low-level rf control system currently commissioned throughout the Spallation Neutron Source (SNS) LINAC evolved from three design iterations over 1 yr intensive research and development. Its digital hardware implementation is efficient, and has succeeded in achieving a minimum latency of less than 150 ns which is the key for accomplishing an all-digital feedback control for the full bandwidth. The control bandwidth is analyzed in frequency domain and characterized by testing its transient response. The hardware implementation also includes the provision of a time-shared input channel for a superior phase differential measurement between the cavity field and the reference. A companion cosimulation system for the digital hardware was developed to ensure a reliable long-term supportability. A large effort has also been made in the operation software development for the practical issues such as the process automations, cavity filling, beam loading compensation, and the cavity mechanical resonance suppression.

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

Rivard, M.

With the recent introduction of heterogeneity correction algorithms for brachytherapy, the AAPM community is still unclear on how to commission and implement these into clinical practice. The recently-published AAPM TG-186 report discusses important issues for clinical implementation of these algorithms. A charge of the AAPM-ESTRO-ABG Working Group on MBDCA in Brachytherapy (WGMBDCA) is the development of a set of well-defined test case plans, available as references in the software commissioning process to be performed by clinical end-users. In this practical medical physics course, specific examples on how to perform the commissioning process are presented, as well as descriptions of themore » clinical impact from recent literature reporting comparisons of TG-43 and heterogeneity-based dosimetry. Learning Objectives: Identify key clinical applications needing advanced dose calculation in brachytherapy. Review TG-186 and WGMBDCA guidelines, commission process, and dosimetry benchmarks. Evaluate clinical cases using commercially available systems and compare to TG-43 dosimetry.« less

Tobacco industry success in Costa Rica: the importance of FCTC article 5.3.

PubMed

Crosbie, Eric; Sebrié, Ernesto M; Glantz, Stanton A

2012-01-01

To analyze how the tobacco industry influenced tobacco control policymaking in Costa Rica. Review of tobacco industry documents, tobacco control legislation, newspaper articles, and interviewing of key informants. During the mid-to-late 1980s, Health Ministry issued several advanced (for their time) smoking restriction decrees causing British American Tobacco (BAT) and Philip Morris International (PMI) to strengthen their political presence there, resulting in passage of a weak 1995 law, which, as of August 2011, remained in effect. Since 1995 the industry has used Costa Rica as a pilot site for Latin American programs and has dominated policymaking by influencing the Health Ministry, including direct private negotiations with the tobacco industry which violate Article 5.3's implementing guidelines of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). The Costa Rica experience demonstrates the importance of vigorous implementation of FCTC Article 5.3 which insulates public health policymaking from industry interference.

Food Fraud Prevention: Policy, Strategy, and Decision-Making - Implementation Steps for a Government Agency or Industry.

PubMed

Spink, John; Fortin, Neal D; Moyer, Douglas C; Miao, Hong; Wu, Yongning

2016-01-01

This paper addresses the role of governments, industry, academics, and non-governmental organizations in Food Fraud prevention. Before providing strategic concepts for governments and authorities, definitions of Food Fraud are reviewed and discussed. Next there is a review of Food Fraud activities by the Global Food Safety Initiative (GFSI), the Elliott Review in the United Kingdom, the European Commission resolution on Food Fraud, and the US Food Safety Modernization Act including the Preventative Controls Rule. Two key concepts for governments or a company are: (1) formally, and specifically, mention food fraud as a food issue and (2) create an enterprise-wide Food Fraud prevention plan. The research includes a case study of the implementation of the concepts by a state or provincial agency. This analysis provides a foundation to review the role of science and technology in detection, deterrence and then contributing to prevention.

User-Defined Data Distributions in High-Level Programming Languages

NASA Technical Reports Server (NTRS)

Diaconescu, Roxana E.; Zima, Hans P.

2006-01-01

One of the characteristic features of today s high performance computing systems is a physically distributed memory. Efficient management of locality is essential for meeting key performance requirements for these architectures. The standard technique for dealing with this issue has involved the extension of traditional sequential programming languages with explicit message passing, in the context of a processor-centric view of parallel computation. This has resulted in complex and error-prone assembly-style codes in which algorithms and communication are inextricably interwoven. This paper presents a high-level approach to the design and implementation of data distributions. Our work is motivated by the need to improve the current parallel programming methodology by introducing a paradigm supporting the development of efficient and reusable parallel code. This approach is currently being implemented in the context of a new programming language called Chapel, which is designed in the HPCS project Cascade.

Resource allocation and budgetary mechanisms for decentralized health systems: experiences from Balochistan, Pakistan.

PubMed

Green, A; Ali, B; Naeem, A; Ross, D

2000-01-01

This paper identifies key political and technical issues involved in the development of an appropriate resource allocation and budgetary system for the public health sector, using experience gained in the Province of Balochistan, Pakistan. The resource allocation and budgetary system is a critical, yet often neglected, component of any decentralization policy. Current systems are often based on historical incrementalism that is neither efficient nor equitable. This article describes technical work carried out in Balochistan to develop a system of resource allocation and budgeting that is needs-based, in line with policies of decentralization, and implementable within existing technical constraints. However, the development of technical systems, while necessary, is not a sufficient condition for the implementation of a resource allocation and decentralized budgeting system. This is illustrated by analysing the constraints that have been encountered in the development of such a system in Balochistan.

Progress toward implementation of human papillomavirus vaccination--the Americas, 2006-2010.

PubMed

2011-10-14

Cervical cancer is a major cause of morbidity and mortality in the Americas, where an estimated 80,574 new cases and 36,058 deaths were reported in 2008, with 85% of this burden occurring in Latin America and the Caribbean. Two oncogenic human papillomavirus (HPV) types (16 and 18) cause approximately 70% of cervical cancers and a substantial proportion of other HPV-related cancers. HPV vaccination provides an opportunity to greatly reduce cervical cancer burden through primary prevention of HPV infection. This report summarizes the progress toward HPV vaccine introduction in the Americas, focusing on countries that have introduced the vaccine in national or regional immunization programs. As of January 2011, four countries in the Americas had introduced HPV vaccine. Overcoming issues related to financing and delivery of HPV vaccine remains a key public health challenge to more widespread implementation of HPV vaccination in the Americas.

