The need to promote behaviour change at the cultural level: one factor explaining the limited impact of the MEMA kwa Vijana adolescent sexual health intervention in rural Tanzania. A process evaluation

PubMed Central

2012-01-01

Background Few of the many behavioral sexual health interventions in Africa have been rigorously evaluated. Where biological outcomes have been measured, improvements have rarely been found. One of the most rigorous trials was of the multi-component MEMA kwa Vijana adolescent sexual health programme, which showed improvements in knowledge and reported attitudes and behaviour, but none in biological outcomes. This paper attempts to explain these outcomes by reviewing the process evaluation findings, particularly in terms of contextual factors. Methods A large-scale, primarily qualitative process evaluation based mainly on participant observation identified the principal contextual barriers and facilitators of behavioural change. Results The contextual barriers involved four interrelated socio-structural factors: culture (i.e. shared practices and systems of belief), economic circumstances, social status, and gender. At an individual level they appeared to operate through the constructs of the theories underlying MEMA kwa Vijana - Social Cognitive Theory and the Theory of Reasoned Action – but the intervention was unable to substantially modify these individual-level constructs, apart from knowledge. Conclusion The process evaluation suggests that one important reason for this failure is that the intervention did not operate sufficiently at a structural level, particularly in regard to culture. Recently most structural interventions have focused on gender or/and economics. Complementing these with a cultural approach could address the belief systems that justify and perpetuate gender and economic inequalities, as well as other barriers to behaviour change. PMID:22978613

Resourcing interventions enhance psychology support capabilities in special operations forces.

PubMed

Myatt, Craig A; Auzenne, J W

2012-01-01

This study provides an examination of approaches to United States Government (USG) resourcing interventions on a national scale that enhance psychology support capabilities in the Special Operations Forces (SOF) community. A review of Congressional legislation and resourcing trends in the form of authorizations and appropriations since 2006 demonstrates how Congress supported enhanced psychology support capabilities throughout the Armed Forces and in SOF supporting innovative command interests that address adverse affects of operations tempo behavioral effects (OTBE). The formulation of meaningful metrics to address SOF specific command interests led to a personnel tempo (PERSTEMPO) analysis in response to findings compiled by the Preservation of the Force and Families (POTFF) Task Force. The review of PERSTEMPO data at subordinate command and unit levels enhances the capability of SOF leaders to develop policy and guidance on training and operational planning that mitigates OTBE and maximizes resourcing authorizations. A major challenge faced by the DoD is in providing behavioral healthcare that meets public and legislative demands while proving suitable and sustainable at all levels of military operations: strategic, operational, and tactical. Current legislative authorizations offer a mechanism of command advocacy for resourced multi-functional program development that enhances psychology support capabilities while reinforcing SOF readiness and performance. 2012.

A noise-reduction program in a pediatric operation theatre is associated with surgeon's benefits and a reduced rate of complications: a prospective controlled clinical trial.

PubMed

Engelmann, Carsten R; Neis, Jan Philipp; Kirschbaum, Clemens; Grote, Gudela; Ure, Benno M

2014-05-01

We assessed the impact of a noise-reduction program in a pediatric operating theatre. Adverse effects from noise pollution in theatres have been demonstrated. In 156 operations spatially resolved, sound levels were measured before and after a noise-reduction program on the basis of education, rules, and technical devices (Sound Ear). Surgical complications were recorded. The surgeon's biometric (saliva cortisol, electrodermal activity) and behavioral stress responses (questionnaires) were measured and correlated with mission protocols and individual noise sensitivity. Median noise levels in the control group versus the interventional group were reduced by -3 ± 3 dB(A) (63 vs 59 dB(A), P < 0.001) with a grossly decreased number of peaks greater than 70 dB(A) (Δn = -61/hour, P < 0.01). The intervention significantly reduced non-operation-related noise. The incidence of postoperative complications was significantly lower in patients of the intervention group (n = 10/56 vs 20/58 control; P < 0.05). "Responders," surgeons with an above-average noise sensitivity (correlation r = -0.6 for the work subscale of the NoiseQ questionnaire, P < 0.05), experienced improved intrateam communication, a decrease in disturbing conversations and sudden noise peaks (P < 0.05). Biometrically, the intervention decreased both the surgeon's pre- to postoperative rise in cortisol by approximately 20% and the surgeon's electrodermal potentials of greater than 15 μS, indicating severe stress by 60% (P > 0.05). Spontaneous noise during pediatric operations attains the magnitude of a lawn mower and peaks resemble a passing truck. The sound intensity could be reduced by 50% by specific measures. This reduction was associated with a significantly lowered number of postoperative complications. The surgeon's benefits are idiosyncratic with "responders" experiencing marked improvements.

Instructor feedback versus no instructor feedback on performance in a laparoscopic virtual reality simulator: a randomized trial.

PubMed

Strandbygaard, Jeanett; Bjerrum, Flemming; Maagaard, Mathilde; Winkel, Per; Larsen, Christian Rifbjerg; Ringsted, Charlotte; Gluud, Christian; Grantcharov, Teodor; Ottesen, Bent; Sorensen, Jette Led

2013-05-01

To investigate the impact of instructor feedback versus no instructor feedback when training a complex operational task on a laparoscopic virtual reality simulator. : Simulators are now widely accepted as a training tool, but there is insufficient knowledge about how much feedback is necessary, which is useful for sustainable implementation. A randomized trial complying with CONSORT Statement. All participants had to reach a predefined proficiency level for a complex operational task on a virtual reality simulator. The intervention group received standardized instructor feedback a maximum of 3 times. The control group did not receive instructor feedback. Participants were senior medical students without prior laparoscopic experience (n = 99). Outcome measures were time, repetitions, and performance score to reach a predefined proficiency level. Furthermore, influence of sex and perception of own surgical skills were examined. Time (in minutes) and repetitions were reduced in the intervention group (162 vs 342 minutes; P < 0.005) and (29 vs 65 repetitions; P < 0.005). The control group achieved a higher performance score than the intervention group (57% vs 49%; P = 0.004). Men used less time (in minutes) than women (P = 0.037), but no sex difference was observed for repetitions (P = 0.20). Participants in the intervention group had higher self-perception regarding surgical skills after the trial (P = 0.011). Instructor feedback increases the efficiency when training a complex operational task on a virtual reality simulator; time and repetitions used to achieve a predefined proficiency level were significantly reduced in the group that received instructor feedback compared with the control group. NCT01497782.

[The accreditation of professional competence: the analysis of nursing
interventions to control anxiety in surgical patients].

PubMed

Brea-Rivero, Pilar; Herrera-Usagre, Manuel; Rojas-de-Mora-Figueroa, Ana; Esposito, Thomas

2016-01-01

. The accreditation of professional competence: the analysis of nursing interventions to control anxiety in surgical patients. The preoperative anxiety is a state of discomfort or unpleasant tension resulting from concerns about illness, hospitalization, anesthesia, surgery or the unknown. Nurses play a vital role reducing preoperative anxiety. An accreditation program was developed in Andalusia (Spain) to measure nurses' competences in this and others fields. To analyze the accredited nurses' interventions spectrum to reduce anxiety in surgical patients and to check if their range of interventions depends upon their professional skills accreditation level. Cross-sectional study. From 20016 to 2014, 1.282 interventions performed by 303 operating room nurses accredited through the Professional Skills Accreditation Program of the Andalusian Agency for Health Care Quality (ACSA) were analyzed with the latent class analysis (LCA) and multinomial logistic regression. Two-thirds of the sample was accredited in Advanced level, about 31% in Expert level and 2.6% in Excellent level. Mean age of patients was 58.5±19.8 years. Three professional profiles were obtained from the LCA. Those nurses classified in Class I (22.4% of the sample) were more likely to be women, to can for younger patients, and to be accredited in Expert or Excellent Level and to perform the larger range of interventions, becoming therefore the most complete professional profile. Those nurses who perform a wider range of interventions and specifically two evidence based interventions such Calming Technique and Coping Enhancement are those who have a higher level of accreditation level.

Radiation Exposure of Interventional Radiologists During Computed Tomography Fluoroscopy-Guided Renal Cryoablation and Lung Radiofrequency Ablation: Direct Measurement in a Clinical Setting.

PubMed

Matsui, Yusuke; Hiraki, Takao; Gobara, Hideo; Iguchi, Toshihiro; Fujiwara, Hiroyasu; Kawabata, Takahiro; Yamauchi, Takatsugu; Yamaguchi, Takuya; Kanazawa, Susumu

2016-06-01

Computed tomography (CT) fluoroscopy-guided renal cryoablation and lung radiofrequency ablation (RFA) have received increasing attention as promising cancer therapies. Although radiation exposure of interventional radiologists during these procedures is an important concern, data on operator exposure are lacking. Radiation dose to interventional radiologists during CT fluoroscopy-guided renal cryoablation (n = 20) and lung RFA (n = 20) was measured prospectively in a clinical setting. Effective dose to the operator was calculated from the 1-cm dose equivalent measured on the neck outside the lead apron, and on the left chest inside the lead apron, using electronic dosimeters. Equivalent dose to the operator's finger skin was measured using thermoluminescent dosimeter rings. The mean (median) effective dose to the operator per procedure was 6.05 (4.52) μSv during renal cryoablation and 0.74 (0.55) μSv during lung RFA. The mean (median) equivalent dose to the operator's finger skin per procedure was 2.1 (2.1) mSv during renal cryoablation, and 0.3 (0.3) mSv during lung RFA. Radiation dose to interventional radiologists during renal cryoablation and lung RFA were at an acceptable level, and in line with recommended dose limits for occupational radiation exposure.

Analyzing the risk factors influencing surgical site infections: the site of environmental factors.

PubMed

Alfonso-Sanchez, Jose L; Martinez, Isabel M; Martín-Moreno, Jose M; González, Ricardo S; Botía, Francisco

2017-06-01

Addressing surgical site infection (SSI) is accomplished, in part, through studies that attempt to clarify the nature of many essential factors in the control of SSI. We sought to examine the link between multiple risk factors, including environmental factors, and SSI for prevention management. We conducted a longitudinal prospective study to identify SSIs in all patients who underwent interventions in 2014 in 8 selected hospitals on the Mediterranean coast of Spain. Risk factors related to the operating theatre included level of fungi and bacterial contamination, temperature and humidity, air renewal and differential air pressure. Patient-related variables included age, sex, comorbidity, nutrition level and transfusion. Other factors were antibiotic prophylaxis, electric versus manual shaving, American Society of Anaesthesiologists physical status classification, type of intervention, duration of the intervention and preoperative stay. Superficial SSI was most often associated with environmental factors, such as environmental contamination by fungi (from 2 colony-forming units) and bacteria as well as surface contamination. When there was no contamination in the operating room, no SSI was detected. Factors that determined deep and organ/space SSI were more often associated with patient characteristics (age, sex, transfusion, nasogastric feeding and nutrition, as measured by the level of albumin in the blood), type of intervention and preoperative stay. Antibiotic prophylaxis and shaving with electric razor were protective factors for both types of infection, whereas the duration of the intervention and the classification of the intervention as "dirty" were shared risk factors. Our results suggest the importance of environmental and surface contamination control to prevent SSI.

Building the Research-Policy Nexus in South Africa: Insights from a Skills Planning Policy Intervention

ERIC Educational Resources Information Center

Ranchod, Rushil

2017-01-01

This paper examines the formation and operation of a research-policy nexus in a research-based national-level government department intervention to improve skills planning policy in South Africa. Through the lens of evidence-informed policymaking, it reflects on understandings of evidence use in policy; it explores the interactions between actors…

[Emodin alleviates pulmonary fibrosis through inactivation of TGF-β1/ADAMTS-1 signaling pathway in rats].

PubMed

Liu, Lijing; Qian, Hong; Xiao, Hua; He, Jianbin; Xie, Maofeng; Wang, Zaiyan; Long, Xingyun

2016-10-01

Objective To explore the role of transforming growth factor-β1 (TGF-β1)/a disintegrin-like and metalloproteinase with thrombospondin type 1 motif (ADAMTS-1) signaling pathway in emodin's anti-pulmonary fibrosis. Methods Sixty SD rats were randomly divided into 6 groups: normal control group, sham-operated group, model group, low-dose emodin intervention group (20 mg/kg), high-dose emodin intervention group (80 mg/kg) and prednisone group (5 mg/kg). Each group included 10 animals. Rats in the latter 4 groups were intratracheally injected with bleomycin A5 to induce pulmonary fibrosis, whereas bleomycin A5 was replaced by normal saline in sham-operated group. From the second day, rats in the low- and high-dose emodin intervention groups were intragastrically treated with 2 mL of 20 and 80 mg/kg emodin, respectively. Rats in the prednisone group were intragastrically administrated with 2 mL of 5 mg/kg prednisone acetate. However, rats in the normal control and sham-operated and model groups were treated with 2 mL of normal saline. All rats were sacrificed on day 28 after modeling. Subsequently, blood and pulmonary tissue specimen were taken. The pathological changes of pulmonary tissues were observed using routine HE and Masson staining. The expressions of TGF-β1, ADAMTS-1, collagen type 1 (Col1) and Col3 in pulmonary tissues were measured by quantitative real-time PCR and Western blotting. Serum levels of procollagen type 1 carboxy terminal propeptide (P1CP) and procollagen type 3 aminoterminal propeptide (P3NP) were detected by ELISA. Results Compare with the model group, the alveolitis and pulmonary fibrosis extent in each drug-treated group were significantly alleviated. In comparison with normal control group or sham-operated group, the mRNA and protein levels of TGF-β1, Col1 and Col3 in pulmonary tissues and the serum levels of P1CP and P3NP increased, but the mRNA and protein levels of ADAMTS-1 decreased in model group. After treatment with low- and high-dose emodin or prednisone, the mRNA and protein levels of TGF-β1, Col1 and Col3 in pulmonary tissues and the serum levels of P1CP and P3NP were significantly downregulated, while the mRNA and protein levels of ADAMTS-1 in pulmonary tissues were significantly upregulated as compared with the model group. Moreover, In comparison with the low-dose emodin intervention group, the above indicators were significantly improved in the high-dose emodin intervention or prednisone group. However, the above indicators were not significantly different between the high-dose emodin intervention group and the prednisone group. Conclusion Increased degradation of Col1 and Col3 in pulmonary tissues due to the inactivation of TGF-β1/ADAMTS-1 signaling pathway may be a significant mechanism by which emodin protects rats against pulmonary fibrosis.

A novel radiation protection device based on tungsten functional paper for application in interventional radiology.

PubMed

Monzen, Hajime; Tamura, Mikoto; Shimomura, Kohei; Onishi, Yuichi; Nakayama, Shinichi; Fujimoto, Takahiro; Matsumoto, Kenji; Hanaoka, Kohei; Kamomae, Takeshi

2017-05-01

Tungsten functional paper (TFP), which contains 80% tungsten by weight, has radiation-shielding properties. We investigated the use of TFP for the protection of operators during interventional or therapeutic angiography. The air kerma rate of scattered radiation from a simulated patient was measured, with and without TFP, using a water-equivalent phantom and fixed C-arm fluoroscopy. Measurements were taken at the level of the operator's eye, chest, waist, and knee, with a variable number of TFP sheets used for shielding. A Monte Carlo simulation was also utilized to analyze the dose rate delivered with and without the TFP shielding. In cine mode, when the number of TFP sheets was varied through 1, 2, 3, 5, and 10, the respective reduction in the air kerma rate relative to no TFP shielding was as follows: at eye level, 24.9%, 29.9%, 41.6%, 50.4%, and 56.2%; at chest level, 25.3%, 33.1%, 34.9%, 46.1%, and 44.3%; at waist level, 45.1%, 57.0%, 64.4%, 70.7%, and 75.2%; and at knee level, 2.1%, 2.2%, 2.1%, 2.1%, and 2.1%. In fluoroscopy mode, the respective reduction in the air kerma rate relative to no TFP shielding was as follows: at eye level, 24.8%, 30.3%, 34.8%, 51.1%, and 58.5%; at chest level, 25.8%, 33.4%, 35.5%, 45.2%, and 44.4%; at waist level, 44.6%, 56.8%, 64.7%, 71.7%, and 77.2%; and at knee level, 2.2%, 0.0%, 2.2%, 2.8%, and 2.5%. The TFP paper exhibited good radiation-shielding properties against the scattered radiation encountered in clinical settings, and was shown to have potential application in decreasing the radiation exposure to the operator during interventional radiology. © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

[The dynamic indices of lipid peroxidation and of the antioxidant system under the influence of surgical treatment in ovarian cystoma].

PubMed

Temchenko, O I

1998-01-01

The state of the lipids peroxide oxidation (LPO) and antioxidant system (AOS) was studied up in 22 patients with ovarian cystoma [correction of cyst]. According to the level of retinoli acetas, acidum ascorbinicum, tocopheroli acetas, the reduced glutation superoxiddysmutase (SOD) activity. The LPO activation and vitamins level lowering in the patients blood plasma were established. The operative intervention conduction caused the LPO activation and the AOS factors level lowering, observed during 7-8 days after the operation.

Power tiller: vibration magnitudes and intervention development for vibration reduction.

PubMed

Chaturvedi, Varun; Kumar, Adarsh; Singh, J K

2012-09-01

The operators of power tiller are exposed to a high level of vibration originating from the dynamic interaction between the soil and the machine. The vibration from the power tiller is transmitted from the handle to hands, arms and shoulders. In the present study, experiments were conducted in three operational conditions i.e. transportation on farm roads, tilling with cultivator and rota-tilling with rota-vator. The highest vibration values were observed in x-direction in all the experiments. The maximum vibration rms values for x-direction were 5.96, 6.81 and 8.00 ms(-2) in tilling with cultivator, transportation and rota-tilling respectively. Three materials were used for intervention development to reduce vibration magnitude. The maximum reduction of 25.30, 31.21 and 30.45% in transportation; 23.50, 30.64 and 20.86% in tilling with cultivator and 24.03, 29.18 and 25.52% in rota-tilling were achieved with polyurethane (PU), rubber and combination of PU and rubber intervention. It was found that the maximum vibration reductions were achieved with the rubber in all three operational conditions. The average exposure time for occurrence of white finger syndrome increased by 28-50% with incorporation of intervention in different operations. Physiological and postural parameters also improved with incorporation of interventions. Copyright © 2012 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Acute gastrointestinal compromise in neonates with congenital diaphragmatic hernia prior to repair.

PubMed

Fox, Catherine; Stewart, Michael; King, Sebastian K; Patel, Neil

2016-12-01

Congenital diaphragmatic hernia (CDH) affects 1 in 3000 live births. Modern management strategies include delayed repair of the diaphragm to permit pre-operative optimization of cardiorespiratory status. We describe a cohort of neonates in whom early emergency operative intervention was required for potentially fatal intestinal compromise. A retrospective review was performed of all neonatal CDH patients managed at a tertiary center in an 8-year period (2005-2012). A total of 126 CDH patients were managed during the 8-year period. Five neonates (male - 1; gestation 37+4-39+7; birth weight 2.9-3.7kg; left CDH - 5) required emergency operative intervention for presumed gastrointestinal compromise. All five neonates demonstrated systemic hypotension despite inotropic support, raised serum lactate (>2mmol/L), and abnormal radiographic findings. Operative intervention occurred within 3days of birth (1-3days). Findings included gastric volvulus, jejunal volvulus, and perforated caecum. All patients underwent primary diaphragmatic repair without a patch. Temporary ileostomy was required in 1 patient. All patients remain alive. Gastrointestinal compromise is a rare, but potentially catastrophic, complication of CDH. Emergency operative intervention may be required in a select cohort of patients. Early deterioration following birth should alert clinicians to the possibility of significant intestinal pathology. Level IV case series with no comparison group. Copyright © 2016 Elsevier Inc. All rights reserved.

The effectiveness of an intervention to reduce alcohol‐related violence in premises licensed for the sale and on‐site consumption of alcohol: a randomized controlled trial

PubMed Central

Alam, M. Fasihul; Heikkinen, Marjukka; Hood, Kerenza; Huang, Chao; Moore, Laurence; Murphy, Simon; Playle, Rebecca; Shepherd, Jonathan; Shovelton, Claire; Sivarajasingam, Vaseekaran; Williams, Anne

2017-01-01

Abstract Background and Aims Premises licensed for the sale and consumption of alcohol can contribute to levels of assault‐related injury through poor operational practices that, if addressed, could reduce violence. We tested the real‐world effectiveness of an intervention designed to change premises operation, whether any intervention effect changed over time, and the effect of intervention dose. Design A parallel randomized controlled trial with the unit of allocation and outcomes measured at the level of individual premises. Setting All premises (public houses, nightclubs or hotels with a public bar) in Wales, UK. Participants A randomly selected subsample (n = 600) of eligible premises (that had one or more violent incidents recorded in police‐recorded crime data; n = 837) were randomized into control and intervention groups. Intervention and comparator Intervention premises were audited by Environmental Health Practitioners who identified risks for violence and provided feedback by varying dose (informal, through written advice, follow‐up visits) on how risks could be addressed. Control premises received usual practice. Measurements Police data were used to derive a binary variable describing whether, on each day premises were open, one or more violent incidents were evident over a 455‐day period following randomization. Findings Due to premises being unavailable at the time of intervention delivery 208 received the intervention and 245 were subject to usual practice in an intention‐to‐treat analysis. The intervention was associated with an increase in police recorded violence compared to normal practice (hazard ratio = 1.34, 95% confidence interval = 1.20–1.51). Exploratory analyses suggested that reduced violence was associated with greater intervention dose (follow‐up visits). Conclusion An Environmental Health Practitioner‐led intervention in premises licensed for the sale and on‐site consumption of alcohol resulted in an increase in police recorded violence. PMID:28543914

The effect of music with and without binaural beat audio on operative anxiety in patients undergoing cataract surgery: a randomized controlled trial

PubMed Central

Wiwatwongwana, D; Vichitvejpaisal, P; Thaikruea, L; Klaphajone, J; Tantong, A; Wiwatwongwana, A

2016-01-01

Purpose To investigate the anxiolytic effects of binaural beat embedded audio in patients undergoing cataract surgery under local anesthesia. Methods This prospective RCT included 141 patients undergoing cataract surgery under local anesthesia. The patients were randomized into three groups; the Binaural beat music group (BB), the plain music intervention group (MI), and a control group (ear phones with no music). Blood pressure (BP) and heart rate were measured on admission, at the beginning of and 20 min after the start of the operation. Peri-operative anxiety level was assessed using the State-Trait Anxiety Inventory questionnaire (STAI). Results The BB and MI groups comprised 44 patients each and the control group 47. Patients in the MI group and BB group showed significant reduction of STAI state scores after music intervention compared with the control group (P<0.001) but the difference was not significant between the MI and BB group (STAI-S score MI group −7.0, BB group −9.0, P=0.085). Systolic BP was significantly lower in both MI (P=0.043) and BB (0.040) groups although there was no difference between the two groups (P=1.000). A significant reduction in heart rate was seen only in the BB group (BB vs control P=0.004, BB vs MI P=0.050, MI vs control P=0.303). Conclusion Music, both with and without binaural beat, was proven to decrease anxiety level and lower systolic BP. Patients who received binaural beat audio showed additional decrease in heart rate. Binaural beat embedded musical intervention may have benefit over musical intervention alone in decreasing operative anxiety. PMID:27740618

The effect of music with and without binaural beat audio on operative anxiety in patients undergoing cataract surgery: a randomized controlled trial.

PubMed

Wiwatwongwana, D; Vichitvejpaisal, P; Thaikruea, L; Klaphajone, J; Tantong, A; Wiwatwongwana, A

2016-11-01

PurposeTo investigate the anxiolytic effects of binaural beat embedded audio in patients undergoing cataract surgery under local anesthesia.MethodsThis prospective RCT included 141 patients undergoing cataract surgery under local anesthesia. The patients were randomized into three groups; the Binaural beat music group (BB), the plain music intervention group (MI), and a control group (ear phones with no music). Blood pressure (BP) and heart rate were measured on admission, at the beginning of and 20 min after the start of the operation. Peri-operative anxiety level was assessed using the State-Trait Anxiety Inventory questionnaire (STAI).ResultsThe BB and MI groups comprised 44 patients each and the control group 47. Patients in the MI group and BB group showed significant reduction of STAI state scores after music intervention compared with the control group (P<0.001) but the difference was not significant between the MI and BB group (STAI-S score MI group -7.0, BB group -9.0, P=0.085). Systolic BP was significantly lower in both MI (P=0.043) and BB (0.040) groups although there was no difference between the two groups (P=1.000). A significant reduction in heart rate was seen only in the BB group (BB vs control P=0.004, BB vs MI P=0.050, MI vs control P=0.303).ConclusionMusic, both with and without binaural beat, was proven to decrease anxiety level and lower systolic BP. Patients who received binaural beat audio showed additional decrease in heart rate. Binaural beat embedded musical intervention may have benefit over musical intervention alone in decreasing operative anxiety.

The Cycle of Reciprocity: A Social Capital Intervention Strategy for SSTR Operations

DTIC Science & Technology

2007-06-01

of Hope, Harvest Initiative, social capital, reciprocity, SSTR, Maslow , intervention, KFOR, game theory , prisoner’s dilemma, civil affairs...power beyond the personal level. Abraham Maslow’s theory is based on a seemingly intuitive prioritization of human needs progressing with 56 the...simply introducing unconditional aid. 57 Figure 4. Maslow’s Hierarchy as a Societal Template88 88 A. H. Maslow , "A Theory

Validation and refinement of a rule to predict emergency intervention in adult trauma patients.

PubMed

Haukoos, Jason S; Byyny, Richard L; Erickson, Catherine; Paulson, Stephen; Hopkins, Emily; Sasson, Comilla; Bender, Brooke; Gravitz, Craig S; Vogel, Jody A; Colwell, Christopher B; Moore, Ernest E

2011-08-01

Trauma centers use "secondary triage" to determine the necessity of trauma surgeon involvement. A clinical decision rule, which includes penetrating injury, an initial systolic blood pressure less than 100 mm Hg, or an initial pulse rate greater than 100 beats/min, was developed to predict which trauma patients require emergency operative intervention or emergency procedural intervention (cricothyroidotomy or thoracotomy) in the emergency department. Our goal was to validate this rule in an adult trauma population and to compare it with the American College of Surgeons' major resuscitation criteria. We used Level I trauma center registry data from September 1, 1995, through November 30, 2008. Outcomes were confirmed with blinded abstractors. Sensitivity, specificity, and 95% confidence intervals (CIs) were calculated. Our patient sample included 20,872 individuals. The median Injury Severity Score was 9 (interquartile range 4 to 16), 15.3% of patients had penetrating injuries, 13.5% had a systolic blood pressure less than 100 mm Hg, and 32.5% had a pulse rate greater than 100 beats/min. Emergency operative intervention or procedural intervention was required in 1,099 patients (5.3%; 95% CI 5.0% to 5.6%). The sensitivities and specificities of the rule and the major resuscitation criteria for predicting emergency operative intervention or emergency procedural intervention were 95.6% (95% CI 94.3% to 96.8%) and 56.1% (95% CI 55.4% to 56.8%) and 85.5% (95% CI 83.3% to 87.5%) and 80.9% (95% CI 80.3% to 81.4%), respectively. This new rule was more sensitive for predicting the need for emergency operative intervention or emergency procedural intervention directly compared with the American College of Surgeons' major resuscitation criteria, which may improve the effectiveness and efficiency of trauma triage. Copyright © 2011 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

A BEFORE AND AFTER TRIAL OF THE EFFECTIVENESS OF NETWORK ANALYSIS IN HEALTH OPERATIONS MANAGEMENT.

PubMed

Bhalwar, R; Srivastava, M; Verma, S S; Vaze, M; Tilak, V W

1996-10-01

An intervention trial using "before-and-after" approach was undertaken to address the question whether network analysis as a health managerial tool of control can favourably affect the delays that occur in planning and executing the antimalaria operations of a Station Health Organization in a large military station. Exposure variable of interest was intervention with a network diagram, by which the potential causes of delay along the various activities were assessed and remedial measures were introduced during the second year. Sample size was calculated using conventional alpha and beta error levels. The study indicated that there was a definite beneficial outcome in that the operations could be started as well as completed in time during the intervention year. There was reduction in time requirement in 5 out of the 9 activities, the exact 'p' value being 0.08, by both parametric and non-parametric tests. The use of network analysis in health care management has been recommended.

The effectiveness of an intervention to reduce alcohol-related violence in premises licensed for the sale and on-site consumption of alcohol: a randomized controlled trial.

PubMed

Moore, Simon C; Alam, M Fasihul; Heikkinen, Marjukka; Hood, Kerenza; Huang, Chao; Moore, Laurence; Murphy, Simon; Playle, Rebecca; Shepherd, Jonathan; Shovelton, Claire; Sivarajasingam, Vaseekaran; Williams, Anne

2017-11-01

Premises licensed for the sale and consumption of alcohol can contribute to levels of assault-related injury through poor operational practices that, if addressed, could reduce violence. We tested the real-world effectiveness of an intervention designed to change premises operation, whether any intervention effect changed over time, and the effect of intervention dose. A parallel randomized controlled trial with the unit of allocation and outcomes measured at the level of individual premises. All premises (public houses, nightclubs or hotels with a public bar) in Wales, UK. A randomly selected subsample (n = 600) of eligible premises (that had one or more violent incidents recorded in police-recorded crime data; n = 837) were randomized into control and intervention groups. Intervention premises were audited by Environmental Health Practitioners who identified risks for violence and provided feedback by varying dose (informal, through written advice, follow-up visits) on how risks could be addressed. Control premises received usual practice. Police data were used to derive a binary variable describing whether, on each day premises were open, one or more violent incidents were evident over a 455-day period following randomization. Due to premises being unavailable at the time of intervention delivery 208 received the intervention and 245 were subject to usual practice in an intention-to-treat analysis. The intervention was associated with an increase in police recorded violence compared to normal practice (hazard ratio = 1.34, 95% confidence interval = 1.20-1.51). Exploratory analyses suggested that reduced violence was associated with greater intervention dose (follow-up visits). An Environmental Health Practitioner-led intervention in premises licensed for the sale and on-site consumption of alcohol resulted in an increase in police recorded violence. © 2017 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

Knowledge translation strategies to improve the use of evidence in public health decision making in local government: intervention design and implementation plan

PubMed Central

2013-01-01

Background Knowledge translation strategies are an approach to increase the use of evidence within policy and practice decision-making contexts. In clinical and health service contexts, knowledge translation strategies have focused on individual behavior change, however the multi-system context of public health requires a multi-level, multi-strategy approach. This paper describes the design of and implementation plan for a knowledge translation intervention for public health decision making in local government. Methods Four preliminary research studies contributed findings to the design of the intervention: a systematic review of knowledge translation intervention effectiveness research, a scoping study of knowledge translation perspectives and relevant theory literature, a survey of the local government public health workforce, and a study of the use of evidence-informed decision-making for public health in local government. A logic model was then developed to represent the putative pathways between intervention inputs, processes, and outcomes operating between individual-, organizational-, and system-level strategies. This formed the basis of the intervention plan. Results The systematic and scoping reviews identified that effective and promising strategies to increase access to research evidence require an integrated intervention of skill development, access to a knowledge broker, resources and tools for evidence-informed decision making, and networking for information sharing. Interviews and survey analysis suggested that the intervention needs to operate at individual and organizational levels, comprising workforce development, access to evidence, and regular contact with a knowledge broker to increase access to intervention evidence; develop skills in appraisal and integration of evidence; strengthen networks; and explore organizational factors to build organizational cultures receptive to embedding evidence in practice. The logic model incorporated these inputs and strategies with a set of outcomes to measure the intervention’s effectiveness based on the theoretical frameworks, evaluation studies, and decision-maker experiences. Conclusion Documenting the design of and implementation plan for this knowledge translation intervention provides a transparent, theoretical, and practical approach to a complex intervention. It provides significant insights into how practitioners might engage with evidence in public health decision making. While this intervention model was designed for the local government context, it is likely to be applicable and generalizable across sectors and settings. Trial registration Australia New Zealand Clinical Trials Register ACTRN12609000953235. PMID:24107358

Speech-generating devices: effectiveness of interface design-a comparative study of autism spectrum disorders.

PubMed

Chen, Chien-Hsu; Wang, Chuan-Po; Lee, I-Jui; Su, Chris Chun-Chin

2016-01-01

We analyzed the efficacy of the interface design of speech generating devices on three non-verbal adolescents with autism spectrum disorder (ASD), in hopes of improving their on-campus communication and cognitive disability. The intervention program was created based on their social and communication needs in school. Two operating interfaces were designed and compared: the Hierarchical Relating Menu and the Pie Abbreviation-Expansion Menu. The experiment used the ABCACB multiple-treatment reversal design. The test items included: (1) accuracy of operating identification; (2) interface operation in response to questions; (3) degree of independent completion. Each of these three items improved with both intervention interfaces. The children were able to operate the interfaces skillfully and respond to questions accurately, which evidenced the effectiveness of the interfaces. We conclude that both interfaces are efficacious enough to help nonverbal children with ASD at different levels.

Musical intervention reduces patients' anxiety in surgical extraction of an impacted mandibular third molar.

PubMed

Kim, Yu-Kyoung; Kim, Soung-Min; Myoung, Hoon

2011-04-01

Patients undergoing impacted mandibular third molar (IMTM) extraction often have severe perioperative anxiety, which may lead to increased perceptions of pain and vital sign instability throughout surgery. Intraoperational musical interventions have been used during operations to decrease patient anxiety levels. We investigated the anxiolytic effects of musical intervention during surgical extraction of an IMTM. We tested the hypothesis that musical intervention would have positive effects on patients' vital signs, anxiety levels, and perceptions of pain. We recruited 219 patients with IMTM surgery to participate in this study. Participants were randomly assigned to a music-treated group (106 subjects) or a control group (113 subjects). In a preoperative meeting, patient demographic data were collected, and the patients' favorite songs were selected. For the music-treated group, their selected music was played from the time of arrival to the operating room until the end of the operation. Perioperative anxiety and perceptions of pain were assessed using the Dental Anxiety Scale and the Visual Analog Scale, respectively. Patients' vital signs (blood pressure, heart rate, and respiratory rate) were monitored throughout the surgery. One-way analysis of covariance using perioperative anxiety as a covariant was performed to compare intraoperative anxiety levels and perioperative perceptions of pain between the 2 groups. Repeated measures analysis of variance was used to compare changes in vital signs across surgical stages between the 2 groups. Vital signs changed significantly throughout surgery according to the stage of the procedure. For both groups, vital signs increased from baseline and reached peak values at the time of the initial incision and then decreased quickly and plateaued within normal limits. There were no significant differences between groups in blood pressure; however, the music-treated group showed a significantly smaller change in heart rate than the control group. The music-treated group reported significantly less intraoperative anxiety than the nonmusic-treated control group when controlling for preoperative anxiety levels (F = 4.226, P < .05). These results support the hypothesis that the use of patient-chosen music during surgical extraction of an IMTM significantly lowers patient intraoperative anxiety levels. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Correlation of technical surgical goals to the GDI and investigation of post-operative GDI change in children with cerebral palsy.

PubMed

Bickley, Christina; Linton, Judi; Scarborough, Nancy; Sullivan, Elroy; Mitchell, Katy; Barnes, Douglas

2017-06-01

The purpose of this study was to introduce a standardized set of surgical technical achievement goals (TAGs) as part of a comprehensive outcome assessment model for children with spastic cerebral palsy (CP) undergoing orthopaedic surgical intervention to improve gait. Examination of relationships of these surgical goals to the Gait Deviation Index (GDI) and use of two assessments in tandem provided a thorough picture of technical surgical outcomes. This study also investigated changes in GDI in children with spastic CP after surgery. Data from 269 participants with spastic CP, aged 4 to 19 years with Gross Motor Function Classification System (GMFCS) levels I, II, and III who underwent lower extremity orthopaedic surgical intervention to improve gait were retrospectively analyzed. Data were examined as one heterogeneous group and sub-grouped based on pattern of involvement and GMFCS level to determine change in GDI and relationships between GDI and TAGs. Differences in TAG achievement and GDI change by GMFCS level suggest a pairing of GDI with another technical measure to be beneficial. Analysis of the outcome tools individually revealed a significant difference between the pre-operative GDI and post-operative GDI mean for the entire group, as well as each of the subgroups. A significant difference in TAG achievement by GMFCS level was also noted. This paper provides evidence that lower extremity orthopedic intervention for the ambulatory child with spastic diplegic or hemiplegic CP improves gait and that a pairing of the GDI and TAGs system is beneficial to capture an accurate technical outcome assessment in both higher and lower functioning patients. Copyright © 2017 Elsevier B.V. All rights reserved.

The Impact of a Multi-Level Multi-Component Childhood Obesity Prevention Intervention on Healthy Food Availability, Sales, and Purchasing in a Low-Income Urban Area.

PubMed

Gittelsohn, Joel; Trude, Angela C; Poirier, Lisa; Ross, Alexandra; Ruggiero, Cara; Schwendler, Teresa; Anderson Steeves, Elizabeth

2017-11-10

The multifactorial causes of obesity require multilevel and multicomponent solutions, but such combined strategies have not been tested to improve the community food environment. We evaluated the impact of a multilevel (operating at different levels of the food environment) multicomponent (interventions occurring at the same level) community intervention. The B'more Healthy Communities for Kids (BHCK) intervention worked at the wholesaler ( n = 3), corner store ( n = 50), carryout ( n = 30), recreation center ( n = 28), household ( n = 365) levels to improve availability, purchasing, and consumption of healthier foods and beverages (low-sugar, low-fat) in low-income food desert predominantly African American zones in the city of Baltimore (MD, USA), ultimately intending to lead to decreased weight gain in children (not reported in this manuscript). For this paper, we focus on more proximal impacts on the food environment, and measure change in stocking, sales and purchase of promoted foods at the different levels of the food system in 14 intervention neighborhoods, as compared to 14 comparison neighborhoods. Sales of promoted products increased in wholesalers. Stocking of these products improved in corner stores, but not in carryouts, and we did not find any change in total sales. Children more exposed to the intervention increased their frequency of purchase of promoted products, although improvement was not seen for adult caregivers. A multilevel food environment intervention in a low-income urban setting improved aspects of the food system, leading to increased healthy food purchasing behavior in children.

The Impact of a Multi-Level Multi-Component Childhood Obesity Prevention Intervention on Healthy Food Availability, Sales, and Purchasing in a Low-Income Urban Area

PubMed Central

Gittelsohn, Joel; Trude, Angela C.; Poirier, Lisa; Ross, Alexandra; Ruggiero, Cara; Schwendler, Teresa; Anderson Steeves, Elizabeth

2017-01-01

The multifactorial causes of obesity require multilevel and multicomponent solutions, but such combined strategies have not been tested to improve the community food environment. We evaluated the impact of a multilevel (operating at different levels of the food environment) multicomponent (interventions occurring at the same level) community intervention. The B’more Healthy Communities for Kids (BHCK) intervention worked at the wholesaler (n = 3), corner store (n = 50), carryout (n = 30), recreation center (n = 28), household (n = 365) levels to improve availability, purchasing, and consumption of healthier foods and beverages (low-sugar, low-fat) in low-income food desert predominantly African American zones in the city of Baltimore (MD, USA), ultimately intending to lead to decreased weight gain in children (not reported in this manuscript). For this paper, we focus on more proximal impacts on the food environment, and measure change in stocking, sales and purchase of promoted foods at the different levels of the food system in 14 intervention neighborhoods, as compared to 14 comparison neighborhoods. Sales of promoted products increased in wholesalers. Stocking of these products improved in corner stores, but not in carryouts, and we did not find any change in total sales. Children more exposed to the intervention increased their frequency of purchase of promoted products, although improvement was not seen for adult caregivers. A multilevel food environment intervention in a low-income urban setting improved aspects of the food system, leading to increased healthy food purchasing behavior in children. PMID:29125558

[Health promotion based on assets: how to work with this perspective in local interventions?

PubMed

Cofiño, Rafael; Aviñó, Dory; Benedé, Carmen Belén; Botello, Blanca; Cubillo, Jara; Morgan, Antony; Paredes-Carbonell, Joan Josep; Hernán, Mariano

2016-11-01

An asset-based approach could be useful to revitalise health promotion or community health interventions combining work with multiple partnerships, positive health, community engagement, equity and orientation of health determinants. We set some recommendations about how to incorporate the assets model in programmes, projects and interventions in health promotion. Some techniques are described for assets mapping and some experiences with this methodology being developed in different regions are systematised. We propose the term "Asset-based Health Promotion/Community Health" as an operational definition to work at the local level with a community engagement and participatory approach, building alliances between different institutions at the state-regional level and trying to create a framework for action with the generation of evaluations and evidence to work on population interventions from the perspective of positive health. Copyright © 2016 SESPAS. All rights reserved.

Barriers to the sustainability of an intervention designed to improve patient engagement within NHS mental health rehabilitation units: a qualitative study nested within a randomised controlled trial.

PubMed

Lean, Melanie; Leavey, Gerard; Killaspy, Helen; Green, Nicholas; Harrison, Isobel; Cook, Sarah; Craig, Thomas; Holloway, Frank; Arbuthnott, Maurice; King, Michael

2015-09-02

We undertook a cluster randomised controlled trial to assess the effectiveness of a staff training intervention to improve patient engagement in activities in inpatient mental health rehabilitation units. Concurrently, we undertook a qualitative study to investigate the experiences of staff within the intervention units and the contextual issues that may have influenced the effectiveness of the intervention. We conducted focus groups with staff working in the inpatient units that received the intervention, sampled using a maximum variation strategy. The intervention was accepted by staff. However, the skills gained, and changes to the unit's processes and structures that were agreed with the intervention team were not sustained after they left. The main reasons for this were a) external factors (economic recession, resource limitations); b) organisation level factors (lack of senior staff support; competing priorities); c) limitations of the intervention itself (length of intensive training period; reinforcement of skills). This study illustrates some of the inter-related factors which operate at different levels within and outside of NHS organisations that may impact on the success of complex interventions. These factors need to be considered when designing interventions to ensure adequate buy-in from senior staff. Current Controlled Trials ISRCTN25898179 (Registered 23 April 2010).

Mothers' level of education and childbirth interventions: A population-based study in Flanders, Northern Belgium.

PubMed

Cammu, Hendrik; Martens, Guy; Keirse, Marc J N C

2011-09-01

  Interventions to influence the time and way to be born have been a global concern for decades. Yet, limited information is available on what drives these interventions and their variation in frequency among countries, institutions, and practitioners. The objective of this study was to examine to what extent first-time mothers' educational achievement contributes to the frequency of childbirth interventions.   Childbirth interventions, including induction of labor, cesarean section, instrumental delivery, and epidural analgesia, registered by the Flemish Study Center for Perinatal Epidemiology for Belgian-born nulliparous women from 1999 to 2006, were linked to the level of maternal education, recorded by the Belgian civil birth registration. Education was divided into four levels based on the highest diploma attained and adjusted for marital and occupational status.   Frequencies of all interventions were inversely related to the level of maternal education. The effect remained after adjustment for birth year, maternal age, marital status, occupation, infant birthweight, gestational age, assisted conception, and type of hospital. Effect sizes between highest and lowest levels of education were relatively small for operative (31% vs 36%) and instrumental vaginal birth (20.7% vs 22.3%) compared with "initiated delivery" (defined as labor induction and prelabor cesarean section; 30.2% vs 40.3%) and epidural analgesia (66.8% vs 78.0%). The educational gradient in initiated delivery occurred at all gestational ages, contributing to lower gestational age and lower birthweight of term infants with decreasing levels of education.   In an affluent society with universal and equitable access to maternity care, the more educated women are, the more likely they are to have a spontaneous labor and spontaneous birth without intervention. (BIRTH 38:3 September 2011). © 2011, Copyright the Authors. Journal compilation © 2011, Wiley Periodicals, Inc.

Structured recording of intraoperative surgical workflows

NASA Astrophysics Data System (ADS)

Neumuth, T.; Durstewitz, N.; Fischer, M.; Strauss, G.; Dietz, A.; Meixensberger, J.; Jannin, P.; Cleary, K.; Lemke, H. U.; Burgert, O.

2006-03-01

Surgical Workflows are used for the methodical and scientific analysis of surgical interventions. The approach described here is a step towards developing surgical assist systems based on Surgical Workflows and integrated control systems for the operating room of the future. This paper describes concepts and technologies for the acquisition of Surgical Workflows by monitoring surgical interventions and their presentation. Establishing systems which support the Surgical Workflow in operating rooms requires a multi-staged development process beginning with the description of these workflows. A formalized description of surgical interventions is needed to create a Surgical Workflow. This description can be used to analyze and evaluate surgical interventions in detail. We discuss the subdivision of surgical interventions into work steps regarding different levels of granularity and propose a recording scheme for the acquisition of manual surgical work steps from running interventions. To support the recording process during the intervention, we introduce a new software architecture. Core of the architecture is our Surgical Workflow editor that is intended to deal with the manifold, complex and concurrent relations during an intervention. Furthermore, a method for an automatic generation of graphs is shown which is able to display the recorded surgical work steps of the interventions. Finally we conclude with considerations about extensions of our recording scheme to close the gap to S-PACS systems. The approach was used to record 83 surgical interventions from 6 intervention types from 3 different surgical disciplines: ENT surgery, neurosurgery and interventional radiology. The interventions were recorded at the University Hospital Leipzig, Germany and at the Georgetown University Hospital, Washington, D.C., USA.

[Effects of Losartan on expression of heme oxygenases in volume-overloaded rats with left-to-right shunt].

PubMed

Yuan, Li-Xing; Liu, Han-Min; Li, Mi; Gao, Ju; Zhou, Tong-Fu

2005-09-01

To study the expression of heme oxygenase-1 mRNA and pulmonary remodeling before and after surgical establishment of left-to-right shunt in volume-overloaded SD rats and rats with Losartan intervention. Left-to-right shunt volume-overloaded SD rat models were established by aortocaval shunt operation. Seven rats with shunt were placed on Losartan (Losartan group), 7 rats with but not given Losartan were included in the operation group, and 4 rats after sham operation served as controls. Pulmonary pressure and right ventricular pressure were measured during catheterization. The relative weights ventricles were determined after execution of the rats. Pulmonary vascular remodeling parameters, including percentage arterial wall thickness and percentage muscularized small arteries, were assessed by morphometry. Heme oxygenase-1 (HO-1) mRNA expression and heme oxygenase-2 (HO-2) mRNA expression were detected RT-PCR method. Pulmonary artery pressure and right ventricular relative weight decreased significantly in the rats of Losartan group; in addition, the percentage arterial wall thickness and percentage of muscularized small arteries in the Losartan group were reduced as compared with those in the operation group. The level 1 mRAN expression in rats with shunt was significantly higher than that in rats without shunt. The level mRNA expression in the Losartan group decreased remarkably as compared against that in the operation The level of HO-1 mRNA expression in lungs was significantly higher than that in ventricles. There statistically significant differences in HO-2 mRNA expression levels between the three rat groups. Losartan intervention can markedly reduce pulmonary pressure, inhibit vascular remodeling in volume-overloaded left-to-right shunt rats, and result in down-regulation of HO-1 mRNA expression.

Differentiating in Number & Operations: A Guide for Ongoing Assessment, Grouping Students, Targeting Instruction, and Adjusting Levels of Cognitive Demand

ERIC Educational Resources Information Center

Taylor-Cox, Jennifer

2008-01-01

Differentiating is good teaching. As a math intervention tool, it's power packed. And as a math acceleration instrument it's unbeatable. And differentiation doesn't have to be difficult. Not with "Differentiation in Number & Operations and the Other Math Content Standards, PreK-Grade 2". The author's five-volume series shows you easy and effective…

Application of an ecological framework to examine barriers to the adoption of safer conception strategies by HIV-affected couples.

PubMed

Saleem, Haneefa T; Surkan, Pamela J; Kerrigan, Deanna; Kennedy, Caitlin E

2016-01-01

Safer conception interventions can significantly reduce the risk of horizontal HIV transmission between HIV-serodiscordant partners. However, prior to implementing safer conception interventions, it is essential to understand potential barriers to their adoption so that strategies can be developed to overcome these barriers. This paper examines potential barriers to the adoption of safer conception strategies by HIV-affected couples in Iringa, Tanzania using an ecological framework. We interviewed 30 HIV-positive women, 30 HIV-positive men and 30 health providers engaged in delivering HIV-related services. We also conducted direct observations at five health facilities. Findings suggest that there are multiple barriers to safer conception that operate at the individual, relational, environmental, structural, and super-structural levels. The barriers to safer conception identified are complex and interact across these levels. Barriers at the individual level included antiretroviral adherence, knowledge of HIV status, knowledge and acceptability of safer conception strategies, and poor nutrition. At the relational level, unplanned pregnancies, non-disclosure of status, gendered power dynamics within relationships, and patient-provider interactions posed a threat to safer conception. HIV stigma and distance to health facilities were environmental barriers to safer conception. At the structural level there were multiple barriers to safer conception, including limited safer conception policy guidelines for people living with HIV (PLHIV), lack of health provider training in safer conception strategies and preconception counseling for PLHIV, limited resources, and lack of integration of HIV and sexual and reproductive health services. Poverty and gender norms were super-structural factors that influenced and reinforced barriers to safer conception, which influenced and operated across different levels of the framework. Multi-level interventions are needed to ensure adoption of safer conception strategies and reduce the risk of HIV transmission between partners within HIV-serodiscordant couples.

Assessing Interventions to Manage West Nile Virus Using Multi-Criteria Decision Analysis with Risk Scenarios

PubMed Central

Hongoh, Valerie; Campagna, Céline; Panic, Mirna; Samuel, Onil; Gosselin, Pierre; Waaub, Jean-Philippe; Ravel, André; Samoura, Karim; Michel, Pascal

2016-01-01

The recent emergence of West Nile virus (WNV) in North America highlights vulnerability to climate sensitive diseases and stresses the importance of preventive efforts to reduce their public health impact. Effective prevention involves reducing environmental risk of exposure and increasing adoption of preventive behaviours, both of which depend on knowledge and acceptance of such measures. When making operational decisions about disease prevention and control, public health must take into account a wide range of operational, environmental, social and economic considerations in addition to intervention effectiveness. The current study aimed to identify, assess and rank possible risk reduction measures taking into account a broad set of criteria and perspectives applicable to the management of WNV in Quebec under increasing transmission risk scenarios, some of which may be related to ongoing warming in higher-latitude regions. A participatory approach was used to collect information on categories of concern to relevant stakeholders with respect to WNV prevention and control. Multi-criteria decision analysis was applied to examine stakeholder perspectives and their effect on strategy rankings under increasing transmission risk scenarios. Twenty-three preventive interventions were retained for evaluation using eighteen criteria identified by stakeholders. Combined evaluations revealed that, at an individual-level, inspecting window screen integrity, wearing light colored, long clothing, eliminating peridomestic larval sites and reducing outdoor activities at peak times were top interventions under six WNV transmission scenarios. At a regional-level, the use of larvicides was a preferred strategy in five out of six scenarios, while use of adulticides and dissemination of sterile male mosquitoes were found to be among the least favoured interventions in almost all scenarios. Our findings suggest that continued public health efforts aimed at reinforcing individual-level preventive behaviours combined with the application of larvicides to manage the risk of WNV infection are the interventions most acceptable and effective at reaching current management objectives now and under future theoretical transmission risk. PMID:27494136

An Intelligent Propulsion Control Architecture to Enable More Autonomous Vehicle Operation

NASA Technical Reports Server (NTRS)

Litt, Jonathan S.; Sowers, T. Shane; Simon, Donald L.; Owen, A. Karl; Rinehart, Aidan W.; Chicatelli, Amy K.; Acheson, Michael J.; Hueschen, Richard M.; Spiers, Christopher W.

2018-01-01

This paper describes an intelligent propulsion control architecture that coordinates with the flight control to reduce the amount of pilot intervention required to operate the vehicle. Objectives of the architecture include the ability to: automatically recognize the aircraft operating state and flight phase; configure engine control to optimize performance with knowledge of engine condition and capability; enhance aircraft performance by coordinating propulsion control with flight control; and recognize off-nominal propulsion situations and to respond to them autonomously. The hierarchical intelligent propulsion system control can be decomposed into a propulsion system level and an individual engine level. The architecture is designed to be flexible to accommodate evolving requirements, adapt to technology improvements, and maintain safety.

Instrumental delivery: clinical practice guidelines from the French College of Gynaecologists and Obstetricians.

PubMed

Vayssière, Christophe; Beucher, Gael; Dupuis, Olivier; Feraud, Olivia; Simon-Toulza, Caroline; Sentilhes, Loïc; Meunier, Emmanuelle; Parant, Olivier; Schmitz, Thomas; Riethmuller, Didier; Baud, Olivier; Galley-Raulin, Fabienne; Diemunsch, Pierre; Pierre, Fabrice; Schaal, Jean-Patrick; Fournié, Alain; Oury, Jean François

2011-11-01

Routine use of a partograph is associated with a reduction in the use of forceps, but is not associated with a reduction in the use of vacuum extraction (Level A). Early artificial rupture of the membranes, associated with oxytocin perfusion, does not reduce the number of operative vaginal deliveries (Level A), but does increase the rate of fetal heart rate abnormalities (Level B). Early correction of lack of progress in dilatation by oxytocin perfusion can reduce the number of operative vaginal deliveries (Level B). The use of low-concentration epidural infusions of bupivacaine potentiated by morphinomimetics reduces the number of operative interventions compared with larger doses (Level A). Placement of an epidural before 3-cm dilatation does not increase the number of operative vaginal deliveries (Level A). Posterior positions of the fetus result in more operative vaginal deliveries (Level B). Manual rotation of the fetus from a posterior position to an anterior position may reduce the number of operative deliveries (Level C). Walking during labour is not associated with a reduction in the number of operative vaginal deliveries (Level A). Continuous support of the parturient by a midwife or partner/family member during labour reduces the number of operative vaginal deliveries (Level A). Under epidural analgesia, delayed pushing (2h after full dilatation) reduces the number of difficult operative vaginal deliveries (Level A). Ultrasound is recommended if there is any clinical doubt about the presentation of the fetus (Level B). The available scientific data are insufficient to contra-indicate attempted midoperative delivery (professional consensus). The duration of the operative intervention is slightly shorter with forceps than with a vacuum extractor (Level C). Nonetheless, the urgency of operative delivery is not a reason to choose one instrument over another (professional consensus). The cup-shaped vacuum extractor seems to be the instrument of choice for operative deliveries of fetuses in a cephalic transverse position, and may also be preferred for fetuses in a posterior position (professional consensus). Vacuum extraction deliveries fail more often than forceps deliveries (Level B). Overall, immediate maternal complications are more common for forceps deliveries than vacuum extraction deliveries (Level B). Compared with forceps, operative vaginal delivery using a vacuum extractor appears to reduce the number of episiotomies (Level B), first- and second-degree perineal lesions, and damage to the anal sphincter (Level B). Among the long-term complications, the rate of urinary incontinence is similar following forceps, vacuum extraction and spontaneous vaginal deliveries (Level B). Anal incontinence is more common following forceps delivery (Level B). Persistent anal incontinence has a similar prevalence regardless of the mode of delivery (caesarean or vaginal, instrumental or non-instrumental), suggesting the involvement of other factors (Level B). Rates of immediate neonatal mortality and morbidity are similar for forceps and vacuum extraction deliveries (Level B). It appears that difficult instrumental delivery may lead to psychological sequelae that may result in a decision not to have more children (Level C). The rates of neonatal convulsions, intracranial haemorrhage and jaundice do not differ between forceps and vacuum extraction deliveries (Levels B and C). Rapid sequence induction with a Sellick manoeuvre (pressure to the cricoid cartilage) and tracheal intubation with a balloon catheter is recommended for any general anaesthesia (Level B). Training must ensure that obstetricians can identify indications and contra-indications, choose the appropriate instrument, use the instruments correctly, and know the principles of quality control applied to operative vaginal delivery. Nowadays, traditional training can be accompanied by simulations. Training should be individualized and extended for some students. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Impact of Injury Mechanisms on Patterns and Management of Facial Fractures.

PubMed

Greathouse, S Travis; Adkinson, Joshua M; Garza, Ramon; Gilstrap, Jarom; Miller, Nathan F; Eid, Sherrine M; Murphy, Robert X

2015-07-01

Mechanisms causing facial fractures have evolved over time and may be predictive of the types of injuries sustained. The objective of this study is to examine the impact of mechanisms of injury on the type and management of facial fractures at our Level 1 Trauma Center. The authors performed an Institutional Review Board-approved review of our network's trauma registry from 2006 to 2010, documenting age, sex, mechanism, Injury Severity Score, Glasgow Coma Scale, facial fracture patterns (nasal, maxillary/malar, orbital, mandible), and reconstructions. Mechanism rates were compared using a Pearson χ2 test. The database identified 23,318 patients, including 1686 patients with facial fractures and a subset of 1505 patients sustaining 2094 fractures by motor vehicle collision (MVC), fall, or assault. Nasal fractures were the most common injuries sustained by all mechanisms. MVCs were most likely to cause nasal and malar/maxillary fractures (P < 0.01). Falls were the least likely and assaults the most likely to cause mandible fractures (P < 0.001), the most common injury leading to surgical intervention (P < 0.001). Although not statistically significant, fractures sustained in MVCs were the most likely overall to undergo surgical intervention. Age, number of fractures, and alcohol level were statistically significant variables associated with operative management. Age and number of fractures sustained were associated with operative intervention. Although there is a statistically significant correlation between mechanism of injury and type of facial fracture sustained, none of the mechanisms evaluated herein are statistically associated with surgical intervention. Clinical Question/Level of Evidence: Therapeutic, III.

Developing a community-level anti-HIV/AIDS stigma and homophobia intervention in new York city: The project CHHANGE model.

PubMed

Frye, Victoria; Paige, Mark Q; Gordon, Steven; Matthews, David; Musgrave, Geneva; Kornegay, Mark; Greene, Emily; Phelan, Jo C; Koblin, Beryl A; Taylor-Akutagawa, Vaughn

2017-08-01

HIV/AIDS stigma and homophobia are associated with significant negative health and social outcomes among people living with HIV/AIDS (PLWHA) and those at risk of infection. Interventions to decrease HIV stigma have focused on providing information and education, changing attitudes and values, and increasing contact with people living with HIV/AIDS (PLWHA), activities that act to reduce stereotyped beliefs and prejudice, as well as acts of discrimination. Most anti-homophobia interventions have focused on bullying reduction and have been implemented at the secondary and post-secondary education levels. Few interventions address HIV stigma and homophobia and operate at the community level. Project CHHANGE, Challenge HIV Stigma and Homophobia and Gain Empowerment, was a community-level, multi-component anti-HIV/AIDS stigma and homophobia intervention designed to reduce HIV stigma and homophobia thus increasing access to HIV prevention and treatment access. The theory-based intervention included three primary components: workshops and trainings with local residents, businesses and community-based organizations (CBO); space-based events at a CBO-partner drop-in storefront and "pop-up" street-based events and outreach; and a bus shelter ad campaign. This paper describes the intervention design process, resultant intervention and the study team's experiences working with the community. We conclude that CHHANGE was feasible and acceptable to the community. Promoting the labeling of gay and/or HIV-related "space" as a non-stigmatized, community resource, as well as providing opportunities for residents to have contact with targeted groups and to understand how HIV stigma and homophobia relate to HIV/AIDS prevalence in their neighborhood may be crucial components of successful anti-stigma and discrimination programming. Copyright © 2017. Published by Elsevier Ltd.

Nourishing networks: A social-ecological analysis of a network intervention for improving household nutrition in Western Kenya.

PubMed

DeLorme, Autumn L; Gavenus, Erika R; Salmen, Charles R; Benard, Gor Ouma; Mattah, Brian; Bukusi, Elizabeth; Fiorella, Kathryn J

2018-01-01

A growing body of research emphasizes the need to engage social networks in maternal and child nutrition interventions. However, an understanding of how interventions functionally engage not only mothers but fathers, grandparents, friends, and other social network members remains limited. This study uses an adaptation of a social-ecological model to analyze the multiple levels at which the Kanyakla Nutrition Program operates to change behavior. This study analyzes focus group data (four groups; n = 35, 7 men and 28 women) following the implementation of the Kanyakla Nutrition Program, a novel nutrition intervention engaging social networks to increase nutrition knowledge, shift perceptions, and promote positive practices for infant and young child feeding and community nutrition in general. Participant perspectives indicate that the Kanyakla Nutrition Program contributed to nutrition knowledge and confidence, changed perceptions, and supported infant and child feeding practices at the individual, interpersonal, and institutional levels. However, many respondents report challenges in transcending barriers at the broader community and systems levels of influence, where environmental and economic constraints continue to affect food access. Analysis of the Kanyakla Nutrition Program suggests that for interventions addressing household level determinants of nutrition, simultaneously engaging the household's network of interpersonal and community relationships can play a role in building momentum and consensus to address persistent structural barriers to improved nutrition. Copyright © 2017 Elsevier Ltd. All rights reserved.

Eye lens dosimetry in interventional cardiology: results of staff dose measurements and link to patient dose levels.

PubMed

Antic, V; Ciraj-Bjelac, O; Rehani, M; Aleksandric, S; Arandjic, D; Ostojic, M

2013-01-01

Workers involved in interventional cardiology procedures receive high eye lens dose if protection is not used. Currently, there is no suitable method for routine use for the measurement of eye dose. Since most angiography machines are equipped with suitable patient dosemeters, deriving factors linking staff eye doses to the patient doses can be helpful. In this study the patient kerma-area product, cumulative dose at an interventional reference point and eye dose in terms of Hp(3) of the cardiologists, nurses and radiographers for interventional cardiology procedures have been measured. Correlations between the patient dose and the staff eye dose were obtained. The mean eye dose was 121 µSv for the first operator, 33 µSv for the second operator/nurse and 12 µSv for radiographer. Normalised eye lens doses per unit kerma-area product were 0.94 µSv Gy⁻¹ cm⁻² for the first operator, 0.33 µSv Gy⁻¹ cm⁻² for the second operator/nurse and 0.16 µSv Gy⁻¹ cm⁻² for radiographers. Statistical analysis indicated that there is a weak but significant (p < 0.01) correlation between the eye dose and the kerma-area product for all three staff categories. These values are based on a local practice and may provide useful reference for other studies for validation and for wider utilisation in assessing the eye dose using patient dose values.

Impact of robotics and a suspended lead suit on physician radiation exposure during percutaneous coronary intervention.

PubMed

Madder, Ryan D; VanOosterhout, Stacie; Mulder, Abbey; Elmore, Matthew; Campbell, Jessica; Borgman, Andrew; Parker, Jessica; Wohns, David

Reports of left-sided brain malignancies among interventional cardiologists have heightened concerns regarding physician radiation exposure. This study evaluated the impact of a suspended lead suit and robotic system on physician radiation exposure during percutaneous coronary intervention (PCI). Real-time radiation exposure data were prospectively collected from dosimeters worn by operating physicians at the head- and chest-level during consecutive PCI cases. Exposures were compared in three study groups: 1) manual PCI performed with traditional lead apparel; 2) manual PCI performed using suspended lead; and 3) robotic PCI performed in combination with suspended lead. Among 336 cases (86.6% manual, 13.4% robotic) performed over 30weeks, use of suspended lead during manual PCI was associated with significantly less radiation exposure to the chest and head of operating physicians than traditional lead apparel (chest: 0.0 [0.1] μSv vs 0.4 [4.0] μSv, p<0.001; head: 0.5 [1.9] μSv vs 14.9 [51.5] μSv, p<0.001). Chest-level radiation exposure during robotic PCI performed in combination with suspended lead was 0.0 [0.0] μSv, which was significantly less chest exposure than manual PCI performed with traditional lead (p<0.001) or suspended lead (p=0.046). In robotic PCI the median head-level exposure was 0.1 [0.2] μSv, which was 99.3% less than manual PCI performed with traditional lead (p<0.001) and 80.0% less than manual PCI performed with suspended lead (p<0.001). Utilization of suspended lead and robotics were observed to result in significantly less radiation exposure to the chest and head of operating physicians during PCI. Copyright © 2016 Elsevier Inc. All rights reserved.

A feasibility study of a psychoeducational intervention program for gynecological cancer patients.

PubMed

Chow, Ka Ming; Chan, Carmen W H; Chan, Joanne C Y; Choi, Kai K C; Siu, K Y

2014-08-01

This study aimed to test the feasibility of implementing a psychoeducational intervention program for gynecological cancer patients. A single-blinded randomized controlled trial and mixed-method design were used. Study subjects were newly diagnosed gynecological cancer patients with surgery as the first-line treatment. They were randomly assigned to the intervention group, in which a psychoeducational intervention program based on a thematic counseling model was offered, or to the attention control group. Quantitative data on sexual functioning, quality of life, uncertainty, anxiety, depression and social support were collected at recruitment, post-operative and during the in-hospital period, and eight weeks after the operation. Participants in the intervention group and three nurses working in the clinical setting were invited to have semi-structured interviews. Of the 30 eligible subjects, 26 were successfully recruited into the study. Following the psychoeducational intervention program, there was significant improvement in the level of inconsistent information about the illness within the category of uncertainty among participants in the intervention group. In addition, trends towards improvement were demonstrated in quality of life, uncertainty, depression and perceived social support with the provision of the interventions. Qualitative data indicated the interventions were desired and appreciated by the participants, as well as being feasible and practical to implement in Hong Kong clinical settings. The findings suggest that it is feasible to deliver the psychoeducational intervention program and it may have beneficial effects in gynecological cancer patients. A full-scale study is warranted to confirm the results. Copyright © 2014 Elsevier Ltd. All rights reserved.

Agent-based human-robot interaction of a combat bulldozer

NASA Astrophysics Data System (ADS)

Granot, Reuven; Feldman, Maxim

2004-09-01

A small-scale supervised autonomous bulldozer in a remote site was developed to experience agent based human intervention. The model is based on Lego Mindstorms kit and represents combat equipment, whose job performance does not require high accuracy. The model enables evaluation of system response for different operator interventions, as well as for a small colony of semiautonomous dozers. The supervising human may better react than a fully autonomous system to unexpected contingent events, which are a major barrier to implement full autonomy. The automation is introduced as improved Man Machine Interface (MMI) by developing control agents as intelligent tools to negotiate between human requests and task level controllers as well as negotiate with other elements of the software environment. Current UGVs demand significant communication resources and constant human operation. Therefore they will be replaced by semi-autonomous human supervisory controlled systems (telerobotic). For human intervention at the low layers of the control hierarchy we suggest a task oriented control agent to take care of the fluent transition between the state in which the robot operates and the one imposed by the human. This transition should take care about the imperfections, which are responsible for the improper operation of the robot, by disconnecting or adapting them to the new situation. Preliminary conclusions from the small-scale experiments are presented.

A safety radiation marker in the cardiac catheterization lab.

PubMed

Kostakou, Peggy M; Damaskos, Dimitris S; Dagre, Anna G; Makavos, Georgios A; Olympios, Christophoros D

2016-04-01

Nowadays, in order to deal with cardiovascular disease, coronary angiography (CRA) is the best tool and gold standard for diagnosis and assessment. CRA inevitably exposes both patient and operator to radiation. The purpose of this study was to calculate the radiation exposure in association with the radiation absorbed by interventional cardiologists, in order to estimate a safety radiation marker in the catheterization laboratory. In 794 successive patients undergoing CRA and in three interventional cardiologists the following parameters were examined: radioscopy duration, radiation exposure during fluoroscopy, total radiation exposure and the number of stents per procedure. Every interventional cardiologist was exposed to 562,936 μGym2 of total radiation during CRA procedures, to 833,371 μGym2 during elective CRA + percutaneous coronary intervention (PCI) procedures and to 328,250 μGym2 during primary CRA + PCI. Hence, the total amount of radiation that every angiographer was exposed to amounted to 1,724,557.5 μGym2 (median values). During the same period, the average radiation that every angiographer absorbed was 15,253 while the average dose of radiation absorbed during one procedure was 0.06 mSv for each operator. Therefore, the ratio between radiation exposure and the radiation finally absorbed by every operator was 113:1 μGym2/mSv. The present study, indicating the ratio above, offers a safety marker in order to realistically estimate the dose absorbed by interventional cardiologists, suggesting a specified number of permitted procedures and an effective level of radiation use protection tools.

Sex pheromone monitoring as a versatile tool for determining presence and abundance of Cydia pomonella (Lep.: Tortricidae) in German apple orchards.

PubMed

Hummel, H E; Czyrt, T; Schmid, S; Leithold, G; Vilcinskas, A

2012-01-01

Cydia pomonella (Lep.: Tortricidae), the codling moth, is an apple, pear, quince and walnut pest with considerable impact on horticultural production systems in many parts of the world. In commercial apple production, it is responsible for a yearly damage level of 40 billion dollars. In response to the need of tight codling moth control there are several options for intervention by pest managers in commercially operated orchards. Spray and count methods have been used for decades with success, but at considerable external costs for the integrity of ecological cycles. Also, problems with pesticide residues and with resistant strains are an issue of concern. For environmental reasons, toxicological means are discounted here. Instead, flight curves based on sex pheromone trapping and monitoring are preferred means towards determining the optimal timing of interventions by biotechnical and biological control methods. Finally, ecological reasons are discussed for vastly different population levels of C. pomonella developing in closely neighboring field sections which operated under different environmental management.

Analysing teachers' operations when teaching students: what constitutes scientific theories?

NASA Astrophysics Data System (ADS)

Holmqvist, Mona O.; Olander, Clas

2017-05-01

The aim of the study is to analyse teachers' efforts to develop secondary school students' knowledge and argumentation skills of what constitutes scientific theories. The analysis is based on Leontiev's three-level structure of activity (activity, action, and operation), as these levels correspond to the questions why, what, and how content is taught. The unit of analysis was a school development project in science education, where design-based interventions were conducted. Data comprised notes and minutes from eight meetings, plans, and video recordings of the lessons, and a written teacher evaluation. The teachers' (n = 7) learning actions were analysed to identify (a) concept formation in science education, (b) expressions of agency, (c) discursive manifestations of contradictions, and (d) patterns of interaction during the science interventions. Three lessons on what constitutes scientific theories were implemented in three different student groups (n = 24, 23, 24), framed by planning and evaluation meetings for each lesson. The results describe (1) the ways in which teachers became more skilled at ensuring instruction met their students' needs and (2) the ways in which teachers' operations during instruction changed as a result of their developed knowledge of how to express the content based on theoretical assumptions.

Major genitourinary-related bicycle trauma: Results from 20 years at a level-1 trauma center.

PubMed

Osterberg, E Charles; Awad, Mohannad A; Gaither, Thomas W; Sanford, Thomas; Alwaal, Amjad; Hampson, Lindsay A; Yoo, Jennie; McAninch, Jack W; Breyer, Benjamin N

2017-01-01

Epidemiological studies have shown that bicycle trauma is associated with genitourinary (GU) injuries. Our objective is to characterize GU-related bicycle trauma admitted to a level I trauma center. We queried a prospective trauma registry for bicycle injuries over a 20-year period. Patient demographics, triage data, operative interventions and hospital details were collected. In total, 1659 patients were admitted with major bicycle trauma. Of these, 48 cases involved a GU organ, specifically the bladder (n=7), testis (n=6), urethra (n=3), adrenal (n=4) and/or kidneys (n=36). The median age of cyclists with GU injuries was 29 (range 5-70). More men were injured versus women (35 versus 13). GU-related bicycle trauma involved a motor vehicle in 52% (25/48) of injuries. The median injury severity score for GU-related bicycle trauma was 17 (range 1-50). The median number of concomitant organ injuries was 2 (range 0-6), the most common of which was the lungs (13/48, 27%) and ribs (13/48, 27%). The majority of GU injured cyclists were admitted to an ICU (15/48, 31%) or hospital floor (12/48, 25%). Operative intervention for a GU-related trauma was low (12/48, 25%). The most common GU organ injured was the kidney (36/48, 75%) however most were managed nonoperatively (33/36, 92%). Bladder injuries most often required operative intervention (6/7, 86%). Mortality following GU-related bicycle trauma was low (2/48, 4%). In a large series of bicycle trauma, GU organs were injured in 3% of cases. The majority of cases were managed non-operatively and mortality was low. Published by Elsevier Ltd.

Does preoperative oral carbohydrate treatment reduce the postoperative surgical stress response in lumbar disc surgery?

PubMed

Dilmen, Ozlem Korkmaz; Yentur, Ercument; Tunali, Yusuf; Balci, Huriye; Bahar, Mois

2017-02-01

Surgical trauma produces metabolic and hormonal responses, which are characterized by insulin resistance. Due to extension of the preoperative fasting period, which increases the magnitude of postoperative insulin resistance, preoperative oral carbohydrates (POC) have been developed. This prospective, randomized, controlled study was performed on 43 ASA I-II patients undergoing elective microsurgical lumbar discectomy. The intervention group received oral carbohydrate solution 800mL the night before and 400mL 2h prior to operation. The other group fasted for 8h prior to operation. Blood samples were obtained the day before the operation, before induction of anesthesia, after skin incision, 1h, 2h, 6h and 24h following skin incision. Blood glucose, plasma insulin, cortisol and interleukin-6 (IL-6) levels were determined. The primary endpoint was to assess the effect of POC treatment on insulin resistance and surgical stress response following lumbar disc surgery. The secondary endpoint was to assess POC's effects on postoperative nausea and vomiting. The serum insulin levels were higher before induction of anesthesia in the study group and returned to fasted group levels by 2h after skin incision. The plasma IL-6 levels were higher in the intervention group at 6h after the skin incision. There were no differences between the two groups with respect to blood glucose, plasma cortisol levels and the incidence of nausea and vomiting. This study suggests that use of POC treatment does not attenuate development of insulin resistance in patients undergoing lumbar disc surgery. Copyright © 2016. Published by Elsevier B.V.

Current food safety management systems in fish-exporting companies require further improvements to adequately cope with contextual pressure: case study.

PubMed

Onjong, Hillary Adawo; Wangoh, John; Njage, Patrick Murigu Kamau

2014-10-01

Fish-processing plants still face food safety (FS) challenges worldwide despite the existence of several quality assurance standards and food safety management systems/s (FSMSs). This study assessed performance of FSMS in fish exporting sector considering pressure from the context in which they operate. A FSMS diagnostic tool with checklist was used to assess the context, FSMS, and FS output in 9 Kenyan fish exporting companies. Majority (67%) companies operated at moderate- to high-risk context but with an average performance in control and assurance activities. This situation could be insufficient to deal with ambiguity, uncertainty, and vulnerability issues in the context characteristics. Contextual risk posed by product characteristics (nature of raw materials) and chain environment characteristics was high. Risk posed by the chain environment characteristics, low power in supplier relationships, and low degree of authority in customer relationships was high. Lack of authority in relationship with suppliers would lead to high raw material risk situation. Even though cooling facilities, a key control activity, was at an advanced level, there was inadequate packaging intervention equipment which coupled with inadequate physical intervention equipment could lead to further weakened FSMS performance. For the fish companies to improve their FSMS to higher level and enhance predictability, they should base their FSMS on scientific information sources, historical results, and own experimental trials in their preventive, intervention, and monitoring systems. Specific suggestions are derived for improvements toward higher FSMS activity levels or lower risk levels in context characteristics. Weak areas in performance of control and assurance activities in export fish-processing sector already implementing current quality assurance guidelines and standards were studied taking into consideration contextual pressure wherein the companies operate. Important mitigation measures toward improved contextual risk, core assurance, and control activities irrespective of applied food safety management systems in fish industries were suggested. © 2014 Institute of Food Technologists®

Examining the reach of a brief alcohol intervention service in routine practice at a level 1 trauma center.

PubMed

Turner, Brianna J; McCann, Barbara S; Dunn, Christopher W; Darnell, Doyanne A; Beam, Christopher R; Kleiber, Blair; Nelson, Kimberly M; Fukunaga, Rena

2017-08-01

The American College of Surgeons requires Level I and II trauma centers to provide brief intervention services to traumatically injured patients who screen positive for alcohol. Despite evidence supporting substantial cost savings and reduced re-injury associated with these services, brief interventions may not be uniformly delivered owing to a variety of demographic, clinical and operational characteristics. To inform service adjustments that may improve the reach of such services, we compared trauma patients who did and did not receive brief alcohol intervention services during their hospitalizations. Electronic medical records of injured patients admitted to a Level I trauma center between September 27, 2013 and March 11, 2014 with a positive blood alcohol concentration (N=189) were coded for demographic and clinical variables. Records of those who did not receive a brief intervention during their admission were reviewed for possible reasons why interventions were not delivered. Of the total sample, 115 patients (60.8%) received brief interventions. Patients who did and did not receive brief interventions did not differ on age, sex, race, blood alcohol concentration at admission, or mechanism of injury, indicating that patient characteristics were unlikely to bias service delivery. Instead, common features of patients who were referred but did not receive SBIRT interventions included admissions lasting fewer than two working days (12.7%) and persistent cognitive impairment following injury (9.0%). These findings align with previous studies suggesting that service reach could be improved by promoting dedicated and flexible staffing and adapting services to allow for SBIRT delivery in follow-up care settings. Copyright © 2017 Elsevier Inc. All rights reserved.

Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions.

PubMed

White Hughto, Jaclyn M; Reisner, Sari L; Pachankis, John E

2015-12-01

Transgender people in the United States experience widespread prejudice, discrimination, violence, and other forms of stigma. This critical review aims to integrate the literature on stigma towards transgender people in the U.S. This review demonstrates that transgender stigma limits opportunities and access to resources in a number of critical domains (e.g., employment, healthcare), persistently affecting the physical and mental health of transgender people. The applied social ecological model employed here elucidates that transgender stigma operates at multiple levels (i.e., individual, interpersonal, structural) to impact health. Stigma prevention and coping interventions hold promise for reducing stigma and its adverse health-related effects in transgender populations. Additional research is needed to document the causal relationship between stigma and adverse health as well as the mediators and moderators of stigma in US transgender populations. Multi-level interventions to prevent stigma towards transgender people are warranted. Copyright © 2015 Elsevier Ltd. All rights reserved.

Transgender Stigma and Health: A Critical Review of Stigma Determinants, Mechanisms, and Interventions

PubMed Central

White Hughto, Jaclyn M.; Reisner, Sari L.; Pachankis, John E.

2015-01-01

Rationale Transgender people in the United States experience widespread prejudice, discrimination, violence, and other forms of stigma. Objective This critical review aims to integrate the literature on stigma towards transgender people in the US. Results This review demonstrates that transgender stigma limits opportunities and access to resources in a number of critical domains (e.g., employment, healthcare), persistently affecting the physical and mental health of transgender people. The applied social ecological model employed here elucidates that transgender stigma operates at multiple levels (i.e., individual, interpersonal, structural) to impact health. Stigma prevention and coping interventions hold promise for reducing stigma and its adverse health-related effects in transgender populations. Conclusion Additional research is needed to document the causal relationship between stigma and adverse health as well as the mediators and moderators of stigma in US transgender populations. Multi-level interventions to prevent stigma towards transgender people are warranted. PMID:26599625

Assessing community pharmacist engagement in a policing partnership strategy to reduce the illicit diversion of pseudoephedrine products.

PubMed

Webster, Julianne L

2013-01-01

The incidence of illicit diversion of pharmaceutical products is a worldwide problem associated with negative health consequences and with other crimes. The illicit diversion of pharmaceuticals containing the active ingredient pseudoephedrine is of concern, primarily due to the role this substance plays in the manufacture of synthetic illicit drugs such as methylamphetamine. There are a range of strategies employed to curb the problem of precursor diversion. Not least is the development of strategies involving front-line health professionals such as community pharmacists to play an important role in reducing the incidence of diversion. This study aimed to examine levels of pharmacist engagement in an intervention expected to decrease diversion of pseudoephedrine products from community pharmacies. The primary objective was to explore levels of community pharmacist engagement with the intervention and to explore their perceptions of intervention effectiveness. A survey instrument was developed to examine six main areas relating to the implementation, operation and outcomes of the intervention, in addition to the roles performed by community pharmacists in two Australian State jurisdictions. The respondent pharmacists were recruited through a combination of email and facsimile communications from the Pharmacy Guild of Australia and through an electronic pharmacy newsletter. Thirty percent of eligible community pharmacies in the study jurisdictions responded to the survey. The results of the survey highlight that in the absence of an alternative strategy to assist community pharmacists to reduce pseudoephedrine diversion, the majority of respondents were satisfied with the effectiveness of the police-pharmacy intervention. It was found that a pharmacist's positive perception of the role police played in the intervention strongly influenced their engagement in the strategy. Identifying the factors that significantly influence pharmacist engagement in this strategy has broader implications for other law enforcement-public health strategies. It is important for policy models to incorporate these significant elements in their design to enhance the implementation, operation and outcomes of prevention-type interventions. Copyright © 2013 Elsevier Inc. All rights reserved.

