Multiobjective Model of Time-of-Use and Stepwise Power Tariff for Residential Consumers in Regulated Power Markets

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

Zhou, Bin; Yang, Rui; Li, Canbing

Here, time-of-use (TOU) rates and stepwise power tariff (SPT) are important economic levers to motivate residents to shift their electricity usage in response to electricity price. In this paper, a new multiobjective optimal tariff-making model of time-of-use and stepwise power tariff (TOUSPT) is proposed, which combines the complementary characteristics of two power tariffs, for residential energy conservation and peak load shaving. In the proposed approach, the residential demand response with price elasticity in regulated power market is considered to determine the optimum peak-valley TOU tariffs for each stepwise electricity partition. Furthermore, a practical case study is implemented to test themore » effectiveness of the proposed TOUSPT, and the results demonstrate that TOUSPT can achieve efficient end-use energy saving and also shift load from peak to off-peak periods.« less

Multiobjective Model of Time-of-Use and Stepwise Power Tariff for Residential Consumers in Regulated Power Markets

DOE PAGES

Zhou, Bin; Yang, Rui; Li, Canbing; ...

2017-07-04

Here, time-of-use (TOU) rates and stepwise power tariff (SPT) are important economic levers to motivate residents to shift their electricity usage in response to electricity price. In this paper, a new multiobjective optimal tariff-making model of time-of-use and stepwise power tariff (TOUSPT) is proposed, which combines the complementary characteristics of two power tariffs, for residential energy conservation and peak load shaving. In the proposed approach, the residential demand response with price elasticity in regulated power market is considered to determine the optimum peak-valley TOU tariffs for each stepwise electricity partition. Furthermore, a practical case study is implemented to test themore » effectiveness of the proposed TOUSPT, and the results demonstrate that TOUSPT can achieve efficient end-use energy saving and also shift load from peak to off-peak periods.« less

Development and Evaluation of an Implementation Strategy for Collecting Data in a National Registry and the Use of Patient-Reported Outcome Measures in Physical Therapist Practices: Quality Improvement Study.

PubMed

Meerhoff, Guus A; van Dulmen, Simone A; Maas, Marjo J M; Heijblom, Karin; Nijhuis-van der Sanden, Maria W G; Van der Wees, Philip J

2017-08-01

In 2013, the Royal Dutch Society for Physical Therapy launched the program "Quality in Motion." This program aims to collect data from electronic health record systems in a registry that is fed back to physical therapists, facilitating quality improvement. The purpose of this study was to describe the development of an implementation strategy for the program and to evaluate the feasibility of building a registry and implementing patient-reported outcome measures (PROMs) in physical therapist practices. A stepwise approach using mixed methods was established in 3 consecutive pilots with 355 physical therapists from 66 practices. Interim results were evaluated using quantitative data from a self-assessment questionnaire and the registry and qualitative data from 21 semistructured interviews with physical therapists. Descriptive statistics and McNemar's symmetry chi-squared test were used to summarize the feasibility of implementing PROMs. PROMs were selected for the 5 most prevalent musculoskeletal conditions in Dutch physical therapist practices. A core component of the implementation strategy was the introduction of knowledge brokers to support physical therapists in establishing the routine use of PROMs in clinical practice and to assist in executing peer assessment workshops. In February 2013, 30.3% of the physical therapist practices delivered 4.4 completed treatment episodes per physical therapist to the registry; this increased to 92.4% in November 2014, delivering 54.1 completed patient episodes per physical therapist. Pre- and posttreatment PROM use increased from 12.2% to 39.5%. It is unclear if the participating physical therapists reflect a representative sample of Dutch therapists. Building a registry and implementing PROMs in physical therapist practices are feasible. The routine use of PROMs needs to increase to ensure valid feedback of outcomes. Using knowledge brokers is promising for implementing the program via peer assessment workshops. © 2017 American Physical Therapy Association

Stepwise introduction of laparoscopic liver surgery: validation of guideline recommendations.

PubMed

van der Poel, Marcel J; Huisman, Floor; Busch, Olivier R; Abu Hilal, Mohammad; van Gulik, Thomas M; Tanis, Pieter J; Besselink, Marc G

2017-10-01

Uncontrolled introduction of laparoscopic liver surgery (LLS) could compromise postoperative outcomes. A stepwise introduction of LLS combined with structured training is advised. This study aimed to evaluate the impact of such a stepwise introduction. A retrospective, single-center case series assessing short term outcomes of all consecutive LLS in the period November 2006-January 2017. The technique was implemented in a stepwise fashion. To evaluate the impact of this stepwise approach combined with structured training, outcomes of LLS before and after a laparoscopic HPB fellowship were compared. A total of 135 laparoscopic resections were performed. Overall conversion rate was 4% (n = 5), clinically relevant complication rate 13% (n = 18) and mortality 0.7% (n = 1). A significant increase in patients with major LLS, multiple liver resections, previous abdominal surgery, malignancies and lesions located in posterior segments was observed after the fellowship as well as a decrease in the use of hand-assistance. Increasing complexity in the post fellowship period was reflected by an increase in operating times, but without comprising other surgical outcomes. A stepwise introduction of LLS combined with structured training reduced the clinical impact of the learning curve, thereby confirming guideline recommendations. Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Implementation of the World Health Organization Regional Office for Africa Stepwise Laboratory Quality Improvement Process Towards Accreditation

PubMed Central

Maruta, Talkmore; Ndlovu, Nqobile; Moyo, Sikhulile; Yahaya, Ali Ahmed; Coulibaly, Sheick Oumar; Kasolo, Francis; Turgeon, David; Abrol, Angelii P.

2016-01-01

Background The increase in disease burden has continued to weigh upon health systems in Africa. The role of the laboratory has become increasingly critical in the improvement of health for diagnosis, management and treatment of diseases. In response, the World Health Organization Regional Office for Africa (WHO AFRO) and its partners created the WHO AFRO Stepwise Laboratory (Quality) Improvement Process Towards Accreditation (SLIPTA) program. SLIPTA implementation process WHO AFRO defined a governance structure with roles and responsibilities for six main stakeholders. Laboratories were evaluated by auditors trained and certified by the African Society for Laboratory Medicine. Laboratory performance was measured using the WHO AFRO SLIPTA scoring checklist and recognition certificates rated with 1–5 stars were issued. Preliminary results By March 2015, 27 of the 47 (57%) WHO AFRO member states had appointed a SLIPTA focal point and 14 Ministers of Health had endorsed SLIPTA as the desired programme for continuous quality improvement. Ninety-eight auditors from 17 African countries, competent in the Portuguese (3), French (12) and English (83) languages, were trained and certified. The mean score for the 159 laboratories audited between May 2013 and March 2015 was 69% (median 70%; SD 11.5; interquartile range 62–77). Of these audited laboratories, 70% achieved 55% compliance or higher (2 or more stars) and 1% scored at least 95% (5 stars). The lowest scoring sections of the WHO AFRO SLIPTA checklist were sections 6 (Internal Audit) and 10 (Corrective Action), which both had mean scores below 50%. Conclusion The WHO AFRO SLIPTA is a process that countries with limited resources can adopt for effective implementation of quality management systems. Political commitment, ownership and investment in continuous quality improvement are integral components of the process. PMID:28879103

Low thrust spacecraft transfers optimization method with the stepwise control structure in the Earth-Moon system in terms of the L1-L2 transfer

NASA Astrophysics Data System (ADS)

Fain, M. K.; Starinova, O. L.

2016-04-01

The paper outlines the method for determination of the locally optimal stepwise control structure in the problem of the low thrust spacecraft transfer optimization in the Earth-Moon system, including the L1-L2 transfer. The total flight time as an optimization criterion is considered. The optimal control programs were obtained by using the Pontryagin's maximum principle. As a result of optimization, optimal control programs, corresponding trajectories, and minimal total flight times were determined.

Stepwise Inquiry into Hard Water in a High School Chemistry Laboratory

ERIC Educational Resources Information Center

Kakisako, Mami; Nishikawa, Kazuyuki; Nakano, Masayoshi; Harada, Kana S.; Tatsuoka, Tomoyuki; Koga, Nobuyoshi

2016-01-01

This study focuses on the design of a learning program to introduce complexometric titration as a method for determining water hardness in a high school chemistry laboratory. Students are introduced to the different properties and reactions of hard water in a stepwise manner so that they gain the necessary chemical knowledge and conceptual…

A stepwise model to predict monthly streamflow

NASA Astrophysics Data System (ADS)

Mahmood Al-Juboori, Anas; Guven, Aytac

2016-12-01

In this study, a stepwise model empowered with genetic programming is developed to predict the monthly flows of Hurman River in Turkey and Diyalah and Lesser Zab Rivers in Iraq. The model divides the monthly flow data to twelve intervals representing the number of months in a year. The flow of a month, t is considered as a function of the antecedent month's flow (t - 1) and it is predicted by multiplying the antecedent monthly flow by a constant value called K. The optimum value of K is obtained by a stepwise procedure which employs Gene Expression Programming (GEP) and Nonlinear Generalized Reduced Gradient Optimization (NGRGO) as alternative to traditional nonlinear regression technique. The degree of determination and root mean squared error are used to evaluate the performance of the proposed models. The results of the proposed model are compared with the conventional Markovian and Auto Regressive Integrated Moving Average (ARIMA) models based on observed monthly flow data. The comparison results based on five different statistic measures show that the proposed stepwise model performed better than Markovian model and ARIMA model. The R2 values of the proposed model range between 0.81 and 0.92 for the three rivers in this study.

Development of a Systemwide Program: Stepwise Implementation of a Predation Index, Predator Control Fisheries and Evaluation Plan in the Columbia River Basin, Volume 1, 1992 Annual Report.

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

Ward, David L.

1994-06-01

Results of the second year are reported of a basinwide program to harvest northern squawfish in an effort to reduce mortality due to squawfish predation on juvenile salmonids during their migration from natal streams to the ocean. Six papers are included in this report. They are entitled: feasibility investigation of a commercial longline fishery for northern squawfish in the Columbia River downstream from Bonneville dam; evaluation of the northern squawfish sport-reward fishery in the Columbia and Snake Rivers; controlled angling for northern squawfish at selected dams on the Columbia and Snake Rivers in 1992; evaluation of harvest technology for squawfishmore » control in Columbia River reservoirs; effectiveness of predator-removal for protecting juvenile fall chinook salmon released from Bonneville Hatchery; and Northern squawfish sport-reward payments.« less

Using Small-Step Refinement for Algorithm Verification in Computer Science Education

ERIC Educational Resources Information Center

Simic, Danijela

2015-01-01

Stepwise program refinement techniques can be used to simplify program verification. Programs are better understood since their main properties are clearly stated, and verification of rather complex algorithms is reduced to proving simple statements connecting successive program specifications. Additionally, it is easy to analyse similar…

Stepwise Iterative Fourier Transform: The SIFT

NASA Technical Reports Server (NTRS)

Benignus, V. A.; Benignus, G.

1975-01-01

A program, designed specifically to study the respective effects of some common data problems on results obtained through stepwise iterative Fourier transformation of synthetic data with known waveform composition, was outlined. Included in this group were the problems of gaps in the data, different time-series lengths, periodic but nonsinusoidal waveforms, and noisy (low signal-to-noise) data. Results on sinusoidal data were also compared with results obtained on narrow band noise with similar characteristics. The findings showed that the analytic procedure under study can reliably reduce data in the nature of (1) sinusoids in noise, (2) asymmetric but periodic waves in noise, and (3) sinusoids in noise with substantial gaps in the data. The program was also able to analyze narrow-band noise well, but with increased interpretational problems. The procedure was shown to be a powerful technique for analysis of periodicities, in comparison with classical spectrum analysis techniques. However, informed use of the stepwise procedure nevertheless requires some background of knowledge concerning characteristics of the biological processes under study.

The Children's Rights Convention in Denmark: A Status Report on Implementation

ERIC Educational Resources Information Center

Jorgensen, Per Schultz; Leth, Ingrid; Montgomery, Edith

2011-01-01

Research Findings: The United Nations Convention on the Rights of the Child was ratified by Denmark in 1991 but never incorporated into Danish legislation; instead the State party has chosen a stepwise implementation in legal and social praxis. However, this process mirrors a remarkable reluctance to approve the Convention as a legitimate part of…

Design Exception In-Service Monitoring Program Development

DOT National Transportation Integrated Search

2017-05-01

This study evaluates various possible program designs for in-service monitoring of design exceptions (DEs) for the Georgia Department of Transportation. The study recommends a multitier stepwise approach to the evaluation of DEs. Specifically, the pr...

Ask-Elle: An Adaptable Programming Tutor for Haskell Giving Automated Feedback

ERIC Educational Resources Information Center

Gerdes, Alex; Heeren, Bastiaan; Jeuring, Johan; van Binsbergen, L. Thomas

2017-01-01

Ask-Elle is a tutor for learning the higher-order, strongly-typed functional programming language Haskell. It supports the stepwise development of Haskell programs by verifying the correctness of incomplete programs, and by providing hints. Programming exercises are added to Ask-Elle by providing a task description for the exercise, one or more…

A proposed Applications Information System - Concept, implementation, and growth

NASA Technical Reports Server (NTRS)

Mcconnell, Dudley G.; Hood, Carroll A.; Butera, M. Kristine

1987-01-01

This paper describes a newly developed concept within NASA for an Applications Information System (AIS). The AIS would provide the opportunity to the public and private sectors of shared participation in a remote sensing research program directed to a particular set of land-use or environmental problems. Towards this end, the AIS would offer the technological framework and information system resources to overcome many of the deficiencies that end-users have faced over the years such as limited access to data, delay in data delivery, and a limited access to data reduction algorithms and models to convert data to geophysical measurements. In addition, the AIS will take advantage of NASA developments in networking among information systems and use of state of the art technology, such as CD Roms and optical disks for the purpose of increasing the scientific benefits of applied environmental research. The rationale for the establishment of an AIS, a methodology for a step-wise, modular implementation, and the relationship of the AIS to other NASA information systems are discussed.

Decision support in vaccination policies.

PubMed

Piso, B; Wild, C

2009-10-09

Looking across boarders reveals that the national immunization programs of various countries differ in their vaccination schedules and decisions regarding the implementation and funding of new vaccines. The aim of this review is to identify decision aids and crucial criteria for a rational decision-making process on vaccine introduction and to develop a theoretical framework for decision-making based on available literature. Systematic literature search supplemented by hand-search. We identified five published decision aids for vaccine introduction and program planning in industrialized countries. Their comparison revealed an overall similarity with some differences in the approach as well as criteria. Burden of disease and vaccine characteristics play a key role in all decision aids, but authors vary in their views on the significance of cost-effectiveness analyses. Other relevant factors that should be considered before vaccine introduction are discussed to highly differing extents. These factors include the immunization program itself as well as its conformity with other programs, its feasibility, acceptability, and equity, as well as ethical, legal and political considerations. Assuming that the most comprehensive framework possible will not provide a feasible tool for decision-makers, we suggest a stepwise procedure. Though even the best rational approach and most comprehensive evaluation is limited by remaining uncertainties, frameworks provide at least a structured approach to evaluate the various aspects of vaccine implementation decision-making. This process is essential in making consistently sound decisions and will facilitate the public's confidence in the decision and its realization.

Embracing change: practical and theoretical considerations for successful implementation of technology assisting upper limb training in stroke

PubMed Central

2012-01-01

Background Rehabilitation technology for upper limb training of stroke patients may play an important role as therapy tool in future, in order to meet the increasing therapy demand. Currently, implementation of this technology in the clinic remains low. This study aimed at identifying criteria and conditions that people, involved in development of such technology, should take into account to achieve a (more) successful implementation of the technology in the clinic. Methods A literature search was performed in PubMed and IEEE databases, and semi-structured interviews with therapists in stroke rehabilitation were held, to identify criteria and conditions technology should meet to facilitate (implementation of) technology-assisted arm-hand skills training in rehabilitation therapy of stroke patients. In addition, an implementation strategy frequently applied in general health care was used to compose a stepwise guidance to facilitate successful implementation of this technology in therapy of stroke patients. Implementation-related criteria mentioned by therapists during the interviews were integrated in this guidance. Results Results indicate that, related to therapy content, technology should facilitate repetition of task-related movements, tailored to the patient and patient’s goals, in a meaningful context. Variability and increasing levels of difficulty in exercises should be on offer. Regarding hardware and software design of technology, the system should facilitate quick familiarisation and be easily adjustable to individual patients during therapy by therapists (and assistants). The system should facilitate adaptation to individual patients’ needs and their progression over time, should be adjustable as to various task-related variables, should be able to provide instructions and feedback, and should be able to document patient’s progression. The implementation process of technology in the clinic is provided as a stepwise guidance that consists of five phases therapists have to go through. The guidance includes criteria and conditions that motivate therapists, and make it possible for them, to actually use technology in their daily clinical practice. Conclusions The reported requirements are important as guidance for people involved in the development of rehabilitation technology for arm-hand therapy of stroke patients. The stepwise guide provides a tool for facilitating successful implementation of technology in clinical practice, thus meeting future therapy demand. PMID:22856548

Implementation of a 'lean' cytopathology service: towards routine same-day reporting.

PubMed

Hewer, Ekkehard; Hammer, Caroline; Fricke-Vetsch, Daniela; Baumann, Cinzia; Perren, Aurel; Schmitt, Anja M

2018-05-01

To systematically assess the effects of a Lean management intervention in an academic cytopathology service. We monitored outcomes including specimen turnaround times during stepwise implementation of a lean cytopathology workflow for gynaecological and non-gynaecological cytology. The intervention resulted in a major reduction of turnaround times for both gynaecological (3rd quartile 4.1 vs 2.3 working days) and non-gynaecological cytology (3rd quartile 1.9 vs. 1.2 working days). Introduction of fully electronic reporting had additional effect over continuous staining of slides alone. The rate of non-gynaecological specimens reported the same day increased from 4.5% to 56.5% of specimens received before noon. Lean management principles provide a useful framework for organization of a cytopathology workflow. Stepwise implementation beginning with a simplified gynaecological cytology workflow allowed involved staff to monitor the effects of individual changes and allowed for a smooth transition. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Decreasing triage time: effects of implementing a step-wise ESI algorithm in an EHR.

PubMed

Villa, Stephen; Weber, Ellen J; Polevoi, Steven; Fee, Christopher; Maruoka, Andrew; Quon, Tina

2018-06-01

To determine if adapting a widely-used triage scale into a computerized algorithm in an electronic health record (EHR) shortens emergency department (ED) triage time. Before-and-after quasi-experimental study. Urban, tertiary care hospital ED. Consecutive adult patient visits between July 2011 and June 2013. A step-wise algorithm, based on the Emergency Severity Index (ESI-5) was programmed into the triage module of a commercial EHR. Duration of triage (triage interval) for all patients and change in percentage of high acuity patients (ESI 1 and 2) completing triage within 15 min, 12 months before-and-after implementation of the algorithm. Multivariable analysis adjusted for confounders; interrupted time series demonstrated effects over time. Secondary outcomes examined quality metrics and patient flow. About 32 546 patient visits before and 33 032 after the intervention were included. Post-intervention patients were slightly older, census was higher and admission rate slightly increased. Median triage interval was 5.92 min (interquartile ranges, IQR 4.2-8.73) before and 2.8 min (IQR 1.88-4.23) after the intervention (P < 0.001). Adjusted mean triage interval decreased 3.4 min (95% CI: -3.6, -3.2). The proportion of high acuity patients completing triage within 15 min increased from 63.9% (95% CI 62.5, 65.2%) to 75.0% (95% CI 73.8, 76.1). Monthly time series demonstrated immediate and sustained improvement following the intervention. Return visits within 72 h and door-to-balloon time were unchanged. Total length of stay was similar. The computerized triage scale improved speed of triage, allowing more high acuity patients to be seen within recommended timeframes, without notable impact on quality.

Implementation of the World Health Organization Regional Office for Africa Stepwise Laboratory Quality Improvement Process Towards Accreditation.

PubMed

Ndihokubwayo, Jean-Bosco; Maruta, Talkmore; Ndlovu, Nqobile; Moyo, Sikhulile; Yahaya, Ali Ahmed; Coulibaly, Sheick Oumar; Kasolo, Francis; Turgeon, David; Abrol, Angelii P

2016-01-01

The increase in disease burden has continued to weigh upon health systems in Africa. The role of the laboratory has become increasingly critical in the improvement of health for diagnosis, management and treatment of diseases. In response, the World Health Organization Regional Office for Africa (WHO AFRO) and its partners created the WHO AFRO Stepwise Laboratory (Quality) Improvement Process Towards Accreditation (SLIPTA) program. WHO AFRO defined a governance structure with roles and responsibilities for six main stakeholders. Laboratories were evaluated by auditors trained and certified by the African Society for Laboratory Medicine. Laboratory performance was measured using the WHO AFRO SLIPTA scoring checklist and recognition certificates rated with 1-5 stars were issued. By March 2015, 27 of the 47 (57%) WHO AFRO member states had appointed a SLIPTA focal point and 14 Ministers of Health had endorsed SLIPTA as the desired programme for continuous quality improvement. Ninety-eight auditors from 17 African countries, competent in the Portuguese (3), French (12) and English (83) languages, were trained and certified. The mean score for the 159 laboratories audited between May 2013 and March 2015 was 69% (median 70%; SD 11.5; interquartile range 62-77). Of these audited laboratories, 70% achieved 55% compliance or higher (2 or more stars) and 1% scored at least 95% (5 stars). The lowest scoring sections of the WHO AFRO SLIPTA checklist were sections 6 (Internal Audit) and 10 (Corrective Action), which both had mean scores below 50%. The WHO AFRO SLIPTA is a process that countries with limited resources can adopt for effective implementation of quality management systems. Political commitment, ownership and investment in continuous quality improvement are integral components of the process.

Long-Term Effectiveness of a Multifactorial Fall and Fracture Prevention Program in Bavarian Nursing Homes: An Analysis Based on Health Insurance Claims Data.

PubMed

Schulz, Claudia; Lindlbauer, Ivonne; Rapp, Kilian; Becker, Clemens; König, Hans-Helmut

2017-06-01

Femoral fractures are frequently consequences of falls in nursing homes and are associated with considerable costs and unfavorable outcomes such as immobility and mortality. The purpose of this study was to examine the long-term effectiveness of a multifactorial fall and fracture prevention program in nursing homes in terms of reducing femoral fractures. Retrospective cohort study. Nursing homes. Health insurance claims data for 2005-2013 including 85,148 insurants of a sickness fund (Allgemeine Ortskrankenkasse Bayern), aged 65 years or older and living in 802 nursing homes in Bavaria, Germany. The fall prevention program was implemented stepwise in 4 time-lagged waves in almost 1,000 nursing homes in Bavaria, Germany, and was financially supported by a Bavarian statutory health insurance for the initial period of 3 years after implementation. The components of Bavarian Fall and Fracture Prevention Program were related to the staff (education), to the residents (progressive strength and balance training, medication, hip protectors), and suggested environmental adaptations as well as fall documentation and feedback on fall statistics. Data were used to create an unbalanced panel data set with observations per resident and quarterly period. We designed each wave to have 9 quarters (2.25 years) before implementation and 15 quarters (3.75 years) as follow-up period, respectively. Time trend-adjusted logistic generalized estimating equations were used to examine the impact of implementation of the fall prevention program on the likelihood of femoral fractures, controlling for resident and nursing home characteristics. The analysis took into account that the fall prevention program was implemented in 4 time-lagged waves. The implementation of the fall prevention program was not associated with a significant reduction in femoral fractures. Only a transient reduction of femoral fractures in the first wave was observed. Patient characteristics were positively associated with the likelihood of femoral fractures (P < .001); women compared to men [odds ratio (OR) = 0.877], age category 2 (OR = 1.486) and 3 (OR = 1.973) compared to category 1, care level 1 compared to 2 (OR = 0.897) and 3 (OR = 0.426), and a prior fracture (OR = 2.230) significantly increased the likelihood of a femoral fracture. There was no evidence for the long-term effectiveness of the fall prevention program in nursing homes. The restriction of the transient reduction to the first implementation wave may be explainable by a higher motivation of nursing homes starting first with the fall prevention program. Efforts should be directed to further identify factors that determine the long-term effectiveness of fall prevention programs in nursing homes. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Layer moduli of Nebraska pavements for the new Mechanistic-Empirical Pavement Design Guide (MEPDG).

DOT National Transportation Integrated Search

2010-12-01

As a step-wise implementation effort of the Mechanistic-Empirical Pavement Design Guide (MEPDG) for the design : and analysis of Nebraska flexible pavement systems, this research developed a database of layer moduli dynamic : modulus, creep compl...

The TeachScheme! Project: Computing and Programming for Every Student

ERIC Educational Resources Information Center

Felleisen, Matthias; Findler, Robert Bruce; Flatt, Matthew; Krishnamurthi, Shriram

2004-01-01

The TeachScheme! Project aims to reform three aspects of introductory programming courses in secondary schools. First, we use a design method that asks students to develop programs in a stepwise fashion such that each step produces a well-specified intermediate product. Second, we use an entire series of sublanguages, not just one. Each element of…

Geriatric Hip Fracture Care: Fixing a Fragmented System.

PubMed

Anderson, Mary E; Mcdevitt, Kelly; Cumbler, Ethan; Bennett, Heather; Robison, Zachary; Gomez, Bryan; Stoneback, Jason W

2017-01-01

Fragmentation in geriatric hip fracture care is a growing concern because of the aging population. Patients with hip fractures at our institution historically were admitted to multiple different services and units, leading to unnecessary variation in inpatient care. Such inconsistency contributed to delays in surgery, discharge, and functional recovery; hospital-acquired complications; failure to adhere to best practices in osteoporosis management; and poor coordination with outpatient practitioners. To describe a stepwise approach to systems redesign for this patient population. We designed and implemented a comprehensive geriatric hip fracture program for patients aged 65 years and older at our academic Medical Center in October 2014. Key interventions included admission of all ward-status patients to the Orthopedics Service with hospitalist comanagement; geographic placement on the Orthopedics Unit; and standardized, evidence-based electronic order sets bundling geriatric best practices and a streamlined workflow for discharge planning. Hospital length of stay. We identified 271 admissions among 267 patients between January 1, 2012, and March 31, 2016; of those, 154 were before and 117 were after program implementation. Mean hospital length of stay significantly improved from 6.4 to 5.5 days (p = 0.004). The 30-day all-cause readmission rate and discharge disposition remained stable. The percentage of patients receiving osteoporosis evaluation and treatment increased significantly. The rate of completed 30-day outpatient follow-up also improved. Our comprehensive geriatric hip fracture program achieved and sustained gains in the quality and efficiency of care by improving fragmentation in the health care system.

Planning for robust reserve networks using uncertainty analysis

USGS Publications Warehouse

Moilanen, A.; Runge, M.C.; Elith, Jane; Tyre, A.; Carmel, Y.; Fegraus, E.; Wintle, B.A.; Burgman, M.; Ben-Haim, Y.

2006-01-01

Planning land-use for biodiversity conservation frequently involves computer-assisted reserve selection algorithms. Typically such algorithms operate on matrices of species presence?absence in sites, or on species-specific distributions of model predicted probabilities of occurrence in grid cells. There are practically always errors in input data?erroneous species presence?absence data, structural and parametric uncertainty in predictive habitat models, and lack of correspondence between temporal presence and long-run persistence. Despite these uncertainties, typical reserve selection methods proceed as if there is no uncertainty in the data or models. Having two conservation options of apparently equal biological value, one would prefer the option whose value is relatively insensitive to errors in planning inputs. In this work we show how uncertainty analysis for reserve planning can be implemented within a framework of information-gap decision theory, generating reserve designs that are robust to uncertainty. Consideration of uncertainty involves modifications to the typical objective functions used in reserve selection. Search for robust-optimal reserve structures can still be implemented via typical reserve selection optimization techniques, including stepwise heuristics, integer-programming and stochastic global search.

Development of a System-Wide Predator Control Program: Stepwise Implementation of a Predation Index, Predator Control Fisheries, and Evaluation Plan in the Columbia River Basin; Northern Pikeminnow Management Program, 2002 Annual Report.

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

Porter, Russell G.; Winther, Eric C.; Fox, Lyle G.

2004-01-01

This report presents results for year twelve in a basin-wide program to harvest northern pikeminnow1 (Ptychocheilus oregonensis). This program was started in an effort to reduce predation by northern pikeminnow on juvenile salmonids during their emigration from natal streams to the ocean. Earlier work in the Columbia River Basin suggested predation by northern pikeminnow on juvenile salmonids might account for most of the 10-20% mortality juvenile salmonids experience in each of eight Columbia River and Snake River reservoirs. Modeling simulations based on work in John Day Reservoir from 1982 through 1988 indicated that, if predator-size northern pikeminnow were exploited atmore » a 10-20% rate, the resulting restructuring of their population could reduce their predation on juvenile salmonids by 50%. To test this hypothesis, we implemented a sport-reward angling fishery and a commercial longline fishery in the John Day Pool in 1990. We also conducted an angling fishery in areas inaccessible to the public at four dams on the mainstem Columbia River and at Ice Harbor Dam on the Snake River. Based on the success of these limited efforts, we implemented three test fisheries on a system-wide scale in 1991--a tribal longline fishery above Bonneville Dam, a sport-reward fishery, and a dam-angling fishery. Low catch of target fish and high cost of implementation resulted in discontinuation of the tribal longline fishery. However, the sport-reward and dam-angling fisheries were continued in 1992 and 1993. In 1992, we investigated the feasibility of implementing a commercial longline fishery in the Columbia River below Bonneville Dam and found that implementation of this fishery was also infeasible. Estimates of combined annual exploitation rates resulting from the sport-reward and damangling fisheries remained at the low end of our target range of 10-20%. This suggested the need for additional effective harvest techniques. During 1991 and 1992, we developed and tested a modified (small-sized) Merwin trapnet. We found this floating trapnet to be very effective in catching northern pikeminnow at specific sites. Consequently, in 1993 we examined a system-wide fishery using floating trapnets, but found this fishery to be ineffective at harvesting large numbers of northern pikeminnow on a system-wide scale.« less

Use of a pretest strategy for physical therapist assistant programs to predict success rate on the national physical therapy exam.

PubMed

Sloas, Stacey B; Keith, Becky; Whitehead, Malcolm T

2013-01-01

This study investigated a pretest strategy that identified physical therapist assistant (PTA) students who were at risk of failure on the National Physical Therapy Examination (NPTE). Program assessment data from five cohorts of PTA students (2005-2009) were used to develop a stepwise multiple regression formula that predicted first-time NPTE licensure scores. Data used included the Nelson-Denny Reading Test, grades from eight core courses, grade point average upon admission to the program, and scores from three mock NPTE exams given during the program. Pearson correlation coefficients were calculated between each of the 15 variables and NPTE scores. Stepwise multiple regression analysis was performed using data collected at the ends of the first, second, and third (final) semesters of the program. Data from the class of 2010 were then used to validate the formula. The end-of-program formula accounted for the greatest variance (57%) in predicted scores. Those students scoring below a predicted scaled score of 620 were identified to be at risk of failure of the licensure exam. These students were counseled, and a remedial plan was developed based on regression predictions prior to them sitting for the licensure exam.

A model of translational research for diabetes prevention in low and middle-income countries: The Diabetes Community Lifestyle Improvement Program (D-CLIP) trial.

PubMed

Weber, Mary Beth; Ranjani, Harish; Meyers, Gaya Celeste; Mohan, Viswanathan; Narayan, K M Venkat

2012-04-01

The Diabetes Community Lifestyle Improvement Program (D-CLIP) aims to implement and evaluate in a controlled, randomized trial the effectiveness, cost-effectiveness, and sustainability of a culturally appropriate, low-cost, and sustainable lifestyle intervention for the prevention of type 2 diabetes mellitus in India. D-CLIP, a translational research project adapted from the methods and curriculum developed and tested for efficacy in the Diabetes Prevention Program, utilizes innovated methods (a step-wise model of diabetes prevention with lifestyle and metformin added when needed; inclusion of individuals with isolated glucose tolerance, impaired fasting glucose, and both; classes team-taught by professionals and trained community educators) with the goals of increasing diabetes prevention, community acceptability, and long-term dissemination and sustainability of the program. The study outcomes are: diabetes incidence (primary measure of effectiveness), cost-effectiveness, changes in anthropometric measures, plasma lipids, blood pressure, blood glucose, and HbA(1c,) Program acceptability and sustainability will be assessed using a mixed methods approach. D-CLIP, a low-cost, community-based, research program, addresses the key components of translational research and can be used as a model for prevention of chronic diseases in other low and middle-income country settings. Copyright © 2011 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Status and trends monitoring of the mainstem Columbia River: sample frame development and review of programs relevant to the development of an integrated approach to monitoring

USGS Publications Warehouse

Counihan, Timothy D.; Hardiman, Jill M.; Waste, Stephen

2013-01-01

Implementing an Integrated Status and Trends Monitoring program (ISTM) for the mainstem Columbia River will help identify trends in important natural resources and help us understand the long-term collective effects of management actions. In this report, we present progress towards the completion of a stepwise process that will facilitate the development of an ISTM for the mainstem Columbia River. We discuss planning and regulatory documents that can be used to identify monitoring goals and objectives and present existing monitoring and research activities that should be considered as the development of a Columbia River ISTM proceeds. We also report progress towards the development of sample frames for the Columbia and Snake Rivers and their floodplains. The sample frames were formulated using Digital Elevation Models (DEM’s) of the river channel and upland areas and a Generalized Random-Tessellation Stratified (GRTS) algorithm for an area based resource to generate “master sample(s).” Working with the Pacific Northwest Aquatic Monitoring Partnership (PNAMP) we facilitated the transfer of the sample frames to the PNAMP “Monitoring Sample Designer” tool. We then discuss aspects of response and survey designs as they pertain to the formulation of a mainstem Columbia River ISTM. As efforts to formulate an ISTM for the mainstem Columbia River proceed, practitioners should utilize the extensive literature describing the planning and implementation of fish and wildlife mitigation and recovery efforts in the Columbia River Basin. While we make progress towards establishing an ISTM framework, considerable work needs to be done to formulate an ISTM program for the mainstem Columbia River. Long-term monitoring programs have been established for other large rivers systems; scientists that have experience planning, implementing, and maintaining large river monitoring efforts such as those in the Colorado, Illinois, and Mississippi Rivers should be consulted and involved as efforts proceed.

Discriminant Analysis as a Tool for Admission Selection to Special Academic Programs. AIR 1986 Annual Forum Paper.

ERIC Educational Resources Information Center

Kissel, Mary Ann

The use of stepwise discriminant analysis as a means to select entering students who would benefit from a special program for the disadvantaged was studied. In fall 1984, 278 full-time black students were admitted as first-time students to a large urban university. Of the total, 200 entered a special program for the disadvantaged and 78 entered…

How to practice person-centred care: A conceptual framework.

PubMed

Santana, Maria J; Manalili, Kimberly; Jolley, Rachel J; Zelinsky, Sandra; Quan, Hude; Lu, Mingshan

2018-04-01

Globally, health-care systems and organizations are looking to improve health system performance through the implementation of a person-centred care (PCC) model. While numerous conceptual frameworks for PCC exist, a gap remains in practical guidance on PCC implementation. Based on a narrative review of the PCC literature, a generic conceptual framework was developed in collaboration with a patient partner, which synthesizes evidence, recommendations and best practice from existing frameworks and implementation case studies. The Donabedian model for health-care improvement was used to classify PCC domains into the categories of "Structure," "Process" and "Outcome" for health-care quality improvement. The framework emphasizes the structural domain, which relates to the health-care system or context in which care is delivered, providing the foundation for PCC, and influencing the processes and outcomes of care. Structural domains identified include: the creation of a PCC culture across the continuum of care; co-designing educational programs, as well as health promotion and prevention programs with patients; providing a supportive and accommodating environment; and developing and integrating structures to support health information technology and to measure and monitor PCC performance. Process domains describe the importance of cultivating communication and respectful and compassionate care; engaging patients in managing their care; and integration of care. Outcome domains identified include: access to care and Patient-Reported Outcomes. This conceptual framework provides a step-wise roadmap to guide health-care systems and organizations in the provision PCC across various health-care sectors. © 2017 The Authors Health Expectations published by John Wiley & Sons Ltd.

Anticipating implementation of colorectal cancer screening in The Netherlands: a nation wide survey on endoscopic supply and demand

PubMed Central

2012-01-01

Background Colorectal cancer (CRC) screening requires sufficient endoscopic resources. The present study aims to determine the Dutch endoscopic production and manpower for 2009, evaluate trends since 2004, determine additional workload which would be caused by implementation of a CRC screening program, and inventory colonoscopy rates performed in other European countries. Methods All Dutch endoscopy units (N = 101) were surveyed for manpower and the numbers of endoscopy procedures performed in 2009. Based on calculations in the report issued by the Dutch Health Council, future additional workload caused by faecal immunochemical test (FIT) screening was estimated. The number of colonoscopies performed in Europe was evaluated by a literature search and an email-inquiry. Results Compared to 2004, there was a 24% increase in total endoscopies (N = 505,226 in 2009), and a 64% increase in colonoscopies (N = 191,339 in 2009) in The Netherlands. The number of endoscopists had increased by 4.6% (N = 583 in 2009). Five years after stepwise implementation of FIT-based CRC screening, endoscopic capacity needs to be increased an additional 15%. A lack of published data on the number of endoscopies performed in Europe was found. Based on our email-inquiry, the number of colonoscopies per 100,000 inhabitants ranged from 126 to 3,031 in 15 European countries. Conclusions Over the last years, endoscopic procedures increased markedly in The Netherlands without a corresponding increase in manpower. A FIT-based CRC screening program requires an estimated additional 15% increase in endoscopic procedures. It is very likely that current colonoscopy density varies widely across European countries. PMID:22280408

Computational technique for stepwise quantitative assessment of equation correctness

NASA Astrophysics Data System (ADS)

Othman, Nuru'l Izzah; Bakar, Zainab Abu

2017-04-01

Many of the computer-aided mathematics assessment systems that are available today possess the capability to implement stepwise correctness checking of a working scheme for solving equations. The computational technique for assessing the correctness of each response in the scheme mainly involves checking the mathematical equivalence and providing qualitative feedback. This paper presents a technique, known as the Stepwise Correctness Checking and Scoring (SCCS) technique that checks the correctness of each equation in terms of structural equivalence and provides quantitative feedback. The technique, which is based on the Multiset framework, adapts certain techniques from textual information retrieval involving tokenization, document modelling and similarity evaluation. The performance of the SCCS technique was tested using worked solutions on solving linear algebraic equations in one variable. 350 working schemes comprising of 1385 responses were collected using a marking engine prototype, which has been developed based on the technique. The results show that both the automated analytical scores and the automated overall scores generated by the marking engine exhibit high percent agreement, high correlation and high degree of agreement with manual scores with small average absolute and mixed errors.

Evaluating employee assistance policy in an HMO-based alcoholism project.

PubMed

Putnam, S L; Stout, R L

1985-01-01

One aspect of successful employee assistance program (EAP) implementation is the adoption of a formal, written policy, reflecting company commitment to EAP guidelines and goals. This study of criteria predictive of such policy adoption was conducted at the occupational alcoholism project of a New England health maintenance organization (HMO). Data on nearly 400 organizations contacted by occupational program consultants (OPCs) over a 20-month period were collected by questionnaire and interview. One third of these organizations adopted employee assistance policies and set about establishing formal programs. Stepwise multiple regression is the principal method used to pinpoint the correlates of policy adoption. Two of the most important of these are the attitudes of contact persons within the organization toward alcoholism and employee assistance programs, particularly their admission of alcohol problems within their social networks; and the consultants' persistence and marketing skills. The adopting organizations also had reputations for being progressive, and actively concerned about employee welfare; they tended to be large, their executives autonomous, and their union membership rates high. Inhibiting policy acceptance were fears that a written policy would jeopardize the reputation and image of the organization, and that an employee assistance program would remove internal control of personal procedures. The adequacy of the evaluative data and methods are discussed, and recommendations are offered in the interests of streamlining the efforts of OPCs and of achieving greater penetration of targeted organizations.

DECISION-MAKING ALIGNED WITH RAPID-CYCLE EVALUATION IN HEALTH CARE.

PubMed

Schneeweiss, Sebastian; Shrank, William H; Ruhl, Michael; Maclure, Malcolm

2015-01-01

Availability of real-time electronic healthcare data provides new opportunities for rapid-cycle evaluation (RCE) of health technologies, including healthcare delivery and payment programs. We aim to align decision-making processes with stages of RCE to optimize the usefulness and impact of rapid results. Rational decisions about program adoption depend on program effect size in relation to externalities, including implementation cost, sustainability, and likelihood of broad adoption. Drawing on case studies and experience from drug safety monitoring, we examine how decision makers have used scientific evidence on complex interventions in the past. We clarify how RCE alters the nature of policy decisions; develop the RAPID framework for synchronizing decision-maker activities with stages of RCE; and provide guidelines on evidence thresholds for incremental decision-making. In contrast to traditional evaluations, RCE provides early evidence on effectiveness and facilitates a stepped approach to decision making in expectation of future regularly updated evidence. RCE allows for identification of trends in adjusted effect size. It supports adapting a program in midstream in response to interim findings, or adapting the evaluation strategy to identify true improvements earlier. The 5-step RAPID approach that utilizes the cumulating evidence of program effectiveness over time could increase policy-makers' confidence in expediting decisions. RCE enables a step-wise approach to HTA decision-making, based on gradually emerging evidence, reducing delays in decision-making processes after traditional one-time evaluations.

Identification of molecular markers associated with mite resistance in coconut (Cocos nucifera L.).

PubMed

Shalini, K V; Manjunatha, S; Lebrun, P; Berger, A; Baudouin, L; Pirany, N; Ranganath, R M; Prasad, D Theertha

2007-01-01

Coconut mite (Aceria guerreronis 'Keifer') has become a major threat to Indian coconut (Coçcos nucifera L.) cultivators and the processing industry. Chemical and biological control measures have proved to be costly, ineffective, and ecologically undesirable. Planting mite-resistant coconut cultivars is the most effective method of preventing yield loss and should form a major component of any integrated pest management stratagem. Coconut genotypes, and mite-resistant and -susceptible accessions were collected from different parts of South India. Thirty-two simple sequence repeat (SSR) and 7 RAPD primers were used for molecular analyses. In single-marker analysis, 9 SSR and 4 RAPD markers associated with mite resistance were identified. In stepwise multiple regression analysis of SSRs, a combination of 6 markers showed 100% association with mite infestation. Stepwise multiple regression analysis for RAPD data revealed that a combination of 3 markers accounted for 83.86% of mite resistance in the selected materials. Combined stepwise multiple regression analysis of RAPD and SSR data showed that a combination of 5 markers explained 100% of the association with mite resistance in coconut. Markers associated with mite resistance are important in coconut breeding programs and will facilitate the selection of mite-resistant plants at an early stage as well as mother plants for breeding programs.

STEP and STEPSPL: Computer programs for aerodynamic model structure determination and parameter estimation

NASA Technical Reports Server (NTRS)

Batterson, J. G.

1986-01-01

The successful parametric modeling of the aerodynamics for an airplane operating at high angles of attack or sideslip is performed in two phases. First the aerodynamic model structure must be determined and second the associated aerodynamic parameters (stability and control derivatives) must be estimated for that model. The purpose of this paper is to document two versions of a stepwise regression computer program which were developed for the determination of airplane aerodynamic model structure and to provide two examples of their use on computer generated data. References are provided for the application of the programs to real flight data. The two computer programs that are the subject of this report, STEP and STEPSPL, are written in FORTRAN IV (ANSI l966) compatible with a CDC FTN4 compiler. Both programs are adaptations of a standard forward stepwise regression algorithm. The purpose of the adaptation is to facilitate the selection of a adequate mathematical model of the aerodynamic force and moment coefficients of an airplane from flight test data. The major difference between STEP and STEPSPL is in the basis for the model. The basis for the model in STEP is the standard polynomial Taylor's series expansion of the aerodynamic function about some steady-state trim condition. Program STEPSPL utilizes a set of spline basis functions.

Geriatric Hip Fracture Care: Fixing a Fragmented System

PubMed Central

Anderson, Mary E; McDevitt, Kelly; Cumbler, Ethan; Bennett, Heather; Robison, Zachary; Gomez, Bryan; Stoneback, Jason W

2017-01-01

Context Fragmentation in geriatric hip fracture care is a growing concern because of the aging population. Patients with hip fractures at our institution historically were admitted to multiple different services and units, leading to unnecessary variation in inpatient care. Such inconsistency contributed to delays in surgery, discharge, and functional recovery; hospital-acquired complications; failure to adhere to best practices in osteoporosis management; and poor coordination with outpatient practitioners. Objective To describe a stepwise approach to systems redesign for this patient population. Design We designed and implemented a comprehensive geriatric hip fracture program for patients aged 65 years and older at our academic Medical Center in October 2014. Key interventions included admission of all ward-status patients to the Orthopedics Service with hospitalist comanagement; geographic placement on the Orthopedics Unit; and standardized, evidence-based electronic order sets bundling geriatric best practices and a streamlined workflow for discharge planning. Main Outcome Measures Hospital length of stay. Results We identified 271 admissions among 267 patients between January 1, 2012, and March 31, 2016; of those, 154 were before and 117 were after program implementation. Mean hospital length of stay significantly improved from 6.4 to 5.5 days (p = 0.004). The 30-day all-cause readmission rate and discharge disposition remained stable. The percentage of patients receiving osteoporosis evaluation and treatment increased significantly. The rate of completed 30-day outpatient follow-up also improved. Conclusion Our comprehensive geriatric hip fracture program achieved and sustained gains in the quality and efficiency of care by improving fragmentation in the health care system. PMID:28488991

A Collaborative Step-Wise Process to Implementing an Innovative Clinic for Adult Survivors of Childhood Cancer.

PubMed

McClellan, Wendy; Fulbright, Joy M; Doolittle, Gary C; Alsman, Kyla; Klemp, Jennifer R; Ryan, Robin; Nelson, Eve-Lynn; Stegenga, Kristin; Krebill, Hope; Al-hihi, Eyad M; Schuetz, Nik; Heiman, Ashley; Lowry, Becky

2015-01-01

With a 5 year survival rate of approximately 80%, there is an increasing number of childhood cancer survivors in the United States. Childhood cancer survivors are at an increased risk for physical and psychosocial health problems many years after treatment. Long-term follow-up care should include education, development of individualized follow up plans and screening for health problems in accordance with the Children's Oncology Group survivor guidelines. Due to survivor, provider and healthcare system related barriers, adult survivors of childhood cancer (ASCC) infrequently are receiving care in accordance to these guidelines. In this paper we describe the stepwise process and collaboration between a children's hospital and an adult academic medical center that was implemented to develop the Survivorship Transition Clinic and address the needs of ASCC in our region. In the clinic model that we designed ASCC follow-up with a primary care physician in the adult setting who is knowledgeable about late effects of childhood cancer treatment and are provided transition support and education by a transition nurse navigator. Copyright © 2015 Elsevier Inc. All rights reserved.

Developing a customised approach for strengthening tuberculosis laboratory quality management systems toward accreditation

PubMed Central

Trollip, Andre; Erni, Donatelle; Kao, Kekeletso

2017-01-01

Background Quality-assured tuberculosis laboratory services are critical to achieve global and national goals for tuberculosis prevention and care. Implementation of a quality management system (QMS) in laboratories leads to improved quality of diagnostic tests and better patient care. The Strengthening Laboratory Management Toward Accreditation (SLMTA) programme has led to measurable improvements in the QMS of clinical laboratories. However, progress in tuberculosis laboratories has been slower, which may be attributed to the need for a structured tuberculosis-specific approach to implementing QMS. We describe the development and early implementation of the Strengthening Tuberculosis Laboratory Management Toward Accreditation (TB SLMTA) programme. Development The TB SLMTA curriculum was developed by customizing the SLMTA curriculum to include specific tools, job aids and supplementary materials specific to the tuberculosis laboratory. The TB SLMTA Harmonized Checklist was developed from the World Health Organisation Regional Office for Africa Stepwise Laboratory Quality Improvement Process Towards Accreditation checklist, and incorporated tuberculosis-specific requirements from the Global Laboratory Initiative Stepwise Process Towards Tuberculosis Laboratory Accreditation online tool. Implementation Four regional training-of-trainers workshops have been conducted since 2013. The TB SLMTA programme has been rolled out in 37 tuberculosis laboratories in 10 countries using the Workshop approach in 32 laboratories in five countries and the Facility-based approach in five tuberculosis laboratories in five countries. Conclusion Lessons learnt from early implementation of TB SLMTA suggest that a structured training and mentoring programme can build a foundation towards further quality improvement in tuberculosis laboratories. Structured mentoring, and institutionalisation of QMS into country programmes, is needed to support tuberculosis laboratories to achieve accreditation. PMID:28879165

System design of a remotely operated, program controlled measurement table for the calibration of the Egret experiment. Part A: Program control

NASA Technical Reports Server (NTRS)

1984-01-01

The structure of the program, the five priority levels, the drive routines, the stepwise drive plan, the figure routines, meander X and y, the range of measurement table, the optimization of figure drive, the figure drive plan, dialogue routines, stack processing, the drive for the main terminal, the protocol routines, the drive for the microterminal, the drive for the experiment computer, and the main program are discussed.

Stepwise Development of a Text Messaging-Based Bullying Prevention Program for Middle School Students (BullyDown)

PubMed Central

Prescott, Tonya L; Espelage, Dorothy L

2016-01-01

Background Bullying is a significant public health issue among middle school-aged youth. Current prevention programs have only a moderate impact. Cell phone text messaging technology (mHealth) can potentially overcome existing challenges, particularly those that are structural (e.g., limited time that teachers can devote to non-educational topics). To date, the description of the development of empirically-based mHealth-delivered bullying prevention programs are lacking in the literature. Objective To describe the development of BullyDown, a text messaging-based bullying prevention program for middle school students, guided by the Social-Emotional Learning model. Methods We implemented five activities over a 12-month period: (1) national focus groups (n=37 youth) to gather acceptability of program components; (2) development of content; (3) a national Content Advisory Team (n=9 youth) to confirm content tone; and (4) an internal team test of software functionality followed by a beta test (n=22 youth) to confirm the enrollment protocol and the feasibility and acceptability of the program. Results Recruitment experiences suggested that Facebook advertising was less efficient than using a recruitment firm to recruit youth nationally, and recruiting within schools for the pilot test was feasible. Feedback from the Content Advisory Team suggests a preference for 2-4 brief text messages per day. Beta test findings suggest that BullyDown is both feasible and acceptable: 100% of youth completed the follow-up survey, 86% of whom liked the program. Conclusions Text messaging appears to be a feasible and acceptable delivery method for bullying prevention programming delivered to middle school students. PMID:27296471

Stepwise Development a Text Messaging-Based Bullying Prevention Program for Middle School Students (BullyDown).

PubMed

Ybarra, Michele L; Prescott, Tonya L; Espelage, Dorothy L

2016-06-13

Bullying is a significant public health issue among middle school-aged youth. Current prevention programs have only a moderate impact. Cell phone text messaging technology (mHealth) can potentially overcome existing challenges, particularly those that are structural (e.g., limited time that teachers can devote to non-educational topics). To date, the description of the development of empirically-based mHealth-delivered bullying prevention programs are lacking in the literature. To describe the development of BullyDown, a text messaging-based bullying prevention program for middle school students, guided by the Social-Emotional Learning model. We implemented five activities over a 12-month period: (1) national focus groups (n=37 youth) to gather acceptability of program components; (2) development of content; (3) a national Content Advisory Team (n=9 youth) to confirm content tone; and (4) an internal team test of software functionality followed by a beta test (n=22 youth) to confirm the enrollment protocol and the feasibility and acceptability of the program. Recruitment experiences suggested that Facebook advertising was less efficient than using a recruitment firm to recruit youth nationally, and recruiting within schools for the pilot test was feasible. Feedback from the Content Advisory Team suggests a preference for 2-4 brief text messages per day. Beta test findings suggest that BullyDown is both feasible and acceptable: 100% of youth completed the follow-up survey, 86% of whom liked the program. Text messaging appears to be a feasible and acceptable delivery method for bullying prevention programming delivered to middle school students.

In vitro selection and amplification protocols for isolation of aptameric sensors for small molecules

PubMed Central

Yang, Kyung-Ae; Pei, Renjun; Stojanovic, Milan N.

2016-01-01

We recently optimized a procedure that directly yields aptameric sensors for small molecules in so-called structure-switching format. The protocol has a high success rate, short time, and is sufficiently simple to be readily implemented in a non-specialist laboratory. We provide a stepwise guide to this selection protocol. PMID:27155227

Council of Europe Black Sea Area Project: International Cooperation for the Development of Activities Related to Donation and Transplantation of Organs in the Region.

PubMed

Arredondo, E; López-Fraga, M; Chatzixiros, E; Senemaud, B; Brezovsky, P; Carella, C; Ballesté, C; Aydin Mehmet, A; Tomadze, G; Codreanu, I; Sarkissian, A A; Simeonova, M; Nikonenko, A; Zota, V; Gómez, M P; Manyalich, M; Bolotinha, C; Franca, A; Costa, A N; Ott, M-O; Buchheit, K-H

2018-03-01

In 2011, the European Directorate for the Quality of Medicines & Healthcare of the Council of Europe launched a 3-year collaborative project to address the organ shortage and improve access to transplant health services in Council of Europe member states in the Black Sea area (Armenia, Azerbaijan, Bulgaria, Georgia, Moldova, Romania, Turkey, Ukraine, and the Russian Federation) through the development of safe and ethical donation and transplantation programs. Support the development of donation and transplantation programs through close interstate cooperation between national health organizations and relevant stakeholders. Several work packages (WP) were established: WP1, project coordination (European Directorate for the Quality of Medicines & Healthcare); WP2, development and implementation of an effective legislative and financial framework (Czech Republic and France); WP3, establishment of National Transplant Authorities (Italy and Portugal); and WP4, clinical practices (DTI Foundation). Data collection, surveys, and expert visits allowed for the collection of first-hand information from each participant country at national, regional, and hospital levels. Data analysis showed the positive impact of the project represented by a tendency to increase the total donation rates (per million people) in the participant countries (2011 vs 2013): Azerbaijan, +7.3; Armenia, -0.7; Georgia, +3.3; Bulgaria, +0.9; Moldova, +2.5; Ukraine:, +0.8; Romania, +2.3; and Turkey, +2.7. Increases in total donation rates are the result of a number of initiatives in the Black Sea area, including the stepwise implementation of legislative, organizational and institutional country-specific recommendations tailored by the CoE, efforts of the respective Ministries of Health in each country and synergism with other European projects in the region. These countries should invest further in implementing the recommendations that emerged from this project to improve their organ donation and transplantation programs and progress toward self-sufficiency. Copyright © 2017 Elsevier Inc. All rights reserved.

Development of a System-wide Predator Control Program: Stepwise Implementation of a Predation Index, Predator Control Fisheries, and Evaluation Plan in the Columbia River Basin; Northern Pikeminnow Management Program, 1998 Annual Report.

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

Young, Franklin R.; Wachtel, Mark L.; Petersen, Marc R.

2003-03-01

We are reporting on the progress of the Northern Pikeminnow Sport-Reward Fishery (NPSRF) in the lower Columbia and Snake rivers for 1998. The objectives of this project were to (1) implement a sport fishery that rewards anglers who harvest northern pikeminnow Ptychocheilus oregonensis {ge}279 mm (11 inches) total length, (2) collect catch data on selected fish species caught by fishery participants while targeting northern pikeminnow, (3) monitor and report incidental catch of sensitive salmonid species by anglers targeting northern pikeminnow and, (4) collect, monitor and report data on angler participation, catch and catch per angler day of northern pikeminnow duringmore » the season. A total of 108,903 northern pikeminnow {ge}279 mm were harvested during the 1998 season and 21,959 angler days were spent harvesting these fish. Harvest was below the seven year average of 150,874 and participation was well below the seven-year average of 51,013 angler days. Catch per angler day for all anglers during the season was 4.96 and exceeded the seven-year average of 2.96 northern pikeminnow per angler day. Peamouth Mylocheilus caurinus, and white sturgeon Acipencer transmontanus, were the other species most often harvested by returning NPSRF anglers targeting northern pikeminnow. Harvest of salmonids Oncorhynchus spp. by NPSRF anglers targeting northern pikeminnow remained below limits established by the National Marine Fisheries Service (NMFS).« less

Promoting interdisciplinary project-based learning to build the skill sets for research and development of medical devices in academia.

PubMed

Krishnan, Shankar

2013-01-01

The worldwide need for rapid expansion and diversification of medical devices and the corresponding requirements in industry pose arduous challenges for educators to train undergraduate biomedical engineering (BME) students. Preparing BME students for working in the research and development (R&D) in medical device industry is not easily accomplished by adopting traditional pedagogical methods. Even with the inclusion of the design and development elements in capstone projects, medical device industry may be still experience a gap in fulfilling their needs in R&D. This paper proposes a new model based on interdisciplinary project-based learning (IDPBL) to address the requirements of building the necessary skill sets in academia for carrying out R&D in medical device industry. The proposed model incorporates IDPBL modules distributed in a stepwise fashion through the four years of a typical BME program. The proposed model involves buy-in and collaboration from faculty as well as students. The implementation of the proposed design in an undergraduate BME program is still in process. However, a variant of the proposed IDPBL method has been attempted at a limited scale at the postgraduate level and has shown some success. Extrapolating the previous results, the adoption of the IDPBL to BME training seems to suggest promising outcomes. Despite numerous implementation challenges, with continued efforts, the proposed IDPBL will be valuable n academia for skill sets building for medical device R&D.

A public hedonic analysis of environmental attributes in an open space preservation program

NASA Astrophysics Data System (ADS)

Nordman, Erik E.

The Town of Brookhaven, on Long Island, NY, has implemented an open space preservation program to protect natural areas, and the ecosystem services they provide, from suburban growth. I used a public hedonic model of Brookhaven's open space purchases to estimate implicit prices for various environmental attributes, locational variables and spatial metrics. I also measured the correlation between cost per acre and non-monetary environmental benefit scores and tested whether including cost data, as opposed to non-monetary environmental benefit score alone, would change the prioritization ranks of acquired properties. The mean acquisition cost per acre was 82,501. I identified the key on-site environmental and locational variables using stepwise regression for four functional forms. The log-log specification performed best ( R2adj= 0.727). I performed a second stepwise regression (log-log form) which included spatial metrics, calculated from a high-resolution land cover classification, in addition to the environmental and locational variables. This markedly improved the model's performance ( R2adj=0.866). Statistically significant variables included the property size, location in the Pine Barrens Compatible Growth Area, location in a FEMA flood zone, adjacency to public land, and several other environmental dummy variables. The single significant spatial metric, the fractal dimension of the tree cover class, had the largest elasticity of any variable. Of the dummy variables, location within the Compatible Growth Area had the largest implicit price (298,792 per acre). The priority rank for the two methods, non-monetary environmental benefit score alone and the ratio of non-monetary environmental benefit score to acquisition cost were significantly positively correlated. This suggests that, despite the lack of cost data in their ranking method, Brookhaven does not suffer from efficiency losses. The economics literature encourages using both environmental benefits and acquisition costs to ensure cost-effective conservation programs. I recommend that Brookhaven consider acquisition costs in addition to environmental benefits to avert potential efficiency losses in future open space purchases. This dissertation shows that the addition of spatial metrics can enhance the performance of hedonic models. It also provides a baseline valuation for the environmental attributes of Brookhaven' open spaces and shows that location is critical when dealing with open space preservation programs.

Structured learning for robotic surgery utilizing a proficiency score: a pilot study.

PubMed

Hung, Andrew J; Bottyan, Thomas; Clifford, Thomas G; Serang, Sarfaraz; Nakhoda, Zein K; Shah, Swar H; Yokoi, Hana; Aron, Monish; Gill, Inderbir S

2017-01-01

We evaluated feasibility and benefit of implementing structured learning in a robotics program. Furthermore, we assessed validity of a proficiency assessment tool for stepwise graduation. Teaching cases included robotic radical prostatectomy and partial nephrectomy. Procedure steps were categorized: basic, intermediate, and advanced. An assessment tool ["proficiency score" (PS)] was developed to evaluate ability to safely and autonomously complete a step. Graduation required a passing PS (PS ≥ 3) on three consecutive attempts. PS and validated global evaluative assessment of robotic skills (GEARS) were evaluated for completed steps. Linear regression was utilized to determine postgraduate year/PS relationship (construct validity). Spearman's rank correlation coefficient measured correlation between PS and GEARS evaluations (concurrent validity). Intraclass correlation (ICC) evaluated PS agreement between evaluator classes. Twenty-one robotic trainees participated within the pilot program, completing a median of 14 (2-69) cases each. Twenty-three study evaluators scored 14 (1-60) cases. Over 4 months, 229/294 (78 %) cases were designated "teaching" cases. Residents completed 91 % of possible evaluations; faculty completed 78 %. Verbal and quantitative feedback received by trainees increased significantly (p = 0.002, p < 0.001, respectively). Average PS increased with PGY (post-graduate year) for basic and intermediate steps (regression slopes: 0.402 (p < 0.0001), 0.323 (p < 0.0001), respectively) (construct validation). Overall, PS correlated highly with GEARS (ρ = 0.81, p < 0.0001) (concurrent validity). ICC was 0.77 (95 % CI 0.61-0.88) for resident evaluations. Structured learning can be implemented in an academic robotic program with high levels of trainee and evaluator participation, encouraging both quantitative and verbal feedback. A proficiency assessment tool developed for step-specific proficiency has construct and concurrent validity.

Diffusion across the modified polyethylene separator GX in the heat-sterilizable AgO-Zn battery

NASA Technical Reports Server (NTRS)

Lutwack, R.

1973-01-01

Models of diffusion across an inert membrane have been studied using the computer program CINDA. The models were constructed to simulate various conditions obtained in the consideration of the diffusion of Ag (OH)2 ions in the AgO-Zn battery. The effects on concentrations across the membrane at the steady state and on the fluxout as a function of time were used to examine the consequences of stepwise reducing the number of sources of ions, of stepwise blocking the source and sink surfaces, of varying the magnitude of the diffusion coefficient for a uniform membrane, of varying the diffusion coefficient across the membrane, and of excluding volumes to diffusion.

Community pharmacist-delivered Medicare Annual Wellness Visits within a family medicine practice.

PubMed

Evans, Taylor A; Fabel, Patricia H; Ziegler, Bryan

To identify the steps to implement a community pharmacist into a family medicine practice to deliver Medicare Annual Wellness Visits (AWVs). Medicine Mart Pharmacy is a locally owned and operated pharmacy that has served the West Columbia, SC, area for over 30 years. The services offered by the pharmacy have expanded over the past 3 years through the addition of a community pharmacy resident. A stepwise approach was developed for a community pharmacist to identify, market, and establish an AWV service through a collaborative practice agreement with a local family medicine practice. The pharmacy team contacted each office and obtained information about the physician practices and their willingness to participate in the program. Two financial models were created and evaluated to determine budget implications. Many patients were seen at the physician offices; they were eligible for AWV, but had not received them. Meetings were scheduled with 3 of the 6 offices; however, none of the offices moved forward with the proposed program. Integrating a pharmacist into the AWV role may be profitable to both the pharmacy and the medical office with persistence and time to have a successful collaboration. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Super-resolution fluorescence microscopy by stepwise optical saturation

PubMed Central

Zhang, Yide; Nallathamby, Prakash D.; Vigil, Genevieve D.; Khan, Aamir A.; Mason, Devon E.; Boerckel, Joel D.; Roeder, Ryan K.; Howard, Scott S.

2018-01-01

Super-resolution fluorescence microscopy is an important tool in biomedical research for its ability to discern features smaller than the diffraction limit. However, due to its difficult implementation and high cost, the super-resolution microscopy is not feasible in many applications. In this paper, we propose and demonstrate a saturation-based super-resolution fluorescence microscopy technique that can be easily implemented and requires neither additional hardware nor complex post-processing. The method is based on the principle of stepwise optical saturation (SOS), where M steps of raw fluorescence images are linearly combined to generate an image with a M-fold increase in resolution compared with conventional diffraction-limited images. For example, linearly combining (scaling and subtracting) two images obtained at regular powers extends the resolution by a factor of 1.4 beyond the diffraction limit. The resolution improvement in SOS microscopy is theoretically infinite but practically is limited by the signal-to-noise ratio. We perform simulations and experimentally demonstrate super-resolution microscopy with both one-photon (confocal) and multiphoton excitation fluorescence. We show that with the multiphoton modality, the SOS microscopy can provide super-resolution imaging deep in scattering samples. PMID:29675306

Testing electroexplosive devices by programmed pulsing techniques

NASA Technical Reports Server (NTRS)

Rosenthal, L. A.; Menichelli, V. J.

1976-01-01

A novel method for testing electroexplosive devices is proposed wherein capacitor discharge pulses, with increasing energy in a step-wise fashion, are delivered to the device under test. The size of the energy increment can be programmed so that firing takes place after many, or after only a few, steps. The testing cycle is automatically terminated upon firing. An energy-firing contour relating the energy required to the programmed step size describes the single-pulse firing energy and the possible sensitization or desensitization of the explosive device.

Payment for obesity services: examples and recommendations for stage 3 comprehensive multidisciplinary intervention programs for children and adolescents.

PubMed

Slusser, Wendy; Staten, Karan; Stephens, Karen; Liu, Lenna; Yeh, Christine; Armstrong, Sarah; DeUgarte, Daniel A; Haemer, Matthew

2011-09-01

The Reimbursement and Payment Subcommittee of the National Association of Children's Hospitals and Related Institutions FOCUS on a Fitter Future group sought to guide medical providers, patients, and payers to better serve obese children and adolescents to enable optimum health. Recommendations are provided for the essential components of a stage 3 comprehensive multidisciplinary intervention program as defined by the 2007 Expert Committee recommendations. In addition, suggestions are offered for a stepwise approach to implement these recommendations. In 2009, key informant interviews were conducted with 15 children's hospitals participating in FOCUS on a Fitter Future and 1 nonparticipating hospital. Interview transcripts identified 5 financially sustainable stage 3 programs, each funded differently. The stage 3 programs interviewed ranged from being nascent to 21 years old (27%, <2 years; 47%, 2-6 years; 27%, >6 years). All of them had multidisciplinary teams that delivered services through 1 of 3 institutional structures: 60% freestanding; 7% specialty; and 33% hospital within a hospital. One-third of them had 1 to 2 funding sources, and 67% had ≥ 3 sources. The stage 3 programs in this review shared some common strategies for achieving financial stability. All of them followed key strategies of the chronic care model, the details of which led to the following recommendation: stage 3 programs should include a health care team with a medical provider, registered dietitian, physical activity specialist, mental health specialist, and coordinator who, as a team, provide service to overweight and obese children at no less than moderate intensity (26-75 hours).