Investigation of Nitride Morphology After Self-Aligned Contact Etch

NASA Technical Reports Server (NTRS)

Hwang, Helen H.; Keil, J.; Helmer, B. A.; Chien, T.; Gopaladasu, P.; Kim, J.; Shon, J.; Biegel, Bryan (Technical Monitor)

2001-01-01

Self-Aligned Contact (SAC) etch has emerged as a key enabling technology for the fabrication of very large-scale memory devices. However, this is also a very challenging technology to implement from an etch viewpoint. The issues that arise range from poor oxide etch selectivity to nitride to problems with post etch nitride surface morphology. Unfortunately, the mechanisms that drive nitride loss and surface behavior remain poorly understood. Using a simple langmuir site balance model, SAC nitride etch simulations have been performed and compared to actual etched results. This approach permits the study of various etch mechanisms that may play a role in determining nitride loss and surface morphology. Particle trajectories and fluxes are computed using Monte-Carlo techniques and initial data obtained from double Langmuir probe measurements. Etched surface advancement is implemented using a shock tracking algorithm. Sticking coefficients and etch yields are adjusted to obtain the best agreement between actual etched results and simulated profiles.

Resource allocation and budgetary mechanisms for decentralized health systems: experiences from Balochistan, Pakistan.

PubMed Central

Green, A.; Ali, B.; Naeem, A.; Ross, D.

2000-01-01

This paper identifies key political and technical issues involved in the development of an appropriate resource allocation and budgetary system for the public health sector, using experience gained in the Province of Balochistan, Pakistan. The resource allocation and budgetary system is a critical, yet often neglected, component of any decentralization policy. Current systems are often based on historical incrementalism that is neither efficient nor equitable. This article describes technical work carried out in Balochistan to develop a system of resource allocation and budgeting that is needs-based, in line with policies of decentralization, and implementable within existing technical constraints. However, the development of technical systems, while necessary, is not a sufficient condition for the implementation of a resource allocation and decentralized budgeting system. This is illustrated by analysing the constraints that have been encountered in the development of such a system in Balochistan. PMID:10994286

Zero-forcing pre-coding for MIMO WiMAX transceivers: Performance analysis and implementation issues

NASA Astrophysics Data System (ADS)

Cattoni, A. F.; Le Moullec, Y.; Sacchi, C.

Next generation wireless communication networks are expected to achieve ever increasing data rates. Multi-User Multiple-Input-Multiple-Output (MU-MIMO) is a key technique to obtain the expected performance, because such a technique combines the high capacity achievable using MIMO channel with the benefits of space division multiple access. In MU-MIMO systems, the base stations transmit signals to two or more users over the same channel, for this reason every user can experience inter-user interference. This paper provides a capacity analysis of an online, interference-based pre-coding algorithm able to mitigate the multi-user interference of the MU-MIMO systems in the context of a realistic WiMAX application scenario. Simulation results show that pre-coding can significantly increase the channel capacity. Furthermore, the paper presents several feasibility considerations for implementation of the analyzed technique in a possible FPGA-based software defined radio.

Corporate ergonomics programme at Ford Motor Company.

PubMed

Joseph, Bradley S

2003-01-01

The use of ergonomic principles in automobile assembly and manufacturing operations has become an important part of a comprehensive health and safety process as well as an integral part of the engineering systems. Ford Motor Company has developed an ergonomics process to manage issues related to injury and illness (e.g., musculoskeletal diseases) and to ensure the appropriate use of human resources on the plant floor. The ergonomics programme uses joint labour and management teams to identify and evaluate jobs and develop and implement solutions. This paper summarises the efforts of the Ford Motor Company in implementing and maintaining the programme. Key strategies are outlined that provide important links to internal organisational units that are critical to fully utilise the ergonomics process. In addition, the paper outlines differences between proactive and reactive efforts and shows the importance of using the information generated by the initiatives for process improvement.

Evaluation of moral case deliberation at the Dutch Health Care Inspectorate: a pilot study.

PubMed

Seekles, Wike; Widdershoven, Guy; Robben, Paul; van Dalfsen, Gonny; Molewijk, Bert

2016-05-21

Moral case deliberation (MCD) as a form of clinical ethics support is usually implemented in health care institutions and educational programs. While there is no previous research on the use of clinical ethics support on the level of health care regulation, employees of regulatory bodies are regularly confronted with moral challenges. This pilot study describes and evaluates the use of MCD at the Dutch Health Care Inspectorate (IGZ). The objective of this pilot study is to investigate: 1) the current way of dealing with moral issues at the IGZ; 2) experience with and evaluation of MCD as clinical ethics support, and 3) future preferences and (perceived) needs regarding clinical ethics support for dealing with moral questions at the IGZ. We performed an explorative pilot study. The research questions were assessed by means of: 1) interviews with MCD participants during four focus groups; and 2) interviews with six key stakeholders at the IGZ. De qualitative data is illustrated by data from questionnaires on MCD outcomes, perspective taking and MCD evaluation. Professionals do not always recognize moral issues. Employees report a need for regular and structured moral support in health care regulation. The MCD meetings are evaluated positively. The most important outcomes of MCD are feeling secure and learning from others. Additional support is needed to successfully implement MCD at the Inspectorate. We conclude that the respondents perceive moral case deliberation as a useful form of clinical ethics support for dealing with moral questions and issues in health care regulation.

Developing standards for reporting implementation studies of complex interventions (StaRI): a systematic review and e-Delphi.

PubMed

Pinnock, Hilary; Epiphaniou, Eleni; Sheikh, Aziz; Griffiths, Chris; Eldridge, Sandra; Craig, Peter; Taylor, Stephanie J C

2015-03-30

Dissemination and implementation of health care interventions are currently hampered by the variable quality of reporting of implementation research. Reporting of other study types has been improved by the introduction of reporting standards (e.g. CONSORT). We are therefore developing guidelines for reporting implementation studies (StaRI). Using established methodology for developing health research reporting guidelines, we systematically reviewed the literature to generate items for a checklist of reporting standards. We then recruited an international, multidisciplinary panel for an e-Delphi consensus-building exercise which comprised an initial open round to revise/suggest a list of potential items for scoring in the subsequent two scoring rounds (scale 1 to 9). Consensus was defined a priori as 80% agreement with the priority scores of 7, 8, or 9. We identified eight papers from the literature review from which we derived 36 potential items. We recruited 23 experts to the e-Delphi panel. Open round comments resulted in revisions, and 47 items went forward to the scoring rounds. Thirty-five items achieved consensus: 19 achieved 100% agreement. Prioritised items addressed the need to: provide an evidence-based justification for implementation; describe the setting, professional/service requirements, eligible population and intervention in detail; measure process and clinical outcomes at population level (using routine data); report impact on health care resources; describe local adaptations to the implementation strategy and describe barriers/facilitators. Over-arching themes from the free-text comments included balancing the need for detailed descriptions of interventions with publishing constraints, addressing the dual aims of reporting on the process of implementation and effectiveness of the intervention and monitoring fidelity to an intervention whilst encouraging adaptation to suit diverse local contexts. We have identified priority items for reporting implementation studies and key issues for further discussion. An international, multidisciplinary workshop, where participants will debate the issues raised, clarify specific items and develop StaRI standards that fit within the suite of EQUATOR reporting guidelines, is planned. The protocol is registered with Equator: http://www.equator-network.org/library/reporting-guidelines-under-development/#17 .