Childhood motocross truncal injuries: high-velocity, focal force to the chest and abdomen

PubMed Central

Kennedy, Raelene D; Potter, D Dean; Osborn, John B; Zietlow, Scott; Zarroug, Abdalla E; Moir, Christopher R; Ishitani, Michael B; McIntosh, Amy

2012-01-01

Objectives To review the need for operative intervention and critical care services for motocross truncal injuries in children. Design cohort Retrospective review of patients identified via the hospital trauma registry. Setting Our Level 1 Pediatric Trauma Center serves five motocross tracks. These patients require frequent medical care for injuries. Participants All patients ≤17 years of age with truncal injuries sustained during motocross activities, between 2000 and 2011, were identified through the trauma registry. Primary and secondary outcome measures Operative intervention, intensive care unit (ICU) admission, length of stay, morbidity and demographics were reviewed. Results Motocross injured 162 children. Thirty (18.5%) were thoracic or abdominal injuries. Operative intervention was required in eight (27%) patients. Mean injury severity score (ISS) was 11.8. ICU admission was required in 50% and average hospital length of stay was 4.1 days. The most common injuries include pulmonary contusion, pneumothorax, spleen and liver lacerations. 13% of subjects suffered truncal injury from motocross on more than one occasion. Conclusions Paediatric motocross-related truncal injuries are significant. Surgical intervention is required in 27% of patients. The lower ISS incurred from motocross combined with high surgical and ICU admission rates suggests focal high-impact injuries to the chest and abdomen. Despite significant injury, 13% of motocross patients suffer recurrent injuries. Parents and children need injury prevention education. PMID:23166134

Interventions for Primary School Children With Difficulties in Mathematics.

PubMed

Dowker, Ann

2017-01-01

Difficulty with arithmetic is a common problem for children and adults, though there has been some work on the topic for a surprisingly long time. This chapter will review some of the research that has been done over the years on interventions with primary school children. Interventions can be of various levels of intensiveness, ranging from whole-class approaches that take account of individual differences through small-group and limited-time individual interventions to extended-time individual interventions. Interventions discussed here include those involving peer tuition and group collaboration; those involving board and computer games; and those that involve assessing children's strengths and weaknesses in different components of mathematics; and targeting remedial activities to the assessed weaknesses. Most of the interventions discussed in this chapter specifically involve mathematics (usually mainly arithmetic), but there is also some discussion of attempts to improve mathematics by training children in domain-general skills, including Piagetian operations, metacognition, and executive functions. © 2017 Elsevier Inc. All rights reserved.

New expert system approach for the design of a diagnosis tool in a production plant

NASA Astrophysics Data System (ADS)

Mouss, H.; Mouss, D.; Scholz Reiter, B.

2001-10-01

The search for an increase in quality and speed of the diagnosis led to the reduction in the unavailability times of the production equipment. Thus, among the objectives of this study, need for operating on the level of the industrial sector of production through making of tools of assistance to the diagnosis of the abnormal operations, which are integrated into the environment of the system and allow the optimization of intervention times.

Vectorial capacity and vector control: reconsidering sensitivity to parameters for malaria elimination

PubMed Central

Brady, Oliver J.; Godfray, H. Charles J.; Tatem, Andrew J.; Gething, Peter W.; Cohen, Justin M.; McKenzie, F. Ellis; Perkins, T. Alex; Reiner, Robert C.; Tusting, Lucy S.; Sinka, Marianne E.; Moyes, Catherine L.; Eckhoff, Philip A.; Scott, Thomas W.; Lindsay, Steven W.; Hay, Simon I.; Smith, David L.

2016-01-01

Background Major gains have been made in reducing malaria transmission in many parts of the world, principally by scaling-up coverage with long-lasting insecticidal nets and indoor residual spraying. Historically, choice of vector control intervention has been largely guided by a parameter sensitivity analysis of George Macdonald's theory of vectorial capacity that suggested prioritizing methods that kill adult mosquitoes. While this advice has been highly successful for transmission suppression, there is a need to revisit these arguments as policymakers in certain areas consider which combinations of interventions are required to eliminate malaria. Methods and Results Using analytical solutions to updated equations for vectorial capacity we build on previous work to show that, while adult killing methods can be highly effective under many circumstances, other vector control methods are frequently required to fill effective coverage gaps. These can arise due to pre-existing or developing mosquito physiological and behavioral refractoriness but also due to additive changes in the relative importance of different vector species for transmission. Furthermore, the optimal combination of interventions will depend on the operational constraints and costs associated with reaching high coverage levels with each intervention. Conclusions Reaching specific policy goals, such as elimination, in defined contexts requires increasingly non-generic advice from modelling. Our results emphasize the importance of measuring baseline epidemiology, intervention coverage, vector ecology and program operational constraints in predicting expected outcomes with different combinations of interventions. PMID:26822603

Impact of Workplace Physical Activity Interventions on Physical Activity and Cardiometabolic Health Among Working-Age Women: A Systematic Review and Meta-Analysis.

PubMed

Reed, Jennifer L; Prince, Stephanie A; Elliott, Cara G; Mullen, Kerri-Anne; Tulloch, Heather E; Hiremath, Swapnil; Cotie, Lisa M; Pipe, Andrew L; Reid, Robert D

2017-02-01

Cardiovascular disease is the leading cause of death among women in high-income Organization for Economic Co-operation and Development countries. Physical activity is protective for cardiovascular disease. The realities of modern life require working-age women to address work-related, family, and social demands. Few working-age women meet current moderate-to-vigorous-intensity physical activity (MVPA) recommendations. Given that working-age women spend a substantial proportion of their waking hours at work, places of employment may be an opportune and a controlled setting to implement programs, improving MVPA levels and enhancing cardiometabolic health. Eight electronic databases were searched to identify all prospective cohort and experimental studies reporting an MVPA outcome of workplace interventions for working-age women (mean age, 18-65 years) in high-income Organization for Economic Co-operation and Development countries. Risk of bias was assessed using the Cochrane risk of bias tool; quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. A qualitative synthesis was performed for all studies, and meta-analyses were conducted where possible. Twenty-four studies met the inclusion criteria; 20 studies were included in the meta-analyses. Workplace interventions significantly increased minutes per week of metabolic equivalents (4 studies; standardized mean differences, 2.07; 95% confidence interval [CI], 1.44 to 2.69), but not minutes per week of MVPA (13 studies; standardized mean differences, 0.38; 95% CI, -0.15 to 0.92) or metabolic equivalents per week (3 studies; standardized mean differences, 0.11; 95% CI, -0.48 to 0.71). Workplace interventions also significantly decreased body mass (7 studies; mean differences, -0.83 kg; 95% CI, -1.64 to -0.02), body mass index (6 studies; mean differences, -0.35 kg/m 2 ; 95% CI, -0.62 to -0.07), low-density lipoprotein (4 studies; mean differences, -0.11 mmol/L; 95% CI, -0.17 to -0.04), and blood glucose (2 studies; mean differences, -0.18 mmol/L; 95% CI, -0.29 to -0.07). These workplace interventions targeting MVPA levels and known beneficial cardiometabolic health sequelae were of lower quality evidence. Workplace interventions variably improve MVPA levels and related cardiometabolic health sequelae of working-age women in high-income Organization for Economic Co-operation and Development countries. Our findings underscore the need for ongoing research in this area but also increased dissemination of the existing programs and knowledge. © 2017 American Heart Association, Inc.

Default operational intervention levels (OILs) for severe nuclear power plant or spent fuel pool emergencies.

PubMed

McKenna, T; Kutkov, V; Vilar Welter, P; Dodd, B; Buglova, E

2013-05-01

Experience and studies show that for an emergency at a nuclear power plant involving severe core damage or damage to the fuel in spent fuel pools, the following actions may need to be taken in order to prevent severe deterministic health effects and reduce stochastic health effects: (1) precautionary protective actions and other response actions for those near the facility (i.e., within the zones identified by the International Atomic Energy Agency) taken immediately upon detection of facility conditions indicating possible severe damage to the fuel in the core or in the spent fuel pool; and (2) protective actions and other response actions taken based on environmental monitoring and sampling results following a release. This paper addresses the second item by providing default operational intervention levels [OILs, which are similar to the U.S. derived response levels (DRLs)] for promptly assessing radioactive material deposition, as well as skin, food, milk and drinking water contamination, following a major release of fission products from the core or spent fuel pool of a light water reactor (LWR) or a high power channel reactor (RBMK), based on the International Atomic Energy Agency's guidance.

Protocol of a randomized controlled trial of the Tobacco Tactics website for operating engineers.

PubMed

Duffy, Sonia A; Ronis, David L; Richardson, Caroline; Waltje, Andrea H; Ewing, Lee A; Noonan, Devon; Hong, Oisaeng; Meeker, John D

2012-05-17

Recent research indicates that 35 percent of blue-collar workers in the US currently smoke while only 20 percent of white-collar workers smoke. Over the last year, we have been working with heavy equipment operators, specifically the Local 324 Training Center of the International Union of Operating Engineers, to study the epidemiology of smoking, which is 29% compared to 21% among the general population. For the current study funded by the National Cancer Institute (1R21CA152247-01A1), we have developed the Tobacco Tactics website which will be compared to the state supported 1-800-QUIT-NOW telephone line. Outcome evaluation will compare those randomized to the Tobacco Tactics web-based intervention to those randomized to the 1-800-QUIT-NOW control condition on: a) 30-day and 6-month quit rates; b) cotinine levels; c) cigarettes smoked/day; d) number of quit attempts; and e) nicotine addiction. Process evaluation will compare the two groups on the: a) contacts with intervention; b) medications used; c) helpfulness of the nurse/coach; and d) willingness to recommend the intervention to others. This will be a randomized controlled trial (N = 184). Both interventions will be offered during regularly scheduled safety training at Local 324 Training Center of the International Union of Operating Engineers and both will include optional provision of over-the-counter nicotine replacement therapy and the same number of telephone contacts. However, the Tobacco Tactics website has graphics tailored to Operating Engineers, tailored cessation feedback from the website, and follow up nurse counseling offered by multimedia options including phone and/or email, and/or e-community. Primary Analysis of Aim 1 will be conducted by using logistic regression to compare smoking habits (e.g., quit rates) of those in the intervention arm to those in the control arm. Primary analyses for Aim 2 will compare process measures (e.g., medications used) between the two groups by linear, logistic, and Poisson regression. Dissemination of an efficacious work-site, web-based smoking cessation intervention has the potential to substantially impact cancer rates among this population. Based on the outcome of this smaller study, wider scale testing in conjunction with the International Environment Technology Testing Center which services Operating Engineers across North America (including US, Mexico, and Canada) will be conducted. NCT01124110.

Cardiovascular Physiology Teaching: Computer Simulations vs. Animal Demonstrations.

ERIC Educational Resources Information Center

Samsel, Richard W.; And Others

1994-01-01

At the introductory level, the computer provides an effective alternative to using animals for laboratory teaching. Computer software can simulate the operation of multiple organ systems. Advantages of software include alteration of variables that are not easily changed in vivo, repeated interventions, and cost-effective hands-on student access.…

Everyday Mathematics. Revised. What Works Clearinghouse Intervention Report

ERIC Educational Resources Information Center

What Works Clearinghouse, 2007

2007-01-01

"Everyday Mathematics," published by Wright Group/McGraw-Hill, is a core curriculum for students in kindergarten through grade 6 covering numeration and order, operations, functions and sequences, data and chance, algebra, geometry and spatial sense, measures and measurement, reference frames, and patterns. At each grade level, the…

Everyday Mathematics. What Works Clearinghouse Intervention Report

ERIC Educational Resources Information Center

What Works Clearinghouse, 2006

2006-01-01

"Everyday Mathematics," published by Wright Group/McGraw-Hill, is a core curriculum for students in kindergarten through grade 6 covering numeration and order, operations, functions and sequences, data and chance, algebra, geometry and spatial sense, measures and measurement, reference frames, and patterns. At each grade level, the "Everyday…

SigTree: A Microbial Community Analysis Tool to Identify and Visualize Significantly Responsive Branches in a Phylogenetic Tree.

PubMed

Stevens, John R; Jones, Todd R; Lefevre, Michael; Ganesan, Balasubramanian; Weimer, Bart C

2017-01-01

Microbial community analysis experiments to assess the effect of a treatment intervention (or environmental change) on the relative abundance levels of multiple related microbial species (or operational taxonomic units) simultaneously using high throughput genomics are becoming increasingly common. Within the framework of the evolutionary phylogeny of all species considered in the experiment, this translates to a statistical need to identify the phylogenetic branches that exhibit a significant consensus response (in terms of operational taxonomic unit abundance) to the intervention. We present the R software package SigTree , a collection of flexible tools that make use of meta-analysis methods and regular expressions to identify and visualize significantly responsive branches in a phylogenetic tree, while appropriately adjusting for multiple comparisons.

Remediation for Students With Mathematics Difficulties: An Intervention Study in Middle Schools.

PubMed

Moser Opitz, Elisabeth; Freesemann, Okka; Prediger, Susanne; Grob, Urs; Matull, Ina; Hußmann, Stephan

As empirical studies have consistently shown, low achievement in mathematics at the secondary level can often be traced to deficits in the understanding of certain basic arithmetic concepts taught in primary school. The present intervention study in middle schools evaluated whether such learning deficits can be reduced effectively and whether the type of instruction influences students' progress. The sample consisted of 123 students in 34 classes, split among one control group and two intervention groups: (a) small group instruction and (b) independent work partially integrated into regular classrooms. Over a period of 14 weeks, students were taught basic concepts, such as place value and basic operations. In addition, they practiced fact retrieval and counting (in groups). Multilevel regression analyses demonstrated that the interventions can be used to reduce given deficits.

Eye dose to staff involved in interventional and procedural fluoroscopy

NASA Astrophysics Data System (ADS)

McLean, D.; Hadaya, D.; Tse, J.

2016-03-01

In 2011 the International Commission on Radiological Protection (ICRP) lowered the occupational eye dose limit from 150 to 20 mSv/yr [1]. While international jurisdictions are in a process of adopting these substantial changes, medical physicists at the clinical level have been advising medical colleagues on specific situations based on dose measurements. Commissioned and calibrated TLDs mounted in commercially available holders designed to simulate the measurement of Hp(3), were applied to staff involved in x-ray procedures for a one month period. During this period clinical procedure data was concurrently collected and subject to audit. The use or not of eye personal protective equipment (PPE) was noted for all staff. Audits were conducted in the cardiac catheterisation laboratory, the interventional angiography rooms and the procedural room where endoscopic retrograde cholangiopancreatography (ERCP) procedures are performed. Significant levels of occupational dose were recorded in the cardiac and interventional procedures, with maximum reading exceeding the new limit for some interventional radiologists. No significant eye doses were measured for staff performing ERCP procedures. One outcome of the studies was increased use of eye PPE for operators of interventional equipment with increased availability also to nursing staff, when standing in close proximity to the patient during procedures.

Predictors Associated with Changes of Weight and Total Cholesterol among two Occupational Cohorts over 10 Years

PubMed Central

Stanford, Joseph B.; Murtaugh, Maureen A.; Greenwood, Jessica L.J.; Gren, Lisa H.; Hegmann, Kurt T.; Thiese, Matthew S.

2015-01-01

Objective To ascertain worker health characteristics and psychosocial factors associated with changes in body weight and total cholesterol (TC) among two production operation populations. Methods We performed descriptive and predictive analysis of questionnaire data and biomedical measurements from two prospective cohort studies. Our key outcomes were changes in weight, and TC over 5–10 years between baseline and exit assessments. Results 146 subjects were analyzed. Increases in weight were associated with belief in being overweight and baseline overweight and obesity. Increases in TC levels were associated with female gender, belief that TC levels were “not good,” and feeling depressed. Conclusion Most of the reported associations with increases in weight and TC levels are amenable to interventions and may be a target for workplace intervention programs. PMID:26147542

MEDICINE SELLERS AND MALARIA TREATMENT IN SUB-SAHARAN AFRICA

PubMed Central

GOODMAN, CATHERINE; BRIEGER, WILLIAM; UNWIN, ALASDAIR; MILLS, ANNE; MEEK, SYLVIA; GREER, GEORGE

2009-01-01

Medicine sellers are widely used for fever and malaria treatment in sub-Saharan Africa, but concerns surround the appropriateness of drugs and information provided. There is increasing interest in improving their services, so we reviewed the literature on their characteristics, and interventions to improve their malaria-related practices. Sixteen interventions were identified, involving a mix of training/capacity building, demand generation, quality assurance and creating an enabling environment. Although evidence is insufficient to prove which approaches are superior, tentative conclusions were possible. Interventions increased rates of appropriate treatment, and medicine sellers were willing to participate. Features of successful interventions included a comprehensive situation analysis of the legal and market environment; “buy-in” from medicine sellers, community members and government; use of a combination of approaches; and maintenance of training and supervision. Interventions must be adapted to include artemisinin-based combination therapies, and their sustainability and potential to operate at national level should be further explored. PMID:18165494

Predictors of obesity in Michigan Operating Engineers.

PubMed

Duffy, Sonia A; Cohen, Kathleen A; Choi, Seung Hee; McCullagh, Marjorie C; Noonan, Devon

2012-06-01

Blue collar workers are at risk for obesity. Little is known about obesity in Operating Engineers, a group of blue collar workers, who operate heavy earth-moving equipment in road building and construction. Therefore, 498 Operating Engineers in Michigan were recruited to participate in a cross-sectional survey to determine variables related to obesity in this group. Bivariate and multivariate analyses were conducted to determine personal, psychological, and behavioral factors predicting obesity. Approximately 45% of the Operating Engineers screened positive for obesity, and another 40% were overweight. Multivariate analysis revealed that younger age, male sex, higher numbers of self-reported co-morbidities, not smoking, and low physical activity levels were significantly associated with obesity among Operating Engineers. Operating Engineers are significantly at risk for obesity, and workplace interventions are needed to address this problem.

Simulator training to automaticity leads to improved skill transfer compared with traditional proficiency-based training: a randomized controlled trial.

PubMed

Stefanidis, Dimitrios; Scerbo, Mark W; Montero, Paul N; Acker, Christina E; Smith, Warren D

2012-01-01

We hypothesized that novices will perform better in the operating room after simulator training to automaticity compared with traditional proficiency based training (current standard training paradigm). Simulator-acquired skill translates to the operating room, but the skill transfer is incomplete. Secondary task metrics reflect the ability of trainees to multitask (automaticity) and may improve performance assessment on simulators and skill transfer by indicating when learning is complete. Novices (N = 30) were enrolled in an IRB-approved, blinded, randomized, controlled trial. Participants were randomized into an intervention (n = 20) and a control (n = 10) group. The intervention group practiced on the FLS suturing task until they achieved expert levels of time and errors (proficiency), were tested on a live porcine fundoplication model, continued simulator training until they achieved expert levels on a visual spatial secondary task (automaticity) and were retested on the operating room (OR) model. The control group participated only during testing sessions. Performance scores were compared within and between groups during testing sessions. : Intervention group participants achieved proficiency after 54 ± 14 and automaticity after additional 109 ± 57 repetitions. Participants achieved better scores in the OR after automaticity training [345 (range, 0-537)] compared with after proficiency-based training [220 (range, 0-452; P < 0.001]. Simulator training to automaticity takes more time but is superior to proficiency-based training, as it leads to improved skill acquisition and transfer. Secondary task metrics that reflect trainee automaticity should be implemented during simulator training to improve learning and skill transfer.

Hospital and operator variations in drug-eluting stent use: a multi-level analysis of 5967 consecutive patients in Scotland.

PubMed

Austin, David; Oldroyd, Keith G; McConnachie, Alex; Slack, Rachel; Eteiba, Hany; Flapan, Andrew D; Jennings, Kevin P; Northcote, Robin J; Pell, Alistair C H; Starkey, Ian R; Pell, Jill P

2008-06-01

To determine whether drug-eluting stent (DES) use varies among Scottish hospitals, and the extent to which any variations are explained by differences between operators, patients and lesions. Multi-level analysis of consecutive patients treated with percutaneous coronary intervention (PCI) between April 2005 and March 2006 in Scotland, using the Scottish Coronary Revascularization Registry. A total of 38 operators performed 5967 PCI procedures on 8489 lesions. Crude level of DES use was 47.6%, and the results varied among hospitals (range 30.6-61.8%, chi(2) = 341.6, P < 0.0001). There was significant between-operator variation in the null model. This was attenuated by the addition of hospital as a fixed effect. Nonetheless, the final model demonstrated significant between-operator variability [sigma(2) = 0.486 (0.249-0.971)] and between-hospital variation, after case-mix adjustment. Within Scotland, marked variation existed among hospitals in the use of DES. Operator was the most important factor at patient level, and hospital of treatment, rather than case-mix, was the most important modifier of between-operator variation. Patient selection for DES is complex and may contribute to much of the variations demonstrated. Consensus criteria would provide more detail than is included in current guidance, may aid decision-making for individual patients, reduce opportunity costs and ensure equity of access.

A randomized controlled trial of chair interventions on back and hip pain among sewing machine operators: the los angeles garment study.

PubMed

Wang, Pin-Chieh; Ritz, Beate R; Janowitz, Ira; Harrison, Robert J; Yu, Fei; Chan, Jacqueline; Rempel, David M

2008-03-01

Determine whether an adjustable chair with a curved or a flat seat pan improved monthly back and hip pain scores in sewing machine operators. This 4-month intervention study randomized 293 sewing machine operators with back and hip pain. The participants in the control group received a placebo intervention, and participants in the intervention groups received the placebo intervention and one of the two intervention chairs. Compared with the control group, mean pain improvement for the flat chair intervention was 0.43 points (95% CI = 0.34, 0.51) per month, and mean pain improvement for the curved chair intervention was 0.25 points (95% CI = 0.16, 0.34) per month. A height-adjustable task chair with a swivel function can reduce back and hip pain in sewing machine operators. The findings may be relevant to workers who perform visual- and hand-intensive manufacturing jobs.

Virtual reality on mobile phones to reduce anxiety in outpatient surgery.

PubMed

Mosso, José L; Gorini, Alessandra; De La Cerda, Gustavo; Obrador, Tomas; Almazan, Andrew; Mosso, Dejanira; Nieto, Jesus J; Riva, Giuseppe

2009-01-01

When undergo ambulatory surgical operations, the majority of patients experience high level of anxiety. Different experimental studies have shown that distraction techniques are effective in reducing pain and related anxiety. Since Virtual reality (VR) has been demonstrated a good distraction technique, it has been repeatedly used in hospital contexts for reducing pain in burned patients, but it has never been used during surgical operations. With the present randomized controlled study we intended to verify the effectiveness of VR in reducing anxiety in patients undergoing ambulatory operations under local or regional anaesthesia. In particular, we measured the degree to which anxiety associated with surgical intervention was reduced by distracting patients with immersive VR provided through a cell phone connected to an HMD compared to a no-distraction control condition. A significant reduction of anxiety was obtained after 45 minutes of operation in the VR group, but not in the control group and, after 90 minutes, the reduction was larger in the experimental group than in other one. In conclusion, this study presents an innovative promising technique to reduce anxiety during surgical interventions, even if more studies are necessary to investigate its effectiveness in other kinds of operations and in larger numbers of patients.

Reduction of radiation exposure while maintaining high-quality fluoroscopic images during interventional cardiology using novel x-ray tube technology with extra beam filtering.

PubMed

den Boer, A; de Feyter, P J; Hummel, W A; Keane, D; Roelandt, J R

1994-06-01

Radiographic technology plays an integral role in interventional cardiology. The number of interventions continues to increase, and the associated radiation exposure to patients and personnel is of major concern. This study was undertaken to determine whether a newly developed x-ray tube deploying grid-switched pulsed fluoroscopy and extra beam filtering can achieve a reduction in radiation exposure while maintaining fluoroscopic images of high quality. Three fluoroscopic techniques were compared: continuous fluoroscopy, pulsed fluoroscopy, and a newly developed high-output pulsed fluoroscopy with extra filtering. To ascertain differences in the quality of images and to determine differences in patient entrance and investigator radiation exposure, the radiated volume curve was measured to determine the required high voltage levels (kVpeak) for different object sizes for each fluoroscopic mode. The fluoroscopic data of 124 patient procedures were combined. The data were analyzed for radiographic projections, image intensifier field size, and x-ray tube kilovoltage levels (kVpeak). On the basis of this analysis, a reference procedure was constructed. The reference procedure was tested on a phantom or dummy patient by all three fluoroscopic modes. The phantom was so designed that the kilovoltage requirements for each projection were comparable to those needed for the average patient. Radiation exposure of the operator and patient was measured during each mode. The patient entrance dose was measured in air, and the operator dose was measured by 18 dosimeters on a dummy operator. Pulsed compared with continuous fluoroscopy could be performed with improved image quality at lower kilovoltages. The patient entrance dose was reduced by 21% and the operator dose by 54%. High-output pulsed fluoroscopy with extra beam filtering compared with continuous fluoroscopy improved the image quality, lowered the kilovoltage requirements, and reduced the patient entrance dose by 55% and the operator dose by 69%. High-output pulsed fluoroscopy with a grid-switched tube and extra filtering improves the image quality and significantly reduces both the operator dose and patient dose.

A Food Retail-Based Intervention on Food Security and Consumption

PubMed Central

Sadler, Richard C.; Gilliland, Jason A.; Arku, Godwin

2013-01-01

The effect of the built environment on diet (and ensuing health outcomes) is less understood than the effect of diet on obesity. Natural experiments are increasingly advocated in place of cross-sectional studies unable to suggest causality. The central research question of this paper, therefore, asks whether a neighborhood-level food retail intervention will affect dietary habits or food security. The intervention did not have a significant impact on fruit and vegetable consumption, and the intervention population actually purchased prepared meals more frequently. More problematic, only 8% of respondents overall regularly consumed enough fruits and vegetables, and 34% were food insecure. Further complicating this public health issue, the new grocery store closed after 17 months of operation. Results indicate that geographic access to food is only one element of malnutrition, and that multi-pronged dietary interventions may be more effective. The economic failure of the store also suggests the importance of non-retail interventions to combat malnutrition. PMID:23921626

Legal Literacy: A Necessity for Florida Preservice/Inservice Teachers.

ERIC Educational Resources Information Center

Ringenberger, Barbara K.; Funk, Fanchon F.

The increasing impact of judicial and legislative intervention at all levels of school operations make it necessary for educators to be more aware of their legal rights and liabilities. Few inservice and preservice teacher education programs in Florida provide legal education for teachers, and a study showed that teachers are largely uninformed of…

Effectiveness of Telementoring in Surgery Compared With On-site Mentoring: A Systematic Review.

PubMed

Bilgic, Elif; Turkdogan, Sena; Watanabe, Yusuke; Madani, Amin; Landry, Tara; Lavigne, Daniel; Feldman, Liane S; Vassiliou, Melina C

2017-08-01

Mentorship is important but may not be feasible for distance learning. To bridge this gap, telementoring has emerged. The purpose of this systematic review was to evaluate the effectiveness of telementoring compared with on-site mentoring. A search was done up to March 2015. Studies were included if they used telementoring between surgeons during a clinical encounter and if they compared on-site mentoring and telementoring. A total of 11 studies were included. All reported no difference in complication rates, and 9 (82%) reported similar operative times; 4 (36%) reported technical issues, which was 3% of the total number of cases in the 11 studies. No study reported on higher levels of evidence for effectiveness of telementoring as an educational intervention. Studies reported that telementoring is associated with similar complication rates and operative times compared with on-site mentoring. However, the level of evidence to support the effectiveness of telementoring as a training tool is limited. There is a need for studies that provide evidence for the equivalence of the effectiveness of telementoring as an educational intervention in comparison with on-site mentoring.

Surgical rescue: The next pillar of acute care surgery.

PubMed

Kutcher, Matthew E; Sperry, Jason L; Rosengart, Matthew R; Mohan, Deepika; Hoffman, Marcus K; Neal, Matthew D; Alarcon, Louis H; Watson, Gregory A; Puyana, Juan Carlos; Bauzá, Graciela M; Schuchert, Vaishali D; Fombona, Anisleidy; Zhou, Tianhua; Zolin, Samuel J; Becher, Robert D; Billiar, Timothy R; Forsythe, Raquel M; Zuckerbraun, Brian S; Peitzman, Andrew B

2017-02-01

The evolving field of acute care surgery (ACS) traditionally includes trauma, emergency general surgery, and critical care. However, the critical role of ACS in the rescue of patients with a surgical complication has not been explored. We here describe the role of "surgical rescue" in the practice of ACS. A prospective, electronic medical record-based ACS registry spanning January 2013 to May 2014 at a large urban academic medical center was screened by ICD-9 codes for acute surgical complications of an operative or interventional procedure. Long-term outcomes were derived from the Social Security Death Index. Of 2,410 ACS patients, 320 (13%) required "surgical rescue": most commonly, from wound complications (32%), uncontrolled sepsis (19%), and acute obstruction (15%). The majority of complications (85%) were related to an operation; 15% were related to interventional procedures. The most common rescue interventions required were bowel resection (23%), wound debridement (18%), and source control of infection (17%); 63% of patients required operative intervention, and 22% required surgical critical care. Thirty-six percent of complications occurred in ACS primary patients ("local"), whereas 38% were referred from another surgical service ("institutional") and 26% referred from another institution ("regional"). Hospital length of stay was longer, and in-hospital and 1-year mortalities were higher in rescue patients compared with those without a complication. Outcomes were equivalent between "local" and "institutional" patients, but hospital length of stay and discharge to home were significantly worse in "institutional" referrals. We here describe the distinct role of the acute care surgeon in the surgical management of complications; this is an additional pillar of ACS. In this vital role, the acute care surgeon provides crucial support to other providers as well as direct patient care in the "surgical rescue" of surgical and procedural complications. Epidemiological study, level III; therapeutic/care management study, level IV.

Use of a multimedia module to aid the informed consent process in patients undergoing gynecologic laparoscopy for pelvic pain: randomized controlled trial.

PubMed

Ellett, Lenore; Villegas, Rocio; Beischer, Andrew; Ong, Nicole; Maher, Peter

2014-01-01

To determine whether providing additional information to the standard consent process, in the form of a multimedia module (MM), improves patient knowledge about operative laparoscopy without increasing anxiety. Randomized controlled trial (Canadian Task Force classification I). Two outpatient gynecologic clinics, one in a private hospital and the other in a public teaching hospital. Forty-one women aged 19 to 51 years (median, 35.6 years) requiring operative laparoscopy for investigation and treatment of pelvic pain. Following the standard informed consent process, patients were randomized to watch the MM (intervention group, n = 21) or not (control group, n = 20). The surgeon was blinded to the group assignments. All patients completed a knowledge questionnaire and the Spielberger short-form State-Trait Anxiety Inventory. Six weeks after recruitment, patients completed the knowledge questionnaire and the State-Trait Anxiety Inventory a second time to assess knowledge retention and anxiety scores. Patient knowledge of operative laparoscopy, anxiety level, and acceptance of the MM were recorded. The MM intervention group demonstrated superior knowledge scores. Mean (SE) score in the MM group was 11.3 (0.49), and in the control group was 7.9 (0.50) (p <.001) (maximum score, 14). This did not translate into improved knowledge scores 6 weeks later; the score in the MM group was 8.4 (0.53) vs. 7.8 (0.50) in the control group (p = .44). There was no difference in anxiety levels between the groups at intervention or after 6 weeks. Overall, patients found the MM acceptable, and 18 women (86%) in the intervention group and 12 (60%) in the control group stated they would prefer this style of informed consent in the future. Use of an MM enhances the informed consent process by improving patient knowledge, in the short term, without increasing anxiety. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

Changing use of surgical antibiotic prophylaxis in Thika Hospital, Kenya: a quality improvement intervention with an interrupted time series design.

PubMed

Aiken, Alexander M; Wanyoro, Anthony K; Mwangi, Jonah; Juma, Francis; Mugoya, Isaac K; Scott, J Anthony G

2013-01-01

In low-income countries, Surgical Site Infection (SSI) is a common form of hospital-acquired infection. Antibiotic prophylaxis is an effective method of preventing these infections, if given immediately before the start of surgery. Although several studies in Africa have compared pre-operative versus post-operative prophylaxis, there are no studies describing the implementation of policies to improve prescribing of surgical antibiotic prophylaxis in African hospitals. We conducted SSI surveillance at a typical Government hospital in Kenya over a 16 month period between August 2010 and December 2011, using standard definitions of SSI and the extent of contamination of surgical wounds. As an intervention, we developed a hospital policy that advised pre-operative antibiotic prophylaxis and discouraged extended post-operative antibiotics use. We measured process, outcome and balancing effects of this intervention in using an interrupted time series design. From a starting point of near-exclusive post-operative antibiotic use, after policy introduction in February 2011 there was rapid adoption of the use of pre-operative antibiotic prophylaxis (60% of operations at 1 week; 98% at 6 weeks) and a substantial decrease in the use of post-operative antibiotics (40% of operations at 1 week; 10% at 6 weeks) in Clean and Clean-Contaminated surgery. There was no immediate step-change in risk of SSI, but overall, there appeared to be a moderate reduction in the risk of superficial SSI across all levels of wound contamination. There were marked reductions in the costs associated with antibiotic use, the number of intravenous injections performed and nursing time spent administering these. Implementation of a locally developed policy regarding surgical antibiotic prophylaxis is an achievable quality improvement target for hospitals in low-income countries, and can lead to substantial benefits for individual patients and the institution.

Changing Use of Surgical Antibiotic Prophylaxis in Thika Hospital, Kenya: A Quality Improvement Intervention with an Interrupted Time Series Design

PubMed Central

Aiken, Alexander M.; Wanyoro, Anthony K.; Mwangi, Jonah; Juma, Francis; Mugoya, Isaac K.; Scott, J. Anthony G

2013-01-01

Introduction In low-income countries, Surgical Site Infection (SSI) is a common form of hospital-acquired infection. Antibiotic prophylaxis is an effective method of preventing these infections, if given immediately before the start of surgery. Although several studies in Africa have compared pre-operative versus post-operative prophylaxis, there are no studies describing the implementation of policies to improve prescribing of surgical antibiotic prophylaxis in African hospitals. Methods We conducted SSI surveillance at a typical Government hospital in Kenya over a 16 month period between August 2010 and December 2011, using standard definitions of SSI and the extent of contamination of surgical wounds. As an intervention, we developed a hospital policy that advised pre-operative antibiotic prophylaxis and discouraged extended post-operative antibiotics use. We measured process, outcome and balancing effects of this intervention in using an interrupted time series design. Results From a starting point of near-exclusive post-operative antibiotic use, after policy introduction in February 2011 there was rapid adoption of the use of pre-operative antibiotic prophylaxis (60% of operations at 1 week; 98% at 6 weeks) and a substantial decrease in the use of post-operative antibiotics (40% of operations at 1 week; 10% at 6 weeks) in Clean and Clean-Contaminated surgery. There was no immediate step-change in risk of SSI, but overall, there appeared to be a moderate reduction in the risk of superficial SSI across all levels of wound contamination. There were marked reductions in the costs associated with antibiotic use, the number of intravenous injections performed and nursing time spent administering these. Conclusion Implementation of a locally developed policy regarding surgical antibiotic prophylaxis is an achievable quality improvement target for hospitals in low-income countries, and can lead to substantial benefits for individual patients and the institution. PMID:24244390

Radiation dose of nurses during IR procedures: a controlled trial evaluating operator alerts before nursing tasks.

PubMed

Komemushi, Atsushi; Suzuki, Satoshi; Sano, Akira; Kanno, Shohei; Kariya, Shuji; Nakatani, Miyuki; Yoshida, Rie; Kono, Yumiko; Ikeda, Koshi; Utsunomiya, Keita; Harima, Yoko; Komemushi, Sadao; Tanigawa, Noboru

2014-08-01

To compare radiation exposure of nurses when performing nursing tasks associated with interventional procedures depending on whether or not the nurses called out to the operator before approaching the patient. In a prospective study, 93 interventional radiology procedures were randomly divided into a call group and a no-call group; there were 50 procedures in the call group and 43 procedures in the no-call group. Two monitoring badges were used to calculate effective dose of nurses. In the call group, the nurse first told the operator she was going to approach the patient each time she was about to do so. In the no-call group, the nurse did not say anything to the operator when she was about to approach the patient. In all the nursing tasks, the equivalent dose at the umbilical level inside the lead apron was below the detectable limit. The equivalent dose at the sternal level outside the lead apron was 0.16 μSv ± 0.41 per procedure in the call group and 0.51 μSv ± 1.17 per procedure in the no-call group. The effective dose was 0.018 μSv ± 0.04 per procedure in the call group and 0.056 μSv ± 0.129 per procedure in the no-call group. The call group had a significantly lower radiation dose (P = .034). Radiation doses of nurses were lower in the group in which the nurse called to the operator before she approached the patient. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

Mechanisms of Change: Testing how Preventative Interventions Impact Psychological and Physiological Stress Functioning in Mothers in Neglectful Families

PubMed Central

Toth, Sheree L.; Sturge-Apple, Melissa L.; Rogosch, Fred A.; Cicchetti, Dante

2015-01-01

The present study applies a multilevel approach to an examination of the effect of two randomized preventative interventions with mothers in neglectful families who are also contending with elevated levels of impoverishment and ecological risk. Specifically, we examined how participation in either Child-Parent Psychotherapy (CPP) or Psychoeducational Parenting (PPI) interventions was associated with reductions in maternal psychological parenting stress and in turn physiological stress system functioning when compared to mothers involved in standard community services (CS) as well as a demographic comparison group of nonmaltreating mothers (NC). The resulting group sizes in the current investigation were: CPP (n = 44), PPI (n = 34), CS (n = 27), and NC (n = 52). Mothers and infants who were 13-months of age were randomly assigned to intervention group at baseline. Mothers completed assessments on stress within the parenting role at baseline and post-intervention. Basal cortisol was sampled at post-intervention and 1-year follow-up. Latent difference score analyses examined change in these constructs over time. Results suggested that mothers within the CPP intervention experienced significant declines in child-related parenting stress while mothers in the PPI intervention reported declines in parent-related parenting stress. In turn, significant decreases in stress within the CPP mothers were further associated with adaptive basal cortisol functioning at 1-year post-intervention. Results highlight the value of delineating how participation in preventtive interventions aimed at ameliorating child maltreatment in neglectful families within the context of poverty may operate through improvements in psychological and physiological stress functioning. Findings are discussed with respect to the importance of multi-level assessments of intervention process and outcome. PMID:26535951

Randomized comparison of operator radiation exposure comparing transradial and transfemoral approach for percutaneous coronary procedures: rationale and design of the minimizing adverse haemorrhagic events by TRansradial access site and systemic implementation of angioX - RAdiation Dose study (RAD-MATRIX).

PubMed

Sciahbasi, Alessandro; Calabrò, Paolo; Sarandrea, Alessandro; Rigattieri, Stefano; Tomassini, Francesco; Sardella, Gennaro; Zavalloni, Dennis; Cortese, Bernardo; Limbruno, Ugo; Tebaldi, Matteo; Gagnor, Andrea; Rubartelli, Paolo; Zingarelli, Antonio; Valgimigli, Marco

2014-06-01

Radiation absorbed by interventional cardiologists is a frequently under-evaluated important issue. Aim is to compare radiation dose absorbed by interventional cardiologists during percutaneous coronary procedures for acute coronary syndromes comparing transradial and transfemoral access. The randomized multicentre MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX) trial has been designed to compare the clinical outcome of patients with acute coronary syndromes treated invasively according to the access site (transfemoral vs. transradial) and to the anticoagulant therapy (bivalirudin vs. heparin). Selected experienced interventional cardiologists involved in this study have been equipped with dedicated thermoluminescent dosimeters to evaluate the radiation dose absorbed during transfemoral or right transradial or left transradial access. For each access we evaluate the radiation dose absorbed at wrist, at thorax and at eye level. Consequently the operator is equipped with three sets (transfemoral, right transradial or left transradial access) of three different dosimeters (wrist, thorax and eye dosimeter). Primary end-point of the study is the procedural radiation dose absorbed by operators at thorax. An important secondary end-point is the procedural radiation dose absorbed by operators comparing the right or left radial approach. Patient randomization is performed according to the MATRIX protocol for the femoral or radial approach. A further randomization for the radial approach is performed to compare right and left transradial access. The RAD-MATRIX study will probably consent to clarify the radiation issue for interventional cardiologist comparing transradial and transfemoral access in the setting of acute coronary syndromes. Copyright © 2014 Elsevier Inc. All rights reserved.

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

Matsui, Yusuke, E-mail: wckyh140@yahoo.co.jp; Hiraki, Takao, E-mail: takaoh@tc4.so-net.ne.jp; Gobara, Hideo, E-mail: gobara@cc.okayama-u.ac.jp

IntroductionComputed tomography (CT) fluoroscopy-guided renal cryoablation and lung radiofrequency ablation (RFA) have received increasing attention as promising cancer therapies. Although radiation exposure of interventional radiologists during these procedures is an important concern, data on operator exposure are lacking.Materials and MethodsRadiation dose to interventional radiologists during CT fluoroscopy-guided renal cryoablation (n = 20) and lung RFA (n = 20) was measured prospectively in a clinical setting. Effective dose to the operator was calculated from the 1-cm dose equivalent measured on the neck outside the lead apron, and on the left chest inside the lead apron, using electronic dosimeters. Equivalent dose to the operator’s finger skinmore » was measured using thermoluminescent dosimeter rings.ResultsThe mean (median) effective dose to the operator per procedure was 6.05 (4.52) μSv during renal cryoablation and 0.74 (0.55) μSv during lung RFA. The mean (median) equivalent dose to the operator’s finger skin per procedure was 2.1 (2.1) mSv during renal cryoablation, and 0.3 (0.3) mSv during lung RFA.ConclusionRadiation dose to interventional radiologists during renal cryoablation and lung RFA were at an acceptable level, and in line with recommended dose limits for occupational radiation exposure.« less

Vectorial capacity and vector control: reconsidering sensitivity to parameters for malaria elimination.

PubMed

Brady, Oliver J; Godfray, H Charles J; Tatem, Andrew J; Gething, Peter W; Cohen, Justin M; McKenzie, F Ellis; Perkins, T Alex; Reiner, Robert C; Tusting, Lucy S; Sinka, Marianne E; Moyes, Catherine L; Eckhoff, Philip A; Scott, Thomas W; Lindsay, Steven W; Hay, Simon I; Smith, David L

2016-02-01

Major gains have been made in reducing malaria transmission in many parts of the world, principally by scaling-up coverage with long-lasting insecticidal nets and indoor residual spraying. Historically, choice of vector control intervention has been largely guided by a parameter sensitivity analysis of George Macdonald's theory of vectorial capacity that suggested prioritizing methods that kill adult mosquitoes. While this advice has been highly successful for transmission suppression, there is a need to revisit these arguments as policymakers in certain areas consider which combinations of interventions are required to eliminate malaria. Using analytical solutions to updated equations for vectorial capacity we build on previous work to show that, while adult killing methods can be highly effective under many circumstances, other vector control methods are frequently required to fill effective coverage gaps. These can arise due to pre-existing or developing mosquito physiological and behavioral refractoriness but also due to additive changes in the relative importance of different vector species for transmission. Furthermore, the optimal combination of interventions will depend on the operational constraints and costs associated with reaching high coverage levels with each intervention. Reaching specific policy goals, such as elimination, in defined contexts requires increasingly non-generic advice from modelling. Our results emphasize the importance of measuring baseline epidemiology, intervention coverage, vector ecology and program operational constraints in predicting expected outcomes with different combinations of interventions. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

Role of patient information handouts following operative treatment of ankle fractures: a prospective randomized study.

PubMed

Mayich, D Joshua; Tieszer, Christina; Lawendy, Abdel; McCormick, William; Sanders, David

2013-01-01

Widespread evidence exists for directed patient information interventions (eg, pamphlets) in the setting of several orthopaedic conditions and interventions. Up until now, no study had assessed the role of these interventions in the management of patients following ankle fractures. Between 2005 and 2007, 40 patients who suffered an operative ankle fracture were randomized to either a standard treatment group for an ankle fracture or an enhanced information group who received an American Academy of Orthopaedic Surgeons ankle fracture information pamphlet that explained postoperative routine at our institution and a physiotherapy handout depicting a standard protocol. Study participants were followed for 3 months clinically and radiographically. At the 6-week and 3-month intervals, study participants completed the Olerud-Molander Questionnaire and 2 questions regarding their level of satisfaction. The primary outcome measure was the Likert-scale-based survey question determining the level of satisfaction with the treating staff. Participants in the enhanced information group were more satisfied with treatment at 3 months (9.2 vs 6.3; P < .001). There were significant improvements in work/activity ability at 6 weeks (P = .01), but this advantage disappeared at 3 months (P = .24). No differences in postoperative complication rates were noted. Information enhancement in the form of pamphlets can be helpful in providing patients with accessible information in the postoperative period. While they do not seem to have a sustained impact on postoperative outcomes, handouts may enhance the interaction between staff and patient at postoperative visits, improving patient satisfaction. Level I, appropriately powered randomized prospective cohort study.

[Management of patients with bronchial asthma received general anesthesia and surgical intervention].

PubMed

To, Masako; Tajima, Makoto; Ogawa, Cyuhei; Otomo, Mamoru; Suzuki, Naohito; Sano, Yasuyuki

2002-01-01

Stimulation to bronchial mucosa is one of the major risk factor of asthma attack. When patients receive surgical intervention and general anesthesia, they are always exposed to stimulation to bronchial mucosa. Prevention method of bronchial asthma attack during surgical intervention is not established yet. We investigated that clinical course of patients with bronchial asthma who received general anesthesia and surgical intervention. Seventy-six patients with bronchial asthma were received general anesthesia and surgical intervention from 1993 to 1998. Twenty-four patients were mild asthmatic patients, 39 were moderate asthmatic patients and 13 were severe asthmatic patients. Preoperative treatment for preventing asthma attack was as follows; Eight patients were given intravenous infusion of aminophylline before operation. Fifty-two patients were given intravenous infusion of aminophylline and hydrocortisone before operation. Three patients were given intravenous infusion of hydrocortisone for consecutive 3 days before operation. Thirteen patients were given no treatment for preventing asthma attack. One patient was suffered from asthma attack during operation. She was given no preventing treatment for asthma attack before operation. Three patients were suffered from asthma attack after operation. No wound dehiscence was observed in all patients. To prevent asthma attack during operation, intravenous infusion of steroid before operation is recommended, when patients with asthma receive general anesthesia and surgical intervention.

Current Evidence Regarding the Treatment of Pediatric Lumbar Spondylolisthesis: A Report From the Scoliosis Research Society Evidence Based Medicine Committee.

PubMed

Crawford, Charles H; Larson, A Noelle; Gates, Marilyn; Bess, R Shay; Guillaume, Tenner J; Kim, Han Jo; Oetgen, Matthew E; Ledonio, Charles G; Sanders, James; Burton, Douglas C

2017-09-01

Structured literature review. The Scoliosis Research Society requested an assessment of the current state of peer-reviewed evidence regarding pediatric lumbar spondylolisthesis to identify what is known and what research remains essential to further understanding. Pediatric lumbar spondylolisthesis is common, yet no formal synthesis of the published literature regarding treatment has been previously performed. A comprehensive literature search was performed. From 6600 initial citations with abstract, 663 articles underwent full-text review. The best available evidence regarding surgical and medical/interventional treatment was provided by 51 studies. None of the studies were graded Level I or II evidence. Eighteen of the studies were Level III, representing the current best available evidence. Thirty-three of the studies were Level IV. Although studies suggest a benign course for "low grade" (<50% slip) isthmic spondylolisthesis, extensive literature suggests that a substantial number of patients present for treatment with pain and activity limitations. Pain resolution and return to activity is common with both medical/interventional and operative treatment. The role of medical/interventional bracing is not well established. Uninstrumented posterolateral fusion has been reported to produce good clinical results, but concerns regarding nonunion exist. Risk of slip progression is a specific concern in the "high grade" or dysplastic type. Although medical/interventional observation has been reported to be reasonable in a small series of asymptomatic high-grade slip patients, surgical treatment is commonly recommended to prevent progression. There is Level III evidence that instrumentation and reduction lowers the risk of nonunion, and that circumferential fusion is superior to posterior-only or anterior-only fusion. There is Level III evidence that patients with a higher slip angle are more likely to fail medical/interventional treatment of high-grade spondylolisthesis. The current "best available" evidence to guide the treatment of pediatric spondylolisthesis is presented. Level III; review of Level III studies. Copyright © 2017 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Blunt Trauma Pancreas in Children: Is Non-Operative Management Appropriate for All Grades?

PubMed

Garg, Ravi Kumar; Mahajan, Jai Kumar

2017-12-01

Blunt trauma of pancreas in children is uncommon and its management varies from observational to early operative intervention. We analysed the feasibility and outcome of non-operative management in all grades of paediatric pancreatic injuries. A total of 15 patients of pancreatic trauma seen in a Paediatric Surgery Unit were retrospectively analyzed. Age of the patients ranged from 3-11 years (mean, 7.7 years). The mode of injury was local trauma in 9 children. Only 3 patients had associated injuries and all were haemodynamically stable. Serum amylase levels were raised in 12 patients at admission which ranged from 400-1,000 IU. Computed tomography scan made a correct diagnosis in 14 patients. Grades of the injury varied from grade I-V (1, 3, 6, 4, 1 patients respectively). Fourteen patients were managed conservatively. One patient underwent laparotomy for suspected superior mesenteric hematoma. The average duration of enteral feeds was 3.7 days and of hospital stay was 9.4 days. Six patients formed pancreatic pseudocysts; two were managed conservatively while the other four underwent cystogastrostomy. The patients were followed up for a period of 1-12 years. All remained asymptomatic and none had exocrine or endocrine deficiencies. Non-operative treatment for isolated blunt trauma of pancreas in children may be safely followed for all the grades of injury; if associated injuries requiring surgical intervention are ruled out with a good quality imaging and the patients are hemodynamically stable. It did not increase the hospital stay and morbidity and avoided operative intervention on acutely injured pancreas.

Self-management interventions: Proposal and validation of a new operational definition.

PubMed

Jonkman, Nini H; Schuurmans, Marieke J; Jaarsma, Tiny; Shortridge-Baggett, Lillie M; Hoes, Arno W; Trappenburg, Jaap C A

2016-12-01

Systematic reviews on complex interventions like self-management interventions often do not explicitly state an operational definition of the intervention studied, which may impact the review's conclusions. This study aimed to propose an operational definition of self-management interventions and determine its discriminative performance compared with other operational definitions. Systematic review of definitions of self-management interventions and consensus meetings with self-management research experts and practitioners. Self-management interventions were defined as interventions that aim to equip patients with skills to actively participate and take responsibility in the management of their chronic condition in order to function optimally through at least knowledge acquisition and a combination of at least two of the following: stimulation of independent sign/symptom monitoring, medication management, enhancing problem-solving and decision-making skills for medical treatment management, and changing their physical activity, dietary, and/or smoking behavior. This definition substantially reduced the number of selected studies (255 of 750). In two preliminary expert meetings (n = 6), the proposed definition was identifiable for self-management research experts and practitioners (80% and 60% agreement, respectively). Future systematic reviews must carefully consider the operational definition of the intervention studied because the definition influences the selection of studies on which conclusions and recommendations for clinical practice are based. Copyright © 2016 Elsevier Inc. All rights reserved.

Touch massage: a pilot study of a complex intervention.

PubMed

Lindgren, Lenita; Lehtipalo, Stefan; Winsö, Ola; Karlsson, Marcus; Wiklund, Urban; Brulin, Christine

2013-11-01

To report and evaluate a complex touch massage intervention according to the British Medical Research Council framework. This study aimed to evaluate the effects of touch massage on levels of anxiety and physiological stress in patients scheduled for elective aortic surgery. The use of touch massage has increased during the past decade but no systematic studies have been implemented to investigate the effectiveness of such treatment. It is important to conduct multidisciplinary investigations into the effects of complex interventions such as touch massage. For this, the British Medical Research Council has provided a useful framework to guide the development, piloting, evaluation and reporting of complex intervention studies. A pilot study with a randomized controlled design including 20 patients (10 + 10) scheduled for elective aortic surgery. Selected outcome parameters included; self-reported anxiety, measured by the State-Trait Anxiety Inventory Form Y instrument, and physiological stress, measured by heart rate variability, blood pressure, respiratory frequency, oxygen saturation and concentrations of cortisol, insulin and glucose in serum. There were significant differences in self-reported anxiety levels before and after touch massage (p = 0.007), this was not observed in the control group (p = 0.833). There was a significant difference in self-reported anxiety levels between the touch massage group and the control group after touch massage and rest (p = 0.001). There were no significant differences in physiological stress-related outcome parameters between patients who received touch massage and controls. In our study, touch massage decreased anxiety levels in patients scheduled for elective aortic surgery, and the British Medical Research Council framework was a useful guideline for the development, evaluation and reporting of a touch massage intervention. Touch massage can reduce patients' anxiety levels and is thus an important nursing intervention in intensive and post-operative care. © 2013 The Authors. Nursing in Critical Care © 2013 British Association of Critical Care Nurses.

Overweight and obesity: effectiveness of interventions in adults.

PubMed

Gómez Puente, Juana María; Martínez-Marcos, Mercedes

To identify the most effective interventions in overweight and obese adults. A narrative review through a search of the literature in databases PubMed, Cochrane, Joanna Briggs Institute, EMBASE, Cuiden y Cinahl with free and controlled language (MeSH terms) using Boolean operators AND and NOT. The research was limited to articles published between 2007 and 2015. Eighteen articles were selected based on the established inclusion and exclusion criteria. Different types of interventions were identified based on the modification of lifestyles, mainly diet, physical activity and behavior. Major differences were found in specific content, degree of intensity of interventions, time tracking and elements evaluated. Most of studies found statistically significant weight loss but this was limited in terms of weight and number of people. Web-based interventions have no uniform effect on weight loss but achieve similar levels to face-to-face interventions in maintaining weight loss. The combination of personalised diet, exercise and cognitive behavioural therapy is the most effective form of intervention in overweight and obesity. There is insufficient data to indicate whether group or individual interventions are more effective. Online intervention allows greater accessibility and lower cost. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Enhanced risk profiling of implanted defibrillator shocks with circulating SCN5A mRNA splicing variants: a pilot trial

PubMed Central

Gao, Ge; Brahmanandam, Vikram; Raicu, Mihai; Gu, Lianzhi; Zhou, Li; Kasturirangan, Srinivasan; Shah, Anish; Negi, Smita I.; Wood, Melissa R.; Desai, Ankit A.; Tatooles, Antone; Schwartz, Alan; Dudley, Samuel C.

2014-01-01

Objectives The aim of this study was to determine the association of SCN5A cardiac sodium (Na+) channel mRNA splice variants in white blood cells (WBCs) with risk of arrhythmias in heart failure (HF). Background HF is associated with upregulation of two cardiac SCN5A mRNA splice variants. that encode prematurely truncated, nonfunctional Na+ channels. Since circulating WBCs demonstrate similar SCN5A splicing patterns, we hypothesized that these WBC-derived splice variants might further stratify HF patients at risk for arrhythmias. Methods Simultaneously obtained myocardial core samples and WBCs were compared for SCN5A variants C (VC) and D (VD). Circulating variant levels were compared between HF patients divided into three groups: HF without an implantable cardioverter-defibrillator (ICD), HF with an ICD without appropriate intervention, and HF with an ICD with appropriate intervention. Results Myocardial tissue-derived SCN5A variant expression levels strongly correlated with circulating WBC samples for both VC and VD variants (r = 0.78 and 0.75, respectively). After controlling for covariates, HF patients who had received an appropriate ICD intervention had higher expression levels of both WBC-derived SCN5A variants compared to HF patients with ICDs who had not (OR= 3.25 (95% CI 1.64–6.45; p=0.001)). Receiver operating characteristics analysis revealed that circulating SCN5A variants levels were highly associated with the risk for appropriate ICD intervention (area under the curve ≥ 0.97). Conclusions Circulating expression levels of SCN5A variants were strongly associated with myocardial tissue levels. Furthermore, circulating variant levels were correlative with arrhythmic risk as measured by ICD events in a HF population within one year. PMID:24703920

[First definition of minimal care model: the role of nurses, physiotherapists, dietitians and psychologists in preventive and rehabilitative cardiology].

PubMed

Bettinardi, Ornella; da Vico, Letizia; Pierobon, Antonia; Iannucci, Manuela; Maffezzoni, Barbara; Borghi, Silvana; Ferrari, Marina; Brazzo, Silvia; Mazza, Antonio; Sommaruga, Marinella; Angelino, Elisabetta; Biffi, Barbara; Agostini, Susanna; Masini, Maria Luisa; Ambrosetti, Marco; Faggiano, Pompilio; Griffo, Raffaele

2014-09-01

Rehabilitative and preventive cardiology (CRP) is configured as intervention prevention to "gain health" through a process of multifactorial care that reduces disability and the risk of subsequent cardiovascular events. It makes use of an interdisciplinary team in which every professional needs to have multiple intervention paths because of the different levels of clinical and functional complexity of cardiac patients who currently have access to the rehabilitation. The document refers to the use of interventions by nurses, physiotherapists, dietitians and psychologists that are part of the rehabilitation team of CRP. Interventions of which have been documented, on scientific bases and clinical practice, empirical effectiveness and organizational efficiency. The methodological approach of this paper is a first attempt to define, through the model of consensus, the minimum standards for a CRP evidence based characterized by clearly defined criteria that can be used by operators of CRP. The document describes the activities to be carried out in each of the phases included in the pathways of care by nurses, physiotherapists, dietitians and psychologists. The routes identified were divided, according to the type of patients who have access to the CRP and to the phases of care, including the initial assessment, intervention, evaluation and final reporting, in high medium and low complexity. Examples of models of reporting, used by the operators of the team according to the principles of good clinical practice, are provided. This is made to allow traceability of operations, encourage communication inside the working group and within the patient and the caregiver. Also to give any possible indication for the post-rehabilitation.

Developing and evaluating the implementation of a complex intervention: using mixed methods to inform the design of a randomised controlled trial of an oral healthcare intervention after stroke

PubMed Central

2011-01-01

Background Many interventions delivered within the stroke rehabilitation setting could be considered complex, though some are more complex than others. The degree of complexity might be based on the number of and interactions between levels, components and actions targeted within the intervention. The number of (and variation within) participant groups and the contexts in which it is delivered might also reflect the extent of complexity. Similarly, designing the evaluation of a complex intervention can be challenging. Considerations include the necessity for intervention standardisation, the multiplicity of outcome measures employed to capture the impact of a multifaceted intervention and the delivery of the intervention across different clinical settings operating within varying healthcare contexts. Our aim was to develop and evaluate the implementation of a complex, multidimensional oral health care (OHC) intervention for people in stroke rehabilitation settings which would inform the development of a randomised controlled trial. Methods After reviewing the evidence for the provision of OHC following stroke, multi-disciplinary experts informed the development of our intervention. Using both quantitative and qualitative methods we evaluated the implementation of the complex OHC intervention across patients, staff and service levels of care. We also adopted a pragmatic approach to patient recruitment, the completion of assessment tools and delivery of OHC, alongside an attention to the context in which it was delivered. Results We demonstrated the feasibility of implementing a complex OHC intervention across three levels of care. The complementary nature of the mixed methods approach to data gathering provided a complete picture of the implementation of the intervention and a detailed understanding of the variations within and interactions between the components of the intervention. Information on the feasibility of the outcome measures used to capture impact across a range of components was also collected, though some process orientated uncertainties including eligibility and recruitment rates remain to be further explored within a Phase II exploratory trial. Conclusions Complex interventions can be captured and described in a manner which facilitates evaluation in the form of exploratory and subsequently definitive clinical trials. If effective, the evidence captured relating to the intervention context will facilitate translation into clinical practice. PMID:21729277

Pre-operative Functional Cardiovascular Reserve Is Associated with Acute Kidney Injury after Intervention.

PubMed

Saratzis, A; Shakespeare, J; Jones, O; Bown, M J; Mahmood, A; Imray, C H E

2017-05-01

Acute kidney injury (AKI) is a common complication after endovascular intervention, associated with poor short and long-term outcomes. However, the mechanisms underlying AKI development remain poorly understood. The impact of pre-existing cardiovascular disease and low cardiovascular reserve (CVR) in AKI is unclear; it remains unknown whether AKI is primarily related to pre-existing comorbidity or to procedural parameters. The association between CVR and AKI after EVAR was therefore assessed. This is a case control study. From a database of 484 patients, 292 undergoing elective endovascular aneurysm repair (EVAR) of an infrarenal abdominal aortic aneurysm (AAA) in two tertiary centres were included. Of these, 73 patients who had developed AKI after EVAR were case matched, based on pre-operative estimated glomerular filtration rate (eGFR; within 5 mL/min/1.73 m 2 ) and age, with patients who had not developed AKI. Cardiopulmonary exercise testing (CPET) was used to assess CVR using the anaerobic threshold (AT). Development of AKI was defined using the Kidney Disease Improving Outcomes (KDIGO) guidance. Associations between CVR (based on AT levels) and AKI development were then analysed. Pre-operative AT levels were significantly different between those who did and did not develop AKI (12.1±2.9 SD vs. 14.8±3.0 mL/min/kg, p < .001). In multivariate analysis, a higher level of AT (per 1 mL/min/kg) was associated with a lower odds ratio (OR) of 0.72 (95% CI, 0.63-0.82, p < .001), relative to AKI development. A pre-operative AT level of < 11 mL/min/kg was associated with post-operative AKI development in adjusted analysis, with an OR of 7.8 (95% CI, 3.75-16.51, p < .001). The area under the curve (receiver operating characteristic) for AT as a predictor of post-operative AKI was 0.81 (standard error, 0.06, 95% CI, 0.69-0.93, p < .001). Poor CVR was strongly associated with the development of AKI. This provides pathophysiological insights into the mechanisms underlying AKI. Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

SPOT4 Management Centre

NASA Technical Reports Server (NTRS)

Labrune, Yves; Labbe, X.; Roussel, A.; Vielcanet, P.

1994-01-01

In the context of the CNES SPOT4 program CISI is particularly responsible for the development of the SPOT4 Management Centre, part of the SPOT4 ground control system located at CNES Toulouse (France) designed to provide simultaneous control over two satellites. The main operational activities are timed to synchronize with satellite visibilities (ten usable passes per day). The automatic capability of this system is achieved through agenda services (sequence of operations as defined and planned by operator). Therefore, the SPOT4 Management Centre offers limited, efficient and secure human interventions for supervision and decision making. This paper emphasizes the main system characteristics as degree of automation, level of dependability and system parameterization.

Concurrent orthopedic and neurosurgical procedures in pediatric patients with spinal deformity.

PubMed

Mooney, James F; Glazier, Stephen S; Barfield, William R

2012-11-01

The management of pediatric patients with complex spinal deformity often requires both an orthopedic and a neurosurgical intervention. The reasons for multiple subspecialty involvement include, but are not limited to, the presence of a tethered cord requiring release or a syrinx requiring decompression. It has been common practice to perform these procedures in a staged manner, although there is little evidence in the literature to support separate interventions. We reviewed a series of consecutive patients who underwent spinal deformity correction and a neurosurgical intervention concurrently in an attempt to assess the safety, efficacy, and possible complications associated with such an approach. Eleven patients were reviewed who underwent concurrent orthopedic and neurosurgical procedures. Data were collected for patient demographics, preoperative diagnosis, procedures performed, intraoperative and perioperative complications, as well as any unexpected return to the operating room for any reason. Operative notes and anesthesia records were reviewed to determine estimated blood loss, surgical time, and the use of intraoperative neurological monitoring. Patient diagnoses included myelodysplasia (N=6), congenital scoliosis and/or kyphosis (N=4), and scoliosis associated with Noonan syndrome (N=1). Age at the time of surgery averaged 9 years 2 months (range=14 months to 17 years 2 months). Estimated blood loss averaged 605 ml (range=50-3000 ml). The operative time averaged 313 min (range=157-477 min). There were no intraoperative complications, including incidental dural tears or deterioration in preoperative neurological status. One patient developed a sore associated with postoperative cast immobilization that led to a deep wound infection. It appears that concurrent orthopedic and neurosurgical procedures in pediatric patients with significant spinal deformities can be performed safely and with minimal intraoperative and postoperative complications when utilizing modern surgical and neuromonitoring techniques. Level of evidence=Level IV. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Impact of the reduction of anaesthesia turnover time on operating room efficiency.

PubMed

Sokolovic, E; Biro, P; Wyss, P; Werthemann, C; Haller, U; Spahn, D; Szucs, T

2002-08-01

We investigated whether an increase in anaesthesia staffing to permit induction of anaesthesia before the previous case had ended ('overlapping') would increase overall efficiency in the operating room. Hitherto, the average duration of operating sessions was too long, thus impeding the timely commencement of physicians' ward duties. The investigation was designed as a prospective, non-randomized, interrupted time-series analysis divided into three phases: (a) a baseline of 3.5 months, (b) a 2.5 month intervention phase, in which anaesthesia staffing was increased by one attending physician and one nurse, and (c) a further 2 months under baseline conditions. Data focussed on process management were collected from operating room staff, anaesthesia personnel and surgeons using a structured questionnaire collected daily during the entire study. Turnover time between consecutive operations decreased from 65 to 52 min per operation (95% CI: 9; 17; P = 0.0001). Operating room occupancy increased from 4:28 to 5:27 h day-1 (95% CI: 50; 68; P = 0.005). The surgeons began their work on the ward 35 min (95% CI: 30; 40) later than before the intervention and their overtime increased from 22:36 to 139:50 h. The time between surgical operations decreased significantly. Increased operating room efficiency owing to overlapping induction of anaesthesia allows more intense scheduling of operations. Thus, physicians and nurses can be released to spend more time with their patients in the ward. Improving the efficiency of the operating room alone is insufficient to improve human resource management at all levels of a surgical clinic.

Contingency Software in Autonomous Systems: Technical Level Briefing

NASA Technical Reports Server (NTRS)

Lutz, Robyn R.; Patterson-Hines, Ann

2006-01-01

Contingency management is essential to the robust operation of complex systems such as spacecraft and Unpiloted Aerial Vehicles (UAVs). Automatic contingency handling allows a faster response to unsafe scenarios with reduced human intervention on low-cost and extended missions. Results, applied to the Autonomous Rotorcraft Project and Mars Science Lab, pave the way to more resilient autonomous systems.

[Educational intervention on malignant hyperthermia with nursing professionals of the operating room].

PubMed

Sousa, Cristina Silva; Bispo, Daniela Magalhaes; Cunha, Ana Lucia Mirancos da; Siqueira, Ivana Lucia Correa Pimentel de

2015-04-01

To evaluate the effectiveness of an educational intervention on malignant hyperthermia with operating room nurses. A quasi-experimental study, aimed at an educational intervention of short duration with the nursing staff in the operating room of the institution hosting the research in the city of São Paulo, with the participation of 96 professionals. Pre-intervention tests and post-intervention tests were applied, which consisted of a lecture followed by simulation. Considering the overall results of the intervention, there was a statistically significant difference (p<0.00). After the educational intervention, there was an increase of the minimum and maximum scores, and average growth of 2.64 points in the knowledge of professionals when compared to the previous step. The educational intervention strategy favors the concept of the content developed by everyone involved and qualifies professionals to work safely.

[The predictive value of plasma B-type natriuretic peptide levels on outcome in children with pulmonary hypertension undergoing congenital heart surgery].

PubMed

Baysal, Ayse; Saşmazel, Ahmet; Yildirim, Ayse; Ozyaprak, Buket; Gundogus, Narin; Kocak, Tuncer

2014-01-01

In children undergoing congenital heart surgery, plasma brain natriuretic peptide levels may have a role in development of low cardiac output syndrome that is defined as a combination of clinical findings and interventions to augment cardiac output in children with pulmonary hypertension. In a prospective observational study, fifty-one children undergoing congenital heart surgery with preoperative echocardiographic study showing pulmonary hypertension were enrolled. The plasma brain natriuretic peptide levels were collected before operation, 12, 24 and 48h after operation. The patients enrolled into the study were divided into two groups depending on: (1) Development of LCOS which is defined as a combination of clinical findings or interventions to augment cardiac output postoperatively; (2) Determination of preoperative brain natriuretic peptide cut-off value by receiver operating curve analysis for low cardiac output syndrome. The secondary end points were: (1) duration of mechanical ventilation ≥72h, (2) intensive care unit stay >7days, and (3) mortality. The differences in preoperative and postoperative brain natriuretic peptide levels of patients with or without low cardiac output syndrome (n=35, n=16, respectively) showed significant differences in repeated measurement time points (p=0.0001). The preoperative brain natriuretic peptide cut-off value of 125.5pgmL-1 was found to have the highest sensitivity of 88.9% and specificity of 96.9% in predicting low cardiac output syndrome in patients with pulmonary hypertension. A good correlation was found between preoperative plasma brain natriuretic peptide level and duration of mechanical ventilation (r=0.67, p=0.0001). In patients with pulmonary hypertension undergoing congenital heart surgery, 91% of patients with preoperative plasma brain natriuretic peptide levels above 125.5pgmL-1 are at risk of developing low cardiac output syndrome which is an important postoperative outcome. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Technology-based intervention programs to promote stimulation control and communication in post-coma persons with different levels of disability

PubMed Central

Lancioni, Giulio E.; Bosco, Andrea; Olivetti Belardinelli, Marta; Singh, Nirbhay N.; O'Reilly, Mark F.; Sigafoos, Jeff; Oliva, Doretta

2013-01-01

Post-coma persons in a minimally conscious state and with extensive motor impairment or emerging/emerged from such a state, but affected by lack of speech and motor impairment, tend to be passive and isolated. A way to help them develop functional responding to control environmental events and communication involves the use of intervention programs relying on assistive technology. This paper provides an overview of technology-based intervention programs for enabling the participants to (a) access brief periods of stimulation through one or two microswitches, (b) pursue stimulation and social contact through the combination of a microswitch and a sensor connected to a speech generating device (SGD) or through two SGD-related sensors, (c) control stimulation options through computer or radio systems and a microswitch, (d) communicate through modified messaging or telephone systems operated via microswitch, and (e) control combinations of leisure and communication options through computer systems operated via microswitch. Twenty-six studies, involving a total of 52 participants, were included in this paper. The intervention programs were carried out using single-subject methodology, and their outcomes were generally considered positive from the standpoint of the participants and their context. Practical implications of the programs are discussed. PMID:24574992

Mass Drug Administration and beyond: how can we strengthen health systems to deliver complex interventions to eliminate neglected tropical diseases?

PubMed

Macpherson, Eleanor E; Adams, Emily R; Bockarie, Moses J; Hollingsworth, T Deirdre; Kelly-Hope, Louise A; Lehane, Mike; Kovacic, Vanja; Harrison, Robert A; Paine, Mark Ji; Reimer, Lisa J; Torr, Stephen J

2015-01-01

Achieving the 2020 goals for Neglected Tropical Diseases (NTDs) requires scale-up of Mass Drug Administration (MDA) which will require long-term commitment of national and global financing partners, strengthening national capacity and, at the community level, systems to monitor and evaluate activities and impact. For some settings and diseases, MDA is not appropriate and alternative interventions are required. Operational research is necessary to identify how existing MDA networks can deliver this more complex range of interventions equitably. The final stages of the different global programmes to eliminate NTDs require eliminating foci of transmission which are likely to persist in complex and remote rural settings. Operational research is required to identify how current tools and practices might be adapted to locate and eliminate these hard-to-reach foci. Chronic disabilities caused by NTDs will persist after transmission of pathogens ceases. Development and delivery of sustainable services to reduce the NTD-related disability is an urgent public health priority. LSTM and its partners are world leaders in developing and delivering interventions to control vector-borne NTDs and malaria, particularly in hard-to-reach settings in Africa. Our experience, partnerships and research capacity allows us to serve as a hub for developing, supporting, monitoring and evaluating global programmes to eliminate NTDs.

Enhanced Sanitation Standard Operating Procedures Have Limited Impact on Listeria monocytogenes Prevalence in Retail Delis.

PubMed

Etter, Andrea J; Hammons, Susan R; Roof, Sherry; Simmons, Courtenay; Wu, Tongyu; Cook, Peter W; Katubig, Alex; Stasiewicz, Matthew J; Wright, Emily; Warchocki, Steven; Hollingworth, Jill; Thesmar, Hilary S; Ibrahim, Salam A; Wiedmann, Martin; Oliver, Haley F

2017-10-20

In a recent longitudinal surveillance study in 30 U.S. retail delicatessens, 9.7% of environmental surfaces were positive for Listeria monocytogenes, and we found substantial evidence of persistence. In this study, we aimed to reduce the prevalence and persistence of L. monocytogenes in the retail deli environment by developing and implementing practical and feasible intervention strategies (i.e., sanitation standard operating procedures; SSOPs). These SSOPs were standardized across the 30 delis enrolled in this study. SSOP implementation was verified by systems inherent to each retailer. Each deli also was equipped with ATP monitoring systems to verify effective sanitation. We evaluated intervention strategy efficacy by testing 28 food and nonfood contact surfaces for L. monocytogenes for 6 months in all 30 retail delis. The efficacy of the intervention on the delis compared with preintervention prevalence level was not statistically significant; we found that L. monocytogenes could persist despite implementation of enhanced SSOPs. Systematic and accurate use of ATP monitoring systems varied widely among delis. The findings indicate that intervention strategies in the form of enhanced daily SSOPs were not sufficient to eliminate L. monocytogenes from highly prevalent and persistently contaminated delis and that more aggressive strategies (e.g., deep cleaning or capital investment in redesign or equipment) may be necessary to fully mitigate persistent contamination.

A structural model of health behavior: a pragmatic approach to explain and influence health behaviors at the population level.

PubMed

Cohen, D A; Scribner, R A; Farley, T A

2000-02-01

Behavior is influenced by individual-level attributes as well as by the conditions under which people live. Altering policies, practices, and the conditions of life can directly and indirectly influence individual behavior. This paper builds on existing ecological theories of health behavior by specifying structural mechanisms by which population-level factors effect change in individual health behaviors. This paper moves ecological theory from model building to a pragmatic characterization of structural interventions. We examined social and environmental factors beyond individual control and mechanisms as to how they influence behavior. Four categories of structural factors are identified: (1) availability of protective or harmful consumer products, (2) physical structures (or physical characteristics of products), (3) social structures and policies, and (4) media and cultural messages. The first three can directly influence individuals through facilitating or constraining behavior. The fourth, media, operates by changing individual-level attitudes, beliefs, and cognitions, as well as group norms. Interventions that target the four identified structural factors are a means to provide conditions that not only reduce high-risk behavior but also prevent the adoption of high-risk behaviors. Structural interventions are important and underutilized approaches for improving our nation's health. Copyright 2000 American Health Foundation and Academic Press.

Examination of the effectiveness of peppermint aromatherapy on nausea in women post C-section.

PubMed

Lane, Betty; Cannella, Kathi; Bowen, Cathy; Copelan, David; Nteff, Grace; Barnes, Katrina; Poudevigne, Melanie; Lawson, Jacqueline

2012-06-01

This study examined the effect of peppermint spirits on postoperative nausea in women following a scheduled C-section. A pretest-posttest research design with three groups was used. The peppermint group inhaled peppermint spirits, the placebo aromatherapy control group inhaled an inert placebo, green-colored sterile water, and the standard antiemetic therapy control group received standard antiemetics, usually intravenous ondansetron or promethazine suppositories. Women were randomly assigned to a group on admission to the hospital. If they became nauseated, nurses on the mother-baby unit assessed their nausea (baseline), administered the assigned intervention, and then reassessed participants' nausea 2 and 5 minutes after the initial intervention. Participants rated their nausea using a 6-point nausea scale. Thirty-five participants became nauseated post-operatively. Participants in all three intervention groups had similar levels of nausea at baseline. The nausea levels of participants in the peppermint spirits group were significantly lower than those of participants in the other two groups 2 and 5 minutes after the initial intervention. Peppermint spirits may be a useful adjunct in the treatment of postoperative nausea. This study should be replicated with more participants, using a variety of aromatherapies to treat nausea in participants with different preoperative diagnoses.

Perioperative psychological and music interventions in elderly patients undergoing spinal anesthesia: effect on anxiety, heart rate variability, and postoperative pain.

PubMed

Wang, Yisha; Dong, Youjing; Li, Yang

2014-07-01

The aim of this study was to evaluate the effects of perioperative psychological and music interventions in elderly patients undergoing elective surgery on anxiety, post-operative pain, and changes in heart rate variability (HRV) to ascertain if perioperative psychological and music interventions can affect overall anxiety levels. Fourty elderly patients undergoing elective surgery were randomized to two groups; one group received psychological and music intervention, and the other was the control. The intervention group underwent psychological intervention and listening to music for 30 min before surgery. The mean change in HRV as determined by low frequency (LF) power measurements. After the intervention, the ratio of mean LF to high frequency (HF) power decreased significantly in the intervention group compared to before the intervention (p<0.05). In the control group, mean LF measurements and the ratio of LF:HF did not change significantly. In the intervention group, mean HF power was significantly higher after the procedure than before (p<0.01). Moreover, the mean self-rating anxiety score of the intervention group decreased after the procedure compared to before (p<0.05). The mean visual analogue score of the intervention group 6 hours after surgery was significantly lower than that of the control group (p<0.01). Perioperative psychological and music interventions can reduce anxiety and postoperative pain in elderly patients.

MRI-guided robotics at the U of Houston: evolving methodologies for interventions and surgeries.

PubMed

Tsekos, Nikolaos V

2009-01-01

Currently, we witness the rapid evolution of minimally invasive surgeries (MIS) and image guided interventions (IGI) for offering improved patient management and cost effectiveness. It is well recognized that sustaining and expand this paradigm shift would require new computational methodology that integrates sensing with multimodal imaging, actively controlled robotic manipulators, the patient and the operator. Such approach would include (1) assessing in real-time tissue deformation secondary to the procedure and physiologic motion, (2) monitoring the tool(s) in 3D, and (3) on-the-fly update information about the pathophysiology of the targeted tissue. With those capabilities, real time image guidance may facilitate a paradigm shift and methodological leap from "keyhole" visualization (i.e. endoscopy or laparoscopy) to one that uses a volumetric and informational rich perception of the Area of Operation (AoO). This capability may eventually enable a wider range and level of complexity IGI and MIS.

13. Operational planning for a specific intervention.

PubMed

2014-05-01

Every intervention must follow an operational plan. Operational plans delineate actions required to meet an objective that is part of the strategic plan (overarching goal). Operational plans dictate the critical pathways for the interventions that will be followed during and following the implementation of the intervention. Operational plans include: (1) an introduction and brief situation report; (2) an overview of the task(s), objectives, and the overarching goal to be addressed; (3) the methods that will be employed; (4) planning factors; (5) the resources that will be required including personnel, equipment, and supplies; (6) timelines, benchmarks, and milestones including their respective indicators, startup time, end point, and estimates of the time required for completion; (7) the administrative structure to be employed; (8) an operating budget; (9) the strategy for acquiring the funding required; (10) roles and responsibilities of the personnel including position descriptions and the competencies required of the personnel (skill sets); (11) mechanisms for monitoring the progress including the indicators that will be employed, (12) safety, including health of the personnel, required immunisations, accommodations, and reporting structure; (13) self-sufficiency; and (14) reporting and accounting. There are many generic items in an operational plan that can be used in successive plans. Without a detailed operational plan, interventions are doomed to probable failure and can profoundly negatively impact other projects operational in the area.

Post-hepatectomy haemorrhage: a definition and grading by the International Study Group of Liver Surgery (ISGLS).

PubMed

Rahbari, Nuh N; Garden, O James; Padbury, Robert; Maddern, Guy; Koch, Moritz; Hugh, Thomas J; Fan, Sheung Tat; Nimura, Yuji; Figueras, Joan; Vauthey, Jean-Nicolas; Rees, Myrddin; Adam, Rene; Dematteo, Ronald P; Greig, Paul; Usatoff, Val; Banting, Simon; Nagino, Masato; Capussotti, Lorenzo; Yokoyama, Yukihiro; Brooke-Smith, Mark; Crawford, Michael; Christophi, Christopher; Makuuchi, Masatoshi; Büchler, Markus W; Weitz, Jürgen

2011-08-01

A standardized definition of post-hepatectomy haemorrhage (PHH) has not yet been established. An international study group of hepatobiliary surgeons from high-volume centres was convened and a definition of PHH was developed together with a grading of severity considering the impact on patients' clinical management. The definition of PHH varies strongly within the hepatic surgery literature. PHH is defined as a drop in haemoglobin level > 3 g/dl post-operatively compared with the post-operative baseline level and/or any post-operative transfusion of packed red blood cells (PRBC) for a falling haemoglobin and/or the need for radiological intervention (such as embolization) and/or re-laparotomy to stop bleeding. Evidence of intra-abdominal bleeding should be obtained by imaging or blood loss via the abdominal drains if present. Transfusion of up to two units of PRBC is considered as being Grade A PHH. Grade B PHH requires transfusion of more than two units of PRBC, whereas the need for invasive re-intervention such as embolization and/ or re-laparotomy defines Grade C PHH. The proposed definition and grading of severity of PHH enables valid comparisons of results from different studies. It is easily applicable in clinical routine and should be applied in future trials to standardize reporting of complications. © 2011 International Hepato-Pancreato-Biliary Association.

Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 4. child health findings.

PubMed

Freeman, Paul A; Schleiff, Meike; Sacks, Emma; Rassekh, Bahie M; Gupta, Sundeep; Perry, Henry B

2017-06-01

This paper assesses the effectiveness of community-based primary health care (CBPHC) in improving child health beyond the neonatal period. Although there has been an accelerated decline in global under-5 mortality since 2000, mortality rates remain high in much of sub-Saharan Africa and in some south Asian countries where under-5 mortality is also decreasing more slowly. Essential interventions for child health at the community level have been identified. Our review aims to contribute further to this knowledge by examining how strong the evidence is and exploring in greater detail what specific interventions and implementation strategies appear to be effective. We reviewed relevant documents from 1950 onwards using a detailed protocol. Peer reviewed documents, reports and books assessing the impact of one or more CBPHC interventions on child health (defined as changes in population coverage of one or more key child survival interventions, nutritional status, serious morbidity or mortality) among children in a geographically defined population was examined for inclusion. Two separate reviews took place of each document followed by an independent consolidated summative review. Data from the latter review were transferred to electronic database for analysis. The findings provide strong evidence that the major causes of child mortality in resource-constrained settings can be addressed at the community level largely by engaging communities and supporting community-level workers. For all major categories of interventions (nutritional interventions; control of pneumonia, diarrheal disease and malaria; HIV prevention and treatment; immunizations; integrated management of childhood diseases; and comprehensive primary health care) we have presented randomized controlled trials that have consistently produced statistically significant and operationally important effects. This review shows that there is strong evidence of effectiveness for CBPHC implementation of an extensive range of interventions to improve child health and that four major strategies for delivering these interventions are effective.