Spectrum and power allocation in cognitive multi-beam satellite communications with flexible satellite payloads

NASA Astrophysics Data System (ADS)

Liu, Zhihui; Wang, Haitao; Dong, Tao; Yin, Jie; Zhang, Tingting; Guo, Hui; Li, Dequan

2018-02-01

In this paper, the cognitive multi-beam satellite system, i.e., two satellite networks coexist through underlay spectrum sharing, is studied, and the power and spectrum allocation method is employed for interference control and throughput maximization. Specifically, the multi-beam satellite with flexible payload reuses the authorized spectrum of the primary satellite, adjusting its transmission band as well as power for each beam to limit its interference on the primary satellite below the prescribed threshold and maximize its own achievable rate. This power and spectrum allocation problem is formulated as a mixed nonconvex programming. For effective solving, we first introduce the concept of signal to leakage plus noise ratio (SLNR) to decouple multiple transmit power variables in the both objective and constraint, and then propose a heuristic algorithm to assign spectrum sub-bands. After that, a stepwise plus slice-wise algorithm is proposed to implement the discrete power allocation. Finally, simulation results show that adopting cognitive technology can improve spectrum efficiency of the satellite communication.

Perceived Social Support as a Determinant of Quality of Life Among Medical Students: 6-Month Follow-up Study.

PubMed

Hwang, In Cheol; Park, Kwi Hwa; Kim, Jin Joo; Yim, Jun; Ko, Kwang Pil; Bae, Seung Min; Kyung, Sun Young

2017-04-01

This longitudinal study aimed to identify the relevant factors related to quality of life (QoL) changes in medical students. For this 6-month follow-up study, we enrolled 109 students from a Korean medical school. To assess students' QoL, we used the World Health Organization QoL scale. Possible determinants of student QoL included demographics, fatigue, and social support. A stepwise multivariate analysis identified factors associated with changes of student QoL. Among sources of support, the "friends" category was the main position affecting their overall QoL, and "significant other" had the strongest influence on psychological and social domains. The impact of support from friends on QoL was confirmed in the longitudinal analysis. Final regression models revealed that providing students with more social support and promoting fatigue reduction best improved medical student sense of well-being. Creating stronger student support programs to prevent social detachment and implementing strategies to reduce fatigue can improve QoL in medical students.

Structured programming: Principles, notation, procedure

NASA Technical Reports Server (NTRS)

JOST

1978-01-01

Structured programs are best represented using a notation which gives a clear representation of the block encapsulation. In this report, a set of symbols which can be used until binding directives are republished is suggested. Structured programming also allows a new method of procedure for design and testing. Programs can be designed top down, that is, they can start at the highest program plane and can penetrate to the lowest plane by step-wise refinements. The testing methodology also is adapted to this procedure. First, the highest program plane is tested, and the programs which are not yet finished in the next lower plane are represented by so-called dummies. They are gradually replaced by the real programs.

Development of a PROficiency-Based StePwise Endovascular Curricular Training (PROSPECT) Program.

PubMed

Maertens, Heidi; Aggarwal, Rajesh; Desender, Liesbeth; Vermassen, Frank; Van Herzeele, Isabelle

2016-01-01

Focus on patient safety, work-hour limitations, and cost-effective education is putting pressure to improve curricula to acquire minimally invasive techniques during surgical training. This study aimed to design a structured training program for endovascular skills and validate its assessment methods. A PROficiency-based StePwise Endovascular Curricular Training (PROSPECT) program was developed, consisting of e-learning and hands-on simulation modules, focusing on iliac and superficial femoral artery atherosclerotic disease. Construct validity was investigated. Performances were assessed using multiple-choice questionnaires, valid simulation parameters, global rating scorings, and examiner checklists. Feasibility was assessed by passage of 2 final-year medical students through this PROSPECT program. Ghent University Hospital, a tertiary clinical care and academic center in Belgium with general surgery residency program. Senior-year medical students were recruited at Ghent University Hospital. Vascular surgeons were invited to participate during conferences and meetings if they had performed at least 100 endovascular procedures as the primary operator during the last 2 years. Overall, 29 medical students and 20 vascular surgeons participated. Vascular surgeons obtained higher multiple-choice questionnaire scores (median: 24.5-22.0 vs. 15.0-12.0; p < 0.001). Students took significantly longer to treat any iliac or femoral artery stenosis (3.3-14.8 vs. 5.8-30.1min; p = 0.001-0.04), whereas in more complex cases, fluoroscopy time was significantly higher in students (8.3 vs. 21.3min; p = 0.002; 7.3 vs. 13.1min; p = 0.03). In all cases, vascular surgeons scored higher on global rating scorings (51.0-42.0 vs. 29.5-18.0; p < 0.001) and examiner checklist (81.5-75.0 vs. 54.5-43.0; p < 0.001). Hence, proficiency levels based on median expert scores could be determined. There were 2 students who completed the program and passed for each step within a 3-month period during their internships. A feasible and construct validated surgical program to train cognitive, technical, and nontechnical endovascular skills was developed. A structured, stepwise, proficiency-based valid endovascular program to train cognitive, technical, and human factor skills has been developed and proven to be feasible. A randomized controlled trial has been initiated to investigate its effect on performances in real life, patient outcomes, and cost-effectiveness. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Design and implementation of a novel mechanical testing system for cellular solids.

PubMed

Nazarian, Ara; Stauber, Martin; Müller, Ralph

2005-05-01

Cellular solids constitute an important class of engineering materials encompassing both man-made and natural constructs. Materials such as wood, cork, coral, and cancellous bone are examples of cellular solids. The structural analysis of cellular solid failure has been limited to 2D sections to illustrate global fracture patterns. Due to the inherent destructiveness of 2D methods, dynamic assessment of fracture progression has not been possible. Image-guided failure assessment (IGFA), a noninvasive technique to analyze 3D progressive bone failure, has been developed utilizing stepwise microcompression in combination with time-lapsed microcomputed tomographic imaging (microCT). This method allows for the assessment of fracture progression in the plastic region, where much of the structural deformation/energy absorption is encountered in a cellular solid. Therefore, the goal of this project was to design and fabricate a novel micromechanical testing system to validate the effectiveness of the stepwise IGFA technique compared to classical continuous mechanical testing, using a variety of engineered and natural cellular solids. In our analysis, we found stepwise compression to be a valid approach for IGFA with high precision and accuracy comparable to classical continuous testing. Therefore, this approach complements the conventional mechanical testing methods by providing visual insight into the failure propagation mechanisms of cellular solids. (c) 2005 Wiley Periodicals, Inc.

Plagiarism, Cheating and Research Integrity: Case Studies from a Masters Program in Peru.

PubMed

Carnero, Andres M; Mayta-Tristan, Percy; Konda, Kelika A; Mezones-Holguin, Edward; Bernabe-Ortiz, Antonio; Alvarado, German F; Canelo-Aybar, Carlos; Maguiña, Jorge L; Segura, Eddy R; Quispe, Antonio M; Smith, Edward S; Bayer, Angela M; Lescano, Andres G

2017-08-01

Plagiarism is a serious, yet widespread type of research misconduct, and is often neglected in developing countries. Despite its far-reaching implications, plagiarism is poorly acknowledged and discussed in the academic setting, and insufficient evidence exists in Latin America and developing countries to inform the development of preventive strategies. In this context, we present a longitudinal case study of seven instances of plagiarism and cheating arising in four consecutive classes (2011-2014) of an Epidemiology Masters program in Lima, Peru, and describes the implementation and outcomes of a multifaceted, "zero-tolerance" policy aimed at introducing research integrity. Two cases involved cheating in graded assignments, and five cases correspond to plagiarism in the thesis protocol. Cases revealed poor awareness of high tolerance to plagiarism, poor academic performance, and widespread writing deficiencies, compensated with patchwriting and copy-pasting. Depending on the events' severity, penalties included course failure (6/7) and separation from the program (3/7). Students at fault did not engage in further plagiarism. Between 2011 and 2013, the Masters program sequentially introduced a preventive policy consisting of: (i) intensified research integrity and scientific writing education, (ii) a stepwise, cumulative writing process; (iii) honor codes; (iv) active search for plagiarism in all academic products; and (v) a "zero-tolerance" policy in response to documented cases. No cases were detected in 2014. In conclusion, plagiarism seems to be widespread in resource-limited settings and a greater response with educational and zero-tolerance components is needed to prevent it.

Controlling methicillin-resistant Staphylococcus aureus by stepwise implementation of preventive strategies in a university hospital: impact of a link-nurse system on the basis of multidisciplinary approaches.

PubMed

Miyachi, Hayato; Furuya, Hiroyuki; Umezawa, Kazuo; Itoh, Yumiko; Ohshima, Toshio; Miyamoto, Motoaki; Asai, Satomi

2007-03-01

Current approaches in the control of methicillin-resistant Staphylococcus aureus (MRSA) in the large tertiary referral hospital have not been universally successful. The trend of MRSA rates and their relationship with stepwise implementation of preventive strategies in Tokai University Hospital during a 76-month period from September 1998 to December 2004, was retrospectively analyzed with a quasi-experimental design. Implementation of strategies including a feedback process with case and epidemic reporting, an infection control team and office, and a preventive guideline for MRSA did not result in reduction in monthly MRSA rates in the hospital, as analyzed with Shewhart u charts. When infection control link nurses were organized and their activities became full-scale, there appeared significant reduction in arithmetic mean of the monthly rates of MRSA from 6.3% to 5.0% in June 2002. Meanwhile the mean values for monthly counts of new MRSA cases also dropped in 15 of 25 wards/units in June 2002, as analyzed with Exponentially Weighted Moving Average charts. Concurrently, there was a significant increase (17.3%) in the monthly consumption of handwashing liquid plain soap. Thereafter the MRSA rates remained low for 2 years within three standard deviations. The sustained reduction of MRSA rates in the hospital can be related to introduction of the infection control link-nurse system on the basis of continuous enforcement of basic and multidisciplinary approaches such as hand-hygiene compliance.

Group Peer Mentoring: An Answer to the Faculty Mentoring Problem? A Successful Program at a Large Academic Department of Medicine.

PubMed

Pololi, Linda H; Evans, Arthur T

2015-01-01

To address a dearth of mentoring and to avoid the pitfalls of dyadic mentoring, the authors implemented and evaluated a novel collaborative group peer mentoring program in a large academic department of medicine. The mentoring program aimed to facilitate faculty in their career planning, and targeted either early-career or midcareer faculty in 5 cohorts over 4 years, from 2010 to 2014. Each cohort of 9-12 faculty participated in a yearlong program with foundations in adult learning, relationship formation, mindfulness, and culture change. Participants convened for an entire day, once a month. Sessions incorporated facilitated stepwise and values-based career planning, skill development, and reflective practice. Early-career faculty participated in an integrated writing program and midcareer faculty in leadership development. Overall attendance of the 51 participants was 96%, and only 3 of 51 faculty who completed the program left the medical school during the 4 years. All faculty completed a written detailed structured academic development plan. Participants experienced an enhanced, inclusive, and appreciative culture; clarified their own career goals, values, strengths and priorities; enhanced their enthusiasm for collaboration; and developed skills. The program results highlight the need for faculty to personally experience the power of forming deep relationships with their peers for fostering successful career development and vitality. The outcomes of faculty humanity, vitality, professionalism, relationships, appreciation of diversity, and creativity are essential to the multiple missions of academic medicine. © 2015 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

Implementing Laboratory Quality Management Systems in Mozambique: The Becton Dickinson-US President's Emergency Plan for AIDS Relief Public-Private Partnership Initiative.

PubMed

Skaggs, Beth; Pinto, Isabel; Masamha, Jessina; Turgeon, David; Gudo, Eduardo Samo

2016-04-15

Mozambique's ministry of health (MOH) recognized the need to establish a national laboratory quality assurance (NLQA) program to improve the reliability and accuracy of laboratory testing. The Becton Dickinson-US President's Emergency Plan for AIDS Relief Public-Private Partnership (PPP) was used to garner MOH commitment and train a cadre of local auditors and managers to support sustainability and country ownership of a NLQA program. From January 2011 to April 2012, the World Health Organization Regional Office for Africa Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist and the Strengthening Laboratory Management Towards Accreditation (SLMTA) curriculum were used in 6 MOH laboratories. PPP volunteers provided training and mentorship to build the capacity of local auditors and program managers to promote institutionalization and sustainability of the program within the MOH. SLIPTA was launched in 6 MOH laboratories, and final audits demonstrated improvements across the 13 quality system essentials, compared with baseline. Training and mentorship of MOH staff by PPP volunteers resulted in 18 qualified auditors and 28 managers/quality officers capacitated to manage the improvement process in their laboratories. SLIPTA helps laboratories improve the quality and reliability of their service even in the absence of full accreditation. Local capacity building ensures sustainability by creating country buy-in, reducing costs of audits, and institutionalizing program management. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Quick generation of Raman spectroscopy based in-process glucose control to influence biopharmaceutical protein product quality during mammalian cell culture.

PubMed

Berry, Brandon N; Dobrowsky, Terrence M; Timson, Rebecca C; Kshirsagar, Rashmi; Ryll, Thomas; Wiltberger, Kelly

2016-01-01

Mitigating risks to biotherapeutic protein production processes and products has driven the development of targeted process analytical technology (PAT); however implementing PAT during development without significantly increasing program timelines can be difficult. The development of a monoclonal antibody expressed in a Chinese hamster ovary (CHO) cell line via fed-batch processing presented an opportunity to demonstrate capabilities of altering percent glycated protein product. Glycation is caused by pseudo-first order, non-enzymatic reaction of a reducing sugar with an amino group. Glucose is the highest concentration reducing sugar in the chemically defined media (CDM), thus a strategy controlling glucose in the production bioreactor was developed utilizing Raman spectroscopy for feedback control. Raman regions for glucose were determined by spiking studies in water and CDM. Calibration spectra were collected during 8 bench scale batches designed to capture a wide glucose concentration space. Finally, a PLS model capable of translating Raman spectra to glucose concentration was built using the calibration spectra and spiking study regions. Bolus feeding in mammalian cell culture results in wide glucose concentration ranges. Here we describe the development of process automation enabling glucose setpoint control. Glucose-free nutrient feed was fed daily, however glucose stock solution was fed as needed according to online Raman measurements. Two feedback control conditions were executed where glucose was controlled at constant low concentration or decreased stepwise throughout. Glycation was reduced from ∼9% to 4% using a low target concentration but was not reduced in the stepwise condition as compared to the historical bolus glucose feeding regimen. © 2015 American Institute of Chemical Engineers.

[On the way to becoming an MD (Dr. med.): What kind of support do doctoral students need? Part 1: Survey and development of a program].

PubMed

Sennekamp, Monika; Paulitsch, Michael A; Broermann, Marischa; Klingebiel, Thomas; Gerlach, Ferdinand M

2016-01-01

In Germany, medical doctorates are regularly criticized for their insufficient quality. In order to improve the quality of doctorates and to support doctoral candidates, a department-wide doctoral research program was established at the Goethe University of Frankfurt am Main in 2011 taking into account the practical needs of doctoral students at the School of Medicine. The program development proceeded in several steps: in the first step (2009/2010), a pilot study with eleven doctoral candidates was carried out at the Institute of General Practice. Their ratings of the perceived relevance and their own knowledge of 15 topics of scientific work were used to identify a provisional need for support. Subsequently an interdisciplinary panel of experts established the program throughout the faculty. Since its implementation, a requirements analysis in the form of questionnaires has been continuously carried out in order to assess the doctoral students' prior knowledge and their preferences expressed. At the same time, systematic searches for support programs in other medical fields have been conducted throughout Germany on several occasions. On the basis of the pilot study, the research results and the expert panel discussions the following topics were found to be particularly relevant: principles of good scientific practice, literature search, reference management, organization and structure of a doctoral thesis, formatting of Word documents, clinical epidemiology and data management. A specific, stepwise development process was used to design a concept for the faculty of medicine that pays close attention to the knowledge and interests of doctoral candidates. The establishment of the doctoral research program in Frankfurt and the results of its evaluation are presented in a second article (Paulitsch et al., 2016). Copyright © 2016. Published by Elsevier GmbH.

Variation in Environmentalism among University Students: Majoring in Outdoor Recreation, Parks, and Tourism Predicts Environmental Concerns and Behaviors

ERIC Educational Resources Information Center

Arnocky, Steven; Stroink, Mirella L.

2011-01-01

In a survey of Canadian university students (N = 205), the relationship between majoring in an outdoor recreation university program and environmental concern, cooperation, and behavior were examined. Stepwise linear regression indicated that enrollment in outdoor recreation was predictive of environmental behavior and ecological cooperation; and…

Improvements of the Eastward Propagation of the MJO in MIROC6

NASA Astrophysics Data System (ADS)

Hirota, N.; Ogura, T.; Shiogama, H.; Kimoto, M.; Watanabe, M.; Tatebe, H.

2016-12-01

A new version of the atmosphere-ocean general circulation model cooperatively produced by the Japanese research community, known as the Model for Interdisciplinary Research on Climate (MIROC6), has recently been developed. Many aspects of the Madden Julian Oscillation (MJO) simulations are improved compared with its previous version MIROC5. For example, MJO amplitudes underestimated in MIROC5 are enhanced; the MJO convective envelopes over the Indian Ocean, which often decays too early around the Maritime Continent in MIROC5, propagate farther to the Central Pacific; the vertical structure of the MJO related humidity shows more realistic stepwise moistening associated with the transition from shallow convection to deep convection. Our preliminary analyses indicate that these improvements are associated with a newly implemented shallow convection scheme. The shallow convection in MIROC6 transports the boundary layer moisture to the lower free troposphere, mitigating dry biases around 800hPa over the Western Pacific. MIROC6 also shows improvements in climatological mean precipitation. The coupling strength between convection and the free tropospheric humidity, that are consider to have large impacts on the reproducibility of the MJO and the mean states, will also be discussed. Acknowledgment: This work was supported by the Program for Risk Information on Climate Change (SOUSEI program) of the Ministry of Education, Culture, Sports, Science and Technology (MEXT), Japan.

ASEAN GMP and pharmaceutical industries in Indonesia.

PubMed

Soesilo, S; Sitorus, U

1995-01-01

Indonesia was appointed by the ASEAN Technical Cooperation in Pharmaceutical as a focal point and to coordinate the development of practical guidelines for the implementation of GMP. The ASEAN GMP Guidelines were endorsed by the ASEAN Technical Cooperation in Pharmaceutical in 1988, which among others required separation of Beta-Lactam dedicated facilities and three degrees of cleanliness for production areas. As it was realised that drug manufacturers in developing countries need more detailed guidelines to be able to implement the GMP, an Operational Manual for GMP was also prepared for providing examples of SOPs lay-outs, documentation etc. It was agreed by the technical cooperation group to leave the implementation of GMP to each member country. However, the ASEAN Manual for Inspection of GMP was drafted and endorsed by the group and training of ASEAN Drug Inspectors was organized to support the implementation. The ASEAN GMP is being implemented in Indonesia through a five-year, stepwise implementation plan, starting in 1989.

Integrative Bayesian variable selection with gene-based informative priors for genome-wide association studies.

PubMed

Zhang, Xiaoshuai; Xue, Fuzhong; Liu, Hong; Zhu, Dianwen; Peng, Bin; Wiemels, Joseph L; Yang, Xiaowei

2014-12-10

Genome-wide Association Studies (GWAS) are typically designed to identify phenotype-associated single nucleotide polymorphisms (SNPs) individually using univariate analysis methods. Though providing valuable insights into genetic risks of common diseases, the genetic variants identified by GWAS generally account for only a small proportion of the total heritability for complex diseases. To solve this "missing heritability" problem, we implemented a strategy called integrative Bayesian Variable Selection (iBVS), which is based on a hierarchical model that incorporates an informative prior by considering the gene interrelationship as a network. It was applied here to both simulated and real data sets. Simulation studies indicated that the iBVS method was advantageous in its performance with highest AUC in both variable selection and outcome prediction, when compared to Stepwise and LASSO based strategies. In an analysis of a leprosy case-control study, iBVS selected 94 SNPs as predictors, while LASSO selected 100 SNPs. The Stepwise regression yielded a more parsimonious model with only 3 SNPs. The prediction results demonstrated that the iBVS method had comparable performance with that of LASSO, but better than Stepwise strategies. The proposed iBVS strategy is a novel and valid method for Genome-wide Association Studies, with the additional advantage in that it produces more interpretable posterior probabilities for each variable unlike LASSO and other penalized regression methods.

Integrated healthy workplace model: An experience from North Indian industry

PubMed Central

Thakur, Jarnail Singh; Bains, Puneet; Kar, Sitanshu Sekhar; Wadhwa, Sanjay; Moirangthem, Prabha; Kumar, Rajesh; Wadwalker, Sanjay; Sharma, Yashpal

2012-01-01

Background: Keeping in view of rapid industrialization and growing Indian economy, there has been a substantial increase in the workforce in India. Currently there is no organized workplace model for promoting health of industrial workers in India. Objective: To develop and implement a healthy workplace model in three industrial settings of North India. Materials and Methods: An operations research was conducted for 12 months in purposively selected three industries of Chandigarh. In phase I, a multi-stakeholder workshop was conducted to finalize the components and tools for the healthy workplace model. NCD risk factors were assessed in 947 employees in these three industries. In phase II, the healthy workplace model was implemented on pilot basis for a period of 12 months in these three industries to finalize the model. Findings: Healthy workplace committee with involvement of representatives of management, labor union and research organization was formed in three industries. Various tools like comprehensive and rapid healthy workplace assessment forms, NCD work-lite format for risk factors surveillance and monitoring and evaluation format were developed. The prevalence of tobacco use, ever alcoholics was found to be 17.8% and 47%, respectively. Around one-third (28%) of employees complained of back pain in the past 12 months. Healthy workplace model with focus on three key components (physical environment, psychosocial work environment, and promoting healthy habits) was developed, implemented on pilot basis, and finalized based on experience in participating industries. A stepwise approach for model with a core, expanded, and optional components were also suggested. An accreditation system is also required for promoting healthy workplace program. Conclusion: Integrated healthy workplace model is feasible, could be implemented in industrial setting in northern India and needs to be pilot tested in other parts of the country. PMID:23776318

Plagiarism, Cheating and Research Integrity: Case Studies from a Masters Program in Peru

PubMed Central

Carnero, Andres M.; Mayta-Tristan, Percy; Konda, Kelika A.; Mezones-Holguin, Edward; Bernabe-Ortiz, Antonio; Alvarado, German F.; Canelo-Aybar, Carlos; Maguiña, Jorge L.; Segura, Eddy R.; Quispe, Antonio M.; Smith, Edward S.; Bayer, Angela M.; Lescano, Andres G.

2017-01-01

Plagiarism is a serious, yet widespread type of research misconduct, and is often neglected in developing countries. Despite its far-reaching implications, plagiarism is poorly acknowledged and discussed in the academic setting, and insufficient evidence exists in Latin America and developing countries to inform the development of preventive strategies. In this context, we present a longitudinal case study of seven instances of plagiarism and cheating arising in four consecutive classes (2011–2014) of an Epidemiology Masters program in Lima, Peru, and describes the implementation and outcomes of a multifaceted, “zero-tolerance” policy aimed at introducing research integrity. Two cases involved cheating in graded assignments, and five cases correspond to plagiarism in the thesis protocol. Cases revealed poor awareness of high tolerance to plagiarism, poor academic performance, and widespread writing deficiencies, compensated with patchwriting and copy-pasting. Depending on the events’ severity, penalties included course failure (6/7) and separation from the program (3/7). Students at fault did not engage in further plagiarism. Between 2011 and 2013, the Masters program sequentially introduced a preventive policy consisting of: (i) intensified research integrity and scientific writing education, (ii) a stepwise, cumulative writing process; (iii) honor codes; (iv) active search for plagiarism in all academic products; and (v) a “zero-tolerance” policy in response to documented cases. No cases were detected in 2014. In conclusion, plagiarism seems to be widespread in resource-limited settings and a greater response with educational and zero-tolerance components is needed to prevent it. PMID:27848191

Asynchronous Knowledge Sharing and Conversation Interaction Impact on Grade in an Online Business Course

ERIC Educational Resources Information Center

Strang, Kenneth David

2011-01-01

Student knowledge sharing and conversation theory interactions were coded from asynchronous discussion forums to measure the effect of learning-oriented utterances on academic performance. The sample was 3 terms of an online business course (in an accredited MBA program) at a U.S.-based university. Correlation, stepwise regression, and multiple…

[Use of hypnosis in the treatment of combat post traumatic stress disorder (PTSD)].

PubMed

Abramowitz, Eitan G; Bonne, Omer

2013-08-01

Clinical reports and observations going back almost two centuries consistently indicate that hypnotherapy is an effective modality for the treatment of post traumatic stress disorder (PTSD). Pierre Janet was the first clinician to describe the successful initiation of stepwise hypnotic techniques in PTSD symptom reduction. Hypnotherapy may accelerate the formation of a therapeutic alliance and contribute to a positive treatment outcome. Hypnotic techniques may be valuable for patients with PTSD who exhibit symptoms such as anxiety, dissociation, widespread somatoform pain complaints and sleep disturbances. Hypnotic techniques may also facilitate the arduous tasks of working through traumatic memories, increasing coping skills, and promoting a sense of competency. In this review we will present guidelines for the stepwise implementation of hypnotherapy in PTSD. Since most data regarding the use of hypnotherapy in PTSD has been gathered from uncontrolled clinical observations, methodologically sound research demonstrating the efficacy of hypnotic techniques in PTSD is required for hypnotherapy to be officially added to the therapeutic armamentarium for this disorder.

The World Health Organization STEPwise Approach to Noncommunicable Disease Risk-Factor Surveillance: Methods, Challenges, and Opportunities

PubMed Central

Guthold, Regina; Cowan, Melanie; Savin, Stefan; Bhatti, Lubna; Armstrong, Timothy; Bonita, Ruth

2016-01-01

Objectives. We sought to outline the framework and methods used by the World Health Organization (WHO) STEPwise approach to noncommunicable disease (NCD) surveillance (STEPS), describe the development and current status, and discuss strengths, limitations, and future directions of STEPS surveillance. Methods. STEPS is a WHO-developed, standardized but flexible framework for countries to monitor the main NCD risk factors through questionnaire assessment and physical and biochemical measurements. It is coordinated by national authorities of the implementing country. The STEPS surveys are generally household-based and interviewer-administered, with scientifically selected samples of around 5000 participants. Results. To date, 122 countries across all 6 WHO regions have completed data collection for STEPS or STEPS-aligned surveys. Conclusions. STEPS data are being used to inform NCD policies and track risk-factor trends. Future priorities include strengthening these linkages from data to action on NCDs at the country level, and continuing to develop STEPS’ capacities to enable a regular and continuous cycle of risk-factor surveillance worldwide. PMID:26696288

The World Health Organization STEPwise Approach to Noncommunicable Disease Risk-Factor Surveillance: Methods, Challenges, and Opportunities.

PubMed

Riley, Leanne; Guthold, Regina; Cowan, Melanie; Savin, Stefan; Bhatti, Lubna; Armstrong, Timothy; Bonita, Ruth

2016-01-01

We sought to outline the framework and methods used by the World Health Organization (WHO) STEPwise approach to noncommunicable disease (NCD) surveillance (STEPS), describe the development and current status, and discuss strengths, limitations, and future directions of STEPS surveillance. STEPS is a WHO-developed, standardized but flexible framework for countries to monitor the main NCD risk factors through questionnaire assessment and physical and biochemical measurements. It is coordinated by national authorities of the implementing country. The STEPS surveys are generally household-based and interviewer-administered, with scientifically selected samples of around 5000 participants. To date, 122 countries across all 6 WHO regions have completed data collection for STEPS or STEPS-aligned surveys. STEPS data are being used to inform NCD policies and track risk-factor trends. Future priorities include strengthening these linkages from data to action on NCDs at the country level, and continuing to develop STEPS' capacities to enable a regular and continuous cycle of risk-factor surveillance worldwide.

Patient Stratification Using Electronic Health Records from a Chronic Disease Management Program.

PubMed

Chen, Robert; Sun, Jimeng; Dittus, Robert S; Fabbri, Daniel; Kirby, Jacqueline; Laffer, Cheryl L; McNaughton, Candace D; Malin, Bradley

2016-01-04

The goal of this study is to devise a machine learning framework to assist care coordination programs in prognostic stratification to design and deliver personalized care plans and to allocate financial and medical resources effectively. This study is based on a de-identified cohort of 2,521 hypertension patients from a chronic care coordination program at the Vanderbilt University Medical Center. Patients were modeled as vectors of features derived from electronic health records (EHRs) over a six-year period. We applied a stepwise regression to identify risk factors associated with a decrease in mean arterial pressure of at least 2 mmHg after program enrollment. The resulting features were subsequently validated via a logistic regression classifier. Finally, risk factors were applied to group the patients through model-based clustering. We identified a set of predictive features that consisted of a mix of demographic, medication, and diagnostic concepts. Logistic regression over these features yielded an area under the ROC curve (AUC) of 0.71 (95% CI: [0.67, 0.76]). Based on these features, four clinically meaningful groups are identified through clustering - two of which represented patients with more severe disease profiles, while the remaining represented patients with mild disease profiles. Patients with hypertension can exhibit significant variation in their blood pressure control status and responsiveness to therapy. Yet this work shows that a clustering analysis can generate more homogeneous patient groups, which may aid clinicians in designing and implementing customized care programs. The study shows that predictive modeling and clustering using EHR data can be beneficial for providing a systematic, generalized approach for care providers to tailor their management approach based upon patient-level factors.

Factors associated with poor Hemoglobin A1c control in Patients with Type 2 Diabetes.

PubMed

Alqudah, Salam; Jarab, Anan S; Alefishat, Eman A; Mayyas, Fadia; Khdour, Maher; Pinto, Sharrel

2018-05-10

Background The limited implementation of clinical pharmacy service programs and the lack of studies identifying barriers to achieve blood glucose control have all attributed to the increased proportion of type 2 diabetes patients who have poor glycemic control in Jordan. Objective To explore factors associated with higher HbA1c in patients with type 2 diabetes in Jordan. Method Variables including socio-demographics, disease and treatment factors were collected from171 patients with type2 diabetes at an outpatient diabetes clinic in Amman. Validated questionnaires were used to assess medication adherence, self-care activities, diabetes knowledge and health-related quality of life in addition to data collected from medical records. After the single-predictor analysis, stepwise linear regression was performed to develop a model with variables that best predicted hemoglobin A1c. Results Medication adherence was inversely associated with HbA1c values (β = -0.275; t = 2.666; P < 0.01), indicating better glycemic control. Receiving insulin therapy was also associated with less HbA1c values and better glycemic control (β = - 0.184; t = 2.080; P < 0.05). Patients who had one or more comorbid conditions (β = 0.215; t = 2.264; P < 0.05) and those with longer diabetes duration (β = 0.092; t = 1.339; P < 0.05) were found to have significantly higher HbA1c values. Conclusions Emphasizing medication adherence, particularly for patients with longer duration of diabetes and those with multiple comorbid diseases should be strongly considered in future diabetes management programs implemented to improve glycemic control in patients with type 2 diabetes. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Technical Note: The Modular Earth Submodel System (MESSy) - a new approach towards Earth System Modeling

NASA Astrophysics Data System (ADS)

Jöckel, P.; Sander, R.; Kerkweg, A.; Tost, H.; Lelieveld, J.

2005-02-01

The development of a comprehensive Earth System Model (ESM) to study the interactions between chemical, physical, and biological processes, requires coupling of the different domains (land, ocean, atmosphere, ...). One strategy is to link existing domain-specific models with a universal coupler, i.e. an independent standalone program organizing the communication between other programs. In many cases, however, a much simpler approach is more feasible. We have developed the Modular Earth Submodel System (MESSy). It comprises (1) a modular interface structure to connect to a , (2) an extendable set of such for miscellaneous processes, and (3) a coding standard. MESSy is therefore not a coupler in the classical sense, but exchanges data between a and several within one comprehensive executable. The internal complexity of the is controllable in a transparent and user friendly way. This provides remarkable new possibilities to study feedback mechanisms (by two-way coupling). Note that the MESSy and the coupler approach can be combined. For instance, an atmospheric model implemented according to the MESSy standard could easily be coupled to an ocean model by means of an external coupler. The vision is to ultimately form a comprehensive ESM which includes a large set of submodels, and a base model which contains only a central clock and runtime control. This can be reached stepwise, since each process can be included independently. Starting from an existing model, process submodels can be reimplemented according to the MESSy standard. This procedure guarantees the availability of a state-of-the-art model for scientific applications at any time of the development. In principle, MESSy can be implemented into any kind of model, either global or regional. So far, the MESSy concept has been applied to the general circulation model ECHAM5 and a number of process boxmodels.

Road-map to plan and structure the preliminary site investigation program for a geological repository in Japan

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

Deguchi, Akira; Tsuchi, Hiroyuki; Kitayama, Kazumi

2007-07-01

Available in abstract form only. Full text of publication follows: A stepwise site selection process has been adopted for geological disposal of HLW in Japan. Literature surveys (LS), followed by preliminary investigations (PI) and, finally, detailed investigations (DI) in underground facilities will be carried out in the successive selection stages. In the PI stage, surface-based investigations such as borehole surveys and geophysical prospecting will be implemented with two main objectives. The first is to obtain information relating to legal requirements on siting, such as the occurrence of igneous or fault activity, and to confirm the extremely low likelihood of adversemore » impacts on the candidate site resulting from such phenomena. The second is to obtain the information required for the design and performance assessment of the engineered barrier system and the repository. In order to implement these preliminary investigations rigorously and efficiently within the constraints of a limited time period, budget and resources, PI planning before commencing investigations and on-site PI management during the investigation phase are very important issues. The planning and management of PI have to be performed by NUMO staff, but not all staff have sufficient experience in the range of disciplines involved. NUMO therefore decided to compile existing knowledge and experience in the planning and management of investigations in the form of manuals to be used to improve and maintain internal expertise. Experts with experience in overseas investigation programs were requested to prepare these manuals. This paper outlines the structure and scope of the upper level manual (road-map) and discusses NUMO's experience in applying it in 'dry-runs' to model sites. (authors)« less

Development, validation and operating room-transfer of a six-step laparoscopic training program for the vesicourethral anastomosis.

PubMed

Klein, Jan; Teber, Dogu; Frede, Tom; Stock, Christian; Hruza, Marcel; Gözen, Ali; Seemann, Othmar; Schulze, Michael; Rassweiler, Jens

2013-03-01

Development and full validation of a laparoscopic training program for stepwise learning of a reproducible application of a standardized laparoscopic anastomosis technique and integration into the clinical course. The training of vesicourethral anastomosis (VUA) was divided into six simple standardized steps. To fix the objective criteria, four experienced surgeons performed the stepwise training protocol. Thirty-eight participants with no previous laparoscopic experience were investigated in their training performance. The times needed to manage each training step and the total training time were recorded. The integration into the clinical course was investigated. The training results and the corresponding steps during laparoscopic radical prostatectomy (LRP) were analyzed. Data analysis of corresponding operating room (OR) sections of 793 LRP was performed. Based on the validity, criteria were determined. In the laboratory section, a significant reduction of OR time for every step was seen in all participants. Coordination: 62%; longitudinal incision: 52%; inverted U-shape incision: 43%; plexus: 47%. Anastomosis catheter model: 38%. VUA: 38%. The laboratory section required a total time of 29 hours (minimum: 16 hours; maximum: 42 hours). All participants had shorter execution times in the laboratory than under real conditions. The best match was found within the VUA model. To perform an anastomosis under real conditions, 25% more time was needed. By using the training protocol, the performance of the VUA is comparable to that of an surgeon with experience of about 50 laparoscopic VUA. Data analysis proved content, construct, and prognostic validity. The use of stepwise training approaches enables a surgeon to learn and reproduce complex reconstructive surgical tasks: eg, the VUA in a safe environment. The validity of the designed system is given at all levels and should be used as a standard in the clinical surgical training in laparoscopic reconstructive urology.

Combined use of fasting plasma glucose and glycated hemoglobin A1c in a stepwise fashion to detect undiagnosed diabetes mellitus.

PubMed

Nakagami, Tomoko; Tominaga, Makoto; Nishimura, Rimei; Daimon, Makoto; Oizumi, Toshihide; Yoshiike, Nobuo; Tajima, Naoko

2007-09-01

Type 2 diabetes mellitus (DM) is a common and serious condition related with considerable morbidity. Screening for DM is one strategy for reducing this burden. In Japan National Diabetes Screening Program (JNDSP) guideline, the combined use of fasting plasma glucose (FPG) and glycated hemoglobin A1c (HbA1c) in a stepwise fashion has been recommended to identify the group of people needing life-style counseling or medical care. However, the efficacy of this program has not been fully evaluated, as an oral glucose tolerance test (OGTT) is not mandatory in the guideline. The aim of this study was to assess the validity of the screening test scenario, in which an OGTT would be applied to people needing life-style counseling or medical care on this guideline: FPG 110-125 mg/dl and HbA1c over 5.5%. Subjects were 1,726 inhabitants without a previous history of DM in the Funagata study, which is a population-based survey conducted in Yamagata prefecture to clarify the risk factors, related conditions, and consequences of DM. DM was diagnosed according to the 1999 World Health Organization criteria. The prevalence of undiagnosed DM was 6.6%. The tested screening scenario gave a sensitivity of 55.3%, a specificity of 98.4%, a positive predictive value of 70.8%, and a negative predictive value of 96.9% for undiagnosed DM. In conclusion, the screening test scenario, in which an OGTT would be followed by the combined use of FPG and HbA1c in a stepwise fashion according to the JNDSP guideline, was not effective in identifying people with undiagnosed DM.

Becoming a health literate organization: Formative research results from healthcare organizations providing care for undeserved communities.

PubMed

Adsul, Prajakta; Wray, Ricardo; Gautam, Kanak; Jupka, Keri; Weaver, Nancy; Wilson, Kristin

2017-11-01

Background Integrating health literacy into primary care institutional policy and practice is critical to effective, patient centered health care. While attributes of health literate organizations have been proposed, approaches for strengthening them in healthcare systems with limited resources have not been fully detailed. Methods We conducted key informant interviews with individuals from 11 low resourced health care organizations serving uninsured, underinsured, and government-insured patients across Missouri. The qualitative inquiry explored concepts of impetus to transform, leadership commitment, engaging staff, alignment to organization wide goals, and integration of health literacy with current practices. Findings Several health care organizations reported carrying out health literacy related activities including implementing patient portals, selecting easy to read patient materials, offering community education and outreach programs, and improving discharge and medication distribution processes. The need for change presented itself through data or anecdotal staff experience. For any change to be undertaken, administrators and medical directors had to be supportive; most often a champion facilitated these changes in the organization. Staff and providers were often resistant to change and worried they would be saddled with additional work. Lack of time and funding were the most common barriers reported for integration and sustainability. To overcome these barriers, managers supported changes by working one on one with staff, seeking external funding, utilizing existing resources, planning for stepwise implementation, including members from all staff levels and clear communication. Conclusion Even though barriers exist, resource scarce clinical settings can successfully plan, implement, and sustain organizational changes to support health literacy.

A novel minimum cost maximum power algorithm for future smart home energy management.

PubMed

Singaravelan, A; Kowsalya, M

2017-11-01

With the latest development of smart grid technology, the energy management system can be efficiently implemented at consumer premises. In this paper, an energy management system with wireless communication and smart meter are designed for scheduling the electric home appliances efficiently with an aim of reducing the cost and peak demand. For an efficient scheduling scheme, the appliances are classified into two types: uninterruptible and interruptible appliances. The problem formulation was constructed based on the practical constraints that make the proposed algorithm cope up with the real-time situation. The formulated problem was identified as Mixed Integer Linear Programming (MILP) problem, so this problem was solved by a step-wise approach. This paper proposes a novel Minimum Cost Maximum Power (MCMP) algorithm to solve the formulated problem. The proposed algorithm was simulated with input data available in the existing method. For validating the proposed MCMP algorithm, results were compared with the existing method. The compared results prove that the proposed algorithm efficiently reduces the consumer electricity consumption cost and peak demand to optimum level with 100% task completion without sacrificing the consumer comfort.

Medication safety and knowledge-based functions: a stepwise approach against information overload.

PubMed

Patapovas, Andrius; Dormann, Harald; Sedlmayr, Brita; Kirchner, Melanie; Sonst, Anja; Müller, Fabian; Pfistermeister, Barbara; Plank-Kiegele, Bettina; Vogler, Renate; Maas, Renke; Criegee-Rieck, Manfred; Prokosch, Hans-Ulrich; Bürkle, Thomas

2013-09-01

The aim was to improve medication safety in an emergency department (ED) by enhancing the integration and presentation of safety information for drug therapy. Based on an evaluation of safety of drug therapy issues in the ED and a review of computer-assisted intervention technologies we redesigned an electronic case sheet and implemented computer-assisted interventions into the routine work flow. We devised a four step system of alerts, and facilitated access to different levels of drug information. System use was analyzed over a period of 6 months. In addition, physicians answered a survey based on the technology acceptance model TAM2. The new application was implemented in an informal manner to avoid work flow disruption. Log files demonstrated that step I, 'valid indication' was utilized for 3% of the recorded drugs and step II 'tooltip for well-known drug risks' for 48% of the drugs. In the questionnaire, the computer-assisted interventions were rated better than previous paper based measures (checklists, posters) with regard to usefulness, support of work and information quality. A stepwise assisting intervention received positive user acceptance. Some intervention steps have been seldom used, others quite often. We think that we were able to avoid over-alerting and work flow intrusion in a critical ED environment. © 2013 The Authors. British Journal of Clinical Pharmacology © 2013 The British Pharmacological Society.

Development of a System-Wide Predator Control Program: Stepwise Implementation of a Predation Index, Predator Control Fisheries, and Evaluation Plan in the Columbia River Basin; Northern Pikeminnow Management Program, 2000 Annual Report.

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

Porter, Russell G.; Glaser, Bryce G.; Amren, Jennifer

2003-03-01

This report presents results for year ten in a basin-wide program to harvest northern pikeminnow (Ptychocheilus oregonensis). This program was started in an effort to reduce predation by northern pikeminnow on juvenile salmonids during their emigration from natal streams to the ocean. Earlier work in the Columbia River Basin suggested predation by northern pikeminnow on juvenile salmonids might account for most of the 10-20% mortality juvenile salmonids experience in each of eight Columbia River and Snake River reservoirs. Modeling simulations based on work in John Day Reservoir from 1982 through 1988 indicated that, if predator-size northern pikeminnow were exploited atmore » a 10-20% rate, the resulting restructuring of their population could reduce their predation on juvenile salmonids by 50%. To test this hypothesis, we implemented a sport-reward angling fishery and a commercial longline fishery in the John Day Pool in 1990. We also conducted an angling fishery in areas inaccessible to the public at four dams on the mainstem Columbia River and at Ice Harbor Dam on the Snake River. Based on the success of these limited efforts, we implemented three test fisheries on a system-wide scale in 1991--a tribal longline fishery above Bonneville Dam, a sport-reward fishery, and a dam-angling fishery. Low catch of target fish and high cost of implementation resulted in discontinuation of the tribal longline fishery. However, the sport-reward and dam-angling fisheries were continued in 1992 and 1993. In 1992, we investigated the feasibility of implementing a commercial longline fishery in the Columbia River below Bonneville Dam and found that implementation of this fishery was also infeasible. Estimates of combined annual exploitation rates resulting from the sport-reward and damangling fisheries remained at the low end of our target range of 10-20%. This suggested the need for additional effective harvest techniques. During 1991 and 1992, we developed and tested a modified (small-sized) Merwin trapnet. We found this floating trapnet to be very effective in catching northern pikeminnow at specific sites. Consequently, in 1993 we examined a system wide fishery using floating trapnets, but found this fishery to be ineffective at harvesting large numbers of northern pikeminnow on a system-wide scale. In 1994, we investigated the use of trapnets and gillnets at specific locations where concentrations of northern pikeminnow were known or suspected to occur during the spring season (i.e., March through early June). In addition, we initiated a concerted effort to increase public participation in the sport-reward fishery through a series of promotional and incentive activities. In 1995, 1996, and 1997, promotional activities and incentives were further improved based on the favorable response in 1994. Results of these efforts are subjects of this annual report under Section I, Implementation. Evaluation of the success of test fisheries in achieving our target goal of a 10-20% annual exploitation rate on northern pikeminnow is presented in Section II of this report. Overall program success in terms of altering the size and age composition of the northern pikeminnow population and in terms of potential reductions in loss of juvenile salmonids to northern pikeminnow predation is also discussed under Section II.« less

Stepwise pumping approach to improve free phase light hydrocarbon recovery from unconfined aquifers

NASA Astrophysics Data System (ADS)

Cooper, Grant S.; Peralta, Richard C.; Kaluarachchi, Jagath J.

1995-04-01

A stepwise, time-varying pumping approach is developed to improve free phase oil recovery of light non-aqueous phase liquids (LNAPL) from a homogeneous, unconfined aquifer. Stepwise pumping is used to contain the floating oil plume and obtain efficient free oil recovery. The graphical plots. The approach uses ARMOS ©, an areal two-dimensional multiphase flow, finite-element simulation model. Systematic simulations of free oil area changes to pumping rates are analyzed. Pumping rates are determined that achieve LNAPL plume containment at different times (i.e. 90, 180 and 360 days) for a planning period of 360 days. These pumping rates are used in reverse order as a stepwise (monotonically increasing) pumping strategy. This stepwise pumping strategy is analyzed further by performing additional simulations at different pumping rates for the last pumping period. The final stepwise pumping strategy is varied by factors of -25% and +30% to evaluate sensitivity in the free oil recovery process. Stepwise pumping is compared to steady pumping rates to determine the best free oil recovery strategy. Stepwise pumping is shown to improve oil recovery by increasing recoveredoil volume (11%) and decreasing residual oil (15%) when compared with traditional steady pumping strategies. The best stepwise pumping strategy recovers more free oil by reducing the amount of residual oil left in the system due to pumping drawdown. This stepwise pumping pproach can be used to enhance free oil recovery and provide for cost-effective design and management of LNAPL cleanup.

[Psychosocial Risk Evaluation in the Workplace: Expert-based Development of a Checklist for Occupational Physicians].

PubMed

Weigl, M; Müller, A; Angerer, P; Petru, R

2016-03-01

The implementation of psychosocial risk assessment at the workplace often fails in practice. One reason is the lack of competence of those who are in charge of the process. We present a checklist for the effective implementation of psychosocial risk assessment at workplace. This tool shall support occupational physicians in the preparation, planning and implementation of a psychosocial risks assessment process. Based on a stepwise development and validation process, specific steps and factors for the successful implementation were identified qualitatively with 15 occupational physicians and experts. This was conducted in a 2-stage Delphi study. In the following, the identified steps and factors were transferred into a checklist. Subsequently, the checklist was evaluated in a focus group of occupational physicians (user evaluation). Thereafter, the contents were subjected to an expert evaluation. Our checklist for the effective implementation of the process of psychosocial risk management in the workplace aims to strengthen the competence of occupational physicians, especially in the implementation of risk assessments in small and medium-sized enterprises (SMEs). © Georg Thieme Verlag KG Stuttgart · New York.

Concurrent Validity of Hill's Educational Cognitive Style Model as a Prototype for Successful Academic Programs Among Lower-Class Students.

ERIC Educational Resources Information Center

London, David T.

Data from the stepwise multiple regression of four educational cognitive style predictor sets on each of six academic competence criteria were used to define the concurrent validity of Hill's educational cognitive style model. The purpose was to determine how appropriate it may be to use this model as a prototype for successful academic programs…

A Proficiency Based Stepwise Endovascular Curricular Training (PROSPECT) Program Enhances Operative Performance in Real Life: A Randomised Controlled Trial.

PubMed

Maertens, H; Aggarwal, R; Moreels, N; Vermassen, F; Van Herzeele, I

2017-09-01

Healthcare evolution requires optimisation of surgical training to provide safe patient care. Operating room performance after completion of proficiency based training in vascular surgery has not been investigated. A randomised controlled trial evaluated the impact of a Proficiency based Stepwise Endovascular Curricular Training program (PROSPECT) on the acquisition of endovascular skills and the transferability of these skills to real life interventions. All subjects performed two endovascular interventions treating patients with symptomatic iliac and/or superficial femoral artery stenosis under supervision. Primary outcomes were technical performances (Global Rating Scale [GRS]; Examiner Checklist), operative metrics, and patient outcomes, adjusted for case difficulty and trainee experience. Secondary outcomes included knowledge and technical performance after 6 weeks and 3 months. Thirty-two general surgical trainees were randomised into three groups. Besides traditional training, the first group (n = 11) received e-learning and simulation training (PROSPECT), the second group (n = 10) only had access to e-learning, while controls (n = 11) did not receive supplementary training. Twenty-nine trainees (3 dropouts) performed 58 procedures. Trainees who completed PROSPECT showed superior technical performance (GRS 39.36 ± 2.05; Checklist 63.51 ± 3.18) in real life with significantly fewer supervisor takeovers compared with trainees receiving e-learning alone (GRS 28.42 ± 2.15; p = .001; Checklist 53.63 ± 3.34; p = .027) or traditional education (GRS 23.09 ± 2.18; p = .001; Checklist 38.72 ± 3.38; p = .001). Supervisors felt more confident in allowing PROSPECT trained physicians to perform basic (p = .006) and complex (p = .003) procedures. No differences were detected in procedural parameters (such as fluoroscopy time, DAP, procedure time, etc.) or complications. Proficiency levels were maintained up to 3 months. A structured, stepwise, proficiency based endovascular curriculum including e-learning and simulation based training should be integrated early into training programs to enhance trainee performance. Copyright © 2017. Published by Elsevier Ltd.

Beyond signal functions in global obstetric care: Using a clinical cascade to measure emergency obstetric readiness

PubMed Central

Dettinger, Julia; Calkins, Kimberly; Kibore, Minnie; Gachuno, Onesmus; Walker, Dilys

2018-01-01

Background Globally, the rate of reduction in delivery-associated maternal and perinatal mortality has been slow compared to improvements in post-delivery mortality in children under five. Improving clinical readiness for basic obstetric emergencies is crucial for reducing facility-based maternal deaths. Emergency readiness is commonly assessed using tracers derived from the maternal signal functions model. Objective-method We compare emergency readiness using the signal functions model and a novel clinical cascade. The cascades model readiness as the proportion of facilities with resources to identify the emergency (stage 1), treat it (stage 2) and monitor-modify therapy (stage 3). Data were collected from 44 Kenyan clinics as part of an implementation trial. Findings Although most facilities (77.0%) stock maternal signal function tracer drugs, far fewer have resources to practically identify and treat emergencies. In hypertensive emergencies for example, 38.6% of facilities have resources to identify the emergency (Stage 1 readiness, including sphygmomanometer, stethoscope, urine collection device, protein test). 6.8% have the resources to treat the emergency (Stage 2, consumables (IV Kit, fluids), durable goods (IV pole) and drugs (magnesium sulfate and hydralazine). No facilities could monitor or modify therapy (Stage 3). Across five maternal emergencies, the signal functions overestimate readiness by 54.5%. A consistent, step-wise pattern of readiness loss across signal functions and care stage emerged and was profoundly consistent at 33.0%. Significance Comparing estimates from the maternal signal functions and cascades illustrates four themes. First, signal functions overestimate practical readiness by 55%. Second, the cascade’s intuitive indicators can support cross-sector health system or program planners to more precisely measure and improve emergency care. Third, adding few variables to existing readiness inventories permits step-wise modeling of readiness loss and can inform more precise interventions. Fourth, the novel aggregate readiness loss indicator provides an innovative and intuitive approach for modeling health system emergency readiness. Additional testing in diverse contexts is warranted. PMID:29474397

Assimilating Traditional Healing Into Preventive Medicine Residency Curriculum.

PubMed

Kesler, Denece O; Hopkins, L Olivia; Torres, Eliseo; Prasad, Arti

2015-11-01

Comprehensive cultural competency includes knowledge and awareness of culturally based healing and wellness practices. Healthcare providers should be aware of the individual patient's beliefs, culture, and use of culturally based health practices because patients may adopt such practices for general wellness or as adjunct therapies without the benefit of discussion with their healthcare provider. This article describes the culturally based traditional healing curriculum that has been implemented in the University of New Mexico Public Health and General Preventive Medicine Residency Program in order to fulfill this knowledge necessity. Curricular elements were added in a stepwise manner starting in 2011, with the full content as described implemented starting in 2013. Data were collected annually with evaluation of the full curriculum occurring in 2015. New Mexico has a diverse population base that includes predominantly Hispanic and Native American cultures, making the inclusion of curriculum regarding traditional healing practices very pertinent. Residents at the University of New Mexico were educated through several curricular components about topics such as Curanderismo, the art of Mexican Folk Healing. An innovative approach was used, with a compendium of training methods that included learning directly from traditional healers and participation in healing practices. The incorporation of this residency curriculum resulted in a means to produce physicians well trained in approaching patient care and population health with knowledge of culturally based health practices in order to facilitate healthy patients and communities. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Innovation in dental education: The "On-the-Fly" approach to simultaneous development, implementation and evidence collection.

PubMed

de Boer, I R; Bakker, D R; Serrano, C M; Koopman, P; Wesselink, P R; Vervoorn, J M

2018-03-01

This study outlines an approach for education innovation and addresses the ambivalence between evidence-based and non-evidence-based conditions. The "on-the-fly" approach was described as involving implementation during the development of an innovation for dental education. The process of designing and implementing cutting-edge technology of the MOOG Simodont Dental Trainer (DT) whilst systematically collecting evidence illustrates the "on-the-fly" approach. Using the "on-the-fly" approach for developing, implementing and collecting evidence simultaneously in an academic environment appears feasible in serving both the professionals, users and developers and system designers. During the implementation of the new technology, growing evidence stepwise strengthened its position; therefore, showing stakeholders that evidence was used to improve the technology seemed to support and increase acceptance of the new technology. When pioneering an innovative technology in a specialty field, the development stage often precedes evidence for its effectiveness. Consciously choosing the "on-the-fly" approach clarifies to stakeholders in advance about the lack of evidence in an innovation and the need of their support to collect such evidence for improvement and in order to facilitate implementation. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Outpost in Jovian system - a stepwise long-term undertaking

NASA Astrophysics Data System (ADS)

Yasaka, Tetsuo

2003-11-01

Space has been attracting human attention since the dawn of our history, and clues thus given have triggered scientific and cultural evolutions. Now the space is in our hands. Near earth space has been developed, providing benefits to daily life. Moon and Mars will become the stage of human activity in a few decades. What will be the next logical step? The next step should be an undertaking that promises substantial influence to human history, both in knowledge and productive activities. Looking into the future directions of technology development combined with their outcome, Kyushu University selected a stepwise long-term undertaking toward establishment of an outpost in the Jovian system. Jupiter is our closest gas planet, which is a replica of the Sun. Its true understanding is essential to our knowledge of the universe. Its satellites abounds versatility providing not only the crucial knowledge of science but energy and materials vital to space activities. Jovian outpost consists of the central station on or around Callisto, controlling several laboratories on other Galilean satellites and dispatching probes to the main planet including Jovian-Crafts to cruise within its atmosphere and Deep Probes to explore the depth of the hydrogen ocean. Utilization of materials especially water on Europa will enable energy management of the stations and probes, and will further provide sound base toward exploration of the outskirts of the solar system and beyond. This understanding needs a long term endeavor that should be handed over many generations. This is a technology development program but education is an essential part of the process. The task is based on a series of short (5 year) targets. Each target provides stepwise solution to the objective, yet provides substantial outputs to the society and industries in a timely manner. The paper describes the overall program and details of the first 5 year targets.

Outpost in Jovian system—a stepwise long-term undertaking

NASA Astrophysics Data System (ADS)

Yasaka, Tetsuo

2006-10-01

Space has been attracting human attention since the dawn of our history, and clues thus given have triggered scientific and cultural evolutions. Now the space is in our hands. Near earth space has been developed, providing benefits to daily life. Moon and Mars will become the stage of human activity in a few decades. What will be the next logical step? The next step should be an undertaking that promises substantial influence to human history, both in knowledge and productive activities. Looking into the future directions of technology development combined with their outcome, Kyushu University selected a stepwise long-term undertaking toward establishment of an outpost in the Jovian system. Jupiter is our closest gas planet, which is a replica of the Sun. Its true understanding is essential to our knowledge of the universe. Its satellites abounds versatility providing not only the crucial knowledge of science but energy and materials vital to space activities. Jovian outpost consists of the central station on or around Callisto, controlling several laboratories on other Galilean satellites and dispatching probes to the main planet including Jovian-Crafts to cruise within its atmosphere and Deep Probes to explore the depth of the hydrogen ocean. Utilization of materials especially water on Europa will enable energy management of the stations and probes, and will further provide sound base toward exploration of the outskirts of the solar system and beyond. This understanding needs a long-term endeavor that should be handed over many generations. This is a technology development program but education is an essential part of the process. The task is based on a series of short (5 year) targets. Each target provides stepwise solution to the objective, yet provides substantial outputs to the society and industries in a timely manner. The paper describes the overall program and details of the first 5 year targets.

Rational Selection, Criticality Assessment, and Tiering of Quality Attributes and Test Methods for Analytical Similarity Evaluation of Biosimilars.

PubMed

Vandekerckhove, Kristof; Seidl, Andreas; Gutka, Hiten; Kumar, Manish; Gratzl, Gyöngyi; Keire, David; Coffey, Todd; Kuehne, Henriette

2018-05-10

Leading regulatory agencies recommend biosimilar assessment to proceed in a stepwise fashion, starting with a detailed analytical comparison of the structural and functional properties of the proposed biosimilar and reference product. The degree of analytical similarity determines the degree of residual uncertainty that must be addressed through downstream in vivo studies. Substantive evidence of similarity from comprehensive analytical testing may justify a targeted clinical development plan, and thus enable a shorter path to licensing. The importance of a careful design of the analytical similarity study program therefore should not be underestimated. Designing a state-of-the-art analytical similarity study meeting current regulatory requirements in regions such as the USA and EU requires a methodical approach, consisting of specific steps that far precede the work on the actual analytical study protocol. This white paper discusses scientific and methodological considerations on the process of attribute and test method selection, criticality assessment, and subsequent assignment of analytical measures to US FDA's three tiers of analytical similarity assessment. Case examples of selection of critical quality attributes and analytical methods for similarity exercises are provided to illustrate the practical implementation of the principles discussed.

[Duration of breastfeeding and its relevant influencing factors on under 2-years-old in rural areas of 10 provinces in China].

PubMed

Wang, Jian-min; Li, Neng; Xie, Sheng-nan; Yang, Sen-bei; Zheng, Xiao-xuan; Zhang, Jing

2013-07-01

To understand the current status and relevant factors influencing the duration of breastfeeding in rural areas in China. Children under two years old were selected as subjects from the study on "Physical growth among the under 7-years-old children from the rural areas of ten provinces in China in 2006". Kaplan-Meier method was used to estimate the survival curves and Cox multivariate stepwise regression was used to identify the relevant factors on the duration of breastfeeding. Median of the duration for breastfeeding was 12 months in rural areas of 10 provinces in China. Results of this study suggested that factors as sex, birth order, areas of residency, nationality, initiation of formula, parents' education levels, maternal services and family income were correlated with the duration of breastfeeding. Duration of breastfeeding among rural children under 2-years of age was short in the 10 provinces of China. Factors as level of education, residential areas and family income of the parents as well as sex of the children were correlated with the duration of breastfeeding. Intervention program should be implemented to improve the current status on breastfeeding.

Functional performance and exercise of older adults in long-term care settings.

PubMed

Resnick, B

2000-03-01

Performing functional activities and exercising are important for older adults living in long-term care settings. Participation in these activities not only improves and maintains function in older adults but also can improve physical and emotional health and quality of life. The purpose of this study was to explore the variables that influence functional performance and exercise activity in a group of nursing home residents. Participants included 59 residents in a long-term care facility. The mean age of participants was 88 +/- 6.9, and the majority were women (76%), White (97%), and unmarried (76%). Residents participated in a single face-to-face interview. Chart reviews for demographic and health information also were performed. Based on stepwise multiple regression analyses, upper and lower extremity contractures and cognitive status were the only variables that significantly influenced functional performance and accounted for 49% of the variance in function. Self-efficacy and outcome expectations were the only variables to significantly influence exercise behavior and accounted for 57% of the variance in this behavior. These findings can be used to help develop and implement effective restorative nursing care programs in long-term care settings.

Better Care Teams: A Stepwise Skill Reinforcement Model.

PubMed

Christopher, Beth-Anne; Grantner, Mary; Coke, Lola A; Wideman, Marilyn; Kwakwa, Francis

2016-06-01

The Building Healthy Urban Communities initiative presents a path for organizations partnering to improve patient outcomes with continuing education (CE) as a key component. Components of the CE initiative included traditional CE delivery formats with an essential element of adaptability and new methods, with rigorous evaluation over time that included evaluation prior to the course, immediately following the CE session, 6 to 8 weeks after the CE session, and then subsequent monthly "testlets." Outcome measures were designed to allow for ongoing adaptation of content, reinforcement of key learning objectives, and use of innovative concordant testing and retrieval practice techniques. The results after 1 year of programming suggest the stepwise skill reinforcement model is effective for learning and is an efficient use of financial and human resources. More important, its design is one that could be adopted at low cost by organizations willing to work in close partnership. J Contin Educ Nurs. 2016;47(6):283-288. Copyright 2016, SLACK Incorporated.

Coping with Academic Stressors: A Pilot Study

DTIC Science & Technology

1976-12-20

Sarason anid James H./Johnso K! N,0𔃺’ -75-90 V 9. PERFORMING ORGANIZATION NAME AND ADDRESS 10. PROGRAM ELEMENT, PROJECT, TASK AREA A WORK UNIT...coping skills in the personnel of functioning organizations , it seemed desirable to approach this task in a stepwise fashion. An impoDrtant first step...research in a complex organization such as a police department. (Research with a police department is currently underway.) Because it was felt

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

Johnson, G.; Thom, R.; Whiting, A.

Habitat restoration in the Columbia River estuary (CRE) is an important off-site mitigation action in the 2000 Biological Opinion (BiOp), an operation of the Federal Columbia River Power System. The CRE, defined as the tidally influenced stretch of river from the mouth to Bonneville Dam 146 miles upstream, is part of the migration pathway for anadromous fish in the Columbia Basin, including salmon listed under the Endangered Species Act (ESA). Salmon in various stages of life, from fry to adults, use tidal channels and wetlands in the CRE to feed, find refuge from predators, and transition physiologically from freshwater tomore » saltwater. Over the last 100 years, however, the area of some wetland habitats has decreased by as much as 70% because of dike and levee building, flow regulation, and other activities. In response to the decline in available habitat, the BiOp's Reasonable and Prudent Alternative (RPA) included mandates to 'develop a plan addressing the habitat needs of juvenile salmon and steelhead in the estuary' (RPA Action 159) and 'develop and implement an estuary restoration program with a goal of protecting and enhancing 10,000 acres of tidal wetlands and other key habitats' (RPA Action 160). To meet Action 159 and support Action 160, this document develops a science-based approach designed to improve ecosystem functions through habitat restoration activities in the CRE. The CRE habitat restoration program's goal and principles focus on habitat restoration projects in an ecosystem context. Since restoration of an entire ecosystem is not generally practical, individual habitat restoration projects have the greatest likelihood of success when they are implemented with an ecosystem perspective. The program's goal is: Implementation of well-coordinated, scientifically sound projects designed to enhance, protect, conserve, restore, and create 10,000 acres of tidal wetlands and other key habitats to aid rebuilding of ESA-listed salmon populations and native species using the CRE. The program's underlying principles are: (1) projects are founded on the best available ecological restoration science, implemented in an ecosystem context, and developed with the intent to restore relevant ecological processes; (2) projects incorporate adaptive management practices with testable hypotheses to track ecological responses to a given restoration effort; and (3) projects are implemented in a coordinated, open process and scientific results from monitoring and evaluation are communicated widely and readily accessible. With this goal and these principles in mind, we developed an approach for CRE habitat restoration. The intent of this document is to provide a scientific basis and implementation guidelines for a habitat restoration program designed to improve ecosystem functions and enhance juvenile salmonid survival in the CRE. The stepwise approach to CRE habitat restoration outlined is somewhat general and broad because the available scientific information is incomplete, e.g., juvenile salmon usage of various CRE wetland habitats. As new data become available, a more specific, detailed plan than was possible here can be produced as an outgrowth of this document. In conclusion, this document provides a scientific basis and implementation guidelines for a habitat restoration program designed to improve ecosystem functions and enhance juvenile salmonid survival in the CRE. As more experience is gained with CRE habitat restoration and scientific uncertainties are resolved, this document should be used as a basis for a detailed habitat restoration plan that specifically addresses (1) which habitat types offer the greatest ecological benefit to salmon, (2) the location of potential sites that if restored would likely provide these habitat types, and (3) how and when the restoration work should be done. This document supports the use of adaptive management so that all elements of salmonid habitat restoration actions in the CRE are under continual evaluation and revision at both the project and program levels. Lessons learned from current and proposed habitat restoration projects need to be applied to all future work, such as the Estuary Partnership's habitat restoration program and the U.S. Army Corps of Engineers General Investigation Study for the CRE, to ensure the most effective use of resources and the best possible long term environment for salmonid growth and survival in the CRE.« less

Step-wise refolding of recombinant proteins.

PubMed

Tsumoto, Kouhei; Arakawa, Tsutomu; Chen, Linda

2010-04-01

Protein refolding is still on trial-and-error basis. Here we describe step-wise dialysis refolding, in which denaturant concentration is altered in step-wise fashion. This technology controls the folding pathway by adjusting the concentrations of the denaturant and other solvent additives to induce sequential folding or disulfide formation.

Developing and marketing a community pharmacy-based asthma management program.

PubMed

Rupp, M T; McCallian, D J; Sheth, K K

1997-01-01

To develop a community pharmacy-based asthma management program and successfully market the program to a managed care organization. Community-based ambulatory care. Independent community pharmacy. Development of a structured, stepwise approach to creating, testing, delivering, and marketing a community pharmacy-based disease management program. Peak expiratory flow rates, quality of life, use of health care services, HMO contract renewal. A pharmacy-based asthma management program was developed, pilot tested, and successfully marketed to a local HMO. During the first full year of the program, HMO patients experienced significant improvements in quality of life and decreases in use of health care services, including a 77% decrease in hospitalization, a 78% decrease in emergency room visits, and a 25% decrease in urgent care visits. A contract that pays the pharmacy a flat fee for each patient admitted to the program has recently been renewed for a third year. The program has proved to be an effective, practical, and profitable addition to the portfolio of services offered by the pharmacy.