Into the void: Regulating pesticide use in Colorado's commercial cannabis markets.

PubMed

Subritzky, Todd; Pettigrew, Simone; Lenton, Simon

2017-04-01

In 2014, Colorado implemented the world's first seed-to-sale recreational cannabis market under a commercial model. This paper aims to provide a thick descriptive account that gives insight into the issues and complexities of Colorado's pioneering and evolving attempt to regulate the use of pesticides on commercial cannabis plantations. The paper examines multiple data sets including: (i) Colorado State Government documents; (ii) recreational cannabis regulations; (iii) mass and niche media publications (n=175); (iv) face-to-face interviews with key stakeholders, including seniors, regulators and industry executives (n=8); and (v) field notes from relevant conferences and cultivation facility tours in Denver in October, 2016. Two key issues are identified. First, a public safety threat has arisen relating to application of pesticides on cannabis with intensified toxicity in concentrated products of particular concern. Second, as a pioneering jurisdiction, Colorado faces a considerable knowledge gap. To expand collective learning on this issue, for which no regulatory template and little research exists, state regulators tapped industry and other stakeholder expertise while attempting to ensure public safety goals were achieved and regulatory capture by industry was limited. Four years since the recreational cannabis market in Colorado was legalised, the State continues to grapple with the pesticide issue as testing regulations and cultivation standards are yet to be finalised. While more work is needed, Colorado has made significant progress in developing regulations relating to this complex matter. As governments of countries such as Canada and US states, including California, contemplate changes to recreational cannabis laws, Colorado's experience can assist regulators in other jurisdictions considering policy change. Copyright © 2017 Elsevier B.V. All rights reserved.

Research Domain Criteria as Psychiatric Nosology.

PubMed

Akram, Faisal; Giordano, James

2017-10-01

Diagnostic classification systems in psychiatry have continued to rely on clinical phenomenology, despite limitations inherent in that approach. In view of these limitations and recent progress in neuroscience, the National Institute of Mental Health (NIMH) has initiated the Research Domain Criteria (RDoC) project to develop a more neuroscientifically based system of characterizing and classifying psychiatric disorders. The RDoC initiative aims to transform psychiatry into an integrative science of psychopathology in which mental illnesses will be defined as involving putative dysfunctions in neural nodes and networks. However, conceptual, methodological, neuroethical, and social issues inherent in and/or derived from the use of RDoC need to be addressed before any attempt is made to implement their use in clinical psychiatry. This article describes current progress in RDoC; defines key technical, neuroethical, and social issues generated by RDoC adoption and use; and posits key questions that must be addressed and resolved if RDoC are to be employed for psychiatric diagnoses and therapeutics. Specifically, we posit that objectivization of complex mental phenomena may raise ethical questions about autonomy, the value of subjective experience, what constitutes normality, what constitutes a disorder, and what represents a treatment, enablement, and/or enhancement. Ethical issues may also arise from the (mis)use of biomarkers and phenotypes in predicting and treating mental disorders, and what such definitions, predictions, and interventions portend for concepts and views of sickness, criminality, professional competency, and social functioning. Given these issues, we offer that a preparatory neuroethical framework is required to define and guide the ways in which RDoC-oriented research can-and arguably should-be utilized in clinical psychiatry, and perhaps more broadly, in the social sphere.

Developing Educational Resources to Advance Umbilical Cord Blood Banking and Research: A Canadian Perspective.

PubMed

Beak, Carla Pereira; Chargé, Sophie B; Isasi, Rosario; Knoppers, Bartha M

2015-05-01

In 2013 Canadian Blood Services (CBS) launched the National Public Cord Blood Bank (NPCBB), a program to collect, process, test, and store cord blood units donated for use in transplantation. A key component of the creation of the NPCBB is the establishment of a program that enables cord blood not suitable for banking or transplantation to be used for biomedical research purposes. Along with the development of processes and policies to manage the NPCBB and the cord blood research program, CBS-in collaboration with researchers from the Stem Cell Network-have also developed educational tools to provide relevant information for target audiences to aid implementation and operation. We describe here one of these tools, the REB Primer on Research and Cord Blood Donation (the Primer), which highlights key ethical and legal considerations and identifies Canadian documents that are relevant to the use of cord blood in biomedical research. The Primer also introduces the NPCBB and describes the systems CBS is implementing to address ethical issues. The Primer is intended to assist research ethics boards in evaluating the ethical acceptability of research protocols, to facilitate harmonized decision-making by providing a common reference, and to highlight the role of research ethics boards in governance frameworks. With the Primer we hope to illustrate how the development of such educational tools can facilitate the ethical implementation and governance of programs related to stem cell research in Canada and abroad.

Opportunities and challenges in implementing community based skilled birth attendance strategy in Kenya.

PubMed

Mannah, Margaret Titty; Warren, Charlotte; Kuria, Shiphrah; Adegoke, Adetoro A

2014-08-15

Availability of skilled care at birth remains a major problem in most developing countries. In an effort to increase access to skilled birth attendance, the Kenyan government implemented the community midwifery programme in 2005. The aim of this programme was to increase women's access to skilled care during pregnancy, childbirth and post-partum within their communities. Qualitative research involving in-depth interviews with 20 community midwives and six key informants. The key informants were funder, managers, coordinators and supervisors of the programme. Interviews were conducted between June to July, 2011 in two districts in Western and Central provinces of Kenya. Findings showed major challenges and opportunities in implementing the community midwifery programme. Challenges of the programme were: socio-economic issues, unavailability of logistics, problems of transportation for referrals and insecurity. Participants also identified the advantages of having midwives in the community which were provision of individualised care; living in the same community with clients which made community midwives easily accessible; and flexible payment options. Although the community midwifery model is a culturally acceptable method to increase skilled birth attendance in Kenya, the use of skilled birth attendance however remains disproportionately lower among poor mothers. Despite several governmental efforts to increase access and coverage of delivery services to the poor, it is clear that the poor may still not access skilled care even with skilled birth attendants residing in the community due to several socio-economic barriers.