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 4. child health findings

PubMed Central

Freeman, Paul A; Schleiff, Meike; Sacks, Emma; Rassekh, Bahie M; Gupta, Sundeep; Perry, Henry B

2017-01-01

Background This paper assesses the effectiveness of community–based primary health care (CBPHC) in improving child health beyond the neonatal period. Although there has been an accelerated decline in global under–5 mortality since 2000, mortality rates remain high in much of sub–Saharan Africa and in some south Asian countries where under–5 mortality is also decreasing more slowly. Essential interventions for child health at the community level have been identified. Our review aims to contribute further to this knowledge by examining how strong the evidence is and exploring in greater detail what specific interventions and implementation strategies appear to be effective. Methods We reviewed relevant documents from 1950 onwards using a detailed protocol. Peer reviewed documents, reports and books assessing the impact of one or more CBPHC interventions on child health (defined as changes in population coverage of one or more key child survival interventions, nutritional status, serious morbidity or mortality) among children in a geographically defined population was examined for inclusion. Two separate reviews took place of each document followed by an independent consolidated summative review. Data from the latter review were transferred to electronic database for analysis. Results The findings provide strong evidence that the major causes of child mortality in resource–constrained settings can be addressed at the community level largely by engaging communities and supporting community–level workers. For all major categories of interventions (nutritional interventions; control of pneumonia, diarrheal disease and malaria; HIV prevention and treatment; immunizations; integrated management of childhood diseases; and comprehensive primary health care) we have presented randomized controlled trials that have consistently produced statistically significant and operationally important effects. Conclusions This review shows that there is strong evidence of effectiveness for CBPHC implementation of an extensive range of interventions to improve child health and that four major strategies for delivering these interventions are effective. PMID:28685042

[Considerations of screening and brief intervention among high-risk drinkers in Japan: from the perspectives of feasibility and cost-effectiveness].

PubMed

Taguchi, Yurie; Yoshimoto, Hisashi; Ikeda, Shunya

2016-02-01

One of the alcohol-related goals in Japan's health promotion campaign called Health Japan 21 (secondary term) is to reduce the number of high-risk drinkers (20 years old or above) who consume 40g or more pure alcohol/day in men and 20g or more in women by year 2022. To achieve this goal, a further expansion of screening and brief intervention (SBI) in the medical setting is essential. In this research, realistic and cost-effective SBI scenarios in Japan were investigated based on international systematic review and clinicians' opinions from a semi-structured interview. Several SBI scenarios were built with 2 levels of intervention based on the AUDIT scores of 8-15 (brief advice) and 16-19 (brief advice and counseling, continuous intervention), and a simulation was conducted by applying different probabilities and success rates into the scenarios. Information associated with preparation and implementation of SBI at the 2 levels was also estimated and annual costs of SBI per drinker were calculated. It was found that approximately 2,390,000 and 530,000 high-risk drinkers require brief and extensive interventions, respectively. Furthermore, incremental costs per quality-adjusted life year (QALY) gained were calculated at 723,415 yen for brief intervention and 944,762 yen for extensive intervention, suggesting cost-effectiveness of SBI in Japan. Given the limited national healthcare budget and operational challenges such as time to provide SBI especially in the primary care setting in Japan, roles of healthcare providers and wider use of information technology were discussed with some suggestions. Furthermore, lighter and more frequent interventions at various levels and not only at the medical setting but also at multiple social settings (such as workplace and among family and friends) were discussed to increase the cost-effectiveness of SBI and to keep the number of high-risk drinkers who have successfully reduced their alcohol consumption.

Morbidity of pediatric dog bites: a case series at a level one pediatric trauma center.

PubMed

Garvey, Erin M; Twitchell, Denice K; Ragar, Rebecca; Egan, John C; Jamshidi, Ramin

2015-02-01

Pediatric dog bite injuries are common and vary in severity. We sought to characterize predisposing factors, required interventions, and morbidity. A prospective clinical database at a level one pediatric trauma center was reviewed for dog bite injuries over 74 consecutive months ending December 2013. This included all patients brought in by ambulance and/or seen by the trauma team. Of 650 dog bite incidents, 282 met the criteria for inclusion in the trauma database. Median age was 5 years (range, 2 months to 17 years) and 55% (154/282) of patients were male. Pit bulls were most frequently responsible, accounting for 39% (83/213) of incidents in which dog breed was documented. Fifty-three percent (150/282) of dogs belonged to the patient's immediate or extended family. Sixty-nine percent (194/282) of patients required operative intervention: 76% laceration repairs, 14% tissue transfers, and 2% neurosurgical interventions. The most severe injuries were depressed skull fractures, intracranial hemorrhage, laryngotracheal transection, and bilateral orchiectomy. Median length of stay was 1 day (range, 0 to 25 days). There were no mortalities. Pediatric dog bites span a wide range of ages, frequently require operative intervention, and can cause severe morbidity. Dog familiarity did not confer safety, and in this series, Pit bulls were most frequently responsible. These findings have great relevance for child safety. Pediatric dog bites are common and can vary in severity from superficial wounds to life-threatening injuries. Dog familiarity may confer a false sense of safety. A national dog bite prevention and education campaign should be developed with the goal of decreasing the incidence of pediatric dog bites. Copyright © 2015 Elsevier Inc. All rights reserved.

Early intervention to promote medical student interest in surgery and the surgical subspecialties.

PubMed

Patel, Madhukar S; Mowlds, Donald S; Khalsa, Bhavraj; Foe-Parker, Jennifer E; Rama, Asheen; Jafari, Fariba; Whealon, Matthew D; Salibian, Ara; Hoyt, David B; Stamos, Michael J; Endres, Jill E; Smith, Brian R

2013-01-01

Concerns about projected workforce shortages are growing, and attrition rates among surgical residents remain high. Early exposure of medical students to the surgical profession may promote interest in surgery and allow students more time to make informed career decisions. The objective of this study was to evaluate the impact of a simple, easily reproducible intervention aimed at increasing first- and second-year medical student interest in surgery. Surgery Saturday (SS) is a student-organized half-day intervention of four faculty-led workshops that introduce suturing, knot tying, open instrument identification, operating room etiquette, and basic laparoscopic skills. Medical students who attended SS were administered pre-/post-surveys that gauged change in surgical interest levels and provided a self-assessment (1-5 Likert-type items) of knowledge and skills acquisition. First- and second-year medical students. Change in interest in the surgical field as well as perceived knowledge and skills acquisition. Thirty-three first- and second-year medical students attended SS and completed pre-/post-surveys. Before SS, 14 (42%) students planned to pursue a surgical residency, 4 (12%) did not plan to pursue a surgical residency, and 15 (46%) were undecided. At the conclusion, 29 (88%) students indicated an increased interested in surgery, including 87% (13/15) who were initially undecided. Additionally, attendees reported a significantly (p < 0.05) higher comfort level in the following: suturing, knot tying, open instrument identification, operating room etiquette, and laparoscopic instrument identification and manipulation. SS is a low resource, high impact half-day intervention that can significantly promote early medical student interest in surgery. As it is easily replicable, adoption by other medical schools is encouraged. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Which patients need critical care intervention after total joint arthroplasty? : a prospective study of factors associated with the need for intensive care following surgery.

PubMed

Courtney, P M; Melnic, C M; Gutsche, J; Hume, E L; Lee, G-C

2015-11-01

Older patients with multiple medical co-morbidities are increasingly being offered and undergoing total joint arthroplasty (TJA). These patients are more likely to require intensive care support, following surgery. We prospectively evaluated the need for intensive care admission and intervention in a consecutive series of 738 patients undergoing elective hip and knee arthroplasty procedures. The mean age was 60.6 years (18 to 91; 440 women, 298 men. Risk factors, correlating with the need for critical care intervention, according to published guidelines, were analysed to identify high-risk patients who would benefit from post-operative critical care monitoring. A total of 50 patients (6.7%) in our series required critical care level interventions during their hospital stay. Six independent multivariate clinical predictors were identified (p < 0.001) including a history of congestive heart failure (odds ratio (OR) 24.26, 95% confidence interval (CI) 9.51 to 61.91), estimated blood loss > 1000 mL (OR 17.36, 95% CI 5.36 to 56.19), chronic obstructive pulmonary disease (13.90, 95% CI 4.78 to 40.36), intra-operative use of vasopressors (OR 8.10, 95% CI 3.23 to 20.27), revision hip arthroplasty (OR 2.71, 95% CI 1.04 to 7.04) and body mass index > 35 kg/m(2) (OR 2.70, 95% CI 123 to 5.94). The model was then validated against an independent, previously published data set of 1594 consecutive patients. The use of this risk stratification model can be helpful in predicting which high-risk patients would benefit from a higher level of monitoring and care after elective TJA and aid hospitals in allocating precious critical care resources. ©2015 The British Editorial Society of Bone & Joint Surgery.

Association of Airborne Microorganisms in the Operating Room With Implant Infections: A Randomized Controlled Trial.

PubMed

Darouiche, Rabih O; Green, David M; Harrington, Melvyn A; Ehni, Bruce L; Kougias, Panagiotis; Bechara, Carlos F; O'Connor, Daniel P

2017-01-01

OBJECTIVE To evaluate the association of airborne colony-forming units (CFU) at incision sites during implantation of prostheses with the incidence of either incisional or prosthesis-related surgical site infections. DESIGN Randomized, controlled trial. SETTING Primary, public institution. PATIENTS Three hundred patients undergoing total hip arthroplasty, instrumented spinal procedures, or vascular bypass graft implantation. METHODS Patients were randomly assigned in a 1:1 ratio to either the intervention group or the control group. A novel device (Air Barrier System), previously shown to reduce airborne CFU at incision sites, was utilized in the intervention group. Procedures assigned to the control group were performed without the device, under routine operating room atmospheric conditions. Patients were followed up for 12 months to determine whether airborne CFU levels at the incision sites predicted the incidence of incisional or prosthesis-related infection. RESULTS Data were available for 294 patients, 148 in the intervention group and 146 in the control group. CFU density at the incision site was significantly lower in the intervention group than in the control group (P<.001). The density of airborne CFU at the incision site during the procedures was significantly related to the incidence of implant infection (P=.021). Airborne CFU densities were 4 times greater in procedures with implant infection versus no implant infection. All 4 of the observed prosthesis infections occurred in the control group. CONCLUSION Reduction of airborne CFU specifically at the incision site during operations may be an effective strategy to reduce prosthesis-related infections. clinicaltrials.gov Identifier: NCT01610271 Infect Control Hosp Epidemiol 2016;1-8.

Unpacking vertical and horizontal integration: childhood overweight/obesity programs and planning, a Canadian perspective

PubMed Central

2010-01-01

Background Increasingly, multiple intervention programming is being understood and implemented as a key approach to developing public health initiatives and strategies. Using socio-ecological and population health perspectives, multiple intervention programming approaches are aimed at providing coordinated and strategic comprehensive programs operating over system levels and across sectors, allowing practitioners and decision makers to take advantage of synergistic effects. These approaches also require vertical and horizontal (v/h) integration of policy and practice in order to be maximally effective. Discussion This paper examines v/h integration of interventions for childhood overweight/obesity prevention and reduction from a Canadian perspective. It describes the implications of v/h integration for childhood overweight and obesity prevention, with examples of interventions where v/h integration has been implemented. An application of a conceptual framework for structuring v/h integration of an overweight/obesity prevention initiative is presented. The paper concludes with a discussion of the implications of vertical/horizontal integration for policy, research, and practice related to childhood overweight and obesity prevention multiple intervention programs. Summary Both v/h integration across sectors and over system levels are needed to fully support multiple intervention programs of the complexity and scope required by obesity issues. V/h integration requires attention to system structures and processes. A conceptual framework is needed to support policy alignment, multi-level evaluation, and ongoing coordination of people at the front lines of practice. Using such tools to achieve integration may enhance sustainability, increase effectiveness of prevention and reduction efforts, decrease stigmatization, and lead to new ways to relate the environment to people and people to the environment for better health for children. PMID:20478054

Unpacking vertical and horizontal integration: childhood overweight/obesity programs and planning, a Canadian perspective.

PubMed

Maclean, Lynne M; Clinton, Kathryn; Edwards, Nancy; Garrard, Michael; Ashley, Lisa; Hansen-Ketchum, Patti; Walsh, Audrey

2010-05-17

Increasingly, multiple intervention programming is being understood and implemented as a key approach to developing public health initiatives and strategies. Using socio-ecological and population health perspectives, multiple intervention programming approaches are aimed at providing coordinated and strategic comprehensive programs operating over system levels and across sectors, allowing practitioners and decision makers to take advantage of synergistic effects. These approaches also require vertical and horizontal (v/h) integration of policy and practice in order to be maximally effective. This paper examines v/h integration of interventions for childhood overweight/obesity prevention and reduction from a Canadian perspective. It describes the implications of v/h integration for childhood overweight and obesity prevention, with examples of interventions where v/h integration has been implemented. An application of a conceptual framework for structuring v/h integration of an overweight/obesity prevention initiative is presented. The paper concludes with a discussion of the implications of vertical/horizontal integration for policy, research, and practice related to childhood overweight and obesity prevention multiple intervention programs. Both v/h integration across sectors and over system levels are needed to fully support multiple intervention programs of the complexity and scope required by obesity issues. V/h integration requires attention to system structures and processes. A conceptual framework is needed to support policy alignment, multi-level evaluation, and ongoing coordination of people at the front lines of practice. Using such tools to achieve integration may enhance sustainability, increase effectiveness of prevention and reduction efforts, decrease stigmatization, and lead to new ways to relate the environment to people and people to the environment for better health for children.

Maternal obesity in the rat programs male offspring exploratory, learning and motivation behavior: prevention by dietary intervention pre-gestation or in gestation.

PubMed

Rodriguez, J S; Rodríguez-González, G L; Reyes-Castro, L A; Ibáñez, C; Ramírez, A; Chavira, R; Larrea, F; Nathanielsz, P W; Zambrano, E

2012-04-01

We studied the effects of maternal high fat diet (HFD, 25% calories from fat administered before and during pregnancy and lactation) and dietary intervention (switching dams from HFD to control diet) at different periconceptional periods on male offspring anxiety related behavior, exploration, learning, and motivation. From weaning at postnatal day (PND) 21, female subjects produced to be the mothers in the study received either control diet (CTR - 5% calories from fat), HFD through pregnancy and lactation (MO), HFD during PNDs 21-90 followed by CTR diet (pre-gestation (PG) intervention) or HFD from PND 21 to 120 followed by CTR diet (gestation and lactation (G) intervention) and bred at PND 120. At 19 days of gestation maternal serum corticosterone was increased in MO and the PG and G dams showed partial recovery with intermediate levels. In offspring, no effects were found in the elevated plus maze test. In the open field test, MO and G offspring showed increase zone entries, displaying less thigmotaxis; PG offspring showed partial recuperation of this behavior. During initial operant conditioning MO, PG and G offspring displayed decreased approach behavior with subsequent learning impairment during the acquisition of FR-1 and FR-5 operant conditioning for sucrose reinforcement. Motivation during the progressive ratio test increased in MO offspring; PG and G intervention recuperated this behavior. We conclude that dietary intervention can reverse negative effects of maternal HFD and offspring outcomes are potentially due to elevated maternal corticosterone. Copyright © 2012 ISDN. Published by Elsevier Ltd. All rights reserved.

Augmented reality and image overlay navigation with OsiriX in laparoscopic and robotic surgery: not only a matter of fashion.

PubMed

Volonté, Francesco; Pugin, François; Bucher, Pascal; Sugimoto, Maki; Ratib, Osman; Morel, Philippe

2011-07-01

New technologies can considerably improve preoperative planning, enhance the surgeon's skill and simplify the approach to complex procedures. Augmented reality techniques, robot assisted operations and computer assisted navigation tools will become increasingly important in surgery and in residents' education. We obtained 3D reconstructions from simple spiral computed tomography (CT) slides using OsiriX, an open source processing software package dedicated to DICOM images. These images were then projected on the patient's body with a beamer fixed to the operating table to enhance spatial perception during surgical intervention (augmented reality). Changing a window's deepness level allowed the surgeon to navigate through the patient's anatomy, highlighting regions of interest and marked pathologies. We used image overlay navigation for laparoscopic operations such cholecystectomy, abdominal exploration, distal pancreas resection and robotic liver resection. Augmented reality techniques will transform the behaviour of surgeons, making surgical interventions easier, faster and probably safer. These new techniques will also renew methods of surgical teaching, facilitating transmission of knowledge and skill to young surgeons.

The effects of exercise on pain, fatigue, insomnia, and health perceptions in patients with operable advanced stage rectal cancer prior to surgery: a pilot trial.

PubMed

Brunet, Jennifer; Burke, Shaunna; Grocott, Michael P W; West, Malcolm A; Jack, Sandy

2017-02-23

Promoting quality of life (QoL) is a key priority in cancer care. We investigated the hypothesis that, in comparison to usual care, exercise post-neoadjuvant chemoradiation therapy/prior to surgical resection will reduce pain, fatigue, and insomnia, and will improve physical and mental health perceptions in patients with locally advanced stage rectal cancer. In this non-randomized controlled pilot trial, patients in the supervised exercise group (EG; M age  = 64 years; 64% male) and in the control group (CG; M age  = 72 years; 69% male) completed the European Organization for Research and Treatment of Cancer core Quality of Life questionnaire and the RAND 36-Item Health Survey three times: pre-neoadjuvant chemoradiation therapy (Time 1; n EC  = 24; n CG  = 11), post-neoadjuvant chemoradiation therapy/pre-exercise intervention (Time 2; n EC  = 23; n CG  = 10), and post-exercise intervention (Time 3; n EC  = 22; n CG  = 10). The 6-week exercise intervention was delivered in hospital and comprised of interval aerobic training. Patients trained in pairs three times per week for 30 to 40 min. Data were analyzed by Mann-Whitney tests and by Wilcoxon matched-pairs signed-rank tests. No significant between-group differences in changes were found for any of the outcomes. In both groups, fatigue levels decreased and physical health perceptions increased from pre- to post-exercise intervention. Pain levels also decreased from pre- to post-exercise intervention, albeit not significantly. The findings from this study can be used to guide a more definitive trial as they provide preliminary evidence regarding the potential effects of pre-operative exercise on self-reported pain, fatigue, insomnia, and health perceptions in patients with locally advanced rectal cancer. This study has been registered with clinicaltrials.gov (NCT01325909; March 29, 2011).

EQUIP Healthcare: An overview of a multi-component intervention to enhance equity-oriented care in primary health care settings.

PubMed

Browne, Annette J; Varcoe, Colleen; Ford-Gilboe, Marilyn; Wathen, C Nadine

2015-12-14

The primary health care (PHC) sector is increasingly relevant as a site for population health interventions, particularly in relation to marginalized groups, where the greatest gains in health status can be achieved. The purpose of this paper is to provide an overview of an innovative multi-component, organizational-level intervention designed to enhance the capacity of PHC clinics to provide equity-oriented care, particularly for marginalized populations. The intervention, known as EQUIP, is being implemented in Canada in four diverse PHC clinics serving populations who are impacted by structural inequities. These PHC clinics serve as case studies for the implementation and evaluation of the EQUIP intervention. We discuss the evidence and theory that provide the basis for the intervention, describe the intervention components, and discuss the methods used to evaluate the implementation and impact of the intervention in diverse contexts. Research and theory related to equity-oriented care, and complexity theory, are central to the design of the EQUIP intervention. The intervention aims to enhance capacity for equity-oriented care at the staff level, and at the organizational level (i.e., policy and operations) and is novel in its dual focus on: (a) Staff education: using standardized educational models and integration strategies to enhance staff knowledge, attitudes and practices related to equity-oriented care in general, and cultural safety, and trauma- and violence-informed care in particular, and; (b) Organizational integration and tailoring: using a participatory approach, practice facilitation, and catalyst grants to foster shifts in organizational structures, practices and policies to enhance the capacity to deliver equity-oriented care, improve processes of care, and shift key client outcomes. Using a mixed methods, multiple case-study design, we are examining the impact of the intervention in enhancing staff knowledge, attitudes and practices; improving processes of care; shifting organizational policies and structures; and improving selected client outcomes. The multiple case study design provides an ideal opportunity to study the contextual factors shaping the implementation, uptake and impact of our tailored intervention within diverse PHC settings. The EQUIP intervention illustrates the complexities involved in enhancing the PHC sector's capacity to provide equity-oriented care in real world clinical contexts.

What Do We Know About Intraoperative Teaching?: A Systematic Review.

PubMed

Timberlake, Matthew D; Mayo, Helen G; Scott, Lauren; Weis, Joshua; Gardner, Aimee K

2017-08-01

There is increasing attention on enhancing surgical trainee performance and competency. The purpose of this review is to identify characteristics and themes related to intraoperative teaching that will better inform interventions and assessment endeavors. A systematic search was carried out of the Ovid MEDLINE, Ovid MEDLINE InProcess, Ovid Embase, and the Cochrane Library databases to identify all studies that discussed teaching in the operating room for trainees at the resident and fellow level. Evidence for main outcome categories was evaluated with the Medical Education Research Study Quality Instrument (MERSQI). A total of 2101 records were identified. After screening by title, abstract, and full text, 34 studies were included. We categorized these articles into 3 groups on the basis of study methodology: perceptions, best practices, and interventions to enhance operative teaching. Overall strength of evidence for each type of study was as follows: perceptions (MERSQI: 7.5-10); best practices (6.5-11.5), and interventions (8-15). Although very few studies (n = 5) examined interventions for intraoperative teaching, these studies demonstrate the efficacy of techniques designed to enhance faculty teaching behaviors. Interventions have a positive impact on trainee ratings of their faculty intraoperative teaching performance. There is discordance between trainee perceptions of quantity and quality of teaching, compared with faculty perceptions of their own teaching behaviors. Frameworks and paradigms designed to provide best practices for intraoperative teaching agree that effective teaching spans 3 phases that take place before, during, and after cases.

Realizing the potential of empowerment: the impact of a feedback intervention on the performance of complex technology.

PubMed

Leach, D J; Jackson, P R; Wall, T D

2001-07-15

An empowerment initiative involving enhanced fault-management responsibility for operators of complex technology had not led to expected increases in performance, and investigations suggested that this was due to a lack of appropriate feedback. Thus, a feedback intervention was designed to provide specific, timely feedback on operator-correctable faults. It was hypothesized that the intervention would increase operator self-reliance in operating complex technology and promote system performance. Moreover, given the feedback was continuous from the point of intervention, it was predicted that gains would increase over time. Time series analysis of data on engineer call-outs (self-reliance) and machine utilization (performance) showed clear positive effects of the feedback intervention, with call-outs also showing progressive improvement. Self-report data showed no change over time in motivation, but an increase in knowledge dissemination and a reduction in the likelihood of making expensive mistakes. There were no detrimental effects on operator well being. Implications for theory and practice in the management of complex technology are discussed.

[Beginners' operations and medical specialist standards : Avoidance of criminal liability and civil liability].

PubMed

Schneider, H

2018-05-16

In all phases, patients are entitled to receive medical treatment according to medical specialist standards. This does not mean that patients necessarily have to be treated by a medical specialist. Operations performed by "beginners", e. g. assistant physicians, are permitted. However, there are increased liability risks, both for the specialist and the assistant physician. Furthermore, there are risks of criminal responsibility for causing bodily harm by negligence or negligent manslaughter. This article portrays the requirements of civil liability and criminal responsibility concerning beginners' operations on the basis of cases and judgments of the Federal Court and the Higher Regional Courts in Germany. Additionally, the reception of the jurisprudence by the relevant legal literature will be discussed. Jurisprudence and legal literature categorize breaches of duty of care. Assistant physicians can be subject to contributory negligence liabilities, while specialists can bear liabilities for negligent selection, organization or supervision. Responsible specialist and assistant physicians can protect themselves (and the patient) and avoid legal risks by only performing operations adequate to their educational level or by delegating operations to beginners and ensuring intervention by a specialist by supervision of the operation which is suitable to the assistant physician's level of education.

Influence of combined dust reducing carpet and compact air filtration unit on the indoor air quality of a classroom.

PubMed

Scheepers, Paul T J; de Hartog, Jeroen J; Reijnaerts, Judith; Beckmann, Gwendolyn; Anzion, Rob; Poels, Katrien; Godderis, Lode

2015-02-01

Primary schools mostly rely on natural ventilation but also have an interest in affordable technology to improve indoor air quality (IAQ). Laboratory tests show promising results for dust reducing carpets and compact air filtration systems but there is no information available on the performance of these interventions in actual operating classrooms. An exploratory study was performed to evaluate a combination of the two systems in a primary school. Measurements of PM-10 and PM-2.5 were performed by filter sampling and aerosol spectrometry. Other IAQ parameters included black smoke (BS), volatile organic compounds (VOC), nitrogen dioxide (NO2) and formaldehyde. Both interventions were introduced in one classroom during one week, using another classroom as a reference. In a second week the interventions were moved to the other classroom, using the first as a reference (cross-over design). In three remaining weeks the classrooms were compared without interventions. Indoor IAQ parameters were compared to the corresponding outdoor parameters using the indoor/outdoor (I/O) ratio. When the classrooms were occupied (teaching hours) interventions resulted in 27-43% reductions of PM-10, PM-2.5 and BS values. During the weekends the systems reduced these levels by 51-87%. Evaluations using the change in I/O ratios gave comparable results. Levels of VOC, NO2 and formaldehyde were rather low and a contribution of the interventions to the improvement of these gas phase IAQ parameters was inconclusive.

Efficacy of a telerehabilitation intervention programme using biofeedback among computer operators.

PubMed

Golebowicz, Merav; Levanon, Yafa; Palti, Ram; Ratzon, Navah Z

2015-01-01

Computer operators spend long periods of time sitting in a static posture at computer workstations and therefore have an increased exposure to work-related musculoskeletal disorders (WRMSD). The present study is aimed at investigating the feasibility and effectiveness of a tele-biofeedback ergonomic intervention programme among computer operators suffering from WRMSD. Twelve subjects with WRMSD were assigned an ergonomic intervention accompanied by remote tele-biofeedback training, which was practised at their workstations. Evaluations of pain symptoms and locations, body posture and psychosocial characteristics were carried out before and after the intervention in the workplace. The hypothesis was partially verified as it showed improved body position at the workstation and decreased pain in some body parts. Tele-biofeedback, as part of an intervention, appears to be feasible and efficient for computer operators who suffer from WRMSD. This study encourages further research on tele-health within the scope of occupational therapy practice. Practitioner summary: Research concerning tele-health using biofeedback is scarce. The present study analyses the feasibility and partial effectiveness of a tele-biofeedback ergonomic intervention programme for computer operators suffering from WRMSD. The uniqueness and singularity of this study is the usage of remote communication between participants and practitioners through the Internet.

Multivariate dynamic linear models for estimating the effect of experimental interventions in an evolutionary operations setup in dairy herds.

PubMed

Stygar, Anna Helena; Krogh, Mogens Agerbo; Kristensen, Troels; Østergaard, Søren; Kristensen, Anders Ringgaard

2017-07-01

Evolutionary operations is a method to exploit the association of often small changes in process variables, planned during systematic experimentation and occurring during the normal production flow, to production characteristics to find a way to alter the production process to be more efficient. The objective of this study was to construct a tool to assess the intervention effect on milk production in an evolutionary operations setup. The method used for this purpose was a dynamic linear model (DLM) with Kalman filtering. The DLM consisted of parameters describing milk yield in a herd, individual cows from a herd, and an intervention effect on a given day. The model was constructed to handle any number of cows, experimental interventions, different data sources, or presence of control groups. In this study, data from 2 commercial Danish herds were used. In herd 1, data on 98,046 and 12,133 milkings registered from an automatic milking system (AMS) were used for model building and testing, respectively. In herd 2, data on 3,689 milkings on test days were used for estimating the initial model parameters. For model testing, data from both bulk tank milk yield (85 observations) and test-day milkings (1,471) were used. In herd 1, the manager wanted to explore the possibility of reducing the amount of concentrate provided to the cows in an AMS. In herd 2, the manager wanted to know if the milk yield could be increased by elevating the energy level provided to the cows in a total mixed ration. The experiment conducted in herd 1 was designed with a treatment and a control group, whereas in herd 2 we used a pretest/posttest design. The constructed tool provided estimates (mean and confidence intervals) for each of 3 interventions carried out in both herds. In herd 1, we concluded that the reduction in concentrate amount provided in the AMS had no negative influence on milk yield. For herd 2, the increased level of energy had a significant positive effect on milk yield but only for the first intervention. In this herd, the effect of intervention was also evaluated for cows in the first lactation and without bulk tank records. The presented model proved to be a flexible and dynamic tool, and it was successfully applied for systematic experimentation in dairy herds. The model can serve as a decision support tool for on-farm process optimization exploiting planned changes in process variables and the response of production characteristics. Copyright © 2017 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Sociodemographic and social contextual predictors of multiple health behavior change: data from the Healthy Directions-Small Business study.

PubMed

Harley, Amy E; Sapp, Amy L; Li, Yi; Marino, Miguel; Quintiliani, Lisa M; Sorensen, Glorian

2013-03-01

Multiple modifiable health behaviors contribute to the chronic diseases that are the leading causes of death in the USA. Disparities for meeting recommended health behavior guidelines exist across occupational classes and socioeconomic levels. The purpose of this paper was to investigate sociodemographic and social contextual predictors of multiple health behavior change in a worksite intervention. We analyzed data on four diet and exercise variables from an intervention trial with worksite-level randomization. Eight hundred forty-one employees had complete data from baseline (response rate = 84 %) and follow-up surveys (response rate = 77 %). Multilevel logistic regression estimated associations between least absolute shrinkage and selection operator-selected sociodemographic and social contextual predictor variables and the multiple health behavior change outcome (changing 2+ versus 0 behaviors). Gender, being married/partnered, and perceived discrimination were significantly associated with multiple health behavior change. Sociodemographic and social contextual factors predict multiple health behavior change and could inform the design and delivery of worksite interventions targeting multiple health behaviors.

[Model of Analysis and Prevention of Accidents - MAPA: tool for operational health surveillance].

PubMed

de Almeida, Ildeberto Muniz; Vilela, Rodolfo Andrade de Gouveia; da Silva, Alessandro José Nunes; Beltran, Sandra Lorena

2014-12-01

The analysis of work-related accidents is important for accident surveillance and prevention. Current methods of analysis seek to overcome reductionist views that see these occurrences as simple events explained by operator error. The objective of this paper is to analyze the Model of Analysis and Prevention of Accidents (MAPA) and its use in monitoring interventions, duly highlighting aspects experienced in the use of the tool. The descriptive analytical method was used, introducing the steps of the model. To illustrate contributions and or difficulties, cases where the tool was used in the context of service were selected. MAPA integrates theoretical approaches that have already been tried in studies of accidents by providing useful conceptual support from the data collection stage until conclusion and intervention stages. Besides revealing weaknesses of the traditional approach, it helps identify organizational determinants, such as management failings, system design and safety management involved in the accident. The main challenges lie in the grasp of concepts by users, in exploring organizational aspects upstream in the chain of decisions or at higher levels of the hierarchy, as well as the intervention to change the determinants of these events.

Physical activity and the environment: conceptual review and framework for intervention research.

PubMed

Panter, Jenna; Guell, Cornelia; Prins, Rick; Ogilvie, David

2017-11-15

Changing the physical environment is one way to promote physical activity and improve health, but evidence on intervention effectiveness is mixed. The theoretical perspectives and conceptual issues discussed or used in evaluative studies and related literature may contribute to these inconsistencies. We aimed to advance the intervention research agenda by systematically searching for and synthesising the literature pertaining to these wider conceptual issues. We searched for editorials, commentaries, reviews, or primary qualitative or quantitative studies in multiple disciplines by electronic searches of key databases (MEDLINE and MEDLINE In-Process, Web of Science, Cochrane Reviews, ProQuest for dissertations, Health Evidence, EPPI-Centre, TRID and NICE) and snowballing. We extracted theoretical and conceptual material and used thematic analysis in an in-depth, configurative narrative approach to synthesis. Our initial searches identified 2760 potential sources from fields including public health, sociology, behavioural science and transport, of which 104 were included. By first separating out and then drawing together this material, we produced a synthesis that identified five high-level conceptual themes: one concerning outcomes (physical activity as a behaviour and a socially embedded practice), one concerning exposures (environmental interventions as structural changes) and three concerning how interventions bring about their effects (the importance of social and physical context; (un) observable mechanisms linking interventions and changes in physical activity; and interventions as events in complex systems). These themes are inter-related but have rarely been considered together in the disparate literatures. Drawing on these insights, we present a more generalisable way of thinking about how environmental interventions work which could be used in future evaluation studies. Environmental and policy interventions are socially embedded and operate within a system. Evaluators should acknowledge this, and the philosophical perspective taken in their evaluation. Across disciplinary fields, future studies should seek to understand how interventions work through considering these systems, the context in which interventions take place, and the (un) observable mechanisms that may operate. This will help ensure that findings can be more easily interpreted and widely applied by policymakers. We hope that highlighting these conceptual issues will help others to interpret and improve upon a somewhat contested evidence base.

A mission to preserve the geostationary region

NASA Astrophysics Data System (ADS)

Smith, D. A.; Martin, C.; Kassebom, M.; Petersen, H.; Shaw, A.; Skidmore, B.; Smith, D.; Stokes, H.; Willig, A.

2004-01-01

The RObotic Geostationary orbit Restorer, ROGER, is a programme aimed at reducing the risk to satellite operations posed by the existence of failed and spent satellites and other categories of space debris. To achieve this, the concept of mass removal by an intervention mission is considered for the GEO region. This paper describes the results of studies into the level of risk posed at present and in the near future to GEO assets. It also investigates practical means for re-orbiting objects that can no longer be manoeuvred away from the operational GEO region by ground command.

A randomized clinical trial of tailored interventions for health promotion and recidivism reduction among homeless parolees: outcomes and cost analysis

PubMed Central

Zhang, Sheldon; Salem, Benissa E.; Farabee, David; Hall, Betsy; Marlow, Elizabeth; Faucette, Mark; Bond, Doug; Yadav, Kartik

2015-01-01

Objectives This study conducted a randomized controlled trial with 600 recently released homeless men exiting California jails and prisons. Methods The purpose of this study was to primarily ascertain how different levels of intensity in peer coaching and nurse-partnered intervention programs may impact reentry outcomes; specifically: (a) an intensive peer coach and nurse case managed (PC-NCM) program; (b) an intermediate peer coaching (PC) program with brief nurse counseling; and (c) the usual care (UC) program involving limited peer coaching and brief nurse counseling. Secondary outcomes evaluated the operational cost of each program. Results When compared to baseline, all three groups made progress on key health-related outcomes during the 12-month intervention period; further, 84.5 % of all participants eligible for hepatitis A/B vaccination completed their vaccine series. The results of the detailed operational cost analysis suggest the least costly approach (i.e., UC), which accounted for only 2.11 % of the total project expenditure, was as effective in achieving comparable outcomes for this parolee population as the PC-NCM and PC approaches, which accounted for 53.98 % and 43.91 %, respectively, of the project budget. Conclusions In this study, all three intervention strategies were found to be comparable in achieving a high rate of vaccine completion, which over time will likely produce tremendous savings to the public health system. PMID:27217822

A randomized clinical trial of tailored interventions for health promotion and recidivism reduction among homeless parolees: outcomes and cost analysis.

PubMed

Nyamathi, Adeline M; Zhang, Sheldon; Salem, Benissa E; Farabee, David; Hall, Betsy; Marlow, Elizabeth; Faucette, Mark; Bond, Doug; Yadav, Kartik

2016-03-01

This study conducted a randomized controlled trial with 600 recently released homeless men exiting California jails and prisons. The purpose of this study was to primarily ascertain how different levels of intensity in peer coaching and nurse-partnered intervention programs may impact reentry outcomes; specifically: (a) an intensive peer coach and nurse case managed (PC-NCM) program; (b) an intermediate peer coaching (PC) program with brief nurse counseling; and (c) the usual care (UC) program involving limited peer coaching and brief nurse counseling. Secondary outcomes evaluated the operational cost of each program. When compared to baseline, all three groups made progress on key health-related outcomes during the 12-month intervention period; further, 84.5 % of all participants eligible for hepatitis A/B vaccination completed their vaccine series. The results of the detailed operational cost analysis suggest the least costly approach (i.e., UC), which accounted for only 2.11 % of the total project expenditure, was as effective in achieving comparable outcomes for this parolee population as the PC-NCM and PC approaches, which accounted for 53.98 % and 43.91 %, respectively, of the project budget. In this study, all three intervention strategies were found to be comparable in achieving a high rate of vaccine completion, which over time will likely produce tremendous savings to the public health system.

Critical review on non-operative management of adolescent idiopathic scoliosis.

PubMed

Wong, M S; Liu, W C

2003-12-01

There are a number of different non-operative interventions which aim to control moderate adolescent idiopathic scoliosis (AIS) from progression. Clinicians may find difficulties in the selection of appropriate interventions for AIS. A comprehensive literature review was carried out to study all contemporary non-operative interventions, it was noted that rigid spinal orthoses apparently give more curve control; however, it would compromise the patient's quality of life via those inevitable factors--physical constraint, poor acceptance and psychological disturbance. There is a trend to develop more effective, acceptable and user-friendly interventions. Under such an aspiration, the theories and clinical evidence of different interventions should be developed along the clinical pathway of early intervention with reliable indicators/predictors, patient's active participation, dynamic control mechanism, holistic psychological and psychosocial considerations, and effective and long-lasting outcome.

Food Choice and Nutrition: A Social Psychological Perspective.

PubMed

Hardcastle, Sarah J; Thøgersen-Ntoumani, Cecilie; Chatzisarantis, Nikos L D

2015-10-01

In this Special Issue, entitled "Food choice and Nutrition: A Social Psychological Perspective", three broad themes have been identified: (1) social and environmental influences on food choice; (2) psychological influences on eating behaviour; and (3) eating behaviour profiling.The studies that addressed the social and environmental influences indicated that further research would do well to promote positive food choices rather than reduce negative food choices; promote the reading and interpretation of food labels and find ways to effectively market healthy food choices through accessibility, availability and presentation. The studies on psychological influences found that intentions, perceived behavioural control, and confidence were predictors of healthy eating. Given the importance of psychological factors, such as perceived behavioural control and self-efficacy, healthy eating interventions should reduce barriers to healthy eating and foster perceptions of confidence to consume a healthy diet. The final theme focused on the clustering of individuals according to eating behaviour. Some "types" of individuals reported more frequent consumption of fast foods, ready meals or convenience meals or greater levels of disinhibitiona nd less control over food cravings. Intervention designs which make use of multi-level strategies as advocated by the Ecological Model of Behaviour change that proposes multi-level (combining psychological, social and environmental) strategies are likely to be more effective in reaching and engaging individuals susceptible to unhealthy eating habits than interventions operating on a single level.

A survey of nurse staffing levels in interventional radiology units throughout the UK.

PubMed

Christie, A; Robertson, I

2016-07-01

To supplement previous surveys analysing provision of interventional radiology (IR), in-hours (IH) and out-of-hours (OOH), by specifically surveying the level of nursing support provided. A web-based questionnaire was distributed to all British Society of Interventional Radiology (BSIR) members. This addressed several aspects of radiology nursing support for IR procedures, both IH and OOH. Sixty percent of respondents indicated that they have a formal OOH service. Of these, all have a dedicated nursing rota, with the vast majority operating with one nurse. IH, 77% of respondents always have a scrubbed nurse assistant, but this reduces to 40% OOH. IH, 4% never have a scrubbed radiology nurse assistant, which rises to 25% OOH. IH, 75% of respondents always have a radiology nurse dedicated to patient monitoring, but this reduces to 20% OOH. IH, 3% never have a radiology nurse dedicated to patient monitoring, which rises to 42% OOH. A significant disparity exists in the level of IR nursing support between IH and OOH. The majority of sites provide a single nurse with ad hoc additional support. This is potentially putting patients at increased risk. Radiology nurses are integral to the safe and sustainable provision of IR OOH services and a greater focus is required to ensure adequate and safe staffing levels for 24/7 IR services. Copyright © 2016. Published by Elsevier Ltd.

Operational Interventions to Maintenance Error

NASA Technical Reports Server (NTRS)

Kanki, Barbara G.; Walter, Diane; Dulchinos, VIcki

1997-01-01

A significant proportion of aviation accidents and incidents are known to be tied to human error. However, research of flight operational errors has shown that so-called pilot error often involves a variety of human factors issues and not a simple lack of individual technical skills. In aircraft maintenance operations, there is similar concern that maintenance errors which may lead to incidents and accidents are related to a large variety of human factors issues. Although maintenance error data and research are limited, industry initiatives involving human factors training in maintenance have become increasingly accepted as one type of maintenance error intervention. Conscientious efforts have been made in re-inventing the team7 concept for maintenance operations and in tailoring programs to fit the needs of technical opeRAtions. Nevertheless, there remains a dual challenge: 1) to develop human factors interventions which are directly supported by reliable human error data, and 2) to integrate human factors concepts into the procedures and practices of everyday technical tasks. In this paper, we describe several varieties of human factors interventions and focus on two specific alternatives which target problems related to procedures and practices; namely, 1) structured on-the-job training and 2) procedure re-design. We hope to demonstrate that the key to leveraging the impact of these solutions comes from focused interventions; that is, interventions which are derived from a clear understanding of specific maintenance errors, their operational context and human factors components.

Reduction of Maintenance Error Through Focused Interventions

NASA Technical Reports Server (NTRS)

Kanki, Barbara G.; Walter, Diane; Rosekind, Mark R. (Technical Monitor)

1997-01-01

It is well known that a significant proportion of aviation accidents and incidents are tied to human error. In flight operations, research of operational errors has shown that so-called "pilot error" often involves a variety of human factors issues and not a simple lack of individual technical skills. In aircraft maintenance operations, there is similar concern that maintenance errors which may lead to incidents and accidents are related to a large variety of human factors issues. Although maintenance error data and research are limited, industry initiatives involving human factors training in maintenance have become increasingly accepted as one type of maintenance error intervention. Conscientious efforts have been made in re-inventing the "team" concept for maintenance operations and in tailoring programs to fit the needs of technical operations. Nevertheless, there remains a dual challenge: to develop human factors interventions which are directly supported by reliable human error data, and to integrate human factors concepts into the procedures and practices of everyday technical tasks. In this paper, we describe several varieties of human factors interventions and focus on two specific alternatives which target problems related to procedures and practices; namely, 1) structured on-the-job training and 2) procedure re-design. We hope to demonstrate that the key to leveraging the impact of these solutions comes from focused interventions; that is, interventions which are derived from a clear understanding of specific maintenance errors, their operational context and human factors components.

Internet based patient education improves informed consent for elective orthopaedic surgery: a randomized controlled trial.

PubMed

Fraval, Andrew; Chandrananth, Janan; Chong, Yew M; Coventry, Lillian S; Tran, Phong

2015-02-07

Obtaining informed consent is an essential step in the surgical pathway. Providing adequate patient education to enable informed decision making is a continued challenge of contemporary surgical practice. This study investigates whether the use of a patient information website, to augment patient education and informed consent for elective orthopaedic procedures is an effective measure. A randomised controlled trial was conducted comparing the quality of informed consent provided by a standard discussion with the treating surgeon compared to augmentation of this discussion with an online education resource (www.orthoanswer.org). Participants were recruited from orthopaedic outpatient clinics. Patients undergoing five common orthopaedic procedures were eligible to participate in the trial. The primary outcome measure was knowledge about their operation. Satisfaction with their informed consent and anxiety relating to their operation were the secondary outcome measures. There was a statistically significant increase in patient knowledge for the intervention arm as compared to the control arm (p < 0.01). Patients in the intervention arm, had an average score of 69.25% (SD 14.91) correct answers as compared to 47.38% (SD 17.77) in the control arm. Satisfaction was also improved in the intervention arm (p = 0.043). There was no statistically significant difference between the control and intervention arm relating to their anxiety scores (p = 0.195). The use of a patient education website as an augment to informed consent improves patient knowledge about their planned operation as well as satisfaction with the consent process whilst not increasing their anxiety levels. We recommend that all patients be directed to web based education tools to augment their consent. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614001058662 .

Surgery of adult bilateral vocal fold paralysis in adduction: history and trends.

PubMed

Sapundzhiev, Nikolay; Lichtenberger, György; Eckel, Hans Edmund; Friedrich, Gerhard; Zenev, Ivan; Toohill, Robert J; Werner, Jochen Alfred

2008-12-01

Bilateral vocal fold paralysis (BVFP) in adduction is characterised by inspiratory dyspnea, due to the paramedian position of the vocal folds with narrowing of the airway at the glottic level. The condition is often life threatening and therefore requires surgical intervention to prevent acute asphyxiation or pulmonary consequences of chronic airway obstruction. Aside from corticosteroid administration and intubation, which are only temporary measures, the standard approach for improving respiration is to perform a tracheotomy. Over the past century, a vast majority of surgical interventions have been developed and applied to restore the patency of the airway and achieve decannulation. Surgeons can generally choose for every individual patient from various well-established treatment options, which have a predictable outcome. An overview of the surgical techniques for laryngeal airway enlargement in BVFP is presented. Included are operative techniques, which have found application in clinical practice, and only to a small extent in purely anatomic or animal studies. The focus is on two major groups of interventions--for temporary and for definitive glottic enlargement. The major types of interventions include the following: (1) resection of anatomical structures; (2) retailoring and displacing the existing structures, with minimal tissue removal; (3) displacing existing structures, without tissue resection; (4) restoration or substitution of the missing innervation of the laryngeal musculature. The single interventions of these four major types have always followed the development of the medical equipment and anaesthesia. At the beginning of the twentieth century, when medicine was unable to counteract surgical infection, endoscopic or extramucosal surgical techniques were dominant. In the 1950s, the microscopic endoscopic laryngeal surgery boomed. At the end of the twentieth century many of the classical endoscopic operations were performed either with the help of surgical lasers alone, or in combination with other interventions.

Blood Pressure and Heart Rate Alterations through Music in Patients Undergoing Cataract Surgery in Greece.

PubMed

Merakou, Kyriakoula; Varouxi, Georgia; Barbouni, Anastasia; Antoniadou, Eleni; Karageorgos, Georgios; Theodoridis, Dimitrios; Koutsouri, Aristea; Kourea-Kremastinou, Jenny

2015-01-01

Music has been proposed as a safe, inexpensive, nonpharmacological antistress intervention. The purpose of this study was to determine whether patients undergoing cataract surgery while listening to meditation music experience lower levels of blood pressure and heart rate. Two hundred individuals undergoing cataract surgery participated in the study. Hundred individuals listened to meditation music, through headphones, before and during the operation (intervention group) and 100 individuals received standard care (control group). Patients stress coping skills were measured by the Sense of Coherence Scale (SOC Scale). Systolic and diastolic blood pressure and heart rate were defined as outcome measures. According to the SOC Scale, both groups had similar stress coping skills (mean score: 127.6 for the intervention group and 127.3 for the control group). Before entering the operating room (OR) as well as during surgery the rise in systolic and diastolic pressures was significantly lower in the intervention group (P < 0.001). Among patients receiving antihypertensive therapy, those in the intervention group presented a lower increase only in systolic pressure (P < 0.001) at both time recordings. For those patients in the intervention group who did not receive antihypertensive treatment, lower systolic blood pressure at both time recordings was recorded (P < 0.001) while lower diastolic pressure was observed only during entry to the OR (P = 0.021). Heart rate was not altered between the two groups in any of the recordings. Meditation music influenced patients' preoperative stress with regard to systolic blood pressure. This kind of music can be used as an alternative or complementary method for blood pressure stabilizing in patients undergoing cataract surgery.

Proyecto MercadoFRESCO: a multi-level, community-engaged corner store intervention in East Los Angeles and Boyle Heights.

PubMed

Ortega, Alexander N; Albert, Stephanie L; Sharif, Mienah Z; Langellier, Brent A; Garcia, Rosa Elena; Glik, Deborah C; Brookmeyer, Ron; Chan-Golston, Alec M; Friedlander, Scott; Prelip, Michael L

2015-04-01

Urban food swamps are typically situated in low-income, minority communities and contribute to overweight and obesity. Changing the food landscape in low income and underserved communities is one strategy to combat the negative health consequences associated with the lack of access to healthy food resources and an abundance of unhealthy food venues. In this paper, we describe Proyecto MercadoFRESCO (Fresh Market Project), a corner store intervention project in East Los Angeles and Boyle Heights in California that used a multi-level approach with a broad range of community, business, and academic partners. These are two neighboring, predominantly Latino communities that have high rates of overweight and obesity. Located in these two communities are approximately 150 corner stores. The project used a community-engaged approach to select, recruit, and convert four corner stores, so that they could become healthy community assets in order to improve residents' access to and awareness of fresh and affordable fruits and vegetables in their immediate neighborhoods. We describe the study framework for the multi-level intervention, which includes having multiple stakeholders, expertise in corner store operations, community and youth engagement strategies, and social marketing campaigns. We also describe the evaluation and survey methodology to determine community and patron impact of the intervention. This paper provides a framework useful to a variety of public health stakeholders for implementing a community-engaged corner store conversion, particularly in an urban food swamp.

Proyecto MercadoFRESCO: A Multi-level, Community-Engaged Corner Store Intervention in East Los Angeles and Boyle Heights

PubMed Central

Albert, Stephanie L.; Sharif, Mienah Z.; Langellier, Brent A.; Garcia, Rosa Elena; Glik, Deborah C.; Brookmeyer, Ron; Chan-Golston, Alec M.; Friedlander, Scott; Prelip, Michael L.

2014-01-01

Urban food swamps are typically situated in low-income, minority communities and contribute to overweight and obesity. Changing the food landscape in low income and underserved communities is one strategy to combat the negative health consequences associated with the lack of access to healthy food resources and an abundance of unhealthy food venues. In this paper, we describe Proyecto MercadoFRESCO (Fresh Market Project), a corner store intervention project in East Los Angeles and Boyle Heights in California that used a multi-level approach with a broad range of community, business, and academic partners. These are two neighboring, predominantly Latino communities that have high rates of overweight and obesity. Located in these two communities are approximately 150 corner stores. The project used a community-engaged approach to select, recruit, and convert four corner stores, so that they could become healthy community assets in order to improve residents’ access to and awareness of fresh and affordable fruits and vegetables in their immediate neighborhoods. We describe the study framework for the multi-level intervention, which includes having multiple stakeholders, expertise in corner store operations, community and youth engagement strategies, and social marketing campaigns. We also describe the evaluation and survey methodology to determine community and patron impact of the intervention. This paper provides a framework useful to a variety of public health stakeholders for implementing a community-engaged corner store conversion, particularly in an urban food swamp. PMID:25209600

Using discrete event computer simulation to improve patient flow in a Ghanaian acute care hospital.

PubMed

Best, Allyson M; Dixon, Cinnamon A; Kelton, W David; Lindsell, Christopher J; Ward, Michael J

2014-08-01

Crowding and limited resources have increased the strain on acute care facilities and emergency departments worldwide. These problems are particularly prevalent in developing countries. Discrete event simulation is a computer-based tool that can be used to estimate how changes to complex health care delivery systems such as emergency departments will affect operational performance. Using this modality, our objective was to identify operational interventions that could potentially improve patient throughput of one acute care setting in a developing country. We developed a simulation model of acute care at a district level hospital in Ghana to test the effects of resource-neutral (eg, modified staff start times and roles) and resource-additional (eg, increased staff) operational interventions on patient throughput. Previously captured deidentified time-and-motion data from 487 acute care patients were used to develop and test the model. The primary outcome was the modeled effect of interventions on patient length of stay (LOS). The base-case (no change) scenario had a mean LOS of 292 minutes (95% confidence interval [CI], 291-293). In isolation, adding staffing, changing staff roles, and varying shift times did not affect overall patient LOS. Specifically, adding 2 registration workers, history takers, and physicians resulted in a 23.8-minute (95% CI, 22.3-25.3) LOS decrease. However, when shift start times were coordinated with patient arrival patterns, potential mean LOS was decreased by 96 minutes (95% CI, 94-98), and with the simultaneous combination of staff roles (registration and history taking), there was an overall mean LOS reduction of 152 minutes (95% CI, 150-154). Resource-neutral interventions identified through discrete event simulation modeling have the potential to improve acute care throughput in this Ghanaian municipal hospital. Discrete event simulation offers another approach to identifying potentially effective interventions to improve patient flow in emergency and acute care in resource-limited settings. Copyright © 2014 Elsevier Inc. All rights reserved.

Operational research as implementation science: definitions, challenges and research priorities.

PubMed

Monks, Thomas

2016-06-06

Operational research (OR) is the discipline of using models, either quantitative or qualitative, to aid decision-making in complex implementation problems. The methods of OR have been used in healthcare since the 1950s in diverse areas such as emergency medicine and the interface between acute and community care; hospital performance; scheduling and management of patient home visits; scheduling of patient appointments; and many other complex implementation problems of an operational or logistical nature. To date, there has been limited debate about the role that operational research should take within implementation science. I detail three such roles for OR all grounded in upfront system thinking: structuring implementation problems, prospective evaluation of improvement interventions, and strategic reconfiguration. Case studies from mental health, emergency medicine, and stroke care are used to illustrate each role. I then describe the challenges for applied OR within implementation science at the organisational, interventional, and disciplinary levels. Two key challenges include the difficulty faced in achieving a position of mutual understanding between implementation scientists and research users and a stark lack of evaluation of OR interventions. To address these challenges, I propose a research agenda to evaluate applied OR through the lens of implementation science, the liberation of OR from the specialist research and consultancy environment, and co-design of models with service users. Operational research is a mature discipline that has developed a significant volume of methodology to improve health services. OR offers implementation scientists the opportunity to do more upfront system thinking before committing resources or taking risks. OR has three roles within implementation science: structuring an implementation problem, prospective evaluation of implementation problems, and a tool for strategic reconfiguration of health services. Challenges facing OR as implementation science include limited evidence and evaluation of impact, limited service user involvement, a lack of managerial awareness, effective communication between research users and OR modellers, and availability of healthcare data. To progress the science, a focus is needed in three key areas: evaluation of OR interventions, embedding the knowledge of OR in health services, and educating OR modellers about the aims and benefits of service user involvement.

Understanding knowledge transfer in an ergonomics intervention at a poultry processing plant.

PubMed

Antle, David M; MacKinnon, Scott N; Molgaard, John; Vézina, Nicole; Parent, Robert; Bornstein, Stephen; Leclerc, Louise

2011-01-01

This case study reviews the knowledge transfer (KT) process of implementing a knife sharpening and steeling program into a poultry processing plant via a participatory ergonomics intervention. This ergonomics intervention required stakeholder participation at the company level to move a 'train-the-trainer' program, developed in Québec, Canada, into action on the plant's deboning line. Communications and exchanges with key stakeholders, as well as changes in steeling and production behaviours were recorded. The intervention was assumed to be at least partially successful because positive changes in work operations occurred. Ergonomic-related changes such as those documented have been cited in the academic literature as beneficial to worker health. However, several components cited in literature that are associated with a successful participatory ergonomics intervention were not attained during the project. A Dynamic Knowledge Transfer Model was used to identify KT issues that impacted on the success of train-the-trainer program. A debriefing analysis reveals that a failure to consider key participatory ergonomics factors necessary for success were related to capacity deficits in the knowledge dissemination strategy.

Nutrition in peri-operative esophageal cancer management.

PubMed

Steenhagen, Elles; van Vulpen, Jonna K; van Hillegersberg, Richard; May, Anne M; Siersema, Peter D

2017-07-01

Nutritional status and dietary intake are increasingly recognized as essential areas in esophageal cancer management. Nutritional management of esophageal cancer is a continuously evolving field and comprises an interesting area for scientific research. Areas covered: This review encompasses the current literature on nutrition in the pre-operative, peri-operative, and post-operative phases of esophageal cancer. Both established interventions and potential novel targets for nutritional management are discussed. Expert commentary: To ensure an optimal pre-operative status and to reduce peri-operative complications, it is key to assess nutritional status in all pre-operative esophageal cancer patients and to apply nutritional interventions accordingly. Since esophagectomy results in a permanent anatomical change, a special focus on nutritional strategies is needed in the post-operative phase, including early initiation of enteral feeding, nutritional interventions for post-operative complications, and attention to long-term nutritional intake and status. Nutritional aspects of pre-optimization and peri-operative management should be incorporated in novel Enhanced Recovery After Surgery programs for esophageal cancer.

Operational fidelity to an evidence-based HIV prevention intervention for people living with HIV/AIDS.

PubMed

Kalichman, Seth C; Hudd, Katie; Diberto, Giorgio

2010-08-01

Evidence-based interventions are often disseminated in public health education with little known about their operational fidelity. This study examined the delivery of intervention components (operational fidelity) of a widely disseminated HIV prevention program designed for people living with HIV/AIDS named Healthy Relationships. Two hundred ninety-nine agencies that had been trained in the intervention by the Centers for Disease Control and Prevention were contacted, and 122 (41%) completed confidential interviews. Among the 93 agencies that implemented the program, 39 (40%) adapted at least one core element activity, and 21 (23%) dropped an activity. Most adaptations were intended to improve the community fit of the intervention. Agencies believed that funders demand that they implement the intervention with fidelity. Models of technology transfer that emphasize behavior change processes rather than specific curriculum content may advance prevention program dissemination.

The Clavicle Trial: A Multicenter Randomized Controlled Trial Comparing Operative with Nonoperative Treatment of Displaced Midshaft Clavicle Fractures.

PubMed

Ahrens, Philip M; Garlick, Nicholas I; Barber, Julie; Tims, Emily M

2017-08-16

The treatment of displaced midshaft clavicle fractures remains controversial. We undertook a multicenter randomized controlled trial to compare effectiveness and safety between nonoperative management and ORIF (open reduction and internal fixation) for displaced midshaft clavicle fractures in adults. Three hundred and one eligible adult patients were randomized to 1 of the 2 treatment groups and followed at 6 weeks, 3 months, and 9 months after recruitment. The primary outcome was the rate of radiographically evident nonunion at 3 months following treatment. Secondary outcomes were the rate of radiographically evident nonunion at 9 months, limb function measured using the Constant-Murley Score and DASH (Disabilities of the Arm, Shoulder and Hand) score, and patient satisfaction. There was no difference in the proportion of patients with radiographic evidence of nonunion at 3 months between the operative (28%) and nonoperative (27%) groups, whereas at 9 months the proportion with nonunion was significantly lower (p < 0.001) in the operative group (0.8%) than in the nonoperative group (11%). The DASH and Constant-Murley scores and patient satisfaction were all significantly better in the operative group than in the nonoperative group at 6 weeks and 3 months. Although at 3 months there was no evidence that surgery had reduced the rate of nonunion of displaced midshaft clavicle fractures, at 9 months nonoperative treatment had led to a significantly higher nonunion rate (11% compared with <1%). The rate of secondary surgical intervention during the trial period was 12 (11%) of the 147 patients in the nonoperative group. ORIF is a safe and reliable intervention with superior early functional outcomes and should be considered for patients who sustain this common injury. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

The Sequential Aerosol Technique: A Major Component in an Integrated Strategy of Intervention against Riverine Tsetse in Ghana

PubMed Central

Adam, Yahaya; Cecchi, Giuliano; Kgori, Patrick M.; Marcotty, Tanguy; Mahama, Charles I.; Abavana, Martin; Anderson, Benita; Paone, Massimo; Mattioli, Raffaele; Bouyer, Jérémy

2013-01-01

Background An integrated strategy of intervention against tsetse flies was implemented in the Upper West Region of Ghana (9.62°–11.00° N, 1.40°–2.76° W), covering an area of ≈18,000 km2 within the framework of the Pan-African Tsetse and Trypanosomosis Eradication Campaign. Two species were targeted: Glossina tachinoides and Glossina palpalis gambiensis. Methodology/Principal Findings The objectives were to test the potentiality of the sequential aerosol technique (SAT) to eliminate riverine tsetse species in a challenging subsection (dense tree canopy and high tsetse densities) of the total sprayed area (6,745 km2) and the subsequent efficacy of an integrated strategy including ground spraying (≈100 km2), insecticide treated targets (20,000) and insecticide treated cattle (45,000) in sustaining the results of tsetse suppression in the whole intervention area. The aerial application of low-dosage deltamethrin aerosols (0.33–0.35 g a.i/ha) was conducted along the three main rivers using five custom designed fixed-wings Turbo thrush aircraft. The impact of SAT on tsetse densities was monitored using 30 biconical traps deployed from two weeks before until two weeks after the operations. Results of the SAT monitoring indicated an overall reduction rate of 98% (from a pre-intervention mean apparent density per trap per day (ADT) of 16.7 to 0.3 at the end of the fourth and last cycle). One year after the SAT operations, a second survey using 200 biconical traps set in 20 sites during 3 weeks was conducted throughout the intervention area to measure the impact of the integrated control strategy. Both target species were still detected, albeit at very low densities (ADT of 0.27 inside sprayed blocks and 0.10 outside sprayed blocks). Conclusions/Significance The SAT operations failed to achieve elimination in the monitored section, but the subsequent integrated strategy maintained high levels of suppression throughout the intervention area, which will contribute to improving animal health, increasing animal production and fostering food security. PMID:23516662

The operative management of children with complex perianal Crohn's disease.

PubMed

Seemann, Natashia M; King, Sebastian K; Elkadri, Abdul; Walters, Thomas; Fish, Joel; Langer, Jacob C

2016-12-01

Perianal Crohn's disease (PCD) can affect both quality of life and psychological wellbeing. A subset of pediatric patients with complex PCD require surgical intervention, although appropriate timing and treatment regimens remain unclear. This study aimed to describe a large pediatric cohort in a tertiary center to determine the range of surgical management in children with complex PCD. A retrospective review of children requiring operative intervention for PCD over 13 years (2002-2014) was performed. PCD was divided into simple and complex based on the type of surgical procedure, and the two groups were compared. The 57 children were divided into two groups: the simple group (N=43) underwent abscess drainage ± seton insertion alone, and the complex group (N=14) underwent loop ileostomy ± more extensive surgery. In the complex group, females were more predominant (57% of complex vs 30% of simple), and the average age at diagnosis was lower. Anti-TNF therapy was utilized in 79.1% of simple and 100% of complex PCD. All 14 complex patients underwent a defunctioning ileostomy, with 7 requiring further operations (subtotal colectomy=4, proctocolectomy ± anal sparing=5, plastic surgery reconstruction with perineal flap/graft=4). Complex PCD represents a small but challenging subset of patients in which major surgical intervention may be necessary to alleviate the symptoms of this debilitating condition. retrospective case study with no control group - level IV. Copyright © 2016 Elsevier Inc. All rights reserved.

Does Racial/Ethnic Identity Influence the Effectiveness of a Community Health Worker Intervention for African American and Latino Adults With Type 2 Diabetes?

PubMed

Murayama, Hiroshi; Spencer, Michael S; Sinco, Brandy R; Palmisano, Gloria; Kieffer, Edith C

2017-06-01

Community health worker (CHW) interventions are known to be an effective strategy to improve health behaviors and outcomes in relation to diabetes, particularly for racial/ethnic communities. Although understanding the function of identity with same race/ethnicity among clients of CHW interventions could contribute to more effective program design, few studies have explored whether levels of racial/ethnic identity among participants can influence the effectiveness of CHW interventions. We tested the relationship between level of racial/ethnic identity and changes in hemoglobin A1c and diabetes self-efficacy among low-income African American and Latino adults with type 2 diabetes who participated in a CHW intervention. Data came from a randomized controlled trial of the CHW intervention with a 6-month delayed control group design for 164 African American and Latino adults in Detroit, Michigan. Racial/ethnic identity was created from two items and classified into high, moderate, and low. We combined the two arms (immediate and delayed) into one because there was no significant difference in baseline characteristics, other than age and postintervention self-efficacy, and multivariable linear regression models were applied in the analysis. Possession of high racial/ethnic identity was associated with greater improvement both in hemoglobin A1c and diabetes self-efficacy at 6 months. Moreover, among those with high hemoglobin A1c at preintervention, higher racial/ethnic identity had a greater impact on hemoglobin A1c improvement, compared with those with lower identity. This study suggests the importance of considering racial/ethnic identity of the participants in designing and operating the CHW intervention for racial/ethnic minority population.

Using formative research to lay the foundation for community level HIV prevention efforts: an example from the AIDS Community Demonstration Projects.

PubMed Central

Higgins, D L; O'Reilly, K; Tashima, N; Crain, C; Beeker, C; Goldbaum, G; Elifson, C S; Galavotti, C; Guenther-Grey, C

1996-01-01

The AIDS Community Demonstration Projects provided community-level HIV prevention interventions to historically hard-to-reach groups at high risk for HIV infection. The projects operated under a common research protocol which encompassed formative research, intervention delivery, process evaluation, and outcome evaluation. A formative research process specifically focusing on intervention development was devised to assist project staff in identifying, prioritizing, accessing, and understanding the intervention target groups. This process was central to the creation of interventions that were acceptable and unique to the target populations. Intended to be rapid, the process took 6 months to complete. Drawn from the disciplines of anthropology, community psychology, sociology, and public health, the formative research process followed distinct steps which included (a) defining the populations at high-risk for HIV; (b) gathering information about these populations through interviews with persons who were outside of, but who had contact with, the target groups (such as staff from the health department and alcohol and drug treatment facilities, as well as persons who interacted in an informal manner with the target groups, such as clerks in neighborhood grocery stores and bartenders); (c) interviewing people with access to the target populations (gatekeepers), and conducting observations in areas where these high-risk groups were reported to gather (from previous interviews); (d) interviewing members of these groups at high risk for HIV infection or transmission; and (e) systematically integrating information throughout the process. Semistructured interview schedules were used for all data collection in this process. This standardized systematic method yielded valuable information about the focal groups in each demonstration project site. The method, if adopted by others, would assist community intervention specialists in developing interventions that are culturally appropriate and meaningful to their respective target populations. PMID:8862154

[Metabolic surgery in treatment of diabetes mellitus of type II].

PubMed

Sedov, V M; Fishman, M B

2013-01-01

Nowadays, according to data of WHO, the diabetes mellitus was diagnosed in more than 280 million people. The diabetes mellitus type II had 90% patients. The applied methods of conservative therapy seldom lead to euglycemia condition of patients. Last years the treatment of diabetes mellitus was carried out by the method of different bariatic interventions. Good results was obtained, they should be analyzed and investigate. The results of treatment of 142 patients from 628 patients (with type II) were estimated. The patients were undergone by different bariatic interventions. Modern laparoscopic operations were performed on all the patients. Controlled bandage of stomach had 81 of patients. Gastric resection was performed in 28. Gastric bypass surgery was carried out in 22 of patients and biliopancreatic diversion - in 11. The improvement of control of leukemia level was obtained. Diabetes type II could be treated by surgical methods. The best results were obtained after combined operations, which potentially could present an alternative method of treatment of type II diabetes.

The utility of a "trauma 1 OP" activation at a level 1 pediatric trauma center.

PubMed

Hunt, Madison M; Stevens, Austin M; Hansen, Kristine W; Fenton, Stephen J

2017-02-01

To expedite flow of injured children suspected to require operative intervention, a "trauma 1 OP" (T1OP) activation classification was created. The purpose of this study was to review this strategy at a level 1 pediatric trauma center. A retrospective review of T1OP activations between 2003 and 2015 was performed. Children suspected of requiring neurosurgical intervention were classified as trauma 1 OP neuro (T1OP(N)). Comparisons were made to trauma 1 (T1) patients who required emergent operative intervention, excluding orthopedic injuries. Overall, 461 T1OP activations occurred (72% T1OP(N)) compared to 129 T1 activations requiring emergent surgery. Demographics were not significantly different between groups, although T1OP patients were slightly younger and more often experienced falls or were victims of abuse. Compared to T1 activations, T1OP activations had a significantly higher mortality rate (21% vs. 7%, p<0.001). Repeat head imaging was more common in the T1OP(N) group compared to imaged children in the T1 group (20% vs. 37%, p=0.05). T1OP(N) patients more often went directly to the OR (45% vs. 33%, p=0.02) and did so in a significantly faster period of time (32min vs. 53min, p<0.001). Use of the T1OP activations appropriately triaged surgical patients, resulting in significantly faster transport times to the OR. II, prognosis study. Copyright © 2017 Elsevier Inc. All rights reserved.

Developing operator capacity estimates for supervisory control of autonomous vehicles.

PubMed

Cummings, M L; Guerlain, Stephanie

2007-02-01

This study examined operators' capacity to successfully reallocate highly autonomous in-flight missiles to time-sensitive targets while performing secondary tasks of varying complexity. Regardless of the level of autonomy for unmanned systems, humans will be necessarily involved in the mission planning, higher level operation, and contingency interventions, otherwise known as human supervisory control. As a result, more research is needed that addresses the impact of dynamic decision support systems that support rapid planning and replanning in time-pressured scenarios, particularly on operator workload. A dual screen simulation that allows a single operator the ability to monitor and control 8, 12, or 16 missiles through high level replanning was tested on 42 U.S. Navy personnel. The most significant finding was that when attempting to control 16 missiles, participants' performance on three separate objective performance metrics and their situation awareness were significantly degraded. These results mirror studies of air traffic control that demonstrate a similar decline in performance for controllers managing 17 aircraft as compared with those managing only 10 to 11 aircraft. Moreover, the results suggest that a 70% utilization (percentage busy time) score is a valid threshold for predicting significant performance decay and could be a generalizable metric that can aid in manning predictions. This research is relevant to human supervisory control of networked military and commercial unmanned vehicles in the air, on the ground, and on and under the water.

Serum human chorionic gonadotropin levels on the day before oocyte retrieval do not correlate with oocyte maturity

PubMed Central

Levy, Gary; Hill, Micah J.; Ramirez, Christina; Plowden, Torrie; Pilgrim, Justin; Howard, Robin S.; Segars, James H.; Csokmay, John

2014-01-01

Objective To evaluate the correlation of preretrieval quantitative serum hCG level with oocyte maturity. Design Retrospective cohort study. Setting Military assisted reproductive technology (ART) program. Patient(s) Fresh autologous ART cycles. Intervention(s) Serum hCG level the day before oocyte retrieval. Main Outcome Measure(s) Linear regression was used to correlate serum hCG levels and oocyte maturity rates. Normal oocyte maturity was defined as ≥ 75% and the Wilcoxon rank sum test was used to compare serum hCG levels in patients with normal and low oocyte maturity. Threshold analysis was performed to determine hCG levels that could predict oocyte maturity. Result(s) A total of 468 ART cycles were analyzed. Serum hCG level was not correlated with hCG dose; however, it was negatively correlated with body mass index (BMI). Serum hCG levels did not differ between patients with oocyte maturity of <75% and ≥ 75%. Serum hCG levels did not correlate with oocyte maturity rates. Receiver operator characteristic and less than efficiency curves failed to demonstrate thresholds at which hCG could predict oocyte maturity. Conclusion(s) Serum hCG levels were not correlated with oocyte maturity. Although a positive hCG was reassuring that mature oocytes would be retrieved for most patients, the specific value was not helpful. PMID:23375205

Towards the estimation of the scattered energy spectra reaching the head of the medical staff during interventional radiology: A Monte Carlo simulation study

NASA Astrophysics Data System (ADS)

Zagorska, A.; Bliznakova, K.; Buchakliev, Z.

2015-09-01

In 2012, the International Commission on Radiological Protection has recommended a reduction of the dose limits to the eye lens for occupational exposure. Recent studies showed that in interventional rooms is possible to reach these limits especially without using protective equipment. The aim of this study was to calculate the scattered energy spectra distribution at the level of the operator's head. For this purpose, an in-house developed Monte Carlo-based computer application was used to design computational phantoms (patient and operator), the acquisition geometry as well as to simulate the photon transport through the designed system. The initial spectra from 70 kV tube voltage and 8 different filtrations were calculated according to the IPEM Report 78. An experimental study was carried out to verify the results from the simulations. The calculated scattered radiation distributions were compared to the initial incident on the patient spectra. Results showed that there is no large difference between the effective energies of the scattered spectra registered in front of the operator's head obtained from simulations of all 8 incident spectra. The results from the experimental study agreed well to simulations as well.

Current status of adult spinal deformity.

PubMed

Youssef, J A; Orndorff, D O; Patty, C A; Scott, M A; Price, H L; Hamlin, L F; Williams, T L; Uribe, J S; Deviren, V

2013-03-01

Purpose To review the current literature for the nonoperative and operative treatment for adult spinal deformity. Recent Findings With more than 11 million baby boomers joining the population of over 60 years of age in the United States, the incidence of lumbar deformity is greatly increasing. Recent literature suggests that a lack of evidence exists to support the effectiveness of nonoperative treatment for adult scoliosis. In regards to operative treatment, current literature reports a varying range of improved clinical outcomes, curve correction, and complication rates. The extension of fusion to S1 compared with L5 and lower thoracic levels compared with L1 remains a highly controversial topic among literature. Summary Most adult deformity patients never seek nonoperative or operative treatment. Of the few that seek treatment, many can benefit from nonoperative treatment. However, in selected patients who have failed nonoperative treatment and who are candidates for surgical intervention, the literature reflects positive outcomes related to surgical intervention as compared with nonoperative treatment despite varying associated ranges in morbidity and mortality rates. If nonoperative therapy fails in addressing a patient's complaints, then an appropriate surgical procedure that relieves neural compression, corrects excessive sagittal or coronal imbalance, and results in a solidly fused, pain-free spine is warranted.

[Experimental study of angiography using vascular interventional robot-2(VIR-2)].

PubMed

Tian, Zeng-min; Lu, Wang-sheng; Liu, Da; Wang, Da-ming; Guo, Shu-xiang; Xu, Wu-yi; Jia, Bo; Zhao, De-peng; Liu, Bo; Gao, Bao-feng

2012-06-01

To verify the feasibility and safety of new vascular interventional robot system used in vascular interventional procedures. Vascular interventional robot type-2 (VIR-2) included master-slave parts of body propulsion system, image navigation systems and force feedback system, the catheter movement could achieve under automatic control and navigation, force feedback was integrated real-time, followed by in vitro pre-test in vascular model and cerebral angiography in dog. Surgeon controlled vascular interventional robot remotely, the catheter was inserted into the intended target, the catheter positioning error and the operation time would be evaluated. In vitro pre-test and animal experiment went well; the catheter can enter any branch of vascular. Catheter positioning error was less than 1 mm. The angiography operation in animal was carried out smoothly without complication; the success rate of the operation was 100% and the entire experiment took 26 and 30 minutes, efficiency was slightly improved compared with the VIR-1, and the time what staff exposed to the DSA machine was 0 minute. The resistance of force sensor can be displayed to the operator to provide a security guarantee for the operation. No surgical complications. VIR-2 is safe and feasible, and can achieve the catheter remote operation and angiography; the master-slave system meets the characteristics of traditional procedure. The three-dimensional image can guide the operation more smoothly; force feedback device provides remote real-time haptic information to provide security for the operation.

[Application of diffusion tensor imaging fractography in minimally invasive surgery of brain tumors].

PubMed

Yang, Lei; Zhang, Mao-zhi; Zhang, Wei; Zhao, Yuan-li; Zhao, Ji-zong

2006-05-23

To investigate the effects and prospect of application of diffusion tensor imaging (DTI) fractography in minimally invasive surgery of brain tumors. DTI fractography was performed in 52 patients with malignant brain tumors. Based on the DTI fractography results, 34 of the 52 patients underwent operation under neuro-navigation, and 18 of the 52 patients underwent operation routine minimally invasive craniotomy and tumor resection without neuro-navigation. The rate of total tumor resection was 86.5% (45/52). The mortality was 1.9% (1/52). The disability rate was 11.5% (6/52). No case needed the second operation. DTI fractography has raised the minimally invasive neurosurgery to the level of protecting the nuclei and nerve tracts and guiding intra-operative management of infiltration of deep-seated tumors, especially when combined with neuro-navigation and interventional MRI.

Virtual surgical planning and 3D printing in repeat calvarial vault reconstruction for craniosynostosis: technical note.

PubMed

LoPresti, Melissa; Daniels, Bradley; Buchanan, Edward P; Monson, Laura; Lam, Sandi

2017-04-01

Repeat surgery for restenosis after initial nonsyndromic craniosynostosis intervention is sometimes needed. Calvarial vault reconstruction through a healed surgical bed adds a level of intraoperative complexity and may benefit from preoperative and intraoperative definitions of biometric and aesthetic norms. Computer-assisted design and manufacturing using 3D imaging allows the precise formulation of operative plans in anticipation of surgical intervention. 3D printing turns virtual plans into anatomical replicas, templates, or customized implants by using a variety of materials. The authors present a technical note illustrating the use of this technology: a repeat calvarial vault reconstruction that was planned and executed using computer-assisted design and 3D printed intraoperative guides.

Is the Grading of Liver Injuries a Useful Clinical Tool in the Initial Management of Blunt Trauma Patients?

PubMed

Helling, Thomas S; Ward, Michael R; Balon, Jennifer

2009-04-01

Computed tomography (CT) has become the preferred method for evaluation of the abdomen for victims of blunt trauma. Grading of liver injuries, primarily by CT, has been advocated as a measure of severity and, by implication, the likelihood for intervention or complications. We have sought to determine if grading of liver injuries, as a clinical tool, affects immediate or extended management of patients. We have retrospectively reviewed all patients sustaining blunt liver injuries as diagnosed by CT over a five-year period at a Level I trauma center to determine if grading of injury influenced management. The AAST organ scaling system was utilized (major grade 4-5, minor grade 1-3), as well as the ISS, AIS, mortality, morbidity, and treatment. There were 133 patients available for review. The patients were grouped into major (n = 20) and minor (n = 113) liver injuries and operative (n = 12) and nonoperative (n = 121) management. Major liver injuries had a higher ISS (39 + 13 vs. 27 + 15, p = 0.001) and were more likely to require operative intervention (5/20 vs. 7/113, p = 0.02). Mortality in this group was not different (major vs. minor), and there were no differences in the incidence of complications. Twelve patients (9%) required operation, all for hemodynamic instability, all within 24 h, and 11/12 within 6 h. At operation 8/12 patients had other sources of bleeding beside the liver injury, and 7/12 had minor hepatic injuries. The operative patients had higher ISS and AIS scores (head/neck, chest, abdomen, extremities) than those managed nonoperatively. More patients died in the operative group (6/12 vs. 8/121, p = 0.0003). There were more pulmonary (6/12 vs. 16/121, p = 0.005), cardiovascular (6/12 vs. 19/121, p = 0.01), and infectious (5/12 vs. 20/121, p = 0.049) complications in the operative group. There were 14 deaths overall; 13/14 were due to traumatic brain injury, and 8/14 required urgent operation for hemorrhage. In conclusion, grading of liver injuries does not seem to influence immediate management. Physiologic behavior dictated management and need for operative intervention, as well as prognosis. However, both major hepatic injuries and need for early operation reflected overall severity and the possibility of associated injuries.

Implementation of Home based management of malaria in children reduces the work load for peripheral health facilities in a rural district of Burkina Faso.

PubMed

Tiono, Alfred B; Kaboré, Youssouf; Traoré, Abdoulaye; Convelbo, Nathalie; Pagnoni, Franco; Sirima, Sodiomon B

2008-10-03

Home Management of Malaria (HMM) is one of the key strategies to reduce the burden of malaria for vulnerable population in endemic countries. It is based on the evidence that well-trained communities health workers can provide prompt and adequate care to patients close to their homes. The strategy has been shown to reduce malaria mortality and severe morbidity and has been adopted by the World Health Organization as a cornerstone of malaria control in Africa. However, the potential fall-out of this community-based strategy on the work burden at the peripheral health facilities level has never been investigated. A two-arm interventional study was conducted in a rural health district of Burkina Faso. The HMM strategy has been implemented in seven community clinics catchment's area (intervention arm). For the other seven community clinics in the control arm, no HMM intervention was implemented. In each of the study arms, presumptive treatment was provided for episodes of fevers/malaria (defined operationally as malaria). The study drug was artemether-lumefantrine, which was sold at a subsidized price by community health workers/Key opinion leaders at the community level and by the pharmacists at the health facility level. The outcome measured was the proportion of malaria cases among all health facility attendance (all causes diseases) in both arms throughout the high transmission season. A total of 7,621 children were enrolled in the intervention arm and 7,605 in the control arm. During the study period, the proportions of malaria cases among all health facility attendance (all causes diseases) were 21.0%, (445/2,111, 95% CI [19.3%-22.7%]) and 70.7% (2,595/3,671, 95% CI 68.5%-71.5%), respectively in the intervention and control arms (p < 0.0001). The relative risk ratio for a fever/malaria episode to be treated at the HF level was 30% (0.30 < RR < 0.32). The number of malaria episodes treated in the intervention arm was much higher than in the control arm (6,661 vs. 2,595), with malaria accounting for 87.4% of all disease episodes recorded in the intervention area and for 34.1% in the control area (P < 0.0001). Of all the malaria cases treated in the intervention arm, only 6.7% were treated at the health facility level. These findings suggest that implementation of HMM, by reducing the workload in health facilities, might contributes to an overall increase of the performance of the peripheral health facilities.