Improving quality of care using a diabetes registry and disease management services in an integrated delivery network.

PubMed

Campion, Francis X; Tully, George L; Barrett, Jo-Ann; Andre, Paulo; Sweeney, Ann

2005-08-01

Disease management for chronic conditions is a call for collaboration among all parties of the health care system. The Caritas Christi Health Care System established a unified American Diabetes Association (ADA) recognized outpatient diabetes self-management education program (DSME) in each of its six hospital communities and has established an Internet data portal with managed care organizations to improve preventive care for thousands of patients with diabetes. This article describes the stepwise process of building the successful Caritas Diabetes Care Program and the central role of the Caritas Diabetes Registry over a 5-year period.

Diffusion of an effective tobacco prevention program. Part II: Evaluation of the adoption phase.

PubMed

Parcel, G S; O'Hara-Tompkins, N M; Harrist, R B; Basen-Engquist, K M; McCormick, L K; Gottlieb, N H; Eriksen, M P

1995-09-01

This paper presents the results of theory-based intervention strategies to increase the adoption of a tobacco prevention program. The adoption intervention followed a series of dissemination intervention strategies targeted at 128 school districts in Texas. Informed by Social Cognitive Theory, the intervention provided opportunities for districts to learn about and model themselves after 'successful' school districts that had adopted the program, and to see the potential for social reinforcement through the knowledge that the program had the potential to have an important influence on students' lives. The proportion of districts in the Intervention condition that adopted the program was significantly greater than in the Comparison condition (P < 0.001). Stepwise logistic regression indicated that the variables most closely related to adoption among intervention districts were teacher attitudes toward the innovation and organizational considerations of administrators. Recommendations for the development of effective strategies for the diffusion of innovations are presented.

Impact of the Japanese 5S management method on patients' and caretakers' satisfaction: a quasi-experimental study in Senegal.

PubMed

Kanamori, Shogo; Castro, Marcia C; Sow, Seydou; Matsuno, Rui; Cissokho, Alioune; Jimba, Masamine

2016-01-01

The 5S method is a lean management tool for workplace organization, with 5S being an abbreviation for five Japanese words that translate to English as Sort, Set in Order, Shine, Standardize, and Sustain. In Senegal, the 5S intervention program was implemented in 10 health centers in two regions between 2011 and 2014. To identify the impact of the 5S intervention program on the satisfaction of clients (patients and caretakers) who visited the health centers. A standardized 5S intervention protocol was implemented in the health centers using a quasi-experimental separate pre-post samples design (four intervention and three control health facilities). A questionnaire with 10 five-point Likert items was used to measure client satisfaction. Linear regression analysis was conducted to identify the intervention's effect on the client satisfaction scores, represented by an equally weighted average of the 10 Likert items (Cronbach's alpha=0.83). Additional regression analyses were conducted to identify the intervention's effect on the scores of each Likert item. Backward stepwise linear regression ( n= 1,928) indicated a statistically significant effect of the 5S intervention, represented by an increase of 0.19 points in the client satisfaction scores in the intervention group, 6 to 8 months after the intervention ( p= 0.014). Additional regression analyses showed significant score increases of 0.44 ( p= 0.002), 0.14 ( p= 0.002), 0.06 ( p= 0.019), and 0.17 ( p= 0.044) points on four items, which, respectively were healthcare staff members' communication, explanations about illnesses or cases, and consultation duration, and clients' overall satisfaction. The 5S has the potential to improve client satisfaction at resource-poor health facilities and could therefore be recommended as a strategic option for improving the quality of healthcare service in low- and middle-income countries. To explore more effective intervention modalities, further studies need to address the mechanisms by which 5S leads to attitude changes in healthcare staff.

Stepwise inference of likely dynamic flux distributions from metabolic time series data.

PubMed

Faraji, Mojdeh; Voit, Eberhard O

2017-07-15

Most metabolic pathways contain more reactions than metabolites and therefore have a wide stoichiometric matrix that corresponds to infinitely many possible flux distributions that are perfectly compatible with the dynamics of the metabolites in a given dataset. This under-determinedness poses a challenge for the quantitative characterization of flux distributions from time series data and thus for the design of adequate, predictive models. Here we propose a method that reduces the degrees of freedom in a stepwise manner and leads to a dynamic flux distribution that is, in a statistical sense, likely to be close to the true distribution. We applied the proposed method to the lignin biosynthesis pathway in switchgrass. The system consists of 16 metabolites and 23 enzymatic reactions. It has seven degrees of freedom and therefore admits a large space of dynamic flux distributions that all fit a set of metabolic time series data equally well. The proposed method reduces this space in a systematic and biologically reasonable manner and converges to a likely dynamic flux distribution in just a few iterations. The estimated solution and the true flux distribution, which is known in this case, show excellent agreement and thereby lend support to the method. The computational model was implemented in MATLAB (version R2014a, The MathWorks, Natick, MA). The source code is available at https://github.gatech.edu/VoitLab/Stepwise-Inference-of-Likely-Dynamic-Flux-Distributions and www.bst.bme.gatech.edu/research.php . mojdeh@gatech.edu or eberhard.voit@bme.gatech.edu. Supplementary data are available at Bioinformatics online. © The Author (2017). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Diels–Alder Reactions of Allene with Benzene and Butadiene: Concerted, Stepwise, and Ambimodal Transition States

PubMed Central

2015-01-01

Multiconfigurational complete active space methods (CASSCF and CASPT2) have been used to investigate the (4 + 2) cycloadditions of allene with butadiene and with benzene. Both concerted and stepwise radical pathways were examined to determine the mechanism of the Diels–Alder reactions with an allene dienophile. Reaction with butadiene occurs via a single ambimodal transition state that can lead to either the concerted or stepwise trajectories along the potential energy surface, while reaction with benzene involves two separate transition states and favors the concerted mechanism relative to the stepwise mechanism via a diradical intermediate. PMID:25216056

Satisfaction among early and mid-career dentists in a metropolitan dental hospital in China

PubMed Central

Cui, Xiaoxi; Dunning, David G; An, Na

2017-01-01

A growing body of research has examined career satisfaction among dentists using a standardized instrument, dentist satisfaction survey (DSS). This project examined career satisfaction of early to mid-career dentists in China, a population whose career satisfaction, heretofore, has not been studied. This is an especially critical time to examine career satisfaction because of health care reform measures being implemented in China. A culturally sensitive Chinese-language version of the DSS (CDSS) was developed and electronically administered to 367 early and mid-career dentists in a tertiary dental hospital in Beijing, China. One hundred and seventy respondents completed the survey. The average total career score was 123, with a range of 82–157. Data analysis showed some significant differences in total career score and several subscales based on gender, working hours per week, and years in practice. A stepwise regression model revealed that two variables predicted total career score: working hours per week and gender. Stepwise regression also demonstrated that four subscales significantly predicted the overall professional satisfaction subscale score: respect, delivery of care, income and patient relations. Implications of these results are discussed in light of the health care delivery system and dentist career paths in China. PMID:29355243

Satisfaction among early and mid-career dentists in a metropolitan dental hospital in China.

PubMed

Cui, Xiaoxi; Dunning, David G; An, Na

2017-01-01

A growing body of research has examined career satisfaction among dentists using a standardized instrument, dentist satisfaction survey (DSS). This project examined career satisfaction of early to mid-career dentists in China, a population whose career satisfaction, heretofore, has not been studied. This is an especially critical time to examine career satisfaction because of health care reform measures being implemented in China. A culturally sensitive Chinese-language version of the DSS (CDSS) was developed and electronically administered to 367 early and mid-career dentists in a tertiary dental hospital in Beijing, China. One hundred and seventy respondents completed the survey. The average total career score was 123, with a range of 82-157. Data analysis showed some significant differences in total career score and several subscales based on gender, working hours per week, and years in practice. A stepwise regression model revealed that two variables predicted total career score: working hours per week and gender. Stepwise regression also demonstrated that four subscales significantly predicted the overall professional satisfaction subscale score: respect, delivery of care, income and patient relations. Implications of these results are discussed in light of the health care delivery system and dentist career paths in China.

Stepwise Analysis of Differential Item Functioning Based on Multiple-Group Partial Credit Model.

ERIC Educational Resources Information Center

Muraki, Eiji

1999-01-01

Extended an Item Response Theory (IRT) method for detection of differential item functioning to the partial credit model and applied the method to simulated data using a stepwise procedure. Then applied the stepwise DIF analysis based on the multiple-group partial credit model to writing trend data from the National Assessment of Educational…

The Patient Portal of the Personal Cross-Enterprise Electronic Health Record (PEHR) in the Rhine-Neckar-Region.

PubMed

Brandner, Antje; Schreiweis, Björn; Aguduri, Lakshmi S; Bronsch, Tobias; Kunz, Aline; Pensold, Peter; Stein, Katharina E; Weiss, Nicolas; Yüksekogul, Nilay; Bergh, Björn; Heinze, Oliver

2016-01-01

Over the last years we stepwise implemented our vision of a personal cross-enterprise electronic health record (PEHR) in the Rhine-Neckar-Region in Germany. The patient portal is one part of the PEHR architecture with IHE connectivity. The patient is enabled to access and manage his medical record by use of the patient portal. Moreover, he can give his consent regarding which healthcare providers are allowed to send data into or read data from his medical record. Forthcoming studies will give evidence for improvements and further requirements to develop.

End of FY10 report - used fuel disposition technical bases and lessons learned : legal and regulatory framework for high-level waste disposition in the United States.

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

Weiner, Ruth F.; Blink, James A.; Rechard, Robert Paul

This report examines the current policy, legal, and regulatory framework pertaining to used nuclear fuel and high level waste management in the United States. The goal is to identify potential changes that if made could add flexibility and possibly improve the chances of successfully implementing technical aspects of a nuclear waste policy. Experience suggests that the regulatory framework should be established prior to initiating future repository development. Concerning specifics of the regulatory framework, reasonable expectation as the standard of proof was successfully implemented and could be retained in the future; yet, the current classification system for radioactive waste, including hazardousmore » constituents, warrants reexamination. Whether or not consideration of multiple sites are considered simultaneously in the future, inclusion of mechanisms such as deliberate use of performance assessment to manage site characterization would be wise. Because of experience gained here and abroad, diversity of geologic media is not particularly necessary as a criterion in site selection guidelines for multiple sites. Stepwise development of the repository program that includes flexibility also warrants serious consideration. Furthermore, integration of the waste management system from storage, transportation, and disposition, should be examined and would be facilitated by integration of the legal and regulatory framework. Finally, in order to enhance acceptability of future repository development, the national policy should be cognizant of those policy and technical attributes that enhance initial acceptance, and those policy and technical attributes that maintain and broaden credibility.« less

Liquid rocket performance computer model with distributed energy release

NASA Technical Reports Server (NTRS)

Combs, L. P.

1972-01-01

Development of a computer program for analyzing the effects of bipropellant spray combustion processes on liquid rocket performance is described and discussed. The distributed energy release (DER) computer program was designed to become part of the JANNAF liquid rocket performance evaluation methodology and to account for performance losses associated with the propellant combustion processes, e.g., incomplete spray gasification, imperfect mixing between sprays and their reacting vapors, residual mixture ratio striations in the flow, and two-phase flow effects. The DER computer program begins by initializing the combustion field at the injection end of a conventional liquid rocket engine, based on injector and chamber design detail, and on propellant and combustion gas properties. It analyzes bipropellant combustion, proceeding stepwise down the chamber from those initial conditions through the nozzle throat.

Guidelines for Adapting Manualized Interventions for New Target Populations: A Step-Wise Approach Using Anger Management as a Model

PubMed Central

Goldstein, Naomi E. S.; Kemp, Kathleen A.; Leff, Stephen S.; Lochman, John E.

2014-01-01

The use of manual-based interventions tends to improve client outcomes and promote replicability. With an increasingly strong link between funding and the use of empirically supported prevention and intervention programs, manual development and adaptation have become research priorities. As a result, researchers and scholars have generated guidelines for developing manuals from scratch, but there are no extant guidelines for adapting empirically supported, manualized prevention and intervention programs for use with new populations. Thus, this article proposes step-by-step guidelines for the manual adaptation process. It also describes two adaptations of an extensively researched anger management intervention to exemplify how an empirically supported program was systematically and efficiently adapted to achieve similar outcomes with vastly different populations in unique settings. PMID:25110403

Positive youth development programs for adolescents with greater psychosocial needs: evaluation based on program implementers.

PubMed

Shek, Daniel T L; Ng, Catalina S M; Law, Moon Y M

2017-02-01

As program implementers' views are seldom included in program evaluation and there are few related studies in different Chinese communities, this study examined the perceptions of the program implementers who implemented the Tier 2 Program of the P.A.T.H.S. Program in Hong Kong. The Tier 2 Program was designed to promote the development of adolescents with greater psychosocial needs. In the community-based P.A.T.H.S. Project, 400 program implementers completed a subjective outcome evaluation form (Form D) for program implementers. Consistent with the previous findings, program implementers generally held positive views towards the program, implementers, and program effectiveness and their views towards these three domains did not differ across grades. In line with the hypotheses, perceived program quality and perceived implementer quality predicted program effectiveness. The present findings provided an alternative perspective showing that the Tier 2 Program was well received by the program implementers and they regarded the program to be beneficial to the program participants.

Is there a step-wise migration in Nigeria? A case study of the migrational histories of migrants in Lagos.

PubMed

Afolayan, A A

1985-09-01

"The paper sets out to test whether or not the movement pattern of people in Nigeria is step-wise. It examines the spatial order in the country and the movement pattern of people. It then analyzes the survey data and tests for the validity of step-wise migration in the country. The findings show that step-wise migration cannot adequately describe all the patterns observed." The presence of large-scale circulatory migration between rural and urban areas is noted. Ways to decrease the pressure on Lagos by developing intermediate urban areas are considered. excerpt

Application of digital computer APU modeling techniques to control system design.

NASA Technical Reports Server (NTRS)

Bailey, D. A.; Burriss, W. L.

1973-01-01

Study of the required controls for a H2-O2 auxiliary power unit (APU) technology program for the Space Shuttle. A steady-state system digital computer program was prepared and used to optimize initial system design. Analytical models of each system component were included. The program was used to solve a nineteen-dimensional problem, and then time-dependent differential equations were added to the computer program to simulate transient APU system and control. Some system parameters were considered quasi-steady-state, and others were treated as differential variables. The dynamic control analysis proceeded from initial ideal control modeling (which considered one control function and assumed the others to be ideal), stepwise through the system (adding control functions), until all of the control functions and their interactions were considered. In this way, the adequacy of the final control design over the required wide range of APU operating conditions was established.

Discriminating between Graduates and Failure in the USAF Medical Laboratory Specialist School: An Explorative Approach.

DTIC Science & Technology

1981-12-01

occurred on the Introversion Scale of the NMPI. 20 A review of the use of psychological tests on MT’s was accomplished by Driver and Feeley [1974...programs, Gondek [1981] has recommended that the best pro- cedure for variable inclusion when using a stepwise procedure is to use the threshold default...values supplied by the package, since no simple rules exist for determining entry or removal thresholds for partial F’s, tolerance statistics, or any of

Clinical utility of the AlphaFIM® instrument in stroke rehabilitation.

PubMed

Lo, Alexander; Tahair, Nicola; Sharp, Shelley; Bayley, Mark T

2012-02-01

The AlphaFIM instrument is an assessment tool designed to facilitate discharge planning of stroke patients from acute care, by extrapolating overall functional status from performance in six key Functional Independence Measure (FIM) instrument items. To determine whether acute care AlphaFIM rating is correlated to stroke rehabilitation outcomes. In this prospective observational study, data were analyzed from 891 patients referred for inpatient stroke rehabilitation through an Internet-based referral system. Simple linear and stepwise regression models determined correlations between rehabilitation-ready AlphaFIM rating and rehabilitation outcomes (admission and discharge FIM ratings, FIM gain, FIM efficiency, and length of stay). Covariates including demographic data, stroke characteristics, medical history, cognitive deficits, and activity tolerance were included in the stepwise regressions. The AlphaFIM instrument was significant in predicting admission and discharge FIM ratings at rehabilitation (adjusted R² 0.40 and 0.28, respectively; P < 0.0001) and was weakly correlated with FIM gain and length of stay (adjusted R² 0.04 and 0.09, respectively; P < 0.0001), but not FIM efficiency. AlphaFIM rating was inversely related to FIM gain. Age, bowel incontinence, left hemiparesis, and previous infarcts were negative predictors of discharge FIM rating on stepwise regression. Intact executive function and physical activity tolerance of 30 to 60 mins were predictors of FIM gain. The AlphaFIM instrument is a valuable tool for triaging stroke patients from acute care to rehabilitation and predicts functional status at discharge from rehabilitation. Patients with low AlphaFIM ratings have the potential to make significant functional gains and should not be denied admission to inpatient rehabilitation programs.

[Aggression and related factors in elementary school students].

PubMed

Ji, Eun Sun; Jang, Mi Heui

2010-10-01

This study was done to explore the relationship between aggression and internet over-use, depression-anxiety, self-esteem, all of which are known to be behavior and psychological characteristics linked to "at-risk" children for aggression. Korean-Child Behavior Check List (K-CBCL), Korean-Internet Addiction Self-Test Scale, and Self-Esteem Scale by Rosenberg (1965) were used as measurement tools with a sample of 743, 5th-6th grade students from 3 elementary schools in Jecheon city. Chi-square, t-test, ANOVA, Pearson's correlation and stepwise multiple regression with SPSS/Win 13.0 version were used to analyze the collected data. Aggression for the elementary school students was positively correlated with internet over-use and depression-anxiety, whereas self-esteem was negatively correlated with aggression. Stepwise multiple regression analysis showed that 68.4% of the variance for aggression was significantly accounted for by internet over-use, depression-anxiety, and self-esteem. The most significant factor influencing aggression was depression-anxiety. These results suggest that earlier screening and intervention programs for depression-anxiety and internet over-use for elementary student will be helpful in preventing aggression.

Evidence for a stepwise program of extrathymic T cell development within the human tonsil

PubMed Central

McClory, Susan; Hughes, Tiffany; Freud, Aharon G.; Briercheck, Edward L.; Martin, Chelsea; Trimboli, Anthony J.; Yu, Jianhua; Zhang, Xiaoli; Leone, Gustavo; Nuovo, Gerard; Caligiuri, Michael A.

2012-01-01

The development of a broad repertoire of T cells, which is essential for effective immune function, occurs in the thymus. Although some data suggest that T cell development can occur extrathymically, many researchers remain skeptical that extrathymic T cell development has an important role in generating the T cell repertoire in healthy individuals. However, it may be important in the setting of poor thymic function or congenital deficit and in the context of autoimmunity, cancer, or regenerative medicine. Here, we report evidence that a stepwise program of T cell development occurs within the human tonsil. We identified 5 tonsillar T cell developmental intermediates: (a) CD34+CD38dimLin– cells, which resemble multipotent progenitors in the bone marrow and thymus; (b) more mature CD34+CD38brightLin– cells; (c) CD34+CD1a+CD11c– cells, which resemble committed T cell lineage precursors in the thymus; (d) CD34–CD1a+CD3–CD11c– cells, which resemble CD4+CD8+ double-positive T cells in the thymus; and (e) CD34–CD1a+CD3+CD11c– cells. The phenotype of each subset closely resembled that of its thymic counterpart. The last 4 populations expressed RAG1 and PTCRA, genes required for TCR rearrangement, and all 5 subsets were capable of ex vivo T cell differentiation. TdT+ cells found within the tonsillar fibrous scaffold expressed CD34 and/or CD1a, indicating that this distinct anatomic region contributes to pre–T cell development, as does the subcapsular region of the thymus. Thus, we provide evidence of a role for the human tonsil in a comprehensive program of extrathymic T cell development. PMID:22378041

The effect of thermal history on crystalline structure and mechanical properties of β-nucleated isotactic polypropylene

NASA Astrophysics Data System (ADS)

Tian, Yefei; Zhou, Jian; Feng, Jiachun

2018-04-01

The effect of thermal history on β-nucleated iPP was systematically investigated by comparing the variance of crystalline microstructures and mechanical property of stepwise crystallized sample and annealed sample, which experienced different thermal history. The mechanical property tests exhibit that that the toughness of stepwise crystallized sample and annealed sample were both decreased compared to control sample, while the tensile strength of the stepwise crystallized sample increased slightly. Structure investigation showed that the α-relaxation peak, which is related to the assignment of chains in rigid amorphous phase, moved to the high temperature region for stepwise crystallized sample, while it moved to the low temperature region for annealed sample. The results indicated the weakening in rigid amorphous fraction (RAF) and the increase in lamellar thickness of β-iPP after stepwise crystallization treatment. For annealed sample, the RAF strengthened and lamellar thickness decreased slightly after thermal treatment. A mechanism of crystalline microstructures evolution of restricted area between the main lamellar under different treatments was proposed.

Improving meat quality of organic pork through post mortem handling of carcasses: an innovative approach.

PubMed

Therkildsen, Margrethe; Kristensen, Lars; Kyed, Sybille; Oksbjerg, Niels

2012-06-01

This study was conducted to examine the best combination of post mortem chilling, suspension and ageing in order to optimize tenderness of organic pork at slaughter, which may be tougher than conventionally produced pork, because of lower daily gain. Combinations of stepwise chilling with a holding period of 6h at 10°C or traditional blast tunnel chilling, suspension in the pelvic bone or Achilles Tendon and ageing 2 or 4 days post mortem were tested. Stepwise chilling and ageing improved tenderness of the loin, and the effects were additive, whereas pelvic suspension was less effective in texture improvements, and non-additive to stepwise chilling. Stepwise chilling improved tenderness to a similar degree as can be obtained within 2-4 days of extended ageing, however, the minimum temperature during the holding period seems to be crucial in order to obtain a positive effect of stepwise chilling, and it should be above 7.5°C. Copyright © 2011 Elsevier Ltd. All rights reserved.

Qualis-SIS: automated standard curve generation and quality assessment for multiplexed targeted quantitative proteomic experiments with labeled standards.

PubMed

Mohammed, Yassene; Percy, Andrew J; Chambers, Andrew G; Borchers, Christoph H

2015-02-06

Multiplexed targeted quantitative proteomics typically utilizes multiple reaction monitoring and allows the optimized quantification of a large number of proteins. One challenge, however, is the large amount of data that needs to be reviewed, analyzed, and interpreted. Different vendors provide software for their instruments, which determine the recorded responses of the heavy and endogenous peptides and perform the response-curve integration. Bringing multiplexed data together and generating standard curves is often an off-line step accomplished, for example, with spreadsheet software. This can be laborious, as it requires determining the concentration levels that meet the required accuracy and precision criteria in an iterative process. We present here a computer program, Qualis-SIS, that generates standard curves from multiplexed MRM experiments and determines analyte concentrations in biological samples. Multiple level-removal algorithms and acceptance criteria for concentration levels are implemented. When used to apply the standard curve to new samples, the software flags each measurement according to its quality. From the user's perspective, the data processing is instantaneous due to the reactivity paradigm used, and the user can download the results of the stepwise calculations for further processing, if necessary. This allows for more consistent data analysis and can dramatically accelerate the downstream data analysis.

Objectivity and validity of EMG method in estimating anaerobic threshold.

PubMed

Kang, S-K; Kim, J; Kwon, M; Eom, H

2014-08-01

The purposes of this study were to verify and compare the performances of anaerobic threshold (AT) point estimates among different filtering intervals (9, 15, 20, 25, 30 s) and to investigate the interrelationships of AT point estimates obtained by ventilatory threshold (VT) and muscle fatigue thresholds using electromyographic (EMG) activity during incremental exercise on a cycle ergometer. 69 untrained male university students, yet pursuing regular exercise voluntarily participated in this study. The incremental exercise protocol was applied with a consistent stepwise increase in power output of 20 watts per minute until exhaustion. AT point was also estimated in the same manner using V-slope program with gas exchange parameters. In general, the estimated values of AT point-time computed by EMG method were more consistent across 5 filtering intervals and demonstrated higher correlations among themselves when compared with those values obtained by VT method. The results found in the present study suggest that the EMG signals could be used as an alternative or a new option in estimating AT point. Also the proposed computing procedure implemented in Matlab for the analysis of EMG signals appeared to be valid and reliable as it produced nearly identical values and high correlations with VT estimates. © Georg Thieme Verlag KG Stuttgart · New York.

Global challenges in pediatric oncology.

PubMed

Rodriguez-Galindo, Carlos; Friedrich, Paola; Morrissey, Lisa; Frazier, Lindsay

2013-02-01

Reduction of child mortality is one of the Millennium Development Goals; as low-income and middle-income countries (LMICs) advance toward the achievement of this goal, initiatives aimed at reducing the burden of noncommunicable diseases, including childhood cancer, need to be developed. Approximately 200 000 children and adolescents are diagnosed with cancer every year worldwide; of those, 80% live in LMICs, which account for 90% of the deaths. Lack of quality population-based cancer registries in LMICs limits our knowledge of the epidemiology of pediatric cancer; however, available information showing variations in incidence may indicate unique interactions between environmental and genetic factors that could provide clues to cause. Outcome of children with cancer in LMICs is dictated by late presentation and underdiagnosis, high abandonment rates, high prevalence of malnutrition and other comorbidities, suboptimal supportive and palliative care, and limited access to curative therapies. Initiatives integrating program building with education of healthcare providers and research have proven to be successful in the development of regional capacity. Intensity-graduated treatments adjusted to the local capacity have been developed. Childhood cancer burden is shifted toward LMICs; global initiatives directed at pediatric cancer care and control are urgently needed. International partnerships facilitating stepwise processes that build capacity while incorporating epidemiology and health services research and implementing intensity-graduated treatments have been shown to be effective.

The Impact of Anesthesia-Influenced Process Measure Compliance on Length of Stay: Results From an Enhanced Recovery After Surgery for Colorectal Surgery Cohort.

PubMed

Grant, Michael C; Pio Roda, Claro M; Canner, Joseph K; Sommer, Philip; Galante, Daniel; Hobson, Deborah; Gearhart, Susan; Wu, Christopher L; Wick, Elizabeth

2018-05-17

Process measure compliance has been associated with improved outcomes in enhanced recovery after surgery (ERAS) programs. Herein, we sought to assess the impact of compliance with measures directly influenced by anesthesiology in an ERAS for colorectal surgery cohort. From January 2013 to April 2015, data from 1140 consecutive patients were collected for all patients before (pre-ERAS) and after (ERAS) implementation of an ERAS program. Compliance with 9 specific process measures directly influenced by the anesthesiologist or acute pain service was analyzed to determine the impact on hospital length of stay (LOS). Process measure compliance was associated with a stepwise reduction in LOS. Patients who received >4 process measures (high compliance) had a significantly shorter LOS (incident rate ratio [IRR], 0.77; 95% CI, 0.70-0.85); P < .001) compared to low compliance (0-2 process measures) counterparts. Multivariable regression suggests that utilization of multimodal nausea and vomiting prophylaxis (IRR, 0.78; 95% CI, 0.68-0.89; P < .001), scheduled postoperative nonsteroidal pain medication use (IRR, 0.76; 95% CI, 0.67-0.85; P < .001), and strict adherence to a postoperative opioid administration (IRR, 0.58; 95% CI, 0.51-0.67; P < .001) protocol for breakthrough pain were independently associated with reduced LOS. Our findings suggest that increased compliance with process measures directly influenced by the anesthesiologists and in concert with a formal anesthesia protocol is associated with reduced LOS. Engaging anesthesiology colleagues throughout the surgical encounter increases the overall value of perioperative care.

Residents' engagement in everyday activities and its association with thriving in nursing homes.

PubMed

Björk, Sabine; Lindkvist, Marie; Wimo, Anders; Juthberg, Christina; Bergland, Ådel; Edvardsson, David

2017-08-01

To describe the prevalence of everyday activity engagement for older people in nursing homes and the extent to which engagement in everyday activities is associated with thriving. Research into residents' engagement in everyday activities in nursing homes has focused primarily on associations with quality of life and prevention and management of neuropsychiatric symptoms. However, the mere absence of symptoms does not necessarily guarantee experiences of well-being. The concept of thriving encapsulates and explores experiences of well-being in relation to the place where a person lives. A cross-sectional survey. A national survey of 172 Swedish nursing homes (2013-2014). Resident (n = 4831) symptoms, activities and thriving were assessed by staff using a study survey based on established questionnaires. Descriptive statistics, simple and multiple linear regression, and linear stepwise multiple regression were performed. The most commonly occurring everyday activities were receiving hugs and physical touch, talking to relatives/friends and receiving visitors, having conversation with staff not related to care and grooming. The least commonly occurring everyday activities were going to the cinema, participating in an educational program, visiting a restaurant and doing everyday chores. Positive associations were found between activity engagement and thriving, where engagement in an activity program, dressing nicely and spending time with someone the resident likes had the strongest positive association with resident thriving. Engagement in everyday activities can support personhood and thriving and can be conceptualized and implemented as nursing interventions to enable residents to thrive in nursing homes. © 2017 John Wiley & Sons Ltd.

Application of a single-objective, hybrid genetic algorithm approach to pharmacokinetic model building.

PubMed

Sherer, Eric A; Sale, Mark E; Pollock, Bruce G; Belani, Chandra P; Egorin, Merrill J; Ivy, Percy S; Lieberman, Jeffrey A; Manuck, Stephen B; Marder, Stephen R; Muldoon, Matthew F; Scher, Howard I; Solit, David B; Bies, Robert R

2012-08-01

A limitation in traditional stepwise population pharmacokinetic model building is the difficulty in handling interactions between model components. To address this issue, a method was previously introduced which couples NONMEM parameter estimation and model fitness evaluation to a single-objective, hybrid genetic algorithm for global optimization of the model structure. In this study, the generalizability of this approach for pharmacokinetic model building is evaluated by comparing (1) correct and spurious covariate relationships in a simulated dataset resulting from automated stepwise covariate modeling, Lasso methods, and single-objective hybrid genetic algorithm approaches to covariate identification and (2) information criteria values, model structures, convergence, and model parameter values resulting from manual stepwise versus single-objective, hybrid genetic algorithm approaches to model building for seven compounds. Both manual stepwise and single-objective, hybrid genetic algorithm approaches to model building were applied, blinded to the results of the other approach, for selection of the compartment structure as well as inclusion and model form of inter-individual and inter-occasion variability, residual error, and covariates from a common set of model options. For the simulated dataset, stepwise covariate modeling identified three of four true covariates and two spurious covariates; Lasso identified two of four true and 0 spurious covariates; and the single-objective, hybrid genetic algorithm identified three of four true covariates and one spurious covariate. For the clinical datasets, the Akaike information criterion was a median of 22.3 points lower (range of 470.5 point decrease to 0.1 point decrease) for the best single-objective hybrid genetic-algorithm candidate model versus the final manual stepwise model: the Akaike information criterion was lower by greater than 10 points for four compounds and differed by less than 10 points for three compounds. The root mean squared error and absolute mean prediction error of the best single-objective hybrid genetic algorithm candidates were a median of 0.2 points higher (range of 38.9 point decrease to 27.3 point increase) and 0.02 points lower (range of 0.98 point decrease to 0.74 point increase), respectively, than that of the final stepwise models. In addition, the best single-objective, hybrid genetic algorithm candidate models had successful convergence and covariance steps for each compound, used the same compartment structure as the manual stepwise approach for 6 of 7 (86 %) compounds, and identified 54 % (7 of 13) of covariates included by the manual stepwise approach and 16 covariate relationships not included by manual stepwise models. The model parameter values between the final manual stepwise and best single-objective, hybrid genetic algorithm models differed by a median of 26.7 % (q₁ = 4.9 % and q₃ = 57.1 %). Finally, the single-objective, hybrid genetic algorithm approach was able to identify models capable of estimating absorption rate parameters for four compounds that the manual stepwise approach did not identify. The single-objective, hybrid genetic algorithm represents a general pharmacokinetic model building methodology whose ability to rapidly search the feasible solution space leads to nearly equivalent or superior model fits to pharmacokinetic data.

Gener: a minimal programming module for chemical controllers based on DNA strand displacement.

PubMed

Kahramanoğulları, Ozan; Cardelli, Luca

2015-09-01

: Gener is a development module for programming chemical controllers based on DNA strand displacement. Gener is developed with the aim of providing a simple interface that minimizes the opportunities for programming errors: Gener allows the user to test the computations of the DNA programs based on a simple two-domain strand displacement algebra, the minimal available so far. The tool allows the user to perform stepwise computations with respect to the rules of the algebra as well as exhaustive search of the computation space with different options for exploration and visualization. Gener can be used in combination with existing tools, and in particular, its programs can be exported to Microsoft Research's DSD tool as well as to LaTeX. Gener is available for download at the Cosbi website at http://www.cosbi.eu/research/prototypes/gener as a windows executable that can be run on Mac OS X and Linux by using Mono. ozan@cosbi.eu. © The Author 2015. Published by Oxford University Press.

Variable selection with stepwise and best subset approaches

PubMed Central

2016-01-01

While purposeful selection is performed partly by software and partly by hand, the stepwise and best subset approaches are automatically performed by software. Two R functions stepAIC() and bestglm() are well designed for stepwise and best subset regression, respectively. The stepAIC() function begins with a full or null model, and methods for stepwise regression can be specified in the direction argument with character values “forward”, “backward” and “both”. The bestglm() function begins with a data frame containing explanatory variables and response variables. The response variable should be in the last column. Varieties of goodness-of-fit criteria can be specified in the IC argument. The Bayesian information criterion (BIC) usually results in more parsimonious model than the Akaike information criterion. PMID:27162786

Melanin fluorescence spectra by step-wise three photon excitation

NASA Astrophysics Data System (ADS)

Lai, Zhenhua; Kerimo, Josef; DiMarzio, Charles A.

2012-03-01

Melanin is the characteristic chromophore of human skin with various potential biological functions. Kerimo discovered enhanced melanin fluorescence by stepwise three-photon excitation in 2011. In this article, step-wise three-photon excited fluorescence (STPEF) spectrum between 450 nm -700 nm of melanin is reported. The melanin STPEF spectrum exhibited an exponential increase with wavelength. However, there was a probability of about 33% that another kind of step-wise multi-photon excited fluorescence (SMPEF) that peaks at 525 nm, shown by previous research, could also be generated using the same process. Using an excitation source at 920 nm as opposed to 830 nm increased the potential for generating SMPEF peaks at 525 nm. The SMPEF spectrum peaks at 525 nm photo-bleached faster than STPEF spectrum.

Neuropsychology 3.0: Evidence-Based Science and Practice

PubMed Central

Bilder, Robert M.

2011-01-01

Neuropsychology is poised for transformations of its concepts and methods, leveraging advances in neuroimaging, the human genome project, psychometric theory, and information technologies. It is argued that a paradigm shift towards evidence-based science and practice can be enabled by innovations, including: (1) formal definition of neuropsychological concepts and tasks in cognitive ontologies; (2) creation of collaborative neuropsychological knowledgebases; and (3) design of web-based assessment methods that permit free development, large-sample implementation, and dynamic refinement of neuropsychological tests and the constructs these aim to assess. This article considers these opportunities, highlights selected obstacles, and offers suggestions for stepwise progress towards these goals. PMID:21092355

Application of a stepwise method for analyzing fouling in shell-and-tube exchangers

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

Prieto, M.M.; Miranda, J.; Sigales, B.

1999-12-01

This article presents the results of the application of a quite simple method for analyzing shell-side fouling in shell-and-tube exchangers, capable of taking into account the formation or irregular fouling deposits with variable thermal conductivity. This method, based on the utilization of elementary heat exchangers, has been implemented for E-shell TEMA-type heat exchangers with two tube passes. Several fouling deposit distributions have been simulated so as to ascertain their effects on the heat transfer rate. These distributions consider that fouling is concentrated in zones where the temperature of the fluids is maximum or minimum.

Epidemiological analysis of factors influencing rate of progress in Echinococcus granulosus control in New Zealand.

PubMed Central

Burridge, M. J.; Schwabe, C. W.

1977-01-01

The factors influencing the rate of progress in Echinococcus granulosus control in New Zealand were analysed by hydatid control area using stepwise multiple regression techniques. The results indicated that the rate of progress was related positively to initial E. granulosus prevalence in dogs and the efficiency with which local authorities implemented national control policy, and negatively to the Maori proportion in the local population and the number of dogs per owner. Problems in analysis of the New Zealand data are discussed and improved methods of monitoring progress in hydatid disease control programmes are described. Images Fig. 1 PMID:265340

International Instrumentation Symposium, 38th, Las Vegas, NV, Apr. 26-30, 1992, Proceedings

NASA Astrophysics Data System (ADS)

The present volume on aerospace instrumentation discusses computer applications, blast and shock, implementation of the Clean Air Act amendments, and thermal systems. Attention is given to measurement uncertainty/flow measurement, data acquisition and processing, force/acceleration/motion measurements, and hypersonics/reentry vehicle systems. Topics addressed include wind tunnels, real time systems, and pressure effects. Also discussed are a distributed data and control system for space simulation and thermal testing a stepwise shockwave velocity determinator, computer tracking and decision making, the use of silicon diodes for detecting the liquid-vapor interface in hydrogen, and practical methods for analysis of uncertainty propagation.

Property-driven functional verification technique for high-speed vision system-on-chip processor

NASA Astrophysics Data System (ADS)

Nshunguyimfura, Victor; Yang, Jie; Liu, Liyuan; Wu, Nanjian

2017-04-01

The implementation of functional verification in a fast, reliable, and effective manner is a challenging task in a vision chip verification process. The main reason for this challenge is the stepwise nature of existing functional verification techniques. This vision chip verification complexity is also related to the fact that in most vision chip design cycles, extensive efforts are focused on how to optimize chip metrics such as performance, power, and area. Design functional verification is not explicitly considered at an earlier stage at which the most sound decisions are made. In this paper, we propose a semi-automatic property-driven verification technique. The implementation of all verification components is based on design properties. We introduce a low-dimension property space between the specification space and the implementation space. The aim of this technique is to speed up the verification process for high-performance parallel processing vision chips. Our experimentation results show that the proposed technique can effectively improve the verification effort up to 20% for the complex vision chip design while reducing the simulation and debugging overheads.

Implementation of the Leaching Environmental Assessment ...

EPA Pesticide Factsheets

LEAF provides a uniform and integrated approach for evaluating leaching from solid materials (e.g., waste, treated wastes such as by solidification/stabilization, secondary materials such as blast furnace slags, energy residuals such as coal fly ash, soil, sediments, mining and mineral processing wastes). Assessment using LEAF applies a stepwise approach that considers the leaching behavior of COPCs in response to chemical and physical factors that control and material properties across a range of plausible field conditions (US EPA, 2010). The framework provides the flexibility to tailor testing to site conditions and select the extent of testing based on assessment objectives and the level of detailed information needed to support decision-making. The main focus will be to discuss the implementation of LEAF in the US and the How to Guide that has recently been completed. To present the How To Guide for the implementation of the leaching environmental assessment framework to an international audience already familiar with comparable leaching tests in use in Europe. Will be meeting with European colleagues on their interest in expanding methods to include organics.

Integrated perinatal mental health care: a national model of perinatal primary care in vulnerable populations.

PubMed

Lomonaco-Haycraft, Kimberly C; Hyer, Jennifer; Tibbits, Britney; Grote, Jennifer; Stainback-Tracy, Kelly; Ulrickson, Claire; Lieberman, Alison; van Bekkum, Lies; Hoffman, M Camille

2018-06-18

IntroductionPerinatal mood and anxiety disorders (PMADs) are the most common complication of pregnancy and have been found to have long-term implications for both mother and child. In vulnerable patient populations such as those served at Denver Health, a federally qualified health center the prevalence of PMADs is nearly double the nationally reported rate of 15-20%. Nearly 17% of women will be diagnosed with major depression at some point in their lives and those numbers are twice as high in women who live in poverty. Women also appear to be at higher risk for depression in the child-bearing years. In order to better address these issues, an Integrated Perinatal Mental Health program was created to screen, assess, and treat PMADs in alignment with national recommendations to improve maternal-child health and wellness. This program was built upon a national model of Integrated Behavioral Health already in place at Denver Health. A multidisciplinary team of physicians, behavioral health providers, public health, and administrators was assembled at Denver Health, an integrated hospital and community health care system that serves as the safety net hospital to the city and county of Denver, CO. This team was brought together to create a universal screen-to-treat process for PMAD's in perinatal clinics and to adapt the existing Integrated Behavioral Health (IBH) model into a program better suited to the health system's obstetric population. Universal prenatal and postnatal depression screening was implemented at the obstetric intake visit, a third trimester prenatal care visit, and at the postpartum visit across the clinical system. At the same time, IBH services were implemented across our health system's perinatal care system in a stepwise fashion. This included our women's care clinics as well as the family medicine and pediatric clinics. These efforts occurred in tandem to support all patients and staff enabling a specially trained behavioral health provider (psychologists and L.C.S.W.'s) to respond immediately to any positive screen during or after pregnancy. In August 2014 behavioral health providers were integrated into the women's care clinics. In January 2015 universal screening for PMADs was implemented throughout the perinatal care system. Screening has improved from 0% of women screened at the obstetric care intake visit in August 2014 to >75% of women screened in August 2016. IBH coverage by a licensed psychologist or licensed clinical social worker exists in 100% of perinatal clinics as of January 2016. As well, in order to gain sustainability, the ability to bill same day visits as well as to bill, and be reimbursed for screening and assessment visits, continues to improve and provide for a model that is self-sustaining for the future. Implementation of a universal screening process for PMADs alongside the development of an IBH model in perinatal care has led to the creation of a program that is feasible and has the capacity to serve as a national model for improving perinatal mental health in vulnerable populations.

Stepwise hydrolysis to improve carbon releasing efficiency from sludge.

PubMed

Liu, Hongbo; Wang, Yuanyuan; Wang, Ling; Yu, Tiantian; Fu, Bo; Liu, He

2017-08-01

Based on thermal alkaline hydrolysis (TAH), a novel strategy of stepwise hydrolysis was developed to improve carbon releasing efficiency from waste activated sludge (WAS). By stepwise increasing hydrolysis intensity, conventional sludge hydrolysis (the control) was divided into four stages for separately recovering sludge carbon sources with different bonding strengths, namely stage 1 (60 °C, pH 6.0-8.0), stage 2 (80 °C, pH 6.0-8.0), stage 3 (80 °C, pH 10.0) and stage 4 (90 °C, pH 12.0). Results indicate stepwise hydrolysis could enhance the amount of released soluble chemical oxygen demand (SCOD) for almost 2 times, from 7200 to 14,693 mg/L, and the released carbon presented better biodegradability, with BOD/COD of 0.47 and volatile fatty acids (VFAs) yield of 0.37 g VFAs/g SCOD via anaerobic fermentation. Moreover, stepwise hydrolysis also improved the dewaterability of hydrolyzed sludge, capillary suction time (CST) reducing from 2500 to 1600 s. Economic assessment indicates stepwise hydrolysis shows less alkali demand and lower thermal energy consumption than those of the control. Furthermore, results of this study help support the concepts of improving carbon recovery in wastewater by manipulating WAS composition and the idea of classifiably recovering the nutrients in WAS. Copyright © 2017 Elsevier Ltd. All rights reserved.

Discrimination of Geographical Origin of Asian Garlic Using Isotopic and Chemical Datasets under Stepwise Principal Component Analysis.

PubMed

Liu, Tsang-Sen; Lin, Jhen-Nan; Peng, Tsung-Ren

2018-01-16

Isotopic compositions of δ 2 H, δ 18 O, δ 13 C, and δ 15 N and concentrations of 22 trace elements from garlic samples were analyzed and processed with stepwise principal component analysis (PCA) to discriminate garlic's country of origin among Asian regions including South Korea, Vietnam, Taiwan, and China. Results indicate that there is no single trace-element concentration or isotopic composition that can accomplish the study's purpose and the stepwise PCA approach proposed does allow for discrimination between countries on a regional basis. Sequentially, Step-1 PCA distinguishes garlic's country of origin among Taiwanese, South Korean, and Vietnamese samples; Step-2 PCA discriminates Chinese garlic from South Korean garlic; and Step-3 and Step-4 PCA, Chinese garlic from Vietnamese garlic. In model tests, countries of origin of all audit samples were correctly discriminated by stepwise PCA. Consequently, this study demonstrates that stepwise PCA as applied is a simple and effective approach to discriminating country of origin among Asian garlics. © 2018 American Academy of Forensic Sciences.

The Balanced Scorecard of acute settings: development process, definition of 20 strategic objectives and implementation.

PubMed

Groene, Oliver; Brandt, Elimer; Schmidt, Werner; Moeller, Johannes

2009-08-01

Strategy development and implementation in acute care settings is often restricted by competing challenges, the pace of policy reform and the existence of parallel hierarchies. To describe a generic approach to strategy development, illustrate the use of the Balanced Scorecard as a tool to facilitate strategy implementation and demonstrate how to break down strategic goals into measurable elements. Multi-method approach using three different conceptual models: Health Promoting Hospitals Standards and Strategies, the European Foundation for Quality Management (EFQM) Model and the Balanced Scorecard. A bundle of qualitative and quantitative methods were used including in-depth interviews, standardized organization-wide surveys on organizational values, staff satisfaction and patient experience. Three acute care hospitals in four different locations belonging to a German holding group. Chief executive officer, senior medical officers, working group leaders and hospital staff. Development and implementation of the Balanced Scorecard. Twenty strategic objectives with corresponding Balanced Scorecard measures. A stepped approach from strategy development to implementation is presented to identify key themes for strategy development, drafting a strategy map and developing strategic objectives and measures. The Balanced Scorecard, in combination with the EFQM model, is a useful tool to guide strategy development and implementation in health care organizations. As for other quality improvement and management tools not specifically developed for health care organizations, some adaptations are required to improve acceptability among professionals. The step-wise approach of strategy development and implementation presented here may support similar processes in comparable organizations.

Factors associated with implementation of a multicomponent responsible beverage service program – results from two surveys in 290 Swedish municipalities

PubMed Central

2013-01-01

Background The purpose of this study was to investigate which factors affected the implementation of a multicomponent Responsible Beverage Service (RBS) program in 290 Swedish municipalities and whether the amount of such factors influenced the level of implementation of the program. Methods This study used variation in the presence of implementation-promoting factors to predict the level of implementation of the RBS program in municipalities throughout Sweden. The presence of such factors and the level of implementation of the program were studied by means of two surveys in all Swedish municipalities (N=290). Logistic regression and Spearman’s correlation analyses were used to analyze the relationship between implementation-promoting factors and the level of implementation of the RBS program. Results The response rates of the two surveys were 96% and 98%, respectively. One main finding was that program fidelity was low. Only 13% of the municipalities surveyed had implemented the RBS program as a whole, as stated in the specification of requirements. In municipalities reporting a higher amount of implementation-promoting factors, a significantly higher level of implementation of the program was shown. Evaluation and feedback was the only factor that correlated significantly with the level of implementation of the RBS program as a whole. Conclusion Evaluation and feedback constitutes an important implementation-promoting factor also in complex programs like the RBS program. Program fidelity is significant for the outcome of an intervention and must be a major focus of the implementation processes. PMID:23497692

Prediction of Academic Achievement in an NATA-Approved Graduate Athletic Training Education Program

PubMed Central

Keskula, Douglas R.; Sammarone, Paula G.; Perrin, David H.

1995-01-01

The Purpose of this investigation was to determine which information used in the applicant selection process would best predict the final grade point average of students in a National Athletic Trainers Association (NATA) graduate athletic training education program. The criterion variable used was the graduate grade-point average (GPAg) calculated at the completion of the program of study. The predictor variables included: 1) Graduate Record Examination-Quantitative (GRE-Q) scores; and 2) Graduate Record Examination-Verbal (GRE-V) scores, 3) preadmission grade point average (GPAp), 4) total athletic training hours (hours), and 5) curriculum or internship undergraduate athletic training education (program). Data from 55 graduate athletic training students during a 5-year period were evaluated. Stepwise multiple regression analysis indicated that GPAp was a significant predictor of GPAg, accounting for 34% of the variance. GRE-Q, GRE-V, hours, and program did not significantly contribute individually or in combination to the prediction of GPAg. The results of this investigation suggest that, of the variables examined, GPAp is the best predictor of academic success in an NATA-approved graduate athletic training education program. PMID:16558312

Insulin degludec/insulin aspart once daily in Type 2 diabetes: a comparison of simple or stepwise titration algorithms (BOOST® : SIMPLE USE).

PubMed

Park, S W; Bebakar, W M W; Hernandez, P G; Macura, S; Hersløv, M L; de la Rosa, R

2017-02-01

To compare the efficacy and safety of two titration algorithms for insulin degludec/insulin aspart (IDegAsp) administered once daily with metformin in participants with insulin-naïve Type 2 diabetes mellitus. This open-label, parallel-group, 26-week, multicentre, treat-to-target trial, randomly allocated participants (1:1) to two titration arms. The Simple algorithm titrated IDegAsp twice weekly based on a single pre-breakfast self-monitored plasma glucose (SMPG) measurement. The Stepwise algorithm titrated IDegAsp once weekly based on the lowest of three consecutive pre-breakfast SMPG measurements. In both groups, IDegAsp once daily was titrated to pre-breakfast plasma glucose values of 4.0-5.0 mmol/l. Primary endpoint was change from baseline in HbA 1c (%) after 26 weeks. Change in HbA 1c at Week 26 was IDegAsp Simple -14.6 mmol/mol (-1.3%) (to 52.4 mmol/mol; 6.9%) and IDegAsp Stepwise -11.9 mmol/mol (-1.1%) (to 54.7 mmol/mol; 7.2%). The estimated between-group treatment difference was -1.97 mmol/mol [95% confidence interval (CI) -4.1, 0.2] (-0.2%, 95% CI -0.4, 0.02), confirming the non-inferiority of IDegAsp Simple to IDegAsp Stepwise (non-inferiority limit of ≤ 0.4%). Mean reduction in fasting plasma glucose and 8-point SMPG profiles were similar between groups. Rates of confirmed hypoglycaemia were lower for IDegAsp Stepwise [2.1 per patient years of exposure (PYE)] vs. IDegAsp Simple (3.3 PYE) (estimated rate ratio IDegAsp Simple /IDegAsp Stepwise 1.8; 95% CI 1.1, 2.9). Nocturnal hypoglycaemia rates were similar between groups. No severe hypoglycaemic events were reported. In participants with insulin-naïve Type 2 diabetes mellitus, the IDegAsp Simple titration algorithm improved HbA 1c levels as effectively as a Stepwise titration algorithm. Hypoglycaemia rates were lower in the Stepwise arm. © 2016 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.

Prescribing physical activity for older patients.

PubMed

Kligman, E W; Pepin, E

1992-08-01

Regular exercise is an effective nonpharmacologic therapy for stress, sleep disorders, depression, and anxiety, as well as such chronic conditions of aging as hypertension, obesity, diabetes mellitus, coronary artery disease, hyperlipidemia, and constipation. Pre-exercise office assessment of cardiac risk, possible limitations, and contraindications is advised. A balanced fitness training program includes activities to increase flexibility, strength, and cardiovascular endurance. The most effective exercise prescription begins with a type of aerobic activity the patient enjoys. A prescribed schedule of stepwise increments in frequency, duration, and intensity gradually leads to a maintenance level of fitness.

Interactive computer simulations of knee-replacement surgery.

PubMed

Gunther, Stephen B; Soto, Gabriel E; Colman, William W

2002-07-01

Current surgical training programs in the United States are based on an apprenticeship model. This model is outdated because it does not provide conceptual scaffolding, promote collaborative learning, or offer constructive reinforcement. Our objective was to create a more useful approach by preparing students and residents for operative cases using interactive computer simulations of surgery. Total-knee-replacement surgery (TKR) is an ideal procedure to model on the computer because there is a systematic protocol for the procedure. Also, this protocol is difficult to learn by the apprenticeship model because of the multiple instruments that must be used in a specific order. We designed an interactive computer tutorial to teach medical students and residents how to perform knee-replacement surgery. We also aimed to reinforce the specific protocol of the operative procedure. Our final goal was to provide immediate, constructive feedback. We created a computer tutorial by generating three-dimensional wire-frame models of the surgical instruments. Next, we applied a surface to the wire-frame models using three-dimensional modeling. Finally, the three-dimensional models were animated to simulate the motions of an actual TKR. The tutorial is a step-by-step tutorial that teaches and tests the correct sequence of steps in a TKR. The student or resident must select the correct instruments in the correct order. The learner is encouraged to learn the stepwise surgical protocol through repetitive use of the computer simulation. Constructive feedback is acquired through a grading system, which rates the student's or resident's ability to perform the task in the correct order. The grading system also accounts for the time required to perform the simulated procedure. We evaluated the efficacy of this teaching technique by testing medical students who learned by the computer simulation and those who learned by reading the surgical protocol manual. Both groups then performed TKR on manufactured bone models using real instruments. Their technique was graded with the standard protocol. The students who learned on the computer simulation performed the task in a shorter time and with fewer errors than the control group. They were also more engaged in the learning process. Surgical training programs generally lack a consistent approach to preoperative education related to surgical procedures. This interactive computer tutorial has allowed us to make a quantum leap in medical student and resident teaching in our orthopedic department because the students actually participate in the entire process. Our technique provides a linear, sequential method of skill acquisition and direct feedback, which is ideally suited for learning stepwise surgical protocols. Since our initial evaluation has shown the efficacy of this program, we have implemented this teaching tool into our orthopedic curriculum. Our plans for future work with this simulator include modeling procedures involving other anatomic areas of interest, such as the hip and shoulder.

Biosimilars: The US Regulatory Framework.

PubMed

Christl, Leah A; Woodcock, Janet; Kozlowski, Steven

2017-01-14

With the passage of the Biologics Price Competition and Innovation Act of 2009, the US Food and Drug Administration established an abbreviated pathway for developing and licensing biosimilar and interchangeable biological products. The regulatory framework and the technical requirements of the US biosimilars program involve a stepwise approach that relies heavily on analytical methods to demonstrate through a "totality of the evidence" that a proposed product is biosimilar to its reference product. By integrating analytical, pharmacological, and clinical data, each of which has limitations, a high level of confidence can be reached regarding clinical performance. Although questions and concerns about the biosimilars pathway remain and may slow uptake, a robust scientific program has been put in place. With three biosimilars already licensed and numerous development programs under way, clinicians can expect to see many new biosimilars come onto the US market in the coming decade. [Note added in proof: Since the writing of this article, a fourth biosimilar has been approved.].

Impact of the Japanese 5S management method on patients’ and caretakers’ satisfaction: a quasi-experimental study in Senegal

PubMed Central

Kanamori, Shogo; Castro, Marcia C.; Sow, Seydou; Matsuno, Rui; Cissokho, Alioune; Jimba, Masamine

2016-01-01

Background The 5S method is a lean management tool for workplace organization, with 5S being an abbreviation for five Japanese words that translate to English as Sort, Set in Order, Shine, Standardize, and Sustain. In Senegal, the 5S intervention program was implemented in 10 health centers in two regions between 2011 and 2014. Objective To identify the impact of the 5S intervention program on the satisfaction of clients (patients and caretakers) who visited the health centers. Design A standardized 5S intervention protocol was implemented in the health centers using a quasi-experimental separate pre-post samples design (four intervention and three control health facilities). A questionnaire with 10 five-point Likert items was used to measure client satisfaction. Linear regression analysis was conducted to identify the intervention's effect on the client satisfaction scores, represented by an equally weighted average of the 10 Likert items (Cronbach's alpha=0.83). Additional regression analyses were conducted to identify the intervention's effect on the scores of each Likert item. Results Backward stepwise linear regression (n=1,928) indicated a statistically significant effect of the 5S intervention, represented by an increase of 0.19 points in the client satisfaction scores in the intervention group, 6 to 8 months after the intervention (p=0.014). Additional regression analyses showed significant score increases of 0.44 (p=0.002), 0.14 (p=0.002), 0.06 (p=0.019), and 0.17 (p=0.044) points on four items, which, respectively were healthcare staff members’ communication, explanations about illnesses or cases, and consultation duration, and clients’ overall satisfaction. Conclusions The 5S has the potential to improve client satisfaction at resource-poor health facilities and could therefore be recommended as a strategic option for improving the quality of healthcare service in low- and middle-income countries. To explore more effective intervention modalities, further studies need to address the mechanisms by which 5S leads to attitude changes in healthcare staff. PMID:27900932

Impact of “Sick” and “Recovery” Roles on Brain Injury Rehabilitation Outcomes

PubMed Central

Barclay, David A.

2012-01-01

This study utilizes a multivariate, correlational, expost facto research design to examine Parsons' “sick role” as a dynamic, time-sensitive process of “sick role” and “recovery role” and the impact of this process on goal attainment (H1) and psychosocial distress (H2) of adult survivors of acquired brain injury. Measures used include the Brief Symptom Inventory-18, a Goal Attainment Scale, and an original instrument to measure sick role process. 60 survivors of ABI enrolled in community reentry rehabilitation participated. Stepwise regression analyses did not fully support the multivariate hypotheses. Two models emerged from the stepwise analyses. Goal attainment, gender, and postrehab responsibilities accounted for 40% of the shared variance of psychosocial distress. Anxiety and depression accounted for 22% of the shared variance of goal attainment with anxiety contributing to the majority of the explained variance. Bivariate analysis found sick role variables, anxiety, somatization, depression, gender, and goal attainment as significant. The study has implications for ABI rehabilitation in placing greater emphasis on sick role processes, anxiety, gender, and goal attainment in guiding program planning and future research with survivors of ABI. PMID:23119164

Effects of stepwise dry/wet-aging and freezing on meat quality of beef loins.

PubMed

Kim, Yuan H Brad; Meyers, Brandon; Kim, Hyun-Wook; Liceaga, Andrea M; Lemenager, Ronald P

2017-01-01

The objective of this study was to evaluate the effects of stepwise dry/wet-aging and freezing method on quality attributes of beef loins. Paired loins (M. Longissimus lumborum) from eight carcasses were assigned to either stepwise dry/wet-aging (carcass dry-aging for 10days then further wet-aging for 7days in vacuum bags) or carcass dry-aging only for 17days. Then, each loin was divided into three sections for freezing (never-frozen, blast or cryogenic freezing). Stepwise dry/wet-aged loin had lower purge/drip loss and shear force than conventionally dry-aged loin (P<0.05), but similar color and sensory characteristics (P>0.05). The cryogenic freezing resulted in a significant decrease in shear force values and a significant improvement in water-holding capacity (WHC). These findings indicate that the stepwise dry/wet-aging coupled with cryogenic freezing could provide beneficial impacts to the local meat industry by providing equivalent quality attributes as conventional dry-aging and improving WHC of frozen/thawed meat, while reducing the time needed for dry-aging. Copyright © 2016 Elsevier Ltd. All rights reserved.

"During early implementation you just muddle through": factors that impacted a statewide arthritis program's implementation.

PubMed

Conte, Kathleen P; Marie Harvey, S; Turner Goins, R

2017-12-01

The need to scale-up effective arthritis self-management programs is pressing as the prevalence of arthritis increases. The CDC Arthritis Program funds state health departments to work with local delivery systems to embed arthritis programs into their day-to-day work. To encourage organizational ownership and sustainability of programs, funding is restricted to offset program start-up costs. The purpose of this study was to identify factors that impacted the success of implementing an evidence-based arthritis self-management program, funded by the CDC Arthritis Program, into the Oregon Extension Service. We interviewed staff and partners involved in implementation who had and had not successfully delivered Walk With Ease (N = 12) to identify barriers and facilitators to scaling-up. Document analysis of administrative records was used to triangulate and expand on findings. Delivery goals defined by the funder were not met in Year 1: only 3 of the expected 28 programs were delivered. Barriers to implementation included insufficient planning for implementation driven by pressure to deliver programs and insufficient resources to support staff time. Facilitators included centralized administration of key implementation activities and staffs' previous experience implementing new programs. The importance of planning and preparing for implementation cannot be overlooked. Funders, however, eager to see deliverables, continue to define implementation goals in terms of program reach, exclusive of capacity-building. Lack of capacity-building can jeopardize staff buy-in, implementation quality, and sustainability. Based on our findings coupled with support from implementation literature, we offer recommendations for future large-scale implementation efforts operating under such funding restrictions.

Measuring the Implementation Fidelity of Student Affairs Programs: A Critical Component of the Outcomes Assessment Cycle

ERIC Educational Resources Information Center

Gerstner, Jerusha J.; Finney, Sara J.

2013-01-01

Implementation fidelity assessment provides a means of measuring the alignment between the planned program and the implemented program. Unfortunately, the implemented program can differ from the planned program, resulting in ambiguous inferences about the planned program's effectiveness (i.e., it is uncertain if poor results are due to an…

Sustainability of teacher implementation of school-based mental health programs.

PubMed

Han, Susan S; Weiss, Bahr

2005-12-01

Evidence-based prevention and intervention programs are increasingly being implemented in schools and it therefore is becoming increasingly important to understand the complexities of program implementation under real-world conditions. Much research has focused on the contextual factors that influence program implementation but less work has attempted to provide an integrated understanding of mechanisms (e.g., teacher-training processes) that affect teachers' program implementation. In this paper, we review literature on factors related to teachers' implementation of school-based prevention and intervention programs, then from this review abstract what we believe are four basic ingredients that characterize potentially sustainable teacher-implemented classroom programs. Finally, we present a sequential model, based on these ingredients, of the naturalistic processes underlying sustainability of teachers' program implementation and describe how this sustainability can be enhanced through provision of teacher training and performance feedback from a classroom consultant.

Increasing fetal ovine number per gestation alters fetal plasma clinical chemistry values.

PubMed

Zywicki, Micaela; Blohowiak, Sharon E; Magness, Ronald R; Segar, Jeffrey L; Kling, Pamela J

2016-08-01

Intrauterine growth restriction (IUGR) is interconnected with developmental programming of lifelong pathophysiology. IUGR is seen in human multifetal pregnancies, with stepwise rises in fetal numbers interfering with placental nutrient delivery. It remains unknown whether fetal blood analyses would reflect fetal nutrition, liver, and excretory function in the last trimester of human or ovine IUGR In an ovine model, we hypothesized that fetal plasma biochemical values would reflect progressive placental, fetal liver, and fetal kidney dysfunction as the number of fetuses per gestation rose. To determine fetal plasma biochemical values in singleton, twin, triplet, and quadruplet/quintuplet ovine gestation, we investigated morphometric measures and comprehensive metabolic panels with nutritional measures, liver enzymes, and placental and fetal kidney excretory measures at gestational day (GD) 130 (90% gestation). As anticipated, placental dysfunction was supported by a stepwise fall in fetal weight, fetal plasma glucose, and triglyceride levels as fetal number per ewe rose. Fetal glucose and triglycerides were directly related to fetal weight. Plasma creatinine, reflecting fetal renal excretory function, and plasma cholesterol, reflecting placental excretory function, were inversely correlated with fetal weight. Progressive biochemical disturbances and growth restriction accompanied the rise in fetal number. Understanding the compensatory and adaptive responses of growth-restricted fetuses at the biochemical level may help explain how metabolic pathways in growth restriction can be predetermined at birth. This physiological understanding is important for clinical care and generating interventional strategies to prevent altered developmental programming in multifetal gestation. © 2016 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

Evidence-based development of school-based and family-involved prevention of overweight across Europe: the ENERGY-project's design and conceptual framework.

PubMed

Brug, Johannes; te Velde, Saskia J; Chinapaw, Mai J M; Bere, Elling; de Bourdeaudhuij, Ilse; Moore, Helen; Maes, Lea; Jensen, Jorgen; Manios, Yannis; Lien, Nanna; Klepp, Knut Inge; Lobstein, Tim; Martens, Marloes; Salmon, Jo; Singh, Amika S

2010-05-25

There is an urgent need for more carefully developed public health measures in order to curb the obesity epidemic among youth. The overall aim of the "EuropeaN Energy balance Research to prevent excessive weight Gain among Youth" (ENERGY)-project is the development and formative evaluation of a theory-informed and evidence-based multi-component school-based and family-involved intervention program ready to be implemented and evaluated for effectiveness across Europe. This program aims at promoting the adoption or continuation of health behaviors that contribute to a healthy energy balance among school-aged children. Earlier studies have indicated that school and family environments are key determinants of energy-balance behaviors in schoolchildren. Schools are an important setting for health promotion in this age group, but school-based interventions mostly fail to target and involve the family environment. Led by a multidisciplinary team of researchers from eleven European countries and supported by a team of Australian experts, the ENERGY-project is informed by the Environmental Research Framework for Weight gain Prevention, and comprises a comprehensive epidemiological analysis including 1) systematic reviews of the literature, 2) secondary analyses of existing data, 3) focus group research, and 4) a cross European school-based survey. The theoretical framework and the epidemiological analysis will subsequently inform stepwise intervention development targeting the most relevant energy balance-related behaviors and their personal, family-environmental and school-environmental determinants applying the Intervention Mapping protocol. The intervention scheme will undergo formative and pilot evaluation in five countries. The results of ENERGY will be disseminated among key stakeholders including researchers, policy makers and the general population. The ENERGY-project is an international, multidisciplinary effort to develop and test an evidence-based and theory-informed intervention program for obesity prevention among school-aged children.

Prenatal Predictors of Maternal Attachment and Their Association with Postpartum Depressive Symptoms in Mexican Women at Risk of Depression.

PubMed

Nieto, Lourdes; Lara, Ma Asunción; Navarrete, Laura

2017-06-01

Objectives Although maternal attachment is an important predictor of infant developmental outcomes, little is known about its pre- and postnatal predictors. The purpose of this secondary data analysis is to assess several risk factors for maternal attachment at 6 months postpartum in a sample of Mexican women at risk of depression. The predictors included were prenatal depressive symptoms, pregnancy intendedness, partner relationship, social support, maternal history of childhood sexual abuse, and postpartum depressive symptoms. Methods A total of 156 pregnant women seeking antenatal care at three health centers were selected because they displayed depressive symptoms (CES-D ≥ 16) or had previously suffered depression. Women were interviewed during pregnancy and at 6 months postpartum. A step-wise multivariate logistic regression was conducted to evaluate the pre- and postpartum risk factors for postpartum depression related to low maternal attachment. Results Pre- and postpartum depressive symptoms increased the risk of low maternal attachment by factors of 3.00 and 3.97, respectively, compared with women who did not present these symptoms; low level of adjustment with the partner increased the risk by a factor of 3.11, low social support by a factor of 2.90, and CSA by a factor of 2.77. Conclusions for practice Prevention programs during pregnancy to reduce depressive symptoms should strengthen strategies to promote maternal attachment by improving partner relations and increasing social support. However, evidence shows that such programs alone are insufficient, so direct interventions should also be implemented. Women with a history of childhood sexual abuse should be given additional attention during prenatal care.