Considerations for an Obesity Policy Research Agenda

PubMed Central

McKinnon, Robin A.; Orleans, C. Tracy; Kumanyika, Shiriki K.; Haire-Joshu, Debra; Krebs-Smith, Susan M.; Finkelstein, Eric A.; Brownell, Kelly D.; Thompson, Joseph W.; Ballard-Barbash, Rachel

2010-01-01

The rise in obesity levels in the U.S. in the past several decades has been dramatic, with serious implications for public health and the economy. Experiences in tobacco control and other public health initiatives have shown that public policy may be a powerful tool to effect structural change to alter population-level behavior. In 2007, the National Cancer Institute convened a meeting to discuss priorities for a research agenda to inform obesity policy. Issues considered were how to define obesity policy research, key challenges and key partners in formulating/implementing an obesity policy research agenda, criteria by which to set research priorities, and specific research needs and questions. Themes that emerged were: (1) the embryonic nature of obesity policy research, (2) the need to study “natural experiments” resulting from policy-based efforts to address the obesity epidemic, (3) the importance of research focused beyond individual-level behavior change, (4) the need for economic research across several relevant policy areas, and (5) the overall urgency of taking action in the policy arena. Moving forward, timely evaluation of natural experiments is of especially high priority. A variety of policies intended to promote healthy weight in children and adults are being implemented in communities and at the state and national levels. Although some of these policies are supported by the findings of intervention research, additional research is needed to evaluate the implementation and quantify the impact of new policies designed to address obesity. PMID:19211215

Emerging ICT implementation issues in aged care.

PubMed

Kapadia, Vasvi; Ariani, Arni; Li, Junhua; Ray, Pradeep K

2015-11-01

Demand for aged care services continues to soar as a result of an aging population. This increasing demand requires more residential aged care facilities and healthcare workforce. One recommended solution is to keep older people in their homes longer and support their independent life through the use of information and communication technologies (ICT). However, the aged care sector is still in the early stages of adopting ICT. The aim of this study was to identify the key issues that affect the adoption of ICT in the aged care sector. A systematic literature review was undertaken and involved four steps. The first two steps aimed to identify and select relevant articles. Data was then extracted from the selected articles and identified issues were analyzed and grouped into three major categories. ICT adoption issues were categorized into different perspectives, representing older people, health professionals and management. Our findings showed that all three groups were mostly concerned with issues around behavior, cost and lack of technical skills. Findings reported in this study will help decision makers at aged care settings to systematically understand issues related to ICT adoption and thus proactively introduce interventions to improve use of ICT in this sector. On the basis of our findings, we suggest future research focus on the examination of aged care workflow and assessment of return on ICT investment. Copyright © 2015. Published by Elsevier Ireland Ltd.

NATIONAL FRAMEWORK FOR THE SUSTAINABILITY OF HEALTH KNOWLEDGE TRANSLATION INITIATIVES IN UGANDA.

PubMed

Basaza, Robert; Kinegyere, Alison; Mutatina, Boniface; Sewankambo, Nelson

2018-01-01

The aim of this study was to provide evidence about the design and implementation of policies for advancing the sustainability of knowledge translation (KT) initiatives and policies in Uganda's health system. We searched for and reviewed evidence about KT sustainability issues in Uganda, the impacts of options, barriers to implementing these options, and implementation strategies to address such barriers. In instances where the systematic reviews provided limited evidence, these were supplemented with relevant primary studies. Documents such as the government reports and unpublished literature were also included in the search. Key informant interviews and a policy dialogue were conducted, and an expert working group guided the study. The KT sustainability issues identified were: the absence of a specific unit within the health sector to coordinate and synthesize research; health worker not familiar with KT activities and not often used. Furthermore, Uganda lacks a mechanism to sustain its current national health frameworks or platforms, and does not have a system to ensure the sustained coordination of existing national health KT platforms. The policy options proposed include: (i) the identification of a KT champion; (ii) the establishment of an operational KT framework; (iii) KT capacity building for researchers and research users, as well as policy and decision makers. The sustainability of KT will be influenced by the prevailing context and concerns within healthcare both in Uganda and internationally. Furthermore, the availability of resources for KT advocacy, communication, and program design will impact on the sustainability of Uganda's KT activities.

Implementing Biosecurity Education: Approaches, Resources and Programmes

PubMed Central

Minehata, Masamichi; Sture, Judi; Shinomiya, Nariyoshi; Whitby, Simon

2016-01-01

This paper aims to present possible approaches, resources and programmes to introduce the topic of biosecurity to life scientists and engineers at the higher education level. Firstly, we summarise key findings from a number of international surveys on biosecurity education that have been carried out in the United States, Europe, Israel and the Asia–Pacific region. Secondly, we describe the development of our openly-accessible education resource, illustrating the scope and content of these materials. Thirdly, we report on actual cases of biosecurity education that have been implemented. These include achievements in and lessons derived from the implementation of biosecurity education at the National Defense Medical College in Japan. These experiences are followed by presentation of the expert-level “Train-the-Trainer” programmes subsequently launched by the University of Bradford in the United Kingdom. These examples will help readers to understand how educators can enhance their own understanding about biosecurity issues and how they can then disseminate their knowledge through development of their own customised, relevantly-targeted and stage-tailored education programmes within their own life science communities. By providing these examples, we argue that education for life scientists, policy-makers and other stakeholders about social responsibility on dual-use issues is easily achievable and need not be expensive, time-consuming or over-burdening. We suggest that recurring classes or courses be held at appropriate times during educational programmes to accommodate the developing expertise and advancing learning stages of students. PMID:22038099

Pitfalls of CITES implementation in Nepal: a policy gap analysis.

PubMed

Dongol, Yogesh; Heinen, Joel T

2012-08-01

Implementation of policy involves multiple agencies operating at multiple levels in facilitating processes and actions to accomplish desired results. The Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) was developed and implemented to regulate and control international wildlife trade, but violations of the agreement are widespread and growing worldwide, including in Nepal. This study attempts to understand how domestic CITES policies are translated into action and what effect actions and processes have on compliance. In doing so, this study provides insights into the implementation and enforcement pitfalls of national legislation that explain CITES violations in Nepal. Primarily, we used 26 key informants interviews to learn opinions of experts, and the grounded theory approach for further qualitative data analysis. In addition, we used Najman's (1995) policy implementation analysis framework to explain gaps. Many interrelated variables in the content of the policy, commitment and capacity of the agencies, the roles of clients and coalitions and contextual issues were observed. Variables that emerged suggest pitfalls in the regulatory policy represented by low probability of detection, arrest and punishment. Moreover, redistributive policies in buffer zones of protected areas are needed into perpetuity to benefit locals. Also, conservation organizations' support for building public and political salience is imperative.