[The advantages of a third party in the “work organization” of head nurses.

PubMed

Dujardin, Pierre-Philippe; Valette, Annick; Reverdy, Thomas; François, Patrice

The organisation of production of care is a task that requires three different levels of competence: operational, structural and learning skills. The organisational requirements (OR) of the Head Nurse (HN) are often centered on the operational level, to the detriment of the other two levels. This difficulty is due to the organisation which presents limited political, cognitive and pragmatic levels of rationality.The aim of this study was to identify the impact of a third party in relation to the organisation and its effect on the HN's OR. An educational device places HN students in the position of a third party to allow them to work on an organisational problem delegated by a HN. The research-intervention followed 17 projects over a period of one year.Intervention by a third party legitimised the problem by recognizing the difficulties in nursing and reconfiguring relations between healthcare professionals in a political dimension. The methods employed by the third party reassured the HN and completed their knowledge, placing particular focus on the importance of methodology and managerial posture. In practice, the third party supported the HN's power to act and coordinate the various members of the team. The third party contributes to the development of the HN's OR and completes certain limits of the HN's rationality. Nevertheless, difficulties still remain in the development of practices outside the medical team, limiting the extension to other services.A unit managerial support, a collective schedule and open spaces of discussion are recommended to bring structure and support to the OR.

A novel attention training paradigm based on operant conditioning of eye gaze: Preliminary findings.

PubMed

Price, Rebecca B; Greven, Inez M; Siegle, Greg J; Koster, Ernst H W; De Raedt, Rudi

2016-02-01

Inability to engage with positive stimuli is a widespread problem associated with negative mood states across many conditions, from low self-esteem to anhedonic depression. Though attention retraining procedures have shown promise as interventions in some clinical populations, novel procedures may be necessary to reliably attenuate chronic negative mood in refractory clinical populations (e.g., clinical depression) through, for example, more active, adaptive learning processes. In addition, a focus on individual difference variables predicting intervention outcome may improve the ability to provide such targeted interventions efficiently. To provide preliminary proof-of-principle, we tested a novel paradigm using operant conditioning to train eye gaze patterns toward happy faces. Thirty-two healthy undergraduates were randomized to receive operant conditioning of eye gaze toward happy faces (train-happy) or neutral faces (train-neutral). At the group level, the train-happy condition attenuated sad mood increases following a stressful task, in comparison to train-neutral. In individual differences analysis, greater physiological reactivity (pupil dilation) in response to happy faces (during an emotional face-search task at baseline) predicted decreased mood reactivity after stress. These Preliminary results suggest that operant conditioning of eye gaze toward happy faces buffers against stress-induced effects on mood, particularly in individuals who show sufficient baseline neural engagement with happy faces. Eye gaze patterns to emotional face arrays may have a causal relationship with mood reactivity. Personalized medicine research in depression may benefit from novel cognitive training paradigms that shape eye gaze patterns through feedback. Baseline neural function (pupil dilation) may be a key mechanism, aiding in iterative refinement of this approach. (c) 2016 APA, all rights reserved).

Monitoring data transfer latency in CMS computing operations

DOE PAGES

Bonacorsi, Daniele; Diotalevi, Tommaso; Magini, Nicolo; ...

2015-12-23

During the first LHC run, the CMS experiment collected tens of Petabytes of collision and simulated data, which need to be distributed among dozens of computing centres with low latency in order to make efficient use of the resources. While the desired level of throughput has been successfully achieved, it is still common to observe transfer workflows that cannot reach full completion in a timely manner due to a small fraction of stuck files which require operator intervention.For this reason, in 2012 the CMS transfer management system, PhEDEx, was instrumented with a monitoring system to measure file transfer latencies, andmore » to predict the completion time for the transfer of a data set. The operators can detect abnormal patterns in transfer latencies while the transfer is still in progress, and monitor the long-term performance of the transfer infrastructure to plan the data placement strategy.Based on the data collected for one year with the latency monitoring system, we present a study on the different factors that contribute to transfer completion time. As case studies, we analyze several typical CMS transfer workflows, such as distribution of collision event data from CERN or upload of simulated event data from the Tier-2 centres to the archival Tier-1 centres. For each workflow, we present the typical patterns of transfer latencies that have been identified with the latency monitor.We identify the areas in PhEDEx where a development effort can reduce the latency, and we show how we are able to detect stuck transfers which need operator intervention. Lastly, we propose a set of metrics to alert about stuck subscriptions and prompt for manual intervention, with the aim of improving transfer completion times.« less

Monitoring data transfer latency in CMS computing operations

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

Bonacorsi, Daniele; Diotalevi, Tommaso; Magini, Nicolo

During the first LHC run, the CMS experiment collected tens of Petabytes of collision and simulated data, which need to be distributed among dozens of computing centres with low latency in order to make efficient use of the resources. While the desired level of throughput has been successfully achieved, it is still common to observe transfer workflows that cannot reach full completion in a timely manner due to a small fraction of stuck files which require operator intervention.For this reason, in 2012 the CMS transfer management system, PhEDEx, was instrumented with a monitoring system to measure file transfer latencies, andmore » to predict the completion time for the transfer of a data set. The operators can detect abnormal patterns in transfer latencies while the transfer is still in progress, and monitor the long-term performance of the transfer infrastructure to plan the data placement strategy.Based on the data collected for one year with the latency monitoring system, we present a study on the different factors that contribute to transfer completion time. As case studies, we analyze several typical CMS transfer workflows, such as distribution of collision event data from CERN or upload of simulated event data from the Tier-2 centres to the archival Tier-1 centres. For each workflow, we present the typical patterns of transfer latencies that have been identified with the latency monitor.We identify the areas in PhEDEx where a development effort can reduce the latency, and we show how we are able to detect stuck transfers which need operator intervention. Lastly, we propose a set of metrics to alert about stuck subscriptions and prompt for manual intervention, with the aim of improving transfer completion times.« less

Probiotics improve insulin resistance status in an experimental model of Alzheimer's disease.

PubMed

Athari Nik Azm, Somayeh; Djazayeri, Abolghassem; Safa, Majid; Azami, Kian; Djalali, Mahmoud; Sharifzadeh, Mohammad; Vafa, Mohammadreza

2017-01-01

Background: Nowadays, Alzheimer's disease (AD) is considered as Type 3 diabetes in which insulin resistance is the common cause of both diseases. Disruption of insulin signaling cascade and insulin resistance can induce AD; and central insulin resistance causes systemic alterations in serum insulin, FBS levels, and lipid profile. Studies have shown that probiotics ( Lactobacillus and Bifidobacterium species) can be used as a nutritional approach to improve these metabolic changes. We assessed the probiotic effect (4 species of Lactobacillus and Bifidobacterium ) on insulin resistance biomarkers in an experimental model of AD. Methods: A total of 60 rats were divided into 5 groups: (1) a control group without surgical and dietary intervention; (2) a controlprobiotics group receiving probiotics for 8 weeks, but not receiving any surgical intervention; (3) a group receiving a sham operation in which PBS was injected intrahippocampus but without dietary intervention; (4) an Alzheimer group for which Amyloid-ß (Aß) 1- 42 was injected intrahippocampus but without dietary intervention; (5) and an Alzheimer-probiotics group for which Aß1-42 was injected intrahippocampus and given 2g probiotics for 8 weeks. The FBS levels and lipid profile were measured by a calorimetric method, insulin levels were detected by an ELISA kit, and HOMA-IR was calculated using a formula. ANOVA (one way analysis of variance followed by Bonferroni comparisons post hoc) was used to compare all the variables between groups. Results: Serum glucose, insulin levels, and HOMA-IR index increased in the Alzheimer group compared to the control (p<0.001), while probiotics decreased only insulin level and HOMA-IR index in AP group compared to Alzheimer group (p<0.001). Also, TG levels increased in the Alzheimer group (p<0.001), but no significant difference was detected between Alzheimer and Alzheimerprobiotics group. Conclusion: It seems that probiotics play an effective role in controlling glycemic status of Alzheimer's disease.

Exploring the nature of governance at the level of implementation for health system strengthening: the DIALHS experience.

PubMed

Scott, Vera; Schaay, Nikki; Olckers, Patti; Nqana, Nomsa; Lehmann, Uta; Gilson, Lucy

2014-09-01

Health system governance has been recognized as a critical element of the health system strengthening agenda. To date, health governance research often focuses at national or global levels, adopting a macro-perspective that deals with governance structures, forms and principles. Little attention has been given to a micro-perspective which recognizes the role of health system actors in governance, or to considering the operational level of the health system. This article presents a South African case study of an intervention to address conflict in roles and responsibilities between multiple actors supporting service delivery at the local level, and explores the broader insights this experience generates about the nature of local health system governance. In an embedded case study, action learning and reflection theory were used to design and implement the intervention. Data in this article were drawn from minutes, observations and recorded reflections of the meetings and workshops that comprised the intervention. A theoretical governance framework was used both to understand the context of the intervention and to analyse the dimensions of governance relevant in the experience. The study shows how, through action learning and reflection, local managers in two organizations came to understand how the higher level misalignment of organizational structures and processes imposed governance constraints on them, and to see the impact this had on their organizational relationships. By re-framing the conflict as organizational, they were then able to create opportunities for staff to understand their context and participate in negotiating principles for communication and collaborative work. The result reduced conflict between staff in the two organizations, leading to improved implementation of programme support. Strengthening relationships among those working at local level by building collaborative norms and values is an important part of local health system governance for improved service delivery by multiple actors. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Exploring the nature of governance at the level of implementation for health system strengthening: the DIALHS experience

PubMed Central

Scott, Vera; Schaay, Nikki; Olckers, Patti; Nqana, Nomsa; Lehmann, Uta; Gilson, Lucy

2014-01-01

Health system governance has been recognized as a critical element of the health system strengthening agenda. To date, health governance research often focuses at national or global levels, adopting a macro-perspective that deals with governance structures, forms and principles. Little attention has been given to a micro-perspective which recognizes the role of health system actors in governance, or to considering the operational level of the health system. This article presents a South African case study of an intervention to address conflict in roles and responsibilities between multiple actors supporting service delivery at the local level, and explores the broader insights this experience generates about the nature of local health system governance. In an embedded case study, action learning and reflection theory were used to design and implement the intervention. Data in this article were drawn from minutes, observations and recorded reflections of the meetings and workshops that comprised the intervention. A theoretical governance framework was used both to understand the context of the intervention and to analyse the dimensions of governance relevant in the experience. The study shows how, through action learning and reflection, local managers in two organizations came to understand how the higher level misalignment of organizational structures and processes imposed governance constraints on them, and to see the impact this had on their organizational relationships. By re-framing the conflict as organizational, they were then able to create opportunities for staff to understand their context and participate in negotiating principles for communication and collaborative work. The result reduced conflict between staff in the two organizations, leading to improved implementation of programme support. Strengthening relationships among those working at local level by building collaborative norms and values is an important part of local health system governance for improved service delivery by multiple actors. PMID:25274641

Expanding the base for teaching of percutaneous coronary interventions: the explicit approach.

PubMed

Lanzer, Peter; Prechelt, Lutz

2011-02-15

Accelerate and improve the training and learning process of operators performing percutaneous coronary interventions (PCI). Operator cognitive, in particular decision-making skills and technical skills are a major factor for the success of coronary interventions. Currently, cognitive skills are commonly developed by three methods: (1) Cognitive learning of rules for which statistical evidence is available. This is very incomprehensive and isolates cognitive learning from skill acquisition. (2) Informal tutoring received from experienced operators, and (3) personal experience by trial-and-error are both very slow. We propose in this concept article a conceptual framework to elicit, capture, and transfer expert PCI skills to complement the current approach. This includes the development of an in-depth understanding of the nature of PCI skills, terminology, and nomenclature needed to streamline communication, propensity of reproducible performance assessment, and in particular an explication of intervention planning and intra-intervention decision-making. We illustrate the impact of improved decision-making by simulation results based on a stochastic model of intervention risk. We identify several key concepts that form the basis of this conceptual framework, in particular different risk types and the notions of strategy, interventional module, and tactic. The increasing complexity of cases have brought PCI to the point where the decision-making skills of master operators need to be made explicit to make them systematically learnable such that the skills of beginner and intermediate operators can be improved much faster than is currently possible. Copyright © 2010 Wiley-Liss, Inc.

Psychological intervention in the Spanish military deployed on international operations.

PubMed

Martínez-Sánchez, Juan A

2014-05-01

Spain was one of the first countries to recognize the importance of psychological aspects in the planning and development of international military operations, and also to include military psychologists in contingents deployed abroad. This paper describes the psychological intervention model used by Spanish military psychologists involved in military operations abroad. This model is comprised of a systematic set of interventions and actions carried out in the different phases of any military operation (concentration, deployment and post-mission). It also contemplates the intervention not only in personnel who integrate the military contingents, but also with their families and, at certain times of the mission, with the local population of the area in which the operation is carried out. The model presented has a preventive orientation, based on the selection and psychological preparation of contingents before deployment, and supplemented by support in the area of operations for personnel who need it, and the psychological care of their families in Spain. Whereas this model has been effective so far, in this work, we present a series of measures aimed at improving the psychological well-being of our troops deployed outside our country.

[The influence of cardiosurgical intervention type and conditions of artificial blood circulation of perioperative dynamics of cardiac biomarkers].

PubMed

Dement'eva, I I; Morozov, Iu A; Charnaia, M A

2013-01-01

125 patients after cardiac surgery operated on with the use of artificial blood circulation (ABC) were followed-up. Blood levels of cardiac protein, binding aliphatic acids and troponin 1 and 3 days after the operation were registered. The study showed that aorta clamping more then 90 minutes and hypothermic perfusion regimen influence cardiomyocites negatively. The state of "surgical trauma" and reperfusional myocardium damage was approximately the same during aortic surgery, myocardium revascularization with the use of aortic clamping and cardioplegia, and correction of the acquired heart disease, according to the dynamics of the studied proteins in blood. The minimal blood level of cardiac protein, binding aliphatic acids after coronary by-pass surgery on the working heart witnesses about negative influence of crystalloid hypothermic cardioplegia on coronary microcirculation.

What is a clinical pathway? Refinement of an operational definition to identify clinical pathway studies for a Cochrane systematic review.

PubMed

Lawal, Adegboyega K; Rotter, Thomas; Kinsman, Leigh; Machotta, Andreas; Ronellenfitsch, Ulrich; Scott, Shannon D; Goodridge, Donna; Plishka, Christopher; Groot, Gary

2016-02-23

Clinical pathways (CPWs) are a common component in the quest to improve the quality of health. CPWs are used to reduce variation, improve quality of care, and maximize the outcomes for specific groups of patients. An ongoing challenge is the operationalization of a definition of CPW in healthcare. This may be attributable to both the differences in definition and a lack of conceptualization in the field of clinical pathways. This correspondence article describes a process of refinement of an operational definition for CPW research and proposes an operational definition for the future syntheses of CPWs literature. Following the approach proposed by Kinsman et al. (BMC Medicine 8(1):31, 2010) and Wieland et al. (Alternative Therapies in Health and Medicine 17(2):50, 2011), we used a four-stage process to generate a five criteria checklist for the definition of CPWs. We refined the operational definition, through consensus, merging two of the checklist's criteria, leading to a more inclusive criterion for accommodating CPW studies conducted in various healthcare settings. The following four criteria for CPW operational definition, derived from the refinement process described above, are (1) the intervention was a structured multidisciplinary plan of care; (2) the intervention was used to translate guidelines or evidence into local structures; (3) the intervention detailed the steps in a course of treatment or care in a plan, pathway, algorithm, guideline, protocol or other 'inventory of actions' (i.e. the intervention had time-frames or criteria-based progression); and (4) the intervention aimed to standardize care for a specific population. An intervention meeting all four criteria was considered to be a CPW. The development of operational definitions for complex interventions is a useful approach to appraise and synthesize evidence for policy development and quality improvement.

Pre-operative interventions (non-surgical and non-pharmacological) for patients with hip or knee osteoarthritis awaiting joint replacement surgery--a systematic review and meta-analysis.

PubMed

Wallis, Jason A; Taylor, Nicholas F

2011-12-01

To determine if pre-operative interventions for hip and knee osteoarthritis provide benefit before and after joint replacement. Systematic review with meta-analysis of randomised controlled trials (RCTs) of pre-operative interventions for people with hip or knee osteoarthritis awaiting joint replacement surgery. Standardised mean differences (SMD) were calculated for pain, musculoskeletal impairment, activity limitation, quality of life, and health service utilisation (length of stay and discharge destination). The GRADE approach was used to determine the quality of the evidence. Twenty-three RCTs involving 1461 participants awaiting hip or knee replacement surgery were identified. Meta-analysis provided moderate quality evidence that pre-operative exercise interventions for knee osteoarthritis reduced pain prior to knee replacement surgery (SMD (95% CI)=0.43 [0.13, 0.73]). None of the other meta-analyses investigating pre-operative interventions for knee osteoarthritis demonstrated any effect. Meta-analyses provided low to moderate quality evidence that exercise interventions for hip osteoarthritis reduced pain (SMD (95% CI)=0.52 [0.04, 1.01]) and improved activity (SMD (95% CI)=0.47 [0.11, 0.83]) prior to hip replacement surgery. Meta-analyses provided low quality evidence that exercise with education programs improved activity after hip replacement with reduced time to reach functional milestones during hospital stay (e.g., SMD (95% CI)=0.50 [0.10, 0.90] for first day walking). Low to moderate evidence from mostly small RCTs demonstrated that pre-operative interventions, particularly exercise, reduce pain for patients with hip and knee osteoarthritis prior to joint replacement, and exercise with education programs may improve activity after hip replacement. Copyright © 2011 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

[Surgical treatment of chronic pancreatitis complicated by biliary hypertension].

PubMed

Pylypchuk, V I

2015-01-01

The results of 29 patients treatment, suffering chronic pancreatitis, complicated by biliary hypertension, in whom operative interventions in Department of Surgery of Regional Ivano-Frankivsk clinical hospital in 2009 - 2014 yrs, were analyzed. The drainage, resectional and combined interventions were performed. Direct intervention on pancreatic gland was not applied in 5 (17.2%) patients. Operation to Frey was performed in 7 (24.1%) patients, in 4--it was added by choledochojejunoanastomosis formation, longitudinal pancreatojejunostomy--in 13 (44.8%). In 4 (14.8%) patients while functional disorders of adjacent organs present a pancreaticoduodenal resection to Whipple was done. For biliary hypertension diagnosis (including the occult one) the method of intraoperative pressure measurement in common biliary duct (CBD) was proposed. The operation was added by biliodigestive anastomosis formation, using choledochoenterostomy to Roux method if while operations to Frey or Beger after intervention on pancreatic head with the intrapancreatic CBD freeing the intraductal pressure witnessed the biliary hypertension presence. In all the patients good and satisfactory results of operative treatment were noted.

I-AUV Docking and Panel Intervention at Sea

PubMed Central

Palomeras, Narcís; Peñalver, Antonio; Massot-Campos, Miquel; Negre, Pep Lluís; Fernández, José Javier; Ridao, Pere; Sanz, Pedro J.; Oliver-Codina, Gabriel

2016-01-01

The use of commercially available autonomous underwater vehicles (AUVs) has increased during the last fifteen years. While they are mainly used for routine survey missions, there is a set of applications that nowadays can be only addressed by manned submersibles or work-class remotely operated vehicles (ROVs) equipped with teleoperated arms: the intervention applications. To allow these heavy vehicles controlled by human operators to perform intervention tasks, underwater structures like observatory facilities, subsea panels or oil-well Christmas trees have been adapted, making them more robust and easier to operate. The TRITON Spanish founded project proposes the use of a light-weight intervention AUV (I-AUV) to carry out intervention applications simplifying the adaptation of these underwater structures and drastically reducing the operational cost. To prove this concept, the Girona 500 I-AUV is used to autonomously dock into an adapted subsea panel and once docked perform an intervention composed of turning a valve and plugging in/unplugging a connector. The techniques used for the autonomous docking and manipulation as well as the design of an adapted subsea panel with a funnel-based docking system are presented in this article together with the results achieved in a water tank and at sea. PMID:27754348

I-AUV Docking and Panel Intervention at Sea.

PubMed

Palomeras, Narcís; Peñalver, Antonio; Massot-Campos, Miquel; Negre, Pep Lluís; Fernández, José Javier; Ridao, Pere; Sanz, Pedro J; Oliver-Codina, Gabriel

2016-10-12

The use of commercially available autonomous underwater vehicles (AUVs) has increased during the last fifteen years. While they are mainly used for routine survey missions, there is a set of applications that nowadays can be only addressed by manned submersibles or work-class remotely operated vehicles (ROVs) equipped with teleoperated arms: the intervention applications. To allow these heavy vehicles controlled by human operators to perform intervention tasks, underwater structures like observatory facilities, subsea panels or oil-well Christmas trees have been adapted, making them more robust and easier to operate. The TRITON Spanish founded project proposes the use of a light-weight intervention AUV (I-AUV) to carry out intervention applications simplifying the adaptation of these underwater structures and drastically reducing the operational cost. To prove this concept, the Girona 500 I-AUV is used to autonomously dock into an adapted subsea panel and once docked perform an intervention composed of turning a valve and plugging in/unplugging a connector. The techniques used for the autonomous docking and manipulation as well as the design of an adapted subsea panel with a funnel-based docking system are presented in this article together with the results achieved in a water tank and at sea.

[The volume of surgery on the abdominal cavity organs in patients with associated cardiovascular and respiratory system diseases].

PubMed

Bondarenko, M V

2004-08-01

The cardiovascular and respiratory disturbances are the main risk factor in acute and chronic surgical deseases of the abdominal cavity organs, including oncological. It is limits the possibility and volume of the diagnostics and surgical tactics choice. The complicated current of main disease is a risk factor of operation perform and the reason of the undertaking inadequate and palliative intervention, which significant reduce of the quality of life. Real by risk level reductions in surgery is a determination of tissues viability, estimation of compensatory reserve sick evidences for determination for operation performance including simultaneous and staged.

Reduction of police vehicle accidents through mechaniically aided supervision

PubMed Central

Larson, Lynn D.; Schnelle, John F.; Kirchner, Robert; Carr, Adam F.; Domash, Michele; Risley, Todd R.

1980-01-01

Tachograph recorders were installed in 224 vehicles of a metropolitan police department to monitor vehicle operation in an attempt to reduce the rate of accidents. Police sergeants reviewed each tachograph chart and provided feedback to officers regarding their driving performance. Reliability checks and additional feedback procedures were implemented so that upper level supervisors monitored and controlled the performance of field sergeants. The tachograph intervention and components of the feedback system nearly eliminated personal injury accidents and sharply reduced accidents caused by officer negligence. A cost-benefit analysis revealed that the savings in vehicle repair and injury claims outweighed the equipment and operating costs. PMID:16795634

Charging up the public for automated external defibrillators

PubMed Central

Willoughby DeJesus, Paula

2005-01-01

Public training in the use of automated external defibrillators to treat out-of-hospital cardiac arrests has been receiving increased attention. The implementation of public access defibrillation programs has been the most significant intervention to improve survival in decades. Dramatic success came when we placed automated external defibrillators in the hands of the public to be utilized without an Emergency Medical Services response having to occur. The device is simple to operate – sixth-grade children have demonstrated safe and effective operation. Training should be taken to its elemental level. Cardiopulmonary resuscitation training should not be forgotten; it too should be taken to its simplest form. PMID:15774067

Why Leadership Matters: Joint Task Force Planning with the Department of State

DTIC Science & Technology

2013-12-10

studies: (1) Operation Just Cause, the intervention into Panama to remove the regime of Manuel Noriega and (2) Operation Uphold Democracy; an intervention...States sphere of influence. Conversely, the invasion of Panama specifically targeted the regime of Manuel Noriega and restoration of the legally elected...OPERATION JUST CAUSE Operation Just Cause was executed to remove the regime of Panamanian dictator Manuel Noriega. The reasoning behind the

"G.P.S Matrices" programme: A method to improve the mastery level of social science students in matrices operations

NASA Astrophysics Data System (ADS)

Lee, Ken Voon

2013-04-01

The purpose of this action research was to increase the mastery level of Form Five Social Science students in Tawau II National Secondary School in the operations of addition, subtraction and multiplication of matrices in Mathematics. A total of 30 students were involved. Preliminary findings through the analysis of pre-test results and questionnaire had identified the main problem faced in which the students felt confused with the application of principles of the operations of matrices when performing these operations. Therefore, an action research was conducted using an intervention programme called "G.P.S Matrices" to overcome the problem. This programme was divided into three phases. 'Gift of Matrices' phase aimed at forming matrix teaching aids. The second and third phases were 'Positioning the Elements of Matrices' and 'Strenghtening the Concept of Matrices'. These two phases were aimed at increasing the level of understanding and memory of the students towards the principles of matrix operations. Besides, this third phase was also aimed at creating an interesting learning environment. A comparison between the results of pre-test and post-test had shown a remarkable improvement in students' performances after implementing the programme. In addition, the analysis of interview findings also indicated a positive feedback on the changes in students' attitude, particularly in the aspect of students' understanding level. Moreover, the level of students' memory also increased following the use of the concrete matrix teaching aids created in phase one. Besides, teachers felt encouraging when conducive learning environment was created through students' presentation activity held in third phase. Furthermore, students were voluntarily involved in these student-centred activities. In conclusion, this research findings showed an increase in the mastery level of students in these three matrix operations and thus the objective of the research had been achieved.

Video-assisted structured teaching to improve aseptic technique during neuraxial block.

PubMed

Friedman, Z; Siddiqui, N; Mahmoud, S; Davies, S

2013-09-01

Teaching epidural catheter insertion tends to focus on developing manual dexterity rather than improving aseptic technique which usually remains poor despite increasing experience. The aim of this study was to compare epidural aseptic technique performance, by novice operators after a targeted teaching intervention, with operators taught aseptic technique before the intervention was initiated. Starting July 2008, two groups of second-year anaesthesia residents (pre- and post-teaching intervention) performing their 4-month obstetric anaesthesia rotation in a university affiliated centre were videotaped three to four times while performing epidural procedures. Trained blinded independent examiners reviewed the procedures. The primary outcome was a comparison of aseptic technique performance scores (0-30 points) graded on a scale task-specific checklist. A total of 86 sessions by 29 residents were included in the study analysis. The intraclass correlation coefficient for inter-rater reliability for the aseptic technique was 0.90. The median aseptic technique scores for the rotation period were significantly higher in the post-intervention group [27.58, inter-quartile range (IQR) 22.33-29.50 vs 16.56, IQR 13.33-22.00]. Similar results were demonstrated when scores were analysed for low, moderate, and high levels of experience throughout the rotation. Procedure-specific aseptic technique teaching, aided by video assessment and video demonstration, helped significantly improve aseptic practice by novice trainees. Future studies should consider looking at retention over longer periods of time in more senior residents.

Inhibiting the Physiological Stress Effects of a Sustained Attention Task on Shoulder Muscle Activity.

PubMed

Wixted, Fiona; O'Riordan, Cliona; O'Sullivan, Leonard

2018-01-11

The objective of this study was to investigate if a breathing technique could counteract the effects of hyperventilation due to a sustained attention task on shoulder muscle activity. The trend towards higher levels of automation in industry is increasing. Consequently, manufacturing operators often monitor automated process for long periods of their work shift. Prolonged monitoring work requires sustained attention, which is a cognitive process that humans are typically poor at and find stressful. As sustained attention becomes an increasing requirement of manufacturing operators' job content, the resulting stress experienced could contribute to the onset of many health problems, including work related musculoskeletal disorders (WRMSDs). The SART attention test was completed by a group of participants before and after a breathing intervention exercise. The effects of the abdominal breathing intervention on breathing rate, upper trapezius muscle activity and end-tidal CO₂ were evaluated. The breathing intervention reduced the moderation effect of end-tidal CO₂ on upper trapezius muscle activity. Abdominal breathing could be a useful technique in reducing the effects of sustained attention work on muscular activity. This research can be applied to highly-automated manufacturing industries, where prolonged monitoring of work is widespread and could, in its role as a stressor, be a potential contributor to WRMSDs.

[Rheumatic tendon pathologies].

PubMed

Thomas, M; Jordan, M

2014-11-01

Rheumatoid arthritis is found in approximately 2 % of the total population in Europe and the peak incidence of the disease is during the fourth and fifth decades of life. In approximately 15 % the first symptoms of the disease occur at the level of the foot and ankle. If the early stage-dependent therapy with pharmaceuticals fails isolated surgery of the tendons (e.g. tenosynovectomy) and reconstructive surgery including the tendons (e.g. tendon transfer and tendon readaptation) are performed to keep the patient mobile. The aim of this article is to give an overview of the most commonly used interventions in the reconstruction of tendons in rheumatism patients and the corresponding indications. The conservative therapy options for rheumatic foot and ankle alterations with a special emphasis on tendon pathologies have a well-established importance and are also presented. A selective literature search was carried out for therapeutic options of rheumatic tendon pathologies. If possible attempts should be made to preserve functional qualities using tenosynovectomy, tendon sutures or tendon transfer operations. If joints are already destroyed or dislocated, tendon operations should be carried out only as combined interventions with arthrodesis, endoprostheses or resection arthroplasty. The time window in which these interventions are possible should not be missed. Orthotic devices, bandages or even orthopedic shoes provide external support and splinting but do not represent a causal therapy.

The Joanna Briggs Institute Best Practice Information Sheet: music as an intervention in hospitals.

PubMed

2011-03-01

This Best Practice Information Sheet aims to synthesize the best-available evidence on music as a therapeutic intervention for the management of anxiety or pain related to procedural or operative interventions. The information that is contained in this sheet has been derived from studies that were included in a systematic review that was conducted by The Joanna Briggs Institute. The original references can be sourced from the systematic review. Music as a therapeutic intervention is a development largely of the mid-20th century; however, it has existed in various forms in most cultures for many centuries. The Best Practice Information Sheet includes music-listening before a procedure or operation, during a procedure or operation, and after a procedure or operation. It excludes other forms of music therapy. Several recommendations for practice are made. © 2011 Blackwell Publishing Asia Pty Ltd.

[Developing local actions: allowing individual talents be expressed and utilised within a strategic framework].

PubMed

Coruble, Gérard; Vandoorne, Chantal

2005-01-01

The Regional Health Programme of Children and Adolescents in Province Alpes Cote d'Azur (PRSJ), developed between March 1998 and May 1999, is characterised by its scope and complexity. It is more a strategic framework for action than an operational programme. To carry out this action, it was adapted to the level of intervention, on the one hand, using instruments at the regional level adapted for professional interventions, and, on the other hand, through the development of territory-based approaches founded on the creation of networks. Evaluations have shown that the actors found the framework proposed by PRSJ positive and adopted it. They expressed their creativity with more spontaneity in the networks with therapeutic objectives, than those responding to health determinants, which needed initial local support. Local communities appeared as the ideal setting for dissemination and sustainability of PRSJ's objectives. PRSJ's strategic framework allowed local actors to express their talent. This mode of action, which accommodates not only programmatic focus within the context of practitioners on the ground, but also, epidemiology and socio-geographic interventions, are pertinent. To go beyond the explicit milestones set by the strategic orientations of the programme, different elements strengthening the framework are highlighted.

Patient Navigation by Community Health Workers Increases Access to Surgical Care in Rural Haiti.

PubMed

Matousek, Alexi C; Addington, Stephen R; Kahan, Joseph; Sannon, Herriot; Luckner, Thelius; Exe, Chauvet; Jean Louis, Rodolphe R Eisenhower; Lipsitz, Stuart; Meara, John G; Riviello, Robert

2017-12-01

In the Hôpital Albert Schweitzer district in rural Haiti, patients from mountain areas receive fewer operations per capita than patients from the plains. Possible additional barriers for mountain patients include lower socioeconomic status, lack of awareness of financial support, illiteracy and unfamiliarity with the hospital system. We sought to increase the rate of elective surgery for a mountain population using a patient navigation program. Patient navigators were trained to guide subjects from a mountain population through the entire hospital process for elective surgery. We compared the rate of elective operations before and after the patient navigation intervention between three groups: a control group from a mountainous area, a control group from the plains and an intervention group from a mountainous area. The baseline elective operation rate differed significantly between the plains control group, the mountain control group and the mountain intervention group (361 vs. 57 vs. 68 operations per 100,000 population per year). The rate of elective surgery between the two mountain groups was not statistically different prior to the intervention. After the intervention, the elective operation rate in the mountain group that received patient navigation increased from 68 to 131 operations per 100,000 population per year (p = 0.017). Patient navigation doubled the elective operation rate for a mountain population in rural Haiti. While additional barriers to access remain for this vulnerable population, patient navigation is an essential augmentation to financial assistance programs to ensure that the poor gain access to surgical care.

Robotics in percutaneous cardiovascular interventions.

PubMed

Pourdjabbar, Ali; Ang, Lawrence; Behnamfar, Omid; Patel, Mitul P; Reeves, Ryan R; Campbell, Paul T; Madder, Ryan D; Mahmud, Ehtisham

2017-11-01

The fundamental technique of performing percutaneous cardiovascular (CV) interventions has remained unchanged and requires operators to wear heavy lead aprons to minimize exposure to ionizing radiation. Robotic technology is now being utilized in interventional cardiology partially as a direct result of the increasing appreciation of the long-term occupational hazards of the field. This review was undertaken to report the clinical outcomes of percutaneous robotic coronary and peripheral vascular interventions. Areas covered: A systematic literature review of percutaneous robotic CV interventions was undertaken. The safety and feasibility of percutaneous robotically-assisted CV interventions has been validated in simple to complex coronary disease, and iliofemoral disease. Studies have shown that robotically-assisted PCI significantly reduces operator exposure to harmful ionizing radiation without compromising procedural success or clinical efficacy. In addition to the operator benefits, robotically-assisted intervention has the potential for patient advantages by allowing more accurate lesion length measurement, precise stent placement and lower patient radiation exposure. However, further investigation is required to fully elucidate these potential benefits. Expert commentary: Incremental improvement in robotic technology and telecommunications would enable treatment of an even broader patient population, and potentially provide remote robotic PCI.

Introduction to the special section: sustainability of work with chronic health conditions.

PubMed

Shaw, William S; Tveito, Torill H; Boot, Cécile R L

2013-06-01

The increasing prevalence of older workers and chronic health conditions represents a growing occupational health concern. More research is needed to understand risk factors, apply and adapt theories, and test workplace-focused interventions that might prevent work disability and disengagement among chronically ill workers. A 2-h roundtable symposium involving 28 participants was held at an international conference (Second Scientific Conference on Work Disability Prevention & Integration, Groningen, The Netherlands) in October 2012. In that symposium, small groups of participants were invited to discuss theoretical, methodological, and implementation considerations for studying workplace function and well-being among workers with chronic health conditions. As a follow-up to the symposium, the organizers invited authors to submit original articles to a Special Section of the Journal of Occupational Rehabilitation for peer review and publication. Results of the symposium reflected the need to address social, not just physical, aspects of the workplace, to include both individual-level and organizational interventions, and to integrate employer perspectives and operational models. Contributions to the Special Issue focus on outcome measurement, symptom self-management at work, job accommodations, prognostic factors for disability escalation, and the perceived needs of affected workers. The content of the Special Section reflects an evolving body of research that continues to grapple with basic issues around choice of outcome measures, level of intervention, and the optimal ways to meet the needs of workers with chronic health conditions, including supporting efforts to manage symptoms and function at work. Future research should focus on integrating organizational and individual-level interventions.

A new perspective on life-saving procedures in a battlefield setting: Emergency cricothyroidotomy, needle thoracostomy, and chest tube thoracostomy with night vision goggles.

PubMed

Bilge, Sedat; Aydın, Attila; Bilge, Meltem; Aydın, Cemile; Çevik, Erdem; Eryılmaz, Mehmet

2017-11-01

In the patients with multiple and serious trauma, early applications of life-saving procedures are related to improved survival. We tried to experimentally determine the feasibility of life-saving interventions that are performed with the aid of night vision goggles (NVG) in nighttime combat scenario. Chest tube thoracostomy (CTT), emergency cricothyroidotomy (EC), and needle thoracostomy (NT) interventions were performed by 10 combatant medical staff. The success and duration of interventions were explored in the study. Procedures were performed on the formerly prepared manikins/models in a bright room and in a dark room with the aid of NVG. Operators graded the ease of interventions. All interventions were found successful. Operators stated that both CTT and EC interventions were more difficult in dark than in daytime (p<0.05). No significant difference was observed in the difficulty in the NT interventions. No significant difference was observed in terms of completion times of interventions between in daytime and in dark scenario. The operators who use NVGs have to be aware of that they can perform their tactic and medical activities without taking off the NVGs and without the requirement of an extra light source.

Inguinal pain syndrome. The influence of intraoperative local administration of 0.5% bupivacaine on postoperative pain control following Lichtenstein hernioplasty. A prospective case-control study.

PubMed

Cybułka, Bartosz

2017-04-30

With current technological advancement and availability of synthetic materials used in inguinal hernia repair, a recurrence after first intervention is not a common and important adverse event. On the other hand, however, some patients complain about chronic pain of the operated site after surgeries using a polypropylene mesh. Many patients are constrained to a prolonged use of analgesics and increased frequency of control visits, which may eventually result in loss of trust in the operator. Every surgical intervention is associated with the risk of immediate or delayed complications. Genitofemoral neuralgia is associated with dysfunction of peripheral nerves passing through the inguinal canal or the surrounding tissue and it is a chronic, troublesome and undesired complication of an inguinal hernia repair. The possibility of minimizing chronic inguinal pain by proper management during herniorraphy should be considered in all cases of an inguinal canal reconstruction. The aim of the study was to investigate whether an intraoperative injection of 0.5% bupivacaine into the operated site (preemptive analgesia) has an influence on the postoperative pain assessed on the day of operation as well as the 1st and 2nd postoperative day after Lichtenstein hernioplasty of an inguinal, scrotal or recurrent hernia. In the studied population, we attempted to identify risk factors affecting pain level after surgical repair of an inguinal, scrotal or recurrent hernia. During the period between December 2015 and May 2016, 133 patients with preoperative diagnosis of an inguinal (81.95%, n=109), scrotal (13.53%, n=18) or recurrent hernia (4.51%, n=6) underwent an elective intervention and were randomly allocated to the group, which intraoperatively received 20 mL of 0.5% bupivacaine locally in selected anatomical points of the inguinal canal. In the group with preoperative diagnosis of an inguinal hernia, this intervention was applied in 56.88% of cases (n=62). In the case of scrotal or recurrent hernia, a similar intervention was applied in 41.67% (n=10) of patients. During the hospital stay, pain was assessed four times a day using the NRS numeric scale. All patients received preoperative antibiotic prophylaxis, and, during observation, analgesics and low-molecular-weight heparin were used. In the studied group, risk factor were identified, which affect the pain level associated with surgical treatment of an inguinal hernia. Mean pain level score according to the NRS scale (0-10) for an inguinal hernia was 4.17 on day 0 (standard deviation 2.22; minimum 0; maximum 10). On day 1 - 2.86 (standard deviation 1.86; minimum 0; maximum 8). On day 2 - 0.84 (standard deviation 1.21; minimum 0; maximum 5). The values of those parameters for a scrotal and recurrent hernia were as follows: on day 0 - 3.67 (standard deviation 1.76; minimum 0; maximum 7). On day 1 - 3.79 (standard deviation 1.67; minimum 0; maximum 7). On day 2 - 2.25 (standard deviation 1.54; minimum 0; maximum 4). Intraoperative application of 20 mL 0.5% bupivacaine did not reduce the postoperative pain on the postoperative day 0, 1, 2. Among independent risk factors exacerbating pain, the following variables were identified: local complications of the operated site including edema, ecchymosis and hematoma of the inguinal region. More frequent dressing changes were directly correlated with an increased pain sensation. Postoperative urethral catheterization due to urinary retention was associated with an increased pain immediately after surgery. In the case of intraoperative diagnosis of concurrent direct and indirect hernia (so-called pantaloon hernia), less intense pain was observed on postoperative day 0. Other parameters such as age, sex, duration of operation, duration of hospitalization and wound drainage did not influence the pain sensation. Local injection of an analgesic into the operated site was not associated with the reduction of pain assessed on postoperative day 0, 1 and 2 after an isolated inguinal, scrotal or recurrent hernia repair. Pathologies of the operated site such as edema, ecchymosis or hematoma were associated with an increased pain sensations on observation. Also, postoperative urinary retention and urethral catheterization increased the pain sensation after an inguinal hernia repair. A lack of wound complications significantly decreased the pain sensation during the immediate postoperative period after hernia repair.

Improving police response to persons with mental illness: A Multi-level conceptualization of CIT

PubMed Central

Watson, Amy C; Morabito, Melissa Schaefer; Draine, Jeffrey; Ottati, Victor

2009-01-01

The large numbers of people with mental illness in jails and prisons has fueled policy concern in all domains of the justice system. This includes police practice, where initial decisions to involve persons in the justice system or divert them to mental health services are made. One approach to focus police response in these situations is the implementation of Crisis Intervention Teams (CIT). The CIT model is being implemented widely, with over 400 programs currently operating. While the limited evidence on CIT effectiveness is promising, research on CIT is limited in scope and conceptualization-much of it focusing on officer characteristics and training. In this paper we review the literature on CIT and present a conceptual model of police response to persons with mental illness that accounts for officer, organizational, mental health system and community level factors likely to influence implementation and effectiveness of CIT and other approaches. By moving our conceptualizations and research in this area to new levels of specificity, we may contribute more to effectiveness research on these interventions. PMID:18632154

Improving operating theatre efficiency: an intervention to significantly reduce changeover time.

PubMed

Soliman, Bishoy A B; Stanton, Raymond; Sowter, Steven; Rozen, Warren Matthew; Shahbaz, Shekib

2013-07-01

Operating theatre inefficiency and changeover delays are not only a significant source of wasted resources, but also a familiar source of frustration to patients and health-care providers. This study aimed to prove that the surgical registrar through active involvement in patient changeover can significantly improve operating room efficiency and minimize delays. A two-phase prospective cohort study was undertaken, conducted over the course of 4 weeks at a single institution. The only inclusion criteria comprised patients to undertake endoscopic urological day surgery cases and require general anaesthesia. There were no exclusions. In the first phase (observational, with no intervention), changeover times between cases were documented. The second phase followed a structured intervention, involving the surgical registrar being actively involved in the patient's operative journey. Outcome measures were qualitative measures of operative efficiency. Statistical analysis was undertaken. There were 42 patients included in this study, with 21 patients in each of its arms. A 48% (P-value < 0.01) reduction in overall case changeover times was demonstrated with the utilization of a structured intervention from 27.7 min (95% confidence interval (CI) 22.8-32.7%) to 15.7 min (95% CI 13.2-18.2%). The intervention results were statistically significant (P-value < 0.05) for all markers of efficiency except for the waiting time in the anaesthetic holding bay (P-value 0.13). The surgical registrar can improve operating room efficiency by using a structured intervention, ultimately reducing patient changeover times. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

Pursuing scale and quality in STI interventions with sex workers: initial results from Avahan India AIDS Initiative

PubMed Central

Steen, R; Mogasale, V; Wi, T; Singh, A K; Das, A; Daly, C; George, B; Neilsen, G; Loo, V; Dallabetta, G

2006-01-01

Background Migration, population mobility, and sex work continue to drive sexually transmitted epidemics in India. Yet interventions targeting high incidence networks are rarely implemented at sufficient scale to have impact. India AIDS Initiative (Avahan), funded by the Bill and Melinda Gates Foundation, is scaling up interventions with sex workers (SWs) and other high risk populations in India's six highest HIV prevalence states. Methods Avahan resources are channelled through state level partners (SLPs) to local level non‐governmental organisations (NGOs) who organise outreach, community mobilisation, and dedicated clinics for SWs. These clinics provide services for sexually transmitted infections (STIs) including Condom Promotion, syndromic case management, regular check‐ups, and treatment of asymptomatic infections. SWs take an active role in service delivery. STI capacity building support functions on three levels. A central capacity building team developed guidelines and standards, trains state level STI coordinators, monitors outcomes, and conducts operations research. Standards are documented in an Avahan‐wide manual. State level STI coordinators train NGO clinic staff and conduct supervision of clinics based on these standards and related quality monitoring tools. Clinic and outreach staff report on indicators that guide additional capacity building inputs. Results In 2 years, clinics with community outreach for SWs have been established in 274 settings covering 77 districts. Mapping and size estimation have identified 187 000 SWs. In a subset of four large states covered by six SLPs (183 000 estimated SWs, 65 districts), 128 326 (70%) of the SWs have been contacted through peer outreach and 74 265 (41%) have attended the clinic at least once. A total of 127 630 clinic visits have been reported, an increasing proportion for recommended routine check ups. Supervision and monitoring facilitate standardisation of services across sites. Conclusion Targeted HIV/STI interventions can be brought to scale and standardised given adequate capacity building support. Intervention coverage, service utilisation, and quality are key parameters that should be monitored and progressively improved with active involvement of SWs themselves. PMID:17012513

Use of water-soluble contrast medium (gastrografin) does not decrease the need for operative intervention nor the duration of hospital stay in uncomplicated acute adhesive small bowel obstruction? A multicenter, randomized, clinical trial (Adhesive Small Bowel Obstruction Study) and systematic review.

PubMed

Scotté, Michel; Mauvais, Francois; Bubenheim, Michael; Cossé, Cyril; Suaud, Leslie; Savoye-Collet, Celine; Plenier, Isabelle; Péquignot, Aurelien; Yzet, Thierry; Regimbeau, Jean Marc

2017-05-01

This study evaluated the association between oral gastrografin administration and the need for operative intervention in patients with presumed adhesive small bowel obstruction. Between October 2006 and August 2009, 242 patients with uncomplicated acute adhesive small bowel obstruction were included in a randomized, controlled trial (the Adhesive Small Bowel Obstruction Study, NCT00389116) and allocated to a gastrografin arm or a saline solution arm. The primary end point was the need for operative intervention within 48 hours of randomization. The secondary end points were the resection rate, the time interval between the initial computed tomography and operative intervention, the time interval between oral refeeding and discharge, risk factors for the failure of nonoperative management, in-hospital mortality, duration of stay, and recurrence or death after discharge. We performed a systematic review of the literature in order to evaluate the relationship between use of gastrografin as a diagnostic/therapeutic measure, the need for operative intervention, and the duration of stay. In the gastrografin and saline solution arms, the rate of operative intervention was 24% and 20%, respectively, the bowel resection rate was 8% and 4%, the time interval between the initial computed tomography and operative intervention, and the time interval between oral refeeding and discharge were similar in the 2 arms. Only age was identified as a potential risk factor for the failure of nonoperative management. The in-hospital mortality was 2.5%, the duration of stay was 3.8 days for patients in the gastrografin arm and 3.5 days for those in the saline solution arm (P = .19), and the recurrence rate of adhesive small bowel obstruction was 7%. These results and those of 10 published studies suggest that gastrografin did not decrease either the rate of operative intervention (21% in the saline solution arm vs 26% in the gastrografin arm) or the number of days from the initial computed tomography to discharge (3.5 vs 3.5; P = NS for both). The results of the present study and those of our systematic review suggest that gastrografin administration is of no benefit in patients with adhesive small bowel obstruction. Copyright © 2016 Elsevier Inc. All rights reserved.

Operative and consultative proportions of neurosurgical disease worldwide: estimation from the surgeon perspective.

PubMed

Dewan, Michael C; Rattani, Abbas; Baticulon, Ronnie E; Faruque, Serena; Johnson, Walter D; Dempsey, Robert J; Haglund, Michael M; Alkire, Blake C; Park, Kee B; Warf, Benjamin C; Shrime, Mark G

2018-05-11

OBJECTIVE The global magnitude of neurosurgical disease is unknown. The authors sought to estimate the surgical and consultative proportion of diseases commonly encountered by neurosurgeons, as well as surgeon case volume and perceived workload. METHODS An electronic survey was sent to 193 neurosurgeons previously identified via a global surgeon mapping initiative. The survey consisted of three sections aimed at quantifying surgical incidence of neurological disease, consultation incidence, and surgeon demographic data. Surgeons were asked to estimate the proportion of 11 neurological disorders that, in an ideal world, would indicate either neurosurgical operation or neurosurgical consultation. Respondent surgeons indicated their confidence level in each estimate. Demographic and surgical practice characteristics-including case volume and perceived workload-were also captured. RESULTS Eighty-five neurosurgeons from 57 countries, representing all WHO regions and World Bank income levels, completed the survey. Neurological conditions estimated to warrant neurosurgical consultation with the highest frequency were brain tumors (96%), spinal tumors (95%), hydrocephalus (94%), and neural tube defects (92%), whereas stroke (54%), central nervous system infection (58%), and epilepsy (40%) carried the lowest frequency. Similarly, surgery was deemed necessary for an average of 88% cases of hydrocephalus, 82% of spinal tumors and neural tube defects, and 78% of brain tumors. Degenerative spine disease (42%), stroke (31%), and epilepsy (24%) were found to warrant surgical intervention less frequently. Confidence levels were consistently high among respondents (lower quartile > 70/100 for 90% of questions), and estimates did not vary significantly across WHO regions or among income levels. Surgeons reported performing a mean of 245 cases annually (median 190). On a 100-point scale indicating a surgeon's perceived workload (0-not busy, 100-overworked), respondents selected a mean workload of 75 (median 79). CONCLUSIONS With a high level of confidence and strong concordance, neurosurgeons estimated that the vast majority of patients with central nervous system tumors, hydrocephalus, or neural tube defects mandate neurosurgical involvement. A significant proportion of other common neurological diseases, such as traumatic brain and spinal injury, vascular anomalies, and degenerative spine disease, demand the attention of a neurosurgeon-whether via operative intervention or expert counsel. These estimates facilitate measurement of the expected annual volume of neurosurgical disease globally.

An operational study on implementation of oral rehydration therapy in a rural community of West Bengal, India.

PubMed

Sircar, B K; Deb, B C; Sengupta, P G; Mondal, S; Gupta, D N; Sarkar, S; Sikder, S N; Ghosh, S; Saha, N C; Pal, S C

1991-09-01

An operational study of a 3-tier strategy for implementation of oral rehydration therapy (ORT) was conducted in a block of West Bengal with 216,825 population through the existing health services facilities. All the grassroot level, health workers including their supervisors at various levels were trained regarding the management of patients of diarrhoea with mild to moderate degree of dehydration, by ORT. Another block in the same district with similar demographic features where this intervention was not provided served as control. After 22 months of observation, it was evident that despite adequate training, the performance of Community Health Guides (CHGs) and Anganwadi Workers (AWWs) was not encouraging because of the low utilization of both home available fluids (32.0%) and oral rehydration solution (18.0%) in the study area. Similarly, diarrhoea associated mortality could not be reduced significantly. Lack of motivation and failure to maintain sustained level of skill by the CHGs and AWWs constitute the major bottlenecks for the successful implementation of the programme at the community level.

Impact of a joint labor-management ergonomics program on upper extremity musculoskeletal symptoms among garment workers.

PubMed

Herbert, R; Dropkin, J; Warren, N; Sivin, D; Doucette, J; Kellogg, L; Bardin, J; Kass, D; Zoloth, S

2001-10-01

This study evaluated the effect of an ergonomics intervention program on the prevalence and intensity of symptoms of upper extremity work-related musculoskeletal disorders among 36 garment workers performing an operation called spooling. Adjustable chairs were introduced and workers were trained in their use. Symptom surveys were administered prior to and 6 months after introduction of adjustable chairs. Quantitative pre- and post-intervention measurement of joint position was performed utilizing videotapes among a subgroup of nineteen. Eighty nine percent of the cohort reported pain in either the neck or at least one upper extremity anatomic site prior to the adjustable chair intervention. Among subjects reporting pain at baseline, there were significantly decreased pain levels in 10 of 11 anatomic sites after the intervention. Among all subjects, the proportion reporting pain decreased for each anatomic site following the intervention, with statistically significant decreases in 3 sites. However, there were only modest declines in awkward posture among the videotaped subgroup. This study suggests that introduction of an ergonomics program focused on education and introduction of an adjustable chair may diminish musculoskeletal symptomatology in apparel manufacturing workers.

Does "Enhanced Support" for Offenders Effectively Reduce Custodial Violence and Disruption? An Evaluation of the Enhanced Support Service Pilot.

PubMed

Camp, Jake; Joy, Kerry; Freestone, Mark

2018-01-01

This study aimed to examine the effectiveness of The Enhanced Support Service (ESS) pilot in reducing custodial violence and disruption, and the associated costs, by observing the behavioural change of the 35 service users who participated in ESS intervention within its first 22 months of operation. Frequencies of recorded incidents of aggressive behaviours, self-harming behaviours, noncompliance, and positive behaviours were counted from routine administrative systems using a coding structure developed in previous studies. The count data were analysed using nonparametric tests and Poisson regression models to derive an Incident Rate Ratio (IRR). Findings suggest the ESS is associated with a reduction in aggressive behaviours and noncompliance, with medium to large effect sizes ( r = .31-.53); however, it was not associated with a reduction in deliberate self-harm or increased positive behaviours. The Poisson models revealed that levels of pre-intervention behaviour, intervention length, intervention completion, and service location had varying effects on postintervention behaviour, with those who completed intervention demonstrating more favourable outcomes. The ESS service model was associated with a reduction in behaviour that challenges, which has implications for the reduction in associated social, economic, and political costs-as well as the commissioning of interventions and future research in this area.

Psychosocial interventions in attention-deficit/hyperactivity disorder: update.

PubMed

Antshel, Kevin M

2015-01-01

Attention-deficit/hyperactivity disorder (ADHD) is the most common reason for referral to child and adolescent psychiatry clinics. Although stimulant medications represent an evidence-based approach to managing ADHD, psychosocial interventions for child/adolescent ADHD target functional impairments as the intervention goal, and rely heavily on behavioral therapy techniques and operant conditioning principles. Evidence-based psychosocial interventions for managing pediatric ADHD include behavioral parent training, school-based interventions relying on behavioral modification, teaching skills, and operant conditioning principles, and intensive summer treatment programs. The use of conjoint psychosocial treatments with ADHD medications may enable lower doses of each form of treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

Medical personnel and patient dosimetry during coronary angiography and intervention

NASA Astrophysics Data System (ADS)

Efstathopoulos, Efstathios P.; Makrygiannis, Stamatis S.; Kottou, Sofia; Karvouni, Evangelia; Giazitzoglou, Eleftherios; Korovesis, Socrates; Tzanalaridou, Efthalia; Raptou, Panagiota D.; Katritsis, Demosthenes G.

2003-09-01

Percutaneous coronary interventions are associated with increased radiation exposure compared to most radiological examinations. This prospective study aimed at (1) measuring entrance doses for all in-room personnel, (2) performing an assessment of patient effective dose and intracoronary doses, (3) investigating the contribution of each projection to kerma-area product (KAP) and irradiation time, (4) comparing results with established DRL values in this clinical setting and (5) estimating the risk for fatal cancer to patients and operators. Measurements were performed during 40 consecutive procedures of coronary angiography (CA), half of which were followed by ad hoc coronary angioplasty (PTCA). KAP measurements were used for patients and thermoluminescent dosimetry for the in-room personnel. The mean KAP value per procedure for CA was 29 +/- 9 Gy cm2. Thirty four per cent of KAP was due to fluoroscopy, whereas the remainder (66%) was due to digital cine. Accordingly, the mean KAP value per PTCA procedure was 75 +/- 30 Gy cm2, and contribution of fluoroscopy is 57%. Effective dose per year was estimated to be 0.04-0.05 mSv y-1 for the primary operator, and 0.03-0.04 mSv y-1 for those assisting. Corresponding measurements for radiographer and nurse were below detectable level, implying minimal radiation hazards for them. Regarding radiation exposure, coronary intervention is considered a quite safe procedure for both patients and personnel in laboratories with modern equipment and experienced operators as long as standard safety precautions are considered. Exposure optimization though should be constantly sought through continuous review of procedures.

Emergency management in patients with late hemorrhage after pancreatoduodenectomy for a periampullary tumor.

PubMed

Jilesen, Anneke P J; Tol, Johanna A M G; Busch, Olivier R C; van Delden, Otto M; van Gulik, Thomas M; Nieveen van Dijkum, Els J M; Gouma, Dirk J

2014-09-01

The mortality rate due to late hemorrhage after surgery for periampullary tumors is high, especially in patients with anastomotic leakage. Patients usually require emergency intervention for late hemorrhage. In this study patients with late hemorrhage and their outcomes were analyzed. Furthermore, independent predictors for late hemorrhage, the need for emergency intervention, and type of intervention are reported. From a prospective database that includes 1,035 patients who underwent pancreatoduodenectomy for periampullary tumors between 1992 and 2012, patients with late hemorrhage (>24 h after index operation) were identified. Patient, disease-specific, and operation characteristics, type of intervention, and outcomes were analyzed. Emergency intervention was defined as surgical or radiological intervention in hemodynamically unstable patients. Of the 47 patients (4.5 %) with late hemorrhage, pancreatic fistula was an independent predictor for developing late hemorrhage (OR 10.2). The mortality rate in patients with late hemorrhage was 13 % compared with 1.5 % in all patients without late hemorrhage. Twenty patients required emergency intervention; 80 % underwent primary radiological intervention and 20 % primary surgical intervention. Extraluminal location of the bleeding (OR 5.6) and occurrence of a sentinel bleed (OR 6.6) are indications for emergency intervention. The type of emergency intervention needed for late hemorrhage is unpredictable. Radiological intervention is preferred, but if it fails, immediate change to surgical treatment is mandatory. This can be difficult to manage but possible when both radiological and surgical interventions are in close proximity such as in a hybrid operating room and should be considered in the emergency management of patients with late hemorrhage.

Health behavior change models for HIV prevention and AIDS care: practical recommendations for a multi-level approach.

PubMed

Kaufman, Michelle R; Cornish, Flora; Zimmerman, Rick S; Johnson, Blair T

2014-08-15

Despite increasing recent emphasis on the social and structural determinants of HIV-related behavior, empirical research and interventions lag behind, partly because of the complexity of social-structural approaches. This article provides a comprehensive and practical review of the diverse literature on multi-level approaches to HIV-related behavior change in the interest of contributing to the ongoing shift to more holistic theory, research, and practice. It has the following specific aims: (1) to provide a comprehensive list of relevant variables/factors related to behavior change at all points on the individual-structural spectrum, (2) to map out and compare the characteristics of important recent multi-level models, (3) to reflect on the challenges of operating with such complex theoretical tools, and (4) to identify next steps and make actionable recommendations. Using a multi-level approach implies incorporating increasing numbers of variables and increasingly context-specific mechanisms, overall producing greater intricacies. We conclude with recommendations on how best to respond to this complexity, which include: using formative research and interdisciplinary collaboration to select the most appropriate levels and variables in a given context; measuring social and institutional variables at the appropriate level to ensure meaningful assessments of multiple levels are made; and conceptualizing intervention and research with reference to theoretical models and mechanisms to facilitate transferability, sustainability, and scalability.

[Studies on occupational stress intervention in workplaces abroad: a systematic review].

PubMed

Hua, Yujie; Dai, Junming

2015-10-01

To evaluate the effects of occupational stress intervention in the workplaces abroad by systematic review and to provide a reference for domestic research. The Medline database was searched to collect the literature on occupational stress intervention published from January 1 in 2000 to September 4 in 2014, Using standardized forms, the methods, contents, subjects, study design, result indicator, effectiveness and evidence of the intervention were extracted and analyzed. Thirty studies met the inclusion criteria, with a total sample size of 5699 participants, including 20 randomized trials and 10 non-randomized or self-controlled studies from 12 countries, such as Germany, Japan, and Britain. The course of intervention ranged from 4 to 16 weeks. Six types of intervention were identified, i.e., cognitive-behavioral treatment (CBT), relaxation technique, physical activity, organization-focused intervention, combined intervention, and multilevel intervention, among which CBT was used most frequently. The outcome variables mainly included social psychological variable and work-related variable. Occupational stress intervention could significantly improve the occupational stress and depressive symptoms, and also had some effects on the work-related outcomes. The effectiveness of the intervention might vary between the subjects with different occupational stress levels before intervention. The effectiveness of the intervention was better at an organizational level than at an individual level, but the effectiveness at a multiple level was not necessarily better than that at a single level. Occupational stress intervention is an effective method to improve the occupational stress at workplace. However, the occupational stress level before intervention, the duration and frequency of intervention, measures and level of intervention, and follow-up period have certain influence on the effectiveness of intervention. Future research should pay attention to methodology, focus on organizational level and network-based intervention, and increase the cost-benefit analysis.

Utility of simultaneous interventional radiology and operative surgery in a dedicated suite for seriously injured patients.

PubMed

D'Amours, Scott K; Rastogi, Pratik; Ball, Chad G

2013-12-01

In recent years, combined interventional radiology and operative suites have been proposed and are now becoming operational in select trauma centres. Given the infancy of this technology, this review aims to review the rationale, benefits and challenges of hybrid suites in the management of seriously injured patients. No specific studies exist that investigate outcomes within hybrid trauma suites. Endovascular and interventional radiology techniques have been successfully employed in thoracic, abdominal, pelvic and extremity trauma. Although the association between delayed haemorrhage control and poorer patient outcomes is intuitive, most supporting scientific data are outdated. The hybrid suite model offers the potential to expedite haemorrhage control through synergistic operative, interventional radiology and resuscitative platforms. Maximizing the utility of these suites requires trained multidisciplinary teams, ergonomic and workplace considerations, as well as a fundamental paradigm shift of trauma care. This often translates into a more damage-control orientated philosophy. Hybrid suites offer tremendous potential to expedite haemorrhage control in trauma patients. Outcome evaluations from trauma units that currently have operational hybrid suites are required to establish clearer guidelines and criteria for patient management.

Using Formative Research to Develop Environmental and Ecological Interventions to Address Overweight and Obesity

PubMed Central

Wilson, Mark G.; Goetzel, Ron Z.; Ozminkowski, Ronald J.; DeJoy, Dave M.; Della, Lindsay; Roemer, Enid Chung; Schneider, Jennifer; Tully, Karen J.; White, John M.; Baase, Catherine M.

2010-01-01

Objective This paper presents the formative research phase of a large multi-site intervention study conducted to inform the feasibility of introducing environmental and ecological interventions. Methods Using mixed methods that included an environmental assessment, climate survey, leadership focus groups and interviews, and archival data, information was collected on employee health and job factors, the physical environment, social-organizational environment, and current health programs. Results Results show that 83% of employees at the study sites were overweight or obese. Leadership was very supportive of health initiatives and felt integrating the strategies into organizational operations would increase their likelihood of success. Environmental assessment scores ranged from 47 to 19 on a 100 point scale. Health services personnel tended to view the organizational climate for health more positively than site leadership (mean of 3.6 vs 3.0 respectively). Conclusions Intervention strategies chosen included increasing healthy food choices in vending, cafeterias, and company meetings, providing a walking path, targeting messages, developing site goals, training leaders, and establishing leaders at the work group level. PMID:18073340

Sustaining success: aligning the public health workforce in South-Eastern Europe with strategic public health priorities.

PubMed

Bjegovic-Mikanovic, Vesna; Santric-Milicevic, Milena; Cichowska, Anna; von Krauss, Martin Krayer; Perfilieva, Galina; Rebac, Boris; Zuleta-Marin, Ingrid; Dieleman, Marjolein; Zwanikken, Prisca

2018-06-01

To map out the Public Health Workforce (PHW) involved in successful public health interventions. We did a pilot assessment of human resources involved in successful interventions addressing public health challenges in the countries of South-Eastern Europe (SEE). High-level representatives of eight countries reported about success stories through the coaching by experts. During synthesizing qualitative data, experts applied triangulation by contacting additional sources of evidence and used the framework method in data analysis. SEE countries tailored public health priorities towards social determinants, health equalities, and prevention of non-communicable diseases. A variety of organizations participated in achieving public health success. The same applies to the wide array of professions involved in the delivery of Essential Public Health Operations (EPHOs). Key enablers of the successful work of PHW were staff capacities, competences, interdisciplinary networking, productivity, and funding. Despite diversity across countries, successful public health interventions have similar ingredients. Although PHW is aligned with the specific public health success, a productive interface between health and other sectors is crucial for rolling-out successful interventions.

Leveled Literacy Intervention. What Works Clearinghouse Intervention Report

ERIC Educational Resources Information Center

What Works Clearinghouse, 2017

2017-01-01

"Leveled Literacy Intervention" ("LLI") is a short-term, supplementary, small-group literacy intervention designed to help struggling readers achieve grade-level competency. The intervention provides explicit instruction in phonological awareness, phonics, fluency, vocabulary, reading comprehension, oral language skills, and…

The theoretical basis for practice-relevant medication use research: patient-centered/behavioral theories.

PubMed

Blalock, Susan J

2011-12-01

There is an urgent need for research to improve the quality of medication use among those who require pharmacotherapy. To describe how behavioral science theories can help to achieve this goal. We begin by describing what a theory is and the functions that theories serve. We then provide 8 guiding principles that are crucial for investigators to understand if they are to use theory appropriately. We conclude by discussing the need for a new model of patient medication self-management that incorporates information concerning factors operating at all levels of the ecological framework, ranging from patient-level to societal-level factors. The 8 guiding principles discussed are the following: (1) There is no single theory that is appropriate for guiding all medication use research; (2) Behavioral science theories are probabilistic, not deterministic; (3) When trying to influence a health behavior, the health behavior of interest must be defined precisely; (4) Many factors outside of patient control influence patient medication use; (5) Every patient is unique; (6) Patient motivation is a fundamental ingredient required to optimize medication use, especially when maintenance of long term behavior is the goal; (7) Health care providers can have a profound effect on patient medication use, and this effect can operate through several possible causal pathways; and (8) When planning an intervention to optimize medication use, it is important to develop a conceptual model that links intervention inputs to the ultimate outcomes that are desired. Medication use can be influenced by a wide variety of factors acting at different levels of the ecological model. The quality of research on medication use could be improved by development of an ecological model specific to medication self-management. Copyright © 2011 Elsevier Inc. All rights reserved.

Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery.

PubMed

Arsenault, Kyle A; Yusuf, Arif M; Crystal, Eugene; Healey, Jeff S; Morillo, Carlos A; Nair, Girish M; Whitlock, Richard P

2013-01-31

Atrial fibrillation is a common post-operative complication of cardiac surgery and is associated with an increased risk of post-operative stroke, increased length of intensive care unit and hospital stays, healthcare costs and mortality. Numerous trials have evaluated various pharmacological and non-pharmacological prophylactic interventions for their efficacy in preventing post-operative atrial fibrillation. We conducted an update to a 2004 Cochrane systematic review and meta-analysis of the literature to gain a better understanding of the effectiveness of these interventions. The primary objective was to assess the effects of pharmacological and non-pharmacological interventions for preventing post-operative atrial fibrillation or supraventricular tachycardia after cardiac surgery. Secondary objectives were to determine the effects on post-operative stroke or cerebrovascular accident, mortality, cardiovascular mortality, length of hospital stay and cost of treatment during the hospital stay. We searched the Cochrane Central Register of ControlLed Trials (CENTRAL) (Issue 8, 2011), MEDLINE (from 1946 to July 2011), EMBASE (from 1974 to July 2011) and CINAHL (from 1981 to July 2011). We selected randomized controlled trials (RCTs) that included adult patients undergoing cardiac surgery who were allocated to pharmacological or non-pharmacological interventions for the prevention of post-operative atrial fibrillation or supraventricular tachycardia, except digoxin, potassium (K(+)), or steroids. Two review authors independently abstracted study data and assessed trial quality. One hundred and eighteen studies with 138 treatment groups and 17,364 participants were included in this review. Fifty-seven of these studies were included in the original version of this review while 61 were added, including 27 on interventions that were not considered in the original version. Interventions included amiodarone, beta-blockers, sotalol, magnesium, atrial pacing and posterior pericardiotomy. Each of the studied interventions significantly reduced the rate of post-operative atrial fibrillation after cardiac surgery compared with a control. Beta-blockers (odds ratio (OR) 0.33; 95% confidence interval) CI 0.26 to 0.43; I(2) = 55%) and sotalol (OR 0.34; 95% CI 0.26 to 0.43; I(2) = 3%) appear to have similar efficacy while magnesium's efficacy (OR 0.55; 95% CI 0.41 to 0.73; I(2) = 51%) may be slightly less. Amiodarone (OR 0.43; 95% CI 0.34 to 0.54; I(2) = 63%), atrial pacing (OR 0.47; 95% CI 0.36 to 0.61; I(2) = 50%) and posterior pericardiotomy (OR 0.35; 95% CI 0.18 to 0.67; I(2) = 66%) were all found to be effective. Prophylactic intervention decreased the hospital length of stay by approximately two-thirds of a day and decreased the cost of hospital treatment by roughly $1250 US. Intervention was also found to reduce the odds of post-operative stroke, though this reduction did not reach statistical significance (OR 0.69; 95% CI 0.47 to 1.01; I(2) = 0%). No significant effect on all-cause or cardiovascular mortality was demonstrated. Prophylaxis to prevent atrial fibrillation after cardiac surgery with any of the studied pharmacological or non-pharmacological interventions may be favored because of its reduction in the rate of atrial fibrillation, decrease in the length of stay and cost of hospital treatment and a possible decrease in the rate of stroke. However, this review is limited by the quality of the available data and heterogeneity between the included studies. Selection of appropriate interventions may depend on the individual patient situation and should take into consideration adverse effects and the cost associated with each approach.

Auditing surgical service provision at a South African tertiary institution: Implications for the development of district services.

PubMed

Laing, G L; Skinner, D L; Bruce, J L; Aldous, C; Govindasamy, V; Thomson, S R; Clarke, D L

2017-11-01

The optimal management of resources within South African state hospitals has been hampered by a paucity of data due to a lack of robust auditing information systems. This study reviews the use of a Hybrid Electronic Medical Record (HEMR) system to capture and aggregate data pertaining to the inpatient service demands on a South African tertiary surgical service. This dataset was used to analyse the appropriateness of tertiary surgical resource utilisation. The HEMR system was implemented at Greys Hospital, in the city of Pietermaritzburg, Kwa-Zulu Natal, South Africa on 1 January 2013. Inpatient data pertaining to surgical admissions and operative interventions were captured prospectively. Following an 18-month study period, the data were extracted, aggregated and analysed. The district referral hospitals were mapped, and district surgical procedures performed within the tertiary center were identified and quantified. Results: 7314 patients were admitted and managed by the tertiary surgical service during the study period. The median patient age was 33 years (IQR 6.5-42.4 years). 59.7% were male and 40.3% were female. General, trauma and paediatric surgical admissions constituted 54.8%, 28.6% and 16.6% respectively. Emergency admissions constituted 62.4% and elective admissions 37.6%. Referral sources were captured for 6653 (91%) of the cohort. 4338 (65.2%) patients were referred from district hospitals. The district hospital (Northdale) closest to Greys Hospital was responsible for 1675 (25.2%) of surgical referrals. 4174 operative procedures were performed during the study period, 54.7% performed as an emergency, 34.1% electively and 11.2% semi-electively. The median waiting time for emergency operative intervention was 535 minutes (IQR 130-663). A total of 1272 (30.5%) operative procedures performed were assessed as district-level operations. The time intervals of 07:00-07:59 and 17:00-17:59 were identified as the time periods during which the least number of emergency procedures were performed in the operating theatres. The HEMR system enabled the Pietermaritzburg Metropolitan Department of Surgery to quantify the burden of surgical disease and map district referral patterns. Thirty percent of operative procedures performed were assessed as district-level operations. Potentially correctable deficits identified within the tertiary center were lengthy delays to emergency surgery and non-optimal theatre utilisation periods.

Treatment Integrity of Interventions with Children in the "Journal of Positive Behavior Interventions" from 1999 to 2009

ERIC Educational Resources Information Center

Sanetti, Lisa M. Hagermoser; Dobey, Lisa M.; Gritter, Katie L.

2012-01-01

For more than 10 years, the "Journal of Positive Behavior Interventions" has published, among other types of articles, behavioral intervention outcome studies related to positive behavior support. Operationally defining interventions is important to facilitating replication studies and adoption of intervention in applied settings. Furthermore,…

Design, implementation, and quality control in the Pathways American-Indian multicenter trial

PubMed Central

Stone, Elaine J.; Norman, James E.; Davis, Sally M.; Stewart, Dawn; Clay, Theresa E.; Caballero, Ben; Lohman, Timothy G.; Murray, David M.

2016-01-01

Background Pathways was the first multicenter American-Indian school-based study to test the effectiveness of an obesity prevention program promoting healthy eating and physical activity. Methods Pathways employed a nested cohort design in which 41 schools were randomized to intervention or control conditions and students within these schools were followed as a cohort (1,704 third graders at baseline). The study’s primary endpoint was percent body fat. Secondary endpoints were levels of fat in school lunches; time spent in physical activity; and knowledge, attitudes, and behaviors regarding diet and exercise. Quality control (QC) included design of data management systems which provided standardization and quality assurance of data collection and processing. Data QC procedures at study centers included manuals of operation, training and certification, and monitoring of performance. Process evaluation was conducted to monitor dose and fidelity of the interventions. Registration and tracking systems were used for students and schools. Results No difference in mean percent body fat at fifth grade was found between the intervention and control schools. Percent of calories from fat and saturated fat in school lunches was significantly reduced in the intervention schools as was total energy intake from 24-hour recalls. Significant increases in self-reported physical activity levels and knowledge of healthy behaviors were found for the intervention school students. Conclusions The Pathways study results provide evidence demonstrating the role schools can play in public health promotion. Its study design and QC systems and procedures provide useful models for other similar school based multi- or single-site studies. PMID:14636805

A typology of practice narratives during the implementation of a preventive, community intervention trial.

PubMed

Riley, Therese; Hawe, Penelope

2009-12-14

Traditional methods of process evaluation encompass what components were delivered, but rarely uncover how practitioners position themselves and act relative to an intervention being tested. This could be crucial for expanding our understanding of implementation and its contribution to intervention effectiveness. We undertook a narrative analysis of in-depth, unstructured field diaries kept by nine community development practitioners for two years. The practitioners were responsible for implementing a multi-component, preventive, community-level intervention for mothers of new babies in eight communities, as part of a cluster randomised community intervention trial. We constructed a narrative typology of approaches to practice, drawing on the phenomenology of Alfred Schutz and Max Weber's Ideal Type theory. Five types of practice emerged, from a highly 'technology-based' type that was faithful to intervention specifications, through to a 'romantic' type that held relationships to be central to daily operations, with intact relationships being the final arbiter of intervention success. The five types also differed in terms of how others involved in the intervention were characterized, the narrative form (e.g., tragedy, satire) and where and how transformative change in communities was best created. This meant that different types traded-off or managed the priorities of the intervention differently, according to the deeply held values of their type. The data set constructed for this analysis is unique. It revealed that practitioners not only exercise their agency within interventions, they do so systematically, that is, according to a pattern. The typology is the first of its kind and, if verified through replication, may have value for anticipating intervention dynamics and explaining implementation variation in community interventions.

A typology of practice narratives during the implementation of a preventive, community intervention trial

PubMed Central

2009-01-01

Background Traditional methods of process evaluation encompass what components were delivered, but rarely uncover how practitioners position themselves and act relative to an intervention being tested. This could be crucial for expanding our understanding of implementation and its contribution to intervention effectiveness. Methods We undertook a narrative analysis of in-depth, unstructured field diaries kept by nine community development practitioners for two years. The practitioners were responsible for implementing a multi-component, preventive, community-level intervention for mothers of new babies in eight communities, as part of a cluster randomised community intervention trial. We constructed a narrative typology of approaches to practice, drawing on the phenomenology of Alfred Schutz and Max Weber's Ideal Type theory. Results Five types of practice emerged, from a highly 'technology-based' type that was faithful to intervention specifications, through to a 'romantic' type that held relationships to be central to daily operations, with intact relationships being the final arbiter of intervention success. The five types also differed in terms of how others involved in the intervention were characterized, the narrative form (e.g., tragedy, satire) and where and how transformative change in communities was best created. This meant that different types traded-off or managed the priorities of the intervention differently, according to the deeply held values of their type. Conclusions The data set constructed for this analysis is unique. It revealed that practitioners not only exercise their agency within interventions, they do so systematically, that is, according to a pattern. The typology is the first of its kind and, if verified through replication, may have value for anticipating intervention dynamics and explaining implementation variation in community interventions. PMID:20003399

Intervention-related increases in preoperative physical activity are maintained 6-months after Bariatric surgery: results from the bari-active trial.

PubMed

Bond, D S; Thomas, J G; Vithiananthan, S; Unick, J; Webster, J; Roye, G D; Ryder, B A; Sax, H C

2017-03-01

Higher preoperative physical activity (PA) strongly predicts higher post-operative PA in bariatric surgery (BS) patients, providing rationale for preoperative PA interventions (PAIs). However, whether PAI-related increases can be maintained post-operatively has not been examined. This study compared PA changes across pre- (baseline, post-intervention) and post-operative (6-month follow up) periods in participants randomized to 6 weeks of preoperative PAI or standard care control (SC). Of 75 participants initially randomized, 36 (PAI n=22; SC n=14) underwent BS. Changes in daily bout-related (⩾10-min bouts) moderate-to-vigorous PA (MVPA) and steps were assessed via the SenseWear Armband monitor. PAI received weekly counseling to increase walking exercise. Retention (86%) at post-operative follow up was similar between groups. Intent-to-treat analyses showed that PAI vs SC had greater increases across time (baseline, post-intervention, follow up) in bout-related MVPA minutes/day (4.3±5.1, 26.3±21.3, 28.7±26.3 vs 10.4±22.9, 11.4±16.0, 18.5±28.2; P=0.013) and steps/day (5163±2901, 7950±3286, 7870±3936 vs 5163±2901, 5601±3368, 5087±2603; P<0.001). PAI differed from SC on bout-related MVPA at post-intervention (P=0.016; d=0.91), but not follow up (P=0.15; d=0.41), and steps at post-intervention (P=0.031; d=0.78) and follow up (P=0.024; d=0.84). PAI participants maintained preoperative PA increases post-operatively. Findings support preoperative PAIs and research to test whether PA changes can be sustained and influence surgical outcomes beyond the initial post-operative period.

High-frequency transcutaneous electrical nerve stimulation attenuates postsurgical pain and inhibits excess substance P in rat dorsal root ganglion.

PubMed

Chen, Yu-Wen; Tzeng, Jann-Inn; Lin, Min-Fei; Hung, Ching-Hsia; Hsieh, Pei-Ling; Wang, Jhi-Joung

2014-01-01

Transcutaneous electrical nerve stimulation (TENS) is a common therapeutic modality for pain management, but its effectiveness in skin/muscle incision and retraction (SMIR)-evoked pain is unknown. We aimed to examine the effects of TENS on postoperative pain and the levels of substance P (SP), N-methyl-D-aspartate receptor 1 (NR1), and interleukin 1β (IL-1β) in rat dorsal root ganglion (DRG). High-frequency (100 Hz) TENS was administered daily beginning on postoperative day 1 (POD1) and continued until animal subjects were killed for tissues. Mechanical sensitivity to von Frey stimuli (6g and 15g) and the levels of NR1, SP, and IL-1β in DRG were assessed in the sham-operated, SMIR-operated, TENS after SMIR surgery, and placebo-TENS after SMIR surgery groups. Skin/muscle incision and retraction rats exhibited a significant hypersensitivity to von Frey stimuli on POD3. In contrast with SMIR rats, SMIR-operated rats receiving TENS therapy demonstrated a rapid recovery of mechanical hypersensitivity. The SMIR-operated rats showed an up-regulation of NR1, SP, and IL-1β in DRG on PODs 14 and 28, whereas the SMIR-operated rats after TENS administration reversed this up-regulation. By contrast, the placebo-TENS after SMIR operation did not alter postsurgical pain nor the levels of NR1, SP, and IL-1β. Our data demonstrated that TENS intervention reduced persistent postoperative pain caused by SMIR operation. Up-regulation of NR1, SP, and IL-1β in DRG, activated after SMIR surgery, is important in the development of prolonged postincisional pain. The TENS pain relief may be related to the suppression of NR1, SP, and IL-1β in DRG of SMIR rats.

A correlation study of eye lens dose and personal dose equivalent for interventional cardiologists.

PubMed

Farah, J; Struelens, L; Dabin, J; Koukorava, C; Donadille, L; Jacob, S; Schnelzer, M; Auvinen, A; Vanhavere, F; Clairand, I

2013-12-01

This paper presents the dosimetry part of the European ELDO project, funded by the DoReMi Network of Excellence, in which a method was developed to estimate cumulative eye lens doses for past practices based on personal dose equivalent values, H(p)(10), measured above the lead apron at several positions at the collar, chest and waist levels. Measurement campaigns on anthropomorphic phantoms were carried out in typical interventional settings considering different tube projections and configurations, beam energies and filtration, operator positions and access routes and using both mono-tube and biplane X-ray systems. Measurements showed that eye lens dose correlates best with H(p)(10) measured on the left side of the phantom at the level of the collar, although this correlation implicates high spreads (41 %). Nonetheless, for retrospective dose assessment, H(p)(10) records are often the only option for eye dose estimates and the typically used chest left whole-body dose measurement remains useful.

Proposed use of two-part interactive modeling as a means to increase functional skills in children with a variety of disabilities.