Endovascular treatment outcomes using the Stroke Triage Education, Procedure Standardization, and Technology (STEPS-T) program.

PubMed

Hassan, Ameer E; Sanchez, Christina; Johnson, Angela N

2018-02-01

Background "Door to treatment" time affects outcomes of acute ischemic stroke (AIS) patients undergoing endovascular treatment (EVT). However, the correlation between staff education and accessible technology with stroke outcomes has not been demonstrated. Objective The objective of this paper is to demonstrate the five-year impact of the Stroke Triage Education, Procedure Standardization, and Technology (STEPS-T) program on time-to-treat and clinical outcomes. Methods The study analyzed a prospectively maintained database of AIS patients who benefited from EVT through implementation of STEPS-T. Demographics, clinical characteristics, and modified Rankin Score at three months were analyzed. Thrombolysis in Cerebral Infarction (TICI) scale was used to grade pre- and post-procedure angiographic recanalization. Using electronic hemodynamic recording, stepwise workflow times were collected for door time (T D ), entering angiography suite (T A ), groin puncture (T G ), first DSA (T DSA ), microcatheter placement (T M ), and final recanalization (T R ). Median intervention time (T A to T R ) and recanalization time (T G to T R ) were compared through Year 1 to Year 5. Results A total of 230 individuals (age 74 ± 12, between 30 to 95) were enrolled. Median intervention and recanalization times were significantly reduced, from 121 minutes to 52 minutes and from 83 minutes to 36 minutes respectively from Year 1 to Year 5, ( p < 0.001). Across the study period, annual recruitment went up from 12 to 66 patients, and modified Rankin Score between 0 and 2 increased from 36% to 59% ( p = 0.024). Conclusions STEPS-T improved time-to-treat in patients undergoing mechanical thrombectomy for AIS. During the observation period, clinical outcomes significantly improved.

Impact of chemical oxidation on indigenous bacteria and mobilization of nutrients and subsequent bioremediation of crude oil-contaminated soil.

PubMed

Xu, Jinlan; Deng, Xin; Cui, Yiwei; Kong, Fanxing

2016-12-15

Fenton pre-oxidation provides nutrients to promote bioremediation. However, the effects of the indigenous bacteria that remain following Fenton oxidation on nutrient mobilization and subsequent bioremediation remain unclear. Experiments were performed with inoculation with native bacteria and foreign bacteria or without inoculation after four regimens of stepwise pre-oxidations. The effects of the indigenous bacteria remaining after stepwise oxidation on nutrient mobilization and subsequent bioremediation over 80 days were investigated. After stepwise Fenton pre-oxidation at a low H 2 O 2 concentration (225×4), the remaining indigenous bacterial populations reached their peak (4.8±0.17×10 6 CFU/g), the nutrients were mobilized rapidly, and the subsequent bioremediation of crude oil was improved (biodegradation efficiency of 35%). However, after stepwise Fenton pre-oxidation at a high H 2 O 2 concentration (450×4), only 3.6±0.16×10 3 CFU/g of indigenous bacteria remained, and the indigenous bacteria that degrade C 15 -C 30 alkanes were inhibited. The nutrient mobilization was then highly limited, and only 19% of total petroleum hydrocarbon was degraded. Furthermore, the recovery period after the low H 2 O 2 concentration stepwise Fenton pre-oxidation (225×4) was less than 20 days, which was 20-30 days shorter than with the other pre-oxidation treatments. Therefore, stepwise Fenton pre-oxidation at a low H 2 O 2 concentration protects indigenous bacterial populations and improves the nutrient mobilization and subsequent bioremediation. Copyright © 2016 Elsevier B.V. All rights reserved.

Relationship between COMLEX-USA scores and performance on the American Osteopathic Board of Emergency Medicine Part I certifying examination.

PubMed

Li, Feiming; Gimpel, John R; Arenson, Ethan; Song, Hao; Bates, Bruce P; Ludwin, Fredric

2014-04-01

Few studies have investigated how well scores from the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) series predict resident outcomes, such as performance on board certification examinations. To determine how well COMLEX-USA predicts performance on the American Osteopathic Board of Emergency Medicine (AOBEM) Part I certification examination. The target study population was first-time examinees who took AOBEM Part I in 2011 and 2012 with matched performances on COMLEX-USA Level 1, Level 2-Cognitive Evaluation (CE), and Level 3. Pearson correlations were computed between AOBEM Part I first-attempt scores and COMLEX-USA performances to measure the association between these examinations. Stepwise linear regression analysis was conducted to predict AOBEM Part I scores by the 3 COMLEX-USA scores. An independent t test was conducted to compare mean COMLEX-USA performances between candidates who passed and who failed AOBEM Part I, and a stepwise logistic regression analysis was used to predict the log-odds of passing AOBEM Part I on the basis of COMLEX-USA scores. Scores from AOBEM Part I had the highest correlation with COMLEX-USA Level 3 scores (.57) and slightly lower correlation with COMLEX-USA Level 2-CE scores (.53). The lowest correlation was between AOBEM Part I and COMLEX-USA Level 1 scores (.47). According to the stepwise regression model, COMLEX-USA Level 1 and Level 2-CE scores, which residency programs often use as selection criteria, together explained 30% of variance in AOBEM Part I scores. Adding Level 3 scores explained 37% of variance. The independent t test indicated that the 397 examinees passing AOBEM Part I performed significantly better than the 54 examinees failing AOBEM Part I in all 3 COMLEX-USA levels (P<.001 for all 3 levels). The logistic regression model showed that COMLEX-USA Level 1 and Level 3 scores predicted the log-odds of passing AOBEM Part I (P=.03 and P<.001, respectively). The present study empirically supported the predictive and discriminant validities of the COMLEX-USA series in relation to the AOBEM Part I certification examination. Although residency programs may use COMLEX-USA Level 1 and Level 2-CE scores as partial criteria in selecting residents, Level 3 scores, though typically not available at the time of application, are actually the most statistically related to performances on AOBEM Part I.

A conceptual framework for the collection of food products in a Total Diet Study.

PubMed

Turrini, Aida; Lombardi-Boccia, Ginevra; Aureli, Federica; Cubadda, Francesco; D'Addezio, Laura; D'Amato, Marilena; D'Evoli, Laura; Darnerud, PerOla; Devlin, Niamh; Dias, Maria Graça; Jurković, Marina; Kelleher, Cecily; Le Donne, Cinzia; López Esteban, Maite; Lucarini, Massimo; Martinez Burgos, Maria Alba; Martínez-Victoria, Emilio; McNulty, Breige; Mistura, Lorenza; Nugent, Anne; Oktay Basegmez, Hatice Imge; Oliveira, Luisa; Ozer, Hayrettin; Perelló, Gemma; Pite, Marina; Presser, Karl; Sokolić, Darja; Vasco, Elsa; Volatier, Jean-Luc

2018-02-01

A total diet study (TDS) provides representative and realistic data for assessing the dietary intake of chemicals, such as contaminants and residues, and nutrients, at a population level. Reproducing the diet through collection of customarily consumed foods and their preparation as habitually eaten is crucial to ensure representativeness, i.e., all relevant foods are included and all potential dietary sources of the substances investigated are captured. Having this in mind, a conceptual framework for building a relevant food-shopping list was developed as a research task in the European Union's 7th Framework Program project, 'Total Diet Study Exposure' (TDS-Exposure), aimed at standardising methods for food sampling, analyses, exposure assessment calculations and modelling, priority foods, and selection of chemical contaminants. A stepwise approach following the knowledge translation (KT) model for concept analysis is proposed to set up a general protocol for the collection of food products in a TDS in terms of steps (characterisation of the food list, development of the food-shopping list, food products collection) and pillars (background documentation, procedures, and tools). A simple model for structuring the information in a way to support the implementation of the process, by presenting relevant datasets, forms to store inherent information, and folders to record the results is also proposed. Reproducibility of the process and possibility to exploit the gathered information are two main features of such a system for future applications.

Culturally Adaptive Walking Intervention for Korean-Chinese Female Migrant Workers.

PubMed

Cho, Sunghye; Lee, Hyeonkyeong; Kim, Jung Hee; Lee, Meenhye; Lee, Young-Me

2017-05-01

Although the literature has commonly cited that development of culturally adaptive interventions is key to improving the health outcomes of culturally and linguistically diverse populations, there have been limited culturally adaptive walking interventions specific to Korean-Chinese (KC) migrants. The objective of this study is to describe the process in development of culturally adaptive walking interventions for KC female migrant workers, using the intervention mapping (IM) method. The culturally adaptive walking intervention was developed using the IM method, which is a stepwise theory and evidence-based approach for planning interventions. The IM method process has six steps, including needs assessment, formulation of change objectives, selection of theory-based methods and practical strategies, development of an intervention program, development of an adoption and implementation plan, and development of an evaluation design. The determinants of walking behavior, including knowledge, self-efficacy, social support, and acculturation, were identified through an extensive literature review, community leader interviews, and a survey of female KC migrant workers. Appropriate intervention methods and strategies were identified based on relevant theories. Acculturation was a determinant of exercise behavior, and various methods to improve cultural adaptation were identified in the context of the lifestyles and working environments of the target population. The IM method provided a foundation for creating a health intervention for KC female migrant workers. This method could easily be useful for health care providers working with other groups.

Program Implementers' Evaluation of the Project P.A.T.H.S.: Findings Based on Different Datasets over Time

PubMed Central

Shek, Daniel T. L.; Ma, Cecilia M. S.

2012-01-01

This paper integrates the evaluation findings based on program implementers in nine datasets collected from 2005 to 2009 (244 schools and 7,926 implementers). Using consolidated data with schools as the unit of analysis, results showed that program implementers generally had positive perceptions of the program, themselves, and benefits of the program, with more than four-fifths of the implementers regarding the program as beneficial to the program participants. The subjective outcome evaluation instrument was found to be internally consistent. Multiple regression analyses revealed that perceived qualities of the program and program implementers predicted perceived effectiveness of the program. In conjunction with evaluation findings based on other sources, the present study provides support for the effectiveness of the Tier 1 Program of the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes) in Hong Kong. PMID:22629224

Country actions to meet UN commitments on non-communicable diseases: a stepwise approach.

PubMed

Bonita, Ruth; Magnusson, Roger; Bovet, Pascal; Zhao, Dong; Malta, Deborah C; Geneau, Robert; Suh, Il; Thankappan, Kavumpurathu Raman; McKee, Martin; Hospedales, James; de Courten, Maximilian; Capewell, Simon; Beaglehole, Robert

2013-02-16

Strong leadership from heads of state is needed to meet national commitments to the UN political declaration on non-communicable diseases (NCDs) and to achieve the goal of a 25% reduction in premature NCD mortality by 2025 (the 25 by 25 goal). A simple, phased, national response to the political declaration is suggested, with three key steps: planning, implementation, and accountability. Planning entails mobilisation of a multisectoral response to develop and support the national action plan, and to build human, financial, and regulatory capacity for change. Implementation of a few priority and feasible cost-effective interventions for the prevention and treatment of NCDs will achieve the 25 by 25 goal and will need only few additional financial resources. Accountability incorporates three dimensions: monitoring of progress, reviewing of progress, and appropriate responses to accelerate progress. A national NCD commission or equivalent, which is independent of government, is needed to ensure that all relevant stakeholders are held accountable for the UN commitments to NCDs. Copyright © 2013 Elsevier Ltd. All rights reserved.

Strategy for design NIR calibration sets based on process spectrum and model space: An innovative approach for process analytical technology.

PubMed

Cárdenas, V; Cordobés, M; Blanco, M; Alcalà, M

2015-10-10

The pharmaceutical industry is under stringent regulations on quality control of their products because is critical for both, productive process and consumer safety. According to the framework of "process analytical technology" (PAT), a complete understanding of the process and a stepwise monitoring of manufacturing are required. Near infrared spectroscopy (NIRS) combined with chemometrics have lately performed efficient, useful and robust for pharmaceutical analysis. One crucial step in developing effective NIRS-based methodologies is selecting an appropriate calibration set to construct models affording accurate predictions. In this work, we developed calibration models for a pharmaceutical formulation during its three manufacturing stages: blending, compaction and coating. A novel methodology is proposed for selecting the calibration set -"process spectrum"-, into which physical changes in the samples at each stage are algebraically incorporated. Also, we established a "model space" defined by Hotelling's T(2) and Q-residuals statistics for outlier identification - inside/outside the defined space - in order to select objectively the factors to be used in calibration set construction. The results obtained confirm the efficacy of the proposed methodology for stepwise pharmaceutical quality control, and the relevance of the study as a guideline for the implementation of this easy and fast methodology in the pharma industry. Copyright © 2015 Elsevier B.V. All rights reserved.

Cushing's syndrome: Stepwise approach to diagnosis

PubMed Central

Lila, Anurag R.; Sarathi, Vijaya; Jagtap, Varsha S.; Bandgar, Tushar; Menon, Padmavathy; Shah, Nalini S.

2011-01-01

The projected prevalence of Cushing's syndrome (CS) inclusive of subclinical cases in the adult population ranges from 0.2–2% and it may no longer be considered as an orphan disease (2–3 cases/million/year). The recognition of CS by physicians is important for early diagnosis and treatment. Late-night salivary cortisol, dexamethasone suppressiontesti, or 24-h urine free cortisol are good screening tests. Positively screened cases need stepwise evaluation by an endocrinologist. This paper discusses the importance of screening for CS and suggests a stepwise diagnostic approach to a case of suspected hypercortisolism. PMID:22145134

Stepwise pH-responsive nanoparticles for enhanced cellular uptake and on-demand intracellular release of doxorubicin.

PubMed

Chen, Wei-Liang; Li, Fang; Tang, Yan; Yang, Shu-di; Li, Ji-Zhao; Yuan, Zhi-Qiang; Liu, Yang; Zhou, Xiao-Feng; Liu, Chun; Zhang, Xue-Nong

2017-01-01

Physicochemical properties, including particle size, zeta potential, and drug release behavior, affect targeting efficiency, cellular uptake, and antitumor effect of nanocarriers in a formulated drug-delivery system. In this study, a novel stepwise pH-responsive nanodrug delivery system was developed to efficiently deliver and significantly promote the therapeutic effect of doxorubicin (DOX). The system comprised dimethylmaleic acid-chitosan-urocanic acid and elicited stepwise responses to extracellular and intracellular pH. The nanoparticles (NPs), which possessed negative surface charge under physiological conditions and an appropriate nanosize, exhibited advantageous stability during blood circulation and enhanced accumulation in tumor sites via enhanced permeability and retention effect. The tumor cellular uptake of DOX-loaded NPs was significantly promoted by the first-step pH response, wherein surface charge reversion of NPs from negative to positive was triggered by the slightly acidic tumor extracellular environment. After internalization into tumor cells, the second-step pH response in endo/lysosome acidic environment elicited the on-demand intracellular release of DOX from NPs, thereby increasing cytotoxicity against tumor cells. Furthermore, stepwise pH-responsive NPs showed enhanced antiproliferation effect and reduced systemic side effect in vivo. Hence, the stepwise pH-responsive NPs provide a promising strategy for efficient delivery of antitumor agents.

Stepwise pH-responsive nanoparticles for enhanced cellular uptake and on-demand intracellular release of doxorubicin

PubMed Central

Chen, Wei-liang; Li, Fang; Tang, Yan; Yang, Shu-di; Li, Ji-zhao; Yuan, Zhi-qiang; Liu, Yang; Zhou, Xiao-feng; Liu, Chun; Zhang, Xue-nong

2017-01-01

Physicochemical properties, including particle size, zeta potential, and drug release behavior, affect targeting efficiency, cellular uptake, and antitumor effect of nanocarriers in a formulated drug-delivery system. In this study, a novel stepwise pH-responsive nanodrug delivery system was developed to efficiently deliver and significantly promote the therapeutic effect of doxorubicin (DOX). The system comprised dimethylmaleic acid-chitosan-urocanic acid and elicited stepwise responses to extracellular and intracellular pH. The nanoparticles (NPs), which possessed negative surface charge under physiological conditions and an appropriate nanosize, exhibited advantageous stability during blood circulation and enhanced accumulation in tumor sites via enhanced permeability and retention effect. The tumor cellular uptake of DOX-loaded NPs was significantly promoted by the first-step pH response, wherein surface charge reversion of NPs from negative to positive was triggered by the slightly acidic tumor extracellular environment. After internalization into tumor cells, the second-step pH response in endo/lysosome acidic environment elicited the on-demand intracellular release of DOX from NPs, thereby increasing cytotoxicity against tumor cells. Furthermore, stepwise pH-responsive NPs showed enhanced antiproliferation effect and reduced systemic side effect in vivo. Hence, the stepwise pH-responsive NPs provide a promising strategy for efficient delivery of antitumor agents. PMID:28652730

How Do Implementation Efforts Relate to Program Adherence? Examining the Role of Organizational, Implementer, and Program Factors

ERIC Educational Resources Information Center

Dariotis, Jacinda K.; Bumbarger, Brian K.; Duncan, Larissa G.; Greenberg, Mark T.

2008-01-01

Widespread replications of evidence-based prevention programs (EBPPs) prompt prevention scientists to examine program implementation adherence in real world settings. Based on Chen's model (1990), we identified five key factors of the implementation system and assessed which characteristics related to program adherence. The sample included 32…

Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns.

PubMed

Moradi-Lakeh, Maziar; Vosoogh-Moghaddam, Abbas

2015-08-31

In 2014, a series of reforms, called as the Health Sector Evolution Plan (HSEP), was launched in the health system of Iran in a stepwise process. HSEP was mainly based on the fifth 5-year health development national strategies (2011-2016). It included different interventions to: increase population coverage of basic health insurance, increase quality of care in the Ministry of Health and Medical Education (MoHME) affiliated hospitals, reduce out-of-pocket (OOP) payments for inpatient services, increase quality of primary healthcare, launch updated relative value units (RVUs) of clinical services, and update tariffs to more realistic values. The reforms resulted in extensive social reaction and different professional feedback. The official monitoring program shows general public satisfaction. However, there are some concerns for sustainability of the programs and equity of financing. Securing financial sources and fairness of the financial contribution to the new programs are the main concerns of policy-makers. Healthcare providers' concerns (as powerful and influential stakeholders) potentially threat the sustainability and efficiency of HSEP. Previous experiences on extending health insurance coverage show that they can lead to a regressive healthcare financing and threat financial equity. To secure financial sources and to increase fairness, the contributions of people to new interventions should be progressive by their income and wealth. A specific progressive tax would be the best source, however, since it is not immediately feasible, a stepwise increase in the progressivity of financing must be followed. Technical concerns of healthcare providers (such as nonplausible RVUs for specific procedures or nonefficient insurance-provider processes) should be addressed through proper revision(s) while nontechnical concerns (which are derived from conflicting interests) must be responded through clarification and providing transparent information. The requirements of HSEP and especially the key element of progressive tax should be considered properly in the coming sixth national development plan (2016-2021). © 2015 by Kerman University of Medical Sciences.

Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns

PubMed Central

Moradi-Lakeh, Maziar; Vosoogh-Moghaddam, Abbas

2015-01-01

In 2014, a series of reforms, called as the Health Sector Evolution Plan (HSEP), was launched in the health system of Iran in a stepwise process. HSEP was mainly based on the fifth 5-year health development national strategies (2011-2016). It included different interventions to: increase population coverage of basic health insurance, increase quality of care in the Ministry of Health and Medical Education (MoHME) affiliated hospitals, reduce out-of-pocket (OOP) payments for inpatient services, increase quality of primary healthcare, launch updated relative value units (RVUs) of clinical services, and update tariffs to more realistic values. The reforms resulted in extensive social reaction and different professional feedback. The official monitoring program shows general public satisfaction. However, there are some concerns for sustainability of the programs and equity of financing. Securing financial sources and fairness of the financial contribution to the new programs are the main concerns of policy-makers. Healthcare providers’ concerns (as powerful and influential stakeholders) potentially threat the sustainability and efficiency of HSEP. Previous experiences on extending health insurance coverage show that they can lead to a regressive healthcare financing and threat financial equity. To secure financial sources and to increase fairness, the contributions of people to new interventions should be progressive by their income and wealth. A specific progressive tax would be the best source, however, since it is not immediately feasible, a stepwise increase in the progressivity of financing must be followed. Technical concerns of healthcare providers (such as nonplausible RVUs for specific procedures or nonefficient insurance-provider processes) should be addressed through proper revision(s) while nontechnical concerns (which are derived from conflicting interests) must be responded through clarification and providing transparent information. The requirements of HSEP and especially the key element of progressive tax should be considered properly in the coming sixth national development plan (2016-2021). PMID:26673172

Impact of stepwise introduction of smoke-free legislation on population rates of acute myocardial infarction deaths in Flanders, Belgium.

PubMed

Cox, Bianca; Vangronsveld, Jaco; Nawrot, Tim S

2014-09-15

Many studies demonstrated a decline in hospital admissions for cardiovascular diseases after the implementation of a smoking ban, but evidence for reductions in cardiovascular mortality is more limited. In Belgium, smoke-free legislation was implemented in different phases. Public places and most workplaces became smoke-free in January 2006, whereas the legislative ban on smoking in restaurants was introduced in January 2007. These successive steps in legislation provided us the opportunity to investigate possible stepwise changes in fatal acute myocardial infarction (AMI) rates. Data on all AMI deaths of 30 years of age or older in Flanders (Belgium) between 2000 and 2009 (n=38 992) were used. Age-standardised AMI death rates were analysed with segmented Poisson regression allowing for secular trends, seasonality, temperature, PM10 and influenza. An immediate decrease in AMI mortality rates was observed in January 2006 (smoking ban at work). The effect was highest for women younger than 60 years of age (-33.8%; 95% CI -49.6 to -13.0), compared with an effect of -13.1% (95% CI -24.3 to -0.3) for male counterparts. Estimates for the elderly (≥60 years) were -9.0% (95% CI -14.1 to -3.7) for men and 7.9% (95% CI -13.5 to -2.0) for women. An additional effect of the smoking ban in restaurants was observed for elderly men, with an annual slope change of -3.8% (95% CI -6.5 to -1.0) after 1 January 2007. Smoking ban interventions are associated with reductions in the population rate of myocardial mortality, with public health gains even before and during the middle-aged period of life. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

African Swine Fever Virus Gets Undressed: New Insights on the Entry Pathway.

PubMed

Andrés, Germán

2017-02-15

African swine fever virus (ASFV) is a large, multienveloped DNA virus composed of a genome-containing core successively wrapped by an inner lipid envelope, an icosahedral protein capsid, and an outer lipid envelope. In keeping with this structural complexity, recent studies have revealed an intricate entry program. This Gem highlights how ASFV uses two alternative pathways, macropinocytosis and clathrin-mediated endocytosis, to enter into the host macrophage and how the endocytosed particles undergo a stepwise, low pH-driven disassembly leading to inner envelope fusion and core delivery in the cytoplasm. Copyright © 2017 American Society for Microbiology.

Implementing Immediate Postpartum Long-Acting Reversible Contraception Programs.

PubMed

Hofler, Lisa G; Cordes, Sarah; Cwiak, Carrie A; Goedken, Peggy; Jamieson, Denise J; Kottke, Melissa

2017-01-01

To understand the most important steps required to implement immediate postpartum long-acting reversible contraception (LARC) programs in different Georgia hospitals and the barriers to implementing such a program. This was a qualitative study. We interviewed 32 key personnel from 10 Georgia hospitals working to establish immediate postpartum LARC programs. Data were analyzed using directed qualitative content analysis principles. We used the Stages of Implementation to organize participant-identified key steps for immediate postpartum LARC into an implementation guide. We compared this guide to hospitals' implementation experiences. At the completion of the study, LARC was available for immediate postpartum placement at 7 of 10 study hospitals. Participants identified common themes for the implementation experience: team member identification and ongoing communication, payer preparedness challenges, interdependent department-specific tasks, and piloting with continuing improvements. Participants expressed a need for anticipatory guidance throughout the process. Key first steps to immediate postpartum LARC program implementation were identifying project champions, creating an implementation team that included all relevant departments, obtaining financial reassurance, and ensuring hospital administration awareness of the project. Potential barriers included lack of knowledge about immediate postpartum LARC, financial concerns, and competing clinical and administrative priorities. Hospitals that were successful at implementing immediate postpartum LARC programs did so by prioritizing clear communication and multidisciplinary teamwork. Although the implementation guide reflects a comprehensive assessment of the steps to implementing immediate postpartum LARC programs, not all hospitals required every step to succeed. Hospital teams report that implementing immediate postpartum LARC programs involves multiple departments and a number of important steps to consider. A stage-based approach to implementation, and a standardized guide detailing these steps, may provide the necessary structure for the complex process of implementing immediate postpartum LARC programs in the hospital setting.

Food Safety Programs Based on HACCP Principles in School Nutrition Programs: Implementation Status and Factors Related to Implementation

ERIC Educational Resources Information Center

Stinson, Wendy Bounds; Carr, Deborah; Nettles, Mary Frances; Johnson, James T.

2011-01-01

Purpose/Objectives: The objectives of this study were to assess the extent to which school nutrition (SN) programs have implemented food safety programs based on Hazard Analysis and Critical Control Point (HACCP) principles, as well as factors, barriers, and practices related to implementation of these programs. Methods: An online survey was…

Implementing a Coach-Delivered Dating Violence Prevention Program with High School Athletes.

PubMed

Jaime, Maria Catrina D; McCauley, Heather L; Tancredi, Daniel J; Decker, Michele R; Silverman, Jay G; O'Connor, Brian; Miller, Elizabeth

2018-05-10

Teen dating violence and sexual violence are severe public health problems. Abusive behaviors within the context of dating or romantic relationships are associated with adverse health outcomes. Promoting positive bystander intervention and increasing knowledge of abusive behaviors are promising strategies for preventing dating and sexual violence. Coaching Boys Into Men (CBIM) is an evidence-based, athletic coach-delivered dating violence prevention program that has been shown to increase positive bystander behaviors and reduce abuse perpetration among high school male athletes. Identifying specific barriers and facilitators based on the coaches' experiences with program delivery combined with the coaches' and athletes' program perceptions may help optimize future CBIM implementation and sustainability. Semi-structured interviews with coaches (n = 36) explored the implementers' perspectives on strategies that worked well and potential barriers to program implementation. Ten focus groups with male athletes (n = 39) assessed their experiences with CBIM and the suitability of having their coaches deliver this program. Coaches described using the CBIM training cards and integrating program delivery during practice. Athletes reported coaches routinely delivering the CBIM program and adding their own personal stories or examples to the discussions. Key facilitators to program implementation include support from the violence prevention advocate, the ease of integrating CBIM into the sports season, and using the program materials. Barriers to implementation included finding sufficient time for the program, dynamics of delivering sensitive program content, and participant constraints. Coaches and athletes alike found the program feasible and acceptable to implement within the sports setting. Both coaches and athletes offered insights on the implementation and the feasibility and acceptability of CBIM within school-based athletic programs. These experiences by implementers and recipients alike can inform future dissemination and implementation efforts of CBIM. Further, by pinpointing where and how coaches were successful in implementing the program and what resonated with athletes, can help better understand how CBIM is effective in promoting athletes to stop violence against women and girls. Coach and athlete reflections on CBIM implementation provide insights for optimizing future program delivery and dissemination.

Advancing a Model-Validated Statistical Method for Decomposing the Key Oceanic Drivers of Regional Climate: Focus on Northern and Tropical African Climate Variability in the Community Earth System Model (CESM)

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

Wang, Fuyao; Yu, Yan; Notaro, Michael

This study advances the practicality and stability of the traditional multivariate statistical method, generalized equilibrium feedback assessment (GEFA), for decomposing the key oceanic drivers of regional atmospheric variability, especially when available data records are short. An advanced stepwise GEFA methodology is introduced, in which unimportant forcings within the forcing matrix are eliminated through stepwise selection. Method validation of stepwise GEFA is performed using the CESM, with a focused application to northern and tropical Africa (NTA). First, a statistical assessment of the atmospheric response to each primary oceanic forcing is carried out by applying stepwise GEFA to a fully coupled controlmore » run. Then, a dynamical assessment of the atmospheric response to individual oceanic forcings is performed through ensemble experiments by imposing sea surface temperature anomalies over focal ocean basins. Finally, to quantify the reliability of stepwise GEFA, the statistical assessment is evaluated against the dynamical assessment in terms of four metrics: the percentage of grid cells with consistent response sign, the spatial correlation of atmospheric response patterns, the area-averaged seasonal cycle of response magnitude, and consistency in associated mechanisms between assessments. In CESM, tropical modes, namely El Niño–Southern Oscillation and the tropical Indian Ocean Basin, tropical Indian Ocean dipole, and tropical Atlantic Niño modes, are the dominant oceanic controls of NTA climate. In complementary studies, stepwise GEFA is validated in terms of isolating terrestrial forcings on the atmosphere, and observed oceanic and terrestrial drivers of NTA climate are extracted to establish an observational benchmark for subsequent coupled model evaluation and development of process-based weights for regional climate projections.« less

Advancing a Model-Validated Statistical Method for Decomposing the Key Oceanic Drivers of Regional Climate: Focus on Northern and Tropical African Climate Variability in the Community Earth System Model (CESM)

DOE PAGES

Wang, Fuyao; Yu, Yan; Notaro, Michael; ...

2017-09-27

This study advances the practicality and stability of the traditional multivariate statistical method, generalized equilibrium feedback assessment (GEFA), for decomposing the key oceanic drivers of regional atmospheric variability, especially when available data records are short. An advanced stepwise GEFA methodology is introduced, in which unimportant forcings within the forcing matrix are eliminated through stepwise selection. Method validation of stepwise GEFA is performed using the CESM, with a focused application to northern and tropical Africa (NTA). First, a statistical assessment of the atmospheric response to each primary oceanic forcing is carried out by applying stepwise GEFA to a fully coupled controlmore » run. Then, a dynamical assessment of the atmospheric response to individual oceanic forcings is performed through ensemble experiments by imposing sea surface temperature anomalies over focal ocean basins. Finally, to quantify the reliability of stepwise GEFA, the statistical assessment is evaluated against the dynamical assessment in terms of four metrics: the percentage of grid cells with consistent response sign, the spatial correlation of atmospheric response patterns, the area-averaged seasonal cycle of response magnitude, and consistency in associated mechanisms between assessments. In CESM, tropical modes, namely El Niño–Southern Oscillation and the tropical Indian Ocean Basin, tropical Indian Ocean dipole, and tropical Atlantic Niño modes, are the dominant oceanic controls of NTA climate. In complementary studies, stepwise GEFA is validated in terms of isolating terrestrial forcings on the atmosphere, and observed oceanic and terrestrial drivers of NTA climate are extracted to establish an observational benchmark for subsequent coupled model evaluation and development of process-based weights for regional climate projections.« less

Implementation and Validation of PACS Integrated Peer Review for Discrepancy Recording of Radiology Reporting.

PubMed

Olthof, A W; van Ooijen, P M A

2016-09-01

The purpose of this work is to demonstrate the possibility of implementation of a PACS-integrated peer review system based on RADPEER™ classification providing a step-wise implementation plan utilizing features already present in the standard PACS implementation and without the requirement of additional software development. Furthermore, we show the usage and effects of the system during the first 30 months of usage. To allow fast and easy implementation into the daily workflow the key-word feature of the PACS was used. This feature allows to add a key-word to an imaging examination for easy searching in the PACS database (e.g. by entering keywords for different kinds of pathology). For peer review we implemented a keyword structure including a code for each of the existing RADPEER™ scoring language terms and a keyword with the phrase "second reading" followed by the name of the individual radiologist. The use of the short-keys to enter the codes in relation to the peer review was a simple to use solution. During the study 599 reports were peer reviewed. The active participation in this study of the radiologists varies and ranges from 3 to 327 reviews per radiologist. The number of peer review is highest in CT and CR. There are no significant technical obstacles to implement a PACS-integrated RADPEER™ -system based on key-words allowing easy integration of peer review into the daily routine without the requirement of additional software. Peer review implemented in a non-random setting based on relevant priors could already help in increasing the quality of radiological reporting and serve as continuing education among peers. Decisiveness, tact and trust are needed to promote use of the system and collaborative discussion of the results by radiologist.

Impact of statistical learning methods on the predictive power of multivariate normal tissue complication probability models.

PubMed

Xu, Cheng-Jian; van der Schaaf, Arjen; Schilstra, Cornelis; Langendijk, Johannes A; van't Veld, Aart A

2012-03-15

To study the impact of different statistical learning methods on the prediction performance of multivariate normal tissue complication probability (NTCP) models. In this study, three learning methods, stepwise selection, least absolute shrinkage and selection operator (LASSO), and Bayesian model averaging (BMA), were used to build NTCP models of xerostomia following radiotherapy treatment for head and neck cancer. Performance of each learning method was evaluated by a repeated cross-validation scheme in order to obtain a fair comparison among methods. It was found that the LASSO and BMA methods produced models with significantly better predictive power than that of the stepwise selection method. Furthermore, the LASSO method yields an easily interpretable model as the stepwise method does, in contrast to the less intuitive BMA method. The commonly used stepwise selection method, which is simple to execute, may be insufficient for NTCP modeling. The LASSO method is recommended. Copyright © 2012 Elsevier Inc. All rights reserved.

Characterizing implementation strategies using a systems engineering survey and interview tool: a comparison across 10 prevention programs for drug abuse and HIV sexual risk behavior.

PubMed

Czaja, Sara J; Valente, Thomas W; Nair, Sankaran N; Villamar, Juan A; Brown, C Hendricks

2016-05-17

Although many behavioral interventions have proven to be efficacious, new methodologies are required beyond efficacy trials to understand how to adopt, implement with fidelity, and sustain behavioral interventions in community settings. In this paper, we present a new approach, based on systems engineering concepts and methods, for characterizing implementation strategies that are used to deliver evidence-based behavioral interventions in health and social service settings. We demonstrate the use of this approach with implementation strategies, used or being used for broader dissemination of 10 evidence-based prevention program projects focused on the prevention of drug or HIV sex risk behaviors. The results indicate that there are wide variations in intervention approaches and that there are challenges in program implementation including maintaining program fidelity, serving community needs, and adequate resources. The results also indicate that implementation requires a committed partnership between the program developers, implementation researchers, and community partners. In addition, there is a need for adaptability within programs to meet community needs, resources, and priorities while maintaining program fidelity. Our methodological approach enabled us to highlight challenges associated with the community implementation of health risk prevention interventions. We also demonstrate how comprehensive descriptions of interventions facilitate understanding of the requirements of program implementation and decisions about the feasibility of implementing a program in community settings.

Using organization theory to understand the determinants of effective implementation of worksite health promotion programs.

PubMed

Weiner, Bryan J; Lewis, Megan A; Linnan, Laura A

2009-04-01

The field of worksite health promotion has moved toward the development and testing of comprehensive programs that target health behaviors with interventions operating at multiple levels of influence. Yet, observational and process evaluation studies indicate that such programs are challenging for worksites to implement effectively. Research has identified several organizational factors that promote or inhibit effective implementation of comprehensive worksite health promotion programs. However, no integrated theory of implementation has emerged from this research. This article describes a theory of the organizational determinants of effective implementation of comprehensive worksite health promotion programs. The model is adapted from theory and research on the implementation of complex innovations in manufacturing, education and health care settings. The article uses the Working Well Trial to illustrate the model's theoretical constructs. Although the article focuses on comprehensive worksite health promotion programs, the conceptual model may also apply to other types of complex health promotion programs. An organization-level theory of the determinants of effective implementation of worksite health promotion programs.

Sporting programs for inactive population groups: factors influencing implementation in the organized sports setting.

PubMed

Ooms, Linda; Veenhof, Cindy; Schipper-van Veldhoven, Nicolette; de Bakker, Dinny H

2015-01-01

The organized sports sector has received increased attention as a setting to promote health-enhancing physical activity (HEPA) to the general population. For significant public health impact, it is important that successful HEPA programs are widely adopted, implemented and continued as ongoing practice. The importance of evaluating the context in which programs are implemented has been identified as critical. However, little research has focused on understanding the organized sports implementation context, including factors facilitating and impeding implementation. In this study, the main factors influencing implementation of HEPA programs in the organized sports setting were studied. Fourteen sporting programs in the Netherlands aimed at increasing participation in sports by inactive population groups and funded within the National Action Plan for Sport and Exercise (NAPSE) were investigated. The programs were developed by ten Dutch National Sports Federations (NSFs) and implemented by different sports clubs in the Netherlands over a 3-year implementation period (June 2008-June 2011). The qualitative research component involved yearly face-to-face interviews (i.e. fourteen interviews each year, n = 12 program coordinators) and a group meeting with the program coordinators of the NSFs (n = 8). Cross-case comparisons and thematic analyses were performed to identify and categorize important facilitating and impeding factors respectively. The quantitative research component, used to identify the most important facilitating and impeding factors across all sporting programs, consisted of ranking of factors according to importance by the program coordinators (n = 12). Different factors act during six identified (implementation) phases. When comparing factors across phases, several key learnings were evident. Successful implementation relied, for example, on program design and enthusiastic individuals within sporting organizations. On the other hand, inactive people were hard to reach and participation of sports clubs was not self-evident. The findings were discussed in a broader context. This study adds to the knowledge base concerning the implementation of sporting programs, aimed at inactive people, in the organized sports setting. The main factors facilitating and impeding implementation were identified. The results of this study can be used by sports practitioners and policy makers when developing and implementing HEPA programs in this setting.

Building Sustainable Professional Development Programs: Applying Strategies From Implementation Science to Translate Evidence Into Practice.

PubMed

Baldwin, Constance D; Chandran, Latha; Gusic, Maryellen E

2017-01-01

Multisite and national professional development (PD) programs for educators are challenging to establish. Use of implementation science (IS) frameworks designed to convert evidence-based intervention methods into effective health care practice may help PD developers translate proven educational methods and models into successful, well-run programs. Implementation of the national Educational Scholars Program (ESP) is used to illustrate the value of the IS model. Four adaptable elements of IS are described: (1) replication of an evidence-based model, (2) systematic stages of implementation, (3) management of implementation using three implementation drivers, and (4) demonstration of program success through measures of fidelity to proven models and sustainability. Implementation of the ESP was grounded on five established principles and methods for successful PD. The process was conducted in four IS stages over 10 years: Exploration, Installation, Initial Implementation, and Full Implementation. To ensure effective and efficient processes, attention to IS implementation drivers helped to manage organizational relationships, build competence in faculty and scholars, and address leadership challenges. We describe the ESP's fidelity to evidence-based structures and methods, and offer three examples of sustainability efforts that enabled achievement of targeted program outcomes, including academic productivity, strong networking, and career advancement of scholars. Application of IS frameworks to program implementation may help other PD programs to translate evidence-based methods into interventions with enhanced impact. A PD program can follow systematic developmental stages and be operationalized by practical implementation drivers, thereby creating successful and sustainable interventions that promote the academic vitality of health professions educators.

Consumption value theory and the marketing of public health: an effective formative research tool.

PubMed

Nelson, Douglas G; Byus, Kent

2002-01-01

Contemporary public health requires the support and participation of its constituency. This study assesses the capacity of consumption value theory to identify the basis of this support. A telephone survey design used simple random sampling of adult residents of Cherokee County, Oklahoma. Factor analysis and stepwise discriminant analysis was used to identify and classify personal and societal level support variables. Most residents base societal level support on epistemic values. Direct services clientele base their support on positive emotional values derived from personal contact and attractive programs. Residents are curious about public health and want to know more about the health department. Where marketing the effectiveness of public health programs would yield relatively little support, marketing health promotion activities may attract public opposition. This formative research tool suggests a marketing strategy for public health practitioners.

A preliminary investigation of the potential applicability of the IPAD system to non-aerospace industry

NASA Technical Reports Server (NTRS)

Hulbert, L. E.

1975-01-01

A study of the applicability of the planned Integrated Programs for Aerospace-Vehicle Design (IPAD) system to the design activities of non-aerospace industries was carried out. It was determined that IPAD could be of significant benefit to a number of industries, with the most likely users being the heavy construction and automotive industries. Two additional short studies were initiated to investigate the possible impact of IPAD on a national energy program and on urban and regional planning activities of local and state governments. These initial studies indicated the possibility of significant payoff in these areas and the need for further investigations. It was also determined that utilization of IPAD by non-aerospace industries will probably involve a long stepwise process, since these industries maintain a policy of gradual introduction of new technology.

Identifying Strategies Programs Adopt to Meet Healthy Eating and Physical Activity Standards in Afterschool Programs.

PubMed

Weaver, Robert G; Moore, Justin B; Turner-McGrievy, Brie; Saunders, Ruth; Beighle, Aaron; Khan, M Mahmud; Chandler, Jessica; Brazendale, Keith; Randell, Allison; Webster, Collin; Beets, Michael W

2017-08-01

The YMCA of USA has adopted Healthy Eating and Physical Activity (HEPA) Standards for its afterschool programs (ASPs). Little is known about strategies YMCA ASPs are implementing to achieve Standards and these strategies' effectiveness. (1) Identify strategies implemented in YMCA ASPs and (2) evaluate the relationship between strategy implementation and meeting Standards. HEPA was measured via accelerometer (moderate-to-vigorous-physical-activity [MVPA]) and direct observation (snacks served) in 20 ASPs. Strategies were identified and mapped onto a capacity building framework ( Strategies To Enhance Practice [STEPs]). Mixed-effects regression estimated increases in HEPA outcomes as implementation increased. Model-implied estimates were calculated for high (i.e., highest implementation score achieved), moderate (median implementation score across programs), and low (lowest implementation score achieved) implementation for both HEPA separately. Programs implemented a variety of strategies identified in STEPs. For every 1-point increase in implementation score 1.45% (95% confidence interval = 0.33% to 2.55%, p ≤ .001) more girls accumulated 30 min/day of MVPA and fruits and/or vegetables were served on 0.11 more days (95% confidence interval = 0.11-0.45, p ≤ .01). Relationships between implementation and other HEPA outcomes did not reach statistical significance. Still regression estimates indicated that desserts are served on 1.94 fewer days (i.e., 0.40 vs. 2.34) in the highest implementing program than the lowest implementing program and water is served 0.73 more days (i.e., 2.37 vs. 1.64). Adopting HEPA Standards at the national level does not lead to changes in routine practice in all programs. Practical strategies that programs could adopt to more fully comply with the HEPA Standards are identified.

Dissemination and Implementation Strategies of Lower Extremity Preventive Training Programs in Youth: A Clinical Review.

PubMed

DiStefano, Lindsay J; Frank, Barnett S; Root, Hayley J; Padua, Darin A

Neuromuscular preventive training programs effectively reduce injury and improve performance in youth athletes. However, program effectiveness is directly linked to program compliance, fidelity, and dosage. Preventive training programs are not widely adopted by youth sport coaches. One way to promote widespread dissemination and compliance is to identify implementation strategies that influence program adoption and maintenance. It is unknown how previously published programs have followed the elements of an implementation framework. The objective of this review was to evaluate how elements of the 7 steps of implementation, developed by Padua et al, have been performed in the evidence of lower extremity preventive training programs. A systematic review of the literature from 1996 through September 2016 was conducted using electronic databases. Investigations that documented implementation of a sport team-based neuromuscular preventive training program in youth athletes and measured lower extremity injury rates were included. Clinical review. Level 4. A total of 12 studies met the inclusion criteria and were reviewed. Information regarding the completion of any of the 7 steps within the implementation framework developed by Padua et al was extracted. None of the 12 articles documented completion of all 7 steps. While each study addressed some of the 7 steps, no study addressed maintenance or an exit strategy for youth athletes. Program implementation appears limited in obtaining administrative support, utilizing an interdisciplinary implementation team, and monitoring or promoting fidelity of the intervention. Despite strong evidence supporting the effectiveness of preventive training programs in youth athletes, there is a gap between short-term improvements and long-term implementation strategies. Future interventions should include all 7 steps of the implementation framework to promote transparent dissemination of preventive training programs.

Finite cohesion due to chain entanglement in polymer melts.

PubMed

Cheng, Shiwang; Lu, Yuyuan; Liu, Gengxin; Wang, Shi-Qing

2016-04-14

Three different types of experiments, quiescent stress relaxation, delayed rate-switching during stress relaxation, and elastic recovery after step strain, are carried out in this work to elucidate the existence of a finite cohesion barrier against free chain retraction in entangled polymers. Our experiments show that there is little hastened stress relaxation from step-wise shear up to γ = 0.7 and step-wise extension up to the stretching ratio λ = 1.5 at any time before or after the Rouse time. In contrast, a noticeable stress drop stemming from the built-in barrier-free chain retraction is predicted using the GLaMM model. In other words, the experiment reveals a threshold magnitude of step-wise deformation below which the stress relaxation follows identical dynamics whereas the GLaMM or Doi-Edwards model indicates a monotonic acceleration of the stress relaxation dynamics as a function of the magnitude of the step-wise deformation. Furthermore, a sudden application of startup extension during different stages of stress relaxation after a step-wise extension, i.e. the delayed rate-switching experiment, shows that the geometric condensation of entanglement strands in the cross-sectional area survives beyond the reptation time τd that is over 100 times the Rouse time τR. Our results point to the existence of a cohesion barrier that can prevent free chain retraction upon moderate deformation in well-entangled polymer melts.

Addressing unmeasured confounding in comparative observational research.

PubMed

Zhang, Xiang; Faries, Douglas E; Li, Hu; Stamey, James D; Imbens, Guido W

2018-04-01

Observational pharmacoepidemiological studies can provide valuable information on the effectiveness or safety of interventions in the real world, but one major challenge is the existence of unmeasured confounder(s). While many analytical methods have been developed for dealing with this challenge, they appear under-utilized, perhaps due to the complexity and varied requirements for implementation. Thus, there is an unmet need to improve understanding the appropriate course of action to address unmeasured confounding under a variety of research scenarios. We implemented a stepwise search strategy to find articles discussing the assessment of unmeasured confounding in electronic literature databases. Identified publications were reviewed and characterized by the applicable research settings and information requirements required for implementing each method. We further used this information to develop a best practice recommendation to help guide the selection of appropriate analytical methods for assessing the potential impact of unmeasured confounding. Over 100 papers were reviewed, and 15 methods were identified. We used a flowchart to illustrate the best practice recommendation which was driven by 2 critical components: (1) availability of information on the unmeasured confounders; and (2) goals of the unmeasured confounding assessment. Key factors for implementation of each method were summarized in a checklist to provide further assistance to researchers for implementing these methods. When assessing comparative effectiveness or safety in observational research, the impact of unmeasured confounding should not be ignored. Instead, we suggest quantitatively evaluating the impact of unmeasured confounding and provided a best practice recommendation for selecting appropriate analytical methods. Copyright © 2018 John Wiley & Sons, Ltd.

An information system design for watershed-wide modeling of water loss to the atmosphere using remote sensing techniques

NASA Technical Reports Server (NTRS)

Khorram, S.

1977-01-01

Results are presented of a study intended to develop a general location-specific remote-sensing procedure for watershed-wide estimation of water loss to the atmosphere by evaporation and transpiration. The general approach involves a stepwise sequence of required information definition (input data), appropriate sample design, mathematical modeling, and evaluation of results. More specifically, the remote sensing-aided system developed to evaluate evapotranspiration employs a basic two-stage two-phase sample of three information resolution levels. Based on the discussed design, documentation, and feasibility analysis to yield timely, relatively accurate, and cost-effective evapotranspiration estimates on a watershed or subwatershed basis, work is now proceeding to implement this remote sensing-aided system.

Practical Unitary Simulator for Non-Markovian Complex Processes

NASA Astrophysics Data System (ADS)

Binder, Felix C.; Thompson, Jayne; Gu, Mile

2018-06-01

Stochastic processes are as ubiquitous throughout the quantitative sciences as they are notorious for being difficult to simulate and predict. In this Letter, we propose a unitary quantum simulator for discrete-time stochastic processes which requires less internal memory than any classical analogue throughout the simulation. The simulator's internal memory requirements equal those of the best previous quantum models. However, in contrast to previous models, it only requires a (small) finite-dimensional Hilbert space. Moreover, since the simulator operates unitarily throughout, it avoids any unnecessary information loss. We provide a stepwise construction for simulators for a large class of stochastic processes hence directly opening the possibility for experimental implementations with current platforms for quantum computation. The results are illustrated for an example process.

Prevalence and Implementation Fidelity of Research-Based Prevention Programs in Public Schools. Final Report

ERIC Educational Resources Information Center

Crosse, Scott; Williams, Barbara; Hagen, Carol A.; Harmon, Michele; Ristow, Liam; DiGaetano, Ralph; Broene, Pamela; Alexander, Debbie; Tseng, Margaret; Derzon, James H.

2011-01-01

This report presents descriptive information about the prevalence and quality of implementation of research-based programs from the Study of the Implementation of Research-Based Programs to Prevent Youth Substance Abuse and School Crime. The study found that, while schools reported implementing a large number of prevention programs during the…

Toward Elimination of Dog-Mediated Human Rabies: Experiences from Implementing a Large-scale Demonstration Project in Southern Tanzania

PubMed Central

Mpolya, Emmanuel Abraham; Lembo, Tiziana; Lushasi, Kennedy; Mancy, Rebecca; Mbunda, Eberhard M.; Makungu, Selemani; Maziku, Matthew; Sikana, Lwitiko; Jaswant, Gurdeep; Townsend, Sunny; Meslin, François-Xavier; Abela-Ridder, Bernadette; Ngeleja, Chanasa; Changalucha, Joel; Mtema, Zacharia; Sambo, Maganga; Mchau, Geofrey; Rysava, Kristyna; Nanai, Alphoncina; Kazwala, Rudovick; Cleaveland, Sarah; Hampson, Katie

2017-01-01

A Rabies Elimination Demonstration Project was implemented in Tanzania from 2010 through to 2015, bringing together government ministries from the health and veterinary sectors, the World Health Organization, and national and international research institutions. Detailed data on mass dog vaccination campaigns, bite exposures, use of post-exposure prophylaxis (PEP), and human rabies deaths were collected throughout the project duration and project areas. Despite no previous experience in dog vaccination within the project areas, district veterinary officers were able to implement district-wide vaccination campaigns that, for most part, progressively increased the numbers of dogs vaccinated with each phase of the project. Bite exposures declined, particularly in the southernmost districts with the smallest dog populations, and health workers successfully transitioned from primarily intramuscular administration of PEP to intradermal administration, resulting in major cost savings. However, even with improved PEP provision, vaccine shortages still occurred in some districts. In laboratory diagnosis, there were several logistical challenges in sample handling and submission but compared to the situation before the project started, there was a moderate increase in the number of laboratory samples submitted and tested for rabies in the project areas with a decrease in the proportion of rabies-positive samples over time. The project had a major impact on public health policy and practice with the formation of a One Health Coordination Unit at the Prime Minister’s Office and development of the Tanzania National Rabies Control Strategy, which lays a roadmap for elimination of rabies in Tanzania by 2030 by following the Stepwise Approach towards Rabies Elimination (SARE). Overall, the project generated many important lessons relevant to rabies prevention and control in particular and disease surveillance in general. Lessons include the need for (1) a specific unit in the government for managing disease surveillance; (2) application of innovative data collection and management approaches such as the use of mobile phones; (3) close cooperation and effective communication among all key sectors and stakeholders; and (4) flexible and adaptive programs that can incorporate new information to improve their delivery, and overcome challenges of logistics and procurement. PMID:28321400

Toward Elimination of Dog-Mediated Human Rabies: Experiences from Implementing a Large-scale Demonstration Project in Southern Tanzania.

PubMed

Mpolya, Emmanuel Abraham; Lembo, Tiziana; Lushasi, Kennedy; Mancy, Rebecca; Mbunda, Eberhard M; Makungu, Selemani; Maziku, Matthew; Sikana, Lwitiko; Jaswant, Gurdeep; Townsend, Sunny; Meslin, François-Xavier; Abela-Ridder, Bernadette; Ngeleja, Chanasa; Changalucha, Joel; Mtema, Zacharia; Sambo, Maganga; Mchau, Geofrey; Rysava, Kristyna; Nanai, Alphoncina; Kazwala, Rudovick; Cleaveland, Sarah; Hampson, Katie

2017-01-01

A Rabies Elimination Demonstration Project was implemented in Tanzania from 2010 through to 2015, bringing together government ministries from the health and veterinary sectors, the World Health Organization, and national and international research institutions. Detailed data on mass dog vaccination campaigns, bite exposures, use of post-exposure prophylaxis (PEP), and human rabies deaths were collected throughout the project duration and project areas. Despite no previous experience in dog vaccination within the project areas, district veterinary officers were able to implement district-wide vaccination campaigns that, for most part, progressively increased the numbers of dogs vaccinated with each phase of the project. Bite exposures declined, particularly in the southernmost districts with the smallest dog populations, and health workers successfully transitioned from primarily intramuscular administration of PEP to intradermal administration, resulting in major cost savings. However, even with improved PEP provision, vaccine shortages still occurred in some districts. In laboratory diagnosis, there were several logistical challenges in sample handling and submission but compared to the situation before the project started, there was a moderate increase in the number of laboratory samples submitted and tested for rabies in the project areas with a decrease in the proportion of rabies-positive samples over time. The project had a major impact on public health policy and practice with the formation of a One Health Coordination Unit at the Prime Minister's Office and development of the Tanzania National Rabies Control Strategy, which lays a roadmap for elimination of rabies in Tanzania by 2030 by following the Stepwise Approach towards Rabies Elimination (SARE). Overall, the project generated many important lessons relevant to rabies prevention and control in particular and disease surveillance in general. Lessons include the need for (1) a specific unit in the government for managing disease surveillance; (2) application of innovative data collection and management approaches such as the use of mobile phones; (3) close cooperation and effective communication among all key sectors and stakeholders; and (4) flexible and adaptive programs that can incorporate new information to improve their delivery, and overcome challenges of logistics and procurement.

Stochastic optimal operation of reservoirs based on copula functions

NASA Astrophysics Data System (ADS)

Lei, Xiao-hui; Tan, Qiao-feng; Wang, Xu; Wang, Hao; Wen, Xin; Wang, Chao; Zhang, Jing-wen

2018-02-01

Stochastic dynamic programming (SDP) has been widely used to derive operating policies for reservoirs considering streamflow uncertainties. In SDP, there is a need to calculate the transition probability matrix more accurately and efficiently in order to improve the economic benefit of reservoir operation. In this study, we proposed a stochastic optimization model for hydropower generation reservoirs, in which 1) the transition probability matrix was calculated based on copula functions; and 2) the value function of the last period was calculated by stepwise iteration. Firstly, the marginal distribution of stochastic inflow in each period was built and the joint distributions of adjacent periods were obtained using the three members of the Archimedean copulas, based on which the conditional probability formula was derived. Then, the value in the last period was calculated by a simple recursive equation with the proposed stepwise iteration method and the value function was fitted with a linear regression model. These improvements were incorporated into the classic SDP and applied to the case study in Ertan reservoir, China. The results show that the transition probability matrix can be more easily and accurately obtained by the proposed copula function based method than conventional methods based on the observed or synthetic streamflow series, and the reservoir operation benefit can also be increased.

A generalized fuzzy linear programming approach for environmental management problem under uncertainty.

PubMed

Fan, Yurui; Huang, Guohe; Veawab, Amornvadee

2012-01-01

In this study, a generalized fuzzy linear programming (GFLP) method was developed to deal with uncertainties expressed as fuzzy sets that exist in the constraints and objective function. A stepwise interactive algorithm (SIA) was advanced to solve GFLP model and generate solutions expressed as fuzzy sets. To demonstrate its application, the developed GFLP method was applied to a regional sulfur dioxide (SO2) control planning model to identify effective SO2 mitigation polices with a minimized system performance cost under uncertainty. The results were obtained to represent the amount of SO2 allocated to different control measures from different sources. Compared with the conventional interval-parameter linear programming (ILP) approach, the solutions obtained through GFLP were expressed as fuzzy sets, which can provide intervals for the decision variables and objective function, as well as related possibilities. Therefore, the decision makers can make a tradeoff between model stability and the plausibility based on solutions obtained through GFLP and then identify desired policies for SO2-emission control under uncertainty.

Implementation research: a mentoring programme to improve laboratory quality in Cambodia

PubMed Central

Voeurng, Vireak; Sek, Sophat; Song, Sophanna; Vong, Nora; Tous, Chansamrach; Flandin, Jean-Frederic; Confer, Deborah; Costa, Alexandre; Martin, Robert

2016-01-01

Abstract Objective To implement a mentored laboratory quality stepwise implementation (LQSI) programme to strengthen the quality and capacity of Cambodian hospital laboratories. Methods We recruited four laboratory technicians to be mentors and trained them in mentoring skills, laboratory quality management practices and international standard organization (ISO) 15189 requirements for medical laboratories. Separately, we trained staff from 12 referral hospital laboratories in laboratory quality management systems followed by tri-weekly in-person mentoring on quality management systems implementation using the LQSI tool, which is aligned with the ISO 15189 standard. The tool was adapted from a web-based resource into a software-based spreadsheet checklist, which includes a detailed action plan and can be used to qualitatively monitor each laboratory’s progress. The tool – translated into Khmer – included a set of quality improvement activities grouped into four phases for implementation with increasing complexity. Project staff reviewed the laboratories’ progress and challenges in weekly conference calls and bi-monthly meetings with focal points of the health ministry, participating laboratories and local partners. We present the achievements in implementation from September 2014 to March 2016. Findings As of March 2016, the 12 laboratories have completed 74–90% of the 104 activities in phase 1, 53–78% of the 178 activities in phase 2, and 18–26% of the 129 activities in phase 3. Conclusion Regular on-site mentoring of laboratories using a detailed action plan in the local language allows staff to learn concepts of quality management system and learn on the job without disruption to laboratory service provision. PMID:27843164

Do Program Implementation Factors or Fidelity Affect Chronic Disease Self-Management Education Programs' Outcomes?

PubMed

Brady, Teresa J; Murphy, Louise B; O'Colmain, Benita J; Hobson, Reeti Desai

2017-09-01

To evaluate whether implementation factors or fidelity moderate chronic disease self-management education program outcomes. Meta-analysis of 34 Arthritis Self-Management Program and Chronic Disease Self-Management Program studies. Community. N = 10 792. Twelve implementation factors: program delivery fidelity and setting and leader and participant characteristics. Eighteen program outcomes: self-reported health behaviors, physical health status, psychological health status, and health-care utilization. Meta-analysis using pooled effect sizes. Modest to moderate statistically significant differences for 4 of 6 implementation factors; these findings were counterintuitive with better outcomes when leaders and participants were unpaid, leaders had less than minimum training, and implementation did not meet fidelity requirements. Exploratory study findings suggest that these interventions tolerate some variability in implementation factors. Further work is needed to identify key elements where fidelity is essential for intervention effectiveness.

14 CFR 120.117 - Implementing a drug testing program.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Implementing a drug testing program. 120... AND ALCOHOL TESTING PROGRAM Drug Testing Program Requirements § 120.117 Implementing a drug testing.... (4) A part 145 certificate holder who has your own drug testing program Obtain an Antidrug and...

14 CFR 120.117 - Implementing a drug testing program.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Implementing a drug testing program. 120... AND ALCOHOL TESTING PROGRAM Drug Testing Program Requirements § 120.117 Implementing a drug testing... 145 certificate holder who has your own drug testing program Obtain an Antidrug and Alcohol Misuse...

14 CFR 120.117 - Implementing a drug testing program.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Implementing a drug testing program. 120... AND ALCOHOL TESTING PROGRAM Drug Testing Program Requirements § 120.117 Implementing a drug testing... 145 certificate holder who has your own drug testing program Obtain an Antidrug and Alcohol Misuse...

14 CFR 120.117 - Implementing a drug testing program.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Implementing a drug testing program. 120... AND ALCOHOL TESTING PROGRAM Drug Testing Program Requirements § 120.117 Implementing a drug testing... Specification, Letter of Authorization, or Drug and Alcohol Testing Program Registration from the FAA: If you...

14 CFR 120.117 - Implementing a drug testing program.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Implementing a drug testing program. 120... AND ALCOHOL TESTING PROGRAM Drug Testing Program Requirements § 120.117 Implementing a drug testing... 145 certificate holder who has your own drug testing program Obtain an Antidrug and Alcohol Misuse...

Evaluation of the international standardized 24-h dietary recall methodology (GloboDiet) for potential application in research and surveillance within African settings.

PubMed

Aglago, Elom Kouassivi; Landais, Edwige; Nicolas, Geneviève; Margetts, Barrie; Leclercq, Catherine; Allemand, Pauline; Aderibigbe, Olaide; Agueh, Victoire Damienne; Amuna, Paul; Annor, George Amponsah; El Ati, Jalila; Coates, Jennifer; Colaiezzi, Brooke; Compaore, Ella; Delisle, Hélène; Faber, Mieke; Fungo, Robert; Gouado, Inocent; El Hamdouchi, Asmaa; Hounkpatin, Waliou Amoussa; Konan, Amoin Georgette; Labzizi, Saloua; Ledo, James; Mahachi, Carol; Maruapula, Segametsi Ditshebo; Mathe, Nonsikelelo; Mbabazi, Muniirah; Mirembe, Mandy Wilja; Mizéhoun-Adissoda, Carmelle; Nzi, Clement Diby; Pisa, Pedro Terrence; El Rhazi, Karima; Zotor, Francis; Slimani, Nadia

2017-06-19

Collection of reliable and comparable individual food consumption data is of primary importance to better understand, control and monitor malnutrition and its related comorbidities in low- and middle-income countries (LMICs), including in Africa. The lack of standardised dietary tools and their related research support infrastructure remains a major obstacle to implement concerted and region-specific research and action plans worldwide. Citing the magnitude and importance of this challenge, the International Agency for Research on Cancer (IARC/WHO) launched the "Global Nutrition Surveillance initiative" to pilot test the use of a standardized 24-h dietary recall research tool (GloboDiet), validated in Europe, in other regions. In this regard, the development of the GloboDiet-Africa can be optimised by better understanding of the local specific methodological needs, barriers and opportunities. The study aimed to evaluate the standardized 24-h dietary recall research tool (GloboDiet) as a possible common methodology for research and surveillance across Africa. A consultative panel of African and international experts in dietary assessment participated in six e-workshop sessions. They completed an in-depth e-questionnaire to evaluate the GloboDiet dietary methodology before and after participating in the e-workshop. The 29 experts expressed their satisfaction on the potential of the software to address local specific needs when evaluating the main structure of the software, the stepwise approach for data collection and standardisation concept. Nevertheless, additional information to better describe local foods and recipes, as well as particular culinary patterns (e.g. mortar pounding), were proposed. Furthermore, food quantification in shared-plates and -bowls eating situations and interviewing of populations with low literacy skills, especially in rural settings, were acknowledged as requiring further specific considerations and appropriate solutions. An overall positive evaluation of the GloboDiet methodology by both African and international experts, supports the flexibility and potential applicability of this tool in diverse African settings and sets a positive platform for improved dietary monitoring and surveillance. Following this evaluation, prerequisite for future implementation and/or adaptation of GloboDiet in Africa, rigorous and robust capacity building as well as knowledge transfer will be required to roadmap a stepwise approach to implement this methodology across pilot African countries/regions.

Experience, Reflect, Critique: The End of the "Learning Cycles" Era

ERIC Educational Resources Information Center

Seaman, Jayson

2008-01-01

According to prevailing models, experiential learning is by definition a stepwise process beginning with direct experience, followed by reflection, followed by learning. It has been argued, however, that stepwise models inadequately explain the holistic learning processes that are central to learning from experience, and that they lack scientific…

A Latent-Variable Causal Model of Faculty Reputational Ratings.

ERIC Educational Resources Information Center

King, Suzanne; Wolfle, Lee M.

A reanalysis was conducted of Saunier's research (1985) on sources of variation in the National Research Council (NRC) reputational ratings of university faculty. Saunier conducted a stepwise regression analysis using 12 predictor variables. Due to problems with multicollinearity and because of the atheoretical nature of stepwise regression,…

Testing Different Model Building Procedures Using Multiple Regression.

ERIC Educational Resources Information Center

Thayer, Jerome D.

The stepwise regression method of selecting predictors for computer assisted multiple regression analysis was compared with forward, backward, and best subsets regression, using 16 data sets. The results indicated the stepwise method was preferred because of its practical nature, when the models chosen by different selection methods were similar…

The impact of middle manager affective commitment on perceived improvement program implementation success.

PubMed

Fryer, Ashley-Kay; Tucker, Anita L; Singer, Sara J

Recent literature suggests that middle manager affective commitment (emotional attachment, identification, and involvement) to an improvement program may influence implementation success. However, less is known about the interplay between middle manager affective commitment and frontline worker commitment, another important driver of implementation success. We contribute to this research by surveying middle managers who directly manage frontline workers on nursing units. We assess how middle manager affective commitment is related to their perceptions of implementation success and whether their perceptions of frontline worker support mediate this relationship. We also test whether a set of organizational support factors foster middle manager affective commitment. We adapt survey measures of manager affective commitment to our research context of hospitals. We surveyed 67 nurse managers from 19 U.S. hospitals. We use hierarchical linear regression to assess relationships among middle manager affective commitment to their units' falls reduction program and their perceptions of three constructs related to the program: frontline worker support, organizational support, and implementation success. Middle manager affective commitment to their unit's falls reduction program is positively associated with their perception of implementation success. This relationship is mediated by their perception of frontline worker support for the falls program. Moreover, middle managers' affective commitment to their unit's falls program mediates the relationship between perceived organizational support for the program and perceived implementation success. We, through this research, offer an important contribution by providing empirical support of factors that may influence successful implementation of an improvement program: middle manager affective commitment, frontline worker support, and organizational support for an improvement program. Increasing levels of middle manager affective commitment to an improvement program could strengthen program implementation success by facilitating frontline worker support for the program. Furthermore, providing the organizational support items in our survey construct may bolster middle manager affective commitment.

An implementation of the programming structural synthesis system (PROSSS)

NASA Technical Reports Server (NTRS)

Rogers, J. L., Jr.; Sobieszczanski-Sobieski, J.; Bhat, R. B.

1981-01-01

A particular implementation of the programming structural synthesis system (PROSSS) is described. This software system combines a state of the art optimization program, a production level structural analysis program, and user supplied, problem dependent interface programs. These programs are combined using standard command language features existing in modern computer operating systems. PROSSS is explained in general with respect to this implementation along with the steps for the preparation of the programs and input data. Each component of the system is described in detail with annotated listings for clarification. The components include options, procedures, programs and subroutines, and data files as they pertain to this implementation. An example exercising each option in this implementation to allow the user to anticipate the type of results that might be expected is presented.