Providing context to the implementation of health promoting schools: A case study.

PubMed

McIsaac, Jessie-Lee D; Mumtaz, Zubia; Veugelers, Paul J; Kirk, Sara F L

2015-12-01

Issues related to program context are important components of population health interventions and particularly among complex, adaptive initiatives in schools. Health Promoting Schools (HPS) is a global approach to support early development of healthy behaviors among children and youth. The purpose of this study was to explicate the practical and contextual processes that influenced implementation of HPS in schools in Nova Scotia (Canada). Using a case-study approach, data was collected using interviews (n=14) with principals, teachers and parents, observations collected during school visits and document review in five diverse schools. Case study schools reported a variety of HPS practices and three key themes emerged that provided context to the processes that facilitated their implementation. The results suggest that although school characteristics (theme 1), like staff allocation, physical location and resources, are important, these barriers can be mitigated by building organizational capacity (theme 2) and establishing a supportive school community culture (theme 3). The study provided insight to the variability in implementation by describing how contextual barriers were experienced and mitigated by schools. Establishing a broad system to support HPS, with collaboration across health and education sectors, could help to progress adoption, implementation and sustainability of HPS. Copyright © 2015 Elsevier Ltd. All rights reserved.

Pitfalls of CITES Implementation in Nepal: A Policy Gap Analysis

NASA Astrophysics Data System (ADS)

Dongol, Yogesh; Heinen, Joel T.

2012-08-01

Implementation of policy involves multiple agencies operating at multiple levels in facilitating processes and actions to accomplish desired results. The Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) was developed and implemented to regulate and control international wildlife trade, but violations of the agreement are widespread and growing worldwide, including in Nepal. This study attempts to understand how domestic CITES policies are translated into action and what effect actions and processes have on compliance. In doing so, this study provides insights into the implementation and enforcement pitfalls of national legislation that explain CITES violations in Nepal. Primarily, we used 26 key informants interviews to learn opinions of experts, and the grounded theory approach for further qualitative data analysis. In addition, we used Najman's (1995) policy implementation analysis framework to explain gaps. Many interrelated variables in the content of the policy, commitment and capacity of the agencies, the roles of clients and coalitions and contextual issues were observed. Variables that emerged suggest pitfalls in the regulatory policy represented by low probability of detection, arrest and punishment. Moreover, redistributive policies in buffer zones of protected areas are needed into perpetuity to benefit locals. Also, conservation organizations' support for building public and political salience is imperative.

Building Stronger State Partnerships with the US Department of Energy (Energy Assurance)

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

Mike Keogh

2011-09-30

From 2007 until 2011, the National Association of Regulatory Utility Commissioners (NARUC) engaged in a partnership with the National Energy Technology Lab (NETL) to improve State-Federal coordination on electricity policy and energy assurance issues. This project allowed State Public Utility Commissioners and their staffs to engage on the most cutting-edge level in the arenas of energy assurance and electricity policy. Four tasks were outlined in the Statement of Performance Objectives: Task 1 - Training for Commissions on Critical Infrastructure Topics; Task 2 - Analyze and Implement Recommendations on Energy Assurance Issues; Task 3 - Ongoing liaison activities & outreach tomore » build stronger networks between federal agencies and state regulators; and Task 4 - Additional Activities. Although four tasks were prescribed, in practice these tasks were carried out under two major activity areas: the critical infrastructure and energy assurance partnership with the US Department of Energy's Infrastructure Security and Emergency Response office, and the National Council on Electricity Policy, a collaborative which since 1994 has brought together State and Federal policymakers to address the most pressing issues facing the grid from restructuring to smart grid implementation. On Critical Infrastructure protection, this cooperative agreement helped State officials yield several important advances. The lead role on NARUC's side was played by our Committee on Critical Infrastructure Protection. Key lessons learned in this arena include the following: (1) Tabletops and exercises work - They improve the capacity of policymakers and their industry counterparts to face the most challenging energy emergencies, and thereby equip these actors with the capacity to face everything up to that point as well. (2) Information sharing is critical - Connecting people who need information with people who have information is a key success factor. However, exposure of critical infrastructure information to bad actors also creates new vulnerabilities. (3) Tensions exist between the transparency-driven basis of regulatory activity and the information-protection requirements of asset protection. (4) Coordination between states is a key success factor - Because comparatively little federal authority exists over electricity and other energy infrastructure, the interstate nature of these energy grids defy centralized command and control governance. Patchwork responses are a risk when addressed at a state-by-state level. Coordination is the key to ensuring consistent response to shared threats. In Electricity Policy, the National Council on Electricity Policy continued to make important strides forward. Coordinated electricity policy among States remains the best surrogate for an absent national electricity policy. In every area from energy efficiency to clean coal, State policies are driving the country's electricity policy, and regional responses to climate change, infrastructure planning, market operation, and new technology deployment depend on a forum for bringing the States together.« less

Key factors influencing the intention of telecare adoption: an institutional perspective.

PubMed

Liu, Chung-Feng

2011-05-01

The objective of this study was to explore key factors of influence on the adoption of telecare by care institutions. This investigation was based on an extensive Technology-Organization-Environment framework comprising the four constructs of technology, organization, environment, and the project planning as well as corresponding variables. This study utilized a self-administered questionnaire for data collection, focusing on the managers of all 339 nursing homes in Taiwan for the census survey. A total of 70 valid questionnaires yielded a response rate of 20.65%. After analyzing the responses through the Partial Least Squares approach, government support, technological knowledge, supplier support, team skills, and compatibility were found to be the five key factors that positively impact intention to adopt telecare from an institutional perspective. The results of this study indicated that care institutions, for the most part, are willing to develop telecare and are already incorporating preliminary applications of telecare, such as distance learning and resident positioning. Solutions to potential issues related to implementing telecare in practice are also proposed in this study.