PubMed

Pepperberg, I M; Sherman, D

2000-01-01

Many behavior modification and intervention programs are based on operant procedures developed for animal subjects, but few use modeling procedures in which one student observes interactions between two proficient trainers. We show how such procedures, which successfully trained Grey parrots (Psittacus erithacus) to produce and comprehend elements of human language, can be adapted for use with children with three types of disabilities: (a) autism with limited social and language skills, (b) developmental delay with physical handicaps and lack of language skills, and (c) hyperactivity with impaired cognitive and social skills. Children were evaluated before entering the program and outcomes were recorded to determine improvement levels. No child reached totally normative (physical age-appropriate) levels, but all significantly improved their social and communication skills and use of contextually appropriate behavior. A two-trainer modeling system can be a valuable intervention tool for children whose disabilities involve social and communicative skills.

Changes in safety climate and teamwork in the operating room after implementation of a revised WHO checklist: a prospective interventional study.

PubMed

Erestam, Sofia; Haglind, Eva; Bock, David; Andersson, Annette Erichsen; Angenete, Eva

2017-01-01

Inter-professional teamwork in the operating room is important for patient safety. The World Health Organization (WHO) checklist was introduced to improve intraoperative teamwork. The aim of this study was to evaluate the safety climate in a Swedish operating room setting before and after an intervention, using a revised version of the WHO checklist to improve teamwork. This study is a single center prospective interventional study. Participants were personnel working in operating room teams including surgeons, anesthesiologists, scrub nurses, nurse anaesthetists and nurse assistants. The study started with pre-interventional observations of the WHO checklist use followed by education on safety climate, the WHO checklist, and non-technical skills in the operating room. Thereafter a revised version of the WHO checklist was introduced. Post-interventional observations regarding the performance of the WHO checklist were carried out. The Safety Attitude Questionnaire was used to assess safety climate at baseline and post-intervention. At baseline we discovered a need for improved teamwork and communication. The participants considered teamwork to be important for patient safety, but had different perceptions of good teamwork between professions. The intervention, a revised version of the WHO checklist, did not affect teamwork climate. Adherence to the revision of the checklist was insufficient, dominated by a lack of structure. There was no significant change in teamwork climate by use of the revised WHO checklist, which may be due to insufficient implementation, as a lack of adherence to the WHO checklist was detected. We found deficiencies in teamwork and communication. Further studies exploring how to improve safety climate are needed. NCT02329691.

Applying the Intervention Mapping protocol to develop a kindergarten-based, family-involved intervention to increase European preschool children's physical activity levels: the ToyBox-study.

PubMed

De Craemer, M; De Decker, E; De Bourdeaudhuij, I; Verloigne, M; Duvinage, K; Koletzko, B; Ibrügger, S; Kreichauf, S; Grammatikaki, E; Moreno, L; Iotova, V; Socha, P; Szott, K; Manios, Y; Cardon, G

2014-08-01

Although sufficient physical activity is beneficial for preschoolers' health, activity levels in most preschoolers are low. As preschoolers spend a considerable amount of time at home and at kindergarten, interventions should target both environments to increase their activity levels. The aim of the current paper was to describe the six different steps of the Intervention Mapping protocol towards the systematic development and implementation of the physical activity component of the ToyBox-intervention. This intervention is a kindergarten-based, family-involved intervention implemented across six European countries. Based on the results of literature reviews and focus groups with parents/caregivers and kindergarten teachers, matrices of change objectives were created. Then, theory-based methods and practical strategies were selected to develop intervention materials at three different levels: (i) individual level (preschoolers); (ii) interpersonal level (parents/caregivers) and (iii) organizational level (teachers). This resulted in a standardized intervention with room for local and cultural adaptations in each participating country. Although the Intervention Mapping protocol is a time-consuming process, using this systematic approach may lead to an increase in intervention effectiveness. The presented matrices of change objectives are useful for future programme planners to develop and implement an intervention based on the Intervention Mapping protocol to increase physical activity levels in preschoolers. © 2014 World Obesity.

Current Status of Adult Spinal Deformity

PubMed Central

Youssef, J. A.; Orndorff, D. O.; Patty, C. A.; Scott, M. A.; Price, H. L.; Hamlin, L. F.; Williams, T. L.; Uribe, J. S.; Deviren, V.

2012-01-01

Purpose To review the current literature for the nonoperative and operative treatment for adult spinal deformity. Recent Findings With more than 11 million baby boomers joining the population of over 60 years of age in the United States, the incidence of lumbar deformity is greatly increasing. Recent literature suggests that a lack of evidence exists to support the effectiveness of nonoperative treatment for adult scoliosis. In regards to operative treatment, current literature reports a varying range of improved clinical outcomes, curve correction, and complication rates. The extension of fusion to S1 compared with L5 and lower thoracic levels compared with L1 remains a highly controversial topic among literature. Summary Most adult deformity patients never seek nonoperative or operative treatment. Of the few that seek treatment, many can benefit from nonoperative treatment. However, in selected patients who have failed nonoperative treatment and who are candidates for surgical intervention, the literature reflects positive outcomes related to surgical intervention as compared with nonoperative treatment despite varying associated ranges in morbidity and mortality rates. If nonoperative therapy fails in addressing a patient's complaints, then an appropriate surgical procedure that relieves neural compression, corrects excessive sagittal or coronal imbalance, and results in a solidly fused, pain-free spine is warranted. PMID:24436852

Peri-operative interventions producing better functional outcomes and enhanced recovery following total hip and knee arthroplasty: an evidence-based review

PubMed Central

2013-01-01

The increasing numbers of patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA), combined with the rapidly growing repertoire of surgical techniques and interventions available have put considerable pressure on surgeons and other healthcare professionals to produce excellent results with early functional recovery and short hospital stays. The current economic climate and the restricted healthcare budgets further necessitate brief hospitalization while minimizing costs. Clinical pathways and protocols introduced to achieve these goals include a variety of peri-operative interventions to fulfill patient expectations and achieve the desired outcomes. In this review, we present an evidence-based summary of common interventions available to achieve enhanced recovery, reduce hospital stay, and improve functional outcomes following THA and TKA. It covers pre-operative patient education and nutrition, pre-emptive analgesia, neuromuscular electrical stimulation, pulsed electromagnetic fields, peri-operative rehabilitation, modern wound dressings, standard surgical techniques, minimally invasive surgery, and fast-track arthroplasty units. PMID:23406499

Pain and Function Recovery Trajectories following Revision Hip Arthroplasty: Short-Term Changes and Comparison with Primary Hip Arthroplasty in the ADAPT Cohort Study.

PubMed

Lenguerrand, Erik; Whitehouse, Michael R; Wylde, Vikki; Gooberman-Hill, Rachael; Blom, Ashley W

2016-01-01

Patients report similar or better pain and function before revision hip arthroplasty than before primary arthroplasty but worse results are reported after revision surgery than after primary surgery. The trajectory of post-operative recovery during the first months and any differences by type of surgery have received little attention. We explored the trajectories of change in pain and function after revision hip arthroplasty to 12-months post-operatively and compare them with those observed after primary hip arthroplasty. This study is a prospective cohort study of patients undergoing primary (n = 80 with 92% for an indication of osteoarthritis) and revision (n = 43) hip arthroplasties. WOMAC pain and function scores and walking speed were collected pre-operatively, at 3 and 12-months post-operatively. Multilevel regression models were used to chart and compare the trajectories of change (0-3 months and 3-12 months) between types of surgery. The improvements in pain and function following revision arthroplasty occurred within the first 3-months with no evidence of further change beyond this initial period. While the pattern of recovery was similar to the one observed after primary arthroplasty, improvements in the first 3-months were smaller after revision compared to primary arthroplasty. Patients listed for revision surgery reported lower pre-operative pain levels but similar post-operative levels compared to those undergoing primary surgery. At 12-months post-operation patients who underwent a revision arthroplasty had not reached the same level of function achieved by those who underwent primary arthroplasty. The post-operative improvements in pain and function are larger following primary hip arthroplasty than following revision hip arthroplasty. Irrespectively of surgery type, most of the improvements occur in the first three post-operative months. More research is required to identify whether the recovery following revision surgery could be improved with specific post-operative interventions.

The Effect of a State Department of Education Teacher Mentor Initiative on Science Achievement

NASA Astrophysics Data System (ADS)

Pruitt, Stephen L.

This study analyzed a state department of education's ability to have actual influence over the improvement of science achievement and proficiency by having direct relationships with science teachers in Georgia's lowest performing schools. The study employed a mixed ANOVA analysis of the mean scale scores and proficiency rates of the science portion of the Georgia High School Graduation Test (GHSGT) for the years 2004 through 2007 to determine if the intervention by the Science Mentor Program (SMP) had significant effect on the science achievement and proficiency within the cohort of schools, as compared to a set of schools receiving no intervention, on various subgroups within the schools, and on various levels of intervention within the SMP. All data used in this study are available to the public through the Georgia Department of Education (GaDOE). SMP schools were selected based on their level of intervention for three consecutive years. Non-SMP schools were selected based on demographic similarities in economically disadvantaged, white, African-American, and students with disabilities to ensure a match of pairings for analyses. The results of this study showed significant improvement of scale scores and proficiency rates between 2004 and 2007. The study showed significant increases in all schools regardless of treatment. The study also showed significant differences in performance within the subgroups. Males, white, non-Economically Disadvantaged, and regular education students were all found to have significantly better performance in both achievement and proficiency rate. Economically Disadvantaged students were found to have a significant difference with regard to treatment groups. There was a significant difference between the mean scale score and proficiency rates of Economically Disadvantaged students in schools receiving high-intervention and schools receiving no-intervention. Further analysis showed that the only significant difference was in 2004, the year prior to implementation. Results indicate while the high-intervention schools did perform lower over all four years, they were not significantly different during the time of treatment indicating high-intervention schools performed at levels equivalent to schools receiving no-intervention. This study provided evidence of the success of a specific intervention by a state education agency to improve science education for the practicing teacher and its role in improving student science achievement. It will be used by policymakers to determine future activities and potential funding of other such programs. This also has a potential for national use as it is the only program of this nature operated by a department of education in the country.

Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy.

PubMed

Shediac-Rizkallah, M C; Bone, L R

1998-03-01

Attention to the sustainability of health intervention programs both in the US and abroad is increasing, but little consensus exists on the conceptual and operational definitions of sustainability. Moreover, an empirical knowledge base about the determinants of sustainability is still at an early stage. Planning for sustainability requires, first, a clear understanding of the concept of sustainability and operational indicators that may be used in monitoring sustainability over time. Important categories of indicators include: (1) maintenance of health benefits achieved through an initial program, (2) level of institutionalization of a program within an organization and (3) measures of capacity building in the recipient community. Second, planning for sustainability requires the use of programmatic approaches and strategies that favor long-term program maintenance. We suggest that the potential influences on sustainability may derive from three major groups of factors: (1) project design and implementation factors, (2) factors within the organizational setting, and (3) factors in the broader community environment. Future efforts to develop sustainable health intervention programs in communities can build on the concepts and strategies proposed here.

Instructor feedback versus no instructor feedback on performance in a laparoscopic virtual reality simulator: a randomized educational trial.

PubMed

Oestergaard, Jeanett; Bjerrum, Flemming; Maagaard, Mathilde; Winkel, Per; Larsen, Christian Rifbjerg; Ringsted, Charlotte; Gluud, Christian; Grantcharov, Teodor; Ottesen, Bent; Soerensen, Jette Led

2012-02-28

Several studies have found a positive effect on the learning curve as well as the improvement of basic psychomotor skills in the operating room after virtual reality training. Despite this, the majority of surgical and gynecological departments encounter hurdles when implementing this form of training. This is mainly due to lack of knowledge concerning the time and human resources needed to train novice surgeons to an adequate level. The purpose of this trial is to investigate the impact of instructor feedback regarding time, repetitions and self-perception when training complex operational tasks on a virtual reality simulator. The study population consists of medical students on their 4th to 6th year without prior laparoscopic experience. The study is conducted in a skills laboratory at a centralized university hospital. Based on a sample size estimation 98 participants will be randomized to an intervention group or a control group. Both groups have to achieve a predefined proficiency level when conducting a laparoscopic salpingectomy using a surgical virtual reality simulator. The intervention group receives standardized instructor feedback of 10 to 12 min a maximum of three times. The control group receives no instructor feedback. Both groups receive the automated feedback generated by the virtual reality simulator. The study follows the CONSORT Statement for randomized trials. Main outcome measures are time and repetitions to reach the predefined proficiency level on the simulator. We include focus on potential sex differences, computer gaming experience and self-perception. The findings will contribute to a better understanding of optimal training methods in surgical education. NCT01497782.

Education and Raising Awareness of Seismic Risk in the Black Sea Basin

NASA Astrophysics Data System (ADS)

Florin Balan, Stefan; Alcaz, Vasile; Trifonova, Petya; Uker, Nalan; Tataru, Dragos

2014-05-01

The Project "Black Sea Earthquake Safety Net(work)" ESNET has the intention to educate and raise awareness of seismic risk in the Black Sea Basin in four countries: Moldova, Romania, Bulgaria and Turkey. The project is financed through "The Black Sea Basin Joint Operational Programme", an EU operational programmes under European Neighborhood & Partnership Instrument (ENPI). The programme is financed by ENPI. The participation of Turkey is financed by Instrument for Pre-accession Assistance. It is implemented during the period 2007 - 2013. The project wants to contribute to the prevention of natural disasters generated by earthquakes in Black Sea Basin by developing a joint monitoring and intervention concept. All the countries involved in the project have their own studies, strategies, prevention and intervention systems in case of earthquakes, but until now there has not been an integrated approach so far in the Black Sea Basin. Given the cross-border character of seismic activity, it is necessary to have a cross-border approach on prevention, monitoring and intervention in case of earthquakes. Main objectives : 1. The assessment of the disaster potential, with accent on the seismic risk degree and the earthquakes effects in the intervention area. For achieving the main objective is to have an accurate and up-to-date assessment of the potential of disasters provoked by earthquakes in the project area/regions. This assessment will be carried out at national level and will be used in designing the common concept/approach for dealing with earthquakes at regional level, thus ensuring the cross-border character of the objective. 2.To develop an integrated seismic monitoring and intervention concept. This integrated concept, built on the basis of the previous objective, will have a cross-border relevance and is at the core of the action. The monitoring and intervention in case of earthquakes will be coordinated among the participating countries based on this, thus a more effective and efficient approach being ensured. 3. To increase the capacity of local institutions emergency intervention units for joint response activities in case of disasters. By involving the local emergency units and public administration in the project activities, especially in trainings, conferences and consultations, a better cooperation at cross-border level will be achieved. Step by step, the respective bodies will increase the cooperation and will benefit from each others expertise. Target groups : Research institutions and universities; Emergency intervention units; Local public authorities; NGOs. Final beneficiaries of the project: the population in the regions of the project. The project has a high educational perspective through its: a)training activities and b)training tools applied in the process. A) the training of 20 people from the emergency units from each country (80 in total) by experts in risk management. B) The Seismic Safety Web Portal of the project presenting all activities, maps and materials posted by members of the network agreement and not only. Also for changing expertise, opinions and long distance conferences is available a special software communication tool. An educational book is printed in 3 languages to be distributed in partner countries with main results.

Effects of HUD-supported lead hazard control interventions in housing on children's blood lead.

PubMed

Clark, Scott; Galke, Warren; Succop, Paul; Grote, Joann; McLaine, Pat; Wilson, Jonathan; Dixon, Sherry; Menrath, William; Roda, Sandy; Chen, Mei; Bornschein, Robert; Jacobs, David

2011-02-01

The Evaluation of the US Department of Housing and Urban Development Lead-Based Paint Hazard Control Grant Program studied the effectiveness of the housing intervention performed in reducing the blood lead of children at four post-intervention times (6-months, 1-year, 2-years, and 3-years). A repeat measures analysis showed that blood lead levels declined up to three-years post-intervention. The results at each successive collection time were significantly lower than at the previous post-intervention time except for the difference between the levels at two and three years. At two-years post-intervention, geometric mean blood lead levels were approximately 37% lower than at pre-intervention. Children with pre-intervention blood lead levels as low as 10 μg/dL experienced substantial declines in blood lead levels. Previous studies have found substantial improvements only if a child's pre-intervention blood lead level was above 20 μg/dL. Individual interior lead hazard control treatments as grouped by Interior Strategy were not a significant predictor of post-intervention blood lead levels. However, children living in dwellings where exterior lead hazard control interventions were done had lower blood lead levels at one-year post-intervention than those living in dwellings without the exterior interventions (all other factors being equal), but those differences were only significant when the mean exterior paint lead loading at pre-intervention was about the 90th percentile (7.0mg/cm(2)). This observation suggests that exterior lead hazard control can be an important component of a lead hazard control plan. Children who were six to eleven months of age at pre-intervention had a significant increase in blood lead at one-year post-intervention, probably due to other exposures. Copyright © 2010 Elsevier Inc. All rights reserved.

[Health surveillance: foundations, interfaces and tendencies].

PubMed

Arreaza, Antonio Luis Vicente; de Moraes, José Cássio

2010-07-01

The present article rescues initially the forms, content and operational projection of the epidemiological surveillance as indispensable tool for the knowledge field and public health practices. After that, we verify that the health surveillance model establishes an enlargement of this operational concept of surveillance by integrating the collectives and individuals practices in different health necessities dimensions, which includes beyond of the risks and damages control also the eco-socials determinants. In the sequence, we search to dimension the distinct levels of actuation of this sanitary practice articulated to the interventions of promotion, protection and recovery under a located and integrated logic of the unique system of Brazilian health. Finally, we argue that all the conceptual-operational model framework of public health surveillance itself constitutes as a politics and sanitary base for the consolidation of the health promotion paradigm in the collective health field.

Public Health Emergency Operations Center - A critical component of mass gatherings management infrastructure.

PubMed

Elachola, Habidah; Al-Tawfiq, Jaffar A; Turkestani, Abdulhafiz; Memish, Ziad A

2016-08-31

Mass gatherings (MG) are characterized by the influx of large numbers of people with the need to have infrastructural changes to support these gatherings. Thus, Public Health Emergency Operations Center (PHEOC) is critical management infrastructure for both the delivery of public health functions and for mounting adequate response during emergencies. The recognition of the importance of PHEOC at the leadership and political level is foundational for the success of any public health intervention during MG. The ability of the PHEOC to effectively function depends on appropriate design and infrastructure, staffing and command structure, and plans and procedures developed prior to the event. Multi-ministerial or jurisdictional coordination will be required and PHEOC should be positioned with such authorities. This paper outlines the essential concepts, elements, design, and operational aspects of PHEOC during MG.

Multilevel Interventions: Study Design and Analysis Issues

PubMed Central

Gross, Cary P.; Zaslavsky, Alan M.; Taplin, Stephen H.

2012-01-01

Multilevel interventions, implemented at the individual, physician, clinic, health-care organization, and/or community level, increasingly are proposed and used in the belief that they will lead to more substantial and sustained changes in behaviors related to cancer prevention, detection, and treatment than would single-level interventions. It is important to understand how intervention components are related to patient outcomes and identify barriers to implementation. Designs that permit such assessments are uncommon, however. Thus, an important way of expanding our knowledge about multilevel interventions would be to assess the impact of interventions at different levels on patients as well as the independent and synergistic effects of influences from different levels. It also would be useful to assess the impact of interventions on outcomes at different levels. Multilevel interventions are much more expensive and complicated to implement and evaluate than are single-level interventions. Given how little evidence there is about the value of multilevel interventions, however, it is incumbent upon those arguing for this approach to do multilevel research that explicates the contributions that interventions at different levels make to the desired outcomes. Only then will we know whether multilevel interventions are better than more focused interventions and gain greater insights into the kinds of interventions that can be implemented effectively and efficiently to improve health and health care for individuals with cancer. This chapter reviews designs for assessing multilevel interventions and analytic ways of controlling for potentially confounding variables that can account for the complex structure of multilevel data. PMID:22623596

Operation Occupation: A College and Career Readiness Intervention for Elementary Students

ERIC Educational Resources Information Center

Mariani, Melissa; Berger, Carolyn; Koerner, Kathleen; Sandlin, Cassie

2017-01-01

This article describes efforts undertaken to design, deliver, and evaluate a college and career readiness (CCR) unit for fifth-grade students. Preliminary findings from the school counselor-developed and -delivered intervention, Operation Occupation, supported interdisciplinary efforts between counselors and classroom teachers. Pre- and…

Evaluating Non-Randomized Educational Interventions: A Graphical Discussion

ERIC Educational Resources Information Center

Theobald, Roddy; Richardson, Thomas

2014-01-01

A central goal of the education literature is to demonstrate that specific educational interventions--instructional interventions at the student or classroom level, structural interventions at the school level, or funding interventions at the school district level, for example--have a "treatment effect" on student achievement. This paper…

Application of Robotics in Decommissioning and Decontamination - 12536

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

Banford, Anthony; Kuo, Jeffrey A.; Bowen, R.A.

Decommissioning and dismantling of nuclear facilities is a significant challenge worldwide and one which is growing in size as more plants reach the end of their operational lives. The strategy chosen for individual projects varies from the hands-on approach with significant manual intervention using traditional demolition equipment at one extreme to bespoke highly engineered robotic solutions at the other. The degree of manual intervention is limited by the hazards and risks involved, and in some plants are unacceptable. Robotic remote engineering is often viewed as more expensive and less reliable than manual approaches, with significant lead times and capital expenditure.more » However, advances in robotics and automation in other industries offer potential benefits for future decommissioning activities, with the high probability of reducing worker exposure and other safety risks as well as reducing the schedule and costs required to complete these activities. Some nuclear decommissioning tasks and facility environments are so hazardous that they can only be accomplished by exclusive use of robotic and remote intervention. Less hazardous tasks can be accomplished by manual intervention and the use of PPE. However, PPE greatly decreases worker productivity and still exposes the worker to both risk and dose making remote operation preferable to achieve ALARP. Before remote operations can be widely accepted and deployed, there are some economic and technological challenges that must be addressed. These challenges will require long term investment commitments in order for technology to be: - Specifically developed for nuclear applications; - At a sufficient TRL for practical deployment; - Readily available as a COTS. Tremendous opportunities exist to reduce cost and schedule and improve safety in D and D activities through the use of robotic and/or tele-operated systems. - Increasing the level of remote intervention reduces the risk and dose to an operator. Better environmental information identifies hazards, which can be assessed, managed and mitigated. - Tele-autonomous control in a congested unstructured environment is more reliable compared to a human operator. Advances in Human Machine Interfaces contribute to reliability and task optimization. Use of standardized dexterous manipulators and COTS, including standardized communication protocols reduces project time scales. - The technologies identified, if developed to a sufficient TRL would all contribute to cost reductions. Additionally, optimizing a project's position on a Remote Intervention Scale, a Bespoke Equipment Scale and a Tele-autonomy Scale would provide cost reductions from the start of a project. Of the technologies identified, tele-autonomy is arguably the most significant, because this would provide a fundamental positive change for robotic control in the nuclear industry. The challenge for technology developers is to develop versatile robotic technology that can be economically deployed to a wide range of future D and D projects and industrial sectors. The challenge for facility owners and project managers is to partner with the developers to provide accurate systems requirements and an open and receptive environment for testing and deployment. To facilitate this development and deployment effort, the NNL and DOE have initiated discussions to explore a collaborative R and D program that would accelerate development and support the optimum utilization of resources. (authors)« less

Evaluation of the feasibility and acceptability of the ‘Care for Stroke’ intervention in India, a smartphone-enabled, carer-supported, educational intervention for management of disability following stroke

PubMed Central

Sureshkumar, K; Murthy, GVS; Natarajan, S; Naveen, C; Goenka, S; Kuper, H

2016-01-01

Objectives (1) To identify operational issues encountered by study participants in using the ‘Care for Stroke’ intervention; (2) to evaluate the feasibility and acceptability of the intervention. Design Mixed-methods research design. Setting Participant's home. Participants were selected from a tertiary hospital in Chennai, South India. Participants Sixty stroke survivors treated and discharged from the hospital, and their caregivers. Intervention ‘Care for Stroke’ is a smartphone-enabled, educational intervention for management of physical disabilities following stroke. It is delivered through a web-based, smartphone-enabled application. It includes inputs from stroke rehabilitation experts in a digitised format. Methods Evaluation of the intervention was completed in two phases. In the first phase, the preliminary intervention was field-tested with 30 stroke survivors for 2 weeks. In the second phase, the finalised intervention was provided to a further 30 stroke survivors to be used in their homes with support from their carers for 4 weeks. Primary and secondary outcome measures Primary outcomes: (1) operational difficulties in using the intervention; (2) feasibility and acceptability of the intervention in an Indian setting. Disability and dependency were assessed as secondary outcomes. Results Field-testing identified operational difficulties related to connectivity, video-streaming, picture clarity, quality of videos, and functionality of the application. The intervention was reviewed, revised and finalised before pilot-testing. Findings from the pilot-testing showed that the ‘Care for Stroke’ intervention was feasible and acceptable. Over 90% (n=27) of the study participants felt that the intervention was relevant, comprehensible and useful. Over 96% (n=29) of the stroke survivors and all the caregivers (100%, n=30) rated the intervention as excellent and very useful. These findings were supported by qualitative interviews. Conclusions Evaluation indicated that the ‘Care for Stroke’ intervention was feasible and acceptable in an Indian context. An assessment of effectiveness is now warranted. PMID:26839011

Caregiver Coaching Strategies for Early Intervention Providers: Moving toward Operational Definitions

ERIC Educational Resources Information Center

Friedman, Mollie; Woods, Juliann; Salisbury, Christine

2012-01-01

Early intervention (EI) providers increasingly coach and collaborate with caregivers to strengthen and support caregiver-child interactions. The EI providers learning to coach other adults benefit from knowing what, exactly, they should do to support caregivers. This article serves two purposes. First, it proposes an operationally defined,…

Day case laparoscopic nephrectomy with vaginal extraction: initial experience.

PubMed

Baldini, Arnaud; Golfier, François; Mouloud, Khaled; Bruge Ansel, Marie-Hélène; Navarro, Rémi; Ruffion, Alain; Paparel, Philippe

2014-12-01

To assess the feasibility of laparoscopic nephrectomy with vaginal extraction in an ambulatory setting. Two patients underwent a laparoscopic (1 was robot assisted) nephrectomy with vaginal extraction for a nonfunctioning kidney in an ambulatory setting. Both interventions were performed by the same surgical team comprising a urologic surgeon and a gynecologic surgeon. The operative specimen was vaginally extracted via an incision in the posterior fornix at the end of the intervention. Patients had to respect very strict socioenvironmental and clinical criteria. Anesthesia was achieved using short-acting agents. Only first- and second-step analgesics were used (morphine-free protocol). The main judgment criteria were visual analog scale assessment for postoperative pain, the Clavien-Dindo classification for surgical complications, and the hospital readmission rate. Two female patients (37 and 41 years old) have been successfully operated with this technique. No major perioperative or postoperative complications (Clavien-Dindo grade >2) were reported, and no patient readmission was required. Postoperative pain was well managed with visual analog scale scores ≤ 5. Both patients operated in the ambulatory setting had Chung scores of 10 before their discharge. Laparoscopic or robotic nephrectomy with vaginal extraction can be performed in an ambulatory setting in carefully selected patients. The association of fast-track surgical techniques and vaginal extraction by eliminating the abdominal wound extraction source of postoperative pain allows performing this operation in this setting with a high level of satisfaction. Copyright © 2014 Elsevier Inc. All rights reserved.

Field quantification of physical exposures of police officers in vehicle operation.

PubMed

McKinnon, Colin D; Callaghan, Jack P; Dickerson, Clark R

2011-01-01

Mobile police officers perform many of their daily duties in their vehicles. Combined workspace inflexibility and prolonged driving create potential musculoskeletal injury risks. Limited research exists that quantitatively describes postural and load exposures associated with mobile police work. The purpose of this study was to characterize officer activity during a typical workday and identify opportunities for ergonomic intervention. Digital video of traffic officers (N = 10) was used to classify postures according to work activity. Cumulative time in 10 activities was calculated, and a time-history of driver activity documented. Most (55.5 ± 13.4%) time was out of the vehicle, and 22.3 ± 10.5% was spent in single-arm driving. On paper documentation and mobile data terminal use were identified as in-car activities that may benefit from targeted interventions. The primary contribution of this study is characterization of daily mobile police activity and the identification of possible intervention strategies to mitigate physical exposure levels.

Communication Policies in Knowledge Networks

NASA Astrophysics Data System (ADS)

Ioannidis, Evangelos; Varsakelis, Nikos; Antoniou, Ioannis

2018-02-01

Faster knowledge attainment within organizations leads to improved innovation, and therefore competitive advantage. Interventions on the organizational network may be risky or costly or time-demanding. We investigate several communication policies in knowledge networks, which reduce the knowledge attainment time without interventions. We examine the resulting knowledge dynamics for real organizational networks, as well as for artificial networks. More specifically, we investigate the dependence of knowledge dynamics on: (1) the Selection Rule of agents for knowledge acquisition, and (2) the Order of implementation of "Selection" and "Filtering". Significant decrease of the knowledge attainment time (up to -74%) can be achieved by: (1) selecting agents of both high knowledge level and high knowledge transfer efficiency, and (2) implementing "Selection" after "Filtering" in contrast to the converse, implicitly assumed, conventional prioritization. The Non-Commutativity of "Selection" and "Filtering", reveals a Non-Boolean Logic of the Network Operations. The results demonstrate that significant improvement of knowledge dynamics can be achieved by implementing "fruitful" communication policies, by raising the awareness of agents, without any intervention on the network structure.

Age-associated impact on presentation and outcome for penetrating thoracic trauma in the adult and pediatric patient populations.

PubMed

Mollberg, Nathan M; Tabachnick, Deborah; Lin, Fang-Ju; Merlotti, Gary J; Varghese, Thomas K; Arensman, Robert M; Massad, Malek G

2014-02-01

Studies reporting on penetrating thoracic trauma in the pediatric population have been limited by small numbers and implied differences with the adult population. Our objectives were to report on a large cohort of pediatric patients presenting with penetrating thoracic trauma and to determine age-related impacts on management and outcome through comparison with an adult cohort. A Level I trauma center registry was queried between 2006 and 2012. All patients presenting with penetrating thoracic trauma were identified. Patient demographics, injury mechanism, injury severity, admission physiology, and outcome were recorded. Patients were compared, and outcomes were analyzed based on age at presentation, with patients 17 years or younger defining our pediatric cohort. A total of 1,423 patients with penetrating thoracic trauma were admitted during the study period. Two hundred twenty patients (15.5%) were pediatric, with 205 being adolescents (13-17 years) and 15 being children (≤ 12 years). In terms of management for the pediatric population, tube thoracostomy alone was needed in 32.7% (72 of 220), whereas operative thoracic exploration was performed in 20.0% (44 of 220). Overall mortality was 13.6% (30 of 220). There was no significant difference between the pediatric and adult population with regard to injury mechanism or severity, need for therapeutic intervention, operative approach, use of emergency department thoracotomy, or outcome. Stepwise logistic regression failed to identify age as a predictor for the need for either therapeutic intervention or mortality between the two age groups as a whole. However, subgroup analysis revealed that being 12 years or younger (odds ratio, 3.84; 95% confidence interval, 1.29-11.4) was an independent predictor of mortality. Management of traumatic penetrating thoracic injuries in terms of the need for therapeutic intervention and operative approach was similar between the adult and pediatric populations. Mortality from penetrating thoracic trauma can be predicted based on injury severity, the use of emergency department thoracotomy, and admission physiology for adolescents and adults. Children may be at increased risk for poor outcome independent of injury severity. Epidemiologic study, level III.

Retrospective review of injury severity, interventions and outcomes among helicopter and nonhelicopter transport patients at a Level 1 urban trauma centre

PubMed Central

Hannay, R. Scott; Wyrzykowski, Amy D.; Ball, Chad G.; Laupland, Kevin; Feliciano, David V.

2014-01-01

Background Air ambulance transport for injured patients is vitally important given increasing patient volumes, the limited number of trauma centres and inadequate subspecialty coverage in nontrauma hospitals. Air ambulance services have been shown to improve patient outcomes compared with ground transport in select circumstances. Our primary goal was to compare injuries, interventions and outcomes in patients transported by helicopter versus nonhelicopter transport. Methods We performed a retrospective 10-year review of 14 440 patients transported to an urban Level 1 trauma centre by helicopter or by other means. We compared injury severity, interventions and mortality between the groups. Results Patients transported by helicopter had higher median injury severity scores (ISS), regardless of penetrating or blunt injury, and were more likely to have Glasgow Coma Scale scores less than 8, require airway control, receive blood transfusions and require admission to the intensive care unit or operating room than patients transported by other means. Helicopter transport was associated with reduced overall mortality (odds ratio 0.41, 95% confidence interval 0.33–0.39). Patients transported by other methods were more likely to die in the emergency department. The mean ISS, regardless of transport method, rose from 12.3 to 15.1 (p = 0.011) during our study period. Conclusion Patients transported by helicopter to an urban trauma centre were more severely injured, required more interventions and had improved survival than those arriving by other means of transport. PMID:24461227

Retrospective review of injury severity, interventions and outcomes among helicopter and nonhelicopter transport patients at a Level 1 urban trauma centre.

PubMed

Hannay, R Scott; Wyrzykowski, Amy D; Ball, Chad G; Laupland, Kevin; Feliciano, David V

2014-02-01

Air ambulance transport for injured patients is vitally important given increasing patient volumes, the limited number of trauma centres and inadequate subspecialty coverage in nontrauma hospitals. Air ambulance services have been shown to improve patient outcomes compared with ground transport in select circumstances. Our primary goal was to compare injuries, interventions and outcomes in patients transported by helicopter versus nonhelicopter transport. We performed a retrospective 10-year review of 14 440 patients transported to an urban Level 1 trauma centre by helicopter or by other means. We compared injury severity, interventions and mortality between the groups. Patients transported by helicopter had higher median injury severity scores (ISS), regardless of penetrating or blunt injury, and were more likely to have Glasgow Coma Scale scores less than 8, require airway control, receive blood transfusions and require admission to the intensive care unit or operating room than patients transported by other means. Helicopter transport was associated with reduced overall mortality (odds ratio 0.41, 95% confidence interval 0.33-0.39). Patients transported by other methods were more likely to die in the emergency department. The mean ISS, regardless of transport method, rose from 12.3 to 15.1 (p = 0.011) during our study period. Patients transported by helicopter to an urban trauma centre were more severely injured, required more interventions and had improved survival than those arriving by other means of transport.

Combining Systems and Teamwork Approaches to Enhance the Effectiveness of Safety Improvement Interventions in Surgery: The Safer Delivery of Surgical Services (S3) Program.

PubMed

McCulloch, Peter; Morgan, Lauren; New, Steve; Catchpole, Ken; Roberston, Eleanor; Hadi, Mohammed; Pickering, Sharon; Collins, Gary; Griffin, Damian

2017-01-01

Patient safety improvement interventions usually address either work systems or team culture. We do not know which is more effective, or whether combining approaches is beneficial. To compare improvement in surgical team performance after interventions addressing teamwork culture, work systems, or both. Suite of 5 identical controlled before-after intervention studies, with preplanned analysis of pooled data for indirect comparisons of strategies. Operating theatres in 5 UK hospitals performing elective orthopedic, plastic, or vascular surgery PARTICIPANTS:: All operating theatres staff, including surgeons, nurses, anaesthetists, and others INTERVENTIONS:: 4-month safety improvement interventions, using teamwork training (TT), systems redesign and standardization (SOP), Lean quality improvement, SOP + TT combination, or Lean + TT combination. Team technical and nontechnical performance and World Health Organization (WHO) checklist compliance, measured for 3 months before and after intervention using validated scales. Pooled data analysis of before-after change in active and control groups, comparing combined versus single and systems versus teamwork interventions, using 2-way ANOVA. We studied 453 operations, (255 intervention, 198 control). TT improved nontechnical skills and WHO compliance (P < 0.001), but not technical performance; systems interventions (Lean & SOP, 2 & 3) improved nontechnical skills and technical performance (P < 0.001) but improved WHO compliance less. Combined interventions (4 & 5) improved all performance measures except WHO time-out attempts, whereas single approaches (1 & 2 & 3) improved WHO compliance less (P < 0.001) and failed to improve technical performance. Safety interventions combining teamwork training and systems rationalization are more effective than those adopting either approach alone. This has important implications for safety improvement strategies in hospitals.

Modifiable risk and protective factors for depressive symptoms in low-income African American mothers.

PubMed

Siefert, Kristine; Finlayson, Tracy L; Williams, David R; Delva, Jorge; Ismail, Amid I

2007-01-01

Low-income African American mothers of young children experience high rates of depression, but many of the risk factors that have been identified provide little direction for intervention. The authors examined modifiable risk and protective factors for probable depression (Center for Epidemiological Studies Depression Scale >or= 23) in 824 African American mothers living in the 39 poorest census tracts in Detroit. Household food insufficiency and deteriorated housing significantly increased the odds of likely depression, whereas availability of a loan in a crisis, help with childcare, and transportation were protective. However, more frequent experiences of everyday discrimination greatly increased the odds of elevated depressive symptoms. These findings support the need for interventions that operate across individual and societal levels to address the fundamental causes of poor mental health.

Engaging with community-based public and private mid-level providers for promoting the use of modern contraceptive methods in rural Pakistan: results from two innovative birth spacing interventions.

PubMed

Azmat, Syed Khurram; Hameed, Waqas; Hamza, Hasan Bin; Mustafa, Ghulam; Ishaque, Muhammad; Abbas, Ghazunfer; Khan, Omar Farooq; Asghar, Jamshaid; Munroe, Erik; Ali, Safdar; Hussain, Wajahat; Ali, Sajid; Ahmed, Aftab; Ali, Moazzam; Temmerman, Marleen

2016-03-17

Family planning (FP) interventions aimed at reducing population growth have negligible during the last two decades in Pakistan. Innovative FP interventions that help reduce the growing population burden are the need of the hour. Marie Stopes Society--Pakistan implemented an operational research project--'Evidence for Innovating to Save Lives', to explore effective and viable intervention models that can promote healthy timing and spacing of pregnancy in rural and under-served communities of Sindh, Punjab and Khyber Pakhtunkhwa provinces of Pakistan. We conducted a quasi-experimental (pre- and post-intervention with control arm) study to assess the effectiveness of each of the two intervention models, (1) Suraj model (meaning 'Sun' in English), which uses social franchises (SF) along with a demand-side financing (DSF) approach using free vouchers, and (2) Community Midwife (CMW) model, in promoting the use of modern contraceptive methods compared to respective controls. Baseline and endline cross-sectional household surveys were conducted, 24 months apart, by recruiting 5566 and 6316 married women of reproductive age (MWRA) respectively. We used Stata version 8 to report the net effect of interventions on outcome indicators using difference-in-differences analysis. Multivariate Cox proportional hazard regression analysis was used to assess the net effect of the intervention on current contraceptive use, keeping time constant and adjusting for other variables in the model. The Suraj model was effective in significantly increasing awareness about FP methods among MWRA by 14% percentage points, current contraceptive use by 5% percentage points and long term modern method--intrauterine device (IUD) use by 6% percentage points. The CMW model significantly increased contraceptive awareness by 28% percentage points, ever use of contraceptives by 7% percentage points and, IUD use by 3% percentage points. Additionally the Suraj intervention led to a 35% greater prevalence (prevalence ratio: 1.35, 95% CI: 1.22-1.50) of contraceptive use among MWRA. Suraj intervention highlights the importance of embedding subsidized FP services within the communities of the beneficiaries. The outcomes of the CMW intervention also improved the use of long-term contraceptives. These findings indicate the necessity of designing and implementing FP initiatives involving local mid-level providers to expand contraceptive coverage in under-served areas.

'I don't need an eye for an eye': Women's responses to intimate partner violence in Sierra Leone and Liberia.

PubMed

Horn, Rebecca; Puffer, Eve S; Roesch, Elisabeth; Lehmann, Heidi

2016-01-01

This paper explores the possibilities for agency in intimate partner violence (IPV) situations from the perspective of women in Sierra Leone and Liberia using focus group discussions (N groups = 14, N participants = 110) and individual interviews (N = 20). Findings identify multiple interrelated factors influencing the decision-making of women experiencing IPV. At the individual level, emotional factors and women's knowledge of their rights and options influence their decision-making. At the relational level, the role of neighbours, family and friends is crucial, both for emotional support and practical assistance. At the community level, more formal structures play a role, such as chiefs and women's groups, though their effectiveness varies. At the structural level are barriers to effective responses, including a poorly functioning criminal justice system and a social system in which children often stay with fathers following separation or divorce. Strong cultural beliefs operate to keep women in abusive relationships. We identify implications for prevention and response services and make practice recommendations. Since the desire of most women experiencing IPV was to live in peace with their husbands, interventions should respect women's priorities by focusing more on prevention and interventions to end the violence, rather than solely assisting women to leave violent relationships.

[Cost estimation of an epidemiological surveillance network for animal diseases in Central Africa: a case study of the Chad network].

PubMed

Ouagal, M; Berkvens, D; Hendrikx, P; Fecher-Bourgeois, F; Saegerman, C

2012-12-01

In sub-Saharan Africa, most epidemiological surveillance networks for animal diseases were temporarily funded by foreign aid. It should be possible for national public funds to ensure the sustainability of such decision support tools. Taking the epidemiological surveillance network for animal diseases in Chad (REPIMAT) as an example, this study aims to estimate the network's cost by identifying the various costs and expenditures for each level of intervention. The network cost was estimated on the basis of an analysis of the operational organisation of REPIMAT, additional data collected in surveys and interviews with network field workers and a market price listing for Chad. These costs were then compared with those of other epidemiological surveillance networks in West Africa. The study results indicate that REPIMAT costs account for 3% of the State budget allocated to the Ministry of Livestock. In Chad in general, as in other West African countries, fixed costs outweigh variable costs at every level of intervention. The cost of surveillance principally depends on what is needed for surveillance at the local level (monitoring stations) and at the intermediate level (official livestock sectors and regional livestock delegations) and on the cost of the necessary equipment. In African countries, the cost of surveillance per square kilometre depends on livestock density.

24 CFR 35.1130 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2012 CFR

2012-04-01

... intervention blood lead level. 35.1130 Section 35.1130 Housing and Urban Development Office of the Secretary... STRUCTURES Public Housing Programs § 35.1130 Child with an environmental intervention blood lead level. (a... been identified as having an environmental intervention blood lead level, the PHA shall complete a risk...

24 CFR 35.730 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2013 CFR

2013-04-01

... intervention blood lead level. 35.730 Section 35.730 Housing and Urban Development Office of the Secretary... STRUCTURES Project-Based Assistance § 35.730 Child with an environmental intervention blood lead level. (a... subpart applies has been identified as having an environmental intervention blood lead level, the owner...

24 CFR 35.730 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2012 CFR

2012-04-01

... intervention blood lead level. 35.730 Section 35.730 Housing and Urban Development Office of the Secretary... STRUCTURES Project-Based Assistance § 35.730 Child with an environmental intervention blood lead level. (a... subpart applies has been identified as having an environmental intervention blood lead level, the owner...

24 CFR 35.830 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2013 CFR

2013-04-01

... intervention blood lead level. 35.830 Section 35.830 Housing and Urban Development Office of the Secretary... intervention blood lead level. (a) Risk assessment. Within 15 days after being notified by a public health... an environmental intervention blood lead level, HUD shall complete a risk assessment of the dwelling...

24 CFR 35.730 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2011 CFR

2011-04-01

... intervention blood lead level. 35.730 Section 35.730 Housing and Urban Development Office of the Secretary... STRUCTURES Project-Based Assistance § 35.730 Child with an environmental intervention blood lead level. (a... subpart applies has been identified as having an environmental intervention blood lead level, the owner...

24 CFR 35.1225 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2010 CFR

2010-04-01

... intervention blood lead level. 35.1225 Section 35.1225 Housing and Urban Development Office of the Secretary... STRUCTURES Tenant-Based Rental Assistance § 35.1225 Child with an environmental intervention blood lead level... as having an environmental intervention blood lead level, the designated party shall complete a risk...

24 CFR 35.830 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2010 CFR

2010-04-01

... intervention blood lead level. 35.830 Section 35.830 Housing and Urban Development Office of the Secretary... intervention blood lead level. (a) Risk assessment. Within 15 days after being notified by a public health... an environmental intervention blood lead level, HUD shall complete a risk assessment of the dwelling...

24 CFR 35.1225 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2012 CFR

2012-04-01

... intervention blood lead level. 35.1225 Section 35.1225 Housing and Urban Development Office of the Secretary... STRUCTURES Tenant-Based Rental Assistance § 35.1225 Child with an environmental intervention blood lead level... as having an environmental intervention blood lead level, the designated party shall complete a risk...

24 CFR 35.1130 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2013 CFR

2013-04-01

... intervention blood lead level. 35.1130 Section 35.1130 Housing and Urban Development Office of the Secretary... STRUCTURES Public Housing Programs § 35.1130 Child with an environmental intervention blood lead level. (a... been identified as having an environmental intervention blood lead level, the PHA shall complete a risk...

24 CFR 35.830 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2011 CFR

2011-04-01

... intervention blood lead level. 35.830 Section 35.830 Housing and Urban Development Office of the Secretary... intervention blood lead level. (a) Risk assessment. Within 15 days after being notified by a public health... an environmental intervention blood lead level, HUD shall complete a risk assessment of the dwelling...

24 CFR 35.325 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2012 CFR

2012-04-01

... intervention blood lead level. 35.325 Section 35.325 Housing and Urban Development Office of the Secretary... environmental intervention blood lead level. If a child less than 6 years of age living in a federally assisted dwelling unit has an environmental intervention blood lead level, the owner shall immediately conduct a...

24 CFR 35.325 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2013 CFR

2013-04-01

... intervention blood lead level. 35.325 Section 35.325 Housing and Urban Development Office of the Secretary... environmental intervention blood lead level. If a child less than 6 years of age living in a federally assisted dwelling unit has an environmental intervention blood lead level, the owner shall immediately conduct a...

24 CFR 35.1225 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2011 CFR

2011-04-01

... intervention blood lead level. 35.1225 Section 35.1225 Housing and Urban Development Office of the Secretary... STRUCTURES Tenant-Based Rental Assistance § 35.1225 Child with an environmental intervention blood lead level... as having an environmental intervention blood lead level, the designated party shall complete a risk...

24 CFR 35.730 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2010 CFR

2010-04-01

... intervention blood lead level. 35.730 Section 35.730 Housing and Urban Development Office of the Secretary... STRUCTURES Project-Based Assistance § 35.730 Child with an environmental intervention blood lead level. (a... subpart applies has been identified as having an environmental intervention blood lead level, the owner...

24 CFR 35.1130 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2011 CFR

2011-04-01

... intervention blood lead level. 35.1130 Section 35.1130 Housing and Urban Development Office of the Secretary... STRUCTURES Public Housing Programs § 35.1130 Child with an environmental intervention blood lead level. (a... been identified as having an environmental intervention blood lead level, the PHA shall complete a risk...

24 CFR 35.830 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2012 CFR

2012-04-01

... intervention blood lead level. 35.830 Section 35.830 Housing and Urban Development Office of the Secretary... intervention blood lead level. (a) Risk assessment. Within 15 days after being notified by a public health... an environmental intervention blood lead level, HUD shall complete a risk assessment of the dwelling...

24 CFR 35.1225 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2014 CFR

2014-04-01

... intervention blood lead level. 35.1225 Section 35.1225 Housing and Urban Development Office of the Secretary... STRUCTURES Tenant-Based Rental Assistance § 35.1225 Child with an environmental intervention blood lead level... as having an environmental intervention blood lead level, the designated party shall complete a risk...

24 CFR 35.1225 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2013 CFR

2013-04-01

... intervention blood lead level. 35.1225 Section 35.1225 Housing and Urban Development Office of the Secretary... STRUCTURES Tenant-Based Rental Assistance § 35.1225 Child with an environmental intervention blood lead level... as having an environmental intervention blood lead level, the designated party shall complete a risk...

24 CFR 35.325 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2011 CFR

2011-04-01

... intervention blood lead level. 35.325 Section 35.325 Housing and Urban Development Office of the Secretary... environmental intervention blood lead level. If a child less than 6 years of age living in a federally assisted dwelling unit has an environmental intervention blood lead level, the owner shall immediately conduct a...

24 CFR 35.325 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2010 CFR

2010-04-01

... intervention blood lead level. 35.325 Section 35.325 Housing and Urban Development Office of the Secretary... environmental intervention blood lead level. If a child less than 6 years of age living in a federally assisted dwelling unit has an environmental intervention blood lead level, the owner shall immediately conduct a...

24 CFR 35.830 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2014 CFR

2014-04-01

... intervention blood lead level. 35.830 Section 35.830 Housing and Urban Development Office of the Secretary... intervention blood lead level. (a) Risk assessment. Within 15 days after being notified by a public health... an environmental intervention blood lead level, HUD shall complete a risk assessment of the dwelling...

24 CFR 35.325 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2014 CFR

2014-04-01

... intervention blood lead level. 35.325 Section 35.325 Housing and Urban Development Office of the Secretary... environmental intervention blood lead level. If a child less than 6 years of age living in a federally assisted dwelling unit has an environmental intervention blood lead level, the owner shall immediately conduct a...

24 CFR 35.1130 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2010 CFR

2010-04-01

... intervention blood lead level. 35.1130 Section 35.1130 Housing and Urban Development Office of the Secretary... STRUCTURES Public Housing Programs § 35.1130 Child with an environmental intervention blood lead level. (a... been identified as having an environmental intervention blood lead level, the PHA shall complete a risk...

24 CFR 35.1130 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2014 CFR

2014-04-01

... intervention blood lead level. 35.1130 Section 35.1130 Housing and Urban Development Office of the Secretary... STRUCTURES Public Housing Programs § 35.1130 Child with an environmental intervention blood lead level. (a... been identified as having an environmental intervention blood lead level, the PHA shall complete a risk...

24 CFR 35.730 - Child with an environmental intervention blood lead level.

Code of Federal Regulations, 2014 CFR

2014-04-01

... intervention blood lead level. 35.730 Section 35.730 Housing and Urban Development Office of the Secretary... STRUCTURES Project-Based Assistance § 35.730 Child with an environmental intervention blood lead level. (a... subpart applies has been identified as having an environmental intervention blood lead level, the owner...

Robust telerobotics - an integrated system for waste handling, characterization and sorting

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

Couture, S.A.; Hurd, R.L.; Wilhelmsen, K.C.

The Mixed Waste Management Facility (MWMF) at the Lawrence Livermore National Laboratory was designed to serve as a national testbed to demonstrate integrated technologies for the treatment of low-level organic mixed waste at a pilot-plant scale. Pilot-scale demonstration serves to bridge the gap between mature, bench-scale proven technologies and full-scale treatment facilities by providing the infrastructure needed to evaluate technologies in an integrated, front-end to back-end facility. Consistent with the intent to focus on technologies that are ready for pilot scale deployment, the front-end handling and feed preparation of incoming waste material has been designed to demonstrate the application ofmore » emerging robotic and remotely operated handling systems. The selection of telerobotics for remote handling in MWMF was made based on a number of factors - personnel protection, waste generation, maturity, cost, flexibility and extendibility. Telerobotics, or shared control of a manipulator by an operator and a computer, provides the flexibility needed to vary the amount of automation or operator intervention according to task complexity. As part of the telerobotics design effort, the technical risk of deploying the technology was reduced through focused developments and demonstrations. The work involved integrating key tools (1) to make a robust telerobotic system that operates at speeds and reliability levels acceptable to waste handling operators and, (2) to demonstrate an efficient operator interface that minimizes the amount of special training and skills needed by the operator. This paper describes the design and operation of the prototype telerobotic waste handling and sorting system that was developed for MWMF.« less

Effects of stimulant medication under varied motivational operations.

PubMed

Mace, F Charles; Prager, Kevin L; Thomas, Karen; Kochy, Jane; Dyer, Tim J; Perry, Lora; Pritchard, Duncan

2009-01-01

We evaluated the evocative effects of four conditions (high- and low-preference activities, low and divided attention) and stimulant medication on the behavior of a 16-year-old boy with attention deficit hyperactivity disorder and moderate mental retardation. All behavior (activity engagement, activity changes, inappropriate touching, rude behaviors, and physical aggression) improved with stimulant medication in most conditions, but undesirable behaviors were not reduced to acceptable levels in all conditions. This finding suggests that stimulant medication may be a valuable adjunct to function-based interventions.

A Hierarchical Approach to Target Recognition and Tracking. Summary of Results for the Period April 1, 1989-November 30, 1989

DTIC Science & Technology

1990-02-07

performance assessment, human intervention, or operator training. Algorithms on different levels are allowed to deal with the world with different degrees...have on the decisions made by the driver are a complex combination of human factors, driving experience, mission objectives, tactics, etc., and...motion. The distinction here is that the decision making program may I 12 1 I not necessarily make its decisions based on the same factors as the human

The effect of a nutrition education program on the nutritional knowledge, hemoglobin levels, and nutritional status of Nicaraguan adolescent girls.

PubMed

Moore, Jean Burley; Pawloski, Lisa; Rodriguez, Claudia; Lumbi, Laura; Ailinger, Rita

2009-01-01

The purpose of this study was to examine the effect of a community-based nutrition education program on the nutritional knowledge, hemoglobin levels, and nutritional status of Nicaraguan adolescent girls and the nutritional knowledge of their mothers. Self-care deficit nursing theory was used in this study. This longitudinal study used a mixed quantitative/qualitative design to study the effect of the nutrition education program. The nonprobability sample consisted of 182 adolescent girls and 67 of their mothers. The setting for the study was a community (barrio) in Managua, Nicaragua. INTERVENTION/MEASUREMENT: A team of nurse and nutrition researchers created the nutrition education program designed to improve girls' and mother's nutrition-related self-care operations. Data collection was carried out for 4 years for girls and 2 years for mothers in Managua, Nicaragua, using questionnaires, a HemoCue, and anthropometric measures. The findings of this study were that girls' and mothers' nutritional knowledge scores significantly improved in most cases after participation in the nutrition intervention program. Girls' hemoglobin levels did not significantly improve and their nutritional status findings were mixed. Girls and mothers described what dietary changes girls made and why.

The cost of integrating a physical activity counselor in the primary health care team.

PubMed

Hogg, William E; Zhao, Xue; Angus, Douglas; Fortier, Michelle; Zhong, Jianwei; O'Sullivan, Tracey; Sigal, Ronald J; Blanchard, Chris

2012-01-01

This article assesses direct costs of integrating a physical activity counselor (PAC) into primary health care teams to improve physical activity levels of inactive patients. A monthly cost analysis was conducted using data from 120 inactive patients, aged 18 to 69 years, who were recruited from a community-based family medicine practice. Relevant cost items for the intensive counseling group included (1) office expenses; (2) equipment purchases; (3) operating costs; (4) costs of training the PAC; and (5) labor costs. Physical and human capital were amortized over a 5-year horizon at a discount rate of 5%. Integrating a PAC into the primary health care team incurred an estimated one-time cost of CA$91.43 per participant per month. Results were very sensitive to the number of patients counseled. The costs associated with the intervention are lower than many other intervention studies attempting to improve population physical activity levels. Demonstrating this competitive cost base should encourage additional research to assess the effectiveness of integrating a PAC into primary health care teams to promote active living among patients who do not meet recommended physical activity levels.

Commentary on the management of type II odontoid process fractures in octogenarians: Article by Graffeo et al. and Editorial by Falavigna (J Neurosurgery Spine August 19, 2016).

PubMed

Epstein, Nancy E

2016-01-01

Establishing a clear treatment paradigm for octogenarians with type II odontoid fractures in hampered by a literature replete with level III articles. In the study by Graffeo et al ., the authors evaluated 111 patients over the age of 79 (average age: 87) with type II odontoid fractures undergoing nonoperative (94 patients) vs. operative intervention (17 total; 15 posterior and 2 anterior). They studied multiple variables and utilized several scales [abbreviated injury scale (AIS), injury severity score (ISS), and the Glasgow coma scale (GCS)] to determine the outcomes of nonoperative vs. operative management. Graffeo et al . concluded that there were no significant differences between nonoperative and operative management for type II odontoid fractures in octogenarians. They found similar frequencies of additional cervical fractures, mechanisms of injury, GCS of 8 or under, AIS/ISS scores, and disposition to "nonhome" facilities. Furthermore, both appeared to have increased mortality rates at 1-year post injury; 13% during hospitalization, 26% within the first post-injury month, and 41% at 1 year. In the editorial by Falavigna, his major criticism of Graffeo's article was the marked disparity in the number of patients in the operative (17 patients) vs. the nonoperative group (94 patients), making it difficult to accept any conclusions as "significant". He further noted that few prior studies provided level I evidence, and that most, like this one, were level III analyses that did not "significantly" advance our knowledge as to whether to treat octogenarians with type II odontoid fractures operatively vs. nonoperatively.

Thoracic spine localization using preoperative placement of fiducial markers and subsequent CT. A technical report.

PubMed

Anaizi, Amjad Nasr; Kalhorn, Christopher; McCullough, Michael; Voyadzis, Jean-Marc; Sandhu, Faheem A

2015-01-01

A retrospective case series evaluating the use of fiducial markers with subsequent computed tomography (CT) or CT myelography for intraoperative localization. To evaluate the safety and utility of preoperative fiducial placement, confirmed with CT myelography, for intraoperative localization of thoracic spinal levels. Thoracic spine surgery is associated with serious complications, not the least of which is the potential for wrong-level surgery. Intraoperative fluoroscopy is often used but can be unreliable due to the patient's body habitus and anatomical variation. Sixteen patients with thoracic spine pathology requiring surgical intervention underwent preoperative fiducial placement at the pedicle of the level of interest in the interventional radiology suite. CT or CT myelogram was then done to evaluate fiducial location relative to the level of pathology. Surgical treatment followed at a later date in all patients. All patients underwent preoperative fiducial placement and CT or CT myelography, which was done on an outpatient basis in 14 of the 16 patients. Intraoperatively, fiducial localization was easily and quickly done with intraoperative fluoroscopy leading to correct localization of spinal level in all cases. All patients had symptomatic improvement following surgery. There were no complications from preoperative localization or operative intervention. Preoperative placement of fiducial markers confirmed with a CT or CT myelogram allows for reliable and fast intraoperative localization of the spinal level of interest with minimal risks and potential complications to the patient. In most cases, a noncontrast CT should be sufficient. This should be an equally reliable means of localization while further decreasing potential for complications. CT myelography should be reserved for pathology that is not evident on noncontrast CT. Accuracy of localization is independent of variations in rib number or vertebral segmentation. The technique is a safe, reliable, and rapid means of localizing spinal level during surgery. Georg Thieme Verlag KG Stuttgart · New York.

Design of Work Facilities for Reducing Musculoskeletal Disorders Risk in Paper Pallet Assembly Station

NASA Astrophysics Data System (ADS)

Mardi Safitri, Dian; Arfi Nabila, Zahra; Azmi, Nora

2018-03-01

Musculoskeletal Disorders (MSD) is one of the ergonomic risks due to manual activity, non-neutral posture and repetitive motion. The purpose of this study is to measure risk and implement ergonomic interventions to reduce the risk of MSD on the paper pallet assembly work station. Measurements to work posture are done by Ovako Working Posture Analysis (OWAS) methods and Rapid Entire Body Assessment (REBA) method, while the measurement of work repetitiveness was using Strain Index (SI) method. Assembly processes operators are identified has the highest risk level. OWAS score, Strain Index, and REBA values are 4, 20.25, and 11. Ergonomic improvements are needed to reduce that level of risk. Proposed improvements will be developed using the Quality Function Deployment (QFD) method applied with Axiomatic House of Quality (AHOQ) and Morphological Chart. As the result, risk level based on OWAS score & REBA score turn out from 4 & 11 to be 1 & 2. Biomechanics analysis of the operator also shows the decreasing values for L4-L5 moment, compression, joint shear, and joint moment strength.

Cost-effectiveness of preventing dental caries and full mouth dental reconstructions among Alaska Native children in the Yukon–Kuskokwim delta region of Alaska

PubMed Central

Atkins, Charisma Y.; Thomas, Timothy K.; Lenaker, Dane; Day, Gretchen M.; Hennessy, Thomas W.; Meltzer, Martin I.

2016-01-01

Objective We conducted a cost-effectiveness analysis of five specific dental interventions to help guide resource allocation. Methods We developed a spreadsheet-based tool, from the healthcare payer perspective, to evaluate the cost effectiveness of specific dental interventions that are currently used among Alaska Native children (6-60 months). Interventions included: water fluoridation, dental sealants, fluoride varnish, tooth brushing with fluoride toothpaste, and conducting initial dental exams on children <18 months of age. We calculated the cost-effectiveness ratio of implementing the proposed interventions to reduce the number of carious teeth and full mouth dental reconstructions (FMDRs) over 10 years. Results A total of 322 children received caries treatments completed by a dental provider in the dental chair, while 161 children received FMDRs completed by a dental surgeon in an operating room. The average cost of treating dental caries in the dental chair was $1,467 (~258,000 per year); while the cost of treating FMDRs was $9,349 (~1.5 million per year). All interventions were shown to prevent caries and FMDRs; however tooth brushing prevented the greatest number of caries at minimum and maximum effectiveness with 1,433 and 1,910, respectively. Tooth brushing also prevented the greatest number of FMDRs (159 and 211) at minimum and maximum effectiveness. Conclusions All of the dental interventions evaluated were shown to produce cost savings. However, the level of that cost saving is dependent on the intervention chosen. PMID:26990678

[A preliminary evaluation of mental status and an investigation of occupational health knowledge demand in operating and maintenance personnel in wind power plants].

PubMed

Hu, S Q; Zhang, Q; Zhu, X H; Sun, K; Chen, S Z; Liu, A G; Luo, G L; Huang, W

2016-10-20

Objective: To investigate the mental status, level of occupational health knowledge, health behaviors, and occupational health knowledge demand in operating and maintenance personnel in wind power plants, and to provide a basis for formulating protective measures of occupational health for operating and maintenance personnel in wind power plants. Methods: A cluster sampling was performed in regionally representative wind power plants in the wind power industry from May 2014 to June 2015, and the Symptom Checklist-90 (SCL-90) and a self-made evaluation questionnaire were used to investigate the general status, mental health, and occupational health knowledge demand in 160 operating and maintenance workers. Results: Of all respondents, 26.9% had mental health issues. The awareness rate of infectious disease knowledge and preventive measures was 11.9%. Of all workers, 96.5% wanted to know the occupational hazard factors in the workplace, and 96.3% wanted to get the knowledge of the prevention of related diseases. Conclusion: Mental health issues in operating and maintenance personnel in wind power plants cannot be neglected and there is a high demand for occupational health services and related knowledge. Comprehensive intervention measures for health promotion in the workplace should be adopted to improve working environment, enhance individual mental health education, increase the level of occupational health management, and protect the health of workers.

Types of Motivating Operations in Interventions with Problem Behavior: A Systematic Review

ERIC Educational Resources Information Center

Simo-Pinatella, David; Font-Roura, Josep; Planella-Morato, Joaquima; McGill, Peter; Alomar-Kurz, Elisabeth; Gine, Climent

2013-01-01

A motivating operation (MO) alters both the effectiveness of a stimulus as a reinforcer and the current frequency of all behavior that has been reinforced by that particular stimulus. This article reviews studies that have manipulated a MO during interventions with school-age participants with intellectual disabilities and problem behavior. A…

Accelerating the development of formal thinking in middle and high school students

NASA Astrophysics Data System (ADS)

Adey, Philip; Shayer, Michael

In an attempt to accelerate the development of formal operations in average young adolescents, intervention lessons relating to all formal schemata were designed in the context of school science courses. Over a period of two years, up to 30 intervention lessons were given by science teachers to their classes in eight schools. Boys who started the program aged 12+ showed a pre-posttest effect size on Piagetian tests of 0.89 SD compared with control classes. In terms of British norms for the development of operational thinking this was a mean change from the 51st to the 74th percentile. Neither the middle school students nor the 12+ girls showed greater gain than the controls. Gains were shown by girls in one 11+ class and in the two 11+ laboratory classes. In the laboratory school students given intervention lessons by the researchers maintained their gains over controls in formal operations at a delayed posttest one year after cessation of the program. There was no effect on tests of science achievement during the intervention. It was argued that the interventions needed to be accompanied by in-service training designed to enable teachers to change their teaching style in line with their students' increased operational thinking capacity.

[Development of an instrument for the assessment of chronic care models].

PubMed

Nuño-Solinís, Roberto; Fernández-Cano, Paloma; Mira-Solves, José Joaquín; Toro-Polanco, Nuria; Carlos Contel, Joan; Guilabert Mora, Mercedes; Solas, Olga

2013-01-01

To present the context, aim and process of designing the Instrument for the Assessment of Chronic Care Models (Instrumento de Evaluación de Modelos de Atención ante la Cronicidad [IEMAC]), which was developed to make the conceptual framework of the chronic care model operational in the Spanish national health system. The IEMAC was developed by a series of national experts with distinct profiles of expertise using qualitative research techniques. A matrix was built with the dimensions selected as basic for the new model. In each dimension, actions were identified and categorized, creating a taxonomy of components and interventions. The clarity and appropriateness of each intervention, and the degree of evidence to support it, were assessed. The resulting questionnaire was validated by other experts from diverse disciplines and settings. Finally, the IEMAC 1.0 was piloted at macro, meso and micro levels. The IEMAC is a tool to be self-administered by health organizations at macro, meso and micro levels. This instrument is composed of six dimensions, 27 components and 80 interventions, whose implementation is assessed with the aid of a scale that combines deployment, systematic evaluation, and orientation improvement. The IEMAC uses a systemic, population-based approach and integrates promotion, prevention, and coordination with social services. The IEMAC contains a set of interventions that can be used as a road map by decision makers, managers and clinicians interested in building a state-of-the-art chronic care model. At the same time, the IEMAC allows healthcare organizations to identify their baseline score and the progress achieved after improvement interventions. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

Status of radiation protection in various interventional cardiology procedures in the Asia Pacific region

PubMed Central

Tsapaki, Virginia; Faruque Ghulam, Mohammed; Lim, Soo Teik; Ngo Minh, Hung; Nwe, Nwe; Sharma, Anil; Sim, Kui-Hian; Srimahachota, Suphot; Rehani, Madan Mohan

2011-01-01

Objective Increasing use of interventional procedures in cardiology with unknown levels of radiation protection in many countries of Asia-Pacific region necessitates the need for status assessment. The study was part of an International Atomic Energy Agency (IAEA) project for achieving improved radiation protection in interventional cardiology (IC) in developing countries. Design The survey covers 18 cardiac catheterisation laboratories in seven countries (Bangladesh, India, Malaysia, Myanmar, Singapore, Thailand and Vietnam). An important step was the creation of the ‘Asian network of Cardiologists in Radiation Protection’ and a newsletter. Data were collected on: radiation protection tools, number of IC laboratories, and annual number of various IC paediatric and adult procedures in the hospital and in the country. Patient radiation dose data were collected in terms of Kerma Area Product (KAP) and cumulative dose (CD). Results It is encouraging that protection devices for staff are largely used in the routine practice. Only 39% of the angiographic machines were equipped with a KAP meter. Operators' initial lack of awareness on radiation-protection optimisation improved significantly after participation in IAEA radiation-protection training. Only two out of five countries reporting patient percutaneous coronary intervention radiation-dose data were fully within the international guidance levels. Data from 51 patients who underwent multiple therapeutic procedures (median 2–3) indicated a total KAP reaching 995 Gy.cm2 (range 10.1–995) and CD 15.1 Gy (range 0.4–15.1), stressing the importance of dose monitoring and optimisation. Conclusions There is a need for interventional cardiology societies to play an active role in training actions and implementation of radiation protection. PMID:27325974

[Technical peculiarities of trans-sphenoidal surgical interventions for prolactin-secreting pituitary adenoma].

PubMed

Vozniak, O M

2013-10-01

The results of treatment of 84 patients, operated on for prolactinoma, using transsphenoidal access, were analyzed. All the stages of transsphenoidal surgical treatment are depicted in details, beginning from the patient's position on operative table and distribution of the devices in operating room and up to performance of nasal tamponade. There was established the dependence of the surgical intervention radicalism from the tumor topographo-histological peculiarities and from the earlier conducted treatment as well.

Ergonomics Climate Assessment: A measure of operational performance and employee well-being.

PubMed

Hoffmeister, Krista; Gibbons, Alyssa; Schwatka, Natalie; Rosecrance, John

2015-09-01

Ergonomics interventions have the potential to improve operational performance and employee well-being. We introduce a framework for ergonomics climate, the extent to which an organization emphasizes and supports the design and modification of work to maximize both performance and well-being outcomes. We assessed ergonomics climate at a large manufacturing facility twice during a two-year period. When the organization used ergonomics to promote performance and well-being equally, and at a high level, employees reported less work-related pain. A larger discrepancy between measures of operational performance and employee well-being was associated with increased reports of work-related pain. The direction of this discrepancy was not significantly related to work-related pain, such that it didn't matter which facet was valued more. The Ergonomics Climate Assessment can provide companies with a baseline assessment of the overall value placed on ergonomics and help prioritize areas for improving operational performance and employee well-being. Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Humanitarian agencies and authoritarian states: a symbiotic relationship?

PubMed

del Valle, Hernan; Healy, Sean

2013-10-01

The relationship between humanitarian agencies and authoritarian states is of growing concern to Médecins Sans Frontières (MSF), given the recurring difficulties experienced in negotiating access and implementing operations in such contexts. The effort to negotiate and gain approval from states to operate on their territory prompts reflection on the sources of legitimacy for action. Drawing on direct field examples in two countries only very rarely examined--Turkmenistan and Uzbekistan--this paper explores MSF's attempts to offer live-saving medical care there. It shows that successful access negotiations hinged heavily on demonstrating added value (medical relevance) while simultaneously building relationships with authorities, identifying possible allies within health ministries, and hoping that such measures could promote a level of acceptance or trust needed to operate. It is clear that the operational space achieved is bound to remain limited and fragile, and that many compromises have to be considered and judged against ethical principles and the overall impact of the intervention. © 2013 The Author(s). Disasters © Overseas Development Institute, 2013.

[Early activation of heart-operated patients as a tool for optimization of cardio-surgery curation (review)].

PubMed

2014-04-01

During last years in foreign countries there was widely introduced tactic of early activation of cardio-surgery patients. Necessary components of this methodical approach are early finishing of post-operation artificial respiration and extubation of trachea, shortening of time spending in intensive therapy till 1 day and sign out from stationary after 5 days. As a result of reducing hospitalization period, the curation costs are reduced significantly. Goal of this research was the analysis of methods of anesthesia that allow early extubation and activation after cardio-surgery interventions. There were analyzed data of protocols of anesthesia and post-operation periods for 270 patients. It was concluded that applied methods of anesthesia ensure adequate protection from operation stress and allow reduce time of post-operation artificial respiration, early activation of patients without reducing level of their safety. It was also proved that application of any type of anesthesia medicines is not influencing the temp of post-operation activation. Conducted research is proving the advisability of using tactic of early activation of patients after heart operations and considers this as a tool for optimization of cardio-surgery curation.

Recreational Diving Impacts on Coral Reefs and the Adoption of Environmentally Responsible Practices within the SCUBA Diving Industry

NASA Astrophysics Data System (ADS)

Roche, Ronan C.; Harvey, Chloe V.; Harvey, James J.; Kavanagh, Alan P.; McDonald, Meaghan; Stein-Rostaing, Vivienne R.; Turner, John R.

2016-07-01

Recreational diving on coral reefs is an activity that has experienced rapidly growing levels of popularity and participation. Despite providing economic activity for many developing coastal communities, the potential role of dive impacts in contributing to coral reef damage is a concern at heavily dived locations. Management measures to address this issue increasingly include the introduction of programmes designed to encourage environmentally responsible practices within the dive industry. We examined diver behaviour at several important coral reef dive locations within the Philippines and assessed how diver characteristics and dive operator compliance with an environmentally responsible diving programme, known as the Green Fins approach, affected reef contacts. The role of dive supervision was assessed by recording dive guide interventions underwater, and how this was affected by dive group size. Of the 100 recreational divers followed, 88 % made contact with the reef at least once per dive, with a mean (±SE) contact rate of 0.12 ± 0.01 per min. We found evidence that the ability of dive guides to intervene and correct diver behaviour in the event of a reef contact decreases with larger diver group sizes. Divers from operators with high levels of compliance with the Green Fins programme exhibited significantly lower reef contact rates than those from dive operators with low levels of compliance. The successful implementation of environmentally responsible diving programmes, which focus on influencing dive industry operations, can contribute to the management of human impacts on coral reefs.

[Effect of leptin on long-term spatial memory of rats with white matter damage in developing brain].

PubMed

Feng, Er-Cui; Jiang, Li

2017-12-01

To investigate the neuroprotective effect of leptin by observing its effect on spatial memory of rats with white matter damage in developing brain. A total of 80 neonatal rats were randomly divided into 3 groups: sham-operation (n=27), model (n=27) and leptin intervention (n=27). The rats in the model and leptin intervention groups were used to prepare a model of white matter damage in developing brain, and the rats in the leptin intervention group were given leptin (100 μg/kg) diluted with normal saline immediately after modelling for 4 consecutive days. The survival rate of the rats was observed and the change in body weight was monitored. When the rats reached the age of 21 days, the Morris water maze test was used to evaluate spatial memory. There was no significant difference in the survival rate of rats between the three groups (P>0.05). Within 10 days after birth, the leptin intervention group had similar body weight as the sham-operation group and significantly lower body weight than the model group (P<0.05); more than 10 days after birth, the leptin intervention group had rapid growth with higher body weight than the model and sham-operation groups (P>0.05). The results of place navigation showed that from the second day of experiment, there was a significant difference in the latency period between the three groups (P<0.05); from the fourth day of experiment, the leptin intervention group had a similar latency period as the sham-operation and a significantly shorter latency period than the model group (P<0.05). The results of space search experiment showed that compared with the sham-operation group, the model group had a significant reduction in the number of platform crossings and a significantly longer latency period (P<0.05); compared with the model group, the leptin intervention group had a significantly increased number of platform crossings and a significantly shortened latency period (P<0.05), while there was no significant difference between the leptin intervention and sham-operation groups. Leptin can alleviate spatial memory impairment of rats with white matter damage in developing brain. It thus exerts a neuroprotective effect, and is worthy of further research.

The effect of pre- and post-operative physical activity on recovery after colorectal cancer surgery (PHYSSURG-C): study protocol for a randomised controlled trial.

PubMed

Onerup, Aron; Angenete, Eva; Bock, David; Börjesson, Mats; Fagevik Olsén, Monika; Grybäck Gillheimer, Elin; Skullman, Stefan; Thörn, Sven-Egron; Haglind, Eva; Nilsson, Hanna

2017-05-08

Surgery for colorectal cancer is associated with a high risk of post-operative adverse events, re-operations and a prolonged post-operative recovery. Previously, the effect of prehabilitation (pre-operative physical activity) has been studied for different types of surgery, including colorectal surgery. However, the trials on colorectal surgery have been of limited methodological quality and size. The aim of this trial is to compare the effect of a combined pre- and post-operative intervention of moderate aerobic physical activity and inspiratory muscle training (IMT) with standard care on post-operative recovery after surgery for colorectal cancer. We are conducting a randomised, controlled, parallel-group, open-label, multi-centre trial with physical recovery within 4 weeks after cancer surgery as the primary endpoint. Some 640 patients planned for surgery for colorectal cancer will be enrolled. The intervention consists of pre- and post-operative physical activity with increased daily aerobic activity of moderate intensity as well as IMT. In the control group, patients will be advised to continue their normal daily exercise routine. The primary outcome is patient-reported physical recovery 4 weeks post-operatively. Secondary outcomes are length of sick leave, complication rate and severity, length of hospital stay, re-admittances, re-operations, post-operative mental recovery, quality of life and mortality, as well as changes in insulin-like growth factor 1 and insulin-like growth factor-binding protein 3, perception of pain and a health economic analysis. An increase in moderate-intensity aerobic physical activity is a safe, cheap and feasible intervention that would be possible to implement in standard care for patients with colorectal cancer. If shown to be effective, this lifestyle intervention could be a clinical parallel to pre-operative smoke cessation that has already been implemented with good clinical results. ClinicalTrials.gov identifier: NCT02299596 . Registered on 17 November 2014.

Operative Outcomes of Grade 3 Turf Toe Injuries in Competitive Football Players.

PubMed

Smith, Kenneth; Waldrop, Norman

2018-06-01

Turf toe is a term used to describe a hyperextension injury to the first metatarsophalangeal joint. Although the vast majority of turf toe injuries can be treated successfully without operative intervention, there are instances where surgery is required to allow the athlete to return to play. Although there is a plethora of literature on turf toe injuries and nonoperative management, there are currently few reports on operative outcomes in athletes. We obtained all cases of turf toe repair according to the ICD-10 procedural code. The inclusion criteria included: age greater than 16, turf toe injury requiring operative management and at least a varsity level high school football player. The charts were reviewed for age, BMI, level of competition, injury mechanism, football position, setting of injury and playing surface. In addition, we recorded the specifics of the operative procedure, a listing of all injured structures, the implants used and the great toe range of motion at final follow-up visit. The AOFAS Hallux score and VAS was used postoperatively as our outcome measures. Our patient population included 15 patients. The average follow-up time was 27.5 months. The average patient was 19.3 years old with a body mass index of 32.3. The average playing time missed was 16.5 weeks. The average dorsiflexion range of motion at the final follow-up was 42.3 degrees. At final follow-up, the average AOFAS Hallux score was 91.3. The average VAS pain score was 0.7 at rest and 0.8 with physical activity. Complete turf toe injuries are often debilitating and may require operative management to restore a pain-free, stable, and functional forefoot. This study represents the largest cohort of operatively treated grade 3 turf toe injuries in the literature and demonstrates that good clinical outcomes were achieved with operative repair. Level IV, case series.

Traffic in the operating room: a review of factors influencing air flow and surgical wound contamination.

PubMed

Pokrywka, Marian; Byers, Karin

2013-06-01

Surgical wound contamination leading to surgical site infection can result from disruption of the intended airflow in the operating room (OR). When personnel enter and exit the OR, or create unnecessary movement and traffic during the procedure, the intended airflow in the vicinity of the open wound becomes disrupted and does not adequately remove airborne contaminants from the sterile field. An increase in the bacterial counts of airborne microorganisms is noted during increased activity levels within the OR. Researchers have studied OR traffic and door openings as a determinant of air contamination. During a surgical procedure the door to the operating room may be open as long as 20 minutes out of each surgical hour during critical procedures involving implants. Interventions into limiting excessive movement and traffic in the OR may lead to reductions in surgical site infections in select populations.

Real time explosive hazard information sensing, processing, and communication for autonomous operation

DOEpatents

Versteeg, Roelof J; Few, Douglas A; Kinoshita, Robert A; Johnson, Doug; Linda, Ondrej

2015-02-24

Methods, computer readable media, and apparatuses provide robotic explosive hazard detection. A robot intelligence kernel (RIK) includes a dynamic autonomy structure with two or more autonomy levels between operator intervention and robot initiative A mine sensor and processing module (ESPM) operating separately from the RIK perceives environmental variables indicative of a mine using subsurface perceptors. The ESPM processes mine information to determine a likelihood of a presence of a mine. A robot can autonomously modify behavior responsive to an indication of a detected mine. The behavior is modified between detection of mines, detailed scanning and characterization of the mine, developing mine indication parameters, and resuming detection. Real time messages are passed between the RIK and the ESPM. A combination of ESPM bound messages and RIK bound messages cause the robot platform to switch between modes including a calibration mode, the mine detection mode, and the mine characterization mode.

Real time explosive hazard information sensing, processing, and communication for autonomous operation

DOEpatents

Versteeg, Roelof J.; Few, Douglas A.; Kinoshita, Robert A.; Johnson, Douglas; Linda, Ondrej

2015-12-15

Methods, computer readable media, and apparatuses provide robotic explosive hazard detection. A robot intelligence kernel (RIK) includes a dynamic autonomy structure with two or more autonomy levels between operator intervention and robot initiative A mine sensor and processing module (ESPM) operating separately from the RIK perceives environmental variables indicative of a mine using subsurface perceptors. The ESPM processes mine information to determine a likelihood of a presence of a mine. A robot can autonomously modify behavior responsive to an indication of a detected mine. The behavior is modified between detection of mines, detailed scanning and characterization of the mine, developing mine indication parameters, and resuming detection. Real time messages are passed between the RIK and the ESPM. A combination of ESPM bound messages and RIK bound messages cause the robot platform to switch between modes including a calibration mode, the mine detection mode, and the mine characterization mode.

Assessment of navigation cues with proximal force sensing during endovascular catheterization.

PubMed

Rafii-Taril, Hedyeh; Payne, Christopher J; Riga, Celia; Bicknell, Colin; Lee, Su-Lin; Yang, Guang-Zhong

2012-01-01

Despite increased use of robotic catheter navigation systems for endovascular intervention procedures, current master-slave platforms have not yet taken into account dexterous manipulation skill used in traditional catheterization procedures. Information on tool forces applied by operators is often limited. A novel force/torque sensor is developed in this paper to obtain behavioural data across different experience levels and identify underlying factors that affect overall operator performance. The miniature device can be attached to any part of the proximal end of the catheter, together with a position sensor attached to the catheter tip, for relating tool forces to catheter dynamics and overall performance. The results show clear differences in manipulation skills between experience groups, thus providing insights into different patterns and range of forces applied during routine endovascular procedures. They also provide important design specifications for ergonomically optimized catheter manipulation platforms with added haptic feedback while maintaining natural skills of the operators.