Integrating Health Education in Core Curriculum Classrooms: Successes, Challenges, and Implications for Urban Middle Schools.

PubMed

Rajan, Sonali; Roberts, Katherine J; Guerra, Laura; Pirsch, Moira; Morrell, Ernest

2017-12-01

School-based health education efforts can positively affect health behaviors and learning outcomes; however, there is limited available time during the school day for separate health education classes. The purpose of this study was to assess the feasibility and sustainability of implementing a classroom-based health education program that integrates skill development with health learning. A wait-list control study design was conducted among 168 6th graders in 2 urban schools. Data on program implementation, feasibility, and health outcomes were collected from students at 3 time points and from 5 teachers across the implementation of the 10-week program. There were barriers to implementation, including time limitations, unexpected school-wide disruptions, and variations in student reading ability and teacher preparedness. However, analyses revealed there were significant increases in self-efficacy regarding fruit and vegetable consumption and outcome expectations following program implementation, which were also sustained post-program implementation. Despite inconsistent implementation in the wait-list control school, small gains were also noted following the completion of the program. Integrating health education efforts within core curricula classes can lead to favorable outcomes. However, implementation barriers must be actively addressed by schools and program developers to improve program fidelity and maximize the sustainability of program gains. © 2017, American School Health Association.

Key ingredients for implementing intensive outpatient programs within patient-centered medical homes: A literature review and qualitative analysis.

PubMed

Breland, Jessica Y; Asch, Steven M; Slightam, Cindie; Wong, Ava; Zulman, Donna M

2016-03-01

Intensive outpatient programs aim to transform care while conserving resources for high-need, high-cost patients, but little is known about factors that influence their implementation within patient-centered medical homes (PCMHs). In this mixed-methods study, we reviewed the literature to identify factors affecting intensive outpatient program implementation, then used semi-structured interviews to determine how these factors influenced the implementation of an intensive outpatient program within the Veterans Affairs' (VA) PCMH. Interviewees included facility leadership and clinical staff who were involved in a pilot Intensive Management Patient Aligned Care Team (ImPACT) intervention for high-need, high-cost VA PCMH patents. We classified implementation factors in the literature review and qualitative analysis using the Consolidated Framework for Implementation Research (CFIR). The literature review (n=9 studies) and analyses of interviews (n=15) revealed key implementation factors in three CFIR domains. First, the Inner Setting (i.e., the organizational and PCMH environment), mostly enabled implementation through a culture of innovation, good networks and communication, and positive tension for change. Second, Characteristics of Individuals, including creativity, flexibility, and interpersonal skills, allowed program staff to augment existing PCMH services. Finally, certain Intervention Characteristics (e.g., adaptability) enabled implementation, while others (e.g., complexity) generated implementation barriers. Resources and structural features common to PCMHs can facilitate implementation of intensive outpatient programs, but program success is also dependent on staff creativity and flexibility, and intervention adaptations to meet patient and organizational needs. Established PCMHs likely provide resources and environments that permit accelerated implementation of intensive outpatient programs. V. Published by Elsevier Inc.

A Framework for Identifying Implementation Issues Affecting Extension Human Sciences Programming

ERIC Educational Resources Information Center

Abell, Ellen; Cummings, Rebekah; Duke, Adrienne M.; Marshall, Jennifer Wells

2015-01-01

Extension programs based on identified needs, relevant theory, and solid research too often fail to realize their objectives. Program implementation is acknowledged to contribute to program effectiveness, yet systematic attention has not been paid to the array of implementation issues that can complicate achieving program goals. We developed the…

Applications of modern statistical methods to analysis of data in physical science

NASA Astrophysics Data System (ADS)

Wicker, James Eric

Modern methods of statistical and computational analysis offer solutions to dilemmas confronting researchers in physical science. Although the ideas behind modern statistical and computational analysis methods were originally introduced in the 1970's, most scientists still rely on methods written during the early era of computing. These researchers, who analyze increasingly voluminous and multivariate data sets, need modern analysis methods to extract the best results from their studies. The first section of this work showcases applications of modern linear regression. Since the 1960's, many researchers in spectroscopy have used classical stepwise regression techniques to derive molecular constants. However, problems with thresholds of entry and exit for model variables plagues this analysis method. Other criticisms of this kind of stepwise procedure include its inefficient searching method, the order in which variables enter or leave the model and problems with overfitting data. We implement an information scoring technique that overcomes the assumptions inherent in the stepwise regression process to calculate molecular model parameters. We believe that this kind of information based model evaluation can be applied to more general analysis situations in physical science. The second section proposes new methods of multivariate cluster analysis. The K-means algorithm and the EM algorithm, introduced in the 1960's and 1970's respectively, formed the basis of multivariate cluster analysis methodology for many years. However, several shortcomings of these methods include strong dependence on initial seed values and inaccurate results when the data seriously depart from hypersphericity. We propose new cluster analysis methods based on genetic algorithms that overcomes the strong dependence on initial seed values. In addition, we propose a generalization of the Genetic K-means algorithm which can accurately identify clusters with complex hyperellipsoidal covariance structures. We then use this new algorithm in a genetic algorithm based Expectation-Maximization process that can accurately calculate parameters describing complex clusters in a mixture model routine. Using the accuracy of this GEM algorithm, we assign information scores to cluster calculations in order to best identify the number of mixture components in a multivariate data set. We will showcase how these algorithms can be used to process multivariate data from astronomical observations.

Implementing three evidence-based program models: early lessons from the Teen Pregnancy Prevention Replication Study.

PubMed

Kelsey, Meredith; Layzer, Jean

2014-03-01

This article describes some of the early implementation challenges faced by nine grantees participating in the Teen Pregnancy Prevention Replication Study and their response to them. The article draws on information collected as part of a comprehensive implementation study. Sources include site and program documents; program officer reports; notes from site investigation, selection and negotiation; ongoing communications with grantees as part of putting the study into place; and semi-structured interviews with program staff. The issues faced by grantees in implementing evidence-based programs designed to prevent teen pregnancy varied by program model. Grantees implementing a classroom-based curriculum faced challenges in delivering the curriculum within the constraints of school schedules and calendars (program length and size of class). Grantees implementing a culturally tailored curriculum faced a series of challenges, including implementing the intervention as part of the regular school curriculum in schools with diverse populations; low attendance when delivered as an after-school program; and resistance on the part of schools to specific curriculum content. The third set of grantees, implementing a program in clinics, faced challenges in identifying and recruiting young women into the program and in retaining young women once they were in the program. The experiences of these grantees reflect some of the complexities that should be carefully considered when choosing to replicate evidence-based programs. The Teen Pregnancy Prevention replication study will provide important context for assessing the effectiveness of some of the more widely replicated evidence-based programs. Copyright © 2014 Society for Adolescent Health and Medicine. All rights reserved.

Challenges to establishing successful partnerships in community health promotion programs: local experiences from the national implementation of healthy eating activity and lifestyle (HEAL™) program.

PubMed

Dennis, Sarah; Hetherington, Sharon A; Borodzicz, Jerrad A; Hermiz, Oshana; Zwar, Nicholas A

2015-04-01

Community-based programs to address physical activity and diet are seen as a valuable strategy to reduce risk factors for chronic disease. Community partnerships are important for successful local implementation of these programs but little is published to describe the challenges of developing partnerships to implement health promotion programs. The aim of this study was to explore the experiences and opinions of key stakeholders on the development and maintenance of partnerships during their implementation of the HEAL™ program. Semi-structured interviews with key stakeholders involved in implementation of HEAL™ in four local government areas. The interviews were transcribed verbatim and analysed thematically. Partnerships were vital to the success of the local implementation. Successful partnerships occurred where the program met the needs of the partnering organisation, or could be adapted to do so. Partnerships took time to develop and were often dependent on key people. Partnering with organisations that had a strong influence in the community could strengthen existing relationships and success. In remote areas partnerships took longer to develop because of fewer opportunities to meet face to face and workforce shortages and this has implications for program funding in these areas. Partnerships are important for the successful implementation of community preventive health programs. They take time to develop, are dependent on the needs of the stakeholders and are facilitated by stable leadership. SO WHAT?: An understanding of the role of partnerships in the implementation of community health programs is important to inform several aspects of program delivery, including flexibility in funding arrangements to allow effective and mutually beneficial partnerships to develop before the implementation phase of the program. It is important that policy makers have an understanding of the time it takes for partnerships to develop and to take this into consideration when programs are funded and implemented in the community.

A Qualitative Exploration of Implementation Factors in a School-Based Mindfulness and Yoga Program: Lessons Learned from Students and Teachers

PubMed Central

Dariotis, Jacinda K.; Mirabal-Beltran, Roxanne; Cluxton-Keller, Fallon; Gould, Laura Feagans; Greenberg, Mark T.; Mendelson, Tamar

2016-01-01

Identifying factors relevant for successful implementation of school-based interventions is essential to ensure that programs are provided in an effective and engaging manner. The perspectives of two key stakeholders critical for identifying implementation barriers and facilitators – students and their classroom teachers – merit attention in this context and have rarely been explored using qualitative methods. This study reports qualitative perspectives of fifth and sixth grade participants and their teachers of a 16-week school-based mindfulness and yoga program in three public schools serving low-income urban communities. Four themes related to program implementation barriers and facilitators emerged: program delivery factors, program buy-in, implementer communication with teachers, and instructor qualities. Feedback from students and teachers is discussed in the context of informing implementation, adaptation, and future development of school-based mindfulness and yoga programming in urban settings. PMID:28670007

A Qualitative Exploration of Implementation Factors in a School-Based Mindfulness and Yoga Program: Lessons Learned from Students and Teachers.

PubMed

Dariotis, Jacinda K; Mirabal-Beltran, Roxanne; Cluxton-Keller, Fallon; Gould, Laura Feagans; Greenberg, Mark T; Mendelson, Tamar

2017-01-01

Identifying factors relevant for successful implementation of school-based interventions is essential to ensure that programs are provided in an effective and engaging manner. The perspectives of two key stakeholders critical for identifying implementation barriers and facilitators - students and their classroom teachers - merit attention in this context and have rarely been explored using qualitative methods. This study reports qualitative perspectives of fifth and sixth grade participants and their teachers of a 16-week school-based mindfulness and yoga program in three public schools serving low-income urban communities. Four themes related to program implementation barriers and facilitators emerged: program delivery factors, program buy-in, implementer communication with teachers, and instructor qualities. Feedback from students and teachers is discussed in the context of informing implementation, adaptation, and future development of school-based mindfulness and yoga programming in urban settings.

Infrared laser driven double proton transfer. An optimal control theory study

NASA Astrophysics Data System (ADS)

Abdel-Latif, Mahmoud K.; Kühn, Oliver

2010-02-01

Laser control of ultrafast double proton transfer is investigated for a two-dimensional model system describing stepwise and concerted transfer pathways. The pulse design has been done by employing optimal control theory in combination with the multiconfiguration time-dependent Hartree wave packet propagation. The obtained laser fields correspond to multiple pump-dump pulse sequences. Special emphasis is paid to the relative importance of stepwise and concerted transfer pathways for the driven wave packet and its dependence on the parameters of the model Hamiltonian as well as on the propagation time. While stepwise transfer is dominating in all cases considered, for high barrier systems concerted transfer proceeding via tunneling can make a contribution.

Response time of mitochondrial oxygen consumption following stepwise changes in cardiac energy demand.

PubMed

van Beek, J H; Westerhof, N

1990-01-01

We determined the speed with which mitochondrial oxygen consumption and therefore the mitochondrial ATP-synthesis adapted to changes in metabolic demand in the rabbit heart. This was done by measuring the oxygen uptake of the whole heart during a stepwise change in heart rate and correcting for the time taken by diffusion and by convective transport in the blood vessels. Data for the correction for transport time were obtained from the response of venous oxygen concentration to a stepwise change of arterial oxygen concentration. The time constant of the response of mitochondrial oxygen consumption to a step change in heart rate was found to be 4-8 s.

Application of stepwise multiple regression techniques to inversion of Nimbus 'IRIS' observations.

NASA Technical Reports Server (NTRS)

Ohring, G.

1972-01-01

Exploratory studies with Nimbus-3 infrared interferometer-spectrometer (IRIS) data indicate that, in addition to temperature, such meteorological parameters as geopotential heights of pressure surfaces, tropopause pressure, and tropopause temperature can be inferred from the observed spectra with the use of simple regression equations. The technique of screening the IRIS spectral data by means of stepwise regression to obtain the best radiation predictors of meteorological parameters is validated. The simplicity of application of the technique and the simplicity of the derived linear regression equations - which contain only a few terms - suggest usefulness for this approach. Based upon the results obtained, suggestions are made for further development and exploitation of the stepwise regression analysis technique.

Developmental milestones across the programmatic life cycle: implementing the CDC's Colorectal Cancer Screening Demonstration Program.

PubMed

Glover-Kudon, Rebecca; DeGroff, Amy; Rohan, Elizabeth A; Preissle, Judith; Boehm, Jennifer E

2013-08-01

In 2005 through 2009, the Centers for Disease Control and Prevention (CDC) funded 5 sites to implement a colorectal cancer screening program for uninsured, low-income populations. These 5 sites composed a demonstration project intended to explore the feasibility of establishing a national colorectal cancer screening program through various service delivery models. A longitudinal, multiple case study was conducted to understand and document program implementation processes. Using metaphor as a qualitative analytic technique, evaluators identified stages of maturation across the programmatic life cycle. Analysis rendered a working theory of program development during screening implementation. In early stages, program staff built relationships with CDC and local partners around screening readiness, faced real-world challenges putting program policies into practice, revised initial program designs, and developed new professional skills. Midterm implementation was defined by establishing program cohesiveness and expanding programmatic reach. In later stages of implementation, staff focused on sustainability and formal program closeout, which prompted reflection about personal and programmatic accomplishments. Demonstration sites evolved through common developmental stages during screening implementation. Findings elucidate ways to target technical assistance to more efficiently move programs along their maturation trajectory. In practical terms, the time and cost associated with guiding a program to maturity may be potentially shortened to maximize return on investment for both organizations and clients receiving service benefits. © 2013 American Cancer Society.

IPM: Integrated Pest Management Kit for Building Managers. How To Implement an Integrated Pest Management Program in Your Building(s).

ERIC Educational Resources Information Center

Mitchell, Brad

This management kit introduces building managers to the concept of Integrated Pest Management (IPM), and provides the knowledge and tools needed to implement an IPM program in their buildings. It discusses the barriers to implementing an IPM program, why such a program should be used, and the general guidelines for its implementation. Managerial…

75 FR 48934 - Coral Reef Conservation Program Implementation Guidelines

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-12

...-01] RIN 0648-ZC19 Coral Reef Conservation Program Implementation Guidelines AGENCY: National Oceanic... Guidelines (Guidelines) for the Coral Reef Conservation Program (CRCP or Program) under the Coral Reef... assistance for coral reef conservation projects under the Act. NOAA revised the Implementation Guidelines for...

36 CFR 230.21 - Implementation of the program.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... 230.21 Section 230.21 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE STATE AND PRIVATE FORESTRY ASSISTANCE Urban and Community Forestry Assistance Program § 230.21 Implementation of the program. (a) The Urban and Community Forestry Assistance Program is implemented through the...

The US Air Force suicide prevention program: implications for public health policy.

PubMed

Knox, Kerry L; Pflanz, Steven; Talcott, Gerald W; Campise, Rick L; Lavigne, Jill E; Bajorska, Alina; Tu, Xin; Caine, Eric D

2010-12-01

We evaluated the effectiveness of the US Air Force Suicide Prevention Program (AFSPP) in reducing suicide, and we measured the extent to which air force installations implemented the program. We determined the AFSPP's impact on suicide rates in the air force by applying an intervention regression model to data from 1981 through 2008, providing 16 years of data before the program's 1997 launch and 11 years of data after launch. Also, we measured implementation of program components at 2 points in time: during a 2004 increase in suicide rates, and 2 years afterward. Suicide rates in the air force were significantly lower after the AFSPP was launched than before, except during 2004. We also determined that the program was being implemented less rigorously in 2004. The AFSPP effectively prevented suicides in the US Air Force. The long-term effectiveness of this program depends upon extensive implementation and effective monitoring of implementation. Suicides can be reduced through a multilayered, overlapping approach that encompasses key prevention domains and tracks implementation of program activities.

Embedding research to improve program implementation in Latin America and the Caribbean.

PubMed

Tran, Nhan; Langlois, Etienne V; Reveiz, Ludovic; Varallyay, Ilona; Elias, Vanessa; Mancuso, Arielle; Becerra-Posada, Francisco; Ghaffar, Abdul

2017-06-08

In the last 10 years, implementation research has come to play a critical role in improving the implementation of already-proven health interventions by promoting the systematic uptake of research findings and other evidence-based strategies into routine practice. The Alliance for Health Policy and Systems Research and the Pan American Health Organization implemented a program of embedded implementation research to support health programs in Latin America and the Caribbean (LAC) in 2014-2015. A total of 234 applications were received from 28 countries in the Americas. The Improving Program Implementation through Embedded Research (iPIER) scheme supported 12 implementation research projects led by health program implementers from nine LAC countries: Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, Panama, Peru, and Saint Lucia. Through this experience, we learned that the "insider" perspective, which implementers bring to the research proposal, is particularly important in identifying research questions that focus on the systems failures that often manifest in barriers to implementation. This paper documents the experience of and highlights key conclusions about the conduct of embedded implementation research. The iPIER experience has shown great promise for embedded research models that place implementers at the helm of implementation research initiatives.

Multifaceted Modularity: A Key for Stepwise Building of Hierarchical Complexity in Actinide Metal–Organic Frameworks

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

Dolgopolova, Ekaterina A.; Ejegbavwo, Otega A.; Martin, Corey R.

Growing necessity for efficient nuclear waste management is a driving force for development of alternative architectures towards fundamental understanding of mechanisms involved in actinide integration inside extended structures. In this manuscript, metal-organic frameworks (MOFs) were investigated as a model system for engineering radionuclide containing materials through utilization of unprecedented MOF modularity, which cannot be replicated in any other type of materials. Through the implementation of recent synthetic advances in the MOF field, hierarchical complexity of An-materials were built stepwise, which was only feasible due to preparation of the first examples of actinide-based frameworks with “unsaturated” metal nodes. The first successfulmore » attempts of solid-state metathesis and metal node extension in An-MOFs are reported, and the results of the former approach revealed drastic differences in chemical behavior of extended structures versus molecular species. Successful utilization of MOF modularity also allowed us to structurally characterize the first example of bimetallic An-An nodes. To the best of our knowledge, through combination of solid-state metathesis, guest incorporation, and capping linker installation, we were able to achieve the highest Th wt% in mono- and bi-actinide frameworks with minimal structural density. Overall, combination of a multistep synthetic approach with homogeneous actinide distribution and moderate solvothermal conditions could make MOFs an exceptionally powerful tool to address fundamental questions responsible for chemical behavior of An-based extended structures, and therefore, shed light on possible optimization of nuclear waste administration.« less

Multifaceted Modularity: A Key for Stepwise Building of Hierarchical Complexity in Actinide Metal-Organic Frameworks.

PubMed

Dolgopolova, Ekaterina A; Ejegbavwo, Otega A; Martin, Corey R; Smith, Mark D; Setyawan, Wahyu; Karakalos, Stavros G; Henager, Charles H; Zur Loye, Hans-Conrad; Shustova, Natalia B

2017-11-22

Growing necessity for efficient nuclear waste management is a driving force for development of alternative architectures toward fundamental understanding of mechanisms involved in actinide (An) integration inside extended structures. In this manuscript, metal-organic frameworks (MOFs) were investigated as a model system for engineering radionuclide containing materials through utilization of unprecedented MOF modularity, which cannot be replicated in any other type of materials. Through the implementation of recent synthetic advances in the MOF field, hierarchical complexity of An-materials was built stepwise, which was only feasible due to preparation of the first examples of actinide-based frameworks with "unsaturated" metal nodes. The first successful attempts of solid-state metathesis and metal node extension in An-MOFs are reported, and the results of the former approach revealed drastic differences in chemical behavior of extended structures versus molecular species. Successful utilization of MOF modularity also allowed us to structurally characterize the first example of bimetallic An-An nodes. To the best of our knowledge, through combination of solid-state metathesis, guest incorporation, and capping linker installation, we were able to achieve the highest Th wt % in mono- and biactinide frameworks with minimal structural density. Overall, the combination of a multistep synthetic approach with homogeneous actinide distribution and moderate solvothermal conditions could make MOFs an exceptionally powerful tool to address fundamental questions responsible for chemical behavior of An-based extended structures and, therefore, shed light on possible optimization of nuclear waste administration.

The concern of emergence of multi-station reaction pathways that might make stepwise the mechanism of the 1,3-dipolar cycloadditions of azides and alkynes

NASA Astrophysics Data System (ADS)

Mohtat, Bita; Siadati, Seyyed Amir; Khalilzadeh, Mohammad Ali; Zareyee, Daryoush

2018-03-01

After hot debates on the concerted or stepwise nature of the mechanism of the catalyst-free 1,3-dipolar cycloadditions (DC)s, nowadays, it is being believed that for the reaction of each dipole and dipolarophile, there is a possibility that the reaction mechanism becomes stepwise, intermediates emerge, and the reaction becomes non-stereospecific. Yield of even minimal amounts of unwanted side products or stereoisomers as impurities could bring many troubles like difficult purification steps. In this project, we have made attempts to study all probable reaction channels of the azide cycloadditions with two functionalized alkynes, in order to answer this question: "is there any possibility that intermediates evolve in the catalyst-free click 1,3-DC reaction of azide-alkynes?". During the calculations, several multi-station reaction pathways supporting the stepwise and concerted mechanisms were detected. Also, the born-oppenheimer molecular dynamic (BOMD) simulation was used to find trustable geometries which could be emerged during the reaction coordinate.

Essential Resources for Implementation and Sustainability of Evidence-Based Health Promotion Programs: A Mixed Methods Multi-Site Case Study.

PubMed

Dattalo, M; Wise, M; Ford Ii, J H; Abramson, B; Mahoney, J

2017-04-01

As of October 2016, use of federal Older Americans Act funds for health promotion and disease prevention will be restricted to the Administration on Aging's criteria for high-level evidence-based health promotion programs. Dissemination of these programs to rural communities remains limited. Therefore a strong need exists to identify strategies that facilitate program implementation and sustainability. The objective of this study was to compare organizational readiness and implementation strategies used by rural communities that achieved varying levels of success in sustaining evidence-based health promotion programs for older adults. We utilized a qualitative multi-site case study design to analyze the longitudinal experiences of eight rural sites working to implement evidence-based health promotion program over 3 years (8/2012-7/2015). Multiple sources of data (interviews, documents, reports, surveys) from each site informed the analysis. We used conventional content analysis to conduct a cross-case comparison to identify common features of rural counties that successfully implemented and sustained their target evidence-based health promotion program. Readiness to implement evidence-based programs as low at baseline as all site leaders described needing to secure additional resources for program implementation. Sites that successfully utilized six essential resources implemented and sustained greater numbers of workshops: (1) External Partnerships, (2) Agency Leadership Commitment, (3) Ongoing Source of Workshop Leaders, (4) Health Promotion Coordination Tasks Assigned to Specific Staff, (5) Organizational Stability, and (6) Change Team Engagement. The six essential resources described in this study can help rural communities assess their readiness to implement health promotion programs and work secure the resources necessary for successful implementation.

Factors related to leader implementation of a nationally disseminated community-based exercise program: a cross-sectional study

PubMed Central

Seguin, Rebecca A; Palombo, Ruth; Economos, Christina D; Hyatt, Raymond; Kuder, Julia; Nelson, Miriam E

2008-01-01

Background The benefits of community-based health programs are widely recognized. However, research examining factors related to community leaders' characteristics and roles in implementation is limited. Methods The purpose of this cross-sectional study was to use a social ecological framework of variables to explore and describe the relationships between socioeconomic, personal/behavioral, programmatic, leadership, and community-level social and demographic characteristics as they relate to the implementation of an evidence-based strength training program by community leaders. Eight-hundred fifty-four trained program leaders in 43 states were invited to participate in either an online or mail survey. Corresponding community-level characteristics were also collected. Programmatic details were obtained from those who implemented. Four-hundred eighty-seven program leaders responded to the survey (response rate = 57%), 78% online and 22% by mail. Results Of the 487 respondents, 270 implemented the program (55%). One or more factors from each category – professional, socioeconomic, personal/behavioral, and leadership characteristics – were significantly different between implementers and non-implementers, determined by chi square or student's t-tests as appropriate. Implementers reported higher levels of strength training participation, current and lifetime physical activity, perceived support, and leadership competence (all p < 0.05). Logistic regression analysis revealed a positive association between implementation and fitness credentials/certification (p = 0.003), program-specific self-efficacy (p = 0.002), and support-focused leadership (p = 0.006), and a negative association between implementation and educational attainment (p = 0.002). Conclusion Among this sample of trained leaders, several factors within the professional, socioeconomic, personal/behavioral, and leadership categories were related to whether they implemented a community-based exercise program. It may benefit future community-based physical activity program disseminations to consider these factors when selecting and training leaders. PMID:19055821

40 CFR 256.31 - Recommendations for developing and implementing resource conservation and recovery programs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... implementing resource conservation and recovery programs. 256.31 Section 256.31 Protection of Environment... SOLID WASTE MANAGEMENT PLANS Resource Conservation and Resource Recovery Programs § 256.31 Recommendations for developing and implementing resource conservation and recovery programs. (a) In order to...

Theoretical study on the reaction mechanism of hydrogenation of furfural to furfuryl alcohol on Lewis acidic BEA zeolites: effects of defect structure and tetravalent metals substitution.

PubMed

Injongkol, Yuwanda; Maihom, Thana; Treesukul, Piti; Sirijaraensre, Jakkapan; Boekfa, Bundet; Limtrakul, Jumras

2017-09-13

Furfural acquired from agricultural sources is receiving extensive attention in the petrochemical industry as it offers an alternative route to generate more valuable hydrocarbon compounds. Herein, we investigate the furfural hydrogenation to furfuryl alcohol catalyzed by Lewis acidic BEA zeolites at the molecular level by means of the M06-L density functional theory. The mechanistic pictures in the catalytic procedure are revealed. The possible reaction pathways are considered to proceed via either concerted or stepwise mechanisms. With the contribution of zeolite oxygen bridging for the H-H splitting, the rate determining step activation barrier for the stepwise mechanism is 14.7 kcal mol -1 lower than that for the concerted mechanism. The stepwise reaction therefore seems to be favored compared to the concerted one. The catalytic effect of the defect zeolite framework on the stepwise mechanism is also investigated. The activation energy for the stepwise rate-determining step over this site is significantly lower than the corresponding step over the perfect one by 14.1 kcal mol -1 . Finally, the catalytic activity of tetravalent metal centers (Sn, Ge, Zr and Hf) substituted in BEA is also preliminarily compared and it is found to follow the order of Hf > Zr > Sn > Ge based on activation energies and the reaction rate. The difference in the activation energy can be traced back to the difference in the charge transfer from the catalytic site to the adsorbed molecules.

Controlled breathing protocols probe human autonomic cardiovascular rhythms

NASA Technical Reports Server (NTRS)

Cooke, W. H.; Cox, J. F.; Diedrich, A. M.; Taylor, J. A.; Beightol, L. A.; Ames, J. E. 4th; Hoag, J. B.; Seidel, H.; Eckberg, D. L.

1998-01-01

The purpose of this study was to determine how breathing protocols requiring varying degrees of control affect cardiovascular dynamics. We measured inspiratory volume, end-tidal CO2, R-R interval, and arterial pressure spectral power in 10 volunteers who followed the following 5 breathing protocols: 1) uncontrolled breathing for 5 min; 2) stepwise frequency breathing (at 0.3, 0.25, 0.2, 0.15, 0.1, and 0.05 Hz for 2 min each); 3) stepwise frequency breathing as above, but with prescribed tidal volumes; 4) random-frequency breathing (approximately 0.5-0.05 Hz) for 6 min; and 5) fixed-frequency breathing (0.25 Hz) for 5 min. During stepwise breathing, R-R interval and arterial pressure spectral power increased as breathing frequency decreased. Control of inspired volume reduced R-R interval spectral power during 0.1 Hz breathing (P < 0.05). Stepwise and random-breathing protocols yielded comparable coherence and transfer functions between respiration and R-R intervals and systolic pressure and R-R intervals. Random- and fixed-frequency breathing reduced end-tidal CO2 modestly (P < 0.05). Our data suggest that stringent tidal volume control attenuates low-frequency R-R interval oscillations and that fixed- and random-rate breathing may decrease CO2 chemoreceptor stimulation. We conclude that autonomic rhythms measured during different breathing protocols have much in common but that a stepwise protocol without stringent control of inspired volume may allow for the most efficient assessment of short-term respiratory-mediated autonomic oscillations.

The SBIRT program matrix: a conceptual framework for program implementation and evaluation.

PubMed

Del Boca, Frances K; McRee, Bonnie; Vendetti, Janice; Damon, Donna

2017-02-01

Screening, Brief Intervention and Referral to Treatment (SBIRT) is a comprehensive, integrated, public health approach to the delivery of services to those at risk for the adverse consequences of alcohol and other drug use, and for those with probable substance use disorders. Research on successful SBIRT implementation has lagged behind studies of efficacy and effectiveness. This paper (1) outlines a conceptual framework, the SBIRT Program Matrix, to guide implementation research and program evaluation and (2) specifies potential implementation outcomes. Overview and narrative description of the SBIRT Program Matrix. The SBIRT Program Matrix has five components, each of which includes multiple elements: SBIRT services; performance sites; provider attributes; patient/client populations; and management structure and activities. Implementation outcomes include program adoption, acceptability, appropriateness, feasibility, fidelity, costs, penetration, sustainability, service provision and grant compliance. The Screening, Brief Intervention and Referral to Treatment Program Matrix provides a template for identifying, classifying and organizing the naturally occurring commonalities and variations within and across SBIRT programs, and for investigating which variables are associated with implementation success and, ultimately, with treatment outcomes and other impacts. © 2017 Society for the Study of Addiction.

Implementing corporate wellness programs: a business approach to program planning.

PubMed

Helmer, D C; Dunn, L M; Eaton, K; Macedonio, C; Lubritz, L

1995-11-01

1. Support of key decision makers is critical to the successful implementation of a corporate wellness program. Therefore, the program implementation plan must be communicated in a format and language readily understood by business people. 2. A business approach to corporate wellness program planning provides a standardized way to communicate the implementation plan. 3. A business approach incorporates the program planning components in a format that ranges from general to specific. This approach allows for flexibility and responsiveness to changes in program planning. 4. Components of the business approach are the executive summary, purpose, background, ground rules, approach, requirements, scope of work, schedule, and financials.

A stepwise protocol for the treatment of refractory gastroesophageal reflux-induced chronic cough

PubMed Central

Xu, Xianghuai; Lv, Hanjing; Yu, Li; Chen, Qiang; Liang, Siwei

2016-01-01

Background Refractory gastroesophageal reflux-induced chronic cough (GERC) is difficult to manage. The purpose of the study is to evaluate the efficacy of a novel stepwise protocol for treating this condition. Methods A total of 103 consecutive patients with suspected refractory reflux-induced chronic cough failing to a standard anti-reflux therapy were treated with a stepwise therapy. Treatment commences with high-dose omeprazole and, if necessary, is escalated to subsequent sequential treatment with ranitidine and finally baclofen. The primary end-point was overall cough resolution, and the secondary end-point was cough resolution after each treatment step. Results High-dose omeprazole eliminated or improved cough in 28.1% of patients (n=29). Further stepwise of treatment with the addition of ranitide yielded a favorable response in an additional 12.6% (n=13) of patients, and subsequent escalation to baclofen provoked response in another 36.9% (n=38) of patients. Overall, this stepwise protocol was successful in 77.6% (n=80) of patients. The diurnal cough symptom score fell from 3 [1] to 1 [0] (Z=6.316, P=0.000), and the nocturnal cough symptom score decreased from 1 [1] to 0 [1] (Z=–4.511, P=0.000), with a corresponding reduction in the Gastroesophageal Reflux Diagnostic Questionnaire score from 8.6±1.7 to 6.8±0.7 (t=3.612, P=0.000). Conversely, the cough threshold C2 to capsaicin was increased from 0.49 (0.49) µmol/L to 1.95 (2.92) µmol/L (Z=–5.892, P=0.000), and the cough threshold C5 was increased from 1.95 (2.92) µmol/L to 7.8 (5.85) µmol/L (Z=–5.171, P=0.000). Conclusions Sequential stepwise anti-reflux therapy is a useful therapeutic strategy for refractory reflux-induced chronic cough. PMID:26904227

Implementing a Batterer's Intervention Program in a Correctional Setting: A Tertiary Prevention Model

ERIC Educational Resources Information Center

Yorke, Nada J.; Friedman, Bruce D.; Hurt, Pat

2010-01-01

This study discusses the pretest and posttest results of a batterer's intervention program (BIP) implemented within a California state prison substance abuse program (SAP), with a recommendation for further programs to be implemented within correctional institutions. The efficacy of utilizing correctional facilities to reach offenders who…

IMPLEMENTATION REVIEW LETTERS, 2002

EPA Science Inventory

The following letters provide a summary of the Environmental Protection Agencys comments regarding 2002 Implementation Review of nineteen estuary programs in the National Estuary Program. Various strengths within the programs included use of implementation progress and tracking s...

Implementation of a tobacco-free workplace program at a local mental health authority.

PubMed

Correa-Fernández, Virmarie; Wilson, William T; Shedrick, Deborah A; Kyburz, Bryce; L Samaha, Hannah; Stacey, Timothy; Williams, Teresa; Lam, Cho Y; Reitzel, Lorraine R

2017-06-01

Tobacco-free workplace policies that incorporate evidence-based practices can increase the reach and effectiveness of tobacco dependence treatment among underserved populations but may be underutilized due to limited knowledge about implementation processes. This paper describes the implementation of a comprehensive tobacco-free workplace program at a behavioral healthcare community center in Texas. The center participated in a tobacco-free workplace program implementation project that provided guidance and resources and allowed center autonomy in implementation. Six employee-based subcommittees guided implementation of program components including consumer and staff surveys, policy development, signage, tobacco use assessments, communication, and nicotine replacement distribution. Timeline development, successes, challenges, lessons learned, and sustainability initiatives are delineated. Concerns about the tobacco-free workplace policy from the center's staff and consumers were gradually replaced by strong support for the initiative. Program success was enabled by consistent support from the center's leadership, publicity of program efforts, and educational campaigns. The center surpassed the program expectations when it adopted a tobacco-free hiring policy, which was not an initial program goal. This center's path to a tobacco-free workplace provides an implementation and sustainability model for other behavioral health community centers and other organizations to become tobacco free.

Optimizing Implementation of Obesity Prevention Programs: A Qualitative Investigation Within a Large-Scale Randomized Controlled Trial.

PubMed

Kozica, Samantha L; Teede, Helena J; Harrison, Cheryce L; Klein, Ruth; Lombard, Catherine B

2016-01-01

The prevalence of obesity in rural and remote areas is elevated in comparison to urban populations, highlighting the need for interventions targeting obesity prevention in these settings. Implementing evidence-based obesity prevention programs is challenging. This study aimed to investigate factors influencing the implementation of obesity prevention programs, including adoption, program delivery, community uptake, and continuation, specifically within rural settings. Nested within a large-scale randomized controlled trial, a qualitative exploratory approach was adopted, with purposive sampling techniques utilized, to recruit stakeholders from 41 small rural towns in Australia. In-depth semistructured interviews were conducted with clinical health professionals, health service managers, and local government employees. Open coding was completed independently by 2 investigators and thematic analysis undertaken. In-depth interviews revealed that obesity prevention programs were valued by the rural workforce. Program implementation is influenced by interrelated factors across: (1) contextual factors and (2) organizational capacity. Key recommendations to manage the challenges of implementing evidence-based programs focused on reducing program delivery costs, aided by the provision of a suite of implementation and evaluation resources. Informing the scale-up of future prevention programs, stakeholders highlighted the need to build local rural capacity through developing supportive university partnerships, generating local program ownership and promoting active feedback to all program partners. We demonstrate that the rural workforce places a high value on obesity prevention programs. Our results inform the future scale-up of obesity prevention programs, providing an improved understanding of strategies to optimize implementation of evidence-based prevention programs. © 2015 National Rural Health Association.

Training School Personnel to Implement a Universal School-Based Prevention of Depression Program under Real-World Conditions

ERIC Educational Resources Information Center

Harnett, P.H.; Dadds, M.R.

2004-01-01

The present study evaluated the impact of a universal prevention of depression program [the Resourceful Adolescent Program (RAP)] when implemented under real-world conditions in a school setting. Prior research has found the RAP program to be beneficial for high-school students when the program was implemented by university staff selected,…

Phlebotomus argentipes seasonal patterns in India and Nepal.

PubMed

Picado, Albert; Das, Murari Lal; Kumar, Vijay; Dinesh, Diwakar S; Rijal, Suman; Singh, Shri P; Das, Pradeep; Coosemans, Marc; Boelaert, Marleen; Davies, Clive

2010-03-01

The current control of Phebotomus argentipes (Annandale and Brunetti), the vector of Leishmania donovani (Laveran and Mesnil), on the Indian subcontinent is base on indoor residual spraying. The efficacy of this method depends, among other factors, on the timing and number of spraying rounds, which depend on the P. argentipes seasonality. To describe P. argentipes' seasonal patterns, six visceral leishmaniasis (VL) endemic villages, three in Muzaffarpur and three in Sunsari districts in India and Nepal, respectively, were selected based on accessibility and VL incidence. Ten houses per cluster with the highest P. argentipes density were monitored monthly for 15-16 mo using Center for Disease Control and Prevention light traps. Minimum and maximum temperature and rainfall data for the months January 2006 through December 2007 were collected from the nearest available weather stations. Backwards stepwise regression was used to generate the minimal adequate model for explaining the monthly variation in P. argentipes populations. The seasonality of P. argentipes is similar in India and Nepal, with two annual density peaks around May and October. Monthly P. argentipes density is positively associated with temperature and negatively associated with rainfall in both study sites. The multivariate climate model explained 57% of the monthly vectorial abundance. Vector control programs against P. argentipes (i.e., indoor residual spraying) should take into account the seasonal described here when implementing and monitoring interventions. Monitoring simple meteorological variables (i.e., temperature, rainfall) may allow prediction of VL epidemics on the Indian subcontinent.

An integrated approach to assess broad-scale condition of coastal wetlands - The Gulf of Mexico Coastal Wetlands pilot survey

USGS Publications Warehouse

Nestlerode, J.A.; Engle, V.D.; Bourgeois, P.; Heitmuller, P.T.; Macauley, J.M.; Allen, Y.C.

2009-01-01

The Environmental Protection Agency (EPA) and U.S. Geological Survey (USGS) initiated a two-year regional pilot survey in 2007 to develop, test, and validate tools and approaches to assess the condition of northern Gulf of Mexico (GOM) coastal wetlands. Sampling sites were selected from estuarine and palustrine wetland areas with herbaceous, forested, and shrub/scrub habitats delineated by the US Fish and Wildlife Service National Wetlands Inventory Status and Trends (NWI S&T) program and contained within northern GOM coastal watersheds. A multi-level, stepwise, iterative survey approach is being applied to multiple wetland classes at 100 probabilistically-selected coastal wetlands sites. Tier 1 provides information at the landscape scale about habitat inventory, land use, and environmental stressors associated with the watershed in which each wetland site is located. Tier 2, a rapid assessment conducted through a combination of office and field work, is based on best professional judgment and on-site evidence. Tier 3, an intensive site assessment, involves on-site collection of vegetation, water, and sediment samples to establish an integrated understanding of current wetland condition and validate methods and findings from Tiers 1 and 2. The results from this survey, along with other similar regional pilots from the Mid-Atlantic, West Coast, and Great Lakes Regions will contribute to a design and implementation approach for the National Wetlands Condition Assessment to be conducted by EPA's Office of Water in 2011. ?? Springer Science+Business Media B.V. 2008.

Successful Stepwise Development of Patient Research Partnership: 14 Years' Experience of Actions and Consequences in Outcome Measures in Rheumatology (OMERACT).

PubMed

de Wit, Maarten; Kirwan, John R; Tugwell, Peter; Beaton, Dorcas; Boers, Maarten; Brooks, Peter; Collins, Sarah; Conaghan, Philip G; D'Agostino, Maria-Antonietta; Hofstetter, Cathie; Hughes, Rod; Leong, Amye; Lyddiatt, Ann; March, Lyn; May, James; Montie, Pamela; Richards, Pamela; Simon, Lee S; Singh, Jasvinder A; Strand, Vibeke; Voshaar, Marieke; Bingham, Clifton O; Gossec, Laure

2017-04-01

There is increasing interest in making patient participation an integral component of medical research. However, practical guidance on optimizing this engagement in healthcare is scarce. Since 2002, patient involvement has been one of the key features of the Outcome Measures in Rheumatology (OMERACT) international consensus effort. Based on a review of cumulative data from qualitative studies and internal surveys among OMERACT participants, we explored the potential benefits and challenges of involving patient research partners in conferences and working group activities. We supplemented our review with personal experiences and reflections regarding patient participation in the OMERACT process. We found that between 2002 and 2016, 67 patients have attended OMERACT conferences, of whom 28 had sustained involvement; many other patients contributed to OMERACT working groups. Their participation provided face validity to the OMERACT process and expanded the research agenda. Essential facilitators have been the financial commitment to guarantee sustainable involvement of patients at these conferences, procedures for recruitment, selection and support, and dedicated time allocated in the program for patient issues. Current challenges include the representativeness of the patient panel, risk of pseudo-professionalization, and disparity in patients' and researchers' perception of involvement. In conclusion, OMERACT has embedded long-term patient involvement in the consensus-building process on the measurement of core health outcomes. This integrative process continues to evolve iteratively. We believe that the practical points raised here can improve participatory research implementation.

A theory-informed approach to mental health care capacity building for pharmacists.

PubMed

Murphy, Andrea L; Gardner, David M; Kutcher, Stan P; Martin-Misener, Ruth

2014-01-01

Pharmacists are knowledgeable, accessible health care professionals who can provide services that improve outcomes in mental health care. Various challenges and opportunities can exist in pharmacy practice to hinder or support pharmacists' efforts. We used a theory-informed approach to development and implementation of a capacity-building program to enhance pharmacists' roles in mental health care. Theories and frameworks including the Consolidated Framework for Implementation Research, the Theoretical Domains Framework, and the Behaviour Change Wheel were used to inform the conceptualization, development, and implementation of a capacity-building program to enhance pharmacists' roles in mental health care. The More Than Meds program was developed and implemented through an iterative process. The main program components included: an education and training day; use of a train-the-trainer approach from partnerships with pharmacists and people with lived experience of mental illness; development of a community of practice through email communications, a website, and a newsletter; and use of educational outreach delivered by pharmacists. Theories and frameworks used throughout the program's development and implementation facilitated a means to conceptualize the component parts of the program as well as its overall presence as a whole from inception through evolution in implementation. Using theoretical foundations for the program enabled critical consideration and understanding of issues related to trialability and adaptability of the program. Theory was essential to the underlying development and implementation of a capacity-building program for enhancing services by pharmacists for people with lived experience of mental illness. Lessons learned from the development and implementation of this program are informing current research and evolution of the program.

SCEW: a Microsoft Excel add-in for easy creation of survival curves.

PubMed

Khan, Haseeb Ahmad

2006-07-01

Survival curves are frequently used for reporting survival or mortality outcomes of experimental pharmacological/toxicological studies and of clinical trials. Microsoft Excel is a simple and widely used tool for creation of numerous types of graphic presentations however it is difficult to create step-wise survival curves in Excel. Considering the familiarity of clinicians and biomedical scientists with Excel, an algorithm survival curves in Excel worksheet (SCEW) has been developed for easy creation of survival curves directly in Excel worksheets. The algorithm has been integrated in the form of Excel add-in for easy installation and usage. The program is based on modification of frequency data for binary break-up using the spreadsheet formula functions whereas a macro subroutine automates the creation of survival curves. The advantages of this program are simple data input, minimal procedural steps and the creation of survival curves in the familiar confines of Excel.

Resolving writer's block.

PubMed Central

Huston, P.

1998-01-01

PROBLEM BEING ADDRESSED: Writer's block, or a distinctly uncomfortable inability to write, can interfere with professional productivity. OBJECTIVE OF PROGRAM: To identify writer's block and to outline suggestions for its early diagnosis, treatment, and prevention. MAIN COMPONENTS OF PROGRAM: Once the diagnosis has been established, a stepwise approach to care is recommended. Mild blockage can be resolved by evaluating and revising expectations, conducting a task analysis, and giving oneself positive feedback. Moderate blockage can be addressed by creative exercises, such as brainstorming and role-playing. Recalcitrant blockage can be resolved with therapy. Writer's block can be prevented by taking opportunities to write at the beginning of projects, working with a supportive group of people, and cultivating an ongoing interest in writing. CONCLUSIONS: Writer's block is a highly treatable condition. A systematic approach can help to alleviate anxiety, build confidence, and give people the information they need to work productively. PMID:9481467

Health-Based Capitation Risk Adjustment in Minnesota Public Health Care Programs

PubMed Central

Gifford, Gregory A.; Edwards, Kevan R.; Knutson, David J.

2004-01-01

This article documents the history and implementation of health-based capitation risk adjustment in Minnesota public health care programs, and identifies key implementation issues. Capitation payments in these programs are risk adjusted using an historical, health plan risk score, based on concurrent risk assessment. Phased implementation of capitation risk adjustment for these programs began January 1, 2000. Minnesota's experience with capitation risk adjustment suggests that: (1) implementation can accelerate encounter data submission, (2) administrative decisions made during implementation can create issues that impact payment model performance, and (3) changes in diagnosis data management during implementation may require changes to the payment model. PMID:25372356

A program for thai rubber tappers to improve the cost of occupational health and safety.

PubMed

Arphorn, Sara; Chaonasuan, Porntip; Pruktharathikul, Vichai; Singhakajen, Vajira; Chaikittiporn, Chalermchai

2010-01-01

The purposes of this research were to determine the cost of occupational health and safety and work-related health problems, accidents, injuries and illnesses in rubber tappers by implementing a program in which rubber tappers were provided training on self-care in order to reduce and prevent work-related accidents, injuries and illnesses. Data on costs for healthcare, the prevention and the treatment of work-related accidents, injuries and illnesses were collected by interview using a questionnaire. The findings revealed that there was no relationship between what was spent on healthcare and the prevention of work-related accidents, injuries and illnesses and that spent on the treatment of work-related accidents, injuries and illnesses. The proportion of the injured subjects after the program implementation was significantly less than that before the program implementation (p<0.001). The level of pain after the program implementation was significantly less than that before the program implementation (p<0.05). The treatment costs incurred after the program implementation were significantly less than those incurred before the program implementation (p<0.001). It was demonstrated that this program raised the health awareness of rubber tappers. It strongly empowered the leadership in health promotion for the community.

Approaches to the simulation of unconfined flow and perched groundwater flow in MODFLOW

USGS Publications Warehouse

Bedekar, Vivek; Niswonger, Richard G.; Kipp, Kenneth; Panday, Sorab; Tonkin, Matthew

2012-01-01

Various approaches have been proposed to manage the nonlinearities associated with the unconfined flow equation and to simulate perched groundwater conditions using the MODFLOW family of codes. The approaches comprise a variety of numerical techniques to prevent dry cells from becoming inactive and to achieve a stable solution focused on formulations of the unconfined, partially-saturated, groundwater flow equation. Keeping dry cells active avoids a discontinuous head solution which in turn improves the effectiveness of parameter estimation software that relies on continuous derivatives. Most approaches implement an upstream weighting of intercell conductance and Newton-Raphson linearization to obtain robust convergence. In this study, several published approaches were implemented in a stepwise manner into MODFLOW for comparative analysis. First, a comparative analysis of the methods is presented using synthetic examples that create convergence issues or difficulty in handling perched conditions with the more common dry-cell simulation capabilities of MODFLOW. Next, a field-scale three-dimensional simulation is presented to examine the stability and performance of the discussed approaches in larger, practical, simulation settings.

Nurses' perceptions, acceptance, and use of a novel in-room pediatric ICU technology: testing an expanded technology acceptance model.

PubMed

Holden, Richard J; Asan, Onur; Wozniak, Erica M; Flynn, Kathryn E; Scanlon, Matthew C

2016-11-15

The value of health information technology (IT) ultimately depends on end users accepting and appropriately using it for patient care. This study examined pediatric intensive care unit nurses' perceptions, acceptance, and use of a novel health IT, the Large Customizable Interactive Monitor. An expanded technology acceptance model was tested by applying stepwise linear regression to data from a standardized survey of 167 nurses. Nurses reported low-moderate ratings of the novel IT's ease of use and low to very low ratings of usefulness, social influence, and training. Perceived ease of use, usefulness for patient/family involvement, and usefulness for care delivery were associated with system satisfaction (R 2  = 70%). Perceived usefulness for care delivery and patient/family social influence were associated with intention to use the system (R 2  = 65%). Satisfaction and intention were associated with actual system use (R 2  = 51%). The findings have implications for research, design, implementation, and policies for nursing informatics, particularly novel nursing IT. Several changes are recommended to improve the design and implementation of the studied IT.

Verification of performance specifications of a molecular test: cystic fibrosis carrier testing using the Luminex liquid bead array.

PubMed

Lacbawan, Felicitas L; Weck, Karen E; Kant, Jeffrey A; Feldman, Gerald L; Schrijver, Iris

2012-01-01

The number of clinical laboratories introducing various molecular tests to their existing test menu is continuously increasing. Prior to offering a US Food and Drug Administration-approved test, it is necessary that performance characteristics of the test, as claimed by the company, are verified before the assay is implemented in a clinical laboratory. To provide an example of the verification of a specific qualitative in vitro diagnostic test: cystic fibrosis carrier testing using the Luminex liquid bead array (Luminex Molecular Diagnostics, Inc, Toronto, Ontario). The approach used by an individual laboratory for verification of a US Food and Drug Administration-approved assay is described. Specific verification data are provided to highlight the stepwise verification approach undertaken by a clinical diagnostic laboratory. Protocols for verification of in vitro diagnostic assays may vary between laboratories. However, all laboratories must verify several specific performance specifications prior to implementation of such assays for clinical use. We provide an example of an approach used for verifying performance of an assay for cystic fibrosis carrier screening.

The Causality Study of External Environment Analysis (EEA), Internal Environment Analysis (IEA), Strategy Implementation on Study Program Performance at Vocational High School (VHS) in Nias Archipelago, Indonesia

ERIC Educational Resources Information Center

Waruwu, Binahati; Sitompul, Harun; Manullang, Belferik

2016-01-01

The purposes of this study are to find out the significant effect of: (1) EEA on strategy implementation, (2) IEA on strategy implementation, (3) EEA on study program performance, (4) IEA on study program performance, and (5) strategy implementation on study program performance of Vocational High School (VHS) in Nias Archipelago. The population of…

Use of multilevel modeling for determining optimal parameters of heat supply systems

NASA Astrophysics Data System (ADS)

Stennikov, V. A.; Barakhtenko, E. A.; Sokolov, D. V.

2017-07-01

The problem of finding optimal parameters of a heat-supply system (HSS) is in ensuring the required throughput capacity of a heat network by determining pipeline diameters and characteristics and location of pumping stations. Effective methods for solving this problem, i.e., the method of stepwise optimization based on the concept of dynamic programming and the method of multicircuit optimization, were proposed in the context of the hydraulic circuit theory developed at Melentiev Energy Systems Institute (Siberian Branch, Russian Academy of Sciences). These methods enable us to determine optimal parameters of various types of piping systems due to flexible adaptability of the calculation procedure to intricate nonlinear mathematical models describing features of used equipment items and methods of their construction and operation. The new and most significant results achieved in developing methodological support and software for finding optimal parameters of complex heat supply systems are presented: a new procedure for solving the problem based on multilevel decomposition of a heat network model that makes it possible to proceed from the initial problem to a set of interrelated, less cumbersome subproblems with reduced dimensionality; a new algorithm implementing the method of multicircuit optimization and focused on the calculation of a hierarchical model of a heat supply system; the SOSNA software system for determining optimum parameters of intricate heat-supply systems and implementing the developed methodological foundation. The proposed procedure and algorithm enable us to solve engineering problems of finding the optimal parameters of multicircuit heat supply systems having large (real) dimensionality, and are applied in solving urgent problems related to the optimal development and reconstruction of these systems. The developed methodological foundation and software can be used for designing heat supply systems in the Central and the Admiralty regions in St. Petersburg, the city of Bratsk, and the Magistral'nyi settlement.

Some Considerations on the Partial Credit Model

ERIC Educational Resources Information Center

Verhelst, N. D.; Verstralen, H. H. F. M.

2008-01-01

The Partial Credit Model (PCM) is sometimes interpreted as a model for stepwise solution of polytomously scored items, where the item parameters are interpreted as difficulties of the steps. It is argued that this interpretation is not justified. A model for stepwise solution is discussed. It is shown that the PCM is suited to model sums of binary…

Adapting and implementing an evidence-based sun-safety education program in rural Idaho, 2012.

PubMed

Cariou, Charlene; Gonzales, Melanie; Krebill, Hope

2014-05-08

Melanoma incidence and mortality rates in Idaho are higher than national averages. The importance of increased awareness of skin cancer has been cited by state and local organizations. St. Luke's Mountain States Tumor Institute (MSTI) prioritized educational outreach efforts to focus on the implementation of a skin cancer prevention program in rural Idaho. As a community cancer center, MSTI expanded cancer education services to include dedicated support to rural communities. Through this expansion, an MSTI educator sought to partner with a community organization to provide sun-safety education. MSTI selected, adapted, and implemented an evidence-based program, Pool Cool. The education program was implemented in 5 phases. In Phase I, we identified and recruited a community partner; in Phase 2, after thorough research, we selected a program, Pool Cool; in Phase 3, we planned the details of the program, including identification of desired short- and long-term outcomes and adaptation of existing program materials; in Phase 4, we implemented the program in summer 2012; in Phase 5, we assessed program sustainability and expansion. MSTI developed a sustainable partnership with Payette Municipal Pool, and in summer 2012, we implemented Pool Cool. Sun-safety education was provided to more than 700 young people aged 2 to 17 years, and educational signage and sunscreen benefitted hundreds of additional pool patrons. Community cancer centers are increasingly being asked to assess community needs and implement evidence-based prevention and screening programs. Clinical staff may become facilitators of evidence-based public health programs. Challenges of implementing evidence-based programs in the context of a community cancer centers are staffing, leveraging of resources, and ongoing training and support.

Adapting and Implementing an Evidence-Based Sun-Safety Education Program in Rural Idaho, 2012

PubMed Central

Gonzales, Melanie; Krebill, Hope

2014-01-01

Background Melanoma incidence and mortality rates in Idaho are higher than national averages. The importance of increased awareness of skin cancer has been cited by state and local organizations. St. Luke’s Mountain States Tumor Institute (MSTI) prioritized educational outreach efforts to focus on the implementation of a skin cancer prevention program in rural Idaho. Community Context As a community cancer center, MSTI expanded cancer education services to include dedicated support to rural communities. Through this expansion, an MSTI educator sought to partner with a community organization to provide sun-safety education. MSTI selected, adapted, and implemented an evidence-based program, Pool Cool. Methods The education program was implemented in 5 phases. In Phase I, we identified and recruited a community partner; in Phase 2, after thorough research, we selected a program, Pool Cool; in Phase 3, we planned the details of the program, including identification of desired short- and long-term outcomes and adaptation of existing program materials; in Phase 4, we implemented the program in summer 2012; in Phase 5, we assessed program sustainability and expansion. Outcome MSTI developed a sustainable partnership with Payette Municipal Pool, and in summer 2012, we implemented Pool Cool. Sun-safety education was provided to more than 700 young people aged 2 to 17 years, and educational signage and sunscreen benefitted hundreds of additional pool patrons. Interpretation Community cancer centers are increasingly being asked to assess community needs and implement evidence-based prevention and screening programs. Clinical staff may become facilitators of evidence-based public health programs. Challenges of implementing evidence-based programs in the context of a community cancer centers are staffing, leveraging of resources, and ongoing training and support. PMID:24809363

Implementation Measurement for Evidence-Based Violence Prevention Programs in Communities.

PubMed

Massetti, Greta M; Holland, Kristin M; Gorman-Smith, Deborah

2016-08-01

Increasing attention to the evaluation, dissemination, and implementation of evidence-based programs (EBPs) has led to significant advancements in the science of community-based violence prevention. One of the prevailing challenges in moving from science to community involves implementing EBPs and strategies with quality. The CDC-funded National Centers of Excellence in Youth Violence Prevention (YVPCs) partner with communities to implement a comprehensive community-based strategy to prevent violence and to evaluate that strategy for impact on community-wide rates of violence. As part of their implementation approach, YVPCs document implementation of and fidelity to the components of the comprehensive youth violence prevention strategy. We describe the strategies and methods used by the six YVPCs to assess implementation and to use implementation data to inform program improvement efforts. The information presented describes the approach and measurement strategies employed by each center and for each program implemented in the partner communities. YVPCs employ both established and innovative strategies for measurement and tracking of implementation across a broad range of programs, practices, and strategies. The work of the YVPCs highlights the need to use data to understand the relationship between implementation of EBPs and youth violence outcomes.

How To Implement a Tech Prep Program Based on the Rhode Island Model. Tech Prep Associate Degree Program. Technical Programs. Business/Office Administration Programs. Allied Health/Dental Health Programs.

ERIC Educational Resources Information Center

Community Coll. of Rhode Island, Warwick.

This implementation guide contains information based on experiences that occurred during the development and implementation of the Rhode Island Tech Prep Model. It is intended to assist educators in addressing challenges and obstacles faced by the program early in the planning process. It begins with a rationale for tech prep. Rhode Island…

Detecting selection effects in community implementations of family-based substance abuse prevention programs.

PubMed

Hill, Laura G; Goates, Scott G; Rosenman, Robert

2010-04-01

To calculate valid estimates of the costs and benefits of substance abuse prevention programs, selection effects must be identified and corrected. A supplemental comparison sample is typically used for this purpose, but in community-based program implementations, such a sample is often not available. We present an evaluation design and analytic approach that can be used in program evaluations of real-world implementations to identify selection effects, which in turn can help inform recruitment strategies, pinpoint possible selection influences on measured program outcomes, and refine estimates of program costs and benefits. We illustrate our approach with data from a multisite implementation of a popular substance abuse prevention program. Our results indicate that the program's participants differed significantly from the population at large.

A stepwise procedure for science communication in the field

NASA Astrophysics Data System (ADS)

Nisancioglu, Kerim; Paasche, Øyvind

2017-04-01

Communicating and disseminating earth science to laypersons, high-school students and their teachers are becoming increasingly important considering the overwhelming impact human civilization have on the planet. One of the main challenges with this type of dissemination arises from the cross-disciplinary nature of the Earth system as it encompasses anything from cloud physics to the geological evidence of ice ages being played out on millennial time scales. During the last four years we have tested and developed an approach referred to as «Turspor» which can be translated to 'Trail Tracks'. The ambition with "Turspor" is to inspire participants to seek in-depth knowledge relating to observations of features made in the field (glacial moraines, active permafrost, clouds, winds and so forth) as we have come to learn that observations made in the field enhances students capability to grasp the bare essentials related to the phenomena in question. By engaging master and PhD students in the process we create a platform where students can improve their teaching and communicative skills through a stepwise procedure. The initial concept was tested on 35 high school students during the summer of 2012 in the mountainous area of Snøheim on Dovre, Southern Norway. Before the arrival of the high school students, the university students prepared one page written summaries describing relevant geological or meteorological features and trained on how to best disseminate a basic scientific understanding of these. Specific examples were patterned ground caused by permafrost, glacier flour, katabatic winds, and equilibrium line altitude of glaciers. Based on the success of the program over the past 4 years with field trips together with local schools, we are in the process of developing the concept to be offered as a course at the master and PhD level, including a week of training in didactics applied to topics in the geosciences as well as practical training in the field. The university students who complete the course will be in charge of guiding local high school students in the field (mostly at university field stations in the mountains of Norway), as well as follow up on the topics discussed in collaboration with the high-school teachers during a subsequent visit to the classroom. By participating in the program, high-school students will experience inquiry-based learning, adding to their understanding of the scientific process. Sites developed through this program so far have been documented with a GPS tag, detailed description, background and pictures and hosted by the Norwegian Trekking Association website: ut.no as well as an associated app. The stepwise procedure of this concept has been developed through continous interaction with teachers, students and the general public. As a consequence, our capability to address and explain many earth science features of large societal relevance such as glacier retreat, thawing permafrost, flooding, snow avalanches, vegetation dynamics and climate change in general has been greatly improved. For examples see https://www.ut.no/gruppe/8.1819/

Linking secondary school physical education with community sport and recreation for girls: a process evaluation.

PubMed

Casey, Meghan M; Telford, Amanda; Mooney, Amanda; Harvey, Jack T; Eime, Rochelle M; Payne, Warren R

2014-10-06

The purpose of this study was to undertake a process evaluation to examine the reach, adoption and implementation of a school-community linked physical activity (PA) program for girls aged 12 - 15 years (School Years 7 - 9) using the RE-AIM framework. Various approaches were used to assess 'reach', 'adoption' and implementation: (a) a school environment survey of intervention schools (n = 6); (b) teacher feedback regarding the professional development component (91.1% response rate) and lesson implementation (60.8% response rate); and (c) post-intervention focus group interviews with physical education (PE) teachers (n = 29), students (n = 125), coaches (n = 13) and instructors (n = 8) regarding program experiences. Reach and Adoption: Seven schools (n = 1491 Year 7-9 female student enrolment; 70% adoption rate), five tennis clubs, eight football clubs and five leisure centres participated in the program during 2011. Program design and professional development opportunities (training, resource manual and opportunities to work with coaches and instructors during PE classes) supported implementation and student engagement in PA. However, there was a lack of individual and organisational readiness to adopt program principles. For some deliverers there were deeply embedded ideologies that were not aligned with the Game Sense teaching approach upon which the program was based. Further, cognitive components of the program such as self-management were not widely adopted as other components of the program tended to be prioritised. The program design and resources supported the success of the program, however, some aspects were not implemented as intended, which may have affected the likelihood of achieving further positive outcomes. Barriers to program implementation were identified and should be considered when designing school-community linked interventions. In particular, future programs should seek to assess and adjust for organizational readiness within the study design. For example, shared commitment and abilities of program deliverers to implement the program needs to be determined to support program implementation. ACTRN12614000446662. April 30th 2014.

Staff Development in the Implementation of a Schoolwide Writing Program.

ERIC Educational Resources Information Center

Knudson, Ruth

A case study examined the implementation of a schoolwide writing program established in a California middle school through a district sponsored school improvement program (SIP). Conducted at an urban sprawl southern California school of approximately 900 students in grades seven and eight, the program was directed and implemented by the English…

Implementation of the Air Program Information Management System (APIMS) Inspection Module

DTIC Science & Technology

2009-05-01

7 5 T H A I R B A S E W I N G Implementation of the Air Program Information Management System (APIMS) Inspection Module 2009 Environment...Implementation of the Air Program Information Management System (APIMS) Inspection Module 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER

The US Air Force Suicide Prevention Program: Implications for Public Health Policy

PubMed Central

Pflanz, Steven; Talcott, Gerald W.; Campise, Rick L.; Lavigne, Jill E.; Bajorska, Alina; Tu, Xin; Caine, Eric D.

2010-01-01

Objectives. We evaluated the effectiveness of the US Air Force Suicide Prevention Program (AFSPP) in reducing suicide, and we measured the extent to which air force installations implemented the program. Methods. We determined the AFSPP's impact on suicide rates in the air force by applying an intervention regression model to data from 1981 through 2008, providing 16 years of data before the program's 1997 launch and 11 years of data after launch. Also, we measured implementation of program components at 2 points in time: during a 2004 increase in suicide rates, and 2 years afterward. Results. Suicide rates in the air force were significantly lower after the AFSPP was launched than before, except during 2004. We also determined that the program was being implemented less rigorously in 2004. Conclusions. The AFSPP effectively prevented suicides in the US Air Force. The long-term effectiveness of this program depends upon extensive implementation and effective monitoring of implementation. Suicides can be reduced through a multilayered, overlapping approach that encompasses key prevention domains and tracks implementation of program activities. PMID:20466973

Implementation of evidence-based home visiting programs aimed at reducing child maltreatment: A meta-analytic review.

PubMed

Casillas, Katherine L; Fauchier, Angèle; Derkash, Bridget T; Garrido, Edward F

2016-03-01

In recent years there has been an increase in the popularity of home visitation programs as a means of addressing risk factors for child maltreatment. The evidence supporting the effectiveness of these programs from several meta-analyses, however, is mixed. One potential explanation for this inconsistency explored in the current study involves the manner in which these programs were implemented. In the current study we reviewed 156 studies associated with 9 different home visitation program models targeted to caregivers of children between the ages of 0 and 5. Meta-analytic techniques were used to determine the impact of 18 implementation factors (e.g., staff selection, training, supervision, fidelity monitoring, etc.) and four study characteristics (publication type, target population, study design, comparison group) in predicting program outcomes. Results from analyses revealed that several implementation factors, including training, supervision, and fidelity monitoring, had a significant effect on program outcomes, particularly child maltreatment outcomes. Study characteristics, including the program's target population and the comparison group employed, also had a significant effect on program outcomes. Implications of the study's results for those interested in implementing home visitation programs are discussed. A careful consideration and monitoring of program implementation is advised as a means of achieving optimal study results. Copyright © 2015 Elsevier Ltd. All rights reserved.

Building capacity in implementation science research training at the University of Nairobi.

PubMed

Osanjo, George O; Oyugi, Julius O; Kibwage, Isaac O; Mwanda, Walter O; Ngugi, Elizabeth N; Otieno, Fredrick C; Ndege, Wycliffe; Child, Mara; Farquhar, Carey; Penner, Jeremy; Talib, Zohray; Kiarie, James N

2016-03-08

Health care systems in sub-Saharan Africa, and globally, grapple with the problem of closing the gap between evidence-based health interventions and actual practice in health service settings. It is essential for health care systems, especially in low-resource settings, to increase capacity to implement evidence-based practices, by training professionals in implementation science. With support from the Medical Education Partnership Initiative, the University of Nairobi has developed a training program to build local capacity for implementation science. This paper describes how the University of Nairobi leveraged resources from the Medical Education Partnership to develop an institutional program that provides training and mentoring in implementation science, builds relationships between researchers and implementers, and identifies local research priorities for implementation science. The curriculum content includes core material in implementation science theory, methods, and experiences. The program adopts a team mentoring and supervision approach, in which fellows are matched with mentors at the University of Nairobi and partnering institutions: University of Washington, Seattle, and University of Maryland, Baltimore. A survey of program participants showed a high degree satisfaction with most aspects of the program, including the content, duration, and attachment sites. A key strength of the fellowship program is the partnership approach, which leverages innovative use of information technology to offer diverse perspectives, and a team model for mentorship and supervision. As health care systems and training institutions seek new approaches to increase capacity in implementation science, the University of Nairobi Implementation Science Fellowship program can be a model for health educators and administrators who wish to develop their program and curricula.