Idaho National Engineering Laboratory High-Level Waste Roadmap. Revision 2

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

Not Available

1993-08-01

The Idaho National Engineering Laboratory (INEL) High-Level Waste (HLW) Roadmap takes a strategic look at the entire HLW life-cycle starting with generation, through interim storage, treatment and processing, transportation, and on to final disposal. The roadmap is an issue-based planning approach that compares ``where we are now`` to ``where we want and need to be.`` The INEL has been effectively managing HLW for the last 30 years. Calcining operations are continuing to turn liquid HLW into a more manageable form. Although this document recognizes problems concerning HLW at the INEL, there is no imminent risk to the public or environment.more » By analyzing the INEL current business operations, pertinent laws and regulations, and committed milestones, the INEL HLW Roadmap has identified eight key issues existing at the INEL that must be resolved in order to reach long-term objectives. These issues are as follows: A. The US Department of Energy (DOE) needs a consistent policy for HLW generation, handling, treatment, storage, and disposal. B. The capability for final disposal of HLW does not exist. C. Adequate processes have not been developed or implemented for immobilization and disposal of INEL HLW. D. HLW storage at the INEL is not adequate in terms of capacity and regulatory requirements. E. Waste streams are generated with limited consideration for waste minimization. F. HLW is not adequately characterized for disposal nor, in some cases, for storage. G. Research and development of all process options for INEL HLW treatment and disposal are not being adequately pursued due to resource limitations. H. HLW transportation methods are not selected or implemented. A root-cause analysis uncovered the underlying causes of each of these issues.« less

Responding to the mental health and substance abuse needs of youth in the juvenile justice system: Ohio's Behavioral Health/Juvenile Justice Initiative.

PubMed

Kretschmar, Jeff M; Butcher, Fredrick; Kanary, Patrick J; Devens, Rebecca

2015-11-01

Nearly half a million inmates with mental health issues are housed in our country’s jails and prisons. The majority of juvenile justice-involved (JJI) youth have a history of behavioral health (mental health or substance use) problems. Multiple studies estimate that between 65% to 75% of juvenile justice-involved youth have at least one behavioral health disorder, and 20% to 30% report suffering from a serious behavioral disorder. With so many juveniles with behavioral health issues entering a system that was not designed to provide comprehensive treatment, communities are reevaluating their approach to juvenile justice. This article describes the origins and the results of Ohio’s Behavioral Health Juvenile Justice Initiative (BHJJ), a diversion program for juvenile justice-involved youth with behavioral health issues. The authors also discuss the key components of program success, offer advice to other jurisdictions considering implementing similar programming, and identify ways to take diversion programs to scale. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (c) 2015 APA, all rights reserved).

Chinese medicine education and its challenges in the United States.

PubMed

Kwon, Yihyun

2014-04-01

Over the past 4 decades Chinese medicine (CM) has come increasingly into the spotlight in the United States as the clinical effectiveness of CM has been not only empirically well-tested over a long period of time but also proven by recent scientific research. It has proven cost effectiveness, safety, and is authorized for natural and holistic approaches. In consideration, CM is one of the underutilized health care professions in the United States with a promising future. However, CM faces many challenges in its education and system, its niche in the health care system as an independent profession, legal and ethical issues. This paper discusses the confronting issues in the United States: present education, standards of CM education with shifting first professional degree level, new delivery systems of CM education. Development of new research models, training of evidence-based practice, and implementation of integrative medicine into CM education also are the key issues in the current CM profession. This paper also discusses opportunities for the CM profession going beyond the current status, especially with a focus on fusion medicine.

Clinical software development for the Web: lessons learned from the BOADICEA project

PubMed Central

2012-01-01

Background In the past 20 years, society has witnessed the following landmark scientific advances: (i) the sequencing of the human genome, (ii) the distribution of software by the open source movement, and (iii) the invention of the World Wide Web. Together, these advances have provided a new impetus for clinical software development: developers now translate the products of human genomic research into clinical software tools; they use open-source programs to build them; and they use the Web to deliver them. Whilst this open-source component-based approach has undoubtedly made clinical software development easier, clinical software projects are still hampered by problems that traditionally accompany the software process. This study describes the development of the BOADICEA Web Application, a computer program used by clinical geneticists to assess risks to patients with a family history of breast and ovarian cancer. The key challenge of the BOADICEA Web Application project was to deliver a program that was safe, secure and easy for healthcare professionals to use. We focus on the software process, problems faced, and lessons learned. Our key objectives are: (i) to highlight key clinical software development issues; (ii) to demonstrate how software engineering tools and techniques can facilitate clinical software development for the benefit of individuals who lack software engineering expertise; and (iii) to provide a clinical software development case report that can be used as a basis for discussion at the start of future projects. Results We developed the BOADICEA Web Application using an evolutionary software process. Our approach to Web implementation was conservative and we used conventional software engineering tools and techniques. The principal software development activities were: requirements, design, implementation, testing, documentation and maintenance. The BOADICEA Web Application has now been widely adopted by clinical geneticists and researchers. BOADICEA Web Application version 1 was released for general use in November 2007. By May 2010, we had > 1200 registered users based in the UK, USA, Canada, South America, Europe, Africa, Middle East, SE Asia, Australia and New Zealand. Conclusions We found that an evolutionary software process was effective when we developed the BOADICEA Web Application. The key clinical software development issues identified during the BOADICEA Web Application project were: software reliability, Web security, clinical data protection and user feedback. PMID:22490389

Clinical software development for the Web: lessons learned from the BOADICEA project.

PubMed

Cunningham, Alex P; Antoniou, Antonis C; Easton, Douglas F

2012-04-10

In the past 20 years, society has witnessed the following landmark scientific advances: (i) the sequencing of the human genome, (ii) the distribution of software by the open source movement, and (iii) the invention of the World Wide Web. Together, these advances have provided a new impetus for clinical software development: developers now translate the products of human genomic research into clinical software tools; they use open-source programs to build them; and they use the Web to deliver them. Whilst this open-source component-based approach has undoubtedly made clinical software development easier, clinical software projects are still hampered by problems that traditionally accompany the software process. This study describes the development of the BOADICEA Web Application, a computer program used by clinical geneticists to assess risks to patients with a family history of breast and ovarian cancer. The key challenge of the BOADICEA Web Application project was to deliver a program that was safe, secure and easy for healthcare professionals to use. We focus on the software process, problems faced, and lessons learned. Our key objectives are: (i) to highlight key clinical software development issues; (ii) to demonstrate how software engineering tools and techniques can facilitate clinical software development for the benefit of individuals who lack software engineering expertise; and (iii) to provide a clinical software development case report that can be used as a basis for discussion at the start of future projects. We developed the BOADICEA Web Application using an evolutionary software process. Our approach to Web implementation was conservative and we used conventional software engineering tools and techniques. The principal software development activities were: requirements, design, implementation, testing, documentation and maintenance. The BOADICEA Web Application has now been widely adopted by clinical geneticists and researchers. BOADICEA Web Application version 1 was released for general use in November 2007. By May 2010, we had > 1200 registered users based in the UK, USA, Canada, South America, Europe, Africa, Middle East, SE Asia, Australia and New Zealand. We found that an evolutionary software process was effective when we developed the BOADICEA Web Application. The key clinical software development issues identified during the BOADICEA Web Application project were: software reliability, Web security, clinical data protection and user feedback.