Patterns and operative treatment of recurrent Crohn's disease: a prospective longitudinal study.

PubMed

Fichera, Alessandro; Lovadina, Stefano; Rubin, Michele; Cimino, Fabrizio; Hurst, Roger D; Michelassi, Fabrizio

2006-10-01

It is believed commonly that Crohn's recurrences always occur at the site of a previous intestinal anastomosis; yet this concept is probably inaccurate and not mindful of the panintestinal nature of the disease. Between October, 1984 and March, 2003, we carried out 1,132 procedures (464 for primary and 668 for recurrent disease) on 981 consecutive patients. Patients in whom we carried out both the original procedure as well as the procedure for recurrent disease constitute this study population. Operative procedures for perineal complications were excluded from this analysis. Data were accrued prospectively. Seventy-eight patients met the study inclusion criteria. They had a total of 149 sites of disease (duodenum, n = 3; jejunum/ileum, n = 53; terminal ileum/neo terminal ileum, n = 67; colon and rectum, n = 26). One hundred thirty-four sites required operative intervention (85 resections and 49 strictureplasties) and 15 did not. Crohn's disease recurred in 79 sites after a mean of 48.4 months (range, 1-161 months, median, 41 months). Site of operative intervention and operative technique influenced patterns of recurrence: when an anastomosis or strictureplasty was constructed with small bowel, the majority of recurrences were limited to the anastomotic line (17/29, 59%); when it was constructed with small bowel and colon, the majority of recurrences extended to the proximal limb (29/35, 83%). The difference in recurrence pattern is significant (P < .01). In addition, fewer recurrences occurred at strictureplasty than resection sites (22/49, 45%, vs 57/85, 70%, respectively, P < .05). At the time of the second procedure, 40 additional recurrences were identified distant from the original operative site. Four of these represented progression of disease at the 15 sites that did not originally need operative intervention. Of 119 total recurrences, 115 required 73 resections, 40 strictureplasties, and 2 other procedures. The site of the original operative intervention is the most common site for recurrence, although as many as one-third of recurrences occur separate from it. Pattern of recurrence is influenced by site of the operative intervention (anastomotic for small bowel, proximal limb for ileocolonic) and by operative technique (fewer recurrences occurred at strictureplasty than resection sites). Disease progression occurred in 25% of the sites not addressed operatively at the original procedure. The operative strategy applied to Crohn's complications in different intestinal sites was similar for primary and recurrent disease.

Ethical challenges in cluster randomized controlled trials: experiences from public health interventions in Africa and Asia

PubMed Central

Azad, Kishwar; Fernandez, Armida; Manandhar, Dharma S; Mwansambo, Charles W; Tripathy, Prasanta; Costello, Anthony M

2009-01-01

Abstract Public health interventions usually operate at the level of groups rather than individuals, and cluster randomized controlled trials (RCTs) are one means of evaluating their effectiveness. Using examples from six such trials in Bangladesh, India, Malawi and Nepal, we discuss our experience of the ethical issues that arise in their conduct. We set cluster RCTs in the broader context of public health research, highlighting debates about the need to reconcile individual autonomy with the common good and about the ethics of public health research in low-income settings in general. After a brief introduction to cluster RCTs, we discuss particular challenges we have faced. These include the nature of – and responsibility for – group consent, and the need for consent by individuals within groups to intervention and data collection. We discuss the timing of consent in relation to the implementation of public health strategies, and the problem of securing ethical review and approval in a complex domain. Finally, we consider the debate about benefits to control groups and the standard of care that they should receive, and the issue of post-trial adoption of the intervention under test. PMID:19876544

Effects of Exergaming and Message Framing in School Environments on Physical Activity Attitudes and Intentions of Children and Adolescents.

PubMed

Lwin, May O; Ho, Shirley S; Younbo, Jung; Leng, Theng Yin; Wardoyo, Reidinar J; Jung, Kim Hyo

2016-09-01

Although interventions targeting the health of students in schools are becoming common, few studies have examined how health messages operate at the group level in school environments. This study examines the effects of message-based health interventions (extrinsic vs. intrinsic goal framing) in group environments (exergame competitive vs. exergame noncompetitive) on eliciting attitudes and intentions toward physical activity among children and adolescents. We conducted a 7-week school-based intervention program involving 336 children and 259 adolescents in Singapore in which pre- and post-intervention responses were recorded. Our findings revealed the difference in responses between child and adolescent groups. Children who participated in noncompetitive exergames with extrinsically framed health messages and those who participated in competitive exergames with intrinsically framed health messages demonstrated more favorable attitudes toward physical activity. However, the same effects were absent in our adolescent group. These findings suggest that the integration of exergames into competitive and noncompetitive environments can serve as a gateway to traditional physical activity in schools when strategically combined with intrinsically and extrinsically framed messages. Practical and theoretical implications for schools and health educators are discussed.

Design, operation, and safety of single-room interventional MRI suites: practical experience from two centers.

PubMed

White, Mark J; Thornton, John S; Hawkes, David J; Hill, Derek L G; Kitchen, Neil; Mancini, Laura; McEvoy, Andrew W; Razavi, Reza; Wilson, Sally; Yousry, Tarek; Keevil, Stephen F

2015-01-01

The design and operation of a facility in which a magnetic resonance imaging (MRI) scanner is incorporated into a room used for surgical or endovascular cardiac interventions presents several challenges. MR safety must be maintained in the presence of a much wider variety of equipment than is found in a diagnostic unit, and of staff unfamiliar with the MRI environment, without compromising the safety and practicality of the interventional procedure. Both the MR-guided cardiac interventional unit at Kings College London and the intraoperative imaging suite at the National Hospital for Neurology and Neurosurgery are single-room interventional facilities incorporating 1.5 T cylindrical-bore MRI scanners. The two units employ similar strategies to maintain MR safety, both in original design and day-to-day operational workflows, and between them over a decade of incident-free practice has been accumulated. This article outlines these strategies, highlighting both similarities and differences between the units, as well as some lessons learned and resulting procedural changes made in both units since installation. © 2014 Wiley Periodicals, Inc.

Effects of organisational-level interventions at work on employees' health: a systematic review.

PubMed

Montano, Diego; Hoven, Hanno; Siegrist, Johannes

2014-02-08

Organisational-level workplace interventions are thought to produce more sustainable effects on the health of employees than interventions targeting individual behaviours. However, scientific evidence from intervention studies does not fully support this notion. It is therefore important to explore conditions of positive health effects by systematically reviewing available studies. We set out to evaluate the effectiveness of 39 health-related intervention studies targeting a variety of working conditions. Systematic review. Organisational-level workplace interventions aiming at improving employees' health were identified in electronic databases and manual searches. The appraisal of studies was adapted from the Cochrane Back Review Group guidelines. To improve comparability of the widely varying studies we classified the interventions according to the main approaches towards modifying working conditions. Based on this classification we applied a logistic regression model to estimate significant intervention effects. 39 intervention studies published between 1993 and 2012 were included. In terms of methodology the majority of interventions were of medium quality, and four studies only had a high level of evidence. About half of the studies (19) reported significant effects. There was a marginally significant probability of reporting effects among interventions targeting several organisational-level modifications simultaneously (Odds ratio (OR) 2.71; 95% CI 0.94-11.12), compared to those targeting one dimension only. Despite the heterogeneity of the 39 organisational-level workplace interventions underlying this review, we were able to compare their effects by applying broad classification categories. Success rates were higher among more comprehensive interventions tackling material, organisational and work-time related conditions simultaneously. To increase the number of successful organisational-level interventions in the future, commonly reported obstacles against the implementation process should be addressed in developing these studies.

Effects of organisational-level interventions at work on employees’ health: a systematic review

PubMed Central

2014-01-01

Background Organisational-level workplace interventions are thought to produce more sustainable effects on the health of employees than interventions targeting individual behaviours. However, scientific evidence from intervention studies does not fully support this notion. It is therefore important to explore conditions of positive health effects by systematically reviewing available studies. We set out to evaluate the effectiveness of 39 health-related intervention studies targeting a variety of working conditions. Methods Systematic review. Organisational-level workplace interventions aiming at improving employees’ health were identified in electronic databases and manual searches. The appraisal of studies was adapted from the Cochrane Back Review Group guidelines. To improve comparability of the widely varying studies we classified the interventions according to the main approaches towards modifying working conditions. Based on this classification we applied a logistic regression model to estimate significant intervention effects. Results 39 intervention studies published between 1993 and 2012 were included. In terms of methodology the majority of interventions were of medium quality, and four studies only had a high level of evidence. About half of the studies (19) reported significant effects. There was a marginally significant probability of reporting effects among interventions targeting several organisational-level modifications simultaneously (Odds ratio (OR) 2.71; 95% CI 0.94-11.12), compared to those targeting one dimension only. Conclusions Despite the heterogeneity of the 39 organisational-level workplace interventions underlying this review, we were able to compare their effects by applying broad classification categories. Success rates were higher among more comprehensive interventions tackling material, organisational and work-time related conditions simultaneously. To increase the number of successful organisational-level interventions in the future, commonly reported obstacles against the implementation process should be addressed in developing these studies. PMID:24507447

Improving operating room efficiency in academic children's hospital using Lean Six Sigma methodology.

PubMed

Tagge, Edward P; Thirumoorthi, Arul S; Lenart, John; Garberoglio, Carlos; Mitchell, Kenneth W

2017-06-01

Lean Six Sigma (LSS) is a process improvement methodology that utilizes a collaborative team effort to improve performance by systematically identifying root causes of problems. Our objective was to determine whether application of LSS could improve efficiency when applied simultaneously to all services of an academic children's hospital. In our tertiary academic medical center, a multidisciplinary committee was formed, and the entire perioperative process was mapped, using fishbone diagrams, Pareto analysis, and other process improvement tools. Results for Children's Hospital scheduled main operating room (OR) cases were analyzed, where the surgical attending followed themselves. Six hundred twelve cases were included in the seven Children's Hospital operating rooms (OR) over a 6-month period. Turnover Time (interval between patient OR departure and arrival of the subsequent patient) decreased from a median 41min in the baseline period to 32min in the intervention period (p<0.0001). Turnaround Time (interval between surgical dressing application and subsequent surgical incision) decreased from a median 81.5min in the baseline period to 71min in the intervention period (p<0.0001). These results demonstrate that a coordinated multidisciplinary process improvement redesign can significantly improve efficiency in an academic Children's Hospital without preselecting specific services, removing surgical residents, or incorporating new personnel or technology. Prospective comparative study, Level II. Copyright © 2017 Elsevier Inc. All rights reserved.

Transmediastinal gunshot wounds in a mature trauma centre: changing perspectives.

PubMed

Okoye, Obi T; Talving, Peep; Teixeira, Pedro G; Chervonski, Michael; Smith, Jennifer A; Inaba, Kenji; Noguchi, Thomas T; Demetriades, Demetrios

2013-09-01

Transmediastinal gunshot wounds are associated with a high mortality and frequently require operative intervention. The purpose of this study was to identify the diagnostic and therapeutic challenges of these injuries in a mature trauma system with decreasing prehospital time intervals. Patients admitted to a large urban Level 1 trauma centre between 1/2006 and 12/2010 sustaining a firearm injury to the torso were identified. Transmediastinal gunshot wounds were defined as missile tracts traversing the mediastinum identified on CT images, operative notes or autopsy reports. Overall, 133 patients met study criteria. A total of 116 patients (87.2%) were haemodynamically unstable or had no vital signs on arrival to the Emergency Department. Ninety-seven (83.6%) of these patients required a resuscitative thoracotomy resulting in 8 survivors (6.0%). There were 17 haemodynamically stable patients (12.8%) identified, 14 of whom underwent CT scan evaluation. Six patients subsequently required operative intervention. Only 11 patients (8.3%) in the study population were successfully managed nonoperatively. The overall mortality was 78.9%, and for those who reached the hospital with vital signs, the mortality was 24.3%. Transmediastinal gunshot wounds encountered in a mature trauma centre are highly lethal injuries requiring resuscitative thoracotomy in most instances. Changing perspectives in these injuries may reflect the effects of an evolving prehospital care. Copyright © 2012 Elsevier Ltd. All rights reserved.

Management of adult blunt hepatic trauma.

PubMed

Kozar, Rosemary A; McNutt, Michelle K

2010-12-01

To review the nonoperative and operative management of blunt hepatic injury in the adult trauma population. Although liver injury scale does not predict need for surgical intervention, a high-grade complex liver injury should alert the physician to a patient at increased risk of hepatic complications following nonoperative management. Blunt hepatic injury remains a frequent intraabdominal injury in the adult trauma population. The management of blunt hepatic injury has undergone a major paradigm shift from mandatory operative exploration to nonoperative management. Hemodynamic instability with a positive focused abdominal sonography for trauma and peritonitis are indications for emergent operative intervention. Although surgical intervention for blunt hepatic trauma is not as common as in years past, it is imperative that the current trauma surgeon be familiar with the surgical skill set to manage complex hepatic injuries. This study represents a review of both nonoperative and operative management of blunt hepatic injury.

Effect of an Ergonomics-Based Educational Intervention Based on Transtheoretical Model in Adopting Correct Body Posture Among Operating Room Nurses

PubMed Central

Moazzami, Zeinab; Dehdari, Tahere; Taghdisi, Mohammad Hosein; Soltanian, Alireza

2016-01-01

Background: One of the preventive strategies for chronic low back pain among operating room nurses is instructing proper body mechanics and postural behavior, for which the use of the Transtheoretical Model (TTM) has been recommended. Methods: Eighty two nurses who were in the contemplation and preparation stages for adopting correct body posture were randomly selected (control group = 40, intervention group = 42). TTM variables and body posture were measured at baseline and again after 1 and 6 months after the intervention. A four-week ergonomics educational intervention based on TTM variables was designed and conducted for the nurses in the intervention group. Results: Following the intervention, a higher proportion of nurses in the intervention group moved into the action stage (p < 0.05). Mean scores of self-efficacy, pros, experimental processes and correct body posture were also significantly higher in the intervention group (p < 0.05). No significant differences were found in the cons and behavioral processes, except for self-liberation, between the two groups (p > 0.05) after the intervention. Conclusions: The TTM provides a suitable framework for developing stage-based ergonomics interventions for postural behavior. PMID:26925897

Effect of an Ergonomics-Based Educational Intervention Based on Transtheoretical Model in Adopting Correct Body Posture Among Operating Room Nurses.

PubMed

Moazzami, Zeinab; Dehdari, Tahere; Taghdisi, Mohammad Hosein; Soltanian, Alireza

2015-11-03

One of the preventive strategies for chronic low back pain among operating room nurses is instructing proper body mechanics and postural behavior, for which the use of the Transtheoretical Model (TTM) has been recommended. Eighty two nurses who were in the contemplation and preparation stages for adopting correct body posture were randomly selected (control group = 40, intervention group = 42). TTM variables and body posture were measured at baseline and again after 1 and 6 months after the intervention. A four-week ergonomics educational intervention based on TTM variables was designed and conducted for the nurses in the intervention group. Following the intervention, a higher proportion of nurses in the intervention group moved into the action stage (p < 0.05). Mean scores of self-efficacy, pros, experimental processes and correct body posture were also significantly higher in the intervention group (p < 0.05). No significant differences were found in the cons and behavioral processes, except for self-liberation, between the two groups (p > 0.05) after the intervention. The TTM provides a suitable framework for developing stage-based ergonomics interventions for postural behavior.

Clinical applications of virtual navigation bronchial intervention.

PubMed

Kajiwara, Naohiro; Maehara, Sachio; Maeda, Junichi; Hagiwara, Masaru; Okano, Tetsuya; Kakihana, Masatoshi; Ohira, Tatsuo; Kawate, Norihiko; Ikeda, Norihiko

2018-01-01

In patients with bronchial tumors, we frequently consider endoscopic treatment as the first treatment of choice. All computed tomography (CT) must satisfy several conditions necessary to analyze images by Synapse Vincent. To select safer and more precise approaches for patients with bronchial tumors, we determined the indications and efficacy of virtual navigation intervention for the treatment of bronchial tumors. We examined the efficacy of virtual navigation bronchial intervention for the treatment of bronchial tumors located at a variety of sites in the tracheobronchial tree using a high-speed 3-dimensional (3D) image analysis system, Synapse Vincent. Constructed images can be utilized to decide on the simulation and interventional strategy as well as for navigation during interventional manipulation in two cases. Synapse Vincent was used to determine the optimal planning of virtual navigation bronchial intervention. Moreover, this system can detect tumor location and alsodepict surrounding tissues, quickly, accurately, and safely. The feasibility and safety of Synapse Vincent in performing useful preoperative simulation and navigation of surgical procedures can lead to safer, more precise, and less invasion for the patient, and makes it easy to construct an image, depending on the purpose, in 5-10 minutes using Synapse Vincent. Moreover, if the lesion is in the parenchyma or sub-bronchial lumen, it helps to perform simulation with virtual skeletal subtraction to estimate potential lesion movement. By using virtual navigation system for simulation, bronchial intervention was performed with no complications safely and precisely. Preoperative simulation using virtual navigation bronchial intervention reduces the surgeon's stress levels, particularly when highly skilled techniques are needed to operate on lesions. This task, including both preoperative simulation and intraoperative navigation, leads to greater safety and precision. These technological instruments are helpful for bronchial intervention procedures, and are also excellent devices for educational training.

The Effects of a Cognitive Acceleration Intervention Programme on the Performance of Secondary School Pupils in Malawi.

ERIC Educational Resources Information Center

Mbano, Nellie

2003-01-01

Investigates whether the critical period for cognitive transition from concrete operations to formal operations at 12-14 years of age actually exists. Uses the Cognitive Acceleration through Science Education (CASE) intervention program in Malawi. Discusses the existence of the critical period, academic achievement, and explanations for age and…

The Effects of an Abolishing Operation Intervention Component on Play Skills, Challenging Behavior, and Stereotypy

ERIC Educational Resources Information Center

Lang, Russell; O'Reilly, Mark; Sigafoos, Jeff; Machalicek, Wendy; Rispoli, Mandy; Lancioni, Giulio E.; Aguilar, Jeannie; Fragale, Christina

2010-01-01

The purpose of this study was to reduce stereotypy and challenging behavior during play skills instruction by adding an abolishing operation component (AOC) to the intervention strategy. An alternating treatments design compared one condition in which participants were allowed to engage in stereotypy freely before beginning the play skills…

[INTERVENTIONAL AND SURGICAL TREATMENT OF THE ANGINA PECTORIS RECURRENCE AFTER CORONARY SHUNTING OPERATION].

PubMed

Fanta, S M

2015-12-01

There were examined 134 patients, in whom in the clinic in 2005-2014 yrs a coronary shunting operation was performed. In patients with the angina pectoris recurrence a reoperation is indicated. The data of repeated coronaroventriculography and shuntography were analyzed. Efficacy of the surgical and interventional methods application in the patients was proved.

Sciatic Nerve Injury After Proximal Hamstring Avulsion and Repair.

PubMed

Wilson, Thomas J; Spinner, Robert J; Mohan, Rohith; Gibbs, Christopher M; Krych, Aaron J

2017-07-01

Muscle bellies of the hamstring muscles are intimately associated with the sciatic nerve, putting the sciatic nerve at risk of injury associated with proximal hamstring avulsion. There are few data informing the magnitude of this risk, identifying risk factors for neurologic injury, or determining neurologic outcomes in patients with distal sciatic symptoms after surgery. To characterize the frequency and nature of sciatic nerve injury and distal sciatic nerve-related symptoms after proximal hamstring avulsion and to characterize the influence of surgery on these symptoms. Cohort study; Level of evidence, 3. This was a retrospective review of patients with proximal partial or complete hamstring avulsion. The outcome of interest was neurologic symptoms referable to the sciatic nerve distribution below the knee. Neurologic symptoms in operative patients were compared pre- and postoperatively. The cohort consisted of 162 patients: 67 (41.4%) operative and 95 (58.6%) nonoperative. Sciatic nerve-related symptoms were present in 22 operative and 23 nonoperative patients, for a total of 45 (27.8%) patients (8 [4.9%] motor deficits, 11 [6.8%] sensory deficits, and 36 [22.2%] with neuropathic pain). Among the operative cohort, 3 of 3 (100.0%) patients showed improvement in their motor deficit postoperatively, 3 of 4 (75.0%) patients' sensory symptoms improved, and 17 of 19 (89.5%) patients had improvement in pain. A new or worsening deficit occurred in 5 (7.5%) patients postoperatively (2 [3.1%] motor deficits, 1 [1.5%] sensory deficit, and 3 [4.5%] with new pain). Predictors of operative intervention included lower age (odds ratio [OR], 0.952; 95% CI, 0.921-0.982; P = .001) and complete avulsion (OR, 10.292; 95% CI, 2.526-72.232; P < .001). Presence of neurologic deficit was not predictive. Sciatic nerve-related symptoms after proximal hamstring avulsion are underrecognized. Currently, neurologic symptoms are not considered when determining whether to pursue operative intervention. Given the high likelihood of improvement with surgical treatment, neurologic symptoms should be considered when making a decision regarding operative treatment.

Implementation of a near-zero fluoroscopy approach in interventional electrophysiology: impact of operator experience.

PubMed

Wannagat, Severin; Loehr, Lena; Lask, Sebastian; Völk, Katharina; Karaköse, Tamer; Özcelik, Cemil; Mügge, Andreas; Wutzler, Alexander

2018-04-01

Catheter ablation is performed under fluoroscopic guidance. Reduction of radiation dose for patients and staff is emphasized by current recommendations. Previous studies have shown that lower operator experience leads to increased radiation dose. On the other hand, less experienced operators may depend even more on fluoroscopic guidance. Our study aimed to evaluate feasibility and efficacy of a non-fluoroscopic approach in different training levels. From January 2017, a near-zero fluoroscopy approach was established in two centers. Four operators (beginner, 1st year fellow, 2nd year fellow, expert) were instructed to perform the complete procedure with the use of a 3-D mapping system without fluoroscopy. A historical cohort that underwent procedures with fluoroscopy use served as control group. Dose area product (DPA), procedure duration, acute procedural success, and complications were compared between the groups and for each operator. Procedures were performed in 157 patients. The first 100 patients underwent procedures with fluoroscopic guidance, the following 57 procedures were performed with the near-zero fluoroscopy approach. The results show a significant reduction in DPA for all operators immediately after implementation of the near-zero fluoroscopy protocol (control 637 ± 611 μGy/m 2 ; beginner 44.1 ± 79.5 μGy/m 2 , p = 0.002; 1st year fellow 24.3 ± 46.4.5 μGy/m 2 , p = 0.001; 2nd year fellow 130.3 ± 233.3 μGy/m 2 , p = 0.003; expert 9.3 ± 37.4 μGy/m 2 , P < 0.001). Procedure duration, acute success, and complications were not significantly different between the groups. Our results show a 90% reduction of DPA shortly after implementation of a near-zero fluoroscopy approach in interventional electrophysiology even in operators in training.

Evaluation of a statewide dissemination and implementation of physical activity intervention in afterschool programs: a nonrandomized trial.

PubMed

Beets, Michael W; Glenn Weaver, R; Turner-McGrievy, Gabrielle; Saunders, Ruth P; Webster, Collin A; Moore, Justin B; Brazendale, Keith; Chandler, Jessica

2017-12-01

In 2015, YMCA-operated afterschool programs (ASPs) across South Carolina pledged to achieve the national standard that calls for every child to accumulate 30 min/day of moderate-to-vigorous physical activity (MVPA) during program time. This study shares the first-year findings related to the dissemination, implementation, and outcomes associated with the statewide intervention to achieve the MVPA Standard. Twenty ASPs were sampled from all YMCA-operated ASPs (N = 97) and visited at baseline (spring 2015) and first-year follow-up (spring 2016). Programs were provided standardized professional development training to increase the MVPA children accumulated while attending ASPs. The training focused on extending the scheduled time for activity opportunities and modifying commonly played games to increase MVPA. The RE-AIM framework was used to evaluate the statewide intervention. Accelerometer-derived MVPA was the primary outcome. Implementation was evaluated via direct observation. Intent-to-treat (ITT) and as-treated comparisons were conducted in summer 2016. Reach/adoption was variable, with attendance at trainings ranging from 0 to 100% across ASPs. Effectiveness of the intervention using ITT models indicated no changes from baseline in the percentage of programs meeting the MVPA standard for boys or girls. Implementation levels also varied and were related to increases in both boys' and girls' MVPA for moderate and high implementers. Findings indicate improvements in MVPA can be made from attending the trainings and implementing some or all of the training components. Additional work is necessary to identify ways to ensure staff attend trainings to implement strategies and to identify which specific factors contributed to increases in MVPA.

[Initial experience of transcatheter implantation with a new aortic valve in sheep].

PubMed

Wang, Jian-ming; Yang, Jian; Yang, Li-fang; Zhang, Xue-xin; Hu, Yun; Liu, Jin-cheng; Yu, Shi-qiang; Yi, Ding-hua

2011-11-01

To evaluate the feasibility and short-term results of transcatheter aortic valve implantation (TAVI) using a new transcatheter valve. Twenty healthy adult sheep received general anesthesia. Under the guidance of X-ray and transthoracic echocardiography (TTE), the new anti-calcification transcatheter valve was released from delivery system and implanted at the level of native aortic annulus via left common carotid artery. Position and function of the new anti-calcification transcatheter valve were evaluated by angiography and TTE immediately after intervention. Thirty day survival rate of animals was obtained. New transcatheter valves were implanted in all sheep. Fifteen sheep (75%) survived up to 30 days and post-operative examination showed that the transcatheter valve was in optimal position without migration and mitral valve impingement. The native coronary artery was patent in these animals. There was a slight paravalvular leak in 5 sheep. Postoperative echocardiography showed reflux percentage was significantly increased (P < 0.05) compared pre-intervention. Effective orifice area, aortic systolic pressure, diastolic aortic pressure, mean aortic pressure, left ventricular systolic pressure, left ventricular end diastolic pressure and heart rate were similar between post and pre-intervention (all P < 0.05). Five sheep died after TAVI within 30 days, including one fatal ventricular fibrillation occurred immediately after releasing the transcatheter valve and another sheep died of acute myocardial infarction due to left main coronary artery occlusion evidenced by angiography. Two sheep died of severe mitral regurgitation at 8 and 12 hours post-operation and one died of infective endocarditis at 26 days after intervention. Our favorable preliminary results showed that it was feasible to perform TAVI using the new transcatheter valve.

Gunshot wounds to the face: level I urban trauma center: a 10-year level I urban trauma center experience.

PubMed

Pereira, Clifford; Boyd, J Brian; Dickenson, Brian; Putnam, Brant

2012-04-01

Gunshot wounds (GSWs) to the face are an infrequent occurrence outside of a war zone. However, when they occur, they constitute a significant reconstructive challenge. We present our 10-year experience at an urban level I trauma center to define the patterns of injury, assess the morbidity and mortality, and estimate the cost to the health care system. A retrospective review was performed on all patients admitted to Harbor-UCLA Medical Center with GSWs to the head and neck region between January 1997 and January 2007. Those who had sustained GSWs to the face requiring operative intervention were closely reviewed. Between 1997 and 2007, a total of 702 patients were admitted to the Harbor UCLA Emergency Department having sustained GSWs to the head and neck region, of which 501 patients survived. Of the survivors, 28 patients (26 male, 2 female) sustained GSWs to their face requiring operative intervention. The mean age of these patients was 28 (±8.3) years. They generally presented within a few hours of the injury, but 1 individual arrived over 24 hours later. Low-velocity single gunshots (from handguns) were predominantly involved, with facial fractures occurring in all cases. Fractures were of a localized shattering type without the major displacement of bony complexes seen in motor vehicle accidents. Most required wound debridement and fracture fixation. A few patients (14.2%) underwent free tissue transfer for reconstruction (3 fibular flaps, 1 TRAM). Tracheostomy was performed in 35.7% of patients. Mean length of hospital stay was 8.3 (±7.1) days, with 50% of cases requiring admission to the intensive care unit. Mean length of intensive care unit stay was 5.2 (±5.7) days. The average cost per patient exceeded $100,000.

Quality factors in interventional neuroradiology.

PubMed

Lasjaunias, P

2001-01-01

The interest we take in medical economics and strategy is like the one we take in politics: we may scorn politics, but it cannot be denied that it commands our entire life. For this reason, we must try to determine the conditions required to evaluate the quality of interventional neuroradiology, its operators, its practice, its advances, its teaching, and to maintain this quality. It is probably vital to the freedom of our future therapeutic decisions that we contribute effectively to this discussion before the standard is forced upon us by an exclusively economical or administrative logic. On the other hand, any advance can only be turned into progress if it is diffused and applied. There is no doubt that several levels of quality are acceptable, thus the best approach will be to look for and identify the minimum standard for quality or the limits of non-quality. We shall refrain from suggesting that the level of excellence at a given moment should be imposed upon all operators and constitute the standard level of practice. Practice is based on knowledge and competence. The most skilled surgical act cannot guarantee safe medical treatment if it is not supported by sufficient knowledge about the diseases and their symptoms. Mastership of the decision process requires a thorough vision of the therapeutic decision tree involved. Quality is a composition of global view and detailed analysis to allow a fuzzy gestion of the performance. Regardless of the plan chosen, openmindedness should be kept to allow adaptation, correction or interruption of a given therapeutic process in view of unpredicted pieces of information. Such input is a predictable possibility that should be explained to the patient prior to starting the procedure. Dealing with human beings, the attitude along with the technical management will be of paramount importance in the overall quality assessment.

Instructor feedback versus no instructor feedback on performance in a laparoscopic virtual reality simulator: a randomized educational trial

PubMed Central

2012-01-01

Abstract Background Several studies have found a positive effect on the learning curve as well as the improvement of basic psychomotor skills in the operating room after virtual reality training. Despite this, the majority of surgical and gynecological departments encounter hurdles when implementing this form of training. This is mainly due to lack of knowledge concerning the time and human resources needed to train novice surgeons to an adequate level. The purpose of this trial is to investigate the impact of instructor feedback regarding time, repetitions and self-perception when training complex operational tasks on a virtual reality simulator. Methods/Design The study population consists of medical students on their 4th to 6th year without prior laparoscopic experience. The study is conducted in a skills laboratory at a centralized university hospital. Based on a sample size estimation 98 participants will be randomized to an intervention group or a control group. Both groups have to achieve a predefined proficiency level when conducting a laparoscopic salpingectomy using a surgical virtual reality simulator. The intervention group receives standardized instructor feedback of 10 to 12 min a maximum of three times. The control group receives no instructor feedback. Both groups receive the automated feedback generated by the virtual reality simulator. The study follows the CONSORT Statement for randomized trials. Main outcome measures are time and repetitions to reach the predefined proficiency level on the simulator. We include focus on potential sex differences, computer gaming experience and self-perception. Discussion The findings will contribute to a better understanding of optimal training methods in surgical education. Trial Registration NCT01497782 PMID:22373062

Preoperative Chemoprophylaxis is Safe in Major Oncology Operations and Effective at Preventing Venous Thromboembolism.

PubMed

Selby, Luke V; Sovel, Mindy; Sjoberg, Daniel D; McSweeney, Margaret; Douglas, Damon; Jones, David R; Scardino, Peter T; Soff, Gerald A; Fabbri, Nicola; Sepkowitz, Kent; Strong, Vivian E; Sarkaria, Inderpal S

2016-02-01

We prospectively evaluated the safety and efficacy of adding preoperative chemoprophylaxis to our institution's operative venous thromboembolism (VTE) prophylaxis policy as part of a physician-led quality improvement initiative. Patients undergoing major cancer surgery between August 2013 and January 2014 were screened according to service-specific eligibility criteria and targeted to receive preoperative VTE chemoprophylaxis. Bleeding, transfusion, and VTE rates were compared with rates of historical controls who had not received preoperative chemoprophylaxis. The 2,058 eligible patients who underwent operation between August 2013 and January 2014 (post-intervention) were compared with a cohort of 4,960 patients operated on between January 2012 and June 2013, who did not receive preoperative VTE chemoprophylaxis (pre-intervention). In total, 71% of patients in the post-intervention group were screened for eligibility; 82% received preoperative anticoagulation. When compared with the pre-intervention group, the post-intervention group had significantly lower transfusion rates (pre- vs post-intervention, 17% vs 14%; difference 3.5%, 95% CI 1.7% to 5%, p = 0.0003) without significant difference in major bleeding (difference 0.3%, 95% CI -0.1% to 0.7%, p = 0.2). Rates of deep venous thrombosis (1.3% vs 0.2%; difference 1.1%, 95% CI 0.7% to 1.4%, p < 0.0001) and pulmonary embolus (1.0% vs 0.4%; difference 0.6%, 95% CI 0.2% to 1%, p = 0.017) were significantly lower in the post-intervention group. In patients undergoing major cancer surgery, institution of a single dose of preoperative chemoprophylaxis, as part of a physician-led quality improvement initiative, did not increase bleeding or blood transfusions and was associated with a significant decrease in VTE rates. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Patient Satisfaction after Thoracoscopic Sympathectomy for Palmar Hyperhidrosis: Do Method and Level Matter?

PubMed Central

Cheng, Amy; Johnsen, Hege; Chang, Michael Y

2015-01-01

Context: Although surgery is widely recognized as the best treatment for palmar hyperhidrosis (PH), the decision to perform a sympathicotomy, sympathectomy, or clipping of the thoracic sympathetic chain is based on surgeon preference. Objective: We investigated the outcomes of patients who underwent surgical intervention for PH with regard to method used and level of sympathetic chain interrupted. Design: This was a retrospective medical chart review. Patients who underwent thoracoscopic intervention for PH were mailed questionnaires regarding their presenting and postoperative symptoms and satisfaction 6 months to 15 years after their procedure. Analyses were performed to investigate whether the surgical method applied affected these outcomes. Results: A total of 635 patients underwent bilateral thoracoscopic procedures for PH between April 1995 and February 2010, and 210 (33%) responded to the questionnaires. Sixteen surgeons performed 108 sympathicotomies, 83 sympathectomies, and 19 ligations with titanium clips for PH. Mean follow-up was 5.5 years. Overall palmar success was 85.4% and was not affected by the surgical method. The rate of compensatory hyperhidrosis was significantly lower if the operative level did not include the R2 ganglion (66.7% vs 80.6%, p = 0.028). Nevertheless, 76.2% of patients were satisfied with the results, and 85.7% would repeat the procedure if given the option to do it again. Conclusion: Most patients reported relief of their PH and were satisfied with surgical intervention, regardless of method used. Although postoperative compensatory hyperhidrosis was common, this did not appear to affect overall patient satisfaction. The inclusion of rib level 2 ganglion resulted in a significantly increased incidence of compensatory hyperhidrosis. PMID:26517433

Validation of the CME Geomagnetic Forecast Alerts Under the COMESEP Alert System

NASA Astrophysics Data System (ADS)

Dumbović, Mateja; Srivastava, Nandita; Rao, Yamini K.; Vršnak, Bojan; Devos, Andy; Rodriguez, Luciano

2017-08-01

Under the European Union 7th Framework Programme (EU FP7) project Coronal Mass Ejections and Solar Energetic Particles (COMESEP, http://comesep.aeronomy.be), an automated space weather alert system has been developed to forecast solar energetic particles (SEP) and coronal mass ejection (CME) risk levels at Earth. The COMESEP alert system uses the automated detection tool called Computer Aided CME Tracking (CACTus) to detect potentially threatening CMEs, a drag-based model (DBM) to predict their arrival, and a CME geoeffectiveness tool (CGFT) to predict their geomagnetic impact. Whenever CACTus detects a halo or partial halo CME and issues an alert, the DBM calculates its arrival time at Earth and the CGFT calculates its geomagnetic risk level. The geomagnetic risk level is calculated based on an estimation of the CME arrival probability and its likely geoeffectiveness, as well as an estimate of the geomagnetic storm duration. We present the evaluation of the CME risk level forecast with the COMESEP alert system based on a study of geoeffective CMEs observed during 2014. The validation of the forecast tool is made by comparing the forecasts with observations. In addition, we test the success rate of the automatic forecasts (without human intervention) against the forecasts with human intervention using advanced versions of the DBM and CGFT (independent tools available at the Hvar Observatory website, http://oh.geof.unizg.hr). The results indicate that the success rate of the forecast in its current form is unacceptably low for a realistic operation system. Human intervention improves the forecast, but the false-alarm rate remains unacceptably high. We discuss these results and their implications for possible improvement of the COMESEP alert system.

Native Transformations in the Pacific Northwest: A strength-based model of protection against substance use disorder.

PubMed

Rasmus, Stacy; Allen, James; Connor, William; Freeman, William; Skewes, Monica

2016-01-01

This paper presents findings from the Native Transformations Project, an exploratory community-based participatory research study that aims to identify sources of strength and protection against substance use disorder in three tribal communities in the coastal Pacific Northwest. Preliminary results from the study describe the specific settings, acts, and behaviors that build strengths and provide protection at the family, community, individual, and spiritual levels within coastal Pacific Northwest local tribal cultures. Findings from this study give voice to stated community preferences for grassroots Native intervention programs based in local cultural knowledge, worldviews, values, and theories of change, that operate at the local level on their own terms.

NATIVE TRANSFORMATIONS IN THE PACIFIC NORTHWEST: A STRENGTH-BASED MODEL OF PROTECTION AGAINST SUBSTANCE USE DISORDER

PubMed Central

Rasmus, Stacy; Allen, James; Connor, William; Freeman, William; Skewes, Monica

2016-01-01

This paper presents findings from the Native Transformations Project, an exploratory community-based participatory research study that aims to identify sources of strength and protection against substance use disorder in three tribal communities in the coastal Pacific Northwest. Preliminary results from the study describe the specific settings, acts, and behaviors that build strengths and provide protection at the family, community, individual, and spiritual levels within coastal Pacific Northwest local tribal cultures. Findings from this study give voice to stated community preferences for grassroots Native intervention programs based in local cultural knowledge, worldviews, values, and theories of change, that operate at the local level on their own terms. PMID:27383091

Ergonomics intervention in a tile industry- case of manual material handling.

PubMed

Dormohammadi, Ali; Amjad Sardrudi, Hosein; Motamedzade, Majid; Dormohammadi, Reza; Musavi, Saeed

2012-12-13

Manual material handling is one of the major health and safety hazards in industry. This study aims to assess the lifting tasks, before and after intervention using NIOSH lifting equation and Manual Handling Assessment Charts (MAC). This interventional study was performed in 2011 in a tile manufacturing industry in Hamadan, located in the West of Iran. The prevalence of musculoskeletal discomfort was determined using Nordic musculoskeletal questionnaire. In order to assess the risk factors related to lifting and identify the high-risk activities, MAC and NIOSH lifting equation were used. In intervention phase, we designed a load-carrying cart with shelves capable of moving vertically up and down, similar to scissor lifts. After intervention, the reassessment of risk factors was conducted to determine the success of the intervention and to compare risk levels before and after intervention using t-test. The outputs of MAC and NIOSH lifting equation assessments before intervention revealed that all activities were at high-risk level. After intervention, the risk level decreased to average level. In conclusion, the results of intervention revealed a considerable decrease in risk level. It may be concluded that the given intervention was acceptable and favorably effective in preventing musculoskeletal disorders especially low back pain.

Population-level interventions to reduce alcohol-related harm: an overview of systematic reviews.

PubMed

Martineau, Fred; Tyner, Elizabeth; Lorenc, Theo; Petticrew, Mark; Lock, Karen

2013-10-01

To analyse available review-level evidence on the effectiveness of population-level interventions in non-clinical settings to reduce alcohol consumption or related health or social harm. Health, social policy and specialist review databases between 2002 and 2012 were searched for systematic reviews of the effectiveness of population-level alcohol interventions on consumption or alcohol-related health or social outcomes. Data were extracted on review research aim, inclusion criteria, outcome indicators, results, conclusions and limitations. Reviews were quality-assessed using AMSTAR criteria. A narrative synthesis was conducted overall and by policy area. Fifty-two reviews were included from ten policy areas. There is good evidence for policies and interventions to limit alcohol sale availability, to reduce drink-driving, to increase alcohol price or taxation. There is mixed evidence for family- and community-level interventions, school-based interventions, and interventions in the alcohol server setting and the mass media. There is weak evidence for workplace interventions and for interventions targeting illicit alcohol sales. There is evidence of the ineffectiveness of interventions in higher education settings. There is a pattern of support from the evidence base for regulatory or statutory enforcement interventions over local non-regulatory approaches targeting specific population groups. © 2013.

Summary of the Italian inter-society recommendations for radiation protection optimization in interventional radiology.

PubMed

Compagnone, Gaetano; Padovani, Renato; D'Avanzo, Maria Antonietta; Grande, Sveva; Campanella, Francesco; Rosi, Antonella

2018-05-01

A Working Group coordinated by the Italian National Institute of Health (Istituto Superiore di Sanità) and the National Workers Compensation Authority (Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro, INAIL) and consisting of 11 Italian scientific/professional societies involved in the fluoroscopically guided interventional practices has been established to define recommendations for the optimization of patients and staff radiation protection in interventional radiology. A summary of these recommendations is here reported. A multidisciplinary approach was used to establish the Working Group by involving radiologists, interventional radiologists, neuroradiologists, interventional cardiologists, occupational health specialists, medical physicists, radiation protection experts, radiographers and nurses. The Group operated as a "Consensus Conference". Three main topics have been addressed: patient radiation protection (summarized in ten "golden rules"); staff radiation protection (summarized in ten "golden rules"); and education/training of interventional radiology professionals. In the "golden rules", practical and operational recommendations were provided to help the professionals in optimizing dose delivered to patients and reducing their own exposure. Operative indications dealt also with continuing education and training, and recommendations on professional accreditation and certification. The "Consensus Conference" was the methodology adopted for the development of these recommendations. Involvement of all professionals is a winning approach to improve practical implementation of the recommendations, thus getting a real impact on the optimization of the interventional radiology practices.

Simulating indoor concentrations of NO(2) and PM(2.5) in multifamily housing for use in health-based intervention modeling.

PubMed

Fabian, P; Adamkiewicz, G; Levy, J I

2012-02-01

Residents of low-income multifamily housing can have elevated exposures to multiple environmental pollutants known to influence asthma. Simulation models can characterize the health implications of changing indoor concentrations, but quantifying the influence of interventions on concentrations is challenging given complex airflow and source characteristics. In this study, we simulated concentrations in a prototype multifamily building using CONTAM, a multizone airflow and contaminant transport program. Contaminants modeled included PM(2.5) and NO(2) , and parameters included stove use, presence and operability of exhaust fans, smoking, unit level, and building leakiness. We developed regression models to explain variability in CONTAM outputs for individual sources, in a manner that could be utilized in simulation modeling of health outcomes. To evaluate our models, we generated a database of 1000 simulated households with characteristics consistent with Boston public housing developments and residents and compared the predicted levels of NO(2) and PM(2.5) and their correlates with the literature. Our analyses demonstrated that CONTAM outputs could be readily explained by available parameters (R(2) between 0.89 and 0.98 across models), but that one-compartment box models would mischaracterize concentrations and source contributions. Our study quantifies the key drivers for indoor concentrations in multifamily housing and helps to identify opportunities for interventions. Many low-income urban asthmatics live in multifamily housing that may be amenable to ventilation-related interventions such as weatherization or air sealing, wall and ceiling hole repairs, and exhaust fan installation or repair, but such interventions must be designed carefully given their cost and their offsetting effects on energy savings as well as indoor and outdoor pollutants. We developed models to take into account the complex behavior of airflow patterns in multifamily buildings, which can be used to identify and evaluate environmental and non-environmental interventions targeting indoor air pollutants which can trigger asthma exacerbations. © 2011 John Wiley & Sons A/S.

[Leadership and vision in the improvement of universal health care coverage in low-income countries].

PubMed

Meda, Ziemlé Clément; Konate, Lassina; Ouedraogo, Hyacinthe; Sanou, Moussa; Hercot, David; Sombie, Issiaka

2011-01-01

In Burkina Faso, as in most developing countries, the operational level of the health system is made up of Health Districts (HDs), the activities of which are typically coordinated by the District Team (DT). Assessing the the core functions of DTs, as described by WHO, shows two important weaknesses. Firstly, instructions from "above" are often implemented rather passively: DTs tend not to display much leadership. Secondly, the current organisation, based on input financing and centralised planning, does not sufficiently promote either the vision or research functions of DTs. In this article, we report our experience in the Orodora HD in Burkina Faso, where the DT's leadership and vision proved to be essential ingredients for effective health action in the district. Our description of six interventions implemented between 2004 and 2008 shows how DT leadership and vision have improved outputs at the HD level. Until 2004, the district applied static health planning. The health system was insufficiently financed and performed poorly. Faced with this situation, the DT decided to set up several priority interventions based on health care access criteria and patient concerns, while respecting and contextualizing national norms and objectives. Six interventions were then implemented. The first was ensure that quality blood (meeting transfusion security norms) was available at the District Hospital (DH), by picking blood up from the regional blood transfusion center weekly. This speeded up care at the DH, reduced the number of cases referred to the regional hospital for transfusion, and reduced neonatal and maternal mortality. The second intervention sought to improve the skills of health workers in managing emergency cases and to improve relationships with the referral hospital through the reintroduction of counter-referral procedures. This led to a decrease in unnecessary referrals and also reduced the mortality rates of serious cases. The third intervention, by implementing a decentralized approach to tuberculosis detection, succeeded in improving access to care and enabled us to quantify the rate of tuberculosis-HIV co-infection in the HD. The fourth intervention improved financial access to emergency obstetric care by providing essential drugs and consumables for emergency obstetric surgery free of charge. The fifth intervention boosted the motivation of health workers by an annual 'competition of excellence', organised for workers and teams in the HD. Finally, our sixth intervention was the introduction of a "culture" of evaluation and transparency, by means of a local health journal, used to interact with stakeholders both at the local level and in the health sector more broadly. We also present our experiences regularly during national health science symposia. Although the DT operates with limited resources, it has over time managed to improve care and services in the HD, through its dynamic management and strategic planning. It has reduced inpatient mortality and improved access to care, particularly for vulnerable groups, in line with the Primary Health Care and Bamako Initiative principles. This case study would have benefited from a stronger methodology. However, it shows that in a context of limited resources it is still possible to strengthen the local health system by improving management practices. To progress towards universal health coverage, all core functions of a DT are worth implementing, including leadership and vision. National and international health strategies should thus include a plan to provide for and train local health system managers who can provide both leadership and strategic vision.

Preconditioning Shields Against Vascular Events in Surgery (SAVES), a multicentre feasibility trial of preconditioning against adverse events in major vascular surgery: study protocol for a randomised control trial.

PubMed

Healy, Donagh; Clarke-Moloney, Mary; Gaughan, Brendan; O'Daly, Siobhan; Hausenloy, Derek; Sharif, Faisal; Newell, John; O'Donnell, Martin; Grace, Pierce; Forbes, John F; Cullen, Walter; Kavanagh, Eamon; Burke, Paul; Cross, Simon; Dowdall, Joseph; McMonagle, Morgan; Fulton, Greg; Manning, Brian J; Kheirelseid, Elrasheid A H; Leahy, Austin; Moneley, Daragh; Naughton, Peter; Boyle, Emily; McHugh, Seamus; Madhaven, Prakash; O'Neill, Sean; Martin, Zenia; Courtney, Donal; Tubassam, Muhammed; Sultan, Sherif; McCartan, Damian; Medani, Mekki; Walsh, Stewart

2015-04-23

Patients undergoing vascular surgery procedures constitute a 'high-risk' group. Fatal and disabling perioperative complications are common. Complications arise via multiple aetiological pathways. This mechanistic redundancy limits techniques to reduce complications that target individual mechanisms, for example, anti-platelet agents. Remote ischaemic preconditioning (RIPC) induces a protective phenotype in at-risk tissue, conferring protection against ischaemia-reperfusion injury regardless of the trigger. RIPC is induced by repeated periods of upper limb ischaemia-reperfusion produced using a blood pressure cuff. RIPC confers some protection against cardiac and renal injury during major vascular surgery in proof-of-concept trials. Similar trials suggest benefit during cardiac surgery. Several uncertainties remain in advance of a full-scale trial to evaluate clinical efficacy. We propose a feasibility trial to fully evaluate arm-induced RIPC's ability to confer protection in major vascular surgery, assess the incidence of a proposed composite primary efficacy endpoint and evaluate the intervention's acceptability to patients and staff. Four hundred major vascular surgery patients in five Irish vascular centres will be randomised (stratified for centre and procedure) to undergo RIPC or not immediately before surgery. RIPC will be induced using a blood pressure cuff with four cycles of 5 minutes of ischaemia followed by 5 minutes of reperfusion immediately before the start of operations. There is no sham intervention. Participants will undergo serum troponin measurements pre-operatively and 1, 2, and 3 days post-operatively. Participants will undergo 12-lead electrocardiograms pre-operatively and on the second post-operative day. Predefined complications within one year of surgery will be recorded. Patient and staff experiences will be explored using qualitative techniques. The primary outcome measure is the proportion of patients who develop elevated serum troponin levels in the first 3 days post-operatively. Secondary outcome measures include length of hospital and critical care stay, unplanned critical care admissions, death, myocardial infarction, stroke, mesenteric ischaemia and need for renal replacement therapy (within 30 days of surgery). RIPC is novel intervention with the potential to significantly improve perioperative outcomes. This trial will provide the first evaluation of RIPC's ability to reduce adverse clinical events following major vascular surgery. www.clinicaltrials.gov NCT02097186 Date Registered: 24 March 2014.

A Comparison of Responsive Interventions on Kindergarteners' Early Reading Achievement

ERIC Educational Resources Information Center

Little, Mary E.; Rawlinson, D'Ann; Simmons, Deborah C.; Kim, Minjung; Kwok, Oi-man; Hagan-Burke, Shanna; Simmons, Leslie E.; Fogarty, Melissa; Oslund, Eric; Coyne, Michael D.

2012-01-01

This study compared the effects of Tier 2 reading interventions that operated in response-to-intervention contexts. Kindergarten children (N = 90) who were identified as at risk for reading difficulties were stratified by school and randomly assigned to receive (a) Early Reading Intervention (ERI; Pearson/Scott Foresman, 2004) modified in response…

[Estimation of surgical treatment capacity for managing mass casualty incidents based on time needed for life-saving emergency operations].

PubMed

Kanz, K-G; Huber-Wagner, S; Lefering, R; Kay, M; Qvick, M; Biberthaler, P; Mutschler, W

2006-04-01

The surgical treatment capacity of a hospital constitutes a significant restriction in the capability to deal with critically injured patients from multiple or mass casualty incidents (MCI). With regard to the time needed for life-saving operative interventions there are no basic reference values available in the literature, which can aid in detailed planning for management of mass casualty incidents. The data of 20,815 trauma patients, recorded in the trauma registry hosted by the German Association for Trauma Surgery DGU, were analyzed to extract the median duration of life-saving surgical interventions carried out in an operating theatre. Inclusion criteria were an ISS > or = 16 and the performance of relevant ICPM coded procedures within 6 h after trauma room admission. Orthopedic procedures as well as the placement of ICP catheters and chest tubes or performance of laparoscopies were not included. Complete data sets with the required variables were available from 9,988 trauma patients with an ISS > or = 16, and included 7,907 interventions that took place within 6 h after hospital admission. From among 1,228 patients 1,793 operations could be identified as relevant life-saving emergency operations. Acute injury to the abdomen was the major cause accounting for 54.1% of all emergency surgical procedures with a median intervention duration of 137 min followed by head injuries accounting for 26.3% with a median duration of 110 min. Interventions in the pelvis amounted to 11.5% taking an average of 136 min, 5.0% were in the thorax requiring 91 min and 3.1% major amputations with 142 min. The average cut to suture time for all emergency surgical interventions was 130 min. A prerequisite for estimating the surgical operation capacity for critically injured patients of an MCI is the number of OR teams available during and outside of the normal working hours of the hospital. The average operation time of 130 min calculated from investigation of 1,793 emergency life-saving surgical procedures provides a realistic guideline. Used in combination with the number of available OR teams the prospective treatment capacity can be estimated and projected into an actual incident admission capacity. The identification and numerical value of such significant variables are the basis for operations research and realistic planning in emergency and disaster medicine.

A comparison of chemoembolization endpoints using angiographic versus transcatheter intraarterial perfusion/MR imaging monitoring.

PubMed

Lewandowski, Robert J; Wang, Dingxin; Gehl, James; Atassi, Bassel; Ryu, Robert K; Sato, Kent; Nemcek, Albert A; Miller, Frank H; Mulcahy, Mary F; Kulik, Laura; Larson, Andrew C; Salem, Riad; Omary, Reed A

2007-10-01

Transcatheter arterial chemoembolization (TACE) is an established treatment for unresectable liver cancer. This study was conducted to test the hypothesis that angiographic endpoints during TACE are measurable and reproducible by comparing subjective angiographic versus objective magnetic resonance (MR) endpoints of TACE. The study included 12 consecutive patients who presented for TACE for surgically unresectable HCC or progressive hepatic metastases despite chemotherapy. All procedures were performed with a dedicated imaging system. Angiographic series before and after TACE were reviewed independently by three board-certified interventional radiologists. A subjective angiographic chemoembolization endpoint (SACE) classification scheme, modified from an established angiographic grading system in the cardiology literature, was designed to assist in reproducibly classifying angiographic endpoints. Reproducibility in SACE classification level was compared among operators, and MR imaging perfusion reduction was compared with SACE levels for each observer. Twelve patients successfully underwent 15 separate TACE sessions. SACE levels ranged from I through IV. There was moderate agreement in SACE classification (kappa = 0.46 +/- 0.12). There was no correlation between SACE level and MR perfusion reduction (r = 0.16 for one operator and 0.02 for the other two). Angiographic endpoints during TACE vary widely, have moderate reproducibility among operators, and do not correlate with functional MR imaging perfusion endpoints. Future research should aim to determine ideal angiographic and functional MR imaging endpoints for TACE according to outcome measures such as imaging response, pathologic response, and survival.

Protocol for a feasibility cluster randomised controlled trial of a peer-led school-based intervention to increase the physical activity of adolescent girls (PLAN-A).

PubMed

Sebire, Simon J; Edwards, Mark J; Campbell, Rona; Jago, Russell; Kipping, Ruth; Banfield, Kathryn; Tomkinson, Keeley; Garfield, Kirsty; Lyons, Ronan A; Simon, Joanne; Blair, Peter S; Hollingworth, William

2016-01-01

Physical activity levels are low amongst adolescent girls, and this population faces specific barriers to being active. Peer influences on health behaviours are important in adolescence and peer-led interventions might hold promise to change behaviour. This paper describes the protocol for a feasibility cluster randomised controlled trial of Peer-Led physical Activity iNtervention for Adolescent girls (PLAN-A), a peer-led intervention aimed at increasing adolescent girls' physical activity levels. A two-arm cluster randomised feasibility trial will be conducted in six secondary schools (intervention n  = 4; control n  = 2) with year 8 (12-13 years old) girls. The intervention will operate at a year group level and consist of year 8 girls nominating influential peers within their year group to become peer-supporters. Approximately 15 % of the cohort will receive 3 days of training about physical activity and interpersonal communication skills. Peer-supporters will then informally diffuse messages about physical activity amongst their friends for 10 weeks. Data will be collected at baseline (time 0 (T0)), immediately after the intervention (time 1 (T1)) and 12 months after baseline measures (time 2 (T2)). In this feasibility trial, the primary interest is in the recruitment of schools and participants (both year 8 girls and peer-supporters), delivery and receipt of the intervention, data provision rates and identifying the cost categories for future economic analysis. Physical activity will be assessed using 7-day accelerometry, with the likely primary outcome in a fully-powered trial being daily minutes of moderate-to-vigorous physical activity. Participants will also complete psychosocial questionnaires at each time point: assessing motivation, self-esteem and peer physical activity norms. Data analysis will be largely descriptive and focus on recruitment, attendance and data provision rates. The findings will inform the sample size required for a definitive trial. A detailed process evaluation using qualitative and quantitative methods will be conducted with a variety of stakeholders (i.e. pupils, parents, teachers and peer-supporter trainers) to identify areas of success and necessary improvements prior to proceeding to a definitive trial. This paper describes the protocol for the PLAN-A feasibility cluster randomised controlled trial which will provide the information necessary to design a fully-powered trial should PLAN-A demonstrate evidence of promise. ISRCTN12543546.

Evaluation of effects of an operational multidisciplinary team on antibiotic use in the medium to long term at a French university hospital.

PubMed

Demoré, Béatrice; Humbert, Pauline; Boschetti, Emmanuelle; Bevilacqua, Sibylle; Clerc-Urmès, Isabelle; May, Thierry; Pulcini, Céline; Thilly, Nathalie

2017-10-01

Background Antibiotic-resistant bacteria are a major public health problem throughout the world. In 2006, in accordance with the national guidelines for antibiotic use, the CHRU of Nancy created an operational multidisciplinary antibiotic team at one of its sites. In 2011, a cluster-controlled trial showed that the operational multidisciplinary antibiotic team (the intervention) had a favourable short-term effect on antibiotic use and costs. Objective Our objective was to determine whether these effects continued over the medium to long term (that is, 2-7 years after creation of the operational multidisciplinary antibiotic team, 2009-2014). Setting The 1800-bed University Hospital of Nancy (France). Method The effect in the medium to long term is measured according to the same criteria and assessed by the same methods as the first study. A cluster controlled trial was performed on the period 2009-2014. The intervention group comprised 11 medical and surgical wards in settings where the operational multidisciplinary antibiotic team was implemented and the control group comprised 6 wards without this operational team. Main outcome measure Consumption of antibiotics overall and by therapeutic class (in defined daily doses per 1000 patient-days) and costs savings (in €). Results The reduction in antibiotic use and costs continued, but at a lower rate than in the short term (11% between 2009 and 2014 compared with 33% between 2007 and 2009) at the site of the intervention. The principal decreases concerned fluoroquinolones and glycopeptides. At the site without an operational multidisciplinary antibiotic team (the control group), total antibiotic use remained stable. Between 2009 and 2014, costs fell 10.5% in the intervention group and 5.7% in the control group. Conclusion This study shows that it is possible to maintain the effectiveness over time of such an intervention and demonstrates its role in defining a hospital's antibiotic policy.

Local and systemic effects of fibrin and cyanoacrylate adhesives on lung lesions in rabbits

PubMed Central

Carvalho, Marcus V.H.; Marchi, Evaldo; Fruchi, Andre J.; Dias, Bruno V.B.; Pinto, Clovis L.; dos Santos, Geovane R.; Acencio, Milena M.P.

2017-01-01

OBJECTIVES: Tissue adhesives can be used to prevent pulmonary air leaks, which frequently occur after lung interventions. The objective of this study is to evaluate local and systemic effects of fibrin and cyanoacrylate tissue adhesives on lung lesions in rabbits. METHODS: Eighteen rabbits were submitted to videothoracoscopy + lung incision alone (control) or videothoracoscopy + lung incision + local application of fibrin or cyanoacrylate adhesive. Blood samples were collected and assessed for leukocyte, neutrophil and lymphocyte counts and interleukin-8 levels preoperatively and at 48 hours and 28 days post-operatively. After 28 days, the animals were euthanized for gross examination of the lung surface, and lung fragments were excised for histopathological analysis. RESULTS: Fibrin and cyanoacrylate produced similar adhesion scores of the lung to the parietal pleura. Microscopic analysis revealed uniform low-cellular tissue infiltration in the fibrin group and an intense tissue reaction characterized by dense inflammatory infiltration of granulocytes, giant cells and necrosis in the cyanoacrylate group. No changes were detected in the leukocyte, neutrophil or lymphocyte count at any time-point, while the interleukin-8 levels were increased in the fibrin and cyanoacrylate groups after 48 hours compared with the pre-operative control levels (p<0.01). CONCLUSION: Both adhesive agents promoted normal tissue healing, with a more pronounced local inflammatory reaction observed for cyanoacrylate. Among the serum markers of inflammation, only the interleukin-8 levels changed post-operatively, increasing after 48 hours and decreasing after 28 days to levels similar to those of the control group in both the fibrin and cyanoacrylate groups. PMID:29160425

Local and systemic effects of fibrin and cyanoacrylate adhesives on lung lesions in rabbits.

PubMed

Carvalho, Marcus V H; Marchi, Evaldo; Fruchi, Andre J; Dias, Bruno V B; Pinto, Clovis L; Dos Santos, Geovane R; Acencio, Milena M P

2017-10-01

Tissue adhesives can be used to prevent pulmonary air leaks, which frequently occur after lung interventions. The objective of this study is to evaluate local and systemic effects of fibrin and cyanoacrylate tissue adhesives on lung lesions in rabbits. Eighteen rabbits were submitted to videothoracoscopy + lung incision alone (control) or videothoracoscopy + lung incision + local application of fibrin or cyanoacrylate adhesive. Blood samples were collected and assessed for leukocyte, neutrophil and lymphocyte counts and interleukin-8 levels preoperatively and at 48 hours and 28 days post-operatively. After 28 days, the animals were euthanized for gross examination of the lung surface, and lung fragments were excised for histopathological analysis. Fibrin and cyanoacrylate produced similar adhesion scores of the lung to the parietal pleura. Microscopic analysis revealed uniform low-cellular tissue infiltration in the fibrin group and an intense tissue reaction characterized by dense inflammatory infiltration of granulocytes, giant cells and necrosis in the cyanoacrylate group. No changes were detected in the leukocyte, neutrophil or lymphocyte count at any time-point, while the interleukin-8 levels were increased in the fibrin and cyanoacrylate groups after 48 hours compared with the pre-operative control levels (p<0.01). Both adhesive agents promoted normal tissue healing, with a more pronounced local inflammatory reaction observed for cyanoacrylate. Among the serum markers of inflammation, only the interleukin-8 levels changed post-operatively, increasing after 48 hours and decreasing after 28 days to levels similar to those of the control group in both the fibrin and cyanoacrylate groups.

Association Between Surgeon Scorecard Use and Operating Room Costs.

PubMed

Zygourakis, Corinna C; Valencia, Victoria; Moriates, Christopher; Boscardin, Christy K; Catschegn, Sereina; Rajkomar, Alvin; Bozic, Kevin J; Soo Hoo, Kent; Goldberg, Andrew N; Pitts, Lawrence; Lawton, Michael T; Dudley, R Adams; Gonzales, Ralph

2017-03-01

Despite the significant contribution of surgical spending to health care costs, most surgeons are unaware of their operating room costs. To examine the association between providing surgeons with individualized cost feedback and surgical supply costs in the operating room. The OR Surgical Cost Reduction (OR SCORE) project was a single-health system, multihospital, multidepartmental prospective controlled study in an urban academic setting. Intervention participants were attending surgeons in orthopedic surgery, otolaryngology-head and neck surgery, and neurological surgery (n = 63). Control participants were attending surgeons in cardiothoracic surgery, general surgery, vascular surgery, pediatric surgery, obstetrics/gynecology, ophthalmology, and urology (n = 186). From January 1 to December 31, 2015, each surgeon in the intervention group received standardized monthly scorecards showing the median surgical supply direct cost for each procedure type performed in the prior month compared with the surgeon's baseline (July 1, 2012, to November 30, 2014) and compared with all surgeons at the institution performing the same procedure at baseline. All surgical departments were eligible for a financial incentive if they met a 5% cost reduction goal. The primary outcome was each group's median surgical supply cost per case. Secondary outcome measures included total departmental surgical supply costs, case mix index-adjusted median surgical supply costs, patient outcomes (30-day readmission, 30-day mortality, and discharge status), and surgeon responses to a postintervention study-specific health care value survey. The median surgical supply direct costs per case decreased 6.54% in the intervention group, from $1398 (interquartile range [IQR], $316-$5181) (10 637 cases) in 2014 to $1307 (IQR, $319-$5037) (11 820 cases) in 2015. In contrast, the median surgical supply direct cost increased 7.42% in the control group, from $712 (IQR, $202-$1602) (16 441 cases) in 2014 to $765 (IQR, $233-$1719) (17 227 cases) in 2015. This decrease represents a total savings of $836 147 in the intervention group during the 1-year study. After controlling for surgeon, department, patient demographics, and clinical indicators in a mixed-effects model, there was a 9.95% (95% CI, 3.55%-15.93%; P = .003) surgical supply cost decrease in the intervention group over 1 year. Patient outcomes were equivalent or improved after the intervention, and surgeons who received scorecards reported higher levels of cost awareness on the health care value survey compared with controls. Cost feedback to surgeons, combined with a small departmental financial incentive, was associated with significantly reduced surgical supply costs, without negatively affecting patient outcomes.

24 CFR 901.210 - Interventions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... operational areas (e.g., maintenance, modernization, occupancy, or financial management) or to a single... PUBLIC HOUSING MANAGEMENT ASSESSMENT PROGRAM § 901.210 Interventions. (a) Interventions under this part..., or participate in the selection of, an AME to assume management responsibility for a specific...

Evidence-Based and Value-Based Decision Making About Healthcare Design: An Economic Evaluation of the Safety and Quality Outcomes.

PubMed

Zadeh, Rana; Sadatsafavi, Hessam; Xue, Ryan

2015-01-01

This study describes a vision and framework that can facilitate the implementation of evidence-based design (EBD), scientific knowledge base into the process of the design, construction, and operation of healthcare facilities and clarify the related safety and quality outcomes for the stakeholders. The proposed framework pairs EBD with value-driven decision making and aims to improve communication among stakeholders by providing a common analytical language. Recent EBD research indicates that the design and operation of healthcare facilities contribute to an organization's operational success by improving safety, quality, and efficiency. However, because little information is available about the financial returns of evidence-based investments, such investments are readily eliminated during the capital-investment decision-making process. To model the proposed framework, we used engineering economy tools to evaluate the return on investments in six successful cases, identified by a literature review, in which facility design and operation interventions resulted in reductions in hospital-acquired infections, patient falls, staff injuries, and patient anxiety. In the evidence-based cases, calculated net present values, internal rates of return, and payback periods indicated that the long-term benefits of interventions substantially outweighed the intervention costs. This article explained a framework to develop a research-based and value-based communication language on specific interventions along the planning, design and construction, operation, and evaluation stages. Evidence-based and value-based design frameworks can be applied to communicate the life-cycle costs and savings of EBD interventions to stakeholders, thereby contributing to more informed decision makings and the optimization of healthcare infrastructures. © The Author(s) 2015.

The SAX Italian scientific satellite. The on-board implemented automation as a support to the ground control capability

NASA Technical Reports Server (NTRS)

Martelli, Andrea

1994-01-01

This paper presents the capabilities implemented in the SAX system for an efficient operations management during its in-flight mission. SAX is an Italian scientific satellite for x-ray astronomy whose major mission objectives impose quite tight constraints on the implementation of both the space and ground segment. The most relevant mission characteristics require an operative lifetime of two years, performing scientific observations both in contact and in noncontact periods, with a low equatorial orbit supported by one ground station, so that only a few minutes of communications are available each orbit. This operational scenario determines the need to have a satellite capable of performing the scheduled mission automatically and reacting autonomously to contingency situations. The implementation approach of the on-board operations management, through which the necessary automation and autonomy are achieved, follows a hierarchical structure. This has been achieved adopting a distributed avionic architecture. Nine different on-board computers, in fact, constitute the on-board data management system. Each of them performs the local control and monitors its own functions while the system level control is performed at a higher level by the data handling applications software. The SAX on-board architecture provides the ground operators with different options of intervention by three classes of telecommands. The management of the scientific operations will be scheduled by the operation control center via dedicated operating plans. The SAX satellite flight mode is presently being integrated at Alenia Spazio premises in Turin for a launch scheduled for the end of 1995. Once in orbit, the SAX satellite will be subject to intensive check-out activities in order to verify the required mission performances. An overview of the envisaged procedure and of the necessary on-ground activities is therefore depicted as well.

Protocol of a randomized controlled trial of sun protection interventions for operating engineers.

PubMed

Duffy, Sonia A; Ronis, David L; Waltje, Andrea H; Choi, Seung Hee

2013-03-26

Skin cancer are increasing and some types of skin cancer are among the most lethal cancers yet are easily preventable. However, sun protection interventions are rarely implemented among outdoor workers. Our prior work shows that Michigan Operating Engineers (heavy equipment operators) spend an average of 4-5 hours in the sun, about one-third reported getting sun burned at least once a summer, and over half burned more than once a summer. About three-quarters of the sample never or only sometimes used sun block. Using the Health Belief Model as a guide, this randomized controlled trial (RCT) will test the efficacy of four sun protection interventions targeting Operating Engineers: a) education only; b) education and mailed sunscreen; c) education and text message reminders; and, d) education, mailed sunscreen, and text message reminders. Participations in the study will be offered during regularly scheduled safety trainings at the Local 324 Training Center. Pre- and post-intervention surveys will be collected to determine changes in sunscreen use and sun burning, the primary dependent variables. The analyses will include: a) paired t-tests to determine changes over time (from pre-intervention to post-intervention) in outcome variables (sunscreen use and burning) separately in the 4 intervention groups, b) Repeated Measures Analysis of Variance (RM-ANOVA) to compare the changes in outcomes across the 4 groups, and c) t-tests on change scores as follow-ups to the RM-ANOVA to determine exactly which groups differ from each other. Based on the outcome of this study, we will develop a RO1 for wider scale testing and dissemination in conjunction with the International Training Center which services North America (including the US, Mexico, and Canada). Wide scale dissemination of an efficacious sun protection intervention has the potential to substantially impact skin cancer rates among this population. The ultimate goal is for high reach, high efficacy, and low cost. NCT01804595.

Protocol of a randomized controlled trial of sun protection interventions for operating engineers

PubMed Central

2013-01-01

Background Skin cancer are increasing and some types of skin cancer are among the most lethal cancers yet are easily preventable. However, sun protection interventions are rarely implemented among outdoor workers. Our prior work shows that Michigan Operating Engineers (heavy equipment operators) spend an average of 4–5 hours in the sun, about one-third reported getting sun burned at least once a summer, and over half burned more than once a summer. About three-quarters of the sample never or only sometimes used sun block. Methods/design Using the Health Belief Model as a guide, this randomized controlled trial (RCT) will test the efficacy of four sun protection interventions targeting Operating Engineers: a) education only; b) education and mailed sunscreen; c) education and text message reminders; and, d) education, mailed sunscreen, and text message reminders. Participations in the study will be offered during regularly scheduled safety trainings at the Local 324 Training Center. Pre- and post-intervention surveys will be collected to determine changes in sunscreen use and sun burning, the primary dependent variables. The analyses will include: a) paired t-tests to determine changes over time (from pre-intervention to post–intervention) in outcome variables (sunscreen use and burning) separately in the 4 intervention groups, b) Repeated Measures Analysis of Variance (RM-ANOVA) to compare the changes in outcomes across the 4 groups, and c) t-tests on change scores as follow-ups to the RM-ANOVA to determine exactly which groups differ from each other. Discussion Based on the outcome of this study, we will develop a RO1 for wider scale testing and dissemination in conjunction with the International Training Center which services North America (including the US, Mexico, and Canada). Wide scale dissemination of an efficacious sun protection intervention has the potential to substantially impact skin cancer rates among this population. The ultimate goal is for high reach, high efficacy, and low cost. Trial registration NCT01804595 PMID:23530608

Ionizing radiation exposure in interventional cardiology: current radiation protection practice of invasive cardiology operators in Lithuania.

PubMed

Valuckiene, Zivile; Jurenas, Martynas; Cibulskaite, Inga

2016-09-01

Ionizing radiation management is among the most important safety issues in interventional cardiology. Multiple radiation protection measures allow the minimization of x-ray exposure during interventional procedures. Our purpose was to assess the utilization and effectiveness of radiation protection and optimization techniques among interventional cardiologists in Lithuania. Interventional cardiologists of five cardiac centres were interviewed by anonymized questionnaire, addressing personal use of protective garments, shielding, table/detector positioning, frame rate (FR), resolution, field of view adjustment and collimation. Effective patient doses were compared between operators who work with and without x-ray optimization. Thirty one (68.9%) out of 45 Lithuanian interventional cardiologists participated in the survey. Protective aprons were universally used, but not the thyroid collars; 35.5% (n  =  11) operators use protective eyewear and 12.9% (n  =  4) wear radio-protective caps; 83.9% (n  =  26) use overhanging shields, 58.1% (n  =  18)-portable barriers; 12.9% (n  =  4)-abdominal patient's shielding; 35.5% (n  =  11) work at a high table position; 87.1% (n  =  27) keep an image intensifier/receiver close to the patient; 58.1% (n  =  18) reduce the fluoroscopy FR; 6.5% (n  =  2) reduce the fluoro image detail resolution; 83.9% (n  =  26) use a 'store fluoro' option; 41.9% (N  =  13) reduce magnification for catheter transit; 51.6% (n  =  16) limit image magnification; and 35.5% (n  =  11) use image collimation. Median effective patient doses were significantly lower with x-ray optimization techniques in both diagnostic and therapeutic interventions. Many of the ionizing radiation exposure reduction tools and techniques are underused by a considerable proportion of interventional cardiology operators. The application of basic radiation protection tools and techniques effectively reduces ionizing radiation exposure and should be routinely used in practice.

Operational performance of an STD control programme in Mwanza Region, Tanzania.

PubMed

Grosskurth, H; Mwijarubi, E; Todd, J; Rwakatare, M; Orroth, K; Mayaud, P; Cleophas, B; Buvé, A; Mkanje, R; Ndeki, L; Gavyole, A; Hayes, R; Mabey, D

2000-12-01

To describe important details of the design and operational features of the Mwanza sexually transmitted diseases (STD) control programme. To assess the feasibility of the intervention, the distribution of STD syndromes observed, the clinical effectiveness of syndromic STD case management, the utilisation of STD services by the population, and the quality of syndromic STD services delivered at rural health units. The intervention was integrated into rural primary healthcare (PHC) units. It comprised improved STD case management using the syndromic approach, facilitated by a regional programme office which ensured the training of health workers, a reliable supply of effective drugs, and regular support supervision. Five studies were performed to evaluate operational performance: (i) a survey of register books to collect data on patients presenting with STDs and reproductive tract infections (RTIs) to rural health units with improved STD services, (ii) a survey of register books from health units in communities without improved services, (iii) a survey of register books from referral clinics, (iv) a home based cross sectional study of STD patients who did not return to the intervention health units for follow up, (v) a cross sectional survey of reported STD treatment seeking behaviour in a random cohort of 8845 adults served by rural health units. During the 2 years of the Mwanza trial, 12,895 STD syndromes were treated at the 25 intervention health units. The most common syndromes were urethral discharge (67%) and genital ulcers (26%) in men and vaginal discharge (50%), lower abdominal tenderness (33%), and genital ulcers (13%) in women. Clinical treatment effectiveness was high in patients from whom complete follow up data were available, reaching between 81% and 98% after first line treatment and 97%-99% after first, second, and third line treatment. Only 26% of patients referred to higher levels of health care had presented to their referral institutions. During the trial period, data from the cohort showed that 12.8% of men and 8.6% of women in the intervention communities experienced at least one STD syndrome. Based on various approaches, utilisation of the improved health units by symptomatic STD patients in these communities was estimated at between 50% and 75%. During the first 6 months of intervention attendance at intervention units increased by 53%. Thereafter, the average attendance rate was about 25% higher than in comparison communities. Home visits to 367 non-returners revealed that 89% had been free of symptoms after treatment, but 28% became symptomatic again within 3 months of treatment. 100% of these patients reported that they had received treatment, but only 74% had been examined, only 57% had been given health education, and only 30% were offered condoms. Patients did not fully recall which treatment they had been given, but possibly only 63% had been treated exactly according to guidelines. This study demonstrated that it is feasible to integrate effective STD services into the existing PHC structure of a developing country. Improved services attract more patients, but additional educational efforts are needed to further improve treatment seeking behaviour. Furthermore, clear treatment guidelines, a reliable drug supply system, and regular supervision are critical. All efforts should be made to treat patients on the spot, without delay, as referral to higher levels of care led to a high number of dropouts. The syndromic approach to STD control should be supported by at least one reference clinic and laboratory per country to ensure monitoring of prevalent aetiologies, of the development of bacterial resistance, and of the effectiveness of the syndromic algorithms in use.

Building Consensus: Development of Best Practice Guidelines on Wrong Level Surgery in Spinal Deformity.

PubMed

Vitale, Michael; Minkara, Anas; Matsumoto, Hiroko; Albert, Todd; Anderson, Richard; Angevine, Peter; Buckland, Aaron; Cho, Samuel; Cunningham, Matthew; Errico, Thomas; Fischer, Charla; Kim, Han Jo; Lehman, Ronald; Lonner, Baron; Passias, Peter; Protopsaltis, Themistocles; Schwab, Frank; Lenke, Lawrence

Consensus-building using the Delphi and nominal group technique. To establish best practice guidelines using formal techniques of consensus building among a group of experienced spinal deformity surgeons to avert wrong-level spinal deformity surgery. Numerous previous studies have demonstrated that wrong-level spinal deformity occurs at a substantial rate, with more than half of all spine surgeons reporting direct or indirect experience operating on the wrong levels. Nevertheless, currently, guidelines to avert wrong-level spinal deformity surgery have not been developed. The Delphi process and nominal group technique were used to formally derive consensus among 16 fellowship-trained spine surgeons. Surgeons were surveyed for current practices, presented with the results of a systematic review, and asked to vote anonymously for or against item inclusion during three iterative rounds. Agreement of 80% or higher was considered consensus. Items near consensus (70% to 80% agreement) were probed in detail using the nominal group technique in a facilitated group meeting. Participants had a mean of 13.4 years of practice (range: 2-32 years) and 103.1 (range: 50-250) annual spinal deformity surgeries, with a combined total of 24,200 procedures. Consensus was reached for the creation of best practice guidelines (BPGs) consisting of 17 interventions to avert wrong-level surgery. A final checklist consisting of preoperative and intraoperative methods, including standardized vertebral-level counting and optimal imaging criteria, was supported by 100% of participants. We developed consensus-based best practice guidelines for the prevention of wrong-vertebral-level surgery. This can serve as a tool to reduce the variability in preoperative and intraoperative practices and guide research regarding the effectiveness of such interventions on the incidence of wrong-level surgery. Level V. Copyright © 2017 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Health inequalities in Germany: do regional-level variables explain differentials in cardiovascular risk?

PubMed Central

Breckenkamp, Juergen; Mielck, Andreas; Razum, Oliver

2007-01-01

Background Socioeconomic status is a predictor not only of mortality, but also of cardiovascular risk and morbidity. An ongoing debate in the field of social inequalities and health focuses on two questions: 1) Is individual health status associated with individual income as well as with income inequality at the aggregate (e. g. regional) level? 2) If there is such an association, does it operate via a psychosocial pathway (e.g. stress) or via a "neo-materialistic" pathway (e.g. systematic under-investment in societal infrastructures)? For the first time in Germany, we here investigate the association between cardiovascular health status and income inequality at the area level, controlling for individual socio-economic status. Methods Individual-level explanatory variables (age, socio-economic status) and outcome data (body mass index, blood pressure, cholesterol level) as well as the regional-level variable (proportion of relative poverty) were taken from the baseline survey of the German Cardiovascular Prevention Study, a cross-sectional, community-based, multi-center intervention study, comprising six socio-economically diverse intervention regions, each with about 1800 participants aged 25–69 years. Multilevel modeling was used to examine the effects of individual and regional level variables. Results Regional effects are small compared to individual effects for all risk factors analyzed. Most of the total variance is explained at the individual level. Only for diastolic blood pressure in men and for cholesterol in both men and women is a statistically significant effect visible at the regional level. Conclusion Our analysis does not support the assumption that in Germany cardiovascular risk factors were to a large extent associated with income inequality at regional level. PMID:17603918

Does the Modified Gartland Classification Clarify Decision Making?

PubMed

Leung, Sophia; Paryavi, Ebrahim; Herman, Martin J; Sponseller, Paul D; Abzug, Joshua M

2018-01-01

The modified Gartland classification system for pediatric supracondylar fractures is often utilized as a communication tool to aid in determining whether or not a fracture warrants operative intervention. This study sought to determine the interobserver and intraobserver reliability of the Gartland classification system, as well as to determine whether there was agreement that a fracture warranted operative intervention regardless of the classification system. A total of 200 anteroposterior and lateral radiographs of pediatric supracondylar humerus fractures were retrospectively reviewed by 3 fellowship-trained pediatric orthopaedic surgeons and 2 orthopaedic residents and then classified as type I, IIa, IIb, or III. The surgeons then recorded whether they would treat the fracture nonoperatively or operatively. The κ coefficients were calculated to determine interobserver and intraobserver reliability. Overall, the Wilkins-modified Gartland classification has low-moderate interobserver reliability (κ=0.475) and high intraobserver reliability (κ=0.777). A low interobserver reliability was found when differentiating between type IIa and IIb (κ=0.240) among attendings. There was moderate-high interobserver reliability for the decision to operate (κ=0.691) and high intraobserver reliability (κ=0.760). Decreased interobserver reliability was present for decision to operate among residents. For fractures classified as type I, the decision to operate was made 3% of the time and 27% for type IIa. The decision was made to operate 99% of the time for type IIb and 100% for type III. There is almost full agreement for the nonoperative treatment of Type I fractures and operative treatment for type III fractures. There is agreement that type IIb fractures should be treated operatively and that the majority of type IIa fractures should be treated nonoperatively. However, the interobserver reliability for differentiating between type IIa and IIb fractures is low. Our results validate the Gartland classfication system as a method to help direct treatment of pediatric supracondylar humerus fractures, although the modification of the system, IIa versus IIb, seems to have limited reliability and utility. Terminology based on decision to treat may lead to a more clinically useful classification system in the evaluation and treatment of pediatric supracondylar humerus fractures. Level III-diagnostic studies.