Implementation Challenges for Tier One and Tier Two School-Based Programs for Early Adolescents

ERIC Educational Resources Information Center

LaRusso, Maria D.; Donovan, Suzanne; Snow, Catherine

2016-01-01

This mixed-method study examined the implementation and the challenges to implementation for participants in randomized controlled trials of two school-based programs for early adolescents: the Tier One Word Generation (WG) program, and the Tier Two Strategic Adolescent Reading Intervention (STARI). Levels of implementation for WG and STARI varied…

Active Implementation Frameworks for Program Success: How to Use Implementation Science to Improve Outcomes for Children

ERIC Educational Resources Information Center

Metz, Allison; Bartley, Leah

2012-01-01

Over the past decade the science related to developing and identifying evidence-based programs and practices for children and families has improved significantly. However, the science related to implementing these programs in early childhood settings has lagged far behind. In this article, the authors outline how the science of implementation and…

Creation of ultracold molecules within the lifetime scale by direct implementation of an optical frequency comb

NASA Astrophysics Data System (ADS)

Liu, Gengyuan; Malinovskaya, S. A.

2018-06-01

A method is proposed to create molecules in the ultracold state from the Feshbach molecules by stepwise adiabatic passage using an optical frequency comb without losses due to decoherence. An emphasis is made on the impact of the vibrational state manifold on controllability of the coherent dynamics by including five excited states into the model. The results are compared with recently reported results on a three-level ? system. Sinusoidal modulation across an individual pulse in the pulse train is applied, leading to the creation of a quasi-dark state, which minimizes population of the transitional, vibrational state manifold, and efficiently mitigates decoherence in the system. The parity of the temporal chirp is shown to be an important factor in designing population dynamics in the system.

A new apparatus for electron tomography in the scanning electron microscope

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

Morandi, V., E-mail: morandi@bo.imm.cnr.it; Maccagnani, P.; Masini, L.

2015-06-23

The three-dimensional reconstruction of a microscopic specimen has been obtained by applying the tomographic algorithm to a set of images acquired in a Scanning Electron Microscope. This result was achieved starting from a series of projections obtained by stepwise rotating the sample under the beam raster. The Scanning Electron Microscope was operated in the scanning-transmission imaging mode, where the intensity of the transmitted electron beam is a monotonic function of the local mass-density and thickness of the specimen. The detection strategy has been implemented and tailored in order to maintain the projection requirement over the large tilt range, as requiredmore » by the tomographic workflow. A Si-based electron detector and an eucentric-rotation specimen holder have been specifically developed for the purpose.« less

Social network analysis for program implementation.

PubMed

Valente, Thomas W; Palinkas, Lawrence A; Czaja, Sara; Chu, Kar-Hai; Brown, C Hendricks

2015-01-01

This paper introduces the use of social network analysis theory and tools for implementation research. The social network perspective is useful for understanding, monitoring, influencing, or evaluating the implementation process when programs, policies, practices, or principles are designed and scaled up or adapted to different settings. We briefly describe common barriers to implementation success and relate them to the social networks of implementation stakeholders. We introduce a few simple measures commonly used in social network analysis and discuss how these measures can be used in program implementation. Using the four stage model of program implementation (exploration, adoption, implementation, and sustainment) proposed by Aarons and colleagues [1] and our experience in developing multi-sector partnerships involving community leaders, organizations, practitioners, and researchers, we show how network measures can be used at each stage to monitor, intervene, and improve the implementation process. Examples are provided to illustrate these concepts. We conclude with expected benefits and challenges associated with this approach.

Social Network Analysis for Program Implementation

PubMed Central

Valente, Thomas W.; Palinkas, Lawrence A.; Czaja, Sara; Chu, Kar-Hai; Brown, C. Hendricks

2015-01-01

This paper introduces the use of social network analysis theory and tools for implementation research. The social network perspective is useful for understanding, monitoring, influencing, or evaluating the implementation process when programs, policies, practices, or principles are designed and scaled up or adapted to different settings. We briefly describe common barriers to implementation success and relate them to the social networks of implementation stakeholders. We introduce a few simple measures commonly used in social network analysis and discuss how these measures can be used in program implementation. Using the four stage model of program implementation (exploration, adoption, implementation, and sustainment) proposed by Aarons and colleagues [1] and our experience in developing multi-sector partnerships involving community leaders, organizations, practitioners, and researchers, we show how network measures can be used at each stage to monitor, intervene, and improve the implementation process. Examples are provided to illustrate these concepts. We conclude with expected benefits and challenges associated with this approach. PMID:26110842

Practical experience from the Office of Adolescent Health's large scale implementation of an evidence-based Teen Pregnancy Prevention Program.

PubMed

Margolis, Amy Lynn; Roper, Allison Yvonne

2014-03-01

After 3 years of experience overseeing the implementation and evaluation of evidence-based teen pregnancy prevention programs in a diversity of populations and settings across the country, the Office of Adolescent Health (OAH) has learned numerous lessons through practical application and new experiences. These lessons and experiences are applicable to those working to implement evidence-based programs on a large scale. The lessons described in this paper focus on what it means for a program to be implementation ready, the role of the program developer in replicating evidence-based programs, the importance of a planning period to ensure quality implementation, the need to define and measure fidelity, and the conditions necessary to support rigorous grantee-level evaluation. Published by Elsevier Inc.

Modeling Open Architecture and Evolutionary Acquisition: Implementation Lessons from the ARCI Program for the Rapid Capability Insertion Process

DTIC Science & Technology

2009-04-22

Implementation Issues Another RCIP implementation risk is program management burnout . The ACRI program manager specifically identified the potential...of burnout in his program management team due to the repeated, intense Integration phases. To investigate the possibility and severity of this risk to...the ACRI simulation. This suggests that the burnout risk will be larger for RCIP than it was for ACRI. Successfully implementing a sustainable RCIP

Guide for Operational Configuration Management Program including the adjunct programs of design reconstitution and material condition and aging management. Part 2

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

Not Available

This standard presents program criteria and implementation guidance for an operational configuration management program for DOE nuclear and non-nuclear facilities. This Part 2 includes chapters on implementation guidance for operational configuration management, implementation guidance for design reconstitution, and implementation guidance for material condition and aging management. Appendices are included on design control, examples of design information, conduct of walkdowns, and content of design information summaries.

A Program Manager's Guide for Program Improvement in Ongoing Psychological Health and Traumatic Brain Injury Programs.

PubMed

Ryan, Gery W; Farmer, Carrie M; Adamson, David M; Weinick, Robin M

2014-01-01

Between 2001 and 2011, the U.S. Department of Defense has implemented numerous programs to support service members and their families in coping with the stressors from a decade of the longstanding conflicts in Iraq and Afghanistan. These programs, which address both psychological health and traumatic brain injury (TBI), number in the hundreds and vary in their size, scope, and target population. To ensure that resources are wisely invested and maximize the benefits of such programs, RAND developed a tool to help assess program performance, consider options for improvement, implement solutions, then assess whether the changes worked, with the intention of helping those responsible for managing or implementing programs to conduct assessments of how well the program is performing and to implement solutions for improving performance. Specifically, the tool is intended to provide practical guidance in program improvement and continuous quality improvement for all programs.

Evaluation of programs for adolescents with greater psychosocial needs: community-based Project P.A.T.H.S. in Hong Kong.

PubMed

Shek, Daniel T L; Law, Moon Y M

2017-02-01

This study examined the perceptions of the Tier 2 Program of the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social programmes) among Chinese secondary school students displaying greater psychosocial needs. Results showed that participants held positive views of program qualities, implementer qualities, as well as the perceived effectiveness of the program. Significant grade differences in terms of various indicators of satisfaction related to program qualities, implementer qualities, and program effectiveness were found. Correlation analyses showed that there were significant inter-relationships amongst program qualities, implementer qualities and program effectiveness. In line with the predictions, both program qualities and implementer qualities were significant predictors of perceived program effectiveness. The present study provides support for the perceived effectiveness of the Tier 2 Program of the Project P.A.T.H.S. in the community-based project context.

Case Study: Using Contemporary Behaviour Change Science to Design and Implement an Effective Nutritional Intervention within Professional Rugby League.

PubMed

Costello, Nessan; McKenna, Jim; Sutton, Louise; Deighton, Kevin; Jones, Ben

2018-01-18

Designing and implementing successful dietary intervention is integral to the role of sport nutrition professionals as they attempt to positively change the dietary behaviour of athletes. High-performance sport is a time-pressured environment where immediate results can often supersede pursuit of the most effective evidence-based practice. However, efficacious dietary intervention necessitates comprehensive, systematic and theoretical behavioural design and implementation if the habitual dietary behaviours of athletes are to be positively changed. Therefore, this case study demonstrates how the Behaviour Change Wheel was used to design and implement an effective nutritional intervention within professional rugby league. The eight-step intervention targeted athlete consumption of a high quality dietary intake of 25.1 MJ each day, to achieve an overall body mass increase of 5 kg across a twelve-week intervention period. The Capability, Opportunity, Motivation-Behaviour model and APEASE criteria were used to identify population-specific intervention functions, policy categories, behaviour change techniques and modes of intervention delivery. The resulting intervention was successful, increasing the average daily energy intake of the athlete to 24.5 MJ, which corresponded in a 6.2 kg body mass gain. Despite consuming 0.6 MJ less per day than targeted, secondary outcome measures of diet quality, strength, body composition and immune function all substantially improved, supporting a sufficient energy intake and the overall efficacy of a behavioural approach. Ultimately, the Behaviour Change Wheel provides sport nutrition professionals with an effective and practical step-wise method via which to design and implement effective nutritional interventions for use within high-performance sport.

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

PubMed

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

2016-08-08

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

[A Matter of Balance: strategy for implementation in Dutch homecare organizations].

PubMed

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

2013-02-01

The Dutch version of A Matter of Balance (AMB-NL) is a cognitive behavioral group program to reduce fear of falling and related activity avoidance in community-living older persons. This paper presents the strategy for implementation of AMB-NL in Dutch homecare organizations and the outcomes of this implementation. The aim was to implement AMB-NL in at least 50 % of 64 homecare organizations in The Netherlands in 2009 and 2010. The implementation strategy was based on the four phases of the Replicating Effective Interventions: pre-conditions, pre-implementation, implementation, and maintenance and evolution. After preparing the implementation activities, such as identifying implementation barriers, consulting stakeholders, preparing the materials involved in the implementation, and training the facilitators of the program (n = 53), AMB-NL was implemented in 16 of the 64 homecare organizations (25 %). Another five homecare organizations indicated that they would shortly include AMB-NL in their care program. These organizations conducted the intervention 19 times to a total of 178 participants. After the implementation phase another 16 facilitators were trained, and program materials were successfully disseminated. The implementation of AMB-NL was well performed. The targeted aim is not fully reached within the two-year timeframe, but the program is well received by participants, trainers and homecare organizations. Further implementation and maintenance of AMB-NL in primary health care is recommended.

Implementation notes on bdes(1). [data encryption implementation

NASA Technical Reports Server (NTRS)

Bishop, Matt

1991-01-01

This note describes the implementation of bdes, the file encryption program being distributed in the 4.4 release of the Berkeley Software Distribution. It implements all modes of the Data Encryption Standard program.

Implementation contexts of a Tuberculosis Control Program in Brazilian prisons

PubMed Central

de Oliveira, Luisa Gonçalves Dutra; Natal, Sonia; Camacho, Luiz Antonio Bastos

2015-01-01

OBJECTIVE To analyze the influence from context characteristics in the control of tuberculosis in prisons, and the influence from the program implementation degrees in observed effects. METHODS A multiple case study, with a qualitative approach, conducted in the prison systems of two Brazilian states in 2011 and 2012. Two prisons were analyzed in each state, and a prison hospital was analyzed in one of them. The data were submitted to a content analysis, which was based on external, political-organizational, implementation, and effect dimensions. Contextual factors and the ones in the program organization were correlated. The independent variable was the program implementation degree and the dependent one, the effects from the Tuberculosis Control Program in prisons. RESULTS The context with the highest sociodemographic vulnerability, the highest incidence rate of tuberculosis, and the smallest amount of available resources were associated with the low implementation degree of the program. The results from tuberculosis treatment in the prison system were better where the program had already been partially implemented than in the case with low implementation degree in both cases. CONCLUSIONS The implementation degree and its contexts – external and political-organizational dimensions – simultaneously contribute to the effects that are observed in the control of tuberculosis in analyzed prisons. PMID:26465668

Some Methods for Evaluating Program Implementation.

ERIC Educational Resources Information Center

Hardy, Roy A.

An approach to evaluating program implementation is described. This approach includes the development of a project description which includes a structure matrix, sampling from the structure matrix, and preparing an implementation evaluation plan. The implementation evaluation plan should include: (1) verification of implementation of planned…

Investigating the criteria and processes used in the selection, implementation, and evaluation of STEM within K-12 education

NASA Astrophysics Data System (ADS)

Delp, Matthew J.

This study utilized survey research to investigate how school districts within K-12 education select, implement, and evaluate Science, Technology, Engineering, and Mathematics (STEM) programs. Thirty school districts within the Math and Science Collaborative located in Western Pennsylvania participated in this research. In addition to characterizing the STEM programs of the participating school districts, this study also analyzed the alignment of these programs to the components of comprehensive STEM programs and critical approaches to substantiate STEM program implementation as stated in the literature (Augustine, 2005; Bybee, 2010a, 2010b; Carnevale et al., 2011; DeJarnette, 2010; Epstein & Miller, 2011b; Gardner et al., 1983; Hossain & Robinson, 2011, 2012; Kuenzi, 2008). Findings suggest that the primary goal for school districts, as it relates to STEM program implementation, is to influence students' interest and pursuit of STEM-related careers and degrees. In order to achieve this goal, results of this study indicate the focus of STEM program implementation occurs with the greatest frequency at the middle school (grades seven and eight) level, are developed as an adaptation to the curriculum, and are very diverse from one school district to the next. In addition, findings suggest that although school districts maintain they aim to promote careers and degrees in STEM, districts rely on traditional methods of evaluating STEM program implementation (i.e. standardized test scores) and do not track the longitudinal impact their STEM programs as they related to degrees and careers in STEM. Furthermore, results indicate district STEM programs are not aligned to the characteristics of comprehensive STEM programs as defined by the literature. In order to address the misalignment of school district goals and evaluation processes involved in STEM program implementation and the absence of the characteristics commensurate with comprehensive STEM programs, this study has created a framework to guide school districts in STEM program selection, implementation, and evaluation.

Using a domestic and sexual violence prevention advocate to implement a dating violence prevention program with athletes.

PubMed

Jaime, M C D; Stocking, M; Freire, K; Perkinson, L; Ciaravino, S; Miller, E

2016-12-01

'Coaching Boys into Men' is an evidence-based dating violence prevention program for coaches to implement with male athletes. A common adaptation of this program is delivery by domestic violence and sexual violence prevention advocates instead of coaches. We explored how this implementer adaptation may influence athlete uptake of program messages and outcomes. Randomly, one school received the program delivered by an advocate while another school received the program delivered by coaches. Athletes completed baseline and follow-up surveys (n = 148), and a subset who received the advocate-led program participated in focus groups (four groups; n = 26). We compared changes in athlete attitudes and behaviors and conducted thematic analyses with qualitative data. We found no significant differences between athletes who received the program from the advocate versus their coaches. Athletes highlighted the advocate's delivery and role as a non-judgmental adult ally as qualities that influenced their uptake of program messages. The acceptability of the advocate-led program may be related to the implementer type along with specific implementer characteristics and delivery methods. Using advocates together with coaches as implementers could increase the reach of this program. Further study of best practices for Coaching Boys into Men adaptation is needed to guide program dissemination and sustainability. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Factors contributing to intervention fidelity in a multi-site chronic disease self-management program.

PubMed

Perrin, Karen M; Burke, Somer Goad; O'Connor, Danielle; Walby, Gary; Shippey, Claire; Pitt, Seraphine; McDermott, Robert J; Forthofer, Melinda S

2006-10-26

Disease self-management programs have been a popular approach to reducing morbidity and mortality from chronic disease. Replicating an evidence-based disease management program successfully requires practitioners to ensure fidelity to the original program design. The Florida Health Literacy Study (FHLS) was conducted to investigate the implementation impact of the Pfizer, Inc. Diabetes Mellitus and Hypertension Disease Self-Management Program based on health literacy principles in 14 community health centers in Florida. The intervention components discussed include health educator recruitment and training, patient recruitment, class sessions, utilization of program materials, translation of program manuals, patient retention and follow-up, and technical assistance. This report describes challenges associated with achieving a balance between adaptation for cultural relevance and fidelity when implementing the health education program across clinic sites. This balance was necessary to achieve effectiveness of the disease self-management program. The FHLS program was implemented with a high degree of fidelity to the original design and used original program materials. Adaptations identified as advantageous to program participation are discussed, such as implementing alternate methods for recruiting patients and developing staff incentives for participation. Effective program implementation depends on the talent, skill and willing participation of clinic staff. Program adaptations that conserve staff time and resources and recognize their contribution can increase program effectiveness without jeopardizing its fidelity.

The effects of pure potassium channel blocker nifekalant and sodium channel blocker mexiletine on malignant ventricular tachyarrhythmias.

PubMed

Otuki, Sou; Hasegawa, Kanae; Watanabe, Hiroshi; Katsuumi, Goro; Yagihara, Nobue; Iijima, Kenichi; Sato, Akinori; Izumi, Daisuke; Furushima, Hiroshi; Chinushi, Masaomi; Aizawa, Yoshifusa; Minamino, Tohru

Patients with repetitive ventricular tachyarrhythmias - so-called electrical storm - frequently require antiarrhythmic drugs. Amiodarone is widely used for the treatment of electrical storm but is ineffective in some patients. Therefore, we investigated the efficacy of stepwise administration of nifekalant, a pure potassium channel blocker, and mexiletine for electrical storm. This study included 44 patients with repetitive ventricular tachyarrhythmias who received stepwise therapy with nifekalant and mexiletine for electrical storm. Nifekalant was initially administered, and mexiletine was subsequently added if nifekalant failed to control ventricular tachyarrhythmias. Nifekalant completely suppressed recurrences of ventricular arrhythmias in 28 patients (64%), including 6 patients in whom oral amiodarone failed to control arrhythmias. In 9 of 16 patients in whom nifekalant was partially effective but failed to suppress ventricular arrhythmias, mexiletine was added. The addition of mexiletine prevented recurrences of ventricular tachyarrhythmias in 5 of these 9 patients (56%). There was no death associated with electrical storm. In total, the stepwise treatment with nifekalant and mexiletine was effective in preventing ventricular tachyarrhythmias in 33 of 44 patients (75%). There was no difference in cycle length of the ventricular tachycardia, QRS interval, QT interval, or left ventricular ejection fraction between patients who responded to antiarrhythmic drugs and those who did not. During follow-up, 8 patients had repetitive ventricular tachyarrhythmia recurrences, and the stepwise treatment was effective in 6 of these 8 patients (75%). The stepwise treatment with nifekalant and mexiletine was highly effective in the suppression of electrical storm. Copyright © 2016. Published by Elsevier Inc.

The Role of the Principal in the Implementation of a Gifted Education Program in a School.

ERIC Educational Resources Information Center

Taylor, C. A.

1987-01-01

The degree to which a principal provides appropriate and sufficient support for implementation of a gifted education program will determine the success of the program. Actions that can facilitate implementation, teacher use, and institutionalization and the effects of various managerial styles are discussed. Components of a gifted program are…

Implementing and Evaluating a Rural Community-Based Sexual Abstinence Program: Challenges and Solutions

ERIC Educational Resources Information Center

Stauss, Kimberly; Boyas, Javier; Murphy-Erby, Yvette

2012-01-01

Informing both program evaluation and practice research, this paper describes lessons learned during the planning, implementation, and pilot phases of an abstinence education program based in a rural community in a southern state in the USA. Although a number of challenges can emerge in successfully implementing and evaluating such a program in a…

Implementing Army Training Programs: An Overview for Managers. Research Report 1382.

ERIC Educational Resources Information Center

Gray, Wayne D.

The place and importance of implementation in the life cycle of Army training programs is frequently misunderstood. Typically, a program's life cycle is thought of as research, development, and use. If implementation is thought of at all, it is regarded as an event, not a process. Many worthwhile programs have failed because the implementation…

Free for All: A Case Study Examining Implementation Factors of One-to-One Device Programs

ERIC Educational Resources Information Center

Howard, Sarah K.; Rennie, Ellie

2013-01-01

Despite significant investment in school one-to-one device programs, little is known about which aspects of program implementation work and why. Through a comparison of two implementation models, adopter-diffusion and saturation, and using existing data from the One Laptop per Child Australia laptop program, we explored how factors of…

Adaptive runtime for a multiprocessing API

DOEpatents

Antao, Samuel F.; Bertolli, Carlo; Eichenberger, Alexandre E.; O'Brien, John K.

2016-11-15

A computer-implemented method includes selecting a runtime for executing a program. The runtime includes a first combination of feature implementations, where each feature implementation implements a feature of an application programming interface (API). Execution of the program is monitored, and the execution uses the runtime. Monitor data is generated based on the monitoring. A second combination of feature implementations are selected, by a computer processor, where the selection is based at least in part on the monitor data. The runtime is modified by activating the second combination of feature implementations to replace the first combination of feature implementations.

Adaptive runtime for a multiprocessing API

DOEpatents

Antao, Samuel F.; Bertolli, Carlo; Eichenberger, Alexandre E.; O'Brien, John K.

2016-10-11

A computer-implemented method includes selecting a runtime for executing a program. The runtime includes a first combination of feature implementations, where each feature implementation implements a feature of an application programming interface (API). Execution of the program is monitored, and the execution uses the runtime. Monitor data is generated based on the monitoring. A second combination of feature implementations are selected, by a computer processor, where the selection is based at least in part on the monitor data. The runtime is modified by activating the second combination of feature implementations to replace the first combination of feature implementations.

HIV Pre-exposure Prophylaxis Program Implementation Using Intervention Mapping.

PubMed

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

2018-04-01

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

Designing, testing, and implementing a sustainable nurse home visiting program: right@home.

PubMed

Goldfeld, Sharon; Price, Anna; Kemp, Lynn

2018-05-01

Nurse home visiting (NHV) offers a potential platform to both address the factors that limit access to services for families experiencing adversity and provide effective interventions. Currently, the ability to examine program implementation is hampered by a lack of detailed description of actual, rather than expected, program development and delivery in published studies. Home visiting implementation remains a black box in relation to quality and sustainability. However, previous literature would suggest that efforts to both report and improve program implementation are vital for NHV to have population impact and policy sustainability. In this paper, we provide a case study of the design, testing, and implementation of the right@home program, an Australian NHV program and randomized controlled trial. We address existing gaps related to implementation of NHV programs by describing the processes used to develop the program to be trialed, summarizing its effectiveness, and detailing the quality processes and implementation evaluation. The weight of our evidence suggests that NHV can be a powerful and sustainable platform for addressing inequitable outcomes, particularly when the program focuses on parent engagement and partnership, delivers evidence-based strategies shown to improve outcomes, includes fidelity monitoring, and is adapted to and embedded within existing service delivery systems. © 2018 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals, Inc. on behalf of The New York Academy of Sciences.

Long Live Love+: Evaluation of the Implementation of an Online School-Based Sexuality Education Program in the Netherlands

ERIC Educational Resources Information Center

van Lieshout, Sanne; Mevissen, Fraukje; de Waal, Esri; Kok, Gerjo

2017-01-01

Schools are a common setting for adolescents to receive health education, but implementation of these programs with high levels of completeness and fidelity is not self-evident. Programs that are only partially implemented (completeness) or not implemented as instructed (fidelity) are unlikely to be effective. Therefore, it is important to…

Creation and Implementation of a Workforce Development Pipeline Program at MSFC

NASA Technical Reports Server (NTRS)

Hix, Billy

2003-01-01

Within the context of NASA's Education Programs, this Workforce Development Pipeline guide describes the goals and objectives of MSFC's Workforce Development Pipeline Program as well as the principles and strategies for guiding implementation. It is designed to support the initiatives described in the NASA Implementation Plan for Education, 1999-2003 (EP-1998-12-383-HQ) and represents the vision of the members of the Education Programs office at MSFC. This document: 1) Outlines NASA s Contribution to National Priorities; 2) Sets the context for the Workforce Development Pipeline Program; 3) Describes Workforce Development Pipeline Program Strategies; 4) Articulates the Workforce Development Pipeline Program Goals and Aims; 5) List the actions to build a unified approach; 6) Outlines the Workforce Development Pipeline Programs guiding Principles; and 7) The results of implementation.

Monotonous and stepwise character of deformation accumulation as a hierarchically organized process under high-temperature deformation of aluminum-magnesium alloy

NASA Astrophysics Data System (ADS)

Makarov, S. V.; Plotnikov, V. A.; Lysikov, M. V.

2017-12-01

Stepwise kinetics of deformation accumulation and monotonous and pulsed acoustic emission bear witness to the active role of acoustic emission in deformation processes. A standing acoustic wave in the region of deformation localization determines the effect of self-organization of dislocations on macroscopic scales around the natural resonator of the system.

Sustained Implementation Support Scale: Validation of a Measure of Program Characteristics and Workplace Functioning for Sustained Program Implementation.

PubMed

Hodge, Lauren M; Turner, Karen M T; Sanders, Matthew R; Filus, Ania

2017-07-01

An evaluation measure of enablers and inhibitors to sustained evidence-based program (EBP) implementation may provide a useful tool to enhance organizations' capacity. This paper outlines preliminary validation of such a measure. An expert informant and consumer feedback approach was used to tailor constructs from two existing measures assessing key domains associated with sustained implementation. Validity and reliability were evaluated for an inventory composed of five subscales: Program benefits, Program burden, Workplace support, Workplace cohesion, and Leadership style. Exploratory and confirmatory factor analysis with a sample of 593 Triple P-Positive Parenting Program-practitioners led to a 28-item scale with good reliability and good convergent, discriminant, and predictive validity. Practitioners sustaining implementation at least 3 years post-training were more likely to have supervision/peer support, reported higher levels of program benefit, workplace support, and positive leadership style, and lower program burden compared to practitioners who were non-sustainers.

Teaching ethics to engineers: ethical decision making parallels the engineering design process.

PubMed

Bero, Bridget; Kuhlman, Alana

2011-09-01

In order to fulfill ABET requirements, Northern Arizona University's Civil and Environmental engineering programs incorporate professional ethics in several of its engineering courses. This paper discusses an ethics module in a 3rd year engineering design course that focuses on the design process and technical writing. Engineering students early in their student careers generally possess good black/white critical thinking skills on technical issues. Engineering design is the first time students are exposed to "grey" or multiple possible solution technical problems. To identify and solve these problems, the engineering design process is used. Ethical problems are also "grey" problems and present similar challenges to students. Students need a practical tool for solving these ethical problems. The step-wise engineering design process was used as a model to demonstrate a similar process for ethical situations. The ethical decision making process of Martin and Schinzinger was adapted for parallelism to the design process and presented to students as a step-wise technique for identification of the pertinent ethical issues, relevant moral theories, possible outcomes and a final decision. Students had greatest difficulty identifying the broader, global issues presented in an ethical situation, but by the end of the module, were better able to not only identify the broader issues, but also to more comprehensively assess specific issues, generate solutions and a desired response to the issue.

Comparison of three portable instruments to measure compression pressure.

PubMed

Partsch, H; Mosti, G

2010-10-01

Measurement of interface pressure between the skin and a compression device has gained practical importance not only for characterizing the efficacy of different compression products in physiological and clinical studies but also for the training of medical staff. A newly developed portable pneumatic pressure transducer (Picopress®) was compared with two established systems (Kikuhime® and SIGaT tester®) measuring linearity, variability and accuracy on a cylindrical model using a stepwise inflated sphygmomanometer as the reference. In addition the variation coefficients were measured by applying the transducers repeatedly under a blood pressure cuff on the distal lower leg of a healthy human subject with stepwise inflation. In the pressure range between 10 and 80 mmHg all three devices showed a linear association compared with the sphygmomanometer values (Pearson r>0.99). The best reproducibility (variation coefficients between 1.05-7.4%) and the highest degree of accuracy demonstrated by Bland-Altman plots was achieved with the Picopress® transducer. Repeated measurements of pressure in a human leg revealed average variation coefficients for the three devices of 4.17% (Kikuhime®), 8.52% (SIGaT®) and 2.79% (Picopress®). The results suggest that the Picopress® transducer, which also allows dynamic pressure tracing in connection with a software program and which may be left under a bandage for several days, is a reliable instrument for measuring the pressure under a compression device.

Impact of a structured ICU training programme in resource-limited settings in Asia.

PubMed

Haniffa, Rashan; Lubell, Yoel; Cooper, Ben S; Mohanty, Sanjib; Alam, Shamsul; Karki, Arjun; Pattnaik, Rajya; Maswood, Ahmed; Haque, R; Pangeni, Raju; Schultz, Marcus J; Dondorp, Arjen M

2017-01-01

To assess the impact on ICU performance of a modular training program in three resource-limited general adult ICUs in India, Bangladesh, and Nepal. A modular ICU training programme was evaluated using performance indicators from June 2009 to June 2012 using an interrupted time series design with an 8 to 15 month pre-intervention and 18 to 24 month post-intervention period. ICU physicians and nurses trained in Europe and the USA provided training for ICU doctors and nurses. The training program consisted of six modules on basic intensive care practices of 2-3 weeks each over 20 months. The performance indicators consisting of ICU mortality, time to ICU discharge, rate at which patients were discharged alive from the ICU, discontinuation of mechanical ventilation or vasoactive drugs and duration of antibiotic use were extracted. Stepwise changes and changes in trends associated with the intervention were analysed. Pre-Training ICU mortality in Rourkela (India), and Patan (Nepal) Chittagong (Bangladesh), was 28%, 41% and 62%, respectively, compared to 30%, 18% and 51% post-intervention. The intervention was associated with a stepwise reduction in cumulative incidence of in-ICU mortality in Chittagong (adjusted subdistribution hazard ratio [aSHR] (95% CI): 0.62 (0.40, 0.97), p = 0.03) and Patan (aSHR 0.16 (0.06, 0.41), p<0.001), but not in Rourkela (aSHR: 1.17 (0.75, 1.82), p = 0.49). The intervention was associated with earlier discontinuation of vasoactive drugs at Rourkela (adjusted hazard ratio for weekly change [aHR] 1.08 (1.03, 1.14), earlier discontinuation of mechanical ventilation in Chittagong (aHR 2.97 (1.24, 7.14), p = 0.02), and earlier ICU discharge in Patan (aHR 1.87 (1.02, 3.43), p = 0.04). This structured training program was associated with a decrease in ICU mortality in two of three sites and improvement of other performance indicators. A larger cluster randomised study assessing process outcomes and longer-term indicators is warranted.

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

PubMed

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

2014-08-01

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

Examining the utility of a train-the-trainer model for dissemination of sexual violence prevention in schools.

PubMed

Weingarten, Christine; Rabago, Jina; Reynolds, Jasmine; Gates, Kalani; Yanagida, Evie; Baker, Charlene

2018-06-01

Rates of childhood sexual abuse are unacceptably high, with potentially long-lasting consequences for those who have been victimized. Currently, there are a number of sexual violence prevention programs that have been developed to lower rates of victimization, increase awareness, and connect victims with resources. Within this area of research, there has been less focus on effective methods of program dissemination. For example, school-based sexual violence prevention programs have had positive outcomes; however, little is known about how these programs are disseminated. The train-the-trainer model of dissemination utilizes master trainers to equip others to implement programs, thereby allowing more adults to teach and subsequently more children to receive the program. This study used survey data from teachers and other school personnel (n = 127) to analyze the utility of a train-the-trainer model of dissemination for a sexual violence prevention program in the state of Hawai'i. Through responses of people who were trained to implement the program (59.8% of whom did implement), aspects of the training, the program itself, and factors affecting whether a person implemented the program were explored. Results suggest that time spent in training, job position, and time in that position predicted whether a person trained to implement the sexual violence prevention program followed through with teaching the program to students. Additionally, 54.7% of people who did implement the program had at least one student disclose sexual violence to them, indicating the importance of sexual violence prevention programming and dissemination of these programs. Copyright © 2018 Elsevier Ltd. All rights reserved.

A stepwise regression tree for nonlinear approximation: applications to estimating subpixel land cover

USGS Publications Warehouse

Huang, C.; Townshend, J.R.G.

2003-01-01

A stepwise regression tree (SRT) algorithm was developed for approximating complex nonlinear relationships. Based on the regression tree of Breiman et al . (BRT) and a stepwise linear regression (SLR) method, this algorithm represents an improvement over SLR in that it can approximate nonlinear relationships and over BRT in that it gives more realistic predictions. The applicability of this method to estimating subpixel forest was demonstrated using three test data sets, on all of which it gave more accurate predictions than SLR and BRT. SRT also generated more compact trees and performed better than or at least as well as BRT at all 10 equal forest proportion interval ranging from 0 to 100%. This method is appealing to estimating subpixel land cover over large areas.

A method for the selection of a functional form for a thermodynamic equation of state using weighted linear least squares stepwise regression

NASA Technical Reports Server (NTRS)

Jacobsen, R. T.; Stewart, R. B.; Crain, R. W., Jr.; Rose, G. L.; Myers, A. F.

1976-01-01

A method was developed for establishing a rational choice of the terms to be included in an equation of state with a large number of adjustable coefficients. The methods presented were developed for use in the determination of an equation of state for oxygen and nitrogen. However, a general application of the methods is possible in studies involving the determination of an optimum polynomial equation for fitting a large number of data points. The data considered in the least squares problem are experimental thermodynamic pressure-density-temperature data. Attention is given to a description of stepwise multiple regression and the use of stepwise regression in the determination of an equation of state for oxygen and nitrogen.

An open trial of outpatient group therapy for bulimic disorders: combination program of cognitive behavioral therapy with assertive training and self-esteem enhancement.

PubMed

Shiina, Akihiro; Nakazato, Michiko; Mitsumori, Makoto; Koizumi, Hiroki; Shimizu, Eiji; Fujisaki, Mihisa; Iyo, Masaomi

2005-12-01

The purposes of this study were to examine the therapeutic efficacy of combined group cognitive behavioral therapy (CGCBT) and to explore the characteristics of the patients who failed to complete it. Our group cognitive behavioral therapy combined with assertiveness training for alexithymia and self-esteem enhancement therapy were attended over a 10-week period. Twenty-five participants were enrolled in the study. The clinical symptoms were assessed before and after treatment, using rating scales including the Eating Disorder Inventory-2, the Bulimic Investigatory Test, Edinburgh, the Toronto Alexithymia Scale, the Rosenberg Self-Esteem Scale, and Global Assessment of Functioning. Sixteen participants (64%) completed the CGCBT program. Completion of the CGCBT resulted in significant improvements in reducing binge-eating behavior and improving social functioning. Eight patients (32%) significantly improved using the Clinical Global Impression Change (CGI-C). Stepwise logistic regression analysis of the results indicated that a lower age (P=0.04) and psychiatric comorbidity (P=0.06) were predictors of dropout from the CGCBT program. Our CGCBT program is a promising first-line treatment for bulimic outpatients. Lower age and the presence of comorbidity had effects on dropout rates.

Evaluation and implementation of highly challenging balance training in clinical practice for people with Parkinson's disease: protocol for the HiBalance effectiveness-implementation trial.

PubMed

Leavy, Breiffni; Kwak, Lydia; Hagströmer, Maria; Franzén, Erika

2017-02-07

If people with progressive neurological diseases are to avail of evidence-based rehabilitation, programs found effective in randomized controlled trials (RCT's) must firstly be adapted and tested in clinical effectiveness studies as a means of strengthening their evidence base. This paper describes the protocol for an effectiveness-implementation trial that will assess the clinical effectiveness of a highly challenging balance training program (the HiBalance program) for people with mild-moderate Parkinson's disease (PD) while simultaneously collecting data concerning the way in which the program is implemented. The HiBalance program is systemically designed to target balance impairments in PD and has been shown effective at improving balance control and gait in a previous RCT. Study aims are to i) determine the effectiveness of the adapted HiBalance program on performance and self-rated outcomes such as balance control, gait and physical activity level ii) conduct a process evaluation of program implementation at the various clinics iii) determine barriers and facilitators to program implementation in these settings. This effectiveness-implementation type 1 hybrid study will use a non-randomized controlled design with consecutive inclusion of people with PD at multiple clinical sites. A mixed method approach will be used to collect clinical effectiveness data and process evaluation data which is both quantitative and qualitative in nature. The consolidated framework for implementation research (CFIR) will be used to guide the planning and collection of data concerning implementation barriers and facilitators. The HiBalance program will be provided by physical therapists as a part of standard rehabilitation care at the clinical sites, while the evaluation of the implementation process will be performed by the research group and funded by research grants. An effectiveness-implementation study design benefits patients by speeding up the process of translating findings from research settings to routine health care. Findings from this study will also be highly relevant for those working with neurological rehabilitation when faced with decisions concerning the translation of training programs from efficacy studies to everyday clinical practice. ClinicalTrials.gov march 2016, NCT02727478 .

Perceptions of California Middle School AVID and Non-AVID Teachers regarding Their Partnership and AVID Program Implementation

ERIC Educational Resources Information Center

Pagano, Paul Gregory

2009-01-01

Purpose. The purposes of this study were to compare the perceptions of public middle school AVID and Non-AVID teachers regarding (a) their partnership in the AVID program, (b) the effectiveness of AVID program implementation, and (c) the factors that impede or facilitate AVID program implementation. Methodology. A descriptive, ex post facto…

Implemented or Not Implemented? Process Evaluation of the School-Based Obesity Prevention Program DOiT and Associations with Program Effectiveness

ERIC Educational Resources Information Center

van Nassau, Femke; Singh, Amika S.; Hoekstra, Trynke; van Mechelen, Willem; Brug, Johannes; Chinapaw, Mai J. M.

2016-01-01

This study investigates if and to what extent the Dutch Obesity Intervention in Teenagers (DOiT) program was implemented as intended and how this affected program effectiveness. We collected data at 20 prevocational education schools in the Netherlands. We assessed seven process indicators: recruitment, reach, dosage, fidelity, satisfaction,…

Description of the Design and Implementation of a School-Based Obesity Prevention Program Addressing Needs of Middle School Students

ERIC Educational Resources Information Center

Ward-Begnoche, Wendy L.; Gance-Cleveland, Bonnie; Harris, Margaret M.; Dean, Janice

2008-01-01

This article describes the design and implementation of a school-based obesity prevention program, the successes associated with its implementation, and challenges with development and application of the program's curriculum base. The program is described, including purpose and goals, content and structure of the curriculum, type and training of…

Design and Implementation of a Pilot Obesity Prevention Program in a Low-Resource School: Lessons Learned and Research Recommendations

ERIC Educational Resources Information Center

Baskin, Monica L.; Zunker, Christie; Worley, Courtney B.; Dial, Brenda; Kimbrough, Linda

2009-01-01

Purpose: This paper seeks to describe the design, implementation, and lessons learned from an obesity prevention pilot program delivered in a low resource school in the USA. Design/methodology/approach: A planned program evaluation was conducted to: document explicitly the process of designing and implementing the program; and assess the…

State Energy Conservation Program Measure Directory. Sourcebook: Volume 8. Part 2 of 2 books

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

Not Available

DOE prepared an 8-volume Sourcebook to provide useful information for states in development and implementation of their Energy Conservation Plans. The purpose of Vol. 8, a 2-book set, is to facilitate exchange of information among states concerning program measures of common interest. DOE/CS--0159/1, Vol. 8, Book 1, announced in EAPA 6: abst. 3475, covered states Alabama through Missouri; this report, Vol. 8, Book 2 begins with Montana and completes the alphabet. Information is summarized also for American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and the Virgin Islands in the two books. Information on the various programs in each statemore » includes identification data; narrative description of program measure; program measure information; and annual energy savings reported. A cross-reference index is included for agriculture, industry, transportation, buildings, government, legislative/regulatory implementation strategies, general education implementation strategies, specific information implementation strategies, demonstration implementation strategies, administration implementation strategies, and renewable-resource implementation strategies.« less

Teacher decision-making in implementing a new environmental education curriculum: A qualitative study

NASA Astrophysics Data System (ADS)

Winther, Austin A.

This was a qualitative study of teacher decision-making during the first year of implementation of a new environmental education curriculum. Eight teachers were included in the study: three high school teachers, two middle school teachers and three elementary teachers. These teachers received summer training in the program, and were chosen at random from those who volunteered for the study. The teachers were interviewed at the close of training, at midyear during implementation, and during the spring. In addition to interview data other data sources were used to verify findings. These additional sources included interviews with high school students, visits to all the schools, examination of teacher prepared and student prepared materials, informal discussions with teacher peers at the schools, and implementation reports from the teachers. Among the factors examined were teachers' perceptions of training, teachers' perceptions of administrative and peer support, and the manner in which the program was implemented in each classroom. It was found that support from administrative and peer was important, but that neither of these were as critical as might have been expected. Administrators were perceived as supporting the program because the program helped to facilitate goals that had already been established in the school. Peer support was social and largely passive. Participants perceived that neither administrators nor peers really understand how the program worked. Participants initially found the training difficult and confusing. As they continued training and implementation some participants found that the program was substantially different from what they were accustomed to doing in their classrooms. Some participants were reluctant to implement the program, either implementing the program late in the year, or limiting implementation in some way. Others implemented the program fully, and were extremely enthusiastic about what their students were doing and learning. The researcher found that teachers' perceptions of training, administrative and peer support, and of the program itself stemmed from cognitive changes that the program stimulated. Comments from all of the teachers reflected reactions to these changes. Some teachers resisted the changes, while others enjoyed the process. Both programmatic and research recommendations were made.

Implementation of Best Practices in Obesity Prevention in Child Care Facilities: The Arizona Empower Program, 2013–2015

PubMed Central

Papa, Jillian; Rodriguez, Gertrudes; Robinson, Deborah

2017-01-01

Introduction Obesity is a major health concern in every US age group. Approximately one in 4 children in Arizona’s Special Supplemental Nutrition Program for Women, Infants, and Children is overweight or obese. The Arizona Department of Health Services developed the Empower program to promote healthy environments in licensed child care facilities. The program consists of 10 standards, including one standard for each of these 5 areas: physical activity and screen time, breastfeeding, fruit juice and water, family-style meals, and staff training. The objective of this evaluation was to determine the level of implementation of these 5 Empower standards. Methods A self-assessment survey was completed from July 2013 through June 2015 by 1,850 facilities to evaluate the level of implementation of 5 Empower standards. We calculated the percentage of facilities that reported the degree to which they implemented each standard and identified common themes in comments recorded in the survey. Results All facilities reported either full or partial implementation of the 5 standards. Of 1,678 facilities, 21.7% (n = 364) reported full implementation of all standards, and 78.3% (n = 1,314) reported at least partial implementation. Staff training, which has only one component, had the highest level of implementation: 77.4% (n = 1,299) reported full implementation. Only 44.0% (n = 738) reported full implementation of the standard on a breastfeeding-friendly environment. Conclusion Arizona child care facilities have begun to implement the Empower program, but facilities will need more education, technical assistance, and support in some areas to fully implement the program. PMID:28880840

Implementation of Best Practices in Obesity Prevention in Child Care Facilities: The Arizona Empower Program, 2013-2015.

PubMed

Papa, Jillian; Agostinelli, Joan; Rodriguez, Gertrudes; Robinson, Deborah

2017-09-07

Obesity is a major health concern in every US age group. Approximately one in 4 children in Arizona's Special Supplemental Nutrition Program for Women, Infants, and Children is overweight or obese. The Arizona Department of Health Services developed the Empower program to promote healthy environments in licensed child care facilities. The program consists of 10 standards, including one standard for each of these 5 areas: physical activity and screen time, breastfeeding, fruit juice and water, family-style meals, and staff training. The objective of this evaluation was to determine the level of implementation of these 5 Empower standards. A self-assessment survey was completed from July 2013 through June 2015 by 1,850 facilities to evaluate the level of implementation of 5 Empower standards. We calculated the percentage of facilities that reported the degree to which they implemented each standard and identified common themes in comments recorded in the survey. All facilities reported either full or partial implementation of the 5 standards. Of 1,678 facilities, 21.7% (n = 364) reported full implementation of all standards, and 78.3% (n = 1,314) reported at least partial implementation. Staff training, which has only one component, had the highest level of implementation: 77.4% (n = 1,299) reported full implementation. Only 44.0% (n = 738) reported full implementation of the standard on a breastfeeding-friendly environment. Arizona child care facilities have begun to implement the Empower program, but facilities will need more education, technical assistance, and support in some areas to fully implement the program.

Developments in Assisting Countries in Implementing the IAEA Additional Protocol

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

Killinger, Mark H.; Hansen, Linda H.; Cain, Ronald A.

In 2008, the U.S. Department of Energy (DOE) began assisting selected non-nuclear weapon states in planning and preparing for implementation of the International Atomic Energy Agency’s Additional Protocol (AP). Since then, the AP international implementation program has contributed to the substantial progress made by Vietnam, Thailand, Iraq, and Malaysia in preparing for entry-into-force of the AP. An overall engagement plan has been developed with components designed to train government AP implementing agencies, inform policy makers, conduct outreach to industry and universities, make AP reporting software available and useful, and plan a detailed approach for implementing the declaration and complementary accessmore » provisions of the AP. DOE recently began collaborating with Indonesia, which has already entered the AP into force, requiring a second method of engagement somewhat different from that taken with countries that have not entered the AP into force. The AP international implementation program, administered by the International Nuclear Safeguards and Engagement Program, is working more closely with DOE’s International Nonproliferation Export Control Program to ensure countries are aware of and prepared to implement the export/import provisions of the AP. As the AP implementation program matures and helps move countries closer to entry-into-force or improved AP implementation, it is identifying characteristics of a country’s “end-state” that indicate that DOE assistance is no longer required. The U.S. AP Implementation Act and Senate Resolution of Ratification require the Administration to report annually to Congress on measures taken to achieve the adoption of the AP in non-nuclear weapon states. DOE’s AP international implementation program is a significant part of these measures. This paper describes recent developments to increase the scope and effectiveness of the program.« less

Mentoring program design and implementation in new medical schools

PubMed Central

Fornari, Alice; Murray, Thomas S.; Menzin, Andrew W.; Woo, Vivian A.; Clifton, Maurice; Lombardi, Marion; Shelov, Steven

2014-01-01

Purpose Mentoring is considered a valuable component of undergraduate medical education with a variety of programs at established medical schools. This study presents how new medical schools have set up mentoring programs as they have developed their curricula. Methods Administrators from 14 US medical schools established since 2006 were surveyed regarding the structure and implementation of their mentoring programs. Results The majority of new medical schools had mentoring programs that varied in structure and implementation. Although the programs were viewed as valuable at each institution, challenges when creating and implementing mentoring programs in new medical schools included time constraints for faculty and students, and lack of financial and professional incentives for faculty. Conclusions Similar to established medical schools, there was little uniformity among mentoring programs at new medical schools, likely reflecting differences in curriculum and program goals. Outcome measures are needed to determine whether a best practice for mentoring can be established. PMID:24962112

Selecting, adapting, and sustaining programs in health care systems

PubMed Central

Zullig, Leah L; Bosworth, Hayden B

2015-01-01

Practitioners and researchers often design behavioral programs that are effective for a specific population or problem. Despite their success in a controlled setting, relatively few programs are scaled up and implemented in health care systems. Planning for scale-up is a critical, yet often overlooked, element in the process of program design. Equally as important is understanding how to select a program that has already been developed, and adapt and implement the program to meet specific organizational goals. This adaptation and implementation requires attention to organizational goals, available resources, and program cost. We assert that translational behavioral medicine necessitates expanding successful programs beyond a stand-alone research study. This paper describes key factors to consider when selecting, adapting, and sustaining programs for scale-up in large health care systems and applies the Knowledge to Action (KTA) Framework to a case study, illustrating knowledge creation and an action cycle of implementation and evaluation activities. PMID:25931825

Evidence-Based Programs for Older Adults: A Disconnect Between U.S. National Strategy and Local Senior Center Implementation.

PubMed

Bobitt, Julie; Schwingel, Andiara

2017-01-01

While U.S. national policies have been developed to support evidence-based (EB) lifestyle programs for older adults, there has been limited research to determine the extent to which these programs actually reach local communities. This study sought to identify factors that impact the implementation of EB physical activity, nutrition, and chronic disease management programs at regional (Area Agencies on Aging [AAAs]) and community levels (senior Centers [SCs]). Interviews were conducted with directors of four AAAs and 12 SCs to understand their perspectives on EB program implementation. Narratives revealed differences between AAAs and SCs regarding knowledge about EB programs and reasons to promote and adopt these programs. The only agreement occurred when discussing concerns about funding and program inflexibility. Substantial gaps exist between how EB lifestyle programs are promoted and implemented at the regional and community levels.

Interim evaluation of the Tier 1 Program of Project P.A.T.H.S.: continuation of evidence.

PubMed

Shek, Daniel T L; Yu, Lu; Chan, Alex C W

2012-01-17

An interim evaluation study was conducted to understand the implementation of the Tier 1 Program of Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes) in the 2008/09 school year. One hundred and twenty-eight schools were randomly selected to provide information on the implementation details of the program via interviews, telephone interviews and self-completed questionnaires. Results showed that a majority of the workers perceived that the students had positive responses to the program and the program was helpful to the students. Program workers' views toward the implementation of the Tier 1 Program were positive across different grades and program implementation modes. In conjunction with previous studies, the present findings suggest that the Tier 1 Program of Project P.A.T.H.S. is well received by different stakeholders.

Food Reformulation, Responsive Regulation, and “Regulatory Scaffolding”: Strengthening Performance of Salt Reduction Programs in Australia and the United Kingdom

PubMed Central

Magnusson, Roger; Reeve, Belinda

2015-01-01

Strategies to reduce excess salt consumption play an important role in preventing cardiovascular disease, which is the largest contributor to global mortality from non-communicable diseases. In many countries, voluntary food reformulation programs seek to reduce salt levels across selected product categories, guided by aspirational targets to be achieved progressively over time. This paper evaluates the industry-led salt reduction programs that operate in the United Kingdom and Australia. Drawing on theoretical concepts from the field of regulatory studies, we propose a step-wise or “responsive” approach that introduces regulatory “scaffolds” to progressively increase levels of government oversight and control in response to industry inaction or under-performance. Our model makes full use of the food industry’s willingness to reduce salt levels in products to meet reformulation targets, but recognizes that governments remain accountable for addressing major diet-related health risks. Creative regulatory strategies can assist governments to fulfill their public health obligations, including in circumstances where there are political barriers to direct, statutory regulation of the food industry. PMID:26133973

Evaluation of a large healthy lifestyle program: informing program implementation and scale-up in the prevention of obesity.

PubMed

Kozica, S L; Lombard, C B; Harrison, C L; Teede, H J

2016-11-24

The Healthy Lifestyle Program for women (HeLP-her) is a low-intensity, self-management program which has demonstrated efficacy in preventing excess weight gain in women. However, little is known about the implementation, reach, and sustainability of low-intensity prevention programs in rural settings, where risk for obesity in women is higher than urban settings. We aimed to evaluate a low-intensity healthy lifestyle program delivered to women in a rural setting to inform development of effective community prevention programs. A mixed method hybrid implementation and evaluation study, guided by the RE-AIM framework (addressing the Reach, Effectiveness, Adoption, Implementation, and Maintenance), was undertaken. Data collection tools included anthropometric measures, program checklists, questionnaires, and semi-structured interviews with participants and local stakeholders. The RE-AIM self-audit tool was applied to assess evaluation rigor. Six hundred and forty-nine women from 41 relatively socio-economic disadvantaged communities in Australia participated: mean age 39.6 years (±SD 6.7) and body mass index of 28.8 kg/m 2 (±SD 6.9). A between-group weight difference of -0.92 kg (95% CI -1.67 to -0.16) showed program effectiveness. Reach was broad across 41 towns with 62% of participants reporting influencing some of the health behaviors of their families. Strong implementation fidelity was achieved with good retention rates at 1 year (76%) and high participant satisfaction (82% of participants willing to recommend this program). Over 300 multi-level community partnerships were established supporting high adoption. Stakeholders reported potential capacity to implement and sustain the prevention program in resource poor rural settings, due to the low-intensity design and minimal resources required. Our comprehensive RE-AIM evaluation demonstrates that an evidence-based obesity prevention program can be successfully implemented in real-world settings. The program achieved broad reach, effectiveness, and satisfaction at the community and stakeholder level, revealing potential for program sustainability. The evaluation addressed implementation knowledge gaps to support future obesity prevention program scale-up. Australian and New Zealand Clinical Trial Registry ACTRN 12612000115831 [ http://www.anzctr.org.au/ ].

Implementation lessons: the importance of assessing organizational "fit" and external factors when implementing evidence-based teen pregnancy prevention programs.

PubMed

Demby, Hilary; Gregory, Alethia; Broussard, Marsha; Dickherber, Jennifer; Atkins, Shantice; Jenner, Lynne W

2014-03-01

In recent years, the demand for evidence-based teen pregnancy prevention programs has increased, but practitioners often struggle to replicate and implement them as designed in real-world community settings. The purpose of this article is to describe the barriers and facilitators encountered during pilot year attempts to implement an evidence-based teen pregnancy prevention program within three types of organizations: (1) small community-based organizations; (2) a school-based organization; and (3) a large decentralized city-sponsored summer youth program. We frame our discussion of these experiences within the context of a systemic, multilevel framework for implementation consisting of (1) core implementation components; (2) organizational components; and (3) external factors. This article explores the organizational and external implementation factors we experienced during the implementation process, describes our lessons learned throughout this process, and offers strategies for other practitioners to proactively address these factors from the start of program planning. These findings may provide useful insight for other organizations looking to implement multi-session, group-level interventions with fidelity. Copyright © 2014 Society for Adolescent Health and Medicine. All rights reserved.

Factors contributing to intervention fidelity in a multi-site chronic disease self-management program

PubMed Central

Perrin, Karen M; Burke, Somer Goad; O'Connor, Danielle; Walby, Gary; Shippey, Claire; Pitt, Seraphine; McDermott, Robert J; Forthofer, Melinda S

2006-01-01

Background and objectives Disease self-management programs have been a popular approach to reducing morbidity and mortality from chronic disease. Replicating an evidence-based disease management program successfully requires practitioners to ensure fidelity to the original program design. Methods The Florida Health Literacy Study (FHLS) was conducted to investigate the implementation impact of the Pfizer, Inc. Diabetes Mellitus and Hypertension Disease Self-Management Program based on health literacy principles in 14 community health centers in Florida. The intervention components discussed include health educator recruitment and training, patient recruitment, class sessions, utilization of program materials, translation of program manuals, patient retention and follow-up, and technical assistance. Results This report describes challenges associated with achieving a balance between adaptation for cultural relevance and fidelity when implementing the health education program across clinic sites. This balance was necessary to achieve effectiveness of the disease self-management program. The FHLS program was implemented with a high degree of fidelity to the original design and used original program materials. Adaptations identified as advantageous to program participation are discussed, such as implementing alternate methods for recruiting patients and developing staff incentives for participation. Conclusion Effective program implementation depends on the talent, skill and willing participation of clinic staff. Program adaptations that conserve staff time and resources and recognize their contribution can increase program effectiveness without jeopardizing its fidelity. PMID:17067388

Identifying and overcoming implementation challenges: Experience of 59 noninstitutional long-term services and support pilot programs in the Veterans Health Administration

PubMed Central

Sullivan, Jennifer L.; Adjognon, Omonyêlé L.; Engle, Ryann L.; Shin, Marlena H.; Afable, Melissa K.; Rudin, Whitney; White, Bert; Shay, Kenneth; Lukas, Carol VanDeusen

2018-01-01

Background: From 2010 to 2013, the Department of Veterans Affairs (VA) funded a large pilot initiative to implement noninstitutional long-term services and supports (LTSS) programs to support aging Veterans. Our team evaluated implementation of 59 VA noninstitutional LTSS programs. Purpose: The specific objectives of this study are to (a) examine the challenges influencing program implementation comparing active sites that remained open and inactive sites that closed during the funding period and (b) identify ways that active sites overcame the challenges they experienced. Methodology: Key informant semistructured interviews occurred between 2011 and 2013. We conducted 217 telephone interviews over four time points. Content analysis was used to identify emergent themes. The study team met regularly to define each challenge, review all codes, and discuss discrepancies. For each follow-up interview with the sites, the list of established challenges was used as a priori themes. Emergent data were also coded. Results: The challenges affecting implementation included human resources and staffing issues, infrastructure, resources allocation and geography, referrals and marketing, leadership support, and team dynamics and processes. Programs were able to overcome challenges by communicating with team members and other areas in the organization, utilizing information technology solutions, creative use of staff and flexible schedules, and obtaining additional resources. Discussion: This study highlights several common challenges programs can address during the program implementation. The most often mentioned strategy was effective communication. Strategies also targeted several components of the organization including organizational functions and processes (e.g., importance of coordination within a team and across disciplines to provide good care), infrastructure (e.g., information technology and human resources), and program fit with priorities in the organization (e.g., leadership support). Implications: Anticipating potential pitfalls of program implementation for future noninstitutional LTSS programs can improve implementation efficiency and program sustainability. Staff at multiple levels in the organization must fully support noninstitutional LTSS programs to address these challenges. PMID:28125459

Identifying and overcoming implementation challenges: Experience of 59 noninstitutional long-term services and support pilot programs in the Veterans Health Administration.

PubMed

Sullivan, Jennifer L; Adjognon, Omonyêlé L; Engle, Ryann L; Shin, Marlena H; Afable, Melissa K; Rudin, Whitney; White, Bert; Shay, Kenneth; Lukas, Carol VanDeusen

From 2010 to 2013, the Department of Veterans Affairs (VA) funded a large pilot initiative to implement noninstitutional long-term services and supports (LTSS) programs to support aging Veterans. Our team evaluated implementation of 59 VA noninstitutional LTSS programs. The specific objectives of this study are to (a) examine the challenges influencing program implementation comparing active sites that remained open and inactive sites that closed during the funding period and (b) identify ways that active sites overcame the challenges they experienced. Key informant semistructured interviews occurred between 2011 and 2013. We conducted 217 telephone interviews over four time points. Content analysis was used to identify emergent themes. The study team met regularly to define each challenge, review all codes, and discuss discrepancies. For each follow-up interview with the sites, the list of established challenges was used as a priori themes. Emergent data were also coded. The challenges affecting implementation included human resources and staffing issues, infrastructure, resources allocation and geography, referrals and marketing, leadership support, and team dynamics and processes. Programs were able to overcome challenges by communicating with team members and other areas in the organization, utilizing information technology solutions, creative use of staff and flexible schedules, and obtaining additional resources. This study highlights several common challenges programs can address during the program implementation. The most often mentioned strategy was effective communication. Strategies also targeted several components of the organization including organizational functions and processes (e.g., importance of coordination within a team and across disciplines to provide good care), infrastructure (e.g., information technology and human resources), and program fit with priorities in the organization (e.g., leadership support). Anticipating potential pitfalls of program implementation for future noninstitutional LTSS programs can improve implementation efficiency and program sustainability. Staff at multiple levels in the organization must fully support noninstitutional LTSS programs to address these challenges.

DSN 70-meter antenna X-band gain, phase, and pointing performance, with particular application for Voyager 2 Neptune encounter

NASA Technical Reports Server (NTRS)

Slobin, S. D.; Bathker, D. A.

1988-01-01

The gain, phase, and pointing performance of the Deep Space Network (DSN) 70 m antennas are investigated using theoretical antenna analysis computer programs that consider the gravity induced deformation of the antenna surface and quadripod structure. The microwave effects are calculated for normal subreflector focusing motion and for special fixed-subreflector conditions that may be used during the Voyager 2 Neptune encounter. The frequency stability effects of stepwise lateral and axial subreflector motions are also described. Comparisons with recently measured antenna efficiency and subreflector motion tests are presented. A modification to the existing 70 m antenna pointing squint correction constant is proposed.

"I write to know what I think": a four-year writing curriculum.

PubMed

Lister, Elena; Kravis, Nathan; Sandberg, Larry; Halpern, Jeffrey K; Cabaniss, Deborah L; Singer, Meriamne B

2008-12-01

The four-year writing curriculum of the Columbia Center for Psychoanalytic Training and Research has as its main objective to teach candidates to learn about analysis through writing. Learning to write about analyses ultimately entails learning to clarify and then express how one thinks and functions as an analyst. Since its inception ten years ago, the program has evolved into its current structure, a stepwise approach through the years of candidate training based on a didactic method called "layering." For each level of the course, candidates' typical writing difficulties are examined, and examples given of write-ups and how they were used in teaching. The essential role of the faculty experience is also described.

[Preservation of ability to work and securing vocational participation : non-pharmaceutical support options for rheumatologists].

PubMed

Drambyan, Y; Parthier, K

2014-02-01

For patients of working age with chronic rheumatic diseases preservation of the ability to work and therefore for equal participation in professional life is of particular importance. Significant supporting actions by rheumatologists include non-pharmaceutical and non-medical interventions in addition to drug therapy. Measures aiming at sustained working capacity such as physiotherapy, occupational therapy, medical rehabilitation and stepwise return to work have to be utilized. This support can include referral to a counseling service and assistance with the application for medical or vocational rehabilitation programs. In order to ensure sustainable success of the initiated measures it is essential that follow-up care and function-related interventions are supervised by a rheumatologist.

Welfare Reform: DOT Has Made Progress in Implementing the Job Access Program but Has Not Evaluated the Impact. Testimony before the Committee on Transportation and Infrastructure, Subcommittee on Highways and Transit, U.S. House of Representatives.

ERIC Educational Resources Information Center

Hecker, JayEtta Z.

A series of reviews of the Department of Transportation's (DOT's) Job Access and Reverse Commute (Job Access) Program explored DOT's and grantees' challenges in implementing the Job Access program and the status of DOT's program evaluation efforts. DOT and grantees faced significant challenges in implementing the Job Access program. DOT's process…

Evaluating the impact of implementation factors on family-based prevention programming: methods for strengthening causal inference.

PubMed

Crowley, D Max; Coffman, Donna L; Feinberg, Mark E; Greenberg, Mark T; Spoth, Richard L

2014-04-01

Despite growing recognition of the important role implementation plays in successful prevention efforts, relatively little work has sought to demonstrate a causal relationship between implementation factors and participant outcomes. In turn, failure to explore the implementation-to-outcome link limits our understanding of the mechanisms essential to successful programming. This gap is partially due to the inability of current methodological procedures within prevention science to account for the multitude of confounders responsible for variation in implementation factors (i.e., selection bias). The current paper illustrates how propensity and marginal structural models can be used to improve causal inferences involving implementation factors not easily randomized (e.g., participant attendance). We first present analytic steps for simultaneously evaluating the impact of multiple implementation factors on prevention program outcome. Then, we demonstrate this approach for evaluating the impact of enrollment and attendance in a family program, over and above the impact of a school-based program, within PROSPER, a large-scale real-world prevention trial. Findings illustrate the capacity of this approach to successfully account for confounders that influence enrollment and attendance, thereby more accurately representing true causal relations. For instance, after accounting for selection bias, we observed a 5% reduction in the prevalence of 11th grade underage drinking for those who chose to receive a family program and school program compared to those who received only the school program. Further, we detected a 7% reduction in underage drinking for those with high attendance in the family program.

46 CFR 16.205 - Implementation of chemical testing programs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 1 2010-10-01 2010-10-01 false Implementation of chemical testing programs. 16.205... CHEMICAL TESTING Required Chemical Testing § 16.205 Implementation of chemical testing programs. (a) When a...) Upon written request of an employer, Commandant (CG-545) will review the employer's chemical testing...

46 CFR 16.205 - Implementation of chemical testing programs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 1 2011-10-01 2011-10-01 false Implementation of chemical testing programs. 16.205... CHEMICAL TESTING Required Chemical Testing § 16.205 Implementation of chemical testing programs. (a) When a...) Upon written request of an employer, Commandant (CG-545) will review the employer's chemical testing...

Teachers' Readiness to Implement Nutrition Education Programs: Beliefs, Attitudes, and Barriers

ERIC Educational Resources Information Center

Perikkou, Anastasia; Kokkinou, Eleni; Panagiotakos, Demosthenes B.; Yannakoulia, Mary

2015-01-01

Teachers' attitudes about school food environments and their readiness to implement school-based nutrition programs were investigated. A total of 1,436 primary-school teachers filled out a questionnaire on their demographic and professional characteristics and their attitudes, beliefs, and barriers for implementing health educational programs. The…

Understanding the Social Context of School Health Promotion Program Implementation

ERIC Educational Resources Information Center

Cargo, Margaret; Salsberg, Jon; Delormier, Treena; Desrosiers, Serge; Macaulay, Ann C.

2006-01-01

Purpose: Although implementation fidelity is an important component in the evaluation of school health promotion programs, it assumes that teaching is the most relevant teacher role. To understand the social context of program implementation, a qualitative study was undertaken with the aim of identifying the schoolteacher's role in implementing…

Effects of Staff Implementation of a Choice Program on Challenging Behaviors in Persons with Developmental Disabilities.

ERIC Educational Resources Information Center

Ip, Sau M. V.; And Others

1994-01-01

Describes quasiexperimental investigation constructed to examine effects of staff implementation of choice program on reduction of challenging behaviors of people with developmental disabilities residing in supported community residences. Results suggest that choice program implementation produced significant decreases in frequency and severity of…

46 CFR 16.205 - Implementation of chemical testing programs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 1 2013-10-01 2013-10-01 false Implementation of chemical testing programs. 16.205... CHEMICAL TESTING Required Chemical Testing § 16.205 Implementation of chemical testing programs. (a) When a...) Upon written request of an employer, Commandant (CG-INV) will review the employer's chemical testing...

46 CFR 16.205 - Implementation of chemical testing programs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 1 2014-10-01 2014-10-01 false Implementation of chemical testing programs. 16.205... CHEMICAL TESTING Required Chemical Testing § 16.205 Implementation of chemical testing programs. (a) When a...) Upon written request of an employer, Commandant (CG-INV) will review the employer's chemical testing...