MICROSPED Information Bulletin, Issues 1-10, 1984. Microcomputers in the Schools--Implementation in Special Education.

ERIC Educational Resources Information Center

Hanley, Tom V., Ed.; And Others

1984-01-01

Ten information bulletins on the implementation of microcomputers in special education are presented. Topics covered include the following: (1) implementation issues (including a description of a study assessing microcomputer applications in 12 local school districts' special education programs); (2) implementation strategies (which focuses on…

Comparing the implementation consequences of the immunisation and emergency department health targets in New Zealand.

PubMed

Tenbensel, Tim; Chalmers, Linda; Willing, Esther

2016-09-19

Purpose Over the last decade there has been considerable debate about the merits of targets as a policy instrument. The purpose of this paper is to examine the implementation of two health targets that were cornerstones of New Zealand health policy between 2009 and 2012: immunisation rates for two-year-olds, and time to treatment, discharge or admission in hospital emergency departments. Design/methodology/approach For each policy target, the authors selected four case-study districts and conducted two waves of key-informant interviews (113 in total) with clinical and management staff involved in target implementation. Findings Despite almost identical levels of target achievement, the research reveals quite different mixes of positive and negative implementation consequences. The authors argue that the differences in implementation consequences are due to the characteristics of the performance measure; and the dynamics of the intra-organisational and inter-organisational implementation context. Research limitations/implications The research is based on interviews with clinical and management staff involved in target implementation, and this approach does not address the issue of effort substitution. Practical implications While literature on health targets pays attention to the attributes of target measures, the paper suggests that policymakers considering the use of targets pay more attention to broader implementation contexts, including the possible impact of, and effects on related services, organisations and staff. Originality/value The research focuses specifically on implementation consequences, as distinct from target success and/or changes in clinical and health outcomes. The paper also adopts a comparative approach to the study of target implementation.

Patient complaints in healthcare services in Vietnam’s health system

PubMed Central

Thi Thu Ha, Bui; Mirzoev, Tolib; Morgan, Rosemary

2015-01-01

Background: There is growing recognition of patient rights in health sectors around the world. Patients’ right to complain in hospitals, often visible in legislative and regulatory protocols, can be an important information source for service quality improvement and achievement of better health outcomes. However, empirical evidence on complaint processes is scarce, particularly in the developing countries. To contribute in addressing this gap, we investigated patients’ complaint handling processes and the main influences on their implementation in public hospitals in Vietnam. Methods: The study was conducted in two provinces of Vietnam. We focused specifically on the implementation of the Law on Complaints and Denunciations and the Ministry of Health regulation on resolving complaints in the health sector. The data were collected using document review and in-depth interviews with key respondents. Framework approach was used for data analysis, guided by a conceptual framework and aided by qualitative data analysis software. Results: Five steps of complaint handling were implemented, which varied in practice between the provinces. Four groups of factors influenced the procedures: (1) insufficient investment in complaint handling procedures; (2) limited monitoring of complaint processes; (3) patients’ low awareness of, and perceived lack of power to change, complaint procedures and (4) autonomization pressures on local health facilities. While the existence of complaint handling processes is evident in the health system in Vietnam, their utilization was often limited. Different factors which constrained the implementation and use of complaint regulations included health system–related issues as well as social and cultural influences. Conclusion: The study aimed to contribute to improved understanding of complaint handling processes and the key factors influencing these processes in public hospitals in Vietnam. Specific policy implications for improving these processes were proposed, which include improving accountability of service providers and better utilization of information on complaints. PMID:26770804

Towards the implementation of malaria elimination policy in South Africa: the stakeholders' perspectives.

PubMed

Hlongwana, Khumbulani Welcome; Tsoka-Gwegweni, Joyce

2017-01-01

The past decade has seen substantial global reduction in malaria morbidity and mortality due to increased international funding and decisive steps by the international malaria community to fight malaria. South Africa has been declared ready to institute malaria elimination. However, research on the factors that would affect this policy implementation is inadequate. To investigate the stakeholders' understanding of the malaria elimination policy in South Africa, including their perceived barriers and facilitators to effective policy implementation. The study followed a constructivist epistemological approach which manifests in phenomenological study design. Twelve purposively selected key informants from malaria researchers, provincial and national malaria programmes were interviewed using semi-structured interviews. Interview questions elicited interviewees' knowledge of the policy and its achievability, including any perceived barriers and facilitating factors to effective implementation. The hybrid approach was used to perform thematic data analysis. The dominant view was that malaria remains a problem in South Africa, exacerbated by staff attitudes and poor capacity, lack of resources, lack of new effective intervention tools, lack of intra- and inter-departmental collaboration, poor cross-border collaboration and weak stakeholder collaboration. Informants were concerned about the target year (2018) for elimination, and about the process followed in developing the policy, including the perceived malaria epidemiology shortfalls, regulatory issues and political context of the policy. Achievability of malaria elimination remains a subject of intense debate for a variety of reasons. These include the sporadic nature of malaria resurgence, raising questions about the contributions of malaria control interventions and climate to the transmission trends in South Africa. The shortage of resources, inadequate staff capacity, lack of any new effective intervention tools, and gaps in malaria epidemiology were key concerns, as was the superficially participative nature of the consultation process followed in developing the policy.

Creating a foundation for implementing an electronic health records (EHR)-integrated Social Knowledge Networking (SKN) system on medication reconciliation.

PubMed

Rangachari, P; Dellsperger, K C; Fallaw, D; Davis, I; Sumner, M; Ray, W; Fiedler, S; Nguyen, T; Rethemeyer, R