Exploring the mental health benefits of participation in an Australian anti-racism intervention.

PubMed

Kelaher, Margaret; Ferdinand, Angeline S; Paradies, Yin; Warr, Deborah

2018-02-01

There is a vast body of research demonstrating the deleterious effects of racism on health. Despite this, there is limited research that considers the health benefits of anti-racism interventions. We assess the mental health effects for young people participating in an anti-racism intervention that was based on the principles of intergroup contact theory and delivered through five projects addressing specific issues and contexts. An evaluation of the intervention used a before-and-after design. The analyses reported here focus on data collected from participants who completed both pre- and post-intervention surveys (n = 246). Analyses examine the characteristics of participants, the environment for intergroup contact (equal status between ethnic groups, shared goals, co-operation and institutional support for intergroup relationships) and basic psychological needs (competence, relatedness and autonomy) as defined by Self-Determination Theory. The results suggest that the projects met the criteria for promoting positive intergroup contact. There was also evidence that participants' involvement in these projects had positive effects on their autonomy, with particular improvements among people with ethnicities other than 'Australian'. The findings suggest that anti-racism interventions can have positive mental health effects for participants. These benefits redress some of the individual-level effects of racism experiences by supporting young people to develop confidence and self-esteem. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

A research model--forecasting incident rates from optimized safety program intervention strategies.

PubMed

Iyer, P S; Haight, J M; Del Castillo, E; Tink, B W; Hawkins, P W

2005-01-01

INTRODUCTION/PROBLEM: Property damage incidents, workplace injuries, and safety programs designed to prevent them, are expensive aspects of doing business in contemporary industry. The National Safety Council (2002) estimated that workplace injuries cost $146.6 billion per year. Because companies are resource limited, optimizing intervention strategies to decrease incidents with less costly programs can contribute to improved productivity. Systematic data collection methods were employed and the forecasting ability of a time-lag relationship between interventions and incident rates was studied using various statistical methods (an intervention is not expected to have an immediate nor infinitely lasting effect on the incident rate). As a follow up to the initial work, researchers developed two models designed to forecast incident rates. One is based on past incident rate performance and the other on the configuration and level of effort applied to the safety and health program. Researchers compared actual incident performance to the prediction capability of each model over 18 months in the forestry operations at an electricity distribution company and found the models to allow accurate prediction of incident rates. These models potentially have powerful implications as a business-planning tool for human resource allocation and for designing an optimized safety and health intervention program to minimize incidents. Depending on the mathematical relationship, one can determine what interventions, where and how much to apply them, and when to increase or reduce human resource input as determined by the forecasted performance.

Closing Achievement Gaps with a Utility-Value Intervention: Disentangling Race and Social Class

PubMed Central

Harackiewicz, Judith M.; Canning, Elizabeth A.; Tibbetts, Yoi; Priniski, Stacy J.; Hyde, Janet S.

2015-01-01

Many college students abandon their goal of completing a degree in STEM when confronted with challenging introductory-level science courses. In the U.S., this trend is more pronounced for underrepresented minority (URM) and first-generation (FG) students, and contributes to persisting racial and social-class achievement gaps in higher education. Previous intervention studies have focused exclusively on race or social class, but have not examined how the two may be confounded and interact. This research therefore investigates the independent and interactive effects of race and social class as moderators of an intervention designed to promote performance, measured by grade in the course. In a double-blind randomized experiment conducted over four semesters of an introductory biology course (N = 1040), we tested the effectiveness of a utility-value intervention in which students wrote about the personal relevance of course material. The utility-value intervention was successful in reducing the achievement gap for FG-URM students by 61%: the performance gap for FG-URM students, relative to CG-Majority students, was large in the control condition, .84 grade points (d = .98), and the treatment effect for FG-URM students was .51 grade points (d = 0.55). The UV intervention helped students from all groups find utility value in the course content, and mediation analyses showed that the process of writing about utility value was particularly powerful for FG-URM students. Results highlight the importance of examining the independent and interactive effects of race and social class when evaluating interventions to close achievement gaps and the mechanisms through which they may operate. PMID:26524001

The working alliance and Clinician-assisted Emotional Disclosure for rheumatoid arthritis.

PubMed

Lumley, Mark A; Anderson, Timothy; Ankawi, Brett; Goldman, Gregory; Perri, LisaCaitlin M; Bianco, Joseph A; Keefe, Francis J

2018-01-01

The working alliance predicts improvement following general psychotherapy, but how it operates in brief interventions conducted with medically ill patients is unknown. Also, the role of the working alliance may differ in emotion-focused versus educational interventions. We report secondary analyses of a randomized clinical trial (Keefe et al.) [35], in which patients with rheumatoid arthritis (RA) received four nurse-provided sessions of either a) Clinician-assisted Emotional Disclosure (CAED), which emphasized the disclosure, expression, and processing of emotions related to stressful events; or b) Arthritis Education (AE), which provided basic education about RA. The Working Alliance Inventory was completed by both patient and nurse after each session. Patients were evaluated on multiple health measures at baseline and 1, 3, and 12months post-treatment. Analyses compared the alliance between interventions and related the alliance to outcomes within interventions. Patients in CAED reported a lower alliance than patients in AE. Interestingly, in CAED, lower alliance ratings predicted better outcomes (improved functioning, lower pain behaviors, lower inflammation, lower daily stress), whereas in AE, the working alliance was largely not predictive of outcomes. Having nurses encourage emotional disclosure among patients with RA reduced the patients' working alliance, but a lower alliance nonetheless predicted better patient outcomes, perhaps reflecting successful engagement in an intervention that is emotionally and relationally challenging. The level and predictive validity of the working alliance likely depends on patient, provider, and intervention factors, and further study of the working alliance in psychosocial interventions in the medical context is needed. Copyright © 2017 Elsevier Inc. All rights reserved.

Determining Responsiveness to Tier 2 Intervention in Response to Intervention: Level of Performance, Growth, or Both

ERIC Educational Resources Information Center

Milburn, Trelani F.; Lonigan, Christopher J.; Phillips, Beth M.

2017-01-01

This response to intervention study examined agreement between classification methods of preschool children's responsiveness to Tier 2 intervention using level of performance (25th percentile), growth (equivalent to small and medium effect sizes), and both level of performance and growth in a dual-discrepancy approach. Overall, 181 children…

The efficacy of exercise referral as an intervention for Irish male prisoners presenting with mental health symptoms.

PubMed

O'Toole, Shay; Maguire, Jim; Murphy, Pearse

2018-06-11

Purpose The use of exercise as an intervention to improve health in the general population is well documented. The purpose of this paper is to explore whether an exercise referral scheme can be an effective health promotion tool for male prisoners in Ireland, presenting with mental health symptoms. Design/methodology/approach This mixed methods study with a pre- and post-intervention design was conducted in Mountjoy Prison, Dublin, which has a capacity for approximately 790 prisoners. Reliable and validated symptom assessment scales were used to assess levels of depression, anxiety, stress, self-esteem and anger amongst a sample of 40 prisoners pre- and post-intervention. The scales used were the Depression, Anxiety and Stress scale or DASS-42 (Lovibond and Lovibond, 1995), the Novaco Anger Scale (Novaco, 1994), the Rosenberg Self-Esteem Scale ( Rosenberg, 1965 ) and the Zung Self-Rated Anxiety Scale (Zung, 1971). Semi-structured interviews were also conducted with a subset of the participants post-intervention to further test and contextualise the symptom ratings. The data gathered from the self-rating scales were imported into SPSS 22 for statistical testing for significance. Wilcoxon's signed-rank test was then used to measure significance of changes. Thematic analysis was performed on the qualitative data. Findings In the post-intervention, significant levels of improvement were achieved in the levels of depression, anxiety (DASS), anxiety (Zung), stress, anger, and self-esteem for 29 of the 30 prisoners who completed the study. The incidence of normal mood scores rose from 33 to 90 per cent after the intervention; the incidence of extremely severe scores for anxiety changed from 40 to 7 per cent, severe stress scores changed from 27 to 3 per cent, normal stress levels rose from 17 to 73 per cent, marked anger ratings reduced from 40 to 3 per cent and low self-esteem levels reduced from 20 per cent of participants pre-intervention to 7 per cent post-intervention. In the main, participants perceived the experiences and outcomes of the intervention positively. Research limitations/implications There are some limitations to the design of this study. Operational circumstances within the prison at the start of this study prevented the authors from accessing a larger sample. A control group would add greatly to the study but this was not possible within a single prison setting. The possible influence of extraneous variables such as increased attention and social contact, and more time out of one's cell may have contributed to improved symptom scores as much as the exercise intervention in this study. This possibility was recognised from the outset but the authors proceeded because the aim was to test if an exercise referral package (and all that inevitably goes with that) would make a difference for symptomatic prisoners. Practical implications The organisation and smooth running of the intervention and the positive results therein underpinned the practicality of this project. The significantly positive results contribute new knowledge to the profile of Irish male prisoners' mental health. Social implications This study could be the foundation for a larger study or set of studies which should include a control group and one or more female prisoner cohorts. The impact of positive changes in prisoners' mental health on the prison staff and environment could also be researched. This type of study could lead to important social implications in relation to its impact on prisoner rehabilitation. Originality/value This study was the first of its kind to explore the effectiveness of exercise referral as a health promotion intervention for Irish male prisoners presenting with mental health symptoms.

Improving health aid for a better planet: The planning, monitoring and evaluation tool (PLANET)

PubMed Central

Sridhar, Devi; Car, Josip; Chopra, Mickey; Campbell, Harry; Woods, Ngaire; Rudan, Igor

2015-01-01

Background International development assistance for health (DAH) quadrupled between 1990 and 2012, from US$ 5.6 billion to US$ 28.1 billion. This generates an increasing need for transparent and replicable tools that could be used to set investment priorities, monitor the distribution of funding in real time, and evaluate the impact of those investments. Methods In this paper we present a methodology that addresses these three challenges. We call this approach PLANET, which stands for planning, monitoring and evaluation tool. Fundamentally, PLANET is based on crowdsourcing approach to obtaining information relevant to deployment of large–scale programs. Information is contributed in real time by a diverse group of participants involved in the program delivery. Findings PLANET relies on real–time information from three levels of participants in large–scale programs: funders, managers and recipients. At each level, information is solicited to assess five key risks that are most relevant to each level of operations. The risks at the level of funders involve systematic neglect of certain areas, focus on donor’s interests over that of program recipients, ineffective co–ordination between donors, questionable mechanisms of delivery and excessive loss of funding to “middle men”. At the level of managers, the risks are corruption, lack of capacity and/or competence, lack of information and /or communication, undue avoidance of governmental structures / preference to non–governmental organizations and exclusion of local expertise. At the level of primary recipients, the risks are corruption, parallel operations / “verticalization”, misalignment with local priorities and lack of community involvement, issues with ethics, equity and/or acceptability, and low likelihood of sustainability beyond the end of the program’s implementation. Interpretation PLANET is intended as an additional tool available to policy–makers to prioritize, monitor and evaluate large–scale development programs. In this, it should complement tools such as LiST (for health care/interventions), EQUIST (for health care/interventions) and CHNRI (for health research), which also rely on information from local experts and on local context to set priorities in a transparent, user–friendly, replicable, quantifiable and specific, algorithmic–like manner. PMID:26322228

Improving health aid for a better planet: The planning, monitoring and evaluation tool (PLANET).

PubMed

Sridhar, Devi; Car, Josip; Chopra, Mickey; Campbell, Harry; Woods, Ngaire; Rudan, Igor

2015-12-01

International development assistance for health (DAH) quadrupled between 1990 and 2012, from US$ 5.6 billion to US$ 28.1 billion. This generates an increasing need for transparent and replicable tools that could be used to set investment priorities, monitor the distribution of funding in real time, and evaluate the impact of those investments. In this paper we present a methodology that addresses these three challenges. We call this approach PLANET, which stands for planning, monitoring and evaluation tool. Fundamentally, PLANET is based on crowdsourcing approach to obtaining information relevant to deployment of large-scale programs. Information is contributed in real time by a diverse group of participants involved in the program delivery. PLANET relies on real-time information from three levels of participants in large-scale programs: funders, managers and recipients. At each level, information is solicited to assess five key risks that are most relevant to each level of operations. The risks at the level of funders involve systematic neglect of certain areas, focus on donor's interests over that of program recipients, ineffective co-ordination between donors, questionable mechanisms of delivery and excessive loss of funding to "middle men". At the level of managers, the risks are corruption, lack of capacity and/or competence, lack of information and /or communication, undue avoidance of governmental structures / preference to non-governmental organizations and exclusion of local expertise. At the level of primary recipients, the risks are corruption, parallel operations / "verticalization", misalignment with local priorities and lack of community involvement, issues with ethics, equity and/or acceptability, and low likelihood of sustainability beyond the end of the program's implementation. PLANET is intended as an additional tool available to policy-makers to prioritize, monitor and evaluate large-scale development programs. In this, it should complement tools such as LiST (for health care/interventions), EQUIST (for health care/interventions) and CHNRI (for health research), which also rely on information from local experts and on local context to set priorities in a transparent, user-friendly, replicable, quantifiable and specific, algorithmic-like manner.

The role of auxiliary nurse-midwives and community health volunteers in expanding access to medical abortion in rural Nepal.

PubMed

Puri, Mahesh; Tamang, Anand; Shrestha, Prabhakar; Joshi, Deepak

2015-02-01

Medical abortion was introduced in Nepal in 2009, but rural women's access to medical abortion services remained limited. We conducted a district-level operations research study to assess the effectiveness of training 13 auxiliary nurse-midwives as medical abortion providers, and 120 female community health volunteers as communicators and referral agents for expanding access to medical abortion for rural women. Interviews with service providers and women who received medical abortion were undertaken and service statistics were analysed. Compared to a neighbouring district with no intervention, there was a significant increase in the intervention area in community health volunteers' knowledge of the legal conditions for abortion, the advantages and disadvantages of medical abortion, safe places for an abortion, medical abortion drugs, correct gestational age for home use of medical abortion, and carrying out a urine pregnancy test. In a one-year period in 2011-12, the community health volunteers did pregnancy tests for 584 women and referred 114 women to the auxiliary nurse-midwives for abortion; 307 women in the intervention area received medical abortion services from auxiliary nurse-midwives. There were no complications that required referral to a higher-level facility except for one incomplete abortion. Almost all women who opted for medical abortion were happy with the services provided. The study demonstrated that auxiliary nurse-midwives can independently and confidently provide medical abortion safely and effectively at the sub-health post level, and community health volunteers are effective change agents in informing women about medical abortion. Copyright © 2015 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Sensory stimulation programme to improve recovery in comatose patients.

PubMed

Oh, Hyunsoo; Seo, Whasook

2003-05-01

The purpose of this study was to examine whether positive changes in consciousness level after applying a sensory stimulation programme exceed natural recovery. A single experimental group interrupted time series design was used. Subjects were brain-injured patients who were hospitalized at a university hospital in South Korea. The sensory stimulation programme was composed of auditory, visual, olfactory, gustatory, tactile and physical stimulation. Levels of consciousness were evaluated using the Glasgow Coma Scale. The intervention was carried out twice, first for 4 weeks, then a recession period was allowed for 4 weeks, and immediately after this the second intervention was implemented for 4 weeks. Results showed significant alterations in consciousness levels 2 weeks after starting intervention 1. This effect increased gradually and was maintained for 3-4 weeks. However, consciousness levels began to decrease 2 weeks after terminating intervention 1 and this decrement continued until starting intervention 2. The pattern of improvement of intervention 1 could be represented as a gradual onset and temporary duration model. At the beginning of intervention 2, consciousness levels were maintained at a low level. However, they began to increase again after 2 weeks and this increment continued even after terminating intervention 2. Therefore, the effect of intervention 2 could be represented as a gradual onset and permanent duration model. These results suggest that an intervention programme should be applied for more than 1 month to achieve a permanent effect on consciousness levels and that at least 2 weeks are required for any significant effect.

Intervention Integrity in the Low Countries: Interventions Targeting Social-Emotional Behaviors in the School

ERIC Educational Resources Information Center

Taal, Margot; Ekels, Elles; van der Valk, Cindel; van der Molen, Maurits

2017-01-01

The current study presents a review of intervention studies conducted in the Low Countries (i.e., The Netherlands and Flanders) focusing on social-emotional behaviors in the school. The primary purpose of this review was to assess whether studies included an operational definition of the intervention under study and reported data on the…

[Effects of an Oral Care Program on the Swallowing Function in Post-Operative Patients With Oral Cancer].

PubMed

Hsiang, Ching-Chi; Hwu, Yueh-Juen

2017-04-01

Oral cancer is the fourth leading cause of death among men in Taiwan. Dysphagia, choking, and aspiration pneumonia are often noted in post-operative patients with oral cancer. Improving patients' swallowing function is an urgent problem that cannot be neglected. To investigate the effects of an oral care program on the swallowing function of post-operative patients with oral cancer. A quasi-experimental research design was conducted and post-operative patients with oral cancer were recruited. The experimental group (n = 20) received 12 weeks of the oral care program intervention, while the control group (n = 20) received standard post-operative care. The modified barium swallow (MBS) study and self-rated degree of dysphagia were compared between the two groups after the intervention period. Post-intervention scores on the MBS test and for the self-rated degree of dysphagia were significantly better in the experimental group than in the control group (p < .001). Performing the oral care program was found to improve the swallowing function of post-operative patients with oral cancer. The results of the present study provide a reference for healthcare providers to improve quality of care.

Shifting away from doorstep distribution of contraceptives in urban Bangladesh: effects on discontinuation and acceptance of family planning.

PubMed

Routh, S; Jahan, S A

2000-01-01

This paper examined the effects of alternative service-delivery strategies with regard to dropouts among the current pill and condom users who, before the intervention, were supplied with the methods by the fieldworkers at their homes in an operations research conducted by the Centre for Health and Population Research in urban Bangladesh. Moreover, the effects of the selective home visitation approach on acceptance of modern family planning methods among current nonusers were assessed. Two program areas of the Concerned Women for Family Planning in Dhaka City, one each at Wari and Siddiquebazar, served as the comparison areas. Data for the analyses came from the service records of the fieldworkers and community-based surveys. Results showed that the contraceptive prevalence rate (CPR) considerably increased in both the intervention areas: from the pre-intervention level of 63% to 68% at the Hazaribag primary health care clinic (PHCC) intervention area and from 55% to 57% at the Gandaria community service points (CSPs) intervention area. The corresponding increases at the two comparison areas were from 61% to 63% at Wari and from 60% to 63% at Siddiquebazar. The quantitative growth in the CPR in the PHCC-based strategy clearly indicated the comparative advantage of the clinic-based strategy in terms of sustainable program performance over conventional doorstep CBD- and CSP-based strategies.

The International Classification of Functioning, Disability and Health and the version for children and youth as a tool in child habilitation/early childhood intervention--feasibility and usefulness as a common language and frame of reference for practice.

PubMed

Björck-Åkesson, Eva; Wilder, Jenny; Granlund, Mats; Pless, Mia; Simeonsson, Rune; Adolfsson, Margareta; Almqvist, Lena; Augustine, Lilly; Klang, Nina; Lillvist, Anne

2010-01-01

Early childhood intervention and habilitation services for children with disabilities operate on an interdisciplinary basis. It requires a common language between professionals, and a shared framework for intervention goals and intervention implementation. The International Classification of Functioning, Disability and Health (ICF) and the version for children and youth (ICF-CY) may serve as this common framework and language. This overview of studies implemented by our research group is based on three research questions: Do the ICF-CY conceptual model have a valid content and is it logically coherent when investigated empirically? Is the ICF-CY classification useful for documenting child characteristics in services? What difficulties and benefits are related to using ICF-CY model as a basis for intervention when it is implemented in services? A series of studies, undertaken by the CHILD researchers are analysed. The analysis is based on data sets from published studies or master theses. Results and conclusion show that the ICF-CY has a useful content and is logically coherent on model level. Professionals find it useful for documenting children's body functions and activities. Guidelines for separating activity and participation are needed. ICF-CY is a complex classification, implementing it in services is a long-term project.

Correlation of Level of Trauma Activation With Emergency Department Intervention.

PubMed

Cooper, Michael C; Srivastava, Geetanjali

2018-06-01

In-hospital trauma team activation criteria are formulated to identify severely injured patients requiring specialized multidisciplinary care. Efficacy of trauma activation (TA) criteria is commonly measured by emergency department (ED) disposition, injury severity score, and mortality. Necessity of critical ED interventions is another measure that has been proposed to evaluate the appropriateness of TA criteria. Two-year retrospective cohort study of 1715 patients from our trauma registry at a Level 1 pediatric trauma center. We abstracted data on acute interventions, level and criterion of TA, ED disposition, and mortality. We report odds ratio (OR) with 95% confidence intervals (CIs), positive predictive value, and frequency of acute interventions. Trauma activation was initiated for 947 (55%) of the 1715 patients. There were 426 ED interventions performed on 235 patients (14%); 67.8% were in level 1 activations; 17.6% in level 2, and 14.6% in level 3. Highest-level activations were highly associated with need for ED interventions (OR, 16.1; 95% CI, 11.5-22.4). The ORs for requiring an ED intervention were low for lower level activations (OR, 0.4; 95% CI, 0.3-0.5), trauma service consults (OR, 0.3; 95% CI, 0.2-0.4), and certain mechanism-based criteria. The ORs for ED intervention for isolated motor vehicle collision (0.2; 95% CI, 0.1-0.7), isolated all-terrain vehicle rollover (0.4; 95% CI, 0.1-1.7), and suspected spinal cord injury (0.5; 95% CI, 0.1-3.7) were significantly lower than 1. Highest-level activation criteria correlate with high utilization of ED resources and interventions. Lower level activation criteria and trauma service consult criteria are not highly correlated with need for ED interventions. Downgrading isolated motor vehicle collision and all-terrain vehicle rollovers and suspected spinal cord injury to lower level activations could decrease the overtriage rate, and adding age-specific bradycardia as a physiologic criterion could improve our undertriage rate.

Closed-loop systems for drug delivery.

PubMed

Fields, Aaron M; Fields, Kevin M; Cannon, Jeremy W

2008-08-01

To discuss closed-loop systems, the engineering behind them, and the application of these systems. The literature demonstrates that closed-loop systems can be used for controlling the depth of anesthesia, muscle relaxation, blood pressure, intravascular volume, and blood glucose levels. The future anesthesiologist may devote less time to easily delegated tasks when in the operating room. The ability of computers to maintain variables in a set range allows some tasks to be automated. Although monitoring of these systems will never be completely eliminated, the necessity for minute-to-minute intervention may.

A surgical intervention for the body politic: Generation Squeeze applies the Advocacy Coalition Framework to social determinants of health knowledge translation.

PubMed

Kershaw, Paul; Swanson, Eric; Stucchi, Andrea

2017-06-16

The World Health Organization Commission on the Social Determinants of Health (SDoH) observes that building political will is central to all its recommendations, because governments respond to those who organize and show up. Since younger Canadians are less likely to vote or to organize in between elections, they are less effective at building political will than their older counterparts. This results in an age gap between SDoH research and government budget priorities. Whereas Global AgeWatch ranks Canada among the top countries for aging, UNICEF ranks Canada among the least generous OECD (Organisation for Economic Co-operation and Development) countries for the generations raising young children. A surgical intervention into the body politic. Guided by the "health political science" literature, the intervention builds a non-profit coalition to perform science-based, non-partisan democratic engagement to increase incentives for policy-makers to translate SDoH research about younger generations into government budget investments. All four national parties integrated policy recommendations from the intervention into their 2015 election platforms. Three referred to, or consulted with, the intervention during the election. The intervention coincided with all parties committing to the single largest annual increase in spending on families with children in over a decade. Since many population-level decisions are made in political venues, the concept of population health interventions should be broadened to include activities designed to mobilize SDoH science in the world of politics. Such interventions must engage with the power dynamics, values, interests and institutional factors that mediate the path by which science shapes government budgets.

Mechanisms of change: Testing how preventative interventions impact psychological and physiological stress functioning in mothers in neglectful families.

PubMed

Toth, Sheree L; Sturge-Apple, Melissa L; Rogosch, Fred A; Cicchetti, Dante

2015-11-01

The present study applies a multilevel approach to an examination of the effect of two randomized preventive interventions with mothers in neglectful families who are also contending with elevated levels of impoverishment and ecological risk. Specifically, we examined how participation in either child-parent psychotherapy (CPP) or psychoeducational parenting intervention (PPI) was associated with reductions in maternal psychological parenting stress and in turn physiological stress system functioning when compared to mothers involved in standard community services as well as a demographic comparison group of nonmaltreating mothers. The resulting group sizes in the current investigation were 44 for CPP, 34 for PPI, 27 for community services, and 52 for nonmaltreating mothers. Mothers and their 13-month-old infants were randomly assigned to intervention group at baseline. Mothers completed assessments on stress within the parenting role at baseline and postintervention. Basal cortisol was sampled at postintervention and 1-year follow-up. Latent difference score analyses examined change in these constructs over time. Results suggested that mothers within the CPP intervention experienced significant declines in child-related parenting stress, while mothers in the PPI intervention reported declines in parent-related parenting stress. In turn, significant decreases in stress within the CPP mothers were further associated with adaptive basal cortisol functioning at 1-year postintervention. The results highlight the value of delineating how participation in preventive interventions aimed at ameliorating child maltreatment in neglectful families within the context of poverty may operate through improvements in psychological and physiological stress functioning. Findings are discussed with respect to the importance of multilevel assessments of intervention process and outcome.

Medics as a channel for worksite health promotion in remote global locations.

PubMed

Bisits Bullen, Piroska A

2012-01-01

In the energy and mining sectors, it is common for employees to work in geographically remote locations, often with a medic for emergency response. This study evaluated an intervention to increase the number of medics conducting health promotion in remote worksites. Interviews were conducted to gather data for informing intervention and survey development. The intervention was evaluated in a quasiexperimental posttest-only comparison group design using survey data collected at baseline and again after 12 months. The intervention was implemented in remote worksites (N  =  201). There were 96 worksites in the intervention condition and 105 sites in the control condition. The target population was medics, including nurses, doctors, and paramedics, operating in remote worksites in 44 countries. The intervention was a series of campaign tool kits. The tool kits were adapted to the remote environment and could be customized for culture, language, and education level. The survey assessed frequency of health promotion activities, satisfaction with the intervention, and barriers to implementation. Survey data were analyzed using descriptive statistics and χ(2) tests. Interview results were coded to identify themes. Most medics (88%) in the intervention group reported running "tool box talks" (short education sessions) on at least a monthly basis, compared with 78% in the comparison group (p  =  .056). The trend was similar for displaying posters (71% vs. 55%; p  =  .021) and advocating for policy changes (84% vs. 71%; p  =  .027). Medic satisfaction was high. Difficulty distributing tool kits was the main barrier to implementation. When provided with appropriate tools, medics may be an ideal channel for health promotion in remote worksites.

[Operative treatment strategies for multiple trauma patients : early total care versus damage control].

PubMed

Klüter, T; Lippross, S; Oestern, S; Weuster, M; Seekamp, A

2013-09-01

The treatment of multiple trauma patients is a great challenge for an interdisciplinary team. After preclinical care and subsequent treatment in the emergency room the order of the interventions is prioritized depending of the individual risk stratification. For planning the surgery management it is essential to distinguish between absolutely essential operations to prevent life-threatening situations for the patient and interventions with shiftable indications, depending on the general condition of the patient. All interventions need to be done without causing significant secondary damage to prohibit hyperinflammation and systemic inflammatory response syndrome. The challenge consists in determination of the appropriate treatment at the right point in time. In general the early primary intervention, early total care, is differentiated from the damage control concept.

A feasibility randomised controlled trial of pre-operative occupational therapy to optimise recovery for patients undergoing primary total hip replacement for osteoarthritis (PROOF-THR).

PubMed

Jepson, Paul; Sands, Gina; Beswick, Andrew D; Davis, Edward T; Blom, Ashley W; Sackley, Catherine M

2016-02-01

To assess the feasibility of a pre-operative occupational therapy intervention for patients undergoing primary total hip replacement. Single blinded feasibility randomised controlled trial, with data collection prior to the intervention, and at 4, 12, and 26 weeks following surgery. Recruitment from two NHS orthopaedic outpatient centres in the West Midlands, UK. Patients awaiting primary total hip replacement due to osteoarthritis were recruited. Following pre-operative assessment, patients were individually randomised to intervention or control by a computer-generated block randomisation algorithm stratified by age and centre. The intervention group received a pre-surgery home visit by an occupational therapist who discussed expectations, assessed home safety, and provided appropriate adaptive equipment. The control group received treatment as usual. The study assessed the feasibility of recruitment procedures, delivery of the intervention, appropriateness of outcome measures and data collection methods. Health related quality of life and resource use were recorded at 4, 12 and 26 weeks. Forty-four participants were recruited, 21 were randomised to the occupational therapy intervention and 23 to usual care. Analysis of 26 week data included 18 participants in the intervention group and 21 in the control. The intervention was delivered successfully with no withdrawals or crossovers; 5/44 were lost to follow-up with further missing data for participation and resource use. The feasibility study provided the information required to conduct a definitive trial. Burden of assessment would need to be addressed. A total of 219 patients would be required in an efficacy trial. © The Author(s) 2015.

Improving the pathologic evaluation of lung cancer resection specimens.

PubMed

Osarogiagbon, Raymond U; Hilsenbeck, Holly L; Sales, Elizabeth W; Berry, Allen; Jarrett, Robert W; Giampapa, Christopher S; Finch-Cruz, Clara N; Spencer, David

2015-08-01

Accurate post-operative prognostication and management heavily depend on pathologic nodal stage. Patients with nodal metastasis benefit from post-operative adjuvant chemotherapy, those with mediastinal nodal involvement may also benefit from adjuvant radiation therapy. However, the quality of pathologic nodal staging varies significantly, with major survival implications in large populations of patients. We describe the quality gap in pathologic nodal staging, and provide evidence of its potential reversibility by targeted corrective interventions. One intervention, designed to improve the surgical lymphadenectomy, specimen labeling, and secure transfer between the operating theatre and the pathology laboratory, involves use of pre-labeled specimen collection kits. Another intervention involves application of an improved method of gross dissection of lung resection specimens, to reduce the inadvertent loss of intrapulmonary lymph nodes to histologic examination for metastasis. These corrective interventions are the subject of a regional dissemination and implementation project in diverse healthcare systems in a tri-state region of the United States with some of the highest lung cancer incidence and mortality rates. We discuss the potential of these interventions to significantly improve the accuracy of pathologic nodal staging, risk stratification, and the quality of specimens available for development of stage-independent prognostic markers in lung cancer.

Inside the beating heart: an in vivo feasibility study on fusing pre- and intra-operative imaging for minimally invasive therapy.

PubMed

Linte, Cristian A; Moore, John; Wedlake, Chris; Bainbridge, Daniel; Guiraudon, Gérard M; Jones, Douglas L; Peters, Terry M

2009-03-01

An interventional system for minimally invasive cardiac surgery was developed for therapy delivery inside the beating heart, in absence of direct vision. A system was developed to provide a virtual reality (VR) environment that integrates pre-operative imaging, real-time intra-operative guidance using 2D trans-esophageal ultrasound, and models of the surgical tools tracked using a magnetic tracking system. Detailed 3D dynamic cardiac models were synthesized from high-resolution pre-operative MR data and registered within the intra-operative imaging environment. The feature-based registration technique was employed to fuse pre- and intra-operative data during in vivo intracardiac procedures on porcine subjects. This method was found to be suitable for in vivo applications as it relies on easily identifiable landmarks, and hence, it ensures satisfactory alignment of pre- and intra-operative anatomy in the region of interest (4.8 mm RMS alignment accuracy) within the VR environment. Our initial experience in translating this work to guide intracardiac interventions, such as mitral valve implantation and atrial septal defect repair demonstrated feasibility of the methods. Surgical guidance in the absence of direct vision and with no exposure to ionizing radiation was achieved, so our virtual environment constitutes a feasible candidate for performing various off-pump intracardiac interventions.

Operating force information on-line acquisition of a novel slave manipulator for vascular interventional surgery.

PubMed

Zhao, Yan; Guo, Shuxiang; Xiao, Nan; Wang, Yuxin; Li, Youxiang; Jiang, Yuhua

2018-04-02

Vascular interventional surgery has its advantages compared to traditional operation. Master-slave robotic technology can further improve the operation accuracy, efficiency and safety of this complicated and high risk surgery. However, on-line acquisition of operating force information of catheter and guidewire remains to be a significant obstacle on the path to enhancing robotic surgery safety. Thus, a novel slave manipulator is proposed in this paper to realize on-line sensing of guidewire torsional operating torque and axial operation force during robotic assisted operations. A strain sensor is specially designed to detect the small scale torsional operation torque with low rotational frequency. Additionally, the axial operating force is detected via a load cell, which is incorporated into a sliding mechanism to eliminate the influence of friction. For validation, calibration and performance evaluation experiments are conducted. The results indicate that the proposed operation torque and force detection device is effective. Thus, it can provide the foundation for enabling accurate haptic feedback to the surgeon to improve surgical safety.

Highlighting the nuances behind interaction of picosecond pulses with human skin: Relating distinct laser-tissue interactions to their potential in cutaneous interventions

NASA Astrophysics Data System (ADS)

Uzunbajakava, Natallia E.; Varghese, Babu; Botchkareva, Natalia V.; Verhagen, Rieko; Vogel, Alfred

2018-02-01

In recent years, several commercial systems relying on picosecond pulses have been introduced into the field of cutaneous interventions. In parallel with this development, a somewhat distinct research prototype also operating in the picosecond regime was described in literature. Albeit both market-available products and the investigational device employ laser beams of nearly the same pulse duration and were reported to cause laser-induced optical breakdown (LIOB), they are different in terms of wavelength, applied fluence, laser beam quality, optical architecture and related focusing optics, resulting in different histomorphological features (such as e.g. lesion size, location, expression of collagen). Understanding the differences between these systems in relation to implications for clinical results raises a need in highlighting the nuances behind interaction of picosecond pulses with biological tissue. To achieve this, we accentuate the interplay of irradiance levels of picosecond pulses in W/cm2 , absorption properties of a target tissue at a wavelength of a light source and resulting interaction mechanisms with biological object. We also relate these nuances to potential consequences for cutaneous interventions.

A systematic review on community-based interventions for elder abuse and neglect.

PubMed

Fearing, Gwendolyn; Sheppard, Christine L; McDonald, Lynn; Beaulieu, Marie; Hitzig, Sander L

2017-03-01

Elder abuse and neglect is a societal issue that requires prevention and intervention strategies at the practice and policy level. A systematic review on the efficacy of community-based elder abuse interventions was undertaken to advance the state of knowledge in the field. The peer-reviewed literature between 2009 and December 2015 were searched across four databases. Two raters independently reviewed all articles, assessed their methodological quality, and used a modified Sackett Scale to assign levels of evidence. Four thousand nine hundred and five articles were identified; nine were selected for inclusion. Although there was Level-1 evidence for psychological interventions (n = 2), only one study on strategies for relatives (START) led to a reported decrease in elder abuse. There was Level-4 evidence for conservatorship, an elder abuse intervention/prevention program (ECARE), and a multidisciplinary intervention (n = 4), in which one study yielded significant decreases in elder abuse and/or neglect. The remaining three were classified as Level-5 evidence (n = 3) for elder mediation and multidisciplinary interventions. There are limited studies with high levels of evidence for interventions that decrease elder abuse and neglect. The scarcity of community-based interventions for older adults and caregivers highlights the need for further work to elevate the quality of studies.

[Mechanical suture in classic and laparoscopic general surgery].

PubMed

Alecu, L; Pascu, A; Deacu, A; Corodeanu, G; Marin, A; Costan, I

2000-01-01

Of this working is the study of employment the mechanical suture in general surgery classic and laparoscopic. We analysed the possibility of accomplishment and postoperatory evolution of 104 mechanical sutures performed in 24 patients, with diverse surgery pathology, operated in Department of General Surgery, between January 1999 and January 2000. Mechanical sutures allowed us to minimize the duration of surgical interventions and to perform some difficult anastomotic assembles (sometimes including creation of organ substitute). We had only two postoperatory fistulas and two postoperatory haemorrhages from anastomotic area (both cases because of bad closing of clips, through tissue excess between anvil and cartridge of the stapler). There are certain advantages in using mechanical sutures (versus manual sutures) consisting in decreasing of time period, both in operation itself and in hospitalization, despite their high level cost.

Procedures for Developing Evidence-Informed Performance Checklists for Improving Early Childhood Intervention Practices

ERIC Educational Resources Information Center

Dunst, Carl J.

2017-01-01

A conceptualization-operationalization-measurement framework is described for developing evidence-informed early childhood intervention performance checklists. Performance checklists include lists of practice indicators where the indicators, taken together, operationally define particular types of intervention practices that, when used as…

14. Implementation, execution, and completion of projects.

PubMed

2014-05-01

Once an intervention has been selected for implementation, it becomes a project. Implementation of a project is a complex process and requires completion of a host of tasks. The implementation process has been deconstructed into its components so that it can be analysed and evaluated. A prerequisite for implementation is an operational plan. The tasks that require completion include: (1) reassessing current status and verifying the needs; (2) activating the operational plan; (3) setting-up and operating an administrative structure; (4) identifying, acquiring, and organising resources (including human resources); (5) assigning roles and responsibilities; (6) educating and training personnel (including mission-specific); (7) briefing staff; (8) preparing/readying resources for transport; (9) assuring project self-sufficiency; (10) arranging for personal necessities; (11) ensuring the safety of personnel and the security of equipment and supplies; (12) insuring personnel; (13) coordinating with other projects/actors; (14) coordinating with other BSF systems (role of the coordination and control centre); (15) communicating with community leaders; (16) initiating the use of standardised progress reports; (17) deploying personnel, equipment, and supplies; (18) initiating the intervention(s); (19) executing the intervention(s); (20) reporting start of interventions; (21) completing the project; and (22) completing and submitting a formal report. This deconstruction is essential in order to study the process and identify critical points of success and failure. It also is recognised that many interventions consist of many components (subfunctions), each of which may be considered a production process.

Empirically Examining the Performance of Approaches to Multi-Level Matching to Study the Effect of School-Level Interventions

ERIC Educational Resources Information Center

Hallberg, Kelly; Cook, Thomas D.; Figlio, David

2013-01-01

The goal of this paper is to provide guidance for applied education researchers in using multi-level data to study the effects of interventions implemented at the school level. Two primary approaches are currently employed in observational studies of the effect of school-level interventions. One approach employs intact school matching: matching…

Teaching Students with Developmental Disabilities to Operate an iPod Touch[R] to Listen to Music

ERIC Educational Resources Information Center

Kagohara, Debora M.; Sigafoos, Jeff; Achmadi, Donna; van der Meer, Larah; O'Reilly, Mark F.; Lancioni, Giulio E.

2011-01-01

We evaluated an intervention procedure for teaching three students with developmental disabilities to independently operate a portable multimedia device (i.e., an iPod Touch[R]) to listen to music. The intervention procedure included the use of video modeling, which was presented on the same iPod Touch[R] that the students were taught to operate…

Changing drug users' risk environments: peer health advocates as multi-level community change agents.

PubMed

Weeks, Margaret R; Convey, Mark; Dickson-Gomez, Julia; Li, Jianghong; Radda, Kim; Martinez, Maria; Robles, Eduardo

2009-06-01

Peer delivered, social oriented HIV prevention intervention designs are increasingly popular for addressing broader contexts of health risk beyond a focus on individual factors. Such interventions have the potential to affect multiple social levels of risk and change, including at the individual, network, and community levels, and reflect social ecological principles of interaction across social levels over time. The iterative and feedback dynamic generated by this multi-level effect increases the likelihood for sustained health improvement initiated by those trained to deliver the peer intervention. The Risk Avoidance Partnership (RAP), conducted with heroin and cocaine/crack users in Hartford, Connecticut, exemplified this intervention design and illustrated the multi-level effect on drug users' risk and harm reduction at the individual level, the social network level, and the larger community level. Implications of the RAP program for designing effective prevention programs and for analyzing long-term change to reduce HIV transmission among high-risk groups are discussed from this ecological and multi-level intervention perspective.

Operational research to inform a sub-national surveillance intervention for malaria elimination in Solomon Islands

PubMed Central

2012-01-01

Background Successful reduction of malaria transmission to very low levels has made Isabel Province, Solomon Islands, a target for early elimination by 2014. High malaria transmission in neighbouring provinces and the potential for local asymptomatic infections to cause malaria resurgence highlights the need for sub-national tailoring of surveillance interventions. This study contributes to a situational analysis of malaria in Isabel Province to inform an appropriate surveillance intervention. Methods A mixed method study was carried out in Isabel Province in late 2009 and early 2010. The quantitative component was a population-based prevalence survey of 8,554 people from 129 villages, which were selected using a spatially stratified sampling approach to achieve uniform geographical coverage of populated areas. Diagnosis was initially based on Giemsa-stained blood slides followed by molecular analysis using polymerase chain reaction (PCR). Local perceptions and practices related to management of fever and treatment-seeking that would impact a surveillance intervention were also explored using qualitative research methods. Results Approximately 33% (8,554/26,221) of the population of Isabel Province participated in the survey. Only one subject was found to be infected with Plasmodium falciparum (Pf) (96 parasites/μL) using Giemsa-stained blood films, giving a prevalence of 0.01%. PCR analysis detected a further 13 cases, giving an estimated malaria prevalence of 0.51%. There was a wide geographical distribution of infected subjects. None reported having travelled outside Isabel Province in the previous three months suggesting low-level indigenous malaria transmission. The qualitative findings provide warning signs that the current community vigilance approach to surveillance will not be sufficient to achieve elimination. In addition, fever severity is being used by individuals as an indicator for malaria and a trigger for timely treatment-seeking and case reporting. In light of the finding of a low prevalence of parasitaemia, the current surveillance system may not be able to detect and prevent malaria resurgence. Conclusion An adaption to the malERA surveillance framework is proposed and recommendations made for a tailored provincial-level surveillance intervention, which will be essential to achieve elimination, and to maintain this status while the rest of the country catches up. PMID:22462770

Operational research to inform a sub-national surveillance intervention for malaria elimination in Solomon Islands.

PubMed

Atkinson, Jo-An; Johnson, Marie-Louise; Wijesinghe, Rushika; Bobogare, Albino; Losi, L; O'Sullivan, Matthew; Yamaguchi, Yuka; Kenilorea, Geoffrey; Vallely, Andrew; Cheng, Qin; Ebringer, Andrew; Bain, Lisa; Gray, Karen; Harris, Ivor; Whittaker, Maxine; Reid, Heidi; Clements, Archie; Shanks, Dennis

2012-03-30

Successful reduction of malaria transmission to very low levels has made Isabel Province, Solomon Islands, a target for early elimination by 2014. High malaria transmission in neighbouring provinces and the potential for local asymptomatic infections to cause malaria resurgence highlights the need for sub-national tailoring of surveillance interventions. This study contributes to a situational analysis of malaria in Isabel Province to inform an appropriate surveillance intervention. A mixed method study was carried out in Isabel Province in late 2009 and early 2010. The quantitative component was a population-based prevalence survey of 8,554 people from 129 villages, which were selected using a spatially stratified sampling approach to achieve uniform geographical coverage of populated areas. Diagnosis was initially based on Giemsa-stained blood slides followed by molecular analysis using polymerase chain reaction (PCR). Local perceptions and practices related to management of fever and treatment-seeking that would impact a surveillance intervention were also explored using qualitative research methods. Approximately 33% (8,554/26,221) of the population of Isabel Province participated in the survey. Only one subject was found to be infected with Plasmodium falciparum (Pf) (96 parasites/μL) using Giemsa-stained blood films, giving a prevalence of 0.01%. PCR analysis detected a further 13 cases, giving an estimated malaria prevalence of 0.51%. There was a wide geographical distribution of infected subjects. None reported having travelled outside Isabel Province in the previous three months suggesting low-level indigenous malaria transmission. The qualitative findings provide warning signs that the current community vigilance approach to surveillance will not be sufficient to achieve elimination. In addition, fever severity is being used by individuals as an indicator for malaria and a trigger for timely treatment-seeking and case reporting. In light of the finding of a low prevalence of parasitaemia, the current surveillance system may not be able to detect and prevent malaria resurgence. An adaption to the malERA surveillance framework is proposed and recommendations made for a tailored provincial-level surveillance intervention, which will be essential to achieve elimination, and to maintain this status while the rest of the country catches up.

Recreational Diving Impacts on Coral Reefs and the Adoption of Environmentally Responsible Practices within the SCUBA Diving Industry.

PubMed

Roche, Ronan C; Harvey, Chloe V; Harvey, James J; Kavanagh, Alan P; McDonald, Meaghan; Stein-Rostaing, Vivienne R; Turner, John R

2016-07-01

Recreational diving on coral reefs is an activity that has experienced rapidly growing levels of popularity and participation. Despite providing economic activity for many developing coastal communities, the potential role of dive impacts in contributing to coral reef damage is a concern at heavily dived locations. Management measures to address this issue increasingly include the introduction of programmes designed to encourage environmentally responsible practices within the dive industry. We examined diver behaviour at several important coral reef dive locations within the Philippines and assessed how diver characteristics and dive operator compliance with an environmentally responsible diving programme, known as the Green Fins approach, affected reef contacts. The role of dive supervision was assessed by recording dive guide interventions underwater, and how this was affected by dive group size. Of the 100 recreational divers followed, 88 % made contact with the reef at least once per dive, with a mean (±SE) contact rate of 0.12 ± 0.01 per min. We found evidence that the ability of dive guides to intervene and correct diver behaviour in the event of a reef contact decreases with larger diver group sizes. Divers from operators with high levels of compliance with the Green Fins programme exhibited significantly lower reef contact rates than those from dive operators with low levels of compliance. The successful implementation of environmentally responsible diving programmes, which focus on influencing dive industry operations, can contribute to the management of human impacts on coral reefs.

Exploring an Ecological Model of Perceived Usability within a Multi-Tiered Vocabulary Intervention

ERIC Educational Resources Information Center

Neugebauer, Sabina R.; Chafouleas, Sandra M.; Coyne, Michael D.; McCoach, D. Betsy; Briesch, Amy M.

2016-01-01

The present study examines an ecological model for intervention use to explain student vocabulary performance in a multi-tiered intervention setting. A teacher self-report measure composed of factors hypothesized to influence intervention use at multiple levels (i.e., individual, intervention, and system level) was administered to 54 teachers and…

The effect of total knee arthroplasty on patients' balance and incidence of falls: a systematic review.

PubMed

Moutzouri, M; Gleeson, N; Billis, E; Tsepis, E; Panoutsopoulou, I; Gliatis, J

2017-11-01

Despite the high incidence of falls in patients with OA, few studies have explored whether falls risk is affected after patients undergo total knee arthroplasty (TKA). Therefore, the aim of this systematic review was to identify the extent of the effects of TKA on balance and incidence of falls by critically reviewing the available literature. A systematic review of published literature sources was conducted up to March 2014. All studies assessing balance and incidence of falls after TKA (without physiotherapeutic intervention) were included. The methodological quality of each study was reviewed using the Critical Appraisal Skill Programme tool. Thirteen studies were included, comprising of ten cohort studies (Level II) and three studies with Level of evidence III. Findings provide evidence that TKA improves significantly single-limb standing balance (~60%) and dynamic balance up to 1-year following surgery (Level of evidence II). Moreover, TKA influences positively fear of falling and incidence of falls by switching 54.2 % of pre-operative fallers to post-operative non-fallers (Level of evidence II-III). It is highlighted that knee extension strength, proprioception and symmetrization of postural strategies have not fully recovered post-TKA and influence balance performance. Clinically, these persistent deficits need to be mitigated by physiotherapy even before TKA takes place.

Evaluating a cognitive/ecological program for the prevention of aggression among urban children.

PubMed

Huesmann, L R; Maxwell, C D; Eron, L; Dahlberg, L L; Guerra, N G; Tolan, P H; VanAcker, R; Henry, D

1996-01-01

The Metropolitan Area Child Study (MACS) is a multifaceted school- and family-based intervention and evaluation study designed to prevent and understand the development of aggressive behavior. The multifaceted interventions are grounded in combined social-cognitive and ecologic theories. Social-cognitive theories contend that cognitive scripts, attributions, and beliefs acquired early in life mediate the effects of ecological factors that influence the development of antisocial behavior. Prevention programs aimed at these cognitions must address multiple dimensions of the child's environment including family, peer, school, and community. The program has three levels of intervention delivered in two-year segments: (1) Level 1: a general enhancement classroom intervention that stresses culturally sensitive student and teacher interaction involving instructional and classroom management strategies and a social-cognitive curriculum that mitigates aggressive development; (2) Level 2: intensive small-group sessions designed to change children's cognitions and enhance peer relationship skills for at-risk children added to the general classroom enhancement program; and (3) Level 3: a one-year family relationship intervention that stresses parenting skill building and emotional responsiveness in family interactions added to the general enhancement and small-group training conditions. Sixteen Chicago-area schools are randomly assigned (four each) to a control group or one of the three intervention levels. Individual child assessment, peer assessments, classroom behavioral observations, and archival data are collected before the interventions begin, during the interventions, at the end of each intervention, and at a follow-up point. The pretests indicate that the children on average have higher levels of aggression than found nationally and elevated clinical levels of other psychopathologies. Across the four intervention levels there are no significant differences in ethnic composition, socio-economic status (SES), aggressive behavior, and normative beliefs about aggression.

Evaluation of a training program for device operators in the Australian Government's Point of Care Testing in General Practice Trial: issues and implications for rural and remote practices.

PubMed

Shephard, Mark D; Mazzachi, Beryl C; Watkinson, Les; Shephard, Anne K; Laurence, Caroline; Gialamas, Angela; Bubner, Tanya

2009-01-01

From September 2005 to February 2007 the Australian Government funded the Point of Care Testing (PoCT) in General Practice Trial, a multi-centre, cluster randomised controlled trial to determine the safety, clinical effectiveness, cost-effectiveness and satisfaction of PoCT in General Practice. In total, 53 practices (23 control and 30 intervention) based in urban, rural or remote locations across three states (South Australia [SA], New South Wales [NSW] and Victoria [VIC]) participated in the Trial. Control practices had pathology testing performed by their local laboratory, while intervention practices conducted pathology testing by PoCT. In total, 4968 patients (1958 control and 3010 intervention) participated in the Trial. The point-of-care (PoC) tests performed by intervention practices were: haemoglobin A1c (HbA1c) and urine albumin:creatinine ratio (ACR) on patients with diabetes, total cholesterol, triglyceride and high density lipoprotein (HDL) cholesterol on patients with hyperlipidaemia, and international normalised ratio (INR) on patients on anticoagulant therapy. Three PoCT devices measured these tests: the Siemens DCA 2000 (Siemens HealthCare Diagnostics, Melbourne, VIC, Australia) for HbA1c and urine ACR; Point of Care Diagnostics Cholestech LDX analyser (Point of Care Diagnostics; Sydney, NSW, Australia) for lipids; and the Roche CoaguChek S (Roche Diagnostics; Sydney, NSW, Australia) for INR. Point-of-care testing in the General Practice Trial was underpinned by a quality management framework which included an on-going training and competency program for PoCT device operators. This article describes the design, implementation and results of the training and competency program. An education and training resource package was developed for the Trial consisting of a training manual, a set of A3 laminated posters and a CD ROM. Five initial training workshops were held for intervention practices from each geographic region between August and October 2005 at three centres - Adelaide (SA), Bendigo (VIC) and Dubbo (NSW). These workshops combined theoretical training in the principles and practice of PoCT with 'hands on' practical training delivered in interactive small group sessions. At the completion of training, practice staff undertook a written and practical competency assessment and received a certificate of competency as a qualified device operator. Following each initial training workshop, practice staff completed a short satisfaction survey. Five refresher training workshops covering all geographic regions were delivered during late August 2006, coinciding with the 12 month point of the live phase of the Trial. At the completion of the Trial in February 2007, device operators completed a further questionnaire. Sixty device operators from 31 practices completed training and competency assessment as part of the Initial Training Workshop series. A further 20 device operators from 12 of the practices were trained in the 12 month period after the initial workshops; 19 of these staff were from rural or remote practices. In total 80 device operators comprising 74 practice staff and six GPs from 31 practices were trained and received competency certificates as part of Trial. In all, 19 device operators left the Trial either through personal resignation from an existing practice or because their practice withdrew from the Trial; the majority (84%) were from rural and remote practices. A total of 42 device operators from 25 practices attended refresher training in the second half of 2006. Results from the satisfaction questionnaire completed by device operators following the initial training workshops showed there was unanimous agreement that the posters were useful for the conduct of daily PoCT and practical training in small groups was satisfactory as a training method. The quality and appropriateness of the PoCT training resources and the workshop overall was rated as either good or excellent by all respondents (100% and 78%, respectively). The responses by device operators to the post-Trial satisfaction questionnaire found a high level of satisfaction with PoCT across all geographic regions. Device operators from remote practices had the highest satisfaction levels for quality of training, usefulness of the training manual, ease of use of devices, confidence in the accuracy of PoCT results and preference for PoCT over laboratory testing. The usefulness of the posters for conducting PoCT achieved the highest satisfaction rating among operators from all three geographic regions. However the highest staff turnover rates and the highest number of requests for training of additional staff were from rural and remote practices. The methods established for the implementation and delivery of training and competency assessment for the PoCT in General Practice Trial were appropriate and effective. Results of the evaluation showed rural and remote practices have a greater need for training and support compared to their urban counterparts and may require more flexible training options to cater for much higher rates of staff turnover.

Effects of a bereavement intervention program on depression and life satisfaction in middle aged widows in Korea.

PubMed

Yoo, Yang Sook; Kang, Hee Young

2006-12-01

This study was designed to examine the effects of a bereavement intervention program on levels of depression and life satisfaction in middle aged widows in Korea. A quasi-experimental design with non-equivalent control-group pretest-posttest was used. The subjects (control group, n = 10; intervention group, n = 17) were bereaved less than 6 months in G City and J Province, Korea. The bereavement intervention program consisted of Dan-jeon breathing, self-help group activities and a health examination. The experimental group attended 10 sessions of a bereavement intervention program. The control group had a health examination without the intervention program. For both groups, the level of depression and life satisfaction levels were measured before and after the experiment. The decrement of depression level in the experimental group was significantly greater than in the control group (p<.001). The increment in life satisfaction in the experimental group was significantly greater than in the control group (p<.001). The results suggested that the bereavement intervention program was effective in decreasing level of depression and in increasing the life satisfaction of widows. Accordingly, a bereavement intervention program can be applied as an intervention to help widows.

Assessing intervention fidelity in a multi-level, multi-component, multi-site program: the Children's Healthy Living (CHL) program.

PubMed

Butel, Jean; Braun, Kathryn L; Novotny, Rachel; Acosta, Mark; Castro, Rose; Fleming, Travis; Powers, Julianne; Nigg, Claudio R

2015-12-01

Addressing complex chronic disease prevention, like childhood obesity, requires a multi-level, multi-component culturally relevant approach with broad reach. Models are lacking to guide fidelity monitoring across multiple levels, components, and sites engaged in such interventions. The aim of this study is to describe the fidelity-monitoring approach of The Children's Healthy Living (CHL) Program, a multi-level multi-component intervention in five Pacific jurisdictions. A fidelity-monitoring rubric was developed. About halfway during the intervention, community partners were randomly selected and interviewed independently by local CHL staff and by Coordinating Center representatives to assess treatment fidelity. Ratings were compared and discussed by local and Coordinating Center staff. There was good agreement between the teams (Kappa = 0.50, p < 0.001), and intervention improvement opportunities were identified through data review and group discussion. Fidelity for the multi-level, multi-component, multi-site CHL intervention was successfully assessed, identifying adaptations as well as ways to improve intervention delivery prior to the end of the intervention.

Current operator volumes of invasive coronary procedures in Medicare patients: implications for future manpower needs in the catheterization laboratory.

PubMed

Maroney, Justin; Khan, Saba; Powell, Wayne; Klein, Lloyd W

2013-01-01

We seek to assess the per-operator volume of diagnostic catheterizations and percutaneous coronary interventions (PCI) among US cardiologists, and its implication for future manpower needs in the catheterization laboratory. The number of annual Medicare PCIs peaked in 2004 and has trended downward since, however the total number of catheterization laboratories nationwide has increased. It is unknown whether these trends have resulted in a dilution of per-operator volumes, and whether the current supply of interventional cardiologists is appropriate to meet future needs. We analyzed the Centers for Medicare and Medicaid Services 2008 Medicare 5% sample file, and extracted the total number of Medicare fee-for-service (Medicare FFS) diagnostic catheterizations and PCIs performed in 2008. We then determined per-physician procedure volumes using National Provider Identifier numbers. There were 1,198,610 Medicare FFS diagnostic catheterizations performed by 11,029 diagnostic cardiologists, and there were 378,372 Medicare FFS PCIs performed by 6,443 interventional cardiologists in 2008. The data reveal a marked difference in the 2008 distribution of diagnostic catheterizations and PCIs among operators. Just over 10% of diagnostic catheterizations were performed by operators performing 40 or fewer Medicare FFS diagnostic catheterizations, contrasted with almost 30% of PCIs performed by operators with 40 of fewer Medicare FFS PCIs. A significant majority of interventional cardiologists (61%) performed 40 or fewer Medicare FFS PCIs in 2008. There is a high percentage of low-volume operators performing PCI, raising questions regarding annual volume recommendations for procedural skill maintenance, and the future manpower requirements in the catheterization laboratory. Copyright © 2012 Wiley Periodicals, Inc.

Non-operative management (NOM) of blunt hepatic trauma: 80 cases.

PubMed

Özoğul, Bünyami; Kısaoğlu, Abdullah; Aydınlı, Bülent; Öztürk, Gürkan; Bayramoğlu, Atıf; Sarıtemur, Murat; Aköz, Ayhan; Bulut, Özgür Hakan; Atamanalp, Sabri Selçuk

2014-03-01

Liver is the most frequently injured organ upon abdominal trauma. We present a group of patients with blunt hepatic trauma who were managed without any invasive diagnostic tools and/or surgical intervention. A total of 80 patients with blunt liver injury who were hospitalized to the general surgery clinic or other clinics due to the concomitant injuries were followed non-operatively. The normally distributed numeric variables were evaluated by Student's t-test or one way analysis of variance, while non-normally distributed variables were analyzed by Mann-Whitney U-test or Kruskal-Wallis variance analysis. Chi-square test was also employed for the comparison of categorical variables. Statistical significance was assumed for p<0.05. There was no significant relationship between patients' Hgb level and liver injury grade, outcome, and mechanism of injury. Also, there was no statistical relationship between liver injury grade, outcome, and mechanism of injury and ALT levels as well as AST level. There was no mortality in any of the patients. During the last quarter of century, changes in the diagnosis and treatment of liver injury were associated with increased survival. NOM of liver injury in patients with stable hemodynamics and hepatic trauma seems to be the gold standard.

Coaching Non-technical Skills Improves Surgical Residents' Performance in a Simulated Operating Room.

PubMed

Yule, Steven; Parker, Sarah Henrickson; Wilkinson, Jill; McKinley, Aileen; MacDonald, Jamie; Neill, Adrian; McAdam, Tim

2015-01-01

To investigate the effect of coaching on non-technical skills and performance during laparoscopic cholecystectomy in a simulated operating room (OR). Non-technical skills (situation awareness, decision making, teamwork, and leadership) underpin technical ability and are critical to the success of operations and the safety of patients in the OR. The rate of developing assessment tools in this area has outpaced development of workable interventions to improve non-technical skills in surgical training and beyond. A randomized trial was conducted with senior surgical residents (n = 16). Participants were randomized to receive either non-technical skills coaching (intervention) or to self-reflect (control) after each of 5 simulated operations. Coaching was based on the Non-Technical Skills For Surgeons (NOTSS) behavior observation system. Surgeon-coaches trained in this method coached participants in the intervention group for 10 minutes after each simulation. Primary outcome measure was non-technical skills, assessed from video by a surgeon using the NOTSS system. Secondary outcomes were time to call for help during bleeding, operative time, and path length of laparoscopic instruments. Non-technical skills improved in the intervention group from scenario 1 to scenario 5 compared with those in the control group (p = 0.04). The intervention group was faster to call for help when faced with unstoppable bleeding in the final scenario (no. 5; p = 0.03). Coaching improved residents' non-technical skills in the simulated OR compared with those in the control group. Important next steps are to implement non-technical skills coaching in the real OR and assess effect on clinically important process measures and patient outcomes. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

30 CFR 769.15 - Intervention.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 3 2012-07-01 2012-07-01 false Intervention. 769.15 Section 769.15 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR AREAS UNSUITABLE... SURFACE COAL MINING OPERATIONS AND FOR TERMINATION OF PREVIOUS DESIGNATIONS § 769.15 Intervention. Up to 3...

30 CFR 769.15 - Intervention.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 3 2013-07-01 2013-07-01 false Intervention. 769.15 Section 769.15 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR AREAS UNSUITABLE... SURFACE COAL MINING OPERATIONS AND FOR TERMINATION OF PREVIOUS DESIGNATIONS § 769.15 Intervention. Up to 3...

30 CFR 769.15 - Intervention.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 3 2011-07-01 2011-07-01 false Intervention. 769.15 Section 769.15 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR AREAS UNSUITABLE... SURFACE COAL MINING OPERATIONS AND FOR TERMINATION OF PREVIOUS DESIGNATIONS § 769.15 Intervention. Up to 3...

30 CFR 769.15 - Intervention.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 3 2014-07-01 2014-07-01 false Intervention. 769.15 Section 769.15 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR AREAS UNSUITABLE... SURFACE COAL MINING OPERATIONS AND FOR TERMINATION OF PREVIOUS DESIGNATIONS § 769.15 Intervention. Up to 3...

30 CFR 769.15 - Intervention.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Intervention. 769.15 Section 769.15 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR AREAS UNSUITABLE... SURFACE COAL MINING OPERATIONS AND FOR TERMINATION OF PREVIOUS DESIGNATIONS § 769.15 Intervention. Up to 3...

Behavior-based safety on construction sites: a case study.

PubMed

Choudhry, Rafiq M

2014-09-01

This work presents the results of a case study and describes an important area within the field of construction safety management, namely behavior-based safety (BBS). This paper adopts and develops a management approach for safety improvements in construction site environments. A rigorous behavioral safety system and its intervention program was implemented and deployed on target construction sites. After taking a few weeks of safety behavior measurements, the project management team implemented the designed intervention and measurements were taken. Goal-setting sessions were arranged on-site with workers' participation to set realistic and attainable targets of performance. Safety performance measurements continued and the levels of performance and the targets were presented on feedback charts. Supervisors were asked to give workers recognition and praise when they acted safely or improved critical behaviors. Observers were requested to have discussions with workers, visit the site, distribute training materials to workers, and provide feedback to crews and display charts. They were required to talk to operatives in the presence of line managers. It was necessary to develop awareness and understanding of what was being measured. In the process, operatives learned how to act safely when conducting site tasks using the designed checklists. Current weekly scores were discussed in the weekly safety meetings and other operational site meetings with emphasis on how to achieve set targets. The reliability of the safety performance measures taken by the company's observers was monitored. A clear increase in safety performance level was achieved across all categories: personal protective equipment; housekeeping; access to heights; plant and equipment, and scaffolding. The research reveals that scores of safety performance at one project improved from 86% (at the end of 3rd week) to 92.9% during the 9th week. The results of intervention demonstrated large decreases in unsafe behaviors and significant increases in safe behaviors. The results of this case study showed that an approach based on goal setting, feedback, and an effective measure of safety behavior if properly applied by committed management, can improve safety performance significantly in construction site environments. The results proved that the BBS management technique can be applied to any country's culture, showing that it would be a good approach for improving the safety of front-line workers and that it has industry wide application for ongoing construction projects. Copyright © 2014 Elsevier Ltd. All rights reserved.

Preservation of the vegetative pelvic nerves and local reccurence in the operative treatment of rectal cancer.

PubMed

Jota, G J; Karadzov, Z; Panovski, M; Vasilevski, V; Serafimoski, V

2006-12-01

Life quality of the patients operated from rectal cancer is a serious problem. Despite the curing as a primary objective in the treatment of the rectal cancer, special attention is paid to the life quality upon the performed operation on the subjected patients. The analyzed series consists of 29 patients with rectal cancer, operated on at the Digestive Surgery Clinic within the framework of the Clinical Centre in Skopje, in the period between 2001-2006. Our series involves patients from the T2 and T3 stage of the illness, where it possible to preserve the vegetative pelvic nerves, that are characterized by a relatively long-lasting symptomatology and relatively high percentage of lymphatic metastases. The standardization of the operative intervention resulted in an increase in the number of patients with continuous operations and preservation of the neuro-vegetative plexus without influencing the radicalism of the intervention. The application of the Stapler and Double Stapler technique brought about an increase in the number of continuous operations characterized by a termino-terminal colorectal anastomosis. On the other hand the preventive creation of LOOP ileostomies in the case of the ultra low resections resulted in a decrease in the level of dehiscence of this type as one of the most common and most difficult complications. The preservation of the pelvic neuro-vegetative plexus prolongs the operation time by 30 to 60 minutes, depending on the case and the patient. We assume that the procedure does not have a particular influence on the frequency of the complications, and at the same time it positively affects the revival of the urinal and sexual function. Taking into consideration the fact that the lymphatic dissection increases the possibility of removal of the malignant tissue and enables an adequate "staging" and on the other hand the preservation of the pelvic plexus improves the quality of life, both in terms of the sexual function and the function of the urinary bladder, it is recommended that this way of treatment becomes an integral part in the surgical treatment of the rectal cancer.

l-Arginine Pathway Metabolites Predict Need for Intra-operative Shunt During Carotid Endarterectomy.

PubMed

Szabo, P; Lantos, J; Nagy, L; Keki, S; Volgyi, E; Menyhei, G; Illes, Z; Molnar, T

2016-12-01

Asymmetric dimethylarginine (ADMA) inhibits nitric oxide (NO) synthesis and is a marker of atherosclerosis. This study examined the correlation between pre-operative l-arginine and ADMA concentration during carotid endarterectomy (CEA), and jugular lactate indicating anaerobic cerebral metabolism, jugular S100B reflecting blood-brain barrier integrity, and with factors of surgical intervention. The concentration of l-arginine, ADMA, and symmetric dimethylarginine was measured in blood taken under regional anaesthesia from the radial artery of 55 patients prior to CEA. Blood gas parameters, concentration of lactate, and S100B were also serially measured in blood taken from both the radial artery and the jugular bulb before and after carotid clamping, and after release of the clamp. To estimate anaerobic metabolism, the jugulo-arterial ratio of CO 2 gap/oxygen extraction was calculated. Positive correlation was found between pre-operative ADMA levels and the ratio of jugulo-arterial CO 2 gap/oxygen extraction during clamp and reperfusion (p = .005 and p = .01, respectively). An inverse correlation was found between the pre-operative l-arginine concentration and jugular lactate at each time point (both p = .002). The critical pre-operative level of l-arginine was determined by receiver operator curve analysis. If l-arginine was below the cutoff value of 35 μmol/L, jugular S100B concentration was higher 24 h post-operatively (p = .03), and jugular lactate levels were increased during reperfusion (p = .02). The median pre-operative concentration of l-arginine was lower in patients requiring an intra-operative shunt than in patients without need of shunt (median: 30.3 μmol/L [interquartile range 24.4-34.4 μmol/L] vs. 57.6 μmol/L [interquartile range 42.3-74.5 μmol/L]; p = .002). High pre-operative ADMA concentration predicts poor cerebral perfusion indicated by elevated jugulo-arterial CO 2 gap/oxygen extraction. Low pre-operative l-arginine concentration predicts the need for a shunt. The inverse correlation between pre-operative l-arginine concentration and both jugular lactate and S100B during carotid clamping suggests a protective role of the NO donor l-arginine. Copyright © 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Advancing the Science of Community-Level Interventions

PubMed Central

Beehler, Sarah; Deutsch, Charles; Green, Lawrence W.; Hawe, Penelope; McLeroy, Kenneth; Miller, Robin Lin; Rapkin, Bruce D.; Schensul, Jean J.; Schulz, Amy J.; Trimble, Joseph E.

2011-01-01

Community interventions are complex social processes that need to move beyond single interventions and outcomes at individual levels of short-term change. A scientific paradigm is emerging that supports collaborative, multilevel, culturally situated community interventions aimed at creating sustainable community-level impact. This paradigm is rooted in a deep history of ecological and collaborative thinking across public health, psychology, anthropology, and other fields of social science. The new paradigm makes a number of primary assertions that affect conceptualization of health issues, intervention design, and intervention evaluation. To elaborate the paradigm and advance the science of community intervention, we offer suggestions for promoting a scientific agenda, developing collaborations among professionals and communities, and examining the culture of science. PMID:21680923

Usefulness of cardiovascular magnetic resonance imaging to predict the need for intervention in patients with coarctation of the aorta.

PubMed

Muzzarelli, Stefano; Meadows, Alison Knauth; Ordovas, Karen Gomes; Higgins, Charles Bernard; Meadows, Jeffery Joshua

2012-03-15

Cardiovascular magnetic resonance (CMR) imaging can predict hemodynamically significant coarctation of the aorta (CoA) with a high degree of discrimination. However, the ability of CMR to predict important clinical outcomes in this patient population is unknown. Therefore, we sought to define the ability of CMR to predict the need for surgical or transcatheter intervention in patients with CoA. We retrospectively reviewed the data from 133 consecutive patients who had undergone CMR for the evaluation of known or suspected CoA. The characteristics of the CMR-derived variables predicting the need for surgical or transcatheter intervention for CoA within 1 year were determined through logistic regression analysis. Therapeutic aortic intervention was performed in 41 (31%) of the 133 patients during the study period. The indexed minimum aortic cross-sectional area was the strongest predictor of subsequent intervention (area under the receiver operating characteristic curve 0.975) followed by heart rate-corrected deceleration time in the descending aorta (area under the receiver operating characteristic curve 0.951), and the percentage of flow increase (area under the receiver operating characteristic curve 0.867). The combination of the indexed minimum aortic cross-sectional area and rate-corrected deceleration time in the descending aorta provided the best predictive model (area under the receiver operating characteristic curve 0.986). In conclusion, CMR findings can predict the need for subsequent intervention in CoA. These findings reinforce the "gate-keeper role" of CMR to cardiac catheterization by providing valuable diagnostic and powerful prognostic information and could guide additional treatment of patients with CoA with the final intent of reducing the number of diagnostic catheterizations in such patients. Copyright © 2012 Elsevier Inc. All rights reserved.

Future orientation: a construct with implications for adolescent health and wellbeing.

PubMed

Johnson, Sarah R Lindstrom; Blum, Robert W; Cheng, Tina L

2014-01-01

Multidisciplinary research has supported a relationship between adolescent future orientation (the ability to set future goals and plans) and positive adolescent health and development outcomes. Many preventive strategies - for example, contracepting, exercising - are based on taking actions in the present to avoid unwanted or negative future consequences. However, research has been hampered by unclear and often divergent conceptualizations of the future orientation construct. The present paper aims to integrate previous conceptual and operational definitions into a conceptual framework that can inform programs and services for youth and efforts to evaluate future orientation as a target for intervention. Recommendations focus on furthering the study of the construct through measurement synthesis as well as studies of the normative development of future orientation. Also suggested is the need to pair environmental intervention strategies with individual level efforts to improve future orientation in order to maximize benefits.

Future Orientation: A Construct with Implications for Adolescent Health and Wellbeing

PubMed Central

Lindstrom Johnson, Sarah; Blum, Robert W; Cheng, Tina L.

2016-01-01

Multi-disciplinary research has supported a relationship between adolescent future orientation (the ability to set future goals and plans) and positive adolescent health and development outcomes. Many preventive strategies—for example contracepting, exercising—are based on taking actions in the present to avoid unwanted or negative future consequences. However, research has been hampered by unclear and often divergent conceptualizations of the future orientation construct. The present paper aims to integrate previous conceptual and operational definitions into a conceptual framework that can inform programs and services for youth and efforts to evaluate future orientation as a target for intervention. Recommendations focus on furthering the study of the construct through measurement synthesis as well as studies of the normative development of future orientation. Also suggested is the need to pair environmental intervention strategies with individual level efforts to improve future orientation in order to maximize benefits. PMID:24523304

Managing nursing assistants with a web-based system: an empirical investigation of the mixed-staff strategy.

PubMed

Lin, I-Chun; Hou, Ying-Hui; Huang, Hui-Ling; Chu, Tsui-Ping; Chang, Ray-E

2010-06-01

Under the global shortage of Registered Nurses (RNs), some hospitals have integrated nursing assistants (NAs) into their teams to help to provide maximum quality care for acute patients, while keeping the hospital's staff-related costs down. However, the RNs may have to shoulder an increased burden of assigning and overseeing NAs. A web-based Nursing Assistants Management System (NAMS) was developed and evaluated for a case hospital in Taiwan to compare the processes of assigning and managing NAs before and after the NAMS intervention. The results showed that NAMS saved 80% of the time needed for manual operation and there were no more complains about NAs being slow in dealing with patients after the system intervention. The satisfaction levels of all NA managers and RNs were acceptable. Based on the research findings, the implication and limitations of this study were discussed.

Proposed diagnostic reference levels for 3 common cardiac interventional procedures in Ireland

NASA Astrophysics Data System (ADS)

D'Helft, C.; McGee, A. M.; Rainford, L. A.; Mc Fadden, S. L.; Hughes, C. M.; Winder, R. J.; Brennan, P. C.

2007-03-01

Radiation doses for 3 common types of cardiac radiological examinations where investigated: coronary angiography (CA), percutaneous coronary intervention (PCI) and pacemaker insertions (PPI). 22 cardiac imaging suites participated in the study. Radiation dose was monitored for 1804 adult patients using dose area product (DAP) meters. Operational and examination details such as cardiologist grade, patient details and examination complexity were recorded for each examination. Both intra and inter-hospital variations where demonstrated by the results. Individual patient DAP values ranged from 136-23,101cGycm2, 475-41,038cGycm2 and 45- 17,192cGycm2 for CA, PCI and PPI respectively, with third quartile values of 4,173cGycm2, 8,836cGycm2 and 2,051cGycm2. Screening times varied from 0.22-27.6mins, 1.8-98mins and 0.33-54.5mins for CA, PCI and PPI respectively.

Alcohol: no ordinary commodity--a summary of the second edition.

PubMed

2010-05-01

This article summarizes the contents of Alcohol: No Ordinary Commodity (2nd edn). The first part of the book describes why alcohol is not an ordinary commodity, and reviews epidemiological data that establish alcohol as a major contributor to the global burden of disease, disability and death in high-, middle- and low-income countries. This section also documents how international beer and spirits production has been consolidated recently by a small number of global corporations that are expanding their operations in Eastern Europe, Asia, Africa and Latin America. In the second part of the book, the scientific evidence for strategies and interventions that can prevent or minimize alcohol-related harm is reviewed critically in seven key areas: pricing and taxation, regulating the physical availability of alcohol, modifying the drinking context, drink-driving countermeasures, restrictions on marketing, education and persuasion strategies, and treatment and early intervention services. Finally, the book addresses the policy-making process at the local, national and international levels and provides ratings of the effectiveness of strategies and interventions from a public health perspective. Overall, the strongest, most cost-effective strategies include taxation that increases prices, restrictions on the physical availability of alcohol, drink-driving countermeasures, brief interventions with at risk drinkers and treatment of drinkers with alcohol dependence.

Effectiveness of a self-administered intervention for criminal thinking: Taking a Chance on Change.

PubMed

Folk, Johanna B; Disabato, David J; Daylor, Jordan M; Tangney, June P; Barboza, Sharen; Wilson, John S; Bonieskie, Lynda; Holwager, James

2016-08-01

The current study tested the effectiveness of a self-administered, cognitive-behavioral intervention targeting criminal thinking for inmates in segregated housing: Taking a Chance on Change (TCC). Participants included 273 inmates in segregated housing at state correctional institutions. Reductions in criminal thinking, as assessed by the Psychological Inventory of Criminal Styles-Simplified Version, were found in the general criminal thinking score as well as the proactive and reactive composite scores. Examination of demographic predictors of change (i.e., age, years of education, length of sentence) revealed older and more educated participants decreased in criminal thinking more than younger and less educated participants. For a subset of 48 inmates, completion of TCC was associated with significant reduction of disciplinary infractions. Reductions in reactive criminal thinking predicted reductions in disciplinary infractions. Although further research is needed to determine the effectiveness of TCC in reducing recidivism, the reductions in criminal thinking and disordered conduct suggest this is a promising intervention and mode of treatment delivery. By utilizing self-directed study at an accessible reading level, the intervention is uniquely suited to a correctional setting where staff and monetary resources are limited and security and operational issues limit the feasibility of traditional cognitive-behavioral group treatment. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

[Improving the provision of major obstetric interventions by task delegation in Africa: An example from the Bogodogo health district hospital in Ouagadougou, Burkina Faso].

PubMed

Ouédraogo, C M; Ouattara, A; Ouédraogo, A; Bikienga, M; Lankoandé, J

2015-01-01

To describe the role of task delegation in the practice of major obstetric procedures in the Bogodogo health district hospital. This descriptive and analytic prospective study took place in the hospital's department of obstetrics and gynecology from February through October 2013. It included all women undergoing a major obstetric surgical intervention, performed by either by a gynecologist-obstetrician or by a nurse specializing in surgery. Data were collected from individual records and analyzed by SPSS and Epidata software. There were 601 major obstetric interventions during the study period. The women's mean age was 26.7 years. Cesarean deliveries accounted for 90% of these procedures, followed by laparotomy (7.7%). The Misgav-Ladach technique was used for cesareans by 86.5% of the obstetricians and 95.3% of the nurses specialized in surgery. The primary complications were anemia and postpartum hemorrhage. Maternal mortality did not differ significantly between the groups of operators, nor did maternal, fetal, and neonatal outcomes. Task delegation in obstetric surgery at the Bogodogo district hospital is effective. Its extension to the national level would make it possible to overcome the lack of highly qualified human resources to enable adequate availability of major obstetric interventions in rural hospitals.

Effectiveness of a self-administered intervention for criminal thinking: Taking a chance on change

PubMed Central

Folk, Johanna B.; Disabato, David J.; Daylor, Jordan M.; Tangney, June P.; Barboza, Sharen; Wilson, John S.; Bonieskie, Lynda; Holwager, James

2016-01-01

The current study tested the effectiveness of a self-administered, cognitive-behavioral intervention targeting criminal thinking for inmates in segregated housing: Taking a Chance on Change (TCC). Participants included 273 inmates in segregated housing at state correctional institutions. Reductions in criminal thinking, as assessed by the Psychological Inventory of Criminal Styles-Simplified Version, were found in the general criminal thinking score as well as the proactive and reactive composite scores. Examination of demographic predictors of change (i.e., age, years of education, length of sentence) revealed older and more educated participants decreased in criminal thinking more than younger and less educated participants. For a subset of 48 inmates, completion of TCC was associated with significant reduction of disciplinary infractions. Reductions in reactive criminal thinking predicted reductions in disciplinary infractions. Although further research is needed to determine the effectiveness of TCC in reducing recidivism, the reductions in criminal thinking and disordered conduct suggest this is a promising intervention and mode of treatment delivery. By utilizing self-directed study at an accessible reading level, the intervention is uniquely suited to a correctional setting where staff and monetary resources are limited and security and operational issues limit the feasibility of traditional cognitive-behavioral group treatment. PMID:27243111

Infant Operant Conditioning and Its Implications for Early Intervention.

ERIC Educational Resources Information Center

Lancioni, Giullo E.

1980-01-01

In this article infant operant conditioning studies are grouped according to distinct procedures: free operant; discrete trial with one discriminative stimulus; discrete trial with two or more discriminative stimuli; controlled operant with two or more discriminative stimuli; and unrestricted operant with two or more discriminative stimuli.…

Obesity prevention and obesogenic behavior interventions in child care: A systematic review.

PubMed

Sisson, Susan B; Krampe, Megan; Anundson, Katherine; Castle, Sherri

2016-06-01

Review peer-reviewed interventions designed to reduce obesity and improve obesogenic behaviors, including physical activity, diet, and screen time, at child care centers. Interventions components and outcomes, study design, duration, use of behavioral theory, and level of social ecological influence are detailed. Article searches were conducted from March 2014, October 2014, March 2015, January 2016 across three databases. Eligible interventions were conducted in child care settings, included 3-to-5-year-old children, included an outcome measure of obesity or obesogenic behavior, and published in English. Study design quality was assessed using Stetler's Level of Quantitative Evidence. All unique records were screened (n=4589): 237 articles were assessed for eligibility. Of these, 97 articles describing 71 interventions met inclusion criteria. Forty-four articles included multi-level interventions. Twenty-nine interventions included an outcome measure of obesity. Forty-one interventions included physical activity. Forty-five included diet. Eight included screen time. Fifty-five percent of interventions were Level II (randomized controlled trials), while 37% were Level III (quasi-experimental or pre-post only study design), and 8% were Level IV (non-experimental or natural experiments). Most interventions had the intended effect on the target: obesity 48% (n=14), physical activity 73% (n=30), diet 87% (n=39), and screen time 63% (n=5). Summarizing intervention strategies and assessing their effectiveness contributes to the existing literature and may provide direction for practitioners and researchers working with young children in child care. Most interventions produced the targeted changes in obesity and obesity-associated behaviors, supporting current and future efforts to collaborate with early-care centers and professionals for obesity prevention. Copyright © 2016 Elsevier Inc. All rights reserved.