46 CFR 16.205 - Implementation of chemical testing programs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 1 2012-10-01 2012-10-01 false Implementation of chemical testing programs. 16.205... CHEMICAL TESTING Required Chemical Testing § 16.205 Implementation of chemical testing programs. (a) When a...) Upon written request of an employer, Commandant (CG-INV) will review the employer's chemical testing...

40 CFR 51.372 - State Implementation Plan submissions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... compliance; (5) Legal authority requiring or allowing implementation of the I/M program and providing either broad or specific authority to perform all required elements of the program; (6) Legal authority for I/M... without an I/M program is approved by EPA); (7) Implementing regulations, interagency agreements, and...

40 CFR 51.372 - State Implementation Plan submissions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... compliance; (5) Legal authority requiring or allowing implementation of the I/M program and providing either broad or specific authority to perform all required elements of the program; (6) Legal authority for I/M... without an I/M program is approved by EPA); (7) Implementing regulations, interagency agreements, and...

40 CFR 51.372 - State Implementation Plan submissions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... compliance; (5) Legal authority requiring or allowing implementation of the I/M program and providing either broad or specific authority to perform all required elements of the program; (6) Legal authority for I/M... without an I/M program is approved by EPA); (7) Implementing regulations, interagency agreements, and...

40 CFR 51.372 - State Implementation Plan submissions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... compliance; (5) Legal authority requiring or allowing implementation of the I/M program and providing either broad or specific authority to perform all required elements of the program; (6) Legal authority for I/M... without an I/M program is approved by EPA); (7) Implementing regulations, interagency agreements, and...

78 FR 41785 - Agency Information Collection Activities; Comment Request; Implementation of Title I/II Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-11

...; Comment Request; Implementation of Title I/II Program Initiatives AGENCY: Institute of Educational... note that written comments received in response to this notice will be considered public records. Title of Collection: Implementation of Title I/II Program Initiatives. OMB Control Number: 1850-New. Type...

The Implementation of Program Evaluation Recommendations in Wisconsin Technical Colleges.

ERIC Educational Resources Information Center

Ruhland, Sheila K.

Implementation of program evaluation recommendations should persuade people that the rewards of an evaluation outweigh the reasons for resistance. A study was undertaken with the following purposes: identify facilitators and barriers to the implementation of program evaluation; determine the proportion of recommendations made in each of the nine…

EVALUATION OF THE IMPLEMENTATION OF OPERATIONS AND MAINTENANCE PROGRAMS IN NEW JERSEY SCHOOLS

EPA Science Inventory

The Asbestos Hazard Emergency Response Act (AHERA) required all schools to develop and implement an asbestos management plan (AMP). The key component of the AMP is the operations and maintenance (O&M) program. A study was conducted to evaluate the implementation of O&M programs a...

Early access programs: Benefits, challenges, and key considerations for successful implementation

PubMed Central

Patil, Sanjaykumar

2016-01-01

Early access programs, (EAPs) are adopted by an increasing number of pharma companies due to several benefits offered by these programs. EAPs offer ethical, compliant, and controlled mechanisms of access to investigational drugs outside of the clinical trial space and before the commercial launch of the drug, to patients with life-threatening diseases having no treatment options available. In addition to the development of positive relationships with key opinion leaders (KOL), patients, advocacy groups and regulators, the data captured from the implementation of EAPs supports in the formulation of global commercialization strategies. This white paper outlines various circumstances to be considered for the implementation of EAPs named patient programs, the regulatory landscape, the benefits and challenges associated with implementing these programs and the key considerations for their successful implementation. PMID:26955570

Overview of implementation of DARPA GPU program in SAIC

NASA Astrophysics Data System (ADS)

Braunreiter, Dennis; Furtek, Jeremy; Chen, Hai-Wen; Healy, Dennis

2008-04-01

This paper reviews the implementation of DARPA MTO STAP-BOY program for both Phase I and II conducted at Science Applications International Corporation (SAIC). The STAP-BOY program conducts fast covariance factorization and tuning techniques for space-time adaptive process (STAP) Algorithm Implementation on Graphics Processor unit (GPU) Architectures for Embedded Systems. The first part of our presentation on the DARPA STAP-BOY program will focus on GPU implementation and algorithm innovations for a prototype radar STAP algorithm. The STAP algorithm will be implemented on the GPU, using stream programming (from companies such as PeakStream, ATI Technologies' CTM, and NVIDIA) and traditional graphics APIs. This algorithm will include fast range adaptive STAP weight updates and beamforming applications, each of which has been modified to exploit the parallel nature of graphics architectures.

Implementing a collaborative return-to-work program: Lessons from a qualitative study in a large Canadian healthcare organization.

PubMed

Skivington, Kathryn; Lifshen, Marni; Mustard, Cameron

2016-11-22

Comprehensive workplace return-to-work policies, applied with consistency, can reduce length of time out of work and the risk of long-term disability. This paper reports on the findings from a qualitative study exploring managers' and return-to-work-coordinators' views on the implementation of their organization's new return-to-work program. To provide practical guidance to organizations in designing and implementing return-to-work programs for their employees. Semi-structured qualitative interviews were undertaken with 20 managers and 10 return-to-work co-ordinators to describe participants' perspectives on the progress of program implementation in the first 18 months of adoption. The study was based in a large healthcare organization in Ontario, Canada. Thematic analysis of the data was conducted. We identified tensions evident in the early implementation phase of the organization's return-to-work program. These tensions were attributed to uncertainties concerning roles and responsibilities and to circumstances where objectives or principles appeared to be in conflict. The implementation of a comprehensive and collaborative return-to-work program is a complex challenge. The findings described in this paper may provide helpful guidance for organizations embarking on the development and implementation of a return-to-work program.

Implementing a collaborative return-to-work program: Lessons from a qualitative study in a large Canadian healthcare organization

PubMed Central

Skivington, Kathryn; Lifshen, Marni; Mustard, Cameron

2016-01-01

BACKGROUND: Comprehensive workplace return-to-work policies, applied with consistency, can reduce length of time out of work and the risk of long-term disability. This paper reports on the findings from a qualitative study exploring managers’ and return-to-work-coordinators’ views on the implementation of their organization’s new return-to-work program. OBJECTIVES: To provide practical guidance to organizations in designing and implementing return-to-work programs for their employees. METHODS: Semi-structured qualitative interviews were undertaken with 20 managers and 10 return-to-work co-ordinators to describe participants’ perspectives on the progress of program implementation in the first 18 months of adoption. The study was based in a large healthcare organization in Ontario, Canada. Thematic analysis of the data was conducted. RESULTS: We identified tensions evident in the early implementation phase of the organization’s return-to-work program. These tensions were attributed to uncertainties concerning roles and responsibilities and to circumstances where objectives or principles appeared to be in conflict. CONCLUSIONS: The implementation of a comprehensive and collaborative return-to-work program is a complex challenge. The findings described in this paper may provide helpful guidance for organizations embarking on the development and implementation of a return-to-work program. PMID:27792035

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

PubMed Central

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

2014-01-01

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

Tai Chi: moving for better balance -- development of a community-based falls prevention program.

PubMed

Li, Fuzhong; Harmer, Peter; Mack, Karin A; Sleet, David; Fisher, K John; Kohn, Melvin A; Millet, Lisa M; Xu, Junheng; Yang, Tingzhong; Sutton, Beth; Tompkins, Yvaughn

2008-05-01

This study was designed to develop an evidence- and community based falls prevention program -- Tai Chi: Moving for Better Balance. A mixed qualitative and quantitative approach was used to develop a package of materials for program implementation and evaluation. The developmental work was conducted in 2 communities in the Pacific Northwest. Participants included a panel of experts, senior service program managers or activity coordinators, and older adults. Outcome measures involved program feasibility and satisfaction. Through an iterative process, a program package was developed. The package contained an implementation plan and class training materials (ie, instructor's manual, videotape, and user's guidebook). Pilot testing of program materials showed that the content was appropriate for the targeted users (community-living older adults) and providers (local senior service organizations). A feasibility survey indicated interest and support from users and providers for program implementation. A 2-week pilot evaluation showed that the program implementation was feasible and evidenced good class attendance, high participant satisfaction, and interest in continuing Tai Chi. The package of materials developed in this study provides a solid foundation for larger scale implementation and evaluation of the program in community settings.

Cost-effectiveness of a participatory return-to-work intervention for temporary agency workers and unemployed workers sick-listed due to musculoskeletal disorders: design of a randomised controlled trial.

PubMed

Vermeulen, Sylvia J; Anema, Johannes R; Schellart, Antonius J M; van Mechelen, Willem; van der Beek, Allard J

2010-03-28

Within the working population there is a vulnerable group: workers without an employment contract and workers with a flexible labour market arrangement, e.g. temporary agency workers. In most cases, when sick-listed, these workers have no workplace/employer to return to. Also, for these workers access to occupational health care is limited or even absent in many countries. For this vulnerable working population there is a need for tailor-made occupational health care, including the presence of an actual return-to-work perspective. Therefore, a participatory return-to-work program has been developed based on a successful return-to-work intervention for workers, sick-listed due to low back pain.The objective of this paper is to describe the design of a randomised controlled trial to study the (cost-)effectiveness of this newly developed participatory return-to-work program adapted for temporary agency workers and unemployed workers, sick-listed due to musculoskeletal disorders, compared to usual care. The design of this study is a randomised controlled trial with one year of follow-up. The study population consists of temporary agency workers and unemployed workers sick-listed between 2 and 8 weeks due to musculoskeletal disorders. The new return-to-work program is a stepwise program aimed at making a consensus-based return-to-work implementation plan with the possibility of a (therapeutic) workplace to return-to-work. Outcomes are measured at baseline, 3, 6, 9 and 12 months. The primary outcome measure is duration of the sickness benefit period after the first day of reporting sick. Secondary outcome measures are: time until first return-to-work, total number of days of sickness benefit during follow-up; functional status; intensity of musculoskeletal pain; pain coping; and attitude, social influence and self-efficacy determinants. Cost-benefit is evaluated from an insurer's perspective. A process evaluation is part of this study. For sick-listed workers without an employment contract there can be gained a lot by improving occupational health care, including return-to-work guidance, and by minimising the 'labour market handicap' by creating a return-to-work perspective. In addition, reduction of sickness absence and work disability, i.e. a reduction of disability claims, may result in substantial benefits for the Dutch Social Security System. NTR1047.

Intensive care unit quality improvement: a "how-to" guide for the interdisciplinary team.

PubMed

Curtis, J Randall; Cook, Deborah J; Wall, Richard J; Angus, Derek C; Bion, Julian; Kacmarek, Robert; Kane-Gill, Sandra L; Kirchhoff, Karin T; Levy, Mitchell; Mitchell, Pamela H; Moreno, Rui; Pronovost, Peter; Puntillo, Kathleen

2006-01-01

Quality improvement is an important activity for all members of the interdisciplinary critical care team. Although an increasing number of resources are available to guide clinicians, quality improvement activities can be overwhelming. Therefore, the Society of Critical Care Medicine charged this Outcomes Task Force with creating a "how-to" guide that focuses on critical care, summarizes key concepts, and outlines a practical approach to the development, implementation, evaluation, and maintenance of an interdisciplinary quality improvement program in the intensive care unit. The task force met in person twice and by conference call twice to write this document. We also conducted a literature search on "quality improvement" and "critical care or intensive care" and searched online for additional resources. DATA SYNTHESIS AND OVERVIEW: We present an overview of quality improvement in the intensive care unit setting and then describe the following steps for initiating or improving an interdisciplinary critical care quality improvement program: a) identify local motivation, support teamwork, and develop strong leadership; b) prioritize potential projects and choose the first target; c) operationalize the measures, build support for the project, and develop a business plan; d) perform an environmental scan to better understand the problem, potential barriers, opportunities, and resources for the project; e) create a data collection system that accurately measures baseline performance and future improvements; f) create a data reporting system that allows clinicians and others to understand the problem; g) introduce effective strategies to change clinician behavior. In addition, we identify four steps for evaluating and maintaining this program: a) determine whether the target is changing with periodic data collection; b) modify behavior change strategies to improve or sustain improvements; c) focus on interdisciplinary collaboration; and d) develop and sustain support from the hospital leadership. We also identify a number of online resources to complement this overview. This Society of Critical Care Medicine Task Force report provides an overview for clinicians interested in developing or improving a quality improvement program using a step-wise approach. Success depends not only on committed interdisciplinary work that is incremental and continuous but also on strong leadership. Further research is needed to refine the methods and identify the most cost-effective means of improving the quality of health care received by critically ill patients and their families.

Implementation activities for the Wisconsin Highway Research Program (WHRP).

DOT National Transportation Integrated Search

2010-03-01

The Wisconsin Highway Research Program (WHRP) Steering Committee commissioned an implementation pilot : program in 2006 to facilitate the incorporation of research results into the programs, standards, and processes of : the Wisconsin Department of T...

Using planned adaptation to implement evidence-based programs with new populations.

PubMed

Lee, Shawna J; Altschul, Inna; Mowbray, Carol T

2008-06-01

The Interactive Systems Framework (ISF) for Dissemination and Implementation (Wandersman et al. 2008) elaborates the functions and structures that move evidence-based programs (EBPs) from research to practice. Inherent in that process is the tension between implementing programs with fidelity and the need to tailor programs to fit the target population. We propose Planned Adaptation as one approach to resolve this tension, with the goal of guiding practitioners in adapting EBPs so that they maintain core components of program theory while taking into account the needs of particular populations. Planned Adaptation is a form of capacity building within the Prevention Support System that provides a framework to guide practitioners in adapting programs while encouraging researchers to provide information relevant to adaptation as a critical aspect of dissemination research, with the goal of promoting wider dissemination and better implementation of EBPs. We illustrate Planned Adaptation using the JOBS Program (Caplan et al. 1989), which was developed for recently laid-off, working- and middle-class workers and subsequently implemented with welfare recipients.

Barriers to Effective Implementation of Programs for the Prevention of Workplace Violence in Hospitals.

PubMed

Blando, James; Ridenour, Marilyn; Hartley, Daniel; Casteel, Carri

2015-01-01

Effective workplace violence (WPV) prevention programs are essential, yet challenging to implement in healthcare. The aim of this study was to identify major barriers to implementation of effective violence prevention programs. After reviewing the related literature, the authors describe their research methods and analysis and report the following seven themes as major barriers to effective implementation of workplace violence programs: a lack of action despite reporting; varying perceptions of violence; bullying; profit-driven management models; lack of management accountability; a focus on customer service; and weak social service and law enforcement approaches to mentally ill patients. The authors discuss their findings in light of previous studies and experiences and offer suggestions for decreasing WPV in healthcare settings. They conclude that although many of these challenges to effective implementation of workplace violence programs are both within the program itself and relate to broader industry and societal issues, creative innovations can address these issues and improve WPV prevention programs.

Barriers to Effective Implementation of Programs for the Prevention of Workplace Violence in Hospitals.

PubMed

Blando, James; Ridenour, Marilyn; Hartley, Daniel; Casteel, Carri

2014-12-04

Effective workplace violence (WPV) prevention programs are essential, yet challenging to implement in healthcare. The aim of this study was to identify major barriers to implementation of effective violence prevention programs. After reviewing the related literature, the authors describe their research methods and analysis and report the following seven themes as major barriers to effective implementation of workplace violence programs: a lack of action despite reporting; varying perceptions of violence; bullying; profit-driven management models; lack of management accountability; a focus on customer service; and weak social service and law enforcement approaches to mentally ill patients. The authors discuss their findings in light of previous studies and experiences and offer suggestions for decreasing WPV in healthcare settings. They conclude that although many of these challenges to effective implementation of workplace violence programs are both within the program itself and relate to broader industry and societal issues, creative innovations can address these issues and improve WPV prevention programs.

The Design and Implementation of an Object-Oriented, Production-Rule Interpreter.

DTIC Science & Technology

1984-12-01

S. CONTRACT OR GRANT NUMBER(s) .Heinz M. McArthur 9. PERFORMING ORGANIZATION NAME AND ADDRESS 10. PROGRAM ELEMENT. PROJECT. TASK AREA & WORK UNIT...implementation of two prototype interpreters for Omega, an object-oriented, production- rule programming language. The first implementation is a throw- away...production-rule programming language. The first implementa- tion is a throw-away prototype written in LISP; the second implementation is a more complete

Algorithms for Large-Scale Astronomical Problems

DTIC Science & Technology

2013-08-01

implemented as a succession of Hadoop MapReduce jobs and sequential programs written in Java . The sampling and splitting stages are implemented as...one MapReduce job, the partitioning and clustering phases make up another job. The merging stage is implemented as a stand-alone Java program. The...Merging. The merging stage is implemented as a sequential Java program that reads the files with the shell information, which were generated by

Piloting laboratory quality system management in six health facilities in Nigeria.

PubMed

Mbah, Henry; Ojo, Emmanuel; Ameh, James; Musuluma, Humphrey; Negedu-Momoh, Olubunmi Ruth; Jegede, Feyisayo; Ojo, Olufunmilayo; Uwakwe, Nkem; Ochei, Kingsley; Dada, Michael; Udah, Donald; Chiegil, Robert; Torpey, Kwasi

2014-01-01

Achieving accreditation in laboratories is a challenge in Nigeria like in most African countries. Nigeria adopted the World Health Organization Regional Office for Africa Stepwise Laboratory (Quality) Improvement Process Towards Accreditation (WHO/AFRO- SLIPTA) in 2010. We report on FHI360 effort and progress in piloting WHO-AFRO recognition and accreditation preparedness in six health facility laboratories in five different states of Nigeria. Laboratory assessments were conducted at baseline, follow up and exit using the WHO/AFRO- SLIPTA checklist. From the total percentage score obtained, the quality status of laboratories were classified using a zero to five star rating, based on the WHO/AFRO quality improvement stepwise approach. Major interventions include advocacy, capacity building, mentorship and quality improvement projects. At baseline audit, two of the laboratories attained 1- star while the remaining four were at 0- star. At follow up audit one lab was at 1- star, two at 3-star and three at 4-star. At exit audit, four labs were at 4- star, one at 3-star and one at 2-star rating. One laboratory dropped a 'star' at exit audit, while others consistently improved. The two weakest elements at baseline; internal audit (4%) and occurrence/incidence management (15%) improved significantly, with an exit score of 76% and 81% respectively. The elements facility and safety was the major strength across board throughout the audit exercise. This effort resulted in measurable and positive impact on the laboratories. We recommend further improvement towards a formal international accreditation status and scale up of WHO/AFRO- SLIPTA implementation in Nigeria.

BoB, a best-of-breed automated text de-identification system for VHA clinical documents.

PubMed

Ferrández, Oscar; South, Brett R; Shen, Shuying; Friedlin, F Jeffrey; Samore, Matthew H; Meystre, Stéphane M

2013-01-01

De-identification allows faster and more collaborative clinical research while protecting patient confidentiality. Clinical narrative de-identification is a tedious process that can be alleviated by automated natural language processing methods. The goal of this research is the development of an automated text de-identification system for Veterans Health Administration (VHA) clinical documents. We devised a novel stepwise hybrid approach designed to improve the current strategies used for text de-identification. The proposed system is based on a previous study on the best de-identification methods for VHA documents. This best-of-breed automated clinical text de-identification system (aka BoB) tackles the problem as two separate tasks: (1) maximize patient confidentiality by redacting as much protected health information (PHI) as possible; and (2) leave de-identified documents in a usable state preserving as much clinical information as possible. We evaluated BoB with a manually annotated corpus of a variety of VHA clinical notes, as well as with the 2006 i2b2 de-identification challenge corpus. We present evaluations at the instance- and token-level, with detailed results for BoB's main components. Moreover, an existing text de-identification system was also included in our evaluation. BoB's design efficiently takes advantage of the methods implemented in its pipeline, resulting in high sensitivity values (especially for sensitive PHI categories) and a limited number of false positives. Our system successfully addressed VHA clinical document de-identification, and its hybrid stepwise design demonstrates robustness and efficiency, prioritizing patient confidentiality while leaving most clinical information intact.

KB3D Reference Manual. Version 1.a

NASA Technical Reports Server (NTRS)

Munoz, Cesar; Siminiceanu, Radu; Carreno, Victor A.; Dowek, Gilles

2005-01-01

This paper is a reference manual describing the implementation of the KB3D conflict detection and resolution algorithm. The algorithm has been implemented in the Java and C++ programming languages. The reference manual gives a short overview of the detection and resolution functions, the structural implementation of the program, inputs and outputs to the program, and describes how the program is used. Inputs to the program can be rectangular coordinates or geodesic coordinates. The reference manual also gives examples of conflict scenarios and the resolution outputs the program produces.

33 CFR 385.13 - Projects implemented under additional program authority.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Implementation Report is prepared and approved in accordance with § 385.26; and (3) Not exceed a total cost of... RESTORATION PLAN CERP Implementation Processes § 385.13 Projects implemented under additional program authority. (a) To expedite implementation of the Plan, the Corps of Engineers and non-Federal sponsors may...

Selecting predictors for discriminant analysis of species performance: an example from an amphibious softwater plant.

PubMed

Vanderhaeghe, F; Smolders, A J P; Roelofs, J G M; Hoffmann, M

2012-03-01

Selecting an appropriate variable subset in linear multivariate methods is an important methodological issue for ecologists. Interest often exists in obtaining general predictive capacity or in finding causal inferences from predictor variables. Because of a lack of solid knowledge on a studied phenomenon, scientists explore predictor variables in order to find the most meaningful (i.e. discriminating) ones. As an example, we modelled the response of the amphibious softwater plant Eleocharis multicaulis using canonical discriminant function analysis. We asked how variables can be selected through comparison of several methods: univariate Pearson chi-square screening, principal components analysis (PCA) and step-wise analysis, as well as combinations of some methods. We expected PCA to perform best. The selected methods were evaluated through fit and stability of the resulting discriminant functions and through correlations between these functions and the predictor variables. The chi-square subset, at P < 0.05, followed by a step-wise sub-selection, gave the best results. In contrast to expectations, PCA performed poorly, as so did step-wise analysis. The different chi-square subset methods all yielded ecologically meaningful variables, while probable noise variables were also selected by PCA and step-wise analysis. We advise against the simple use of PCA or step-wise discriminant analysis to obtain an ecologically meaningful variable subset; the former because it does not take into account the response variable, the latter because noise variables are likely to be selected. We suggest that univariate screening techniques are a worthwhile alternative for variable selection in ecology. © 2011 German Botanical Society and The Royal Botanical Society of the Netherlands.

Porous media fracturing dynamics: stepwise crack advancement and fluid pressure oscillations

NASA Astrophysics Data System (ADS)

Cao, Toan D.; Hussain, Fazle; Schrefler, Bernhard A.

2018-02-01

We present new results explaining why fracturing in saturated porous media is not smooth and continuous but is a distinct stepwise process concomitant with fluid pressure oscillations. All exact solutions and almost all numerical models yield smooth fracture advancement and fluid pressure evolution, while recent experimental results, mainly from the oil industry, observation from geophysics and a very few numerical results for the quasi-static case indeed reveal the stepwise phenomenon. We summarize first these new experiments and these few numerical solutions for the quasi-static case. Both mechanical loading and pressure driven fractures are considered because their behaviours differ in the direction of the pressure jumps. Then we explore stepwise crack tip advancement and pressure fluctuations in dynamic fracturing with a hydro-mechanical model of porous media based on the Hybrid Mixture Theory. Full dynamic analyses of examples dealing with both hydraulic fracturing and mechanical loading are presented. The stepwise fracture advancement is confirmed in the dynamic setting as well as in the pressure fluctuations, but there are substantial differences in the frequency contents of the pressure waves in the two loading cases. Comparison between the quasi-static and fully dynamic solutions reveals that the dynamic response gives much more information such as the type of pressure oscillations and related frequencies and should be applied whenever there is a doubt about inertia forces playing a role - the case in most fracturing events. In the absence of direct relevant dynamic tests on saturated media some experimental results on dynamic fracture in dry materials, a fast hydraulic fracturing test and observations from geophysics confirm qualitatively the obtained results such as the type of pressure oscillations and the substantial difference in the behaviour under the two loading cases.

Novel Investigation on Nanostructured Multilayer and Functionally Graded Ni-P Electroless Coatings on Stainless Steel

NASA Astrophysics Data System (ADS)

Anvari, S. R.; Monirvaghefi, S. M.; Enayati, M. H.

2015-06-01

In this study, step-wise multilayer and functionally graded Ni-P coatings were deposited with electroless in which the content of phosphorus and nickel would be changed gradually and step-wise through the thickness of the coatings, respectively. To compare the properties of these coatings with Ni-P single-layer coatings, three types of coatings with different phosphorus contents were deposited. Heat treatment of coatings was performed at 400 °C for 1 h. The microstructure and phase transformation of coatings were characterized by SEM/EDS, TEM, and XRD. The mechanical properties of coatings were studied by nanoindentation test. According to the results of the single-layer coatings, low P coating had the maximum hardness and also the ratio of hardness ( H) to elasticity modulus ( E) for the mentioned coating was maximum. In addition, low and medium P coatings had crystalline and semi-crystalline structure, respectively. The mentioned coatings had <111> texture and after heat treatment their texture didn't change. While high P coating had amorphous structure, after heat treatment it changed to crystalline structure with <100> texture for nickel grains. Furthermore, the results showed that functionally graded and step-wise multilayer coatings were deposited successfully by using the same initial bath and changing the temperature and pH during deposition. Nanoindentation test results showed that the hardness of the mentioned coatings changed from 670 Hv near the substrate to 860 Hv near the top surface of coatings. For functionally graded coating the hardness profile had gradual changes, while step-wise multilayer coating had step-wise hardness profile. After heat treatment trend of hardness profiles was changed, so that near the substrate, hardness was measured 1400 Hv and changed to 1090 Hv at the top coat.

Implementation fidelity trajectories of a health promotion program in multidisciplinary settings: managing tensions in rehabilitation care.

PubMed

Hoekstra, Femke; van Offenbeek, Marjolein A G; Dekker, Rienk; Hettinga, Florentina J; Hoekstra, Trynke; van der Woude, Lucas H V; van der Schans, Cees P

2017-12-01

Although the importance of evaluating implementation fidelity is acknowledged, little is known about heterogeneity in fidelity over time. This study aims to generate insight into the heterogeneity in implementation fidelity trajectories of a health promotion program in multidisciplinary settings and the relationship with changes in patients' health behavior. This study used longitudinal data from the nationwide implementation of an evidence-informed physical activity promotion program in Dutch rehabilitation care. Fidelity scores were calculated based on annual surveys filled in by involved professionals (n = ± 70). Higher fidelity scores indicate a more complete implementation of the program's core components. A hierarchical cluster analysis was conducted on the implementation fidelity scores of 17 organizations at three different time points. Quantitative and qualitative data were used to explore organizational and professional differences between identified trajectories. Regression analyses were conducted to determine differences in patient outcomes. Three trajectories were identified as the following: 'stable high fidelity' (n = 9), 'moderate and improving fidelity' (n = 6), and 'unstable fidelity' (n = 2). The stable high fidelity organizations were generally smaller, started earlier, and implemented the program in a more structured way compared to moderate and improving fidelity organizations. At the implementation period's start and end, support from physicians and physiotherapists, professionals' appreciation, and program compatibility were rated more positively by professionals working in stable high fidelity organizations as compared to the moderate and improving fidelity organizations (p < .05). Qualitative data showed that the stable high fidelity organizations had often an explicit vision and strategy about the implementation of the program. Intriguingly, the trajectories were not associated with patients' self-reported physical activity outcomes (adjusted model β = - 651.6, t(613) = - 1032, p = .303). Differences in organizational-level implementation fidelity trajectories did not result in outcome differences at patient-level. This suggests that an effective implementation fidelity trajectory is contingent on the local organization's conditions. More specifically, achieving stable high implementation fidelity required the management of tensions: realizing a localized change vision, while safeguarding the program's standardized core components and engaging the scarce physicians throughout the process. When scaling up evidence-informed health promotion programs, we propose to tailor the management of implementation tensions to local organizations' starting position, size, and circumstances. The Netherlands National Trial Register NTR3961 . Registered 18 April 2013.

From Implementation to Outcomes to Impacts: Designing a Comprehensive Program Evaluation

NASA Astrophysics Data System (ADS)

Shebby, S.

2015-12-01

Funders are often interested in learning about the impact of program activities, yet before the impacts are determined, educational evaluations should first examine program implementation and outcomes. Implementation evaluation examines how and the extent to which program activities are delivered as intended, including the extent to which activities reached the targeted participants. Outcome evaluation is comprised of a systematic examination of the effects that a program has on program participants, such as changes in knowledge, attitudes, beliefs, values, and behaviors. In this presentation, presenters will share insights on evaluating the implementation, outcomes, and impacts associated with an online science curriculum for K-2 students. The science curriculum was designed to provide students with access to science concepts and skills in an interactive and innovative environment, and teachers with embedded, aligned, and on-demand professional development. One of the most important—and challenging—steps in this evaluation was to select outcomes that were well-defined, measurable, and aligned to program activities, as well as relevant to program stakeholders. An additional challenge was to measure implementation given limited access to the classroom environment. This presentation will include a discussion of the process evaluators used to select appropriate implementation indicators and outcomes (teacher and student), design an evaluation approach, and craft data collection instruments. Although examples provided are specific to the K-2 science intervention, the best practices discussed are pertinent to all program and event evaluations. Impact evaluation goes beyond implementation and outcome evaluation to inform whether a program is working or not. It requires a comparison group to inform what outcomes would have been in the absence of the intervention. As such, this presentation will also include a discussion of impacts, including how impacts are defined and measured, and some common challenges in evaluating program impact.

Reciprocal Relations between Coalition Functioning and the Provision of Implementation Support

PubMed Central

Brown, Louis D.; Feinberg, Mark E.; Shapiro, Valerie B.; Greenberg, Mark T.

2014-01-01

Community coalitions have been promoted as a strategy to help overcome challenges to the dissemination and implementation of evidence-based prevention programs. This paper explores the characteristics of coalitions that enable the provision of implementation support for prevention programs in general, and for the implementation of evidence-based prevention programs with fidelity. Longitudinal cross-lagged panel models were used to study 74 Communities That Care (CTC) coalitions in Pennsylvania. These analyses provide evidence of a unidirectional influence of coalition functioning on the provision of implementation support. Coalition member knowledge of the CTC model best predicted the coalition’s provision of support for evidence-based program implementation with fidelity. Implications for developing and testing innovative methods for delivering training and technical assistance to enhance coalition member knowledge are discussed. PMID:24323363

24 CFR 984.301 - Program implementation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... DEVELOPMENT SECTION 8 AND PUBLIC HOUSING FAMILY SELF-SUFFICIENCY PROGRAM Program Operation § 984.301 Program... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Program implementation. 984.301 Section 984.301 Housing and Urban Development Regulations Relating to Housing and Urban Development...

Implementing an Employee Assistance Program.

ERIC Educational Resources Information Center

Gam, John; And Others

1983-01-01

Describes in detail the implementation of an employee assistance program in a textile plant. Reviews the historical development, referral process, and termination guidelines of the program and contains descriptive statistics for six periods of the program's operation. (Author/JAC)

Effect of the Garrett Lee Smith Memorial Suicide Prevention Program on Suicide Attempts Among Youths.

PubMed

Godoy Garraza, Lucas; Walrath, Christine; Goldston, David B; Reid, Hailey; McKeon, Richard

2015-11-01

Youth suicide prevention is a major public health priority. Studies documenting the effectiveness of community-based suicide prevention programs in reducing the number of nonlethal suicide attempts have been sparse. To determine whether a reduction in suicide attempts among youths occurs following the implementation of the Garrett Lee Smith Memorial Suicide Prevention Program (hereafter referred to as the GLS program), consistent with the reduction in mortality documented previously. We conducted an observational study of community-based suicide prevention programs for youths across 46 states and 12 tribal communities. The study compared 466 counties implementing the GLS program between 2006 and 2009 with 1161 counties that shared key preintervention characteristics but were not exposed to the GLS program. The unweighted rounded numbers of respondents used in this analysis were 84 000 in the control group and 57 000 in the intervention group. We used propensity score-based techniques to increase comparability (on background characteristics) between counties that implemented the GLS program and counties that did not. We combined information on program activities collected by the GLS national evaluation with information on county characteristics from several secondary sources. The data analysis was performed between April and August 2014. P < .05 was considered statistically significant. Comprehensive, multifaceted suicide prevention programs, including gatekeeper training, education and mental health awareness programs, screening activities, improved community partnerships and linkages to service, programs for suicide survivors, and crisis hotlines. Suicide attempt rates for each county following implementation of the GLS program for youths 16 to 23 years of age at the time the program activities were implemented. We obtained this information from the National Survey on Drug Use and Health administered to a large national probabilistic sample between 2008 and 2011. Counties implementing GLS program activities had significantly lower suicide attempt rates among youths 16 to 23 years of age in the year following implementation of the GLS program than did similar counties that did not implement GLS program activities (4.9 fewer attempts per 1000 youths [95% CI, 1.8-8.0 fewer attempts per 1000 youths]; P = .003). More than 79 000 suicide attempts may have been averted during the period studied following implementation of the GLS program. There was no significant difference in suicide attempt rates among individuals older than 23 years during that same period. There was no evidence of longer-term differences in suicide attempt rates. Comprehensive GLS program activities were associated with a reduction in suicide attempt rates. Sustained suicide prevention programming efforts may be needed to maintain the reduction in suicide attempt rates.

An inter-networking mechanism with stepwise synchronization for wireless sensor networks.

PubMed

Yamamoto, Hiroshi; Wakamiya, Naoki; Murata, Masayuki

2011-01-01

To realize the ambient information society, multiple wireless networks deployed in the region and devices carried by users are required to cooperate with each other. Since duty cycles and operational frequencies are different among networks, we need a mechanism to allow networks to efficiently exchange messages. For this purpose, we propose a novel inter-networking mechanism where two networks are synchronized with each other in a moderate manner, which we call stepwise synchronization. With our proposal, to bridge the gap between intrinsic operational frequencies, nodes near the border of networks adjust their operational frequencies in a stepwise fashion based on the pulse-coupled oscillator model as a fundamental theory of synchronization. Through simulation experiments, we show that the communication delay and the energy consumption of border nodes are reduced, which enables wireless sensor networks to communicate longer with each other.

Organizational Strategies to Implement Hospital Pressure Ulcer Prevention Programs: Findings from a National Survey

PubMed Central

SOBAN, LYNN M.; KIM, LINDA; YUAN, ANITA H.; MILTNER, REBECCA S.

2017-01-01

Aim To describe the presence and operationalization of organizational strategies to support implementation of pressure ulcer prevention programs across acute care hospitals in a large, integrated healthcare system. Background Comprehensive pressure ulcer programs include nursing interventions such as use of a risk assessment tool and organizational strategies such as policies and performance monitoring to embed these interventions into routine care. The current literature provides little detail about strategies used to implement pressure ulcer prevention programs. Methods Data were collected by an email survey to all Chief Nursing Officers in Veterans Health Administration acute care hospitals. Descriptive and bivariate statistics were used to summarize survey responses and evaluate relationships between some variables. Results Organizational strategies that support pressure ulcer prevention program implementation (policy, committee, staff education, wound care specialists, and use of performance data) were reported at high levels. Considerable variations were noted in how these strategies were operationalized within individual hospitals. Conclusion Organizational strategies to support implementation of pressure ulcer preventive programs are often not optimally operationalized to achieve consistent, sustainable performance. Implications for Nursing Management The results of this study highlight the role and influence of nurse leaders on pressure ulcer prevention program implementation. PMID:27487972

An implementation of the distributed programming structural synthesis system (PROSSS)

NASA Technical Reports Server (NTRS)

Rogers, J. L., Jr.

1981-01-01

A method is described for implementing a flexible software system that combines large, complex programs with small, user-supplied, problem-dependent programs and that distributes their execution between a mainframe and a minicomputer. The Programming Structural Synthesis System (PROSSS) was the specific software system considered. The results of such distributed implementation are flexibility of the optimization procedure organization and versatility of the formulation of constraints and design variables.

14 CFR 120.225 - How to implement an alcohol testing program.

Code of Federal Regulations, 2010 CFR

2010-01-01

... principal place of business prior to starting operations, (ii) Implement an FAA alcohol testing program no... District Office nearest to your principal place of business. (3) An air traffic control facility not... Specification,(ii) Implement an FAA alcohol testing program no later than the date you start operations, and...

76 FR 709 - Guidelines for Awarding Clean Water Act Section 319 Base Grants to Indian Tribes

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-06

... in implementing approved NPS management programs developed pursuant to section 319(b). The primary goal of the NPS management program is to control NPS pollution through implementation of management... may be used for a range of activities that implement the tribe's approved NPS management program...

Performing Arts Program, Badger High School: Justification, Proposal, Implementation, Stage One Implementation.

ERIC Educational Resources Information Center

Holmes, Dan

This document presents a justification, proposal, and implementation plan for a comprehensive theatre arts program at Badger High School, Lake Geneva, Wisconsin that would offer a full schedule of amateur and professional arts programs involving the students and the community. The brief Justification section notes that every elementary and…

Implementing a centralized institutional peer tutoring program.

PubMed

Gaughf, Natalie White; Foster, Penni Smith

2016-01-01

Peer tutoring has been found to be beneficial to both students and peer tutors in health sciences education programs. This article describes the implementation of a centralized, institutional peer tutoring program at the University of Mississippi Medical Center, an academic health science center in the U.S. The Program: This multispecialty peer tutoring program paired students experiencing academic difficulties with peer tutors who showed prior academic success, professionalism and effective communication skills. The program allowed students and peer tutors to coordinate their own tutoring services. Evaluations by both students and peer tutors showed satisfaction with the program. Recommendations for developing and implementing an effective peer tutoring program are presented, including utilization of an online system, consistent program policy with high professionalism expectations, funding, program evaluation and data tracking.

Renewable platform chemicals from directional microwave-assisted liquefaction coupling stepwise extraction of waste biomass

Treesearch

Junfeng Feng; Chungyun Hse; Zhongzhi Yang; Kui Wang; Jianchun Jiang; Junming Xu

2017-01-01

Directional microwave-assisted liquefaction and stepwise extraction are introduced for producing platform chemicals: aromatics and monosaccharides. When sulfuric acid was used as a catalyst, a 45% monosaccharides yield and a 29% aromatics yield were obtained from bamboo with 0.3 g catalyst per 18 g methanol and 2 g bamboo at 160 °C with 10 min. Approximately 78–86 wt%...

Application of the stepwise focusing method to optimize the cost-effectiveness of genome-wide association studies with limited research budgets for genotyping and phenotyping.

PubMed

Ohashi, J; Clark, A G

2005-05-01

The recent cataloguing of a large number of SNPs enables us to perform genome-wide association studies for detecting common genetic variants associated with disease. Such studies, however, generally have limited research budgets for genotyping and phenotyping. It is therefore necessary to optimize the study design by determining the most cost-effective numbers of SNPs and individuals to analyze. In this report we applied the stepwise focusing method, with two-stage design, developed by Satagopan et al. (2002) and Saito & Kamatani (2002), to optimize the cost-effectiveness of a genome-wide direct association study using a transmission/disequilibrium test (TDT). The stepwise focusing method consists of two steps: a large number of SNPs are examined in the first focusing step, and then all the SNPs showing a significant P-value are tested again using a larger set of individuals in the second focusing step. In the framework of optimization, the numbers of SNPs and families and the significance levels in the first and second steps were regarded as variables to be considered. Our results showed that the stepwise focusing method achieves a distinct gain of power compared to a conventional method with the same research budget.

Multi-layered nanoparticles for penetrating the endosome and nuclear membrane via a step-wise membrane fusion process.

PubMed

Akita, Hidetaka; Kudo, Asako; Minoura, Arisa; Yamaguti, Masaya; Khalil, Ikramy A; Moriguchi, Rumiko; Masuda, Tomoya; Danev, Radostin; Nagayama, Kuniaki; Kogure, Kentaro; Harashima, Hideyoshi

2009-05-01

Efficient targeting of DNA to the nucleus is a prerequisite for effective gene therapy. The gene-delivery vehicle must penetrate through the plasma membrane, and the DNA-impermeable double-membraned nuclear envelope, and deposit its DNA cargo in a form ready for transcription. Here we introduce a concept for overcoming intracellular membrane barriers that involves step-wise membrane fusion. To achieve this, a nanotechnology was developed that creates a multi-layered nanoparticle, which we refer to as a Tetra-lamellar Multi-functional Envelope-type Nano Device (T-MEND). The critical structural elements of the T-MEND are a DNA-polycation condensed core coated with two nuclear membrane-fusogenic inner envelopes and two endosome-fusogenic outer envelopes, which are shed in stepwise fashion. A double-lamellar membrane structure is required for nuclear delivery via the stepwise fusion of double layered nuclear membrane structure. Intracellular membrane fusions to endosomes and nuclear membranes were verified by spectral imaging of fluorescence resonance energy transfer (FRET) between donor and acceptor fluorophores that had been dually labeled on the liposome surface. Coating the core with the minimum number of nucleus-fusogenic lipid envelopes (i.e., 2) is essential to facilitate transcription. As a result, the T-MEND achieves dramatic levels of transgene expression in non-dividing cells.

Stepwise crystallization and the layered distribution in crystallization kinetics of ultra-thin poly(ethylene terephthalate) film

NASA Astrophysics Data System (ADS)

Zuo, Biao; Xu, Jianquan; Sun, Shuzheng; Liu, Yue; Yang, Juping; Zhang, Li; Wang, Xinping

2016-06-01

Crystallization is an important property of polymeric materials. In conventional viewpoint, the transformation of disordered chains into crystals is usually a spatially homogeneous process (i.e., it occurs simultaneously throughout the sample), that is, the crystallization rate at each local position within the sample is almost the same. Here, we show that crystallization of ultra-thin poly(ethylene terephthalate) (PET) films can occur in the heterogeneous way, exhibiting a stepwise crystallization process. We found that the layered distribution of glass transition dynamics of thin film modifies the corresponding crystallization behavior, giving rise to the layered distribution of the crystallization kinetics of PET films, with an 11-nm-thick surface layer having faster crystallization rate and the underlying layer showing bulk-like behavior. The layered distribution in crystallization kinetics results in a particular stepwise crystallization behavior during heating the sample, with the two cold-crystallization temperatures separated by up to 20 K. Meanwhile, interfacial interaction is crucial for the occurrence of the heterogeneous crystallization, as the thin film crystallizes simultaneously if the interfacial interaction is relatively strong. We anticipate that this mechanism of stepwise crystallization of thin polymeric films will allow new insight into the chain organization in confined environments and permit independent manipulation of localized properties of nanomaterials.

Stepwise crystallization and the layered distribution in crystallization kinetics of ultra-thin poly(ethylene terephthalate) film

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

Zuo, Biao, E-mail: chemizuo@zstu.edu.cn, E-mail: wxinping@yahoo.com; Xu, Jianquan; Sun, Shuzheng

2016-06-21

Crystallization is an important property of polymeric materials. In conventional viewpoint, the transformation of disordered chains into crystals is usually a spatially homogeneous process (i.e., it occurs simultaneously throughout the sample), that is, the crystallization rate at each local position within the sample is almost the same. Here, we show that crystallization of ultra-thin poly(ethylene terephthalate) (PET) films can occur in the heterogeneous way, exhibiting a stepwise crystallization process. We found that the layered distribution of glass transition dynamics of thin film modifies the corresponding crystallization behavior, giving rise to the layered distribution of the crystallization kinetics of PET films,more » with an 11-nm-thick surface layer having faster crystallization rate and the underlying layer showing bulk-like behavior. The layered distribution in crystallization kinetics results in a particular stepwise crystallization behavior during heating the sample, with the two cold-crystallization temperatures separated by up to 20 K. Meanwhile, interfacial interaction is crucial for the occurrence of the heterogeneous crystallization, as the thin film crystallizes simultaneously if the interfacial interaction is relatively strong. We anticipate that this mechanism of stepwise crystallization of thin polymeric films will allow new insight into the chain organization in confined environments and permit independent manipulation of localized properties of nanomaterials.« less

COPD: A stepwise or a hit hard approach?

PubMed

Ferreira, A J; Reis, A; Marçal, N; Pinto, P; Bárbara, C

2016-01-01

Current guidelines differ slightly on the recommendations for treatment of Chronic Obstructive Pulmonary Disease (COPD) patients, and although there are some undisputed recommendations, there is still debate regarding the management of COPD. One of the hindrances to deciding which therapeutic approach to choose is late diagnosis or misdiagnosis of COPD. After a proper diagnosis is achieved and severity assessed, the choice between a stepwise or "hit hard" approach has to be made. For GOLD A patients the stepwise approach is recommended, whilst for B, C and D patients this remains debatable. Moreover, in patients for whom inhaled corticosteroids (ICS) are recommended, a step-up or "hit hard" approach with triple therapy will depend on the patient's characteristics and, for patients who are being over-treated with ICS, ICS withdrawal should be performed, in order to optimize therapy and reduce excessive medications. This paper discusses and proposes stepwise, "hit hard", step-up and ICS withdrawal therapeutic approaches for COPD patients based on their GOLD group. We conclude that all approaches have benefits, and only a careful patient selection will determine which approach is better, and which patients will benefit the most from each approach. Copyright © 2016 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

78 FR 68016 - Disadvantaged Business Enterprise: Program Implementation Modifications

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-13

... 2105-AE08 Disadvantaged Business Enterprise: Program Implementation Modifications AGENCY: Office of the... to the Department's Disadvantaged Business Enterprise (DBE) program found in the Notice of Proposed... notice of proposed rulemaking (NPRM) entitled, ``Disadvantaged Business Enterprise: Program...

An analysis of the adaptability of a professional development program in public health: results from the ALPS Study.

PubMed

Richard, Lucie; Torres, Sara; Tremblay, Marie-Claude; Chiocchio, François; Litvak, Éric; Fortin-Pellerin, Laurence; Beaudet, Nicole

2015-06-14

Professional development is a key component of effective public health infrastructures. To be successful, professional development programs in public health and health promotion must adapt to practitioners' complex real-world practice settings while preserving the core components of those programs' models and theoretical bases. An appropriate balance must be struck between implementation fidelity, defined as respecting the core nature of the program that underlies its effects, and adaptability to context to maximize benefit in specific situations. This article presents a professional development pilot program, the Health Promotion Laboratory (HPL), and analyzes how it was adapted to three different settings while preserving its core components. An exploratory analysis was also conducted to identify team and contextual factors that might have been at play in the emergence of implementation profiles in each site. This paper describes the program, its core components and adaptive features, along with three implementation experiences in local public health teams in Quebec, Canada. For each setting, documentary sources were analyzed to trace the implementation of activities, including temporal patterns throughout the project for each program component. Information about teams and their contexts/settings was obtained through documentary analysis and semi-structured interviews with HPL participants, colleagues and managers from each organization. While each team developed a unique pattern of implementing the activities, all the program's core components were implemented. Differences of implementation were observed in terms of numbers and percentages of activities related to different components of the program as well as in the patterns of activities across time. It is plausible that organizational characteristics influencing, for example, work schedule flexibility or learning culture might have played a role in the HPL implementation process. This paper shows how a professional development program model can be adapted to different contexts while preserving its core components. Capturing the heterogeneity of the intervention's exposure, as was done here, will make possible in-depth impact analyses involving, for example, the testing of program-context interactions to identify program outcomes predictors. Such work is essential to advance knowledge on the action mechanisms of professional development programs.

Decision analysis to complete diagnostic research by closing the gap between test characteristics and cost-effectiveness.

PubMed

Schaafsma, Joanna D; van der Graaf, Yolanda; Rinkel, Gabriel J E; Buskens, Erik

2009-12-01

The lack of a standard methodology in diagnostic research impedes adequate evaluation before implementation of constantly developing diagnostic techniques. We discuss the methodology of diagnostic research and underscore the relevance of decision analysis in the process of evaluation of diagnostic tests. Overview and conceptual discussion. Diagnostic research requires a stepwise approach comprising assessment of test characteristics followed by evaluation of added value, clinical outcome, and cost-effectiveness. These multiple goals are generally incompatible with a randomized design. Decision-analytic models provide an important alternative through integration of the best available evidence. Thus, critical assessment of clinical value and efficient use of resources can be achieved. Decision-analytic models should be considered part of the standard methodology in diagnostic research. They can serve as a valid alternative to diagnostic randomized clinical trials (RCTs).

A new device for high-temperature in situ GISAXS measurements

NASA Astrophysics Data System (ADS)

Fritz-Popovski, Gerhard; Bodner, Sabine C.; Sosada-Ludwikowska, Florentyna; Maier, Günther A.; Morak, Roland; Chitu, Livia; Bruegemann, Lutz; Lange, Joachim; Krane, Hans-Georg; Paris, Oskar

2018-03-01

A heating stage originally designed for diffraction experiments is implemented into a Bruker NANOSTAR instrument for in situ grazing incidence small-angle x-ray scattering experiments. A controlled atmosphere is provided by a dome separating the sample environment from the evacuated scattering instrument. This dome is double shelled in order to enable cooling water to flow through it. A mesoporous silica film templated by a self-assembled block copolymer system is investigated in situ during step-wise heating in air. The GISAXS pattern shows the structural development of the ordered lattice of parallel cylindrical pores. The deformation of the elliptical pore-cross section perpendicular to the film surface was studied with increasing temperature. Moreover, the performance of the setup was tested by controlled in situ heating of a copper surface under controlled oxygen containing atmosphere.

Using Promotores Programs to Improve Latino Health Outcomes: Implementation Challenges for Community-based Nonprofit Organizations

PubMed Central

Twombly, Eric C.; Holtz, Kristen D.; Stringer, Kimberly

2012-01-01

Promotores are community lay health workers, who provide outreach and services to Latinos. Little research on the promotores programs exists and the focus of this article is to identify the challenges faced by community-based nonprofits when implementing promotores programs. To explore this type of program telephone interviews were conducted with ten promotores academic experts and nonprofit executives. The results suggest that implementation challenges fall into three major categories: the lack of standardized information on promotores programs, labor issues, and organizational costs. Future recommendations are made which highlight promotores recruitment and retention strategies, and the development of a clearinghouse of programmatic implementation information for community-based nonprofits. PMID:23188929

State of the science on implementation research in early child development and future directions.

PubMed

Aboud, Frances E; Yousafzai, Aisha K; Nores, Milagros

2018-05-01

We summarize the state of the field of implementation research and practice for early child development and propose recommendations. First, conclusions are drawn regarding what is generally known about the implementation of early childhood development programs, based on papers and discussions leading to a published series on the topic. Second, recommendations for short-term activities emphasize the use of newly published guidelines for reporting data collection methods and results for implementation processes; knowledge of the guidelines and a menu of measures allows for planning ahead. Additional recommendations include careful documentation of early-stage implementation, such as adapting a program to a different context and assessing feasibility, as well as the process of sustaining and scaling up a program. Using existing implementation information by building on and improving past programs and translating them into policy are recommended. Longer term goals are to identify implementation characteristics of effective programs and determinants of these characteristics. © 2018 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals Inc. on behalf of The New York Academy of Sciences.

Evaluating the Impact of Implementation Factors on Family-Based Prevention Programming: Methods for Strengthening Causal Inference

PubMed Central

Crowley, D. Max; Coffman, Donna L.; Feinberg, Mark; Greenberg, Mark; Spoth, Richard

2013-01-01

Despite growing recognition of the important role implementation plays in successful prevention efforts, relatively little work has sought to demonstrate a causal relationship between implementation factors and participant outcomes. In turn, failure to explore the implementation-to-outcome link limits our understanding of the mechanisms essential to successful programming. This gap is partially due to the inability of current methodological procedures within prevention science to account for the multitude of confounders responsible for variation in implementation factors (i.e., selection bias). The current paper illustrates how propensity and marginal structural models can be used to improve causal inferences involving implementation factors not easily randomized (e.g., participant attendance). We first present analytic steps for simultaneously evaluating the impact of multiple implementation factors on prevention program outcome. Then we demonstrate this approach for evaluating the impact of enrollment and attendance in a family program, over and above the impact of a school-based program, within PROSPER, a large scale real-world prevention trial. Findings illustrate the capacity of this approach to successfully account for confounders that influence enrollment and attendance, thereby more accurately representing true causal relations. For instance, after accounting for selection bias, we observed a 5% reduction in the prevalence of 11th grade underage drinking for those who chose to receive a family program and school program compared to those who received only the school program. Further, we detected a 7% reduction in underage drinking for those with high attendance in the family program. PMID:23430578

Implementation of an ergonomics program for the welding department inside a car assembly company.

PubMed

Francisco, Caceres; Edwin, Troya

2012-01-01

The premise for this project is to implement an ergonomics program for the welding department of a car assembly company, considering that this area represents the highest occupational risk in relation to musculoskeletal injuries. The project also allows the demonstration of the different implementation processes of an ergonomics program; it also permits the determination of individual risks faced by workers of the welding department, and finally gives a chance of improving common injuries using the sentinel system. The main challenge is to reduce musculoskeletal injuries and absenteeism among welders through actions implemented by the ergonomics program.

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

PubMed Central

Gunning, Melissa; Sun, Ping; Sussman, Steve

2009-01-01

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

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

PubMed

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

2010-03-01

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

The application of the rapid assessment and response methodology for cannabis prevention research among youth in the Netherlands.

PubMed

Dupont, Hans B; Kaplan, Charles D; Braam, Richard V; Verbraeck, Hans T; de Vries, Nanne K

2015-08-01

Drug prevention methods tailored to specific target groups have become increasingly important. There is a growing need to find ways to rapidly assess and situate target groups in their particular contexts. This need is associated with the implementation of evidence-based interventions (EBIs) for these specific target groups. This article describes the application of Rapid Assessment and Response (RAR) as a necessary first step in designing and implementing a prevention intervention plan for problematic cannabis use among "loitering" youth in the South of the Netherlands. Seven RAR studies were conducted using an innovative stepwise model in which the prevention field worker is central. The normative structure for the use of cannabis was found to vary across the neighborhoods of the RAR studies and emerged as the focal point in designing a suitable response. The RAR studies also identified the need in the prevention toolbox for a tailored, low-threshold, effective, individual brief intervention for youth problematic cannabis use. The RAR was found to provide a powerful methodology for detecting target groups and generating contextual and normative data that enable the prevention field worker to select and adapt from the spectrum of existing Evidence based Interventions (EBIs) or develop the most promising model for implementation with the specific target group. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

Physicians' reactions to uncertainty in the context of shared decision making.

PubMed

Politi, Mary C; Légaré, France

2010-08-01

Physicians' reactions towards uncertainty may influence their willingness to engage in shared decision making (SDM). This study aimed to identify variables associated with physician's anxiety from uncertainty and reluctance to disclose uncertainty to patients. We conducted a cross-sectional secondary analysis of longitudinal data of an implementation study of SDM among primary care professionals (n=122). Outcomes were anxiety from uncertainty and reluctance to disclose uncertainty to patients. Hypothesized factors that would be associated with outcomes included attitude, social norm, perceived behavioral control, intention to implement SDM in practice, and socio-demographics. Stepwise linear regression was used to identify predictors of anxiety from uncertainty and reluctance to disclose uncertainty to patients. In multivariate analyses, anxiety from uncertainty was influenced by female gender (beta=0.483; p=0.0039), residency status (1st year: beta=0.600; p=0.001; 2nd year: beta=0.972; p<0.001), and number of hours worked per week (beta=-0.012; p=0.048). Reluctance to disclose uncertainty to patients was influenced by having more years in formal education (beta=-1.996; p=0.012). Variables associated with anxiety from uncertainty differ from those associated with reluctance to disclose uncertainty to patients. Given the importance of communicating uncertainty during SDM, measuring physicians' reactions to uncertainty is essential in SDM implementation studies. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

Design, implementation and scaling up of the balanced scorecard for hospitals in Lebanon: policy coherence and application lessons for low and middle income countries.

PubMed

El-Jardali, Fadi; Saleh, Shadi; Ataya, Nour; Jamal, Diana

2011-12-01

This paper describes the development and implementation of the first national hospital performance indicators in Lebanon including its institutionalization within existing policy framework and the initiation of independent governance structure for sustainability. Guided by the Ontario Acute Care Balanced Scorecard framework, a step-wise approach was used. Guiding principles were non-punitive reporting, anonymity, voluntary participation, stakeholder involvement, consensus and feasibility. Modified Delphi technique was used, readiness assessment surveys in 52 hospitals were conducted, pilot testing and evaluation were completed in 14 hospitals. Initial balanced set of 21 indicators were selected. Findings showed wide variations in indicators' measurement in hospitals including formulas and tools. Barriers to measurement included lack of quality culture, physician resistance and resources. A gradual implementation strategy was developed and selected indicators were divided into two levels. Most piloted indicators proved to be valid, feasible and reliable. The initiative was linked to the national hospital accreditation system resulting in a balanced set of 40 indicators. An independent, not-for-profit, arm's-length organization was established. This is among the first attempts made in the East Mediterranean Region to adapt the BSC approach and translate the experience of its development to addresses local needs and contextual reality. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Lack of strategy holding: a new pattern of learning deficit in cortical dementias.

PubMed

Benedet, María J; Lauro-Grotto, Rosapia; Giotti, Chiara

2009-09-01

The aim of this study was to demonstrate, by means of systematic research and qualitative data analysis, the presence, among a group of patients with fronto-temporal lobar degeneration of a subgroup that, at variance with the standard pattern, is able to devise and implement learning strategies, but appear impaired at carrying them on from a trial to the next. In order to provide evidence of the existence of a group of patients showing this type of learning disability, that we refer to as lack of strategy holding, we performed a stepwise hierarchical cluster analysis of a set of variables whose scores were selected from the subject's performance at the Test de Aprendizaje Verbal España-Complutense. Results substantiate the segregation of three groups of subjects characterized by the following patterns of performance: normal elderly individuals, who show a quite preserved ability to discover a semantic strategy along the learning trials and to carry it from a trial to the next, patients presenting with a deficit in implementing semantic learning strategies and possibly use of serial and/or phonological strategies to perform the task, and to patients who, although able to generate and implement appropriate learning strategies, appear unable to carry them over the learning trials. The presence of this new pattern raises a few questions that seem worth trying to address.

Process evaluation of the project P.A.T.H.S. (secondary 2 program): findings based on the co-walker scheme.

PubMed

Shek, Daniel T L; Tam, Suet-yan

2009-01-01

To understand the implementation quality of the Tier 1 Program (Secondary 2 Curriculum) of the P.A.T.H.S. Project, process evaluation was carried out by co-walkers through classroom observation of 195 units in 131 schools. Results showed that the overall level of program adherence was generally high with an average of 84.55%, and different factors of the implementation process were evaluated as positive. Quality of program implementation and achievement of program objectives were predicted by students' participation and involvement, strategies to enhance students' motivation, opportunity for reflection, time management, and class preparation. Success in program implementation was predicted by students' participation and involvement, classroom control, interactive delivery method, strategies to enhance students' motivation, opportunity for reflection, and lesson preparation.

Implementation of the Secondary 3 Program of Project P.A.T.H.S.: observations based on the co-walker scheme.

PubMed

Shek, Daniel T L; Ma, Cecilia M S

2012-01-17

The present study was conducted to explore the implementation quality of the Secondary 3 Program of the Tier 1 Program of Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes) in the third year of the Full Implementation Phase. Classroom observations of 182 units in 129 schools were conducted. Results showed that the overall level of program adherence was 73.9%. Thirteen aspects concerning program delivery were significantly correlated. Multiple regression analyses revealed that overall implementation quality was significantly predicted by student participation and involvement, strategies to enhance student motivation, use of positive and supportive feedback, degree of achievement of the objectives, and lesson preparation. Success of implementation was significantly predicted by student participation and involvement, classroom control, use of positive and supportive feedback, opportunity for reflection, degree of achievement of the objectives and time management. The present findings generally suggest that the implementation quality of Project P.A.T.H.S. was high.

SWOT analysis of program design and implementation: a case study on the reduction of maternal mortality in Afghanistan.

PubMed

Ahmadi, Qudratullah; Danesh, Homayoon; Makharashvili, Vasil; Mishkin, Kathryn; Mupfukura, Lovemore; Teed, Hillary; Huff-Rousselle, Maggie

2016-07-01

This case study analyzes the design and implementation of the Basic Package of Health Services (BPHS) in Afghanistan by synthesizing the literature with a focus on maternal health services. The authors are a group of graduate students in the Brandeis University International Health Policy and Management Program and Sustainable International Development Program who used the experience in Afghanistan to analyze an example of successfully implementing policy; two of the authors are Afghan physicians with direct experience in implementing the BPHS. Data is drawn from a literature review, and a unique aspect of the case study is the application of the business-oriented SWOT analysis to the design and implementation of the program that successfully targeted lowering maternal mortality in Afghanistan. It provides a useful example of how SWOT analysis can be used to consider the reasons for, or likelihood of, successful or unsuccessful design and implementation of a policy or program. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Innovatively Supporting Teachers' Implementation of School-Based Sex Education: Developing A Web-Based Coaching Intervention From Problem to Solution.

PubMed

Schutte, Lisette; van den Borne, Marieke; Kok, Gerjo; Meijer, Suzanne; Mevissen, Fraukje Ef

2016-07-12

Full program implementation is crucial for effectiveness but is often overlooked or insufficiently considered during development of behavioral change interventions. For school-based health promotion programs, teachers are key players in program implementation, but teacher support in this phase is mostly limited to technical support and information. To ensure optimal implementation of the Dutch school-based sexual health program Long Live Love, a Web-based coaching website was developed to support teachers in completeness and fidelity of program implementation. The aim of this paper is to provide insight into the process of systematic development of a Web-based coaching intervention to support teachers in their implementation of a school-based sexual health program. The intervention mapping (IM) protocol was applied for the development of a theory- and evidence-based intervention. The IM process begins with (1) a needs assessment, followed by (2) the formulation of change objectives, (3) the selection of theory-based intervention methods and practical applications that take the parameters for effectiveness into consideration, (4) integration of practical applications into an organized program, (5) planning for adoption, implementation, and sustainability of the program, and finally, (6) generating an evaluation plan to measure program effectiveness. Teacher's implementation behavior was characterized by inconsistently selecting parts of the program and not delivering (all) lessons as intended by program developers. Teachers, however, did not perceive this behavior as problematic, revealing the discrepancy between teacher's actual and perceived need for support in delivering Long Live Love lessons with completeness and fidelity. Teachers did, however, acknowledge different difficulties they encountered which could potentially negatively influence the quality of implementation. With the IM protocol, this Web-based coaching intervention was developed based on a concept of unobtrusive coaching, by and for teachers, to bring about change in teachers' implementation behavior. This paper provides an example of a Web-based intervention to bring about behavioral change in a target group of intermediaries who lack intrinsic motivation for coaching and who's perceptions differ from their actual problematic behavior. The IM protocol is a useful tool for guiding the scientific development of interventions and making them compatible with the needs and preferences of the target group.

Innovatively Supporting Teachers’ Implementation of School-Based Sex Education: Developing A Web-Based Coaching Intervention From Problem to Solution

PubMed Central

Kok, Gerjo; Meijer, Suzanne; Mevissen, Fraukje EF

2016-01-01

Background Full program implementation is crucial for effectiveness but is often overlooked or insufficiently considered during development of behavioral change interventions. For school-based health promotion programs, teachers are key players in program implementation, but teacher support in this phase is mostly limited to technical support and information. To ensure optimal implementation of the Dutch school-based sexual health program Long Live Love, a Web-based coaching website was developed to support teachers in completeness and fidelity of program implementation. Objective The aim of this paper is to provide insight into the process of systematic development of a Web-based coaching intervention to support teachers in their implementation of a school-based sexual health program. Methods The intervention mapping (IM) protocol was applied for the development of a theory- and evidence-based intervention. The IM process begins with (1) a needs assessment, followed by (2) the formulation of change objectives, (3) the selection of theory-based intervention methods and practical applications that take the parameters for effectiveness into consideration, (4) integration of practical applications into an organized program, (5) planning for adoption, implementation, and sustainability of the program, and finally, (6) generating an evaluation plan to measure program effectiveness. Results Teacher’s implementation behavior was characterized by inconsistently selecting parts of the program and not delivering (all) lessons as intended by program developers. Teachers, however, did not perceive this behavior as problematic, revealing the discrepancy between teacher’s actual and perceived need for support in delivering Long Live Love lessons with completeness and fidelity. Teachers did, however, acknowledge different difficulties they encountered which could potentially negatively influence the quality of implementation. With the IM protocol, this Web-based coaching intervention was developed based on a concept of unobtrusive coaching, by and for teachers, to bring about change in teachers’ implementation behavior. Conclusions This paper provides an example of a Web-based intervention to bring about behavioral change in a target group of intermediaries who lack intrinsic motivation for coaching and who’s perceptions differ from their actual problematic behavior. The IM protocol is a useful tool for guiding the scientific development of interventions and making them compatible with the needs and preferences of the target group. PMID:27405241

[The German program for disease management guidelines--implementation with pathways and quality management].

PubMed

Ollenschläger, Günter; Lelgemann, Monika; Kopp, Ina

2007-07-15

In Germany, physicians enrolled in disease management programs are legally obliged to follow evidence-based clinical practice guidelines. That is why a Program for National Disease Management Guidelines (German DM-CPG Program) was established in 2002 aiming at implementation of best-practice evidence-based recommendations for nationwide as well as regional disease management programs. Against this background the article reviews programs, methods and tools for implementing DM-CPGs via clinical pathways as well as regional guidelines for outpatient care. Special reference is given to the institutionalized program of adapting DM-CPGs for regional use by primary-care physicians in the State of Hesse.

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

PubMed

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

2009-10-01

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

Health care use of patients with osteoarthritis of the hip or knee after implementation of a stepped-care strategy: an observational study.

PubMed

Smink, Agnes J; Dekker, Joost; Vliet Vlieland, Thea P M; Swierstra, Bart A; Kortland, Joke H; Bijlsma, Johannes W J; Teerenstra, Steven; Voorn, Theo B; Bierma-Zeinstra, Sita M A; Schers, Henk J; van den Ende, Cornelia H M

2014-06-01

To enhance guideline-based nonsurgical management of osteoarthritis (OA), a multidisciplinary stepped-care strategy has been implemented in clinical practice. This study aimed to describe health care use after implementation of this strategy and to identify factors related to such use at multiple levels. For this 2-year observational prospective cohort, patients with symptomatic hip or knee OA were included by their general practitioner. Activities aligned with patients and health care providers were executed to implement the strategy. Health care use was described as the cumulative percentage of "users" for each modality recommended in the strategy. Determinants were identified at the level of the patient, general practitioner, and practice using backward stepwise logistic multilevel regression models. Three hundred thirteen patients were included by 70 general practitioners of 38 practices. Their mean ± SD age was 64 ± 10 years and 120 (38%) were men. The most frequently used modalities were education, acetaminophen, lifestyle advice, and exercise therapy, which were used by 242 (82%), 250 (83%), 214 (73%), and 187 (63%) patients, respectively. Fourteen percent of the overweight patients reported being treated by a dietician. Being female, having an active coping style, using the booklet "Care for Osteoarthritis," and having limitations in functioning were recurrently identified as determinants of health care use. After implementation of the stepped-care strategy, most recommended nonsurgical modalities seem to be well used. Health care could be further improved by providing dietary therapy in overweight patients and making more efforts to encourage patients with a passive coping style to use nonsurgical modalities. Copyright © 2014 by the American College of Rheumatology.

The Integrated Transport and Health Impact Modeling Tool in Nashville, Tennessee, USA: Implementation Steps and Lessons Learned

PubMed Central

Whitfield, Geoffrey P; Meehan, Leslie A; Maizlish, Neil; Wendel, Arthur M

2016-01-01

The Integrated Transport and Health Impact Model (ITHIM) is a comprehensive tool that estimates the hypothetical health effects of transportation mode shifts through changes to physical activity, air pollution, and injuries. The purpose of this paper is to describe the implementation of ITHIM in greater Nashville, Tennessee (USA), describe important lessons learned, and serve as an implementation guide for other practitioners and researchers interested in running ITHIM. As might be expected in other metropolitan areas in the US, not all the required calibration data was available locally. We utilized data from local, state, and federal sources to fulfill the 14 ITHIM calibration items, which include disease burdens, travel habits, physical activity participation, air pollution levels, and traffic injuries and fatalities. Three scenarios were developed that modeled stepwise increases in walking and bicycling, and one that modeled reductions in car travel. Cost savings estimates were calculated by scaling national-level, disease-specific direct treatment costs and indirect lost productivity costs to the greater Nashville population of approximately 1.5 million. Implementation required approximately one year of intermittent, part-time work. Across the range of scenarios, results suggested that 24 to 123 deaths per year could be averted in the region through a 1%–5% reduction in the burden of several chronic diseases. This translated into $10–$63 million in estimated direct and indirect cost savings per year. Implementing ITHIM in greater Nashville has provided local decision makers with important information on the potential health effects of transportation choices. Other jurisdictions interested in ITHIM might find the Nashville example as a useful guide to streamline the effort required to calibrate and run the model. PMID:27595067

Building local human resources to implement SLMTA with limited donor funding: The Ghana experience

PubMed Central

van der Puije, Beatrice; Bekoe, Veronica; Adukpo, Rowland; Kotey, Nii A.; Yao, Katy; Fonjungo, Peter N.; Luman, Elizabeth T.; Duh, Samuel; Njukeng, Patrick A.; Addo, Nii A.; Khan, Fazle N.; Woodfill, Celia J.I.

2014-01-01

Background In 2009, Ghana adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme in order to improve laboratory quality. The programme was implemented successfully with limited donor funding and local human resources. Objectives To demonstrate how Ghana, which received very limited PEPFAR funding, was able to achieve marked quality improvement using local human resources. Method Local partners led the SLMTA implementation and local mentors were embedded in each laboratory. An in-country training-of-trainers workshop was conducted in order to increase the pool of local SLMTA implementers. Three laboratory cohorts were enrolled in SLMTA in 2011, 2012 and 2013. Participants from each cohort attended in a series of three workshops interspersed with improvement projects and mentorship. Supplemental training on internal audit was provided. Baseline, exit and follow-up audits were conducted using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. In November 2013, four laboratories underwent official SLIPTA audits by the African Society for Laboratory Medicine (ASLM). Results The local SLMTA team successfully implemented three cohorts of SLMTA in 15 laboratories. Seven out of the nine laboratories that underwent follow-up audits have reached at least one star. Three out of the four laboratories that underwent official ASLM audits were awarded four stars. Patient satisfaction increased from 25% to 70% and sample rejection rates decreased from 32% to 10%. On average, $40 000 was spent per laboratory to cover mentors’ salaries, SLMTA training and improvement project support. Conclusion Building in-country capacity through local partners is a sustainable model for improving service quality in resource-constrained countries such as Ghana. Such models promote country ownership, capacity building and the use of local human resources for the expansion of SLMTA. PMID:26937417

Building local human resources to implement SLMTA with limited donor funding: The Ghana experience.

PubMed

Nkrumah, Bernard; van der Puije, Beatrice; Bekoe, Veronica; Adukpo, Rowland; Kotey, Nii A; Yao, Katy; Fonjungo, Peter N; Luman, Elizabeth T; Duh, Samuel; Njukeng, Patrick A; Addo, Nii A; Khan, Fazle N; Woodfill, Celia J I

2014-11-03

In 2009, Ghana adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme in order to improve laboratory quality. The programme was implemented successfully with limited donor funding and local human resources. To demonstrate how Ghana, which received very limited PEPFAR funding, was able to achieve marked quality improvement using local human resources. Local partners led the SLMTA implementation and local mentors were embedded in each laboratory. An in-country training-of-trainers workshop was conducted in order to increase the pool of local SLMTA implementers. Three laboratory cohorts were enrolled in SLMTA in 2011, 2012 and 2013. Participants from each cohort attended in a series of three workshops interspersed with improvement projects and mentorship. Supplemental training on internal audit was provided. Baseline, exit and follow-up audits were conducted using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. In November 2013, four laboratories underwent official SLIPTA audits by the African Society for Laboratory Medicine (ASLM). The local SLMTA team successfully implemented three cohorts of SLMTA in 15 laboratories. Seven out of the nine laboratories that underwent follow-up audits have reached at least one star. Three out of the four laboratories that underwent official ASLM audits were awarded four stars. Patient satisfaction increased from 25% to 70% and sample rejection rates decreased from 32% to 10%. On average, $40 000 was spent per laboratory to cover mentors' salaries, SLMTA training and improvement project support. Building in-country capacity through local partners is a sustainable model for improving service quality in resource-constrained countries such as Ghana. Such models promote country ownership, capacity building and the use of local human resources for the expansion of SLMTA.

PG4KDS: A Model for the Clinical Implementation of Pre-emptive Pharmacogenetics

PubMed Central

Hoffman, James M.; Haidar, Cyrine E.; Wilkinson, Mark R.; Crews, Kristine R.; Baker, Donald K.; Kornegay, Nancy M.; Yang, Wenjian; Pui, Ching-Hon; Reiss, Ulrike M.; Gaur, Aditya H.; Howard, Scott C.; Evans, William E.; Broeckel, Ulrich; Relling, Mary V.

2014-01-01

Pharmacogenetics is frequently cited as an area for initial focus of the clinical implementation of genomics. Through the PG4KDS protocol, St. Jude Children’s Research Hospital pre-emptively genotypes patients for 230 genes using the Affymetrix Drug Metabolizing Enzymes and Transporters (DMET) Plus array supplemented with a CYP2D6 copy number assay. The PG4KDS protocol provides a rational, stepwise process for implementing gene/drug pairs, organizing data, and obtaining consent from patients and families. Through August 2013, 1559 patients have been enrolled, and 4 gene tests have been released into the electronic health record (EHR) for clinical implementation: TPMT, CYP2D6, SLCO1B1, and CYP2C19. These genes are coupled to 12 high-risk drugs. Of the 1016 patients with genotype test results available, 78% of them had at least one high-risk (i.e., actionable) genotype result placed in their EHR. Each diplotype result released to the EHR is coupled with an interpretive consult that is created in a concise, standardized format. To support-gene based prescribing at the point of care, 55 interruptive clinical decision support (CDS) alerts were developed. Patients are informed of their genotyping result and its relevance to their medication use through a letter. Key elements necessary for our successful implementation have included strong institutional support, a knowledgeable clinical laboratory, a process to manage any incidental findings, a strategy to educate clinicians and patients, a process to return results, and extensive use of informatics, especially CDS. Our approach to pre-emptive clinical pharmacogenetics has proven feasible, clinically useful, and scalable. PMID:24619595

PG4KDS: a model for the clinical implementation of pre-emptive pharmacogenetics.

PubMed

Hoffman, James M; Haidar, Cyrine E; Wilkinson, Mark R; Crews, Kristine R; Baker, Donald K; Kornegay, Nancy M; Yang, Wenjian; Pui, Ching-Hon; Reiss, Ulrike M; Gaur, Aditya H; Howard, Scott C; Evans, William E; Broeckel, Ulrich; Relling, Mary V

2014-03-01

Pharmacogenetics is frequently cited as an area for initial focus of the clinical implementation of genomics. Through the PG4KDS protocol, St. Jude Children's Research Hospital pre-emptively genotypes patients for 230 genes using the Affymetrix Drug Metabolizing Enzymes and Transporters (DMET) Plus array supplemented with a CYP2D6 copy number assay. The PG4KDS protocol provides a rational, stepwise process for implementing gene/drug pairs, organizing data, and obtaining consent from patients and families. Through August 2013, 1,559 patients have been enrolled, and four gene tests have been released into the electronic health record (EHR) for clinical implementation: TPMT, CYP2D6, SLCO1B1, and CYP2C19. These genes are coupled to 12 high-risk drugs. Of the 1,016 patients with genotype test results available, 78% of them had at least one high-risk (i.e., actionable) genotype result placed in their EHR. Each diplotype result released to the EHR is coupled with an interpretive consult that is created in a concise, standardized format. To support-gene based prescribing at the point of care, 55 interruptive clinical decision support (CDS) alerts were developed. Patients are informed of their genotyping result and its relevance to their medication use through a letter. Key elements necessary for our successful implementation have included strong institutional support, a knowledgeable clinical laboratory, a process to manage any incidental findings, a strategy to educate clinicians and patients, a process to return results, and extensive use of informatics, especially CDS. Our approach to pre-emptive clinical pharmacogenetics has proven feasible, clinically useful, and scalable. © 2014 Wiley Periodicals, Inc.

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

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

Swezey, B.; Bird, L.

2001-09-13

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

Actualizing a provider alliance to expand health services access to a low-income urban community.

PubMed

Tataw, David; Bazargan-Hejazi, Shahrzad; James, Frederick W

2011-01-01

Social change to facilitate health care access for vulnerable populations sometimes involves model-driven innovative structures and innovative planning and implementation approaches. This paper described and analyzed the rationale, conceptual framework, program components, and implementation of the South Central Health Care Alliance (SCHCA) implemented in South Los Angeles from January 2002 to December 2004. The program development and implementation was guided by an integrated framework linking the Open Systems Theory, the Social Cognitive Theory, the Health Belief Model, and the Preventive Health Education and Medical Home Project. The performance of the SCHCA as a social system, partnership, and participatory implementation program is also presented. While the SCHCA was found to be a dynamic social system that responded well to contingencies, its performance as a partnership and participatory implementation program was wanting in many respects.

User-Side Subsidy Programs for Special Needs Transportation : A Planning Handbook

DOT National Transportation Integrated Search

1983-06-01

This handbook, first of a series, provides guidance for designing and implementing a user-side subsidy program. The book is divided into two parts--Program Planning and Program Implementation. The Planning section covers six areas--Goals and Objectiv...

Implementing a citizen's DWI reporting program using the Extra Eyes model

DOT National Transportation Integrated Search

2008-09-01

This manual is a guide for law enforcement agencies and community organizations in creating and implementing a citizens DWI reporting program in their communities modeling the Operation Extra Eyes program. Extra Eyes is a program that engages volu...

Urology technical and non-technical skills development: the emerging role of simulation.

PubMed

Rashid, Prem; Gianduzzo, Troy R J

2016-04-01

To review the emerging role of technical and non-technical simulation in urological education and training. A review was conducted to examine the current role of simulation in urology training. A PUBMED search of the terms 'urology training', 'urology simulation' and 'urology education' revealed 11,504 titles. Three hundred and fifty-seven abstracts were identified as English language, peer reviewed papers pertaining to the role of simulation in urology and related topics. Key papers were used to explore themes. Some cross-referenced papers were also included. There is an ongoing need to ensure that training time is efficiently utilised while ensuring that optimal technical and non-technical skills are achieved. Changing working conditions and the need to minimise patient harm by inadvertent errors must be taken into account. Simulation models for specific technical aspects have been the mainstay of graduated step-wise low and high fidelity training. Whole scenario environments as well as non-technical aspects can be slowly incorporated into the curriculum. Doing so should also help define what have been challenging competencies to teach and evaluate. Dedicated time, resources and trainer up-skilling are important. Concurrent studies are needed to help evaluate the effectiveness of introducing step-wise simulation for technical and non-technical competencies. Simulation based learning remains the best avenue of progressing surgical education. Technical and non-technical simulation could be used in the selection process. There are good economic, logistic and safety reasons to pursue the process of ongoing development of simulation co-curricula. While the role of simulation is assured, its progress will depend on a structured program that takes advantage of what can be delivered via this medium. Overall, simulation can be developed further for urological training programs to encompass technical and non-technical skill development at all stages, including recertification. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

Psychoactive substances use and associated factors among middle and high school students in the North Center of Morocco: a cross-sectional questionnaire survey.

PubMed

Zarrouq, B; Bendaou, B; El Asri, A; Achour, S; Rammouz, I; Aalouane, R; Lyoussi, B; Khelafa, S; Bout, A; Berhili, N; Hlal, H; Najdi, A; Nejjari, C; El Rhazi, K

2016-06-04

Data on psychoactive substance (PAS) consumption among adolescents in the North Center of Morocco are not at all available. Therefore, the current study aimed at investigating the prevalence and the determinants of psychoactive substances use among middle and high school students in this region. A cross-sectional study was conducted from April 2012 to November 2013 in public middle and high schools in the North Central Region of Morocco. An anonymous self-administered questionnaire was used to assess psychoactive substances use among a representative sample of school students from the 7th to the 12th grade, aged 11-23 years, selected by stratified cluster random sampling. Factors associated with psychoactive substance use were identified using multivariate stepwise logistic regression analyses. A total of 3020 school students completed the questionnaires, 53.0 % of which were males. The overall lifetime smoking prevalence was 16.1 %. The lifetime, annual and past month rates of any psychoactive substance use among the study subjects were 9.3, 7.5, and 6.3 % respectively. Cannabis recorded the highest lifetime prevalence of 8.1 %, followed by alcohol 4.3 %, inhalants 1.7 %, psychotropic substances without medical prescription 1.0, cocaine 0.7, heroine 0.3, and amphetamine with only 0.2 %. Psychoactive substance use was associated with males more than females. The risk factors identified by multivariate stepwise logistic regression analyses were being male, studying in secondary school level, smoking tobacco, living with a family member who uses tobacco, and feeling insecure within the family. The prevalence among all school students reported by the current study was comparable to the national prevalence. Efforts to initiate psychoactive substance prevention programs among school students should be made by designing such programs based on the significant factors associated with psychoactive substance use identified in this study.

The University of North Carolina Medical Center pharmacy resident leadership certificate program.

PubMed

Lyons, Kayley; Griggs, Danielle; Lebovic, Rachel; Roth, Mary E; South, David A; Hatfield, Chad

2017-03-15

The development and implementation of a certificate program for pharmacy residents are described. University of North Carolina (UNC) Medical Center met the call for increased efforts in the area of pharmacy residency leadership training through the design, implementation, and evaluation of a leadership certificate program. The purpose of the UNC certificate program is to develop leaders who will serve others, improve their communities, and advance the profession. The program is designed to (1) foster self-awareness, social awareness, and altruism, (2) provide transferable and individualized leadership experiences, (3) enrich other residency components through integration of leadership development opportunities, and (4) create role models for departmental leadership. A team of preceptors and residents implemented the certificate program by integrating program components into the existing pharmacy residency infrastructure. The certificate program includes required and flexible components to allow residents to set and achieve their determined leadership development goals. Overall, residents are satisfied with the program and perceive it as worthwhile. During the first 3 years since implementation of the certification initiative, program facilitators improved the feasibility of, participant engagement in, and sustainability of the program. Future directions include an effectiveness evaluation and a "scale-up" to other institutions. The need for a pharmacy residency leadership certificate was met by designing, implementing, and evaluating such a program at UNC. Through its first 3 years, the program was feasible, sustainable, and valued by program participants. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Long Live Love+: evaluation of the implementation of an online school-based sexuality education program in the Netherlands.

PubMed

van Lieshout, Sanne; Mevissen, Fraukje; de Waal, Esri; Kok, Gerjo

2017-06-01

Schools are a common setting for adolescents to receive health education, but implementation of these programs with high levels of completeness and fidelity is not self-evident. Programs that are only partially implemented (completeness) or not implemented as instructed (fidelity) are unlikely to be effective. Therefore, it is important to identify which determinants affect completeness and fidelity of program implementation. As part of the launch of Long Live Love+ (LLL+), an online school-based sexuality education program for adolescents aged 15-17, we performed a process evaluation among teachers and students to measure the levels of completeness and fidelity, identify factors influencing teachers' implementation, and to evaluate the students' response. Sixteen Biology teachers from nine secondary schools throughout the Netherlands who implemented LLL+ were interviewed and 60 students participated in 13 focus group discussions. Results showed that teachers' completeness ranged between 22-100% (M = 75%). Fidelity was high, but many teachers added elements. Teachers and students enjoyed LLL+, particularly the diversity in the exercises and its interactive character. The most important factors that influenced implementation were time and organizational constraints, lack of awareness on the impact of completeness and fidelity, and student response. These factors should be taken into account when developing school-based prevention programs. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Programming Support Library (PSL). Users Manual.

DTIC Science & Technology

1978-05-01

which provides the tools to organize, implement, and control computer program develop- ment. This involves the support of the actual programming process...provides the tools toorganize, implement, and control computer program development. The system is designed specifically to support top-down development...Structured Programming are finding increasing application in the computing community. Structured programs are, however, difficult to write in

"Report to the Legislature on": The Implementation of the Special Education Reimbursement ("Circuit Breaker") Program. Line-Item 7061-0012

ERIC Educational Resources Information Center

Massachusetts Department of Education, 2008

2008-01-01

This paper reports on the implementation of the Special Education Reimbursement ("Circuit Breaker") Program. Fiscal Year 2007 is the fourth year implementing the Circuit Breaker reimbursement program which provides additional state support for students with disabilities. School districts are eligible for a reimbursement of eligible costs…

Implementing and Evaluating School-Based Primary Prevention Programs and the Importance of Differential Effects on Outcomes

ERIC Educational Resources Information Center

Hussey, David L.; Flannery, Daniel J.

2007-01-01

In 2004, Second Step (Committee for Children, 2002), a violence prevention program, was implemented in the Cleveland Heights-University Heights school district for 1,416 K through second grade students. Both process and outcome measures were used to evaluate program impact and examine issues related to the implementation and evaluation of…

The Role of Organizational Context and External Influences in the Implementation of Evidence-Based Programs: An Exploratory Study. Report IV

ERIC Educational Resources Information Center

Collins, Ashleigh; Burkhauser, Mary

2008-01-01

The implementation of high-quality evidence-based practices cannot occur without facilitative administration, systems-level partnerships, and decision-support data systems. The authors believe that understanding "what works" in program "implementation" is just as important as understanding "what works" in a program "model." Recently, researchers…

Urban Tree Risk Management:A Community Guide to Program Design and Implementation

Treesearch

Jill Pokorny; Joseph O' Brien; Richard Hauer; Gary Johnson; Jana Albers; Peter Bedker; Manfred Mielke

2003-01-01

Urban Tree Risk Management: A Community Guide to Program Design and Implementation is a fully illustrated, easy to read training manual written for community leaders, administrators, city foresters, parks and public works staff, and private tree care practitioners. The manual is designed to assist communities design, adopt and implement tree risk management programs,...

Digital Mapping, Charting and Geodesy Data Standardization

DTIC Science & Technology

1994-12-19

The primary objective of the audit was to evaluate DMA’s implementation of the Defense Standardization Program. Specifically, the audit determined...interoperability of digital MC&G data. The audit also evaluated DMA’s implementation of the DoD Internal Management Control Program as it pertains to DMA’S implementation of the Defense Standardization Program.

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

ERIC Educational Resources Information Center

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

2007-01-01

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

The Family Transition Program: Implementation and Three-Year Impacts of Florida's Initial Time-Limited Welfare Program.

ERIC Educational Resources Information Center

Bloom, Dan; Farrell, Mary; Kemple, James J.; Verma, Nandita

This report focuses on implementation, impacts, and time limit in Florida's Family Transition Program (FTP), a welfare reform initiative. Chapter 1 describes FTP and evaluation, target population, and data. Chapter 2 describes implementation of FTP in Escambia County: staffing and organizational structure of FTP and traditional Aid to Families…

Nurses' perceptions of nurse residency: identifying barriers to implementation.

PubMed

Wierzbinski-Cross, Heather; Ward, Kristin; Baumann, Paula

2015-01-01

The purpose of this project was to describe the benefits and components of successful nurse residency programs, as well as gain insight into the perceptions of staff nurses, nurse educators, and nurse leaders regarding value, feasibility, and barriers to implementing nurse residency programs in acute care settings. This study has important implications for implementing an effective residency program.

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

ERIC Educational Resources Information Center

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

2014-01-01

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

Using a Domestic and Sexual Violence Prevention Advocate to Implement a Dating Violence Prevention Program with Athletes

ERIC Educational Resources Information Center

Jaime, M. C. D.; Stocking, M.; Freire, K.; Perkinson, L.; Ciaravino, S.; Miller, E.

2016-01-01

"Coaching Boys into Men" is an evidence-based dating violence prevention program for coaches to implement with male athletes. A common adaptation of this program is delivery by domestic violence and sexual violence prevention advocates instead of coaches. We explored how this implementer adaptation may influence athlete uptake of program…

Design of training programs for a positive youth development program: Project P.A.T.H.S. in Hong Kong.

PubMed

Shek, Daniel T L; Chak, Yammy L Y

2010-01-01

To facilitate the implementation of the Secondary 1 to Secondary 3 program of the Project P.A.T.H.S. in Hong Kong, systematic training programs are designed for the potential program implementers. The rationales, objectives and design of the Secondary 1 to Secondary 3 training programs are outlined in this paper. The training programs cover theories of adolescent development, positive youth development, background and curricula of the Project P.A.T.H.S., factors affecting program implementation quality and evaluation of the project. Besides introducing the curriculum units, the training programs also focus on nature of learning and related theories (particularly experiential learning), teaching methods and instructional techniques, motivating students, and classroom management.

28 CFR 19.6 - Responsibility of DOJ organizational units for program implementation and implementation procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... consent to use the photograph and biographical information. See 28 CFR 0.1, Organizational Structure of... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Responsibility of DOJ organizational... Responsibility of DOJ organizational units for program implementation and implementation procedures. (a) The...

Patient involvement in research programming and implementation: A responsive evaluation of the Dialogue Model for research agenda setting.

PubMed

Abma, Tineke A; Pittens, Carina A C M; Visse, Merel; Elberse, Janneke E; Broerse, Jacqueline E W

2015-12-01

The Dialogue Model for research agenda-setting, involving multiple stakeholders including patients, was developed and validated in the Netherlands. However, there is little insight into whether and how patient involvement is sustained during the programming and implementation of research agendas. To understand how the Dialogue Model can be optimised by focusing on programming and implementation, in order to stimulate the inclusion of (the perspectives of) patients in research. A responsive evaluation of the programming and implementation phases of nine agenda-setting projects that had used the Dialogue Model for agenda-setting was conducted. Fifty-four semi-structured interviews were held with different stakeholders (patients, researchers, funding agencies). Three focus groups with patients, funding agencies and researchers (16 participants) were organized to validate the findings. Patient involvement in programming and implementation of the research agendas was limited. This was partly related to poor programming and implementation, partly to pitfalls in earlier phases of the agenda-setting. Optimization of the Dialogue Model is possible by attending to the nature of the agenda and its intended use in earlier phases. Attention should also be given to the ambassadors and intended users of agenda topics. Support is needed during programming and implementation to organize patient involvement and adapt organizational structures like review procedures. In all phases the attitude to patient involvement, stakeholder participation, especially of researchers, and formal and informal relationships between parties need to be addressed to build a strong relationship with a shared goal. Patient involvement in agenda-setting is not automatically followed by patient involvement in programming and implementation. More attention should be paid, in earlier stages, to the attitude and engagement of researchers and funding agencies. © 2014 John Wiley & Sons Ltd.

Implementing a high-fidelity simulation program in a community college setting.

PubMed

Tuoriniemi, Pamela; Schott-Baer, Darlene

2008-01-01

Despite their relatively high cost, there is heightened interest by faculty in undergraduate nursing programs to implement high-fidelity simulation (HFS) programs. High-fidelity simulators are appealing because they allow students to experience high-risk, low-volume patient problems in a realistic setting. The decision to purchase a simulator is the first step in the process of implementing and maintaining an HFS lab. Knowledge, technical skill, commitment, and considerable time are needed to develop a successful program. The process, as experienced by one community college nursing program, is described.

Qualitative process evaluation of an Australian alcohol media literacy study: recommendations for designing culturally responsive school-based programs.

PubMed

Gordon, Chloe S; Kervin, Lisa K; Jones, Sandra C; Howard, Steven J

2017-02-02

Alcohol media literacy programs seek to mitigate the potentially harmful effects of alcohol advertising on children's drinking intentions and behaviours through equipping them with skills to challenge media messages. In order for such programs to be effective, the teaching and learning experiences must be tailored to their specific cultural context. Media in the Spotlight is an alcohol media literacy program aimed at 9 to 12 year old Australian children. This study evaluates the process and implementation of the program, outlining the factors that facilitated and inhibited implementation. From this evaluation, a pedagogical framework has been developed for health professionals implementing culturally responsive programs in school settings. Process measures included: semi-structured interviews with teachers before and after the program was implemented (n = 11 interviews), program evaluation questionnaires completed by children (n = 166), lesson observations completed by teachers (n = 35 observations), and reflective journal entries completed by the researcher (n = 44 entries). A thematic analysis approach was used to analyse all of the data sets using NVivo. Inductive coding was used, whereby the findings were derived from the research objectives and multiple readings and interpretations of the data. Five key pedagogical considerations were identified that facilitated implementation. These were: connecting to the students' life worlds to achieve cultural significance; empowering students with real-world skills to ensure relevance; ensuring programs are well structured with strong connections to the school curriculum; creating developmentally appropriate activities while providing a range of assessment opportunities; and including hands-on and interactive activities to promote student engagement. Three potential inhibitors to implementing the alcohol media literacy program in upper-elementary school classrooms were identified. These included topic sensitivities, classroom management challenges, and fitting new programs into already busy school schedules. Overall, the program content and individual lessons were well received by the teachers and students. The lessons learned from the development, implementation and evaluation of this program can provide health professionals with key pedagogical strategies for designing culturally responsive educational programs. Culturally responsive programs are critical for ensuring interventions are effective for their specific context.

Nurse Leaders' Experiences of Implementing Career Advancement Programs for Nurses in Iran.

PubMed

Sheikhi, Mohammad Reza; Fallahi Khoshknab, Masoud; Mohammadi, Farahnaz; Oskouie, Fatemeh

2015-02-24

Career advancement programs are currently implemented in many countries. In Iran, the first career advancement program was Nurses' Career Advancement Pathway. The purpose of this study was to explore nurse leaders' experiences about implementing the Nurses' Career Advancement Pathway program in Iran. This exploratory qualitative study was conducted in 2013. Sixteen nurse managers were recruited from the teaching hospitals affiliated to Shahid Behesthi, Qazvin, and Iran Universities of Medical Sciences in Iran. Participants were recruited using purposive sampling method. Study data were collected through in-depth semi-structured interviews. The conventional content analysis approach was used for data analysis. participants' experiences about implementing the Nurses' Career Advancement Pathway fell into three main categories including: a) the shortcomings of performance evaluation, b) greater emphasis on point accumulation, c) the advancement-latitude mismatch. The Nurses' Career Advancement pathway has several shortcomings regarding both its content and its implementation. Therefore, it is recommended to revise the program.

[The CHILT I project (Children's Health Interventional Trial). A multicomponent intervention to prevent physical inactivity and overweight in primary schools].

PubMed

Graf, C; Dordel, S

2011-03-01

Child and juvenile obesity is increasing worldwide; therefore, effective preventive strategies are warranted. The stepwise project CHILT (Children's Health Interventional Trial) was initiated in 2000 and combines in its multicomponent school-based arm CHILT I health education and physical activity for primary school children to prevent physical inactivity and overweight. The effect on obesity and physical performance was studied in 12 primary schools (intervention schools, IS) compared with 5 control schools (CS). Anthropometric data were recorded. Physical performance was measured by a coordination test for children (the "Körperkoordinationstest für Kinder", KTK) and the 6-minute run. Anthropometric and motoric data of 436 children in IS (55.0% of the population) and 179 children in CS (62.8%) were available at baseline and at follow-up. No difference in the incidence of overweight was found between the IS and CS after 4 years of intervention. Remission of overweight was higher in IS (23.2% versus 19.2%), but not significant. The increase in BMI was significantly lower in IS, in which the program was regularly performed. There was an improvement in selected items of the KTK in IS. In particular, endurance performance tended to be higher at final examination. School-based preventive intervention seems to have a positive influence on physical motor skills and the remission of overweight. To optimize the effects, a consistent and quality assured implementation and the integration of the children's whole environment are warranted.

Developing an active implementation model for a chronic disease management program.

PubMed

Smidth, Margrethe; Christensen, Morten Bondo; Olesen, Frede; Vedsted, Peter

2013-04-01

Introduction and diffusion of new disease management programs in healthcare is usually slow, but active theory-driven implementation seems to outperform other implementation strategies. However, we have only scarce evidence on the feasibility and real effect of such strategies in complex primary care settings where municipalities, general practitioners and hospitals should work together. The Central Denmark Region recently implemented a disease management program for chronic obstructive pulmonary disease (COPD) which presented an opportunity to test an active implementation model against the usual implementation model. The aim of the present paper is to describe the development of an active implementation model using the Medical Research Council's model for complex interventions and the Chronic Care Model. We used the Medical Research Council's five-stage model for developing complex interventions to design an implementation model for a disease management program for COPD. First, literature on implementing change in general practice was scrutinised and empirical knowledge was assessed for suitability. In phase I, the intervention was developed; and in phases II and III, it was tested in a block- and cluster-randomised study. In phase IV, we evaluated the feasibility for others to use our active implementation model. The Chronic Care Model was identified as a model for designing efficient implementation elements. These elements were combined into a multifaceted intervention, and a timeline for the trial in a randomised study was decided upon in accordance with the five stages in the Medical Research Council's model; this was captured in a PaTPlot, which allowed us to focus on the structure and the timing of the intervention. The implementation strategies identified as efficient were use of the Breakthrough Series, academic detailing, provision of patient material and meetings between providers. The active implementation model was tested in a randomised trial (results reported elsewhere). The combination of the theoretical model for complex interventions and the Chronic Care Model and the chosen specific implementation strategies proved feasible for a practice-based active implementation model for a chronic-disease-management-program for COPD. Using the Medical Research Council's model added transparency to the design phase which further facilitated the process of implementing the program. http://www.clinicaltrials.gov/(NCT01228708).

The Collier Chautauqua program: A formative evaluation of the implementation of the Iowa Chautauqua model of professional development and its effectiveness in improving science teaching

NASA Astrophysics Data System (ADS)

Dass, Pradeep Maxwell

1997-11-01

A formative evaluation of the implementation of the Iowa Chautauqua model of professional development in Collier County, Florida, was conducted during 1995-97, focusing on implementation issues and teacher enhancement. Major findings are as follows: Implementation issues. (1) Development of a shared vision through collaborative interaction between teachers, school administrators, and district administrators is critical to successful program implementation. (2) When a new program is implemented on a district-wide basis, the success of implementation depends upon how well the program matches local goals and needs and how ready the district and teachers are to make changes necessary for implementing the tenets of the program. (3) Development of proper understanding of desired pedagogical approaches requires modeling of these approaches in program activities, with explicit attention drawn to the modeling. (4) Successful implementation of desired pedagogical approaches in the classroom is critically influenced by the support and continual feedback teachers receive from district administrators, building administrators, and their peers. (5) Unwavering commitment of district and school administrators is essential for encouraging more teachers to participate in the program, leading to district-wide implementation without making it mandatory. Teacher Enhancement. (1) Participants developed leadership skills in mentorship, teamwork, presenting at professional meetings, and assuming responsibility within the program. (2) Participants learned to focus more on student questions and concerns, value prior conceptions of students, and develop instructional activities accordingly. They grew in their understanding and use of the constructivist pedagogy. (3) Participants attitude toward teaching in general and science in particular improved markedly, leading to new excitement and enthusiasm toward their profession. (4) Participants became more confident about teaching science. Elementary teachers reported spending more time on science activities and integrating science topics more with other curricular areas. (5) Participants collaborated more with their peers, administrators, and local community resources in improving instructional activities, providing more meaningful learning experiences for their students. (6) Participants integrated more technological resources than they did formerly, helping students explore avenues otherwise inaccessible. This investigation reveals that teacher enhancement is closely related to changed practice, which is critically influenced by implementation issues at broader levels.

Method of selective reduction of polyhalosilanes with alkyltin hydrides

DOEpatents

Sharp, Kenneth G.; D'Errico, John J.

1989-01-01

The invention relates to the selective and stepwise reduction of polyhalosilanes by reacting at room temperature or below with alkyltin hydrides without the use of free radical intermediates. Alkyltin hydrides selectively and stepwise reduce the Si--Br, Si--Cl, or Si--I bonds while leaving intact any Si--F bonds. When two or more different halogens are present on the polyhalosilane, the halogen with the highest atomic weight is preferentially reduced.

An Inter-Networking Mechanism with Stepwise Synchronization for Wireless Sensor Networks

PubMed Central

Yamamoto, Hiroshi; Wakamiya, Naoki; Murata, Masayuki

2011-01-01

To realize the ambient information society, multiple wireless networks deployed in the region and devices carried by users are required to cooperate with each other. Since duty cycles and operational frequencies are different among networks, we need a mechanism to allow networks to efficiently exchange messages. For this purpose, we propose a novel inter-networking mechanism where two networks are synchronized with each other in a moderate manner, which we call stepwise synchronization. With our proposal, to bridge the gap between intrinsic operational frequencies, nodes near the border of networks adjust their operational frequencies in a stepwise fashion based on the pulse-coupled oscillator model as a fundamental theory of synchronization. Through simulation experiments, we show that the communication delay and the energy consumption of border nodes are reduced, which enables wireless sensor networks to communicate longer with each other. PMID:22164073

Efficient red organic electroluminescent devices by doping platinum(II) Schiff base emitter into two host materials with stepwise energy levels.

PubMed

Zhou, Liang; Kwok, Chi-Chung; Cheng, Gang; Zhang, Hongjie; Che, Chi-Ming

2013-07-15

In this work, organic electroluminescent (EL) devices with double light-emitting layers (EMLs) having stepwise energy levels were designed to improve the EL performance of a red-light-emitting platinum(II) Schiff base complex. A series of devices with single or double EML(s) were fabricated and characterized. Compared with single-EML devices, double-EML devices showed improved EL efficiency and brightness, attributed to better balance in carriers. In addition, the stepwise distribution in energy levels of host materials is instrumental in broadening the recombination zone, thus delaying the roll-off of EL efficiency. The highest EL current efficiency and power efficiency of 17.36 cd/A and 14.73 lm/W, respectively, were achieved with the optimized double-EML devices. At high brightness of 1000 cd/m², EL efficiency as high as 8.89 cd/A was retained.

Stepwise photochromism of bisnaphthopyrans exhibiting an excitation intensity-dependent color change.

PubMed

Inagaki, Yuki; Mutoh, Katsuya; Abe, Jiro

2018-06-07

Non-linear photoresponses against excitation light intensity are important for the development of attractive photofunctional materials exhibiting high spatial selective photoswitching that is not affected by weak background light. Biphotochromic systems composed of two fast photochromic units have the potential to show a stepwise two-photon absorption process in which the optical properties can be non-linearly controlled by changing the excitation light conditions. Herein, we designed and synthesized novel bisnaphthopyran derivatives containing fast photoswitchable naphthopyran units. The bisnaphthopyran derivatives show a stepwise two-photon-induced photochromic reaction upon UV light irradiation accompanied by a drastic color change due to a large change in the molecular structure between the one-photon product and the two-photon product. Consequently, the color of the bisnaphthopyran derivatives can be non-linearly controlled by changing the excitation intensity. This characteristic photochromic property of the biphotochromic system provides important insight into advanced photoresponsive materials.

CORRELATION PURSUIT: FORWARD STEPWISE VARIABLE SELECTION FOR INDEX MODELS

PubMed Central

Zhong, Wenxuan; Zhang, Tingting; Zhu, Yu; Liu, Jun S.

2012-01-01

In this article, a stepwise procedure, correlation pursuit (COP), is developed for variable selection under the sufficient dimension reduction framework, in which the response variable Y is influenced by the predictors X1, X2, …, Xp through an unknown function of a few linear combinations of them. Unlike linear stepwise regression, COP does not impose a special form of relationship (such as linear) between the response variable and the predictor variables. The COP procedure selects variables that attain the maximum correlation between the transformed response and the linear combination of the variables. Various asymptotic properties of the COP procedure are established, and in particular, its variable selection performance under diverging number of predictors and sample size has been investigated. The excellent empirical performance of the COP procedure in comparison with existing methods are demonstrated by both extensive simulation studies and a real example in functional genomics. PMID:23243388

Design and Implementation of High Interaction Client Honeypot for Drive-by-Download Attacks

NASA Astrophysics Data System (ADS)

Akiyama, Mitsuaki; Iwamura, Makoto; Kawakoya, Yuhei; Aoki, Kazufumi; Itoh, Mitsutaka

Nowadays, the number of web-browser targeted attacks that lead users to adversaries' web sites and exploit web browser vulnerabilities is increasing, and a clarification of their methods and countermeasures is urgently needed. In this paper, we introduce the design and implementation of a new client honeypot for drive-by-download attacks that has the capacity to detect and investigate a variety of malicious web sites. On the basis of the problems of existing client honeypots, we enumerate the requirements of a client honeypot: 1) detection accuracy and variety, 2) collection variety, 3) performance efficiency, and 4) safety and stability. We improve our system with regard to these requirements. The key features of our developed system are stepwise detection focusing on exploit phases, multiple crawler processing, tracking of malware distribution networks, and malware infection prevention. Our evaluation of our developed system in a laboratory experiment and field experiment indicated that its detection variety and crawling performance are higher than those of existing client honeypots. In addition, our system is able to collect information for countermeasures and is secure and stable for continuous operation. We conclude that our system can investigate malicious web sites comprehensively and support countermeasures.

Implementing and Assessing Inquiry-Based Learning through the CAREER Award

NASA Astrophysics Data System (ADS)

Brudzinski, M. R.

2011-12-01

In order to fully attain the benefits of inquiry-based learning, instructors who typically employ the traditional lecture format need to make many adjustments to their approach. This change in styles can be intimidating and logistically difficult to overcome, both for instructors and students, such that a stepwise approach to this transformation is likely to be more manageable. In this session, I will describe a series of tools to promote inquiry-based learning that I am helping to implement and assess in classroom courses and student research projects. I will demonstrate the importance of integrating with existing institutional initiatives as well as recognizing how student development plays a key role in student engagement. Some of the features I will highlight include: defining both student learning outcomes and student development outcomes, converting content training to be self-directed and asynchronous, utilizing conceptests to help students practice thinking like scientists, and employing both objective pre/post assessment and student self-reflective assessment. Lastly, I will reflect on how the well-defined goal of teaching and research integration in the CAREER award solicitation resonated with me even as an undergraduate and helped inspire my early career.

Ab initio implementation of quantum trajectory mean-field approach and dynamical simulation of the N{sub 2}CO photodissociation

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

Xie, Binbin; Liu, Lihong; Cui, Ganglong

2015-11-21

In this work, the recently introduced quantum trajectory mean-field (QTMF) approach is implemented and employed to explore photodissociation dynamics of diazirinone (N{sub 2}CO), which are based on the high-level ab initio calculation. For comparison, the photodissociation process has been simulated as well with the fewest-switches surface hopping (FSSH) and the ab initio multiple spawning (AIMS) methods. Overall, the dynamical behavior predicted by the three methods is consistent. The N{sub 2}CO photodissociation at λ > 335 nm is an ultrafast process and the two C—N bonds are broken in a stepwise way, giving birth to CO and N{sub 2} as themore » final products in the ground state. Meanwhile, some noticeable differences were found in the QTMF, FSSH, and AIMS simulated time constants for fission of the C—N bonds, excited-state lifetime, and nonadiabatic transition ratios in different intersection regions. These have been discussed in detail. The present study provides a clear evidence that direct ab initio QTMF approach is one of the reliable tools for simulating nonadiabatic dynamics processes.« less

Active-learning implementation in an advanced elective course on infectious diseases.

PubMed

Hidayat, Levita; Patel, Shreya; Veltri, Keith

2012-06-18

To describe the development, implementation, and assessment of an advanced elective course on infectious diseases using active-learning strategies. Pedagogy for active learning was incorporated by means of mini-lecture, journal club, and debate with follow-up discussion. Forty-eight students were enrolled in this 4-week elective course, in which 30% of course time was allocated for active-learning exercises. All activities were fundamentally designed as a stepwise approach in complementing each active-learning exercise. Achievement of the course learning objectives was assessed using a 5-point Likert scale survey instrument. Students' awareness of the significance of antimicrobial resistance was improved (p ≤ 0.05). Students' ability to critically evaluate the infectious-disease literature and its application in informed clinical judgments was also enhanced through these active-learning exercises (p ≤ 0.05). Students agreed that active learning should be part of the pharmacy curriculum and that active-learning exercises improved their critical-thinking, literature-evaluation, and self-learning skills. An elective course using active-learning strategies allowed students to combine information gained from the evaluation of infectious-disease literature, critical thinking, and informed clinical judgment. This blended approach ultimately resulted in an increased knowledge and awareness of infectious diseases.

An Effective Model for Improving Global Health Nursing Competence.

PubMed

Kang, Sun-Joo

2016-01-01

This paper proposed an effective model for improving global health nursing competence among undergraduate students. A descriptive case study was conducted by evaluation of four implemented programs by the author. All programs were conducted with students majoring in nursing and healthcare, where the researcher was a program director, professor, or facilitator. These programs were analyzed in terms of students' needs assessment, program design, and implementation and evaluation factors. The concept and composition of global nursing competence, identified within previous studies, were deemed appropriate in all of our programs. Program composition varied from curricular to extracurricular domains. During the implementation phase, some of the programs included non-Korean students to improve cultural diversity and overcome language barriers. Qualitative and quantitative surveys were conducted to assess program efficacy. Data triangulation from students' reflective journals was examined. Additionally, students' awareness regarding changes within global health nursing, improved critical thinking, cultural understanding, and global leadership skills were investigated pre- and post-program implementation. The importance of identifying students' needs regarding global nursing competence when developing appropriate curricula is discussed.

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

PubMed

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

2018-03-23

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

Development and Implementation of a Mental Health Work Rehabilitation Program: Results of a Developmental Evaluation.

PubMed

Sylvain, Chantal; Durand, Marie-José; Velasquez Sanchez, Astrid; Lessard, Nathalie; Maillette, Pascale

2018-05-23

Purpose Long-term work disability due to common mental disorders (CMDs) is a growing problem. Yet optimal interventions remain unclear and little is known about implementation challenges in everyday practice. This study aimed to support and evaluate, in real time, the development and implementation of a work rehabilitation program (WRP) designed to promote post-CMD return-to-work (RTW). Methods A 2-year developmental evaluation was performed using a participatory approach. At program outset, the researchers held five work meetings to revise the program's logic model and discuss its underlying change theory with clinicians. Data collection tools used throughout the study period were structured charts of activities conducted with workers (n = 41); in-depth interviews with program clinicians and managers (n = 9); and participant observation during work meetings. Quantitative data were analyzed using descriptive statistics. Qualitative data underwent thematic analysis using a processual approach. Results Three types of activity were developed and implemented: individual and group interventions targeting workers, and joint activities targeting partners (physicians, employers, others). While worker-targeted activities were generally implemented as planned, joint activities were sporadic. Analysis of the implementation process revealed five challenges faced by clinicians. Determinants included clinicians, host organization, sociopolitical context and resources provided by the evaluation. Conclusion The program studied is original in that it is based on the best available scientific knowledge, yet adapted to contextual particularities. The identified implementation challenges highlight the need for greater importance to be placed on the external, non-program context to ensure sustainable implementation in everyday practice.

Perspectives of HIV Clinic Staff on the Implementation of a Client Financial Incentives Program Targeting Viral Suppression.

PubMed

Anderson, Susannah; Jenner, Eric; Lass, Katherine; Burgess, Samuel

We present perspectives of health care providers and clinic staff on the implementation of a financial incentive program for clients living with HIV in three Louisiana clinics. Interviews were conducted in May-June 2015 with 27 clinic staff to assess their perspectives on implementation of the Health Models financial incentive program, which was initiated in September 2013. Many providers and staff welcomed the program, but some were concerned about sustainability and the ethics of a program that paid patients to receive care. Most said they eventually found the program to be helpful for patients and clinic operations in general, by facilitating partnerships between providers and patients, improving appointment keeping, providing opportunities for patient education, engaging patients in care, and helping patients form new prevention habits. The findings can improve understanding of staff and leadership perceptions of incentive programs and can inform planning and implementation of these programs in the future. Copyright © 2017 Association of Nurses in AIDS Care. All rights reserved.

Social determinants of loneliness among older Americans.

PubMed

Mullins, L C; Elston, C H; Gutkowski, S M

1996-11-01

To further understand loneliness among older persons, a conceptual model, predicated on a social-support perspective, was examined. Results were based on 1,071 participants in the congregate and home-delivered meal programs of the Senior Citizens Nutrition and Activities Program in Hillsborough County, Florida. A series of stepwise multiple regression analyses showed that loneliness was greater among men, those with no children, those with no friends, those more physically disabled, those who subjectively felt that their health was poorer, and those who subjectively felt that their economic condition was inadequate. Not related directly to loneliness but with indirect influence were age, race, education, marital status, and poverty status. Those variables with no direct or indirect effect included rural or urban location, identification of emotional closeness with existing children or friends, and living alone. Theoretically, the results do not fully support the social-support perspective but point to the impact of a broad spectrum of demographic, health, economic, and social factors.

How was the UNAIDS drug access initiative implemented in Chile?

PubMed Central

Brousselle, Astrid; Champagne, François

2012-01-01

In 1997, UNAIDS decided to implement Drug Access Initiatives (DAI) in four different pilot-countries. We studied the implementation of the DAI in Chile as part of the evaluation program conducted by the ‘Agence Nationale de Recherche sur le SIDA’ (ANRS/France). The objective was to understand how the politico-organizational dynamic influenced the implementation process of the DAI. Approximately 50 semi-directed interviews and observation activities were conducted with the actors who participated in the implementation of the DAI or who played a role in the HIV/AIDS context. The program theory models were established and their evolution analyzed. This article offers an original analysis of an international HIV/AIDS drug access program that was put in place at a time when such programs were seen as a priority by international and governmental institutions. It also offers some insights for the creation of international projects that will be locally implemented. PMID:23230344

Organizational Implementation of Evidence-Based Substance Abuse Treatment in Racial and Ethnic Minority Communities

PubMed Central

He, Amy; Kim, Ahraemi; Aarons, Gregory A.

2013-01-01

We evaluated organizational factors associated with the implementation of contingency management treatment (CMT) and medication-assisted treatment (MAT) in substance abuse treatment (SAT) programs serving racial and ethnic minority communities. Analysis of cross-sectional data collected in 2010–2011 from a random sample of 148 publicly funded SAT programs showed that accepting private insurance was positively associated with CMT and MAT implementation, whereas larger programs were associated with greater implementation of MAT. Supervisorial openness to and expectations about implementing evidence-based practices (EBPs) and attributes for change were strongly associated with CMT, whereas the interactions between openness to EBPs and programs that accept private insurance and that are governed by parent organizations were positively associated with MAT. These external expectations and managerial attitudes supported the implementation of psychosocial and pharmacotherapy treatments in SAT. Implications for improving standards of care in minority communities are discussed. PMID:24046236

German Language and Culture: 9-Year Program Guide to Implementation, Grades 4-5-6

ERIC Educational Resources Information Center

Alberta Education, 2008

2008-01-01

This implementation guide is intended to support the Grade 4 to Grade 6 portion of the German Language and Culture Nine-year Program (the program of studies). It was developed primarily for teachers, yet it includes information that may be useful for administrators and other stakeholders in their efforts to plan for and implement the new Chinese…

Lessons Learned from the Development and Implementation of a Knowledge Management Program for the Naval Sea Systems Command

DTIC Science & Technology

2017-03-01

ABSTRACT (maximum 200 words) This study applied knowledge management (KM) theories and principles to develop and implement a KM program for the... principles to develop and implement a KM program for the Naval Sea Systems Command (NAVSEA) that strengthens the workforce’s understanding of the...23 C. EXECUTION AND SUSTAINMENT .............................................. 24 1. Marketing

41 CFR 102-38.360 - What must an executive agency do to implement the eFAS program?

Code of Federal Regulations, 2011 CFR

2011-01-01

... agency do to implement the eFAS program? 102-38.360 Section 102-38.360 Public Contracts and Property... must an executive agency do to implement the eFAS program? (a) An executive agency must review the... value added services) of the eFAS SCs. Agencies should give full consideration to sales solutions...

41 CFR 102-38.360 - What must an executive agency do to implement the eFAS program?

Code of Federal Regulations, 2010 CFR

2010-07-01

... agency do to implement the eFAS program? 102-38.360 Section 102-38.360 Public Contracts and Property... must an executive agency do to implement the eFAS program? (a) An executive agency must review the... value added services) of the eFAS SCs. Agencies should give full consideration to sales solutions...

41 CFR 102-38.360 - What must an executive agency do to implement the eFAS program?

Code of Federal Regulations, 2014 CFR

2014-01-01

... agency do to implement the eFAS program? 102-38.360 Section 102-38.360 Public Contracts and Property... must an executive agency do to implement the eFAS program? (a) An executive agency must review the... value added services) of the eFAS SCs. Agencies should give full consideration to sales solutions...

41 CFR 102-38.360 - What must an executive agency do to implement the eFAS program?

Code of Federal Regulations, 2013 CFR

2013-07-01

... agency do to implement the eFAS program? 102-38.360 Section 102-38.360 Public Contracts and Property... must an executive agency do to implement the eFAS program? (a) An executive agency must review the... value added services) of the eFAS SCs. Agencies should give full consideration to sales solutions...

41 CFR 102-38.360 - What must an executive agency do to implement the eFAS program?

Code of Federal Regulations, 2012 CFR

2012-01-01

... agency do to implement the eFAS program? 102-38.360 Section 102-38.360 Public Contracts and Property... must an executive agency do to implement the eFAS program? (a) An executive agency must review the... value added services) of the eFAS SCs. Agencies should give full consideration to sales solutions...

A Quantitative, Correlational Study of the Relationship between Comprehensive School Counseling Program Implementation and School Counselors' Perceived Leadership Styles in Title I Schools

ERIC Educational Resources Information Center

Harris-Bingham, Tranae

2017-01-01

The purpose of this study is to examine the relationships among the level of comprehensive school counseling program implementation, school counselors' leadership practices, and their schools' Title I status. Existing research examining the level of program implementation and school counselor leadership practices is limited and the representation…

Punjabi Language and Culture: 9-Year Program Guide to Implementation, Grades 4-5-6

ERIC Educational Resources Information Center

Alberta Education, 2008

2008-01-01

This implementation guide is intended to support the Grade 4 to Grade 6 portion of the Punjabi Language and Culture Nine-Year Program (the program of studies.) It was developed primarily for teachers, yet it includes information that may be useful for administrators and other stakeholders in their efforts to plan for and implement the new Punjabi…

Translating a National Laboratory Strategic Plan into action through SLMTA in a district hospital laboratory in Botswana.

PubMed

Ntshambiwa, Keoratile; Ntabe-Jagwer, Winnie; Kefilwe, Chandapiwa; Samuel, Fredrick; Moyo, Sikhulile

2014-01-01

The Ministry of Health (MOH) of Botswana adopted Strengthening Laboratory Management Toward Accreditation (SLMTA), a structured quality improvement programme, as a key tool for the implementation of quality management systems in its public health laboratories. Coupled with focused mentorship, this programme aimed to help MOH achieve the goals of the National Laboratory Strategic Plan to provide quality and timely clinical diagnoses. This article describes the impact of implementing SLMTA in Sekgoma Memorial Hospital Laboratory (SMHL) in Serowe, Botswana. SLMTA implementation in SMHL included trainings, improvement projects, site visits and focused mentorship. To measure progress, audits using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist were conducted at baseline and exit of the programme, with scores corresponding to a zero- to five-star scale. Turnaround times, customer satisfaction, and several other health service indicators were tracked. The laboratory scored 53% (zero stars) at the baseline audit and 80% (three stars) at exit. Nearly three years later, the laboratory scored 85% (four stars) in an official audit conducted by the African Society for Laboratory Medicine. Turnaround times became shorter after SLMTA implementation, with reductions ranging 19% to 52%; overall patient satisfaction increased from 56% to 73%; and clinician satisfaction increased from 41% to 72%. Improvements in inventory management led to decreases in discarded reagents, reducing losses from US $18 000 in 2011 to $40 in 2013. The SLMTA programme contributed to enhanced performance of the laboratory, which in turn yielded potential positive impacts for patient care at the hospital.

The impact of SLMTA in improving laboratory quality systems in the Caribbean Region.

PubMed

Guevara, Giselle; Gordon, Floris; Irving, Yvette; Whyms, Ismae; Parris, Keith; Beckles, Songee; Maruta, Talkmore; Ndlovu, Nqobile; Albalak, Rachel; Alemnji, George

Past efforts to improve laboratory quality systems and to achieve accreditation for better patient care in the Caribbean Region have been slow. To describe the impact of the Strengthening of Laboratory Management Toward Accreditation (SLMTA) training programme and mentorship amongst five clinical laboratories in the Caribbean after 18 months. Five national reference laboratories from four countries participated in the SLMTA programme that incorporated classroom teaching and implementation of improvement projects. Mentors were assigned to the laboratories to guide trainees on their improvement projects and to assist in the development of Quality Management Systems (QMS). Audits were conducted at baseline, six months, exit (at 12 months) and post-SLMTA (at 18 months) using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist to measure changes in implementation of the QMS during the period. At the end of each audit, a comprehensive implementation plan was developed in order to address gaps. Baseline audit scores ranged from 19% to 52%, corresponding to 0 stars on the SLIPTA five-star scale. After 18 months, one laboratory reached four stars, two reached three stars and two reached two stars. There was a corresponding decrease in nonconformities and development of over 100 management and technical standard operating procedures in each of the five laboratories. The tremendous improvement in these five Caribbean laboratories shows that SLMTA coupled with mentorship is an effective, user-friendly, flexible and customisable approach to the implementation of laboratory QMS. It is recommended that other laboratories in the region consider using the SLMTA training programme as they engage in quality systems improvement and preparation for accreditation.

Exploring Possibilities for Transforming Established Subscription-based Scientific Journals into Open Access Journals. Present Situation, Transformation Criteria, and Exemplary Implementation within Trans-O-MIM.

PubMed

Haux, Reinhold; Kuballa, Stefanie; Schulze, Mareike; Böhm, Claudia; Gefeller, Olaf; Haaf, Jan; Henning, Peter; Mielke, Corinna; Niggemann, Florian; Schürg, Andrea; Bergemann, Dieter

2016-12-07

Based on today's information and communication technologies the open access paradigm has become an important approach for adequately communicating new scientific knowledge. Summarizing the present situation for journal transformation. Presenting criteria for adequate transformation as well as a specific approach for it. Describing our exemplary implementation of such a journal transformation. Studying the respective literature as well as discussing this topic in various discussion groups and meetings (primarily of editors and publishers, but also of authors and readers), with long term experience as editors and /or publishers of scientific publications as prerequisite. There is a clear will, particularly of political and funding organizations, towards open access publishing. In spite of this, there is still a large amount of scientific knowledge, being communicated through subscription-based journals. For successfully transforming such journals into open access, sixteen criteria for a goal-oriented, stepwise, sustainable, and fair transformation are suggested. The Tandem Model as transformation approach is introduced. Our exemplary implementation is done in the Trans-O-MIM project. It is exploring strategies, models and evaluation metrics for journal transformation. As instance the journal Methods of Information in Medicine will apply the Tandem Model from 2017 onwards. Within Trans-O-MIM we will reach at least nine of the sixteen criteria for adequate transformation. It was positive to implement Trans-O-MIM as international research project. After first steps for transforming Methods have successfully been made, challenges will remain, among others, in identifying appropriate incentives for open access publishing in order to support its transformation.

Optimal environmental management strategy and implementation for groundwater contamination prevention and restoration.

PubMed

Wang, Mingyu

2006-04-01

An innovative management strategy is proposed for optimized and integrated environmental management for regional or national groundwater contamination prevention and restoration allied with consideration of sustainable development. This management strategy accounts for availability of limited resources, human health and ecological risks from groundwater contamination, costs for groundwater protection measures, beneficial uses and values from groundwater protection, and sustainable development. Six different categories of costs are identified with regard to groundwater prevention and restoration. In addition, different environmental impacts from groundwater contamination including human health and ecological risks are individually taken into account. System optimization principles are implemented to accomplish decision-makings on the optimal resources allocations of the available resources or budgets to different existing contaminated sites and projected contamination sites for a maximal risk reduction. Established management constraints such as budget limitations under different categories of costs are satisfied at the optimal solution. A stepwise optimization process is proposed in which the first step is to select optimally a limited number of sites where remediation or prevention measures will be taken, from all the existing contaminated and projected contamination sites, based on a total regionally or nationally available budget in a certain time frame such as 10 years. Then, several optimization steps determined year-by-year optimal distributions of the available yearly budgets for those selected sites. A hypothetical case study is presented to demonstrate a practical implementation of the management strategy. Several issues pertaining to groundwater contamination exposure and risk assessments and remediation cost evaluations are briefly discussed for adequately understanding implementations of the management strategy.

Hood River and Pelton Ladder Evaluation Studies : Annual Report 1994.

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

Olsen, Erik A.; French, Rod A.; Ritchey, Alan D.

1995-09-01

In 1992, the Northwest Power Planning Council approved the Hood River and Pelton ladder master plans within the framework of the Columbia River Basin Fish and Wildlife Program. The master plans define an approach for implementing a hatchery supplementation program in the Hood River subbasin. The hatchery program as defined in the master plans is called the Hood River Hatchery Production Program (HRPP). The HRPP will be phased in over several years and will be jointly implemented by the Oregon Department of Fish and Wildlife (ODFW) and the Confederated Tribes of the Warm Springs (CTWS) Reservation. In December 1991, amore » monitoring and evaluation program was implemented in the Hood River subbasin to collect life history and production information on stocks of anadromous salmonids returning to the Hood River subbasin. The program was implemented to provide the baseline information needed to: (1) evaluate various management options for implementing the HRPP and (2) determine any post-project impacts the HRPP has on indigenous populations of resident fish. Information collected during the 1992-94 fiscal years will also be used to prepare an environmental impact statement (EIS) evaluating the program`s impact on the human environment. To begin construction on project facilities, it was proposed that the HRPP be implemented in two phases. Phase I would include work that would fall under a {open_quotes}categorical exclusion{close_quotes} from NEPA, and Phase II would include work requiring an EIS prior to implementation. This report summarizes the life history and escapement data collected in the Hood River subbasin and the status work of implemented under Phase I of the HR Life history and escapement data will be used to: (1) test the assumptions on which harvest and escapement goals for the Hood River and Pelton ladder master plans are based and (2) develop biologically based management recommendations for implementing the HRPP.« less

Fostering Healthy Futures for Teens: Adaptation of an Evidence-Based Program

PubMed Central

Taussig, Heather; Weiler, Lindsey; Rhodes, Tara; Hambrick, Erin; Wertheimer, Robyn; Fireman, Orah; Combs, Melody

2015-01-01

Objective This article describes the process of adapting and implementing a complex, multicomponent intervention for a new population. Specifically, the article delineates the development and implementation of the Fostering Healthy Futures for Teens (FHF-T) program, which is an adaptation and extension of the Fostering Healthy Futures® (FHF) preventive intervention. FHF is a 9-month mentoring and skills group program for 9 to 11 year olds recently placed in foster care. Following the designation of FHF as an evidence-based intervention, there was increasing demand for the program. However, the narrow population for which FHF had demonstrated efficacy limited broader implementation of the existing intervention. FHF-T was designed to extend the reach of the program by adapting the FHF intervention for adolescents in the early years of high school who have a history of out-of-home care. Specifically, this adaptation recognizes key developmental differences between preadolescent and adolescent populations. Method After designing a program model and adapting the program components, the FHF-T mentoring program was implemented with 42 youth over 2 program years. Results Of the teens who were offered the program, 75% chose to enroll, and 88% of those graduated 9 months later. Although the program evidenced high rates of uptake and participant satisfaction, some unexpected challenges were encountered that will need to be addressed in future iterations of the program. Conclusions Too often program adaptations are made without careful consideration of important contextual issues, and too infrequently, these adapted programs are studied. Our process of program adaptation with rigorous measurement of program implementation provides a useful model for other evidence-based programs seeking thoughtful adaptation. PMID:27019678

An analysis of the relationship of seven selected variables to State Board Test Pool Examination performance of the University of Tennessee, Knoxville, College of Nursing.

PubMed

Sharp, T G

1984-02-01

The study was designed to determine whether any one of seven selected variables or a combination of the variables is predictive of performance on the State Board Test Pool Examination. The selected variables studied were: high school grade point average (HSGPA), The University of Tennessee, Knoxville, College of Nursing grade point average (GPA), and American College Test Assessment (ACT) standard scores (English, ENG; mathematics, MA; social studies, SS; natural sciences, NSC; composite, COMP). Data utilized were from graduates of the baccalaureate program of The University of Tennessee, Knoxville, College of Nursing from 1974 through 1979. The sample of 322 was selected from a total population of 572. The Statistical Analysis System (SAS) was designed to accomplish analysis of the predictive relationship of each of the seven selected variables to State Board Test Pool Examination performance (result of pass or fail), a stepwise discriminant analysis was designed for determining the predictive relationship of the strongest combination of the independent variables to overall State Board Test Pool Examination performance (result of pass or fail), and stepwise multiple regression analysis was designed to determine the strongest predictive combination of selected variables for each of the five subexams of the State Board Test Pool Examination. The selected variables were each found to be predictive of SBTPE performance (result of pass or fail). The strongest combination for predicting SBTPE performance (result of pass or fail) was found to be GPA, MA, and NSC.

Cingi Steps for preoperative computer-assisted image editing before reduction rhinoplasty.

PubMed

Cingi, Can Cemal; Cingi, Cemal; Bayar Muluk, Nuray

2014-04-01

The aim of this work is to provide a stepwise systematic guide for a preoperative photo-editing procedure for rhinoplasty cases involving the cooperation of a graphic artist and a surgeon. One hundred female subjects who planned to undergo a reduction rhinoplasty operation were included in this study. The Cingi Steps for Preoperative Computer Imaging (CS-PCI) program, a stepwise systematic guide for image editing using Adobe PhotoShop's "liquify" effect, was applied to the rhinoplasty candidates. The stages of CS-PCI are as follows: (1) lowering the hump; (2) shortening the nose; (3) adjusting the tip projection, (4) perfecting the nasal dorsum, (5) creating a supratip break, and (6) exaggerating the tip projection and/or dorsal slope. Performing the Cingi Steps allows the patient to see what will happen during the operation and observe the final appearance of his or her nose. After the application of described steps, 71 patients (71%) accepted step 4, and 21 (21%) of them accepted step 5. Only 10 patients (10%) wanted to make additional changes to their operation plans. The main benefits of using this method is that it decreases the time needed by the surgeon to perform a graphic analysis, and it reduces the time required for the patient to reach a decision about the procedure. It is an easy and reliable method that will provide improved physician-patient communication, increased patient confidence, and enhanced surgical planning while limiting the time needed for planning. © 2014 ARS-AAOA, LLC.

Implementation of a computer database testing and analysis program.

PubMed

Rouse, Deborah P

2007-01-01

The author is the coordinator of a computer software database testing and analysis program implemented in an associate degree nursing program. Computer software database programs help support the testing development and analysis process. Critical thinking is measurable and promoted with their use. The reader of this article will learn what is involved in procuring and implementing a computer database testing and analysis program in an academic nursing program. The use of the computerized database for testing and analysis will be approached as a method to promote and evaluate the nursing student's critical thinking skills and to prepare the nursing student for the National Council Licensure Examination.

Factors associated with sustainability of 2 quality improvement programs after achieving early implementation success. A qualitative case study.

PubMed

Ament, Stephanie M C; Gillissen, Freek; Moser, Albine; Maessen, José M C; Dirksen, Carmen D; von Meyenfeldt, Maarten F; van der Weijden, Trudy

2017-12-01

Sustainability of innovations is a relatively new concept in health care research and has become an issue of growing interest. The current study explored factors related to the sustainability of 2 multidisciplinary hospital-based programs 3 to 6 years after achieving early implementation success. An exploratory qualitative study was conducted into 2 implementation cases, an Enhanced Recovery After Surgery program for colorectal surgery and a short-stay program for breast cancer surgery. Semistructured interviews were held with key persons involved in the care process in 14 hospitals from both cases minimally 3 years after the implementation, between March 2012 and May 2013. The Consolidated Framework for Implementation Research was used to direct the development of the interview guide, during data collection and during analysis. A directed content analysis was performed. A total of 21 interviews with 26 individuals were held, 18 regarding the Enhanced Recovery After Surgery case and 8 regarding the short-stay program case. Respondents mentioned the following factors associated with sustainability of the programs: modification and adaptability of the program, cost-effectiveness, institutionalization into existing systems, short communication lines within the multidisciplinary team, an innovative culture, benefits for patients, cosmopolitanism, the existence of external policies and incentives, trust and belief in the program, and spread of the program to other settings. Two factors are not covered by the Consolidated Framework for Implementation Research, ie, modification of the program over the years and spread of the program to other contexts. The factors associated with sustainability put forward in both cases were largely the same. Leadership and the implementation project were not mentioned as having influenced the long-term sustainability of the benefits achieved. Sustainability of the innovations is influenced by determinants stemming from all ecological levels of the health care system and demands continuous effort in the postimplementation phase. © 2017 John Wiley & Sons, Ltd.