2018-04-01

In fall 2016, Augusta University received a two-year grant from AHRQ, to implement a Social Knowledge Networking (SKN) system for enabling its health system, AU-Health, to progress from "limited use" of EHR Medication Reconciliation (MedRec) Technology, to "meaningful use." Phase 1 sought to identify a comprehensive set of issues related to EHR MedRec encountered by practitioners at AU-Health. These efforts helped develop a Reporting Tool , which, along with a Discussion Tool , was incorporated into the AU-Health EHR, at the end of Phase 1. Phase 2 (currently underway), comprises a 52-week pilot of the EHR-integrated SKN system in outpatient and inpatient medicine units. The purpose of this paper is to describe the methods and results of Phase 1. Phase 1 utilized an exploratory mixed-method approach, involving two rounds of data collection. This included 15 individual interviews followed by a survey of 200 practitioners, i.e., physicians, nurses, and pharmacists, based in the outpatient and inpatient medicine service at AU Health. Thematic analysis of interviews identified 55 issue-items related to EHR MedRec under 9 issue-categories. The survey sought practitioners' importance-rating of all issue-items identified from interviews. A total of 127 (63%) survey responses were received. Factor analysis served to validate the following 6 of the 9 issue-categories, all of which, were rated "Important" or higher (on average), by over 70% of all respondents: 1) Care-Coordination (CCI); 2) Patient-Education (PEI); 3) Ownership-and-Accountability (OAI); 4) Processes-of-Care (PCI); 5) IT-Related (ITRI); and 6) Workforce-Training (WTI). Significance-testing of importance-rating by professional affiliation revealed no statistically significant differences for CCI and PEI; and some statistically significant differences for OAI, PCI, ITRI, and WTI. There were two key gleanings from the issues related to EHR MedRec unearthed by this study: 1) there was an absence of shared understanding among practitioners, of the value of EHR MedRec in promoting patient safety, which contributed to workarounds, and suboptimal use of the EHR MedRec system; and 2) there was a socio-technical dimension to many of the issues, creating an added layer of complexity. These gleanings in turn, provide insights into best practices for managing both clinical transitions-of-care in the EHR MedRec process; and socio-technical challenges encountered in EHR MedRec implementation.

Creating a foundation for implementing an electronic health records (EHR)-integrated Social Knowledge Networking (SKN) system on medication reconciliation

PubMed Central

Rangachari, P.; Dellsperger, K.C; Fallaw, D.; Davis, I.; Sumner, M.; Ray, W.; Fiedler, S.; Nguyen, T.; Rethemeyer, R.

2018-01-01

Background In fall 2016, Augusta University received a two-year grant from AHRQ, to implement a Social Knowledge Networking (SKN) system for enabling its health system, AU-Health, to progress from “limited use” of EHR Medication Reconciliation (MedRec) Technology, to “meaningful use.” Phase 1 sought to identify a comprehensive set of issues related to EHR MedRec encountered by practitioners at AU-Health. These efforts helped develop a Reporting Tool, which, along with a Discussion Tool, was incorporated into the AU-Health EHR, at the end of Phase 1. Phase 2 (currently underway), comprises a 52-week pilot of the EHR-integrated SKN system in outpatient and inpatient medicine units. The purpose of this paper is to describe the methods and results of Phase 1. Methods Phase 1 utilized an exploratory mixed-method approach, involving two rounds of data collection. This included 15 individual interviews followed by a survey of 200 practitioners, i.e., physicians, nurses, and pharmacists, based in the outpatient and inpatient medicine service at AU Health. Results Thematic analysis of interviews identified 55 issue-items related to EHR MedRec under 9 issue-categories. The survey sought practitioners’ importance-rating of all issue-items identified from interviews. A total of 127 (63%) survey responses were received. Factor analysis served to validate the following 6 of the 9 issue-categories, all of which, were rated “Important” or higher (on average), by over 70% of all respondents: 1) Care-Coordination (CCI); 2) Patient-Education (PEI); 3) Ownership-and-Accountability (OAI); 4) Processes-of-Care (PCI); 5) IT-Related (ITRI); and 6) Workforce-Training (WTI). Significance-testing of importance-rating by professional affiliation revealed no statistically significant differences for CCI and PEI; and some statistically significant differences for OAI, PCI, ITRI, and WTI. Conclusion There were two key gleanings from the issues related to EHR MedRec unearthed by this study: 1) there was an absence of shared understanding among practitioners, of the value of EHR MedRec in promoting patient safety, which contributed to workarounds, and suboptimal use of the EHR MedRec system; and 2) there was a socio-technical dimension to many of the issues, creating an added layer of complexity. These gleanings in turn, provide insights into best practices for managing both clinical transitions-of-care in the EHR MedRec process; and socio-technical challenges encountered in EHR MedRec implementation. PMID:29682132

Standing Up a Narcotic Confirmation Laboratory for the Russian Federation Ministry of Defense Nuclear Personnel Reliability Program

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

LukyanenkoMD, Victor; Eisele, Gerhard R; Coates, Cameron W

2010-01-01

Through a cooperative effort between the U. S. Department of Energy and the Russian Federation (RF) Ministry of Defense (MOD) a Personnel Reliability Program (PRP) for the nuclear handlers within the RF MOD has been implemented. A key element in the RF MOD PRP is the detection and confirmation of narcotic use in subject military and civilian personnel. This paper describes the process of narcotics screening and testing in the RF MOD and explains the confirmation process once screening has shown a positive result. Issues of laboratory certification, employee certification, employee training, sample chain-of-custody, and equipment needs will be addressed.

Risk selection and risk adjustment: improving insurance in the individual and small group markets.

PubMed

Baicker, Katherine; Dow, William H

2009-01-01

Insurance market reforms face the key challenge of addressing the threat that risk selection poses to the availability, of stable, high-value insurance policies that provide long-term risk protection. Many of the strategies in use today fail to address this breakdown in risk pooling, and some even exacerbate it. Flexible risk adjustment schemes are a promising avenue for promoting market stability and limiting insurer cream-skimming, potentially providing greater benefits at lower cost. Reforms intended to increase insurance coverage and the value of care delivered will be much more effective if implemented in conjunction with policies that address these fundamental selection issues.

Democratising health care governance? New Zealand's inaugural district health board elections, 2001.

PubMed

Gauld, Robin

2002-01-01

New Zealand's 'district health board' (DHB) system has been under implementation since the 1999 general election. A key factor motivating the change to DHBs is the democratisation of health care governance. A majority of the new DHB members are popularly elected. Previously, hospital board members were government appointees. Inaugural DHB elections were held in October 2001. This article reports on the election results and the wider operating context for DHBs. It notes organisational issues to be considered for the next DHB elections in 2004, and questions the extent to which the elections and DHB governance structure will enhance health care democratisation in New Zealand.

Current applications of nanotechnology in dentistry: a review.

PubMed

Bhavikatti, Shaeesta Khaleelahmed; Bhardwaj, Smiti; Prabhuji, M L V

2014-01-01

With the increasing demand for advances in diagnosis and treatment modalities, nanotechnology is being considered as a groundbreaking and viable research subject. This technology, which deals with matter in nanodimensions, has widened our views of poorly understood health issues and provided novel means of diagnosis and treatment. Researchers in the field of dentistry have explored the potential of nanoparticles in existing therapeutic modalities with moderate success. The key implementations in the field of dentistry include local drug delivery agents, restorative materials, bone graft materials, and implant surface modifications. This review provides detailed insights about current developments in the field of dentistry, and discusses potential future uses of nanotechnology.