An evaluation of the psychological impact of operational rest and recuperation in United Kingdom Armed Forces personnel: a post-intervention survey

PubMed Central

Jones, Norman; Fertout, Mohammed; Parsloe, Laura; Greenberg, Neil

2013-01-01

Objective Rest and Recuperation (R&R) is a period of home leave taken during an operational deployment; we sought to examine the relationship between taking R&R and mental health. Design A survey-based post-intervention evaluation. Setting UK Participants 232 members of the UK Armed Forces; 42 of which completed pre and post R&R surveys. Main Outcome Measures Alcohol use, Post Traumatic Stress Disorder, Common Mental Disorder Symptoms and R&R experiences. Results 12.1% of respondents (n=27) reported symptoms of common mental disorder and 3.7% (n=8) reported probable PTSD. 50.0% (n=110) reported hazardous use of alcohol during R&R. In the pre- and post-assessed sample, mental health status and alcohol use levels were similar at both survey points. Using principal component analysis, five components of R&R were identified; mentally switching off from deployment, travel experience, physical recovery, relaxation, rest and social support. R&R was extremely popular and although it did not improve mental health overall, the ability to engage with or derive satisfaction from aspects of the five components was significantly associated with better mental health and less alcohol use at the end of R&R. Conclusion Operational commanders should advise personnel about the best way to actively engage with R&R before they leave theatre and be aware of the significant detrimental impact of disrupted travel arrangements upon the ability to benefit from R&R. PMID:23824329

Relation between coping and posttrauma cognitions on PTSD in a combat-trauma population.

PubMed

Sheerin, Christina M; Chowdhury, Nadia; Lind, Mackenzie J; Kurtz, Erin D; Rappaport, Lance M; Berenz, Erin C; Brown, Ruth C; Pickett, Treven; McDonald, Scott D; Danielson, Carla Kmett; Amstadter, Ananda B

2018-01-01

Individual differences in cognitive processes and coping behaviors play a role in the development and maintenance of posttraumatic stress disorder (PTSD). Given the large numbers of combat-exposed service members returning from the Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) conflicts, exploring individual differences in cognitive-affective processes is important for informing our understanding of PTSD etiology and early intervention in military samples. The present study examined the unique main and interactive effects of negative posttrauma cognitions (i.e., negative beliefs about self [NS], the world [NW], and self-blame [SB]) and coping strategies (i.e., positive behavioral, positive cognitive, avoidant coping, and social and emotional coping) on PTSD diagnosis within 155 ( M age = 30.7, SD = 4.48) OEF/OIF/OND combat trauma-exposed veterans recruited from an ongoing study examining the effects of combat trauma and stress reactivity. In the final, stepwise logistic regression analysis, avoidant coping, but no other coping strategy, was significantly positively related to PTSD diagnosis in the initial step. Higher levels of NS, but not NW, were significantly associated with having a PTSD diagnosis, while SB was associated with decreased likelihood of PTSD, above and beyond coping strategies. A significant interaction effect was found between NS and positive cognitive coping, such that greater positive cognitive coping weakened the relationship between NS and PTSD. Examining and addressing coping behaviors and negative thoughts of self jointly may benefit assessment and intervention approaches in a combat-trauma population.

An evaluation of the psychological impact of operational rest and recuperation in United Kingdom Armed Forces personnel: a post-intervention survey.

PubMed

Jones, Norman; Fertout, Mohammed; Parsloe, Laura; Greenberg, Neil

2013-11-01

Rest and Recuperation (R&R) is a period of home leave taken during an operational deployment; we sought to examine the relationship between taking R&R and mental health. A survey-based post-intervention evaluation. UK PARTICIPANTS: 232 members of the UK Armed Forces; 42 of which completed pre and post R&R surveys. Alcohol use, Post Traumatic Stress Disorder, Common Mental Disorder Symptoms and R&R experiences. 12.1% of respondents (n=27) reported symptoms of common mental disorder and 3.7% (n=8) reported probable PTSD. 50.0% (n=110) reported hazardous use of alcohol during R&R. In the pre- and post-assessed sample, mental health status and alcohol use levels were similar at both survey points. Using principal component analysis, five components of R&R were identified; mentally switching off from deployment, travel experience, physical recovery, relaxation, rest and social support. R&R was extremely popular and although it did not improve mental health overall, the ability to engage with or derive satisfaction from aspects of the five components was significantly associated with better mental health and less alcohol use at the end of R&R. Operational commanders should advise personnel about the best way to actively engage with R&R before they leave theatre and be aware of the significant detrimental impact of disrupted travel arrangements upon the ability to benefit from R&R.

Community-based participatory research projects and policy engagement to protect environmental health on St Lawrence Island, Alaska

PubMed Central

Miller, Pamela K.; Waghiyi, Viola; Welfinger-Smith, Gretchen; Byrne, Samuel Carter; Kava, Jane; Gologergen, Jesse; Eckstein, Lorraine; Scrudato, Ronald; Chiarenzelli, Jeff; Carpenter, David O.; Seguinot-Medina, Samarys

2013-01-01

Objectives This article synthesizes discussion of collaborative research results, interventions and policy engagement for St Lawrence Island (SLI), Alaska, during the years 2000–2012. Methods As part of on-going community-based participatory research (CBPR) studies on SLI, 5 discrete exposure-assessment projects were conducted: (a) a biomonitoring study of human blood serum; (b–d) 3 investigations of levels of contaminants in environmental media at an abandoned military site at Northeast Cape – using sediment cores and plants, semi-permeable membrane devices and blackfish, respectively; and (e) a study of traditional foods. Results Blood serum in residents of SLI showed elevated levels of polychlorinated biphenyls (PCBs) with higher levels among those exposed to the military site at Northeast Cape, an important traditional subsistence-use area. Environmental studies at the military site demonstrated that the site is a continuing source of PCBs to a major watershed, and that clean-up operations at the military site generated PCB-contaminated dust on plants in the region. Important traditional foods eaten by the people of SLI showed elevated concentrations of PCBs, which are primarily derived from the long-range transport of persistent pollutants that are transported by atmospheric and marine currents from more southerly latitudes to the north. Interventions An important task for all CBPR projects is to conduct intervention strategies as needed in response to research results. Because of the findings of the CBPR projects on SLI, the CBPR team and the people of the Island are actively engaging in interventions to ensure cleanup of the formerly used military sites; reform chemicals policy on a national level; and eliminate persistent pollutants internationally. The goal is to make the Island and other northern/Arctic communities safe for themselves and future generations. Conclusions As part of the CBPR projects conducted from 2000 to 2012, a series of exposure assessments demonstrate that the leaders of SLI have reason to be concerned about the health of people due to the presence of carcinogenic chemicals as measured in biomonitoring and environmental samples and important traditional foods. PMID:23977641

Challenges to HIV prevention in psychiatric settings: Perceptions of South African mental health care providers

PubMed Central

Collins, Pamela Y.

2009-01-01

Mental health services in South Africa increasingly feel the brunt of the AIDS epidemic. Despite the high prevalence of infection in the psychiatric setting, HIV risk reduction interventions targeting South Africans with psychiatric illness remain few and far between. The attitudes of mental health care providers about sexual relations and HIV among people with mental illness continue to influence the extent to which these issues are addressed in care settings. This study examines these attitudes through the use of a semi-structured interview administered to 46 mental health care providers in four provinces of South Africa. I found that personal, contextual and political factors in the clinic and the hospital create barriers to integrating prevention activities. In particular, providers face at least three challenges to intervening in the epidemic among their patients: their own views of psychiatric illness, the transitions occurring in the mental health care system, and shifting social attitudes toward sexuality. Barriers operate at the individual level, the institutional level, and the societal level. At the individual level providers’ perceptions of psychiatric symptoms shape their outlook on intervention with psychiatric patients. At the institutional level disruptive transitions in service delivery relegate HIV services to lesser importance. At the societal level, personal beliefs about sexuality and mental illness have remained slow to change despite major political changes. Minimizing barriers to implementing HIV prevention services requires institutional and health care policies that ensure adequate resources for treating people with mental illness and for staff development and support. PMID:16647793

Addressing Early Retention in Antenatal Care Among HIV-Positive Women Through a Simple Intervention in Kinshasa, DRC: The Elombe "Champion" Standard Operating Procedure.

PubMed

Gill, Michelle M; Ditekemena, John; Loando, Aimé; Mbonze, Nana; Bakualufu, Jo; Machekano, Rhoderick; Nyombe, Cady; Temmerman, Marleen; Fwamba, Franck

2018-03-01

This cluster-randomized study aimed to assess the Elombe ("Champion") standard operating procedure (SOP), implemented by providers and Mentor Mothers, on HIV-positive pregnant women's retention between first and second antenatal visits. Sixteen facilities in Kinshasa were randomly assigned to intervention (SOP) or comparison (no SOP). Effect of the SOP was estimated using relative risk. Women in comparison facilities were more likely to miss second visits (RR 2.5, 95% CI 1.05-5.98) than women in intervention facilities (30.0%, n = 27 vs. 12.0%, n = 9, p < 0.002). Findings demonstrate that a simple intervention can reduce critical early loss to care in PMTCT programs providing universal, lifelong treatment.

Cardiac Valve Noise Reduction by Non-Drug Interventions Improves the Sleep Quality of Patients after Mechanical Cardiac Valve Implantation.

PubMed

Lin, Yanjuan; Xu, Le; Huang, Xizhen; Jiang, Fei; Lin, Fen; Ye, Qingyang; Lin, Jianling

2016-01-01

To investigate the effects of non-drug interventions on the sleep quality of patients after mechanical cardiac valve implantation. In this prospective, randomized, controlled trial, 64 patients scheduled for mechanical mitral valve replacement were recruited. Patients underwent cognitive behavioral therapy and wore noise cancelling earplugs and eye mask. Sleep quality was evaluated on the 4th after admission and the 5th days after operation. The primary outcome was the total sleep quality score differences between the 4th day after admission and the 5th day after operation. All patients had been suffering from poor sleep quality for a month before admission. There was no difference between both groups on the 4th day after admission. Overall sleep quality in the intervention group was better than in the control group on the 5th day after operation. The subjective sleep quality of the patients in each group was significantly lower on the 5th day after the operation than on the 4th day after admission (P <0.05). Non-drug intervention could improve the sleep quality of patients after mechanical cardiac valve implantation and help the postoperative recovery of the patients. ( ChiCTR-TRC-14004405, 21 March 2014.).

An intervention for parents with AIDS and their adolescent children.

PubMed

Rotheram-Borus, M J; Lee, M B; Gwadz, M; Draimin, B

2001-08-01

This study evaluated an intervention designed to improve behavioral and mental health outcomes among adolescents and their parents with AIDS. Parents with AIDS (n = 307) and their adolescent children (n = 412) were randomly assigned to an intensive intervention or a standard care control condition. Ninety-five percent of subjects were reassessed at least once annually over 2 years. Adolescents in the intensive intervention condition reported significantly lower levels of emotional distress, of multiple problem behaviors, of conduct problems, and of family-related stressors and higher levels of self-esteem than adolescents in the standard care condition. Parents with AIDS in the intervention condition also reported significantly lower levels of emotional distress and multiple problem behaviors. Coping style, levels of disclosure regarding serostatus, and formation of legal custody plans were similar across intervention conditions. Interventions can reduce the long-term impact of parents' HIV status on themselves and their children.

Predictors of treatment use among foster mothers in an attachment-based intervention program.

PubMed

Bick, Johanna; Dozier, Mary; Moore, Shannon

2012-01-01

The current study examined predictors of treatment use among 56 foster mothers who participated in an attachment-based intervention program for foster infants. Foster mothers' levels of treatment use were coded at early, middle, and late phases of the intervention program. Foster mothers' states of mind with regard to attachment predicted their understanding of the intervention session concepts. Specifically, autonomous foster mothers showed higher levels of understanding at the start of the intervention program, when compared with non-autonomous foster mothers. State of mind with regard to attachment also predicted foster mothers' levels of reflective functioning during the intervention sessions. Autonomous foster mothers showed higher levels of reflective functioning at early, middle, and late stages of the intervention program, when compared with non-autonomous foster mothers. The relevance of these findings for both treatment effectiveness and treatment delivery is discussed.

Multilevel Interventions To Address Health Disparities Show Promise In Improving Population Health.

PubMed

Paskett, Electra; Thompson, Beti; Ammerman, Alice S; Ortega, Alexander N; Marsteller, Jill; Richardson, DeJuran

2016-08-01

Multilevel interventions are those that affect at least two levels of influence-for example, the patient and the health care provider. They can be experimental designs or natural experiments caused by changes in policy, such as the implementation of the Affordable Care Act or local policies. Measuring the effects of multilevel interventions is challenging, because they allow for interaction among levels, and the impact of each intervention must be assessed and translated into practice. We discuss how two projects from the National Institutes of Health's Centers for Population Health and Health Disparities used multilevel interventions to reduce health disparities. The interventions, which focused on the uptake of the human papillomavirus vaccine and community-level dietary change, had mixed results. The design and implementation of multilevel interventions are facilitated by input from the community, and more advanced methods and measures are needed to evaluate the impact of the various levels and components of such interventions. Project HOPE—The People-to-People Health Foundation, Inc.

Effect of pre-operative octenidine nasal ointment and showering on surgical site infections in patients undergoing cardiac surgery.

PubMed

Reiser, M; Scherag, A; Forstner, C; Brunkhorst, F M; Harbarth, S; Doenst, T; Pletz, M W; Hagel, S

2017-02-01

To evaluate the effect of pre-operative octenidine (OCT) decolonization on surgical site infection (SSI) rates. Before-and-after cohort study. Patients undergoing an elective isolated coronary artery bypass graft (CABG) procedure: control group (1 st January to 31 st December 2013), N=475; intervention group (1 st January to 31 st December 2014), N=428. The intervention consisted of nasal application of OCT ointment three times daily, beginning on the day before surgery, and showering the night before and on the day of surgery with OCT soap. A median sternotomy was performed in 805 (89.1%) patients and a minimally invasive direct coronary artery bypass procedure was performed in 98 (10.9%) patients. Overall, there was no difference in SSI rates between the control and intervention groups (15.4% vs 13.3%, P=0.39). The rate of harvest site SSIs was significantly lower in patients in the intervention group (2.5% vs 0.5%, P=0.01). Patients who had undergone a median sternotomy in the intervention group had a significantly lower rate of organ/space sternal SSIs (1.9% vs 0.3%, P=0.04). However, there was a trend towards an increased rate of deep incisional sternal SSIs (1.2% vs 2.9%, P=0.08). Multi-variate analysis did not identify a significant protective effect of the intervention (odds ratio 0.79, 95% confidence interval 0.53-1.15, P=0.27). Pre-operative decolonization with OCT did not reduce overall SSI rates in patients undergoing an elective isolated CABG procedure, but significantly decreased harvest site and organ/space sternal SSIs. Randomized controlled trials, including controlled patient adherence to the intervention, are required to confirm these observations and to determine the clinical utility of OCT in pre-operative decolonization. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Residency training: a failed lumbar puncture is more about obesity than lack of ability.

PubMed

Edwards, Cory; Leira, Enrique C; Gonzalez-Alegre, Pedro

2015-03-10

To identify factors influencing the success of lumbar puncture (LP) performed by neurology residents in an outpatient clinic. There is a need to understand the specific influence of patient or operator characteristics in LP performance in order to identify situations at high risk for failure that could benefit from compensatory interventions. We performed a retrospective analysis of all consecutive patients who underwent elective LP in the Neurology Clinic at the University of Iowa between 2009 and 2012. We recorded demographic, anthropometric, and clinical information, and the level of training of the resident performing the procedure. Outcomes measure was unsuccessful LP, defined as no quantifiable CSF. This study was previously approved by the University of Iowa institutional review board. A total of 328 patients (59% women) were included. Men were significantly older than women, and the indication of the procedure differed by sex. Headache or possible multiple sclerosis were more common indications in women than in men. Nineteen percent of the LPs were unsuccessful. We found a strong correlation between patient body mass index (BMI) and unsuccessful outcome (p < 0.0001). Age of the patient and level of training of the operator did not predict unsuccessful LP. Patient BMI is the key factor that determines an unsuccessful LP by neurology residents in an outpatient setting, an association that might be applicable to different clinical settings. The high failure rate in patients with BMI >35 suggests that implementing compensatory interventions such as the use of imaging guidance might be cost-effective and better tolerated by these patients. © 2015 American Academy of Neurology.

A RE-AIM evaluation of evidence-based multi-level interventions to improve obesity-related behaviours in adults: a systematic review (the SPOTLIGHT project).

PubMed

Compernolle, Sofie; De Cocker, Katrien; Lakerveld, Jeroen; Mackenbach, Joreintje D; Nijpels, Giel; Oppert, Jean-Michel; Rutter, Harry; Teixeira, Pedro J; Cardon, Greet; De Bourdeaudhuij, Ilse

2014-12-06

This systematic literature review describes the potential public health impact of evidence-based multi-level interventions to improve obesity-related behaviours in adults, using the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework. Electronic databases (PubMed, Embase, and The Cochrane Library) were searched to identify intervention studies published between January 2000 and October 2013. The following inclusion criteria were used: (1) the study included at least one outcome measure assessing obesity-related behaviours (i.e. diet, physical activity or sedentary behaviour), (2) the study collected data over at least one year and (3) the study's intervention targeted adults, was conducted in a specified geographical area or worksite, and was multi-level (i.e. targeting both individual and environmental level). Evidence of RE-AIM of the selected interventions was assessed. Potential public health impact of an intervention was evaluated if information was provided on at least four of the five RE-AIM dimensions. Thirty-five multi-level interventions met the inclusion criteria. RE-AIM evaluation revealed that the included interventions generally had the potential to: reach a large number of people (on average 58% of the target population was aware of the intervention); achieve the assumed goals (89% found positive outcomes); be broadly adopted (the proportion of intervention deliverers varied from 9% to 92%) and be sustained (sixteen interventions were maintained). The highest potential public health impact was found in multi-level interventions that: 1) focused on all levels at the beginning of the planning process, 2) guided the implementation process using diffusion theory, and 3) used a website to disseminate the intervention. Although most studies underreported results within the RE-AIM dimensions, the reported Reach, Effectiveness, Adoption, Implementation and Maintenance were positively evaluated. However, more information on external validity and sustainability is needed in order to take informed decisions on the choice of interventions that should be implemented in real-world settings to accomplish long-term changes in obesity-related behaviours.

The ACTIVATE study: results from a group-randomized controlled trial comparing a traditional worksite health promotion program with an activated consumer program.

PubMed

Terry, Paul E; Fowles, Jinnet Briggs; Xi, Min; Harvey, Lisa

2011-01-01

PURPOSE. This study compares a traditional worksite-based health promotion program with an activated consumer program and a control program DESIGN. Group randomized controlled trial with 18-month intervention. SETTING. Two large Midwestern companies. SUBJECTS. Three hundred and twenty employees (51% response). INTERVENTION. The traditional health promotion intervention offered population-level campaigns on physical activity, nutrition, and stress management. The activated consumer intervention included population-level campaigns for evaluating health information, choosing a health benefits plan, and understanding the risks of not taking medications as prescribed. The personal development intervention (control group) offered information on hobbies. The interventions also offered individual-level coaching for high risk individuals in both active intervention groups. MEASURES. Health risk status, general health status, consumer activation, productivity, and the ability to evaluate health information. ANALYSIS. Multivariate analyses controlled for baseline differences among the study groups. RESULTS. At the population level, compared with baseline performance, the traditional health promotion intervention improved health risk status, consumer activation, and the ability to recognize reliable health websites. Compared with baseline performance, the activated consumer intervention improved consumer activation, productivity, and the ability to recognize reliable health websites. At the population level, however, only the activated consumer intervention improved any outcome more than the control group did; that outcome was consumer activation. At the individual level for high risk individuals, both traditional health coaching and activated consumer coaching positively affected health risk status and consumer activation. In addition, both coaching interventions improved participant ability to recognize a reliable health website. Consumer activation coaching also significantly improved self-reported productivity. CONCLUSION. An effective intervention can change employee health risk status and activation both at the population level and at the individual high risk level. However, program engagement at the population level was low, indicating that additional promotional strategies, such as greater use of incentives, need to be examined. Less intensive coaching can be as effective as more intensive, albeit both interventions produced modest behavior change and retention in the consumer activation arm was most difficult. Further research is needed concerning recruitment and retention methods that will enable populations to realize the full potential of activated consumerism.

34 CFR 303.654 - Annual report to the Secretary.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Secretary on the status of early intervention programs operated within the State for children eligible under... AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND...

Radiological interventions in malignant biliary obstruction

PubMed Central

Madhusudhan, Kumble Seetharama; Gamanagatti, Shivanand; Srivastava, Deep Narayan; Gupta, Arun Kumar

2016-01-01

Malignant biliary obstruction is commonly caused by gall bladder carcinoma, cholangiocarcinoma and metastatic nodes. Percutaneous interventions play an important role in managing these patients. Biliary drainage, which forms the major bulk of radiological interventions, can be palliative in inoperable patients or pre-operative to improve liver function prior to surgery. Other interventions include cholecystostomy and radiofrequency ablation. We present here the indications, contraindications, technique and complications of the radiological interventions performed in patients with malignant biliary obstruction. PMID:27247718

The Devon Active Villages Evaluation (DAVE) trial of a community-level physical activity intervention in rural south-west England: a stepped wedge cluster randomised controlled trial.

PubMed

Solomon, Emma; Rees, Tim; Ukoumunne, Obioha C; Metcalf, Brad; Hillsdon, Melvyn

2014-07-18

The majority of adults are not meeting the guidelines for physical activity despite activity being linked with numerous improvements to long-term health. In light of this, researchers have called for more community-level interventions. The main objective of the present study was to evaluate whether a community-level physical activity intervention increased the activity levels of rural communities. 128 rural villages (clusters) were randomised to receive the intervention in one of four time periods between April 2011 and December 2012. The Devon Active Villages intervention provided villages with 12 weeks of physical activity opportunities for all age groups, including at least three different types of activities per village. Each village received an individually tailored intervention, incorporating a local needs-led approach. Support was provided for a further 12 months following the intervention. The evaluation study used a stepped wedge cluster randomised controlled trial design. All 128 villages were measured at each of five data collection periods using a postal survey. The primary outcome of interest was the proportion of adults reporting sufficient physical activity to meet internationally recognised guidelines. Minutes spent in moderate-and-vigorous activity per week was analysed as a secondary outcome. To compare between intervention and control modes, random effects linear regression and marginal logistic regression models were implemented for continuous and binary outcomes respectively. 10,412 adults (4693 intervention, 5719 control) completed the postal survey (response rate 32.2%). The intervention did not increase the odds of adults meeting the physical activity guideline (adjusted OR 1.02, 95% CI: 0.88 to 1.17; P = 0.80), although there was weak evidence of an increase in minutes of moderate-and-vigorous-intensity activity per week (adjusted mean difference = 171, 95% CI: -16 to 358; P = 0.07). The ineffectiveness of the intervention may have been due to its low penetration-only 16% of intervention mode participants reported awareness of the intervention and just 4% reported participating in intervention events. A community-level physical activity intervention providing tailored physical activity opportunities to rural villages did not improve physical activity levels in adults. Greater penetration of such interventions must be achieved if they are to increase physical activity prevalence at the community level. Current Controlled Trials ISRCTN37321160.

Vascular surgery trainees still need to learn how to sew: importance of learning surgical techniques in the era of endovascular surgery.

PubMed

Aziz, Faisal

2015-01-01

Vascular surgery represents one of the most rapidly evolving specialties in the field of surgery. It was merely 100 years ago when Dr. Alexis Carrel described vascular anastomosis. Over the course of next several decades, vascular surgeons distinguished themselves from general surgeons by horning the techniques of vascular surgery operations. In the era of minimally invasive interventions, the number of endovascular interventions performed by vascular surgeons has increased exponentially. Vascular surgery trainees in the current times spend considerable time in mastering the techniques of endovascular operations. Unfortunately, the reduction in number of open surgical operations has lead to concerns in regards to adequacy of learning open surgical techniques. In future, majority of vascular interventions will be done with minimally invasive techniques. Combination of poor training in open operations and increasing complexity of open surgical operations may lead to poor surgical outcomes. It is the need of the hour for vascular surgery trainees to realize the importance of learning and mastering open surgical techniques. One of the most distinguishing features of contemporary vascular surgeons is their ability to perform both endovascular and open vascular surgery operations, and we should strive to maintain our excellence in both of these arenas.

Rationale for early versus late intervention with arthroscopy for treatment of inflammatory/degenerative temporomandibular joint disorders.

PubMed

Israel, Howard A; Behrman, David A; Friedman, Joel M; Silberstein, Jennifer

2010-11-01

The goal of this study was to determine if there were differences in outcomes of arthroscopic surgery in patients with inflammatory/degenerative temporomandibular joint (TMJ) disease who underwent early surgical intervention versus late surgical intervention. The study population included 44 consecutive patients who met the criteria for TMJ operative arthroscopy who were divided into early and late intervention groups. The time between the onset of symptoms and the performance of arthroscopy was used to determine entry into the early versus late intervention group. All groups were evaluated for changes in preoperative versus postoperative pain levels based on visual analog scale (VAS) scores and maximum interincisal opening distance. Statistical analyses included the Student t test to determine if there were significant differences between preoperative and postoperative assessments in the early and late intervention groups. The mean time between onset of symptoms in the early intervention group (21 patients) was 5.4 months compared with 33 months in the late intervention group (23 patients). All patient groups had statistically significant decreases in pain and improvement in maximum interincisal opening distance after arthroscopy. The early intervention group had a mean decrease in VAS pain scores of 5.14 compared with the late intervention group with a mean decrease in VAS pain scores of 2.84, and this difference was significant (P = .012). The early intervention group had a mean increase in maximum interincisal opening of 12.38 mm compared with the late intervention group with a mean increase of 7.70. Although statistical significance was not achieved for increases in maximum interincisal opening between the early and late intervention groups (P = .089), the difference between the 2 groups was suggestive of a trend. There were no surgical complications for either group; however, 2 patients in the late intervention group developed persistent chronic neuropathic pain, requiring pain management. TMJ arthroscopy reliably decreased pain and increased the maximum interincisal opening distance in the early and late intervention groups. The early intervention group had better surgical outcomes than the late intervention group. Arthroscopic surgery should be considered early in the management of patients with inflammatory/degenerative TMJ disease. Copyright © 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Use of early gastrografin small bowel follow-through in small bowel obstruction management.

PubMed

Galardi, Nicholas; Collins, Jay; Friend, Kara

2013-08-01

Small bowel follow-through (SBFT) is a diagnostic tool commonly used in the management of patients with small bowel obstruction (SBO). This study assessed whether early implementation of Gastrografin SBFT would reduce the time to resolution of the SBO and decrease the time to operative intervention. In this retrospective chart review, 103 patients with the clinical diagnosis of adhesive SBO were evaluated. End points of the study were resolution of SBO with nonoperative management or operative intervention. The patient group that had received a SBFT was then compared with those that did not receive a SBFT. There were 103 patients with adhesive SBO who met inclusion criteria for this study. Seventy-two of 103 patients had undergone Gastrografin SBFT and 31 did not. In the SBFT group, mean time to the operating room was 1.0 days after SBFTs, whereas in the group that did not receive SBFT, it was 3.7 days (P < 0.0001). Mean time to nonoperative resolution of SBO in the SBFT group was 1.8 days and 4.7 days in the no SBFT group (P < 0.0001). There were no Gastrografin-related complications. Obtaining Gastrografin SBFT in patients with adhesive SBO leads to both a shorter time in identifying the need for operative intervention and to resolution of SBO with nonoperative management. SBFT seems to be a more definitive assessment of whether an SBO will resolve on its own or if operative intervention is necessary.

The natural history of Dandy-Walker syndrome in the United States: A population-based analysis.

PubMed

McClelland, Shearwood; Ukwuoma, Onyinyechi I; Lunos, Scott; Okuyemi, Kolawole S

2015-01-01

Dandy-Walker syndrome (DWS) is a congenital disorder typically manifesting with hydrocephalus. The classic anatomic hallmarks of DWS are hypoplasia of the cerebellar vermis, anterior-posterior enlargement of the posterior fossa, upward displacement of the torcula and transverse sinuses, and cystic dilatation of the fourth ventricle. Although optimal treatment of DWS typically requires neurosurgical intervention to prevent intracranial pressure increases incompatible with life, the natural history of this disorder has yet to be evaluated on a nationwide level. The Kids' Inpatient Database covering 1997-2003 was used for analysis. Children younger than age 18 admitted for DWS (ICD-9-CM = 742.3) were analyzed with a matched control group. The primary procedure codes for operative CSF drainage were coded into the analysis. The incidence of DWS was 0.136%; 14,599 DWS patients were included. Multiple logistic regression models were used. Odds ratios (OR) were reported with 95% confidence intervals. Mortality (OR = 10.02; P < 0.0001) and adverse discharge disposition (OR = 4.59; P < 0.0001) were significantly greater in DWS patients compared with controls. 20.4% of DWS patients received operative cerebrospinal fluid (CSF) drainage, 81-times more than controls (P < 0.0001). CSF drainage reduced mortality by 44% among DWS patients (P < 0.0001). Although DWS is associated with a 10-fold increase in mortality, operative CSF drainage nearly halves the mortality rate. Based on these findings (Class IIB evidence), it is likely that the increased mortality associated with DWS is directly attributable to the nearly 80% of DWS patients who did not receive operative CSF drainage for hydrocephalus. Consequently, increased access to neurosurgical intervention could reduce the mortality rate of DWS towards that of the general population.

Evaluation and Management of Traumatic Diaphragmatic Injuries: A Practice Management Guideline from the Eastern Association for the Surgery of Trauma.

PubMed

McDonald, Amy A; Robinson, Bryce R H; Alarcon, Louis; Bosarge, Patrick L; Dorion, Heath; Haut, Elliott R; Juern, Jeremy; Madbak, Firas; Reddy, Srinivas; Weiss, Patricia; Como, John J

2018-04-02

Traumatic diaphragm injuries (TDI) pose both diagnostic and therapeutic challenges in both the acute and chronic phases. There are no published practice management guidelines to date for TDI. We aim to formulate a practice management guideline for TDI using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The working group formulated five Patient, Intervention, Comparator, Outcome (PICO) questions regarding the following topics: 1) diagnostic approach (laparoscopy vs. computed tomography); 2) non-operative management of penetrating right-sided injuries; 3) surgical approach (abdominal or thoracic) for acute TDI, including 4) the use of laparoscopy; and 5) surgical approach (abdominal or thoracic) for delayed TDI. A systematic review was undertaken and last updated December 2016. RevMan 5 (Cochran Collaboration) and GRADEpro (Grade Working Group) software were utilized. Recommendations were voted on by working group members. Consensus was obtained for each recommendation. A total of 56 articles were utilized to formulate the recommendations. Most studies were retrospective case series with variable reporting of outcomes measures and outcomes frequently not stratified to intervention or comparator. The overall quality of the evidence was very low for all PICOs. Therefore, only conditional recommendations could be made. Recommendations were made in favor of laparoscopy over CT for diagnosis, non-operative vs. operative approach for right-sided penetrating injuries, abdominal vs. thoracic approach for acute TDI, and laparoscopy (with the appropriate skill set and resources) vs. open approach for isolated TDI. No recommendation could be made for the preferred operative approach for delayed TDI. Very low-quality evidence precluded any strong recommendations. Further study of the diagnostic and therapeutic approaches to TDI is warranted. Guideline LEVEL OF EVIDENCE: 4.

A coalition partnership of vision health through a health-promoting school program for primary school students in Taiwan.

PubMed

Chang, Li-Chun; Guo, Jong-Long; Liao, Li-Ling; Peng, Hsiu-Ying; Hsieh, Pei-Lin

2017-09-01

Myopia, the most common refractive error, is the most common cause of avoidable visual impairment among children and has reached epidemic proportions among children and young adults in urban areas of East and Southeast Asia that contain populations of Chinese ancestry. Moreover, vision health is an important theme of the health-promoting school program issued by the Ministry of Education in Taiwan. The aim of this study is to assess the impact of pre- and post-intervention proposed by the health-promoting school (HPS) model. The objectives are to understand whether the HPS model influenced the vision screening results and the attitude, knowledge level, and vision care behavior of the students involved. A prospective cohort study design was used to evaluate a vision health program. Four elementary schools, local education authorities, and one university in northern Taiwan established a coalition partnership to design a six-month program to combat myopia among students. The target population was 6668 school children from local elementary schools. For the purpose of this study, the outcome of visual acuity testing (in logMAR) was analyzed with a sampling of 373 school children (aged 11-12 years old) who were chosen from high prevalence of poor vision classes. After the HPS program, the attitudes, behaviors, and knowledge levels of the school children regarding vision health were significantly improved. The pre-intervention mean logMAR of all participating students ( N = 373) was -.10, which increased to -.19 after the intervention. Analysis using the Wilcoxon signed-rank test showed that the logMAR value was significantly improved after the intervention ( t = 2.13, p < 0.05). Our findings highlight the relevance and effectiveness of the coalition's efforts, which reinforces the usefulness of co-operatively implementing the HPS program.

Developing a tool to measure pharmacoeconomic outcomes of post-surgical pain management interventions.

PubMed

Keller, Deborah S; Smalarz, Amy; Haas, Eric M

2016-01-01

Financial pressures have limited the ability of providers to use medication that may improve clinical outcomes and patient satisfaction. New interventions are often fraught with resistance from individual cost centers. A value realization tool (VRT) is essential for separate cost centers to communicate and comprehend the overall financial and clinical implications of post-surgical pain management medication interventions (PSMI). The goal was to describe development of a VRT. An evaluation of common in-patient PSMI approaches, impacts, and costs was performed. A multidisciplinary task force guided development of the VRT to ensure appropriate representation and relevance to clinical practice. The main outcome was an Excel-based tool that communicates the overall cost/benefit of PSMI for the post-operative patient encounter. The VRT aggregated input data on costs, clinical impact, and nursing burden of PSMI assessment and monitoring into two high-level outcome reports: Overall Cost Impact and Nurse & Patient Impact. Costs included PSMI specific medication, equipment, professional placement, labor, overall/opioid-related adverse events, re-admissions, and length of stay. Nursing impact included level of practice interference, job satisfaction, and patient care metrics. Patient impact included pain scores, opioid use, PACU time, and satisfaction. Reference data was provided for individual institutions that may not collect all variables included in the VRT. The VRT is a valuable way for administrators to assess PSMI cost/benefits and for individual cost centers to see the overall value of individual interventions. The user-friendly, decision-support tool allows the end-user to use built-in referenced or personalized outcome data, increasing relevance to their institutions. This broad picture could facilitate communication across cost centers and evidence-based decisions for appropriate use and impacts of PSMI.

Weight gain prevention in the school worksite setting: Results of a multi-level cluster randomized trial

PubMed Central

Lemon, Stephenie C.; Wang, Monica L.; Wedick, Nicole M.; Estabrook, Barbara; Druker, Susan; Schneider, Kristin L.; Li, Wenjun; Pbert, Lori

2014-01-01

Objective To describe the effectiveness, reach and implementation of a weight gain prevention intervention among public school employees. Method A multi-level intervention was tested in a cluster randomized trial among 782 employees in 12 central Massachusetts public high schools from 2009 to 2012. The intervention targeted the nutrition and physical activity environment and policies, the social environment and individual knowledge, attitudes and skills. The intervention was compared to a materials only condition. The primary outcome measures were change in weight and body mass index (BMI) at 24-month follow-up. Implementation of physical environment, policy and social environment strategies at the school and interpersonal levels, and intervention participation at the individual level were assessed. Results At 24-month follow-up, there was a net change (difference of the difference) of −3.03 pounds (p=.04) and of −.48 BMI units (p=.05) between intervention and comparison conditions. The majority of intervention strategies were successfully implemented by all intervention schools, although establishing formal policies was challenging. Employee participation in programs targeting the physical and social environment was maintained over time. Conclusion This study supports that a multi-level intervention integrated within the organizational culture can be successfully implemented and prevent weight gain in public high school employees. PMID:24345602

Identifying Synergies in Multilevel Interventions.

PubMed

Lewis, Megan A; Fitzgerald, Tania M; Zulkiewicz, Brittany; Peinado, Susana; Williams, Pamela A

2017-04-01

Social ecological models of health often describe multiple levels of influence that interact to influence health. However, it is still common for interventions to target only one or two of these levels, perhaps owing in part to a lack of guidance on how to design multilevel interventions to achieve optimal impact. The convergence strategy emphasizes that interventions at different levels mutually reinforce each other by changing patterns of interaction among two or more intervention audiences; this strategy is one approach for combining interventions at different levels to produce synergistic effects. We used semistructured interviews with 65 representatives in a cross-site national initiative that enhanced health and outcomes for patients with diabetes to examine whether the convergence strategy was a useful conceptual model for multilevel interventions. Using a framework analysis approach to analyze qualitative interview data, we found three synergistic themes that match the convergence strategy and support how multilevel interventions can be successful. These three themes were (1) enhancing engagement between patient and provider and access to quality care; (2) supporting communication, information sharing, and coordination among providers, community stakeholders, and systems; and (3) building relationships and fostering alignment among providers, community stakeholders, and systems. These results support the convergence strategy as a testable conceptual model and provide examples of successful intervention strategies for combining multilevel interventions to produce synergies across levels and promote diabetes self-management and that may extend to management of other chronic illnesses as well.

[Surgical aspects of radicalism in the treatment of the thyroid gland cancer].

PubMed

Sterniuk, Iu M; Niederle, B

2007-07-01

The results of surgical treatment of 149 patients, suffering differentiated cancer of the thyroid gland (CTG) and 89--with medullar pathology were analyzed. In differentiated CTG the recurrence after performance of subtotal resection of the organ had occurred in (41.2 +/- 12.3)% observations, after thyroidectomy performance without cervical lymph nodes (LN) dissection--in (31.1 +/- 5.9)%, after thyroidectomy with LN dissection--in (11.3 +/- 3.8)%. The operation radicalism for differentiated CTG secures, as minimum, by application of thyroidectomy with central LN dissection. For optimization of indications for dissection of lateral and mediastinal LN diagnostic lymphadenectomy is performed or the process stage is analyzed. Radicalism of surgical intervention for medullar cancer necessitates as minimal procedure thyroidectomy, dissection of central and also, for prophylaxis, lateral LN during the first stage of the operation, securing in 60% of patients the treatment radicalism. While application of radical surgical tactics only during performance of subsequent (for recurrence) operations the essential lowering of calcitonin level is observed only in 17.6% of patients.

From Here to Autonomy.

PubMed

Endsley, Mica R

2017-02-01

As autonomous and semiautonomous systems are developed for automotive, aviation, cyber, robotics and other applications, the ability of human operators to effectively oversee and interact with them when needed poses a significant challenge. An automation conundrum exists in which as more autonomy is added to a system, and its reliability and robustness increase, the lower the situation awareness of human operators and the less likely that they will be able to take over manual control when needed. The human-autonomy systems oversight model integrates several decades of relevant autonomy research on operator situation awareness, out-of-the-loop performance problems, monitoring, and trust, which are all major challenges underlying the automation conundrum. Key design interventions for improving human performance in interacting with autonomous systems are integrated in the model, including human-automation interface features and central automation interaction paradigms comprising levels of automation, adaptive automation, and granularity of control approaches. Recommendations for the design of human-autonomy interfaces are presented and directions for future research discussed.

Minimum Control Requirements for Advanced Life Support Systems

NASA Technical Reports Server (NTRS)

Boulange, Richard; Jones, Harry; Jones, Harry

2002-01-01

Advanced control technologies are not necessary for the safe, reliable and continuous operation of Advanced Life Support (ALS) systems. ALS systems can and are adequately controlled by simple, reliable, low-level methodologies and algorithms. The automation provided by advanced control technologies is claimed to decrease system mass and necessary crew time by reducing buffer size and minimizing crew involvement. In truth, these approaches increase control system complexity without clearly demonstrating an increase in reliability across the ALS system. Unless these systems are as reliable as the hardware they control, there is no savings to be had. A baseline ALS system is presented with the minimal control system required for its continuous safe reliable operation. This baseline control system uses simple algorithms and scheduling methodologies and relies on human intervention only in the event of failure of the redundant backup equipment. This ALS system architecture is designed for reliable operation, with minimal components and minimal control system complexity. The fundamental design precept followed is "If it isn't there, it can't fail".

Hierarchical HMM based learning of navigation primitives for cooperative robotic endovascular catheterization.

PubMed

Rafii-Tari, Hedyeh; Liu, Jindong; Payne, Christopher J; Bicknell, Colin; Yang, Guang-Zhong

2014-01-01

Despite increased use of remote-controlled steerable catheter navigation systems for endovascular intervention, most current designs are based on master configurations which tend to alter natural operator tool interactions. This introduces problems to both ergonomics and shared human-robot control. This paper proposes a novel cooperative robotic catheterization system based on learning-from-demonstration. By encoding the higher-level structure of a catheterization task as a sequence of primitive motions, we demonstrate how to achieve prospective learning for complex tasks whilst incorporating subject-specific variations. A hierarchical Hidden Markov Model is used to model each movement primitive as well as their sequential relationship. This model is applied to generation of motion sequences, recognition of operator input, and prediction of future movements for the robot. The framework is validated by comparing catheter tip motions against the manual approach, showing significant improvements in the quality of catheterization. The results motivate the design of collaborative robotic systems that are intuitive to use, while reducing the cognitive workload of the operator.

Does education level affect the efficacy of a community based salt reduction program? - A post-hoc analysis of the China Rural Health Initiative Sodium Reduction Study (CRHI-SRS).

PubMed

Wang, Xin; Li, Xian; Vaartjes, Ilonca; Neal, Bruce; Bots, Michiel L; Hoes, Arno W; Wu, Yangfeng

2016-08-11

Whether educational level influences the effects of health education is not clearly defined. This study examined whether the impact of a community-based dietary salt reduction program was affected by the level of education of participants. The China Rural Health Initiative Sodium Reduction Study (CRHI-SRS) was a cluster-randomized controlled trial conducted in 120 villages from five Northern Chinese provinces. The intervention comprised a village-wide health education program and availability of salt substitute at village shops. 24-h urine samples were collected among 1903 participants for primary evaluation of the intervention effect. A post-hoc analysis was done to explore for heterogeneity of intervention effects by education level using generalized estimating equations. All models were adjusted for age, sex, body mass index and province. Daily salt intake was lower in intervention than in control at all educational levels with no evidence of a difference in the effect of the intervention across different levels of education. P value for the interaction term between education level and the intervention was 0.35. There was likewise no evidence of an interaction for effects of the intervention on potassium intake (p = 0.71), the sodium to potassium ratio (p = 0.07), or knowledge and behaviors related to salt (all p > 0.05). The study suggests that the effects of the intervention were achieved regardless of the level of education and that the intervention should therefore be broadly effective in rural Chinese populations. The trial was registered with clinicaltrial.gov ( NCT01259700 ).

Impact of the World Health Organization's Surgical Safety Checklist on safety culture in the operating theatre: a controlled intervention study

PubMed Central

Haugen, A. S.; Søfteland, E.; Eide, G. E.; Sevdalis, N.; Vincent, C. A.; Nortvedt, M. W.; Harthug, S.

2013-01-01

Background Positive changes in safety culture have been hypothesized to be one of the mechanisms behind the reduction in mortality and morbidity after the introduction of the World Health Organization's Surgical Safety Checklist (SSC). We aimed to study the checklist effects on safety culture perceptions in operating theatre personnel using a prospective controlled intervention design at a single Norwegian university hospital. Methods We conducted a study with pre- and post-intervention surveys using the intervention and control groups. The primary outcome was the effects of the Norwegian version of the SSC on safety culture perceptions. Safety culture was measured using the validated Norwegian version of the Hospital Survey on Patient Safety Culture. Descriptive characteristics of operating theatre personnel and checklist compliance data were also recorded. A mixed linear regression model was used to assess changes in safety culture. Results The response rate was 61% (349/575) at baseline and 51% (292/569) post-intervention. Checklist compliance ranged from 77% to 85%. We found significant positive changes in the checklist intervention group for the culture factors ‘frequency of events reported’ and ‘adequate staffing’ with regression coefficients at −0.25 [95% confidence interval (CI), −0.47 to −0.07] and 0.21 (95% CI, 0.07–0.35), respectively. Overall, the intervention group reported significantly more positive culture scores—including at baseline. Conclusions Implementation of the SSC had rather limited impact on the safety culture within this hospital. PMID:23404986

Cost-effectiveness of preventing dental caries and full mouth dental reconstructions among Alaska Native children in the Yukon-Kuskokwim delta region of Alaska.

PubMed

Atkins, Charisma Y; Thomas, Timothy K; Lenaker, Dane; Day, Gretchen M; Hennessy, Thomas W; Meltzer, Martin I

2016-06-01

We conducted a cost-effectiveness analysis of five specific dental interventions to help guide resource allocation. We developed a spreadsheet-based tool, from the healthcare payer perspective, to evaluate the cost effectiveness of specific dental interventions that are currently used among Alaska Native children (6-60 months). Interventions included: water fluoridation, dental sealants, fluoride varnish, tooth brushing with fluoride toothpaste, and conducting initial dental exams on children <18 months of age. We calculated the cost-effectiveness ratio of implementing the proposed interventions to reduce the number of carious teeth and full mouth dental reconstructions (FMDRs) over 10 years. A total of 322 children received caries treatments completed by a dental provider in the dental chair, while 161 children received FMDRs completed by a dental surgeon in an operating room. The average cost of treating dental caries in the dental chair was $1,467 (∼258,000 per year); while the cost of treating FMDRs was $9,349 (∼1.5 million per year). All interventions were shown to prevent caries and FMDRs; however tooth brushing prevented the greatest number of caries at minimum and maximum effectiveness with 1,433 and 1,910, respectively. Tooth brushing also prevented the greatest number of FMDRs (159 and 211) at minimum and maximum effectiveness. All of the dental interventions evaluated were shown to produce cost savings. However, the level of that cost saving is dependent on the intervention chosen. © 2016 The Authors. Journal of Public Health Dentistry published by Wiley Periodicals, Inc. on behalf of American Association of Public Health Dentistry.

Effect of supportive supervision on routine immunization service delivery-a randomized post-test study in Odisha.

PubMed

Som, Meena; Panda, Bhuputra; Pati, Sanghamitra; Nallala, Srinivas; Anasuya, Anita; Chauhan, Abhimanyu Singh; Sen, Ashish Kumar; Zodpey, Sanjay

2014-06-30

Routine immunization is a key child survival intervention. Issues related to quality of service delivery pose operational challenges in delivering effective immunization services. Accumulated evidences suggest that "supportive supervision" improves the quality of health care services. During 2009-10, Govt. of Odisha (GoO) and UNICEF jointly piloted this strategy in four districts to improve routine immunization. The present study aims to assess the effect of supportive supervision strategy on improvement of knowledge and practices on routine immunization among service providers. We adopted a 'post-test only' study design to compare the knowledge and practices of frontline health workers and their supervisors in four intervention districts with that of two control districts. Altogether we interviewed 170 supervisors and supervisees (health workers), each, using semi-structured interview schedules. We also directly observed 25 ice lined refrigerator (ILR) points in both groups of districts. The findings were compared with the baseline information, available only for the intervention districts. The health workers in the intervention districts displayed a higher knowledge score in selected items than in the control group. No significant difference in knowledge was observed between control and intervention supervisors. The management practices at ILR points on key routine immunization components were found to have improved significantly in intervention districts. The observed improvements in the ILR management practices indicate positive influence of supportive supervision. Higher level of domain knowledge among intervention health workers on specific items related to routine immunization could be due to successful transfer of knowledge from supervisors. A 'pre-post' study design should be undertaken to gain insights into the effectiveness of supportive supervision in improving routine immunization services.

Validation of Rules to Predict Emergent Surgical Intervention in Pediatric Trauma Patients

PubMed Central

Boatright, Dowin H; Byyny, Richard L; Hopkins, Emily; Bakes, Katherine; Hissett, Jennifer; Tunson, Java; Easter, Joshua S; Vogel, Jody A; Bensard, Denis; Haukoos, Jason S

2014-01-01

Background Trauma centers use guidelines to determine when a trauma surgeon is needed in the emergency department (ED) on patient arrival. A decision rule from Loma Linda University identified patients with penetrating injury and tachycardia as requiring emergent surgical intervention. Our goal was to validate this rule and to compare it to the American College of Surgeons’ Major Resuscitation Criteria (MRC). Study Design We used data from 1993 through 2010 from two Level 1 trauma centers in Denver, Colorado. Patient demographics, injury severity, times of ED arrival and surgical intervention, and all variables of the Loma Linda Rule and the MRC were obtained. The outcome, emergent intervention (defined as requiring operative intervention by a trauma surgeon within one hour of arrival to the ED or performance of cricothyroidotomy or thoracotomy in the ED) was confirmed using standardized abstraction. Sensitivities, specificities, and 95% confidence intervals (CIs) were calculated. Results 8,078 patients were included and 47 (0.6%) required emergent intervention. Of the 47 patients, the median age was 11 years (IQR: 7–14), 70% were male, 30% had penetrating mechanisms, and the median ISS was 25 (IQR: 9–41). At the two institutions, the Loma Linda Rule had a sensitivity and specificity of 69% (95% CI: 45%–94%) and 76% (95% CI: 69%–83%), respectively, and the MRC had a sensitivity and specificity of 80% (95% CI: 70%–92%) and 81% (95% CI: 77%–85%), respectively. Conclusions Emergent surgical intervention is rare in the pediatric trauma population. Although precision of predictive accuracies of the Loma Linda Rule and MRC were limited by small numbers of outcomes, neither set of criteria appears to be sufficiently accurate to recommend their routine use. PMID:23623222

Closing achievement gaps with a utility-value intervention: Disentangling race and social class.

PubMed

Harackiewicz, Judith M; Canning, Elizabeth A; Tibbetts, Yoi; Priniski, Stacy J; Hyde, Janet S

2016-11-01

Many college students abandon their goal of completing a degree in science, technology, engineering, or math (STEM) when confronted with challenging introductory-level science courses. In the U.S., this trend is more pronounced for underrepresented minority (URM) and first-generation (FG) students, and contributes to persisting racial and social-class achievement gaps in higher education. Previous intervention studies have focused exclusively on race or social class, but have not examined how the 2 may be confounded and interact. This research therefore investigates the independent and interactive effects of race and social class as moderators of an intervention designed to promote performance, measured by grade in the course. In a double-blind randomized experiment conducted over 4 semesters of an introductory biology course (N = 1,040), we tested the effectiveness of a utility-value intervention in which students wrote about the personal relevance of course material. The utility-value intervention was successful in reducing the achievement gap for FG-URM students by 61%: the performance gap for FG-URM students, relative to continuing generation (CG)-Majority students, was large in the control condition, .84 grade points (d = .98), and the treatment effect for FG-URM students was .51 grade points (d = 0.55). The UV intervention helped students from all groups find utility value in the course content, and mediation analyses showed that the process of writing about utility value was particularly powerful for FG-URM students. Results highlight the importance of intersectionality in examining the independent and interactive effects of race and social class when evaluating interventions to close achievement gaps and the mechanisms through which they may operate. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Current Trends in the Management of Ballistic Fractures of the Hand and Wrist: Experiences of a High-Volume Level I Trauma Center.

PubMed

Ghareeb, Paul A; Daly, Charles; Liao, Albert; Payne, Diane

2018-03-01

Ballistic fractures of the carpus and hand are routinely treated in large urban centers. These injuries can be challenging due to many factors. Various treatment options exist for these complicated injuries, but there are limited data available. This report analyzes patient demographics, treatments, and outcomes at a large urban trauma center. All ballistic fractures of the hand and wrist of the patients who presented to a single center from 2011 to 2014 were retrospectively reviewed. Patient demographics, injury mechanism, treatment modalities, and outcomes were analyzed. Seventy-seven patients were identified; 70 were male, and 7 were female. Average age of the patients was 29.6 years. Seventy-five injuries were low velocity, whereas 2 were high velocity. Sixty-seven patients had fractures of a metacarpal or phalanx, whereas 4 had isolated carpal injuries. Six had combined carpal and metacarpal or phalanx fractures. Thirty-six patients had concomitant tendon, nerve, or vascular injuries requiring repair. Sixty-three patients underwent operative intervention, with the most common intervention being percutaneous fixation. Sixteen patients required secondary surgery. Eighteen complications were reported. The majority of patients in this report underwent early operative intervention with percutaneous fixation. Antibiotics were administered in almost all cases and can usually be discontinued within 24 hours after surgery. It is important to consider concomitant nerve, vascular, or tendon injuries requiring repair. We recommend early treatment of these injuries with debridement and stabilization. Due to lack of follow-up and patient noncompliance, early definitive treatment with primary bone grafting should be considered.

Fully automatic characterization and data collection from crystals of biological macromolecules

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

Svensson, Olof; Malbet-Monaco, Stéphanie; Popov, Alexander

A fully automatic system has been developed that performs X-ray centring and characterization of, and data collection from, large numbers of cryocooled crystals without human intervention. Considerable effort is dedicated to evaluating macromolecular crystals at synchrotron sources, even for well established and robust systems. Much of this work is repetitive, and the time spent could be better invested in the interpretation of the results. In order to decrease the need for manual intervention in the most repetitive steps of structural biology projects, initial screening and data collection, a fully automatic system has been developed to mount, locate, centre to themore » optimal diffraction volume, characterize and, if possible, collect data from multiple cryocooled crystals. Using the capabilities of pixel-array detectors, the system is as fast as a human operator, taking an average of 6 min per sample depending on the sample size and the level of characterization required. Using a fast X-ray-based routine, samples are located and centred systematically at the position of highest diffraction signal and important parameters for sample characterization, such as flux, beam size and crystal volume, are automatically taken into account, ensuring the calculation of optimal data-collection strategies. The system is now in operation at the new ESRF beamline MASSIF-1 and has been used by both industrial and academic users for many different sample types, including crystals of less than 20 µm in the smallest dimension. To date, over 8000 samples have been evaluated on MASSIF-1 without any human intervention.« less

Screening and Intervention for Comorbid Substance Disorders, PTSD, Depression, and Suicide: A Trauma Center Survey.

PubMed

Love, Jeff; Zatzick, Douglas

2014-07-01

Few investigations have examined screening and intervention procedures for comorbid substance use and mental disorders at trauma centers in the United States, although these disorders are endemic among survivors of traumatic injury. In 2006, the American College of Surgeons (ACS) mandated that level I and level II trauma centers screen for alcohol use problems and that level I centers provide brief intervention for those who screen positive. The ACS is expected to recommend best practice policy guidelines for screening for drug use problems and posttraumatic stress disorder (PTSD). This study examined screening and intervention procedures for the full spectrum of comorbid mental and substance use disorders at U.S. trauma centers. Respondents at all level I and level II trauma centers (N=518) in the United States were asked to complete a survey describing screening and intervention procedures for alcohol and drug use problems, suicidality, depression, and PTSD. There were 391 (75%) respondents. Over 80% of trauma centers routinely screened for alcohol and drug use problems. Routine screening and intervention for suicidality, depression, and PTSD were markedly less common; in fact, only 7% of centers reported routine screening for PTSD. Consistent with ACS policy, level I centers were significantly more likely than level II centers to provide alcohol intervention. Alcohol screening and intervention occurred frequently at U.S. trauma centers and appeared to be responsive to ACS mandates. In the future, efforts to orchestrate clinical investigation and policy could enhance screening and intervention procedures for highly prevalent, comorbid mental disorders.

Calf management practices and associations with herd-level morbidity and mortality on beef cow-calf operations.

PubMed

Murray, C F; Fick, L J; Pajor, E A; Barkema, H W; Jelinski, M D; Windeyer, M C

2016-03-01

The objective of this study was to investigate calf management practices on beef cow-calf operations and determine associations with herd-level morbidity and mortality of pre-weaned calves. A 40-question survey about management practices, morbidity and mortality was administered to cow-calf producers by distributing paper surveys and by circulating an online link through various media. A total of 267 producers completed the survey. Data were analyzed with descriptive statistics and multivariable linear regression models. Average herd-level treatment risk for pre-weaning calf diarrhea (PCD) and bovine respiratory disease (BRD) were 4.9% and 3.0%, respectively. Average herd-level mortality within the first 24 h of life (stillbirth), from 1 to 7 days and 7 days to weaning were 2.3%, 1.1%, and 1.4%, respectively. Operations that never intervened at parturition had 4.7% higher PCD than those that occasionally did. On operations using small elastrator bands for castration, PCD was 1.9% higher than those using other methods. For every increase of 100 cows in herd size, BRD decreased by 1.1%. The association between BRD and PCD varied by when calving season began. Operations that used off-farm, frozen colostrum had a 1.1% increase in stillbirths. Operations that verified a calf had suckled had 0.7% lower mortality from 1 to 7 days of age. Those that intervened when colostrum was abnormal or that used small elastrator bands for castration had 1.9% and 1.4% higher mortality during the 1st week of life, respectively, compared with other operations. Mortality from 7 days to weaning was lower by 0.7% when calving season started in April compared with January or February and was higher by 1.0% for each additional week of calving season. Operations that intervened with colostrum consumption for assisted calvings had lower mortality from 7 days to weaning by 0.8% compared with those that did not. For every 1.0% increase in BRD, mortality from 7 days to weaning increased by 1.0%. Stillbirths and mortality from 7 days to weaning decreased non-linearly with herd size. Factors related to calving season, herd size, interventions at calving, colostrum management and castration impacted herd-level morbidity and mortality. However, effect size was generally small and causation cannot be determined with a cross-sectional study design. This study identifies several common health management practices associated with calfhood morbidity and mortality that should be further investigated to establish evidence-based management strategies to improve the health and survival of beef calves.

Multilevel Interventions: Measurement and Measures

PubMed Central

Charns, Martin P.; Alligood, Elaine C.; Benzer, Justin K.; Burgess, James F.; Mcintosh, Nathalie M.; Burness, Allison; Partin, Melissa R.; Clauser, Steven B.

2012-01-01

Background Multilevel intervention research holds the promise of more accurately representing real-life situations and, thus, with proper research design and measurement approaches, facilitating effective and efficient resolution of health-care system challenges. However, taking a multilevel approach to cancer care interventions creates both measurement challenges and opportunities. Methods One-thousand seventy two cancer care articles from 2005 to 2010 were reviewed to examine the state of measurement in the multilevel intervention cancer care literature. Ultimately, 234 multilevel articles, 40 involving cancer care interventions, were identified. Additionally, literature from health services, social psychology, and organizational behavior was reviewed to identify measures that might be useful in multilevel intervention research. Results The vast majority of measures used in multilevel cancer intervention studies were individual level measures. Group-, organization-, and community-level measures were rarely used. Discussion of the independence, validity, and reliability of measures was scant. Discussion Measurement issues may be especially complex when conducting multilevel intervention research. Measurement considerations that are associated with multilevel intervention research include those related to independence, reliability, validity, sample size, and power. Furthermore, multilevel intervention research requires identification of key constructs and measures by level and consideration of interactions within and across levels. Thus, multilevel intervention research benefits from thoughtful theory-driven planning and design, an interdisciplinary approach, and mixed methods measurement and analysis. PMID:22623598

36 CFR 251.96 - Intervention.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 36 Parks, Forests, and Public Property 2 2011-07-01 2011-07-01 false Intervention. 251.96 Section... of Decisions Relating to Occupancy and Use of National Forest System Lands § 251.96 Intervention. (a... discretionary review level (§ 251.87(d)) shall be denied. (b) To request intervention in a first-level appeal...

36 CFR 251.96 - Intervention.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Intervention. 251.96 Section... of Decisions Relating to Occupancy and Use of National Forest System Lands § 251.96 Intervention. (a... discretionary review level (§ 251.87(d)) shall be denied. (b) To request intervention in a first-level appeal...

36 CFR 251.96 - Intervention.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 36 Parks, Forests, and Public Property 2 2012-07-01 2012-07-01 false Intervention. 251.96 Section... of Decisions Relating to Occupancy and Use of National Forest System Lands § 251.96 Intervention. (a... discretionary review level (§ 251.87(d)) shall be denied. (b) To request intervention in a first-level appeal...

[Community nursing intervention in population with high-risk coronary heart disease in Hengyang].

PubMed

Huang, Yanjin; Chen, Jia; Zeng, Ying; Liu, Dan; He, Guoping

2014-10-01

To explore the effect of community nursing intervention on awareness regarding primary prevention knowledge, self-management, and risk factors for coronary heart disease (CHD) in Hengyang City, Hunan Province. A total of 120 individuals at high risk of CHD were recruited and divided into a control group and an intervention group. The intervention group was given the health knowledge lecture and individual community nursing intervention. The control group was given the routine management. Before and after the intervention, all of the recruiters were evaluated by the awareness on primary prevention knowledge, self-management and risk factors for CHD. Before the intervention, there was no significant difference in the demographic data, the cognitive levels regarding primary prevention knowledge, the self-management and the risk factors for CHD between the 2 groups (P>0.05). After the intervention, the cognitive levels regarding primary prevention knowledge, the self-management and the risk factors for CHD between the 2 groups changed. In the intervention group, the cognitive level was significantly increased (P<0.05); the self management score was improved; the systolic blood pressure, BMI, and the levels of fasting glucose, TC and low density lipoprotein-cholesterol were significantly decreased and the level of high density lipoprotein-cholesterol was significantly increased (P<0.05). There was no significant difference in the above-mentioned parameters between before and after intervention in the control group (P>0.05). The cognitive levels regarding primary prevention knowledge and self-management for CHD can be improved effectively by community nursing intervention in high-risk population of CHD, and the risk factors for CHD can also be reduced.

Novel Hybrid Operating Table for Neuroendovascular Treatment.

PubMed

Jong-Hyun, Park; Jonghyeon, Mun; Dong-Seung, Shin; Bum-Tae, Kim

2017-03-25

The integration of interventional and surgical techniques is requiring the development of a new working environment equipped for the needs of an interdisciplinary neurovascular team. However, conventional surgical and interventional tables have only a limited ability to provide for these needs. We have developed a concept mobile hybrid operating table that provides the ability for such a team to conduct both endovascular and surgical procedures in a single session. We developed methods that provide surgeons with angiography-guided surgery techniques for use in a conventional operating room environment. In order to design a convenient device ideal for practical use, we consulted with mechanical engineers. The mobile hybrid operating table consists of two modules: a floating tabletop and a mobile module. In brief, the basic principle of the mobile hybrid operating table is as follows: firstly, the length of the mobile hybrid operating table is longer than that of a conventional surgical table and yet shorter than a conventional interventional table. It was designed with the goal of exhaustively meeting the intensive requirements of both endovascular and surgical procedures. Its mobile module allows for the floating tabletop to be moved quickly and precisely. It is important that during a procedure, a patient can be moved without being repositioned, particularly with a catheter in situ. Secondly, a slim-profile headrest facilitates the mounting of a radiolucent head cramp system for cranial stabilization and fixation. We have introduced a novel invention, a mobile hybrid operating table for use in an operating suite.

Aviation Safety: Efforts to Implement Flight Operational Quality Assurance Programs

DOT National Transportation Integrated Search

1997-12-01

Flight Operational Quality Assurance (FOQA) programs seek to use flight data to : detect technical flaws, unsafe practices, or conditions outside of desired : operating procedures early enough to allow timely intervention to avert : accidents or inci...

Mass Analyzers Facilitate Research on Addiction

NASA Technical Reports Server (NTRS)

2012-01-01

The famous go/no go command for Space Shuttle launches comes from a place called the Firing Room. Located at Kennedy Space Center in the Launch Control Center (LCC), there are actually four Firing Rooms that take up most of the third floor of the LCC. These rooms comprise the nerve center for Space Shuttle launch and processing. Test engineers in the Firing Rooms operate the Launch Processing System (LPS), which is a highly automated, computer-controlled system for assembly, checkout, and launch of the Space Shuttle. LPS monitors thousands of measurements on the Space Shuttle and its ground support equipment, compares them to predefined tolerance levels, and then displays values that are out of tolerance. Firing Room operators view the data and send commands about everything from propellant levels inside the external tank to temperatures inside the crew compartment. In many cases, LPS will automatically react to abnormal conditions and perform related functions without test engineer intervention; however, firing room engineers continue to look at each and every happening to ensure a safe launch. Some of the systems monitored during launch operations include electrical, cooling, communications, and computers. One of the thousands of measurements derived from these systems is the amount of hydrogen and oxygen inside the shuttle during launch.

Evidence-based review of interventions for medically at-risk older drivers.

PubMed

Classen, Sherrilene; Monahan, Miriam; Auten, Beth; Yarney, Abraham

2014-01-01

OBJECTIVE. To conduct an evidence-based review of intervention studies of older drivers with medical conditions. METHOD. We used the American Occupational Therapy Association's classification criteria (Levels I-V, I = highest level of evidence) to identify driving interventions. We classified studies using letters to represent the strength of recommendations: A = strongly recommend the intervention; B = recommend intervention is provided routinely; C = weak evidence that the intervention can improve outcomes; D = recommend not to provide the intervention; I = insufficient evidence to recommend for or against the intervention. RESULTS. For clients with stroke, we recommend a graded simulator intervention (A) and multimodal training in traffic theory knowledge and on-road interventions (B); we make no recommendation for or against Dynavision, Useful Field of View, or visual-perceptual interventions (I). For clients with visual deficits, we recommend educational intervention (A) and bioptic training (B); we make no recommendation for or against prism lenses (I). For clients with dementia, we recommend driving restriction interventions (C) and make no recommendation for or against use of compensatory driving strategies (I). CONCLUSION. Level I studies are needed to identify effective interventions for medically at-risk older drivers. Copyright © 2014 by the American Occupational Therapy Association, Inc.

Improving operative flow during pediatric airway evaluation: a quality-improvement initiative.

PubMed

Prager, Jeremy D; Ruiz, Amanda G; Mooney, Kristin; Gao, Dexiang; Szolnoki, Judit; Shah, Rahul K

2015-03-01

Microlaryngoscopy and bronchoscopy procedures (MLBs) are short-duration, high-acuity procedures that carry risk. Poor case flow and communication exacerbate such potential risk. Efficient operative flow is critical for patient safety and resource expenditure. To identify areas for improvement and evaluate the effectiveness of a multidisciplinary quality-improvement (QI) initiative. A QI project using the "Plan-Do-Study-Act" (PDSA) cycle was implemented to assess MLBs performed on pediatric patients in a tertiary academic children's hospital. Forty MLBs were audited using a QI evaluation tool containing 144 fields. Each MLB was evaluated for flow, communication, and timing. Opportunities for improvement were identified. Subsequently, QI interventions were implemented in an iterative cycle, and 66 MLBs were audited after the intervention. Specific QI interventions addressed issues of personnel frequently exiting the operating room (OR) and poor preoperative preparation, identified during QI audit as areas for improvement. Interventions included (1) conducting "huddles" between surgeon and OR staff to discuss needed equipment; (2) implementing improvements to surgeon case ordering and preference cards review; (3) posting an OR door sign to limit traffic during airway procedures; and (4) discouraging personnel breaks during airway procedures. Operating room exiting behavior of OR personnel, preoperative preparation, and case timing were assessed and compared before and after the QI intervention. Personnel exiting the OR during the MLB was identified as a preintervention issue, with the surgical technologist, circulator, or surgeon exiting the room in 55% of cases (n = 22). The surgical technologist and circulator left the room to retrieve equipment in 40% of cases (n = 16), which indicated the need for increased preoperative preparation to improve case timing and operative flow. The QI interventions implemented to address these concerns included education regarding break timing, improvements in communication, and improvements in ordering and preparation of equipment. After the QI intervention, the surgical technologist exiting rate decreased from 20% (n = 8) to 8% (n = 5), and the circulator exiting rate decreased from 38% (n = 15) to 27% (n = 17). In addition, the rate of surgeon exiting decreased significantly (from 25% [n = 10 of 40] to 9% [n = 6 of 66]) (P = .03). The surgical technologist and circulating nurse remaining in the room were significantly associated with decreased operating time (1.84-minute decrease for surgical technologist [P = .04] and 1.95-minute decrease for circulating nurse [P = .001]). Gains were made in personnel exiting behavior and case timing after implementation of the QI interventions, potentially leading to decreased risk. This process is easily reproduced and is widely accepted by stakeholders.

Update to a protocol for a feasibility cluster randomised controlled trial of a peer-led school-based intervention to increase the physical activity of adolescent girls (PLAN-A).

PubMed

Sebire, Simon J; Edwards, Mark J; Campbell, Rona; Jago, Russell; Kipping, Ruth; Banfield, Kathryn; Kadir, Bryar; Garfield, Kirsty; Lyons, Ronan A; Blair, Peter S; Hollingworth, William

2016-01-01

Physical activity levels are low amongst adolescent girls, and this population faces specific barriers to being active. Peer influences on health behaviours are important in adolescence, and peer-led interventions might hold promise to change behaviour. This paper describes the protocol for a feasibility cluster randomised controlled trial of Peer-Led physical Activity iNtervention for Adolescent girls (PLAN-A), a peer-led intervention aimed at increasing adolescent girls' physical activity levels. In addition, this paper describes an update that has been made to the protocol for the PLAN-A feasibility cluster randomised controlled trial. A two-arm cluster randomised feasibility trial will be conducted in six secondary schools (intervention n  = 4; control n  = 2) with year 8 (12-13 years old) girls. The intervention will operate at a year group level and consist of year 8 girls nominating influential peers within their year group to become peer supporters. Approximately 15% of the cohort will receive 3 days of training about physical activity and interpersonal communication skills. Peer supporters will then informally diffuse messages about physical activity amongst their friends for 10 weeks. Data will be collected at baseline (time 0 (T0)), immediately after the intervention (time 1 (T1)) and 12 months after baseline measures (time 2 (T2)). In this feasibility trial, the primary interest is in the recruitment of schools and participants (both year 8 girls and peer supporters), delivery and receipt of the intervention, data provision rates and identifying the cost categories for future economic analysis. Physical activity will be assessed using 7-day accelerometry, with the likely primary outcome in a fully powered trial being daily minutes of moderate-to-vigorous physical activity. Participants will also complete psychosocial questionnaires at each time point: assessing motivation, self-esteem and peer physical activity norms. Data analysis will be largely descriptive and focus on recruitment, attendance and data provision rates. The findings will inform the sample size required for a definitive trial. A detailed process evaluation using qualitative and quantitative methods will be conducted with a variety of stakeholders (i.e. pupils, parents, teachers and peer-supporter trainers) to identify areas of success and necessary improvements prior to proceeding to a definitive trial. The study will provide the information necessary to design a fully powered trial should PLAN-A demonstrate evidence of promise. This paper describes an update to the protocol for the PLAN-A feasibility cluster randomised controlled trial related to the data-linkage component. ISRCTN12543546.

Contextual influences on health worker motivation in district hospitals in Kenya

PubMed Central

Mbindyo, Patrick; Gilson, Lucy; Blaauw, Duane; English, Mike

2009-01-01

Background Organizational factors are considered to be an important influence on health workers' uptake of interventions that improve their practices. These are additionally influenced by factors operating at individual and broader health system levels. We sought to explore contextual influences on worker motivation, a factor that may modify the effect of an intervention aimed at changing clinical practices in Kenyan hospitals. Methods Franco LM, et al's (Health sector reform and public sector health worker motivation: a conceptual framework. Soc Sci Med. 2002, 54: 1255–66) model of motivational influences was used to frame the study Qualitative methods including individual in-depth interviews, small-group interviews and focus group discussions were used to gather data from 185 health workers during one-week visits to each of eight district hospitals. Data were collected prior to a planned intervention aiming to implement new practice guidelines and improve quality of care. Additionally, on-site observations of routine health worker behaviour in the study sites were used to inform analyses. Results Study settings are likely to have important influences on worker motivation. Effective management at hospital level may create an enabling working environment modifying the impact of resource shortfalls. Supportive leadership may foster good working relationships between cadres, improve motivation through provision of local incentives and appropriately handle workers' expectations in terms of promotions, performance appraisal processes, and good communication. Such organisational attributes may counteract de-motivating factors at a national level, such as poor schemes of service, and enhance personally motivating factors such as the desire to maintain professional standards. Conclusion Motivation is likely to influence powerfully any attempts to change or improve health worker and hospital practices. Some factors influencing motivation may themselves be influenced by the processes chosen to implement change. PMID:19627590

Effect of yoga based lifestyle intervention on state and trait anxiety.

PubMed

Gupta, Nidhi; Khera, Shveta; Vempati, R P; Sharma, Ratna; Bijlani, R L

2006-01-01

Considerable evidence exists for the place of mind body medicine in the treatment of anxiety disorders. Excessive anxiety is maladaptive. It is often considered to be the major component of unhealthy lifestyle that contributes significantly to the pathogenesis of not only psychiatric but also many other systemic disorders. Among the approaches to reduce the level of anxiety has been the search for healthy lifestyles. The aim of the study was to study the short-term impact of a comprehensive but brief lifestyle intervention, based on yoga, on anxiety levels in normal and diseased subjects. The study was the result of operational research carried out in the Integral Health Clinic (IHC) at the Department of Physiology of All India Institute of Medical Sciences. The subjects had history of hypertension, coronary artery disease, diabetes mellitus, obesity, psychiatric disorders (depression, anxiety, 'stress'), gastrointestinal problems (non ulcer dyspepsia, duodenal ulcers, irritable bowel disease, Crohn's disease, chronic constipation) and thyroid disorders (hyperthyroidism and hypothyroidism). The intervention consisted of asanas, pranayama, relaxation techniques, group support, individualized advice, and lectures and films on philosophy of yoga, the place of yoga in daily life, meditation, stress management, nutrition, and knowledge about the illness. The outcome measures were anxiety scores, taken on the first and last day of the course. Anxiety scores, both state and trait anxiety were significantly reduced. Among the diseased subjects significant improvement was seen in the anxiety levels of patients of hypertension, coronary artery disease, obesity, cervical spondylitis and those with psychiatric disorders. The observations suggest that a short educational programme for lifestyle modification and stress management leads to remarkable reduction in the anxiety scores within a period of 10 days.

The Impact of Direct Involvement I and Direct Involvement II Experiences on Secondary School Students' Social Capital, as Measured by Co-Cognitive Factors of the Operation Houndstooth Intervention Theory

ERIC Educational Resources Information Center

Sands, Michelle M.; Heilbronner, Nancy N.

2014-01-01

A mixed-methods study grounded in Renzulli's Operation Houndstooth Intervention Theory examined the impact of different types of volunteer experiences on the six co-cognitive factors (Optimism, Courage, Romance With a Topic/Discipline, Sensitivity to Human Concerns, Physical/Mental Energy, and Vision/Sense of Destiny) associated with the…

North Atlantic Treaty Organization, the United States, and International Legitimacy

DTIC Science & Technology

2014-05-22

with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1...and Libya in 2011. NATO’s Operation Allied Force intervention campaign in Kosovo, demonstrated NATO’s application of political and military pressure...case studies: Kosovo from 1998-1999, the Democratic Republic of Georgia in 2008, and Libya in 2011. NATO’s Operation Allied Force intervention campaign

[Influence of an observer in the haemolysis produced during the extraction of blood samples in primary care].

PubMed

Bel-Peña, N; Mérida-de la Torre, F J

2015-01-01

To check whether an intervention based on direct observation and complementary information to nurses helps reduce haemolysis when drawing blood specimens. Random sampling study in primary care centres in the serrania de Málaga health management area, using a cross-sectional, longitudinal pre- and post-intervention design. The study period was from August 2012 to January 2015. The level of free haemoglobin was measured by direct spectrophotometry in the specimens extracted. It was then checked whether the intervention influenced the level of haemolysis, and if this was maintained over time. The mean haemolysis measured pre-intervention was 17%, and after intervention it was 6.1%. A year later and under the same conditions, the frequency of haemolysis was measured again the samples analysed, and the percentage was 9% These results are low when compared to the level obtained pre-intervention, but are higher when compared to the levels obtained immediately after the intervention. The transport and analysis conditions were the same. An intervention based on a direct and informative observation in the process of collecting blood samples contributes significantly to reduce the level of haemolysis. This effect is maintained in time. This intervention needs to be repeated to maintain its effectiveness. Audits and continuing education programs are useful for quality assurance procedures, and maintain the level of care needed for a good quality of care. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

Cardiac surgery productivity and throughput improvements.

PubMed

Lehtonen, Juha-Matti; Kujala, Jaakko; Kouri, Juhani; Hippeläinen, Mikko

2007-01-01

The high variability in cardiac surgery length--is one of the main challenges for staff managing productivity. This study aims to evaluate the impact of six interventions on open-heart surgery operating theatre productivity. A discrete operating theatre event simulation model with empirical operation time input data from 2603 patients is used to evaluate the effect that these process interventions have on the surgery output and overtime work. A linear regression model was used to get operation time forecasts for surgery scheduling while it also could be used to explain operation time. A forecasting model based on the linear regression of variables available before the surgery explains 46 per cent operating time variance. The main factors influencing operation length were type of operation, redoing the operation and the head surgeon. Reduction of changeover time between surgeries by inducing anaesthesia outside an operating theatre and by reducing slack time at the end of day after a second surgery have the strongest effects on surgery output and productivity. A more accurate operation time forecast did not have any effect on output, although improved operation time forecast did decrease overtime work. A reduction in the operation time itself is not studied in this article. However, the forecasting model can also be applied to discover which factors are most significant in explaining variation in the length of open-heart surgery. The challenge in scheduling two open-heart surgeries in one day can be partly resolved by increasing the length of the day, decreasing the time between two surgeries or by improving patient scheduling procedures so that two short surgeries can be paired. A linear regression model is created in the paper to increase the accuracy of operation time forecasting and to identify factors that have the most influence on operation time. A simulation model is used to analyse the impact of improved surgical length forecasting and five selected process interventions on productivity in cardiac surgery.

Improving chronic disease prevention and screening in primary care: results of the BETTER pragmatic cluster randomized controlled trial.

PubMed

Grunfeld, Eva; Manca, Donna; Moineddin, Rahim; Thorpe, Kevin E; Hoch, Jeffrey S; Campbell-Scherer, Denise; Meaney, Christopher; Rogers, Jess; Beca, Jaclyn; Krueger, Paul; Mamdani, Muhammad

2013-11-20

Primary care provides most of the evidence-based chronic disease prevention and screening services offered by the healthcare system. However, there remains a gap between recommended preventive services and actual practice. This trial (the BETTER Trial) aimed to improve preventive care of heart disease, diabetes, colorectal, breast and cervical cancers, and relevant lifestyle factors through a practice facilitation intervention set in primary care. Pragmatic two-way factorial cluster RCT with Primary Care Physicians' practices as the unit of allocation and individual patients as the unit of analysis. The setting was urban Primary Care Team practices in two Canadian provinces. Eight Primary Care Team practices were randomly assigned to receive the practice-level intervention or wait-list control; 4 physicians in each team (32 physicians) were randomly assigned to receive the patient-level intervention or wait-list control. Patients randomly selected from physicians' rosters were stratified into two groups: 1) general and 2) moderate mental illness. The interventions involved a multifaceted, evidence-based, tailored practice-level intervention with a Practice Facilitator, and a patient-level intervention involving a one-hour visit with a Prevention Practitioner where patients received a tailored 'prevention prescription'. The primary outcome was a composite Summary Quality Index of 28 evidence-based chronic disease prevention and screening actions with pre-defined targets, expressed as the ratio of eligible actions at baseline that were met at follow-up. A cost-effectiveness analysis was conducted. 789 of 1,260 (63%) eligible patients participated. On average, patients were eligible for 8.96 (SD 3.2) actions at baseline. In the adjusted analysis, control patients met 23.1% (95% CI: 19.2% to 27.1%) of target actions, compared to 28.5% (95% CI: 20.9% to 36.0%) receiving the practice-level intervention, 55.6% (95% CI: 49.0% to 62.1%) receiving the patient-level intervention, and 58.9% (95% CI: 54.7% to 63.1%) receiving both practice- and patient-level interventions (patient-level intervention versus control, P < 0.001). The benefit of the patient-level intervention was seen in both strata. The extra cost of the intervention was $26.43CAN (95% CI: $16 to $44) per additional action met. A Prevention Practitioner can improve the implementation of clinically important prevention and screening for chronic diseases in a cost-effective manner.

Effectiveness of a Grief Intervention for Caregivers of People With Dementia.

PubMed

MacCourt, Penny; McLennan, Marianne; Somers, Sandie; Krawczyk, Marian

2017-08-01

In this article, we report on the structure and effectiveness of a grief management coaching intervention with caregivers of individuals with dementia. The intervention was informed by Marwit and Meuser's Caregiver Grief Model and considered levels of grief, sense of empowerment, coping, and resilience using five methods of delivery. Results indicate that the intervention had significant positive effects on caregivers' levels of grief and increased their levels of empowerment, coping, and resilience. The intervention was found to be effective across caregivers' characteristics as well as across five delivery modalities. Through description of this intervention, as well as outcome, this research contributes to the body of knowledge about caregivers' disenfranchised grief and ways to effectively address